Question: What causes Depression ?
Answer: Several lines of research have shown that depressive illnesses are disorders of the brain. But the exact causes for these illnesses are not yet clear and are still being studied. Changes in the Brain Imaging technologies show that the brains of people with depression look different or are working differently than those who do not have the illness. The areas of the brain that control moods, thinking, sleep, appetite, and behavior appear not to be functioning well. The scans also show very high or very low levels of important brain chemicals. But these images do not reveal WHY the depression has occurred. Many Possible Causes In general, there is no one cause or risk factor for depression. It most likely results from many factors, such as family history, life experiences, and environment. Older adults with depression may have had it when they were younger, or they may have a family history of the illness. They may also be going through difficult life events, such as losing a loved one, a difficult relationship with a family member or friend, or financial troubles. For older adults who experience depression for the first time later in life, other factors may be at play. Depression may be related to changes that occur in the brain and body as a person ages. For example, some older adults who are at risk for illnesses such as heart disease or stroke may have hardening and inflammation of the blood vessels, and blood may not be able to flow normally to the body's organs, including the brain. Over time, this blood vessel disease and restricted blood flow can damage nearby brain tissue and harm the nerve connections that help different parts of the brain communicate with each other. If this happens, an older adult with no family history of depression may develop what some doctors call "vascular depression." Older adults may also experience depression as a result of brain changes caused by illnesses such as Alzheimers disease or Parkinsons disease. This type of depression can appear in the early stages of these diseases, before many symptoms appear. Depression Can Occur With Other Illnesses Depression can also co-occur with other serious medical illnesses such as diabetes, cancer, and Parkinson's disease. Depression can make these conditions worse, and vice versa. Sometimes, medications taken for these illnesses may cause side effects that contribute to depression. Because many older adults face these illnesses along with various social and economic difficulties, some health care professionals may wrongly conclude that these problems are the cause of the depression -- an opinion often shared by patients themselves. All these factors can cause depression to go undiagnosed or untreated in older people. Yet, treating the depression will help an older adult better manage other conditions he or she may have.
Source: NIHSeniorHealth

Question: What are the symptoms of Depression ?
Answer: Common Symptoms There are many symptoms associated with depression, and some will vary depending on the individual. However, some of the most common symptoms are listed below. If you have several of these symptoms for more than two weeks, you may have depression. - feeling nervous or emotionally "empty" - feelings of excessive guilt or worthlessness - tiredness or a "slowed down" feeling - restlessness and irritability - feeling like life is not worth living - sleep problems, including trouble getting to sleep, wakefulness in the middle of the night, or sleeping too much - eating more or less than usual, usually with unplanned weight gain or loss - having persistent headaches, stomach-aches or other chronic pain that does not go away when treated - loss of interest in once pleasurable activities, including sex - frequent crying - difficulty focusing, remembering or making decisions - thoughts of death or suicide, or a suicide attempt feeling nervous or emotionally "empty" feelings of excessive guilt or worthlessness tiredness or a "slowed down" feeling restlessness and irritability feeling like life is not worth living sleep problems, including trouble getting to sleep, wakefulness in the middle of the night, or sleeping too much eating more or less than usual, usually with unplanned weight gain or loss having persistent headaches, stomach-aches or other chronic pain that does not go away when treated loss of interest in once pleasurable activities, including sex frequent crying difficulty focusing, remembering or making decisions thoughts of death or suicide, or a suicide attempt Is it Depression or Something Else? The first step to getting appropriate treatment is to visit a doctor. Certain medications taken for other medical conditions, vitamin B12 deficiency, some viruses, or a thyroid disorder can cause symptoms similar to depression. If an older adult is taking several medications for other conditions and is depressed, seeing a doctor is especially important. A doctor can rule out medications or another medical condition as the cause of the depression by doing a complete physical exam, interview, and lab tests. If these other factors can be ruled out, he or she may refer you to a mental health professional, such as a psychologist, counselor, social worker, or psychiatrist. Some doctors called geriatric psychiatrists and clinical geropsychologists are specially trained to treat depression and other mental illnesses in older adults. The doctor or mental health professional will ask about the history of your symptoms, such as when they started, how long they have lasted, their severity, whether they have occurred before, and if so, whether they were treated and how. He or she will then diagnose the depression and work with you to choose the most appropriate treatment.
