What is depression?
- Depression which is probably one of most common known word in the world, is poorly understood and many people may have a different understandings according to a different cultures, in fact some people may think that it is equivalent to madness especially in the developing countries, now a better understanding of the word has been happening, and more and more patients are accepting the diagnosis of depression and willing to accept treatment for it that is particularly so among women, but men are now catching up, as they have been forced by the reality of life. The definition of depression is simply low mood. Before going into the clinical detail, it important to mention that depression can be classified according to the cause and the type of the depression. According to the cause it can be classified into primary and secondary depression, Primary depression is when the person is depressed but no cause can be identified, secondary depression is when there is a cause for it. Secondary depression can be situational example like problems in the life of the person or organic causes.
- The most common organic causes for depression are endocrine diseases including under active thyroid, under or over active adrenal glands which are 2 glands located above the kidneys and secrete many hormones the most important is cortisone, lack of sex hormones estrogen in women and testosterone in men lead to a profound depression which leave the person incapacitated and have no desire to do anything and worse even this type of depression does not respond well to antidepressants however it responds well and quickly to hormonal replacement therapy. Among other causes of secondary depression is overactive parathyroid glands which regulate the calcium metabolism, they secrete a hormone called parathyroid hormone which increase the serum calcium,and hypercalcemia causes depression, also other causes include chronic illnesses, and some medications. It is important to mention that it was noticed that after an open heart surgery, depression is very common however the exact cause has not been elucidated. When we come to the type of depression, it can be classified into simple depression of various degree like mild, moderate,or severe and the second type is the major depression which is a very serious condition and should be treated promptly.
- Treatment of depression depends upon its causes, in primary depression the treatment will start immediately with antidepressant medications, with secondary depression, if there is an underlying disease, it should be treated first, if the depression still exists then an element of situational depression must be coexisting and medications will be needed, unless the depression is mild and in this case, exercise will be the initial treatment. Major depression should be treated very vigorously usually with more than one medications and as a last resort, electroconvulsive therapy is used which is a safe treatment if properly done. Now before I conclude this article I will like to write about 2 things: first the clinical presentation of depression and the medications for depression. People frequently perceive themselves as depressed when they have low mood, lethargy, lack of motivation, however what it is more important symptoms of depression that may not be realized are anxiety, mood swings like sudden change of the mood from one extreme to the other having poor tolerance to people and getting easily angry with them,fatigue, and chronic insomnia( which is frequently overlooked by the Drs as an underlying symptoms of depression). The recent medications for depression most of them belongs to a group of drugs abbreviated as SSRI, which act by increasing the neurotransmitters in the brain. If you drive in Cairo you are bound to be suffering from depression even if you think you are very fine.
The Pituitary Gland
- The pituitary gland is located at the base of the brain, and it is considered the master of the endocrine glands, as it regulates most of them. It is composed from 2 lobes, the anterior lobe which comprises 80%, of the gland, and the posterior lobe comprising only 20%. The hormones secreted by the anterior pituitary are the followings: 1-The thyroid stimulating hormone(TSH) which controls and regules the function of the thyroid gland, it is essential for the growth and the maturity of the gland, it also helps the thyroid to take the iodine from the blood and it is essential for the formation of the thyroid hormones. Defiency of the TSH leads to decrease in the function of thyroid gland, a condition called hypothyroidism resulting in many symptoms and signs (discussed another time), too much secretion of the TSH leads to a different condition called hyperthyroidism which again presents with other symptoms and signs.
- Hyperthyroidism on the whole is more serious and although both conditions should never be left untreated, hyperthyroidism is particularly so. There is a relation between the pituitary and the thyroid defined as a negative feed back which means if the thyroid secretes too little hormones(T3 and T4), this decrease secretion will push the pituitary to secrete more TSH to drive the thyroid to secrete more T3 and T4, to keep their concentration in the blood within normal limits, therefore when the thyroid is low in function, the TSH will be high. On the contrary when the thyroid secretes too much T3 and T4, then the pituitary secretes less TSH to decrease the too much secretion of T3 and T4, therefore in underactive thyroid, the TSH will be high and in overactive thyroid the TSH will be low, and therefore the TSH is considered the most sensitive test of the thyroid simply speaking. 2-The second hormone secreted by the pituitary is called cortitropin abbreviated as ACTH. this hormone controls part of the adrenal glands which are 2 glands located above the kidneys, they play a very important role in regulating many bodily functions,including water and sodium metabolism and the immunity of the body. The adrenals secrete many hormones, the most important of them is cortisone. They are regulated by ACTH in the same manner as the TSH control the thyroid.
- The ovaries are very important endocrine glands in women. they secrete 3 important hormones The estrogen, the progesterone and small amount of the male hormone testosterone. Estrogen is the main female sex hormone it is responsible for all the female sexual characteristics including the female distribution of hair the breast and genital development, also with the progesterone, it regulate the menstrual cycle and contributes to ovulation. The estrogen is VERY IMPORTANT for the emotional and and physical well being of the woman, its lack leads to profound depression(not responding adequately to antidepressants), emotional liability, and persistent insomnia among other things, the progesterone together with the estrogen is important for menstrual regulation, if pregnancy happens, the progesterone is also important for the development of the placenta which plays a very important role during the pregnancy. The male hormone testosterone is secreted in very small amount and it is responsible for the normal sexual desire in female. the ovaries are under the control of another important endocrine gland, named the pituitary, which regulates the function of the ovaries by secreting 2 other hormones named the FSH and the LH, the pituitary itself is controlled by a center in the brain named the hypothalamus, which is further regulated by the highest central which is a frontal cortex which regulates the thinking process.
- It is clear then that the higher function in the brain controls the ovaries,and there is a relation between the ovarian function and the central nervous system, emotional elements can affect the functions of the ovaries, and vice versa. In evaluating the ovarian function, the most important step is complete history and physical examination, relying on the blood tