Depression: An Overview
Mrs. Indu Sharma1*, Mandeep Kaur1, Dr. Bharat Parashar2, Ms Amrita Kainth3
1Assistant Professor, The Department of Pharmacy, Satyam Polytechnic College, Amritsar.
2H.O.D. & Associate Professor, The Department of Pharmacy, Manav Bharti University, Solan.
3Assistant Professor, The Department of Pharmacy, Manav Bharti University, Solan.
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer. There are many factors that play role in depression are like alcohol or drug abuse, Divorce, sleeping problem, job loss, death or illness of someone close to you, social isolation etc. Depression can change or distort the way you see yourself, your life, and those around you. People who have depression usually see everything with a more negative attitude, unable to imagine that any problem or situation can be solved in a positive way. Conventional antidepressant drugs are usually associated with many side effects. Sometimes herbal remedies play important role in treatment of depression. However, Ayurvedic knowledge needs to be coupled with modern medicine and more scientific research needs to be done to verify the effectiveness, and elucidate the safety profile of such herbal remedies for their antidepressant potential, now a day’s herbal remedies are more in use due to fewer side effects. The present review article give idea about different forms of depression and the treatment of depression with the use of some herbal remedies and it also include some alternatives of antidepressant. Generally antidepressants are drugs that are used to treat depression.
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless. They may lose interest in activities that once were pleasurable; experience loss of appetite or overeating, have problems concentrating, remembering details, or making decisions; and may contemplate or attempt suicide, Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains or digestive problems that are resistant to treatment may be present. Depressed mood is not necessarily a psychiatric disorder. It is a normal reaction to certain life events, a symptom of some medical conditions, and a side effect of some medical treatments. Life events that may precipitate depressed mood include personal conflicts or disputes with family members or friends, bereavement, moving, losing a job or income, divorce, retirement, menopause, social isolation, and social rejection.
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer. 
Causes, Incidence, and Risk Factors of Depression
The exact cause of depression is not known. Many researchers believe it is caused by chemical changes in the brain. This may be due to a problem with your genes, or triggered by certain stressful events. More likely, it's a combination of both.
Some types of depression run in families. But depression can also occur if you have no family history of the illness. Anyone can develop depression, even kids.
The following may play a role in depression:
· Alcohol or drug abuse
· Certain medical conditions, including underactive thyroid, cancer, or long-term pain
· Certain medications such as steroids
· Sleeping problems
Stressful life events, such as:-
· Breaking up with a boyfriend or girlfriend
· Failing a class
· Death or illness of someone close to you
· Childhood abuse or neglect
· Job loss
· Social isolation (common in the elderly)
Symptoms of Depression
Depression can change or distort the way you see yourself, your life, and those around you.
People who have depression usually see everything with a more negative attitude, unable to imagine that any problem or situation can be solved in a positive way.
Different Symptoms of depression can include:-
· Dramatic change in appetite, often with weight gain or loss
· Very difficult to concentrate
· Fatigue and lack of energy
· Feelings of hopelessness and helplessness
· Feelings of worthlessness, self-hate, and guilt
· Loss of interest or pleasure in activities that were once enjoyed
· Thoughts of death or suicide
· Trouble sleeping or excessive sleeping
· Depression can appear as anger and discouragement, rather than feelings of sadness.
· If depression is very severe, there may also be psychotic symptoms, such as hallucinations and delusions. 
Different Forms of depression
There are several forms of depressive disorders.
A. Major depressive disorder, or major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. Some people may experience only a single episode within their lifetime, but more often a person may have multiple episodes.
B. Dysthymic disorder, or dysthymia, is characterized by long-term (2 years or longer) symptoms that may also experience one or more episodes of major depression during their lifetimes.
C. Minor depression is characterized by having symptoms for 2 weeks or longer that do not meet full criteria for major depression. Without treatment, people with minor depression are at high risk for developing major depressive disorder. Some forms of depression are slightly different, or they may develop under unique circumstances. However, not everyone agrees on how to characterize and define these forms of depression. They include:
Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
Postpartum depression, which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
D. Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
E. Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression). More information about bipolar disorder is available. 
Natural Remedies for the Treatment of Depression
For some people suffering from depression, antidepressants may not be a favorable remedy. Some may prefer more natural remedies for depression. Described below are some common natural cures for depression, which include natural antidepressants and other alternative treatments for depression. In research studies, some natural depression treatments have been shown effective in alleviating depressive symptoms while other natural remedies have not been formally studied, but reported to be helpful anecdotally. In general, natural treatments may be helpful for mild to moderate forms of depression.
i) B12 Vitamins:
Some studies have shown a link between B12 vitamin deficiency and depression (e.g. worsening). B12 (and folic acid) may defend against depression and help maintain positive mood. This natural remedy would not be sufficient alone to treat clinical depression, but may be a helpful addition. B12 is found in foods such as meat/liver, chicken, fish, milk, cheese, yogurt, eggs or B12 vitamin supplements can be taken.