Source: NIHSeniorHealth

Question: what research (or clinical trials) is being done for Depression ?
Answer: Treating Older Adults Studies show that the majority of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy or a combination of both. In addition, research has indicated that treating depression in older adults often improves the outcomes of co-existing medical conditions. Some research has also suggested that the risk for developing depression in people who have had a stroke may be reduced if they receive preventative treatment with an antidepressant or talk therapy. Special Considerations However, there are some special considerations that doctors must take into account when treating older adults. The commonly prescribed medications for depression may not work well for some older adults because they may interact unfavorably with other medications being taken for other conditions. Some older adults with depression may also have some problems thinking clearly, and these individuals often respond poorly to the drugs. Which Form of Treatment Is Most Effective? Many older adults prefer to get counseling or psychotherapy for depression rather than add more medications to those they are already taking for other conditions. Research suggests that for older adults, psychotherapy is just as likely to be an effective first treatment for depression as taking an antidepressant. There is a great deal of evidence indicating that cognitive-behavioral therapy (CBT), including a version called problem solving therapy, may be an especially useful type of psychotherapy for treating older adults and improving their quality of life. However, a practical issue to consider when deciding on treatment is that it may be harder for many older people to find or be able to travel to meetings with a well-trained psychotherapist than to get a prescription for antidepressant medication from their primary care doctor. Also, some research suggests that treatment with medication may be more effective if the depression is quite severe or if the older adult is coping with other serious illnesses. Overall, research has suggested that, when possible, a combination of medication and psychotherapy treatment is likely to be most effective in treating depression in older adults and, in particular, for reducing the number of new episodes. Late-Life Depression is Often Undiagnosed Despite progress in treatment research, late-life depression often goes undiagnosed or is inadequately treated in older adults. In fact, several studies have found that up to 75 percent of older adults who die by suicide had visited their primary care doctors within one month of their deaths. Collaborative or comprehensive care may lead to better treatment results. Collaborative Care The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) offered antidepressant medication and/or psychotherapy to depressed older adults, along with a "care manager" -- a social worker, nurse or psychologist -- who monitored their symptoms, side effects of medication, and progress. The study found that those participants who had case-managed care got better more quickly, had longer periods without depression, and in general responded better to treatment than those who did not have case-managed care. Another study called the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) trial also found that collaborative care was more effective than usual care, and was less expensive over the long run as well. Improving Diagnosis of Depression Several studies are looking at ways to help older adults get better access to depression treatment. One is developing and testing an education and intervention program to help primary care clinics and providers identify and treat late-life depression. Another study found that depressed older adults who had a "care manager" monitor their symptoms, side effects, and progress got better more quickly -- and stayed better longer -- than those who did not have case-managed care. Still other projects are investigating ways of improving older adults engagement in and ability to follow treatment plans for depression. Researchers are also looking at ways to - better understand the relationship between other medical illnesses and depression - integrate treatment for depression with treatments for other medical conditions a person may have - produce a quicker response to treatment - develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies) - help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression. better understand the relationship between other medical illnesses and depression integrate treatment for depression with treatments for other medical conditions a person may have produce a quicker response to treatment develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies) help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression. Findings from these and other studies will provide important information for doctors to treat late-life depression. In a Crisis? Get Help! If you are in a crisis... If you are thinking about harming yourself or attempting suicide, tell someone who can help immediately. - Call your doctor. - Call 911 for emergency services. - Go to the nearest hospital emergency room. - Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to be connected to a trained counselor at a suicide crisis center nearest you. Call your doctor. Call 911 for emergency services. Go to the nearest hospital emergency room. Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to be connected to a trained counselor at a suicide crisis center nearest you.
Source: NIHSeniorHealth