Depression

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    A , Family Medicine, answered
    Treatment options for people with treatment-resistant depression include taking a higher dose of their antidepressant drugs or taking a combination of depression medications. Other medications or hormones may also be prescribed to help antidepressants work better. 
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    A , Family Medicine, answered
    Antidepressants and antipsychotics are the medications used to treat psychotic depression. In this mood disorder, a depressed person experiences episodes of psychosis or losing touch with reality, such as delusions or hallucinations. When medications don't help, electroconvulsive therapy (ECT) may be used.
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    A , Family Medicine, answered
    Psychotic depression is major depression with episodes of psychosis, in which you lose sense of reality. During such episodes, you may have beliefs that are untrue (delusions) or see or hear things that aren't there (hallucinations).
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    A , Psychology, answered

    Psychotic symptoms are: a loss of touch with reality often resulting in delusions (very far-fetched or bizarre beliefs; the belief that one’s thoughts are being broadcast on television). With psychosis delusions are believed by the patient with great conviction and they have lost the ability to recognize that such beliefs are unrealistic. The other symptoms are hallucinations, disorganized thinking, bizarre behavior and confusion. With psychosis seen in schizophrenia and drug-induced psychosis it is hard to miss the symptoms; thinking is so disorganized that just listening to the person will reveal the greatly impaired thought processes.

    Psychosis can be seen in very severe depression (in major unipolar depression and bipolar disorder). Here most of the time, despite the presence of delusions and hallucinations, over all thought processes remain normal; outward behavior may not look bizarre.

    Psychotic symptoms in depression generally are seen by the patient as unusual; they choose not to talk about the beliefs (afraid others will think they are crazy).

    Most depressive delusions are somatic delusions (e.g. fear that all of their internal organs are rotting), paranoid (e.g. being afraid that people are out to get them), and delusions involving very unrealistic feelings of guilt and worthlessness (e.g. they 100% believe that they are sinful and should be executed). Most severely depressed clients never tell others about their delusions; they suffer in isolation.

    This is important to assess. First, the presence of psychotic symptoms strongly indicate the need to treat with antipsychotic medications (such as Seroquel or Abilify). Antidepressants and mood stabilizers alone are not effective in treating depression-related psychotic symptoms

    The tragedy of unreported psychotic symptoms is three fold: it adds a huge amount of additional fear and suffering, without knowledge of these symptoms, often antipsychotic medications are not used, and some delusions, especially ones that involve guilt and worthlessness can lead to suicide attempts.

    With all depressed people this question should be asked: “Since you have been depressed have you started to worry about certain things that have never worried you before and that might, to others seem kind of bizarre or crazy?…this often can occur in severe depression and we need to know if you are experiencing this so we’ll know what treatments will be most beneficial.”


     

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    A , Family Medicine, answered
    Psychosis means a lost sense of reality. Some people experience moments of psychosis along with their depression.
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    A , Family Medicine, answered
    Certain medications may increase a person's risk of many types of depression, including atypical depression. These include some high blood pressure medications, sleeping pills, and certain other drugs. Talk to your doctor if you suspect your depression may be the result of medicine you are taking. Do not stop taking prescribed medication without first speaking with your doctor.
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    Atypical depression symptoms include a feeling of melancholy and sorrow, as well as a lack of interest in formerly enjoyable activities. These symptoms are the same for most types of depression. The difference is that with atypical depression your mood can improve temporarily if something positive happens in your life. Other symptoms of this form of depression include tendencies to overeat and/or oversleep, feelings of heaviness in the limbs, and an extreme sensitivity to rejection from others. Additionally, atypical depression symptoms do not seem to be affected by tricyclic antidepressants.

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    Women are at greater risk for developing atypical depression than men. Also, if you have a family history of depression, alcoholism, or suicide, your risk will also be greater. If you were treated for depression at a young age, your risk is also higher. Going through a traumatic event, having few close friends, being overly critical of yourself, and having poor self-esteem are other risk factors for this condition.

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    Atypical depression often occurs along with other types of health problems. Research shows an increased risk of substance abuse among people with this condition. Also, this form of depression is similar to bipolar disorder or with seasonal affective disorder. Some of the symptoms may also suggest the presence of a personality disorder.

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    Medications used to treat atypical depression do cause side effects. SSRIs, such as Prozac and Zoloft, can cause a drop in sexual desire or problems achieving orgasm. Headaches, trouble sleeping, and nausea can also be caused by the medication, but these side effects usually go away with continued use. MAOIs, a drug used when the others fail, can cause mild side effects, such as diarrhea and nausea, but also more serious ones. If you eat foods containing tyramine while taking MAOIs, your blood pressure could jump and cause you to have a stroke. Also, MAOIs combined with SSRIs can cause a dangerous condition known as serotonin syndrome which requires immediate medical attention.