ii) 5-Hydroxy-Tryptophan (5-HTP):
A natural antidepressant made from the seeds of the Griffonia Simplicifolia plant. 5-HTP is a precursor to neurotransmitter, Serotonin and as a result increases Serotonin levels. This herbal remedy primarily comes in capsule form. Some small studies indicate that 5-HTP may be useful in treating depression, but further research is needed. Side effects appear to be fewer and less severe than usual antidepressants. They include nausea, constipation, heartburn, gas, drowsiness, and decreased sexual desire. 5-HTP can interact with other drugs. Consult a doctor before taking 5-HTP.
iii) Omega 3 Fatty Acids:
Although not sufficient by itself to treat depression, studies have shown that this all-natural remedy is a useful adjunct to other depression treatment. The best way to get Omega 3s is to eat fresh fish (e.g. salmon, sardines) or you can take Omega3 supplements (e.g. capsules, oil).
Alternatives to Antidepressants
Therapy of course:
Talking to a therapist can both help alleviate depressive symptoms and help you cope with the stressors that trigger or make depression worse. In fact, therapy can change brain chemistry (as well as your thoughts – especially ones that are repetitive or intense). The most common types of therapy to treat depression include Cognitive Behavioral Therapy (CBT or Cognitive Restructuring), Interpersonal and Solution Focused. For more information, please see Get Depression Help and Finding a Therapist.
To help therapy move along more quickly or for mild to moderate depression, you can read a self-help book on treating depression using cognitive behavioral therapy (CBT) techniques. CBT can be relatively easy to learn which makes it well suited for self-help type workbooks.
Has many health benefits including improving mood and other depressive symptoms like low energy and trouble sleeping. Research has shown that exercise may be helpful in treating mild to moderate depression. Exercise, when effective, may take longer to work than anti-depressants.
Type of remedy that is used to treat Seasonal Affective Disorder (SAD), which is depression that only occurs at specific times of the year (e.g. fall, winter). As an alternative to antidepressants, people with SAD are exposed to bright light (through a florescent light unit) that is equivalent to being outside during a sunny day. It is believed that sunlight exposure helps regulate the body clock. When sunlight is registered through the eyes, certain chemical changes occur in the brain which involve Serotonin and Melatonin (which is associated with sleep/wake patterns).
Numerous studies have shown meditation to have many health benefits as well as improving mood, anxiety and stress. Meditation can be a helpful addition to treating depression. Over time, meditation can help one feel more at peace and be able to step back and let go of thoughts, which is helpful since depressed individuals often experience repetitive negative thoughts. Meditation can be as simple as sitting quietly with eyes closed and concentrating on one’s breath. When you notice yourself no longer focusing on your breath, gently bring your focus back to your breathing.
An ancient healing remedy from China which uses very tiny needles to activate certain points (meridians) on the body to control symptoms, treat illnesses and improve health. Acupuncture can act as an antidepressant by improving mood and symptoms associated with depression such as insomnia, fatigue, changes in appetite and anxiety.
Medications for Depression
Drugs used to treat depression are called antidepressants. Common types of antidepressants include:
Selective Serotonin Re-uptake Inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox), citalopram (celexa) and escitalopram (Lexapro).
Serotonin Norepinephrine Re-uptake Inhibitors (SNRIs), including Desvenlafaxine (Pristiq), Venlafaxine (Effxor) and duloxetine (cymbalta).
Other Medicines Used to Treat Depression
v Tricyclic antidepressants
v Bupropion (Wellbutrin)
v Monoamine oxidase inhibitors
If you have delusions or hallucinations, your doctor may prescribe additional medications.
Side effects of conventional medicines
Most occurring side effects of these conventional drugs are Nausea, diarrhea, headaches, Sexual side-effects are also common with SSRIs, such as loss of sexual drive, failure to reach orgasm and erectile dysfunction. Side effects of Tricyclic antidepressant (TCAs) are dry mouth, blurred vision, drowsiness, dizziness, tremors, sexual problems, skin rash, and weight gain or loss. Monoamine oxadase inhibitors cause like phenelzine (Nardil) and tranylcypromine (Parnate) include hepatitis, heart attack, stroke, and seizures. Serotonin syndrome is a side-effect of MAOIs when combined with certain medications.
Medicinal plants have wondrous constituents which may give health benefits to humankind. The use of herbal anti-depressant drugs is not common among the depressant patients. This review has also specified the side effects of conventional medicines for depression while herbal remedies and alternative therapies have either no or fewer side effects. As we know that plants have been used as remedial agent for variety of ailments since ancient times, thus importance should be given to the potentiality of ethnomedicinal studies as these can provide a very effective strategy for the discovery of useful medicinally active identity. The patients should also be encouraged for the use of these herbal drugs as these may help in managing the disease and prove beneficial to attain good health.
I would like to thank My Parents, faculty of Manav Bharti University, Solan (H.P), My Honorable Guide HOD of Pharmaceutical department Dr. Bharat Parashar, My Co-Guide Ms Amrita Kainth.
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Received on 23.02.2014 Accepted on 23.03.2014
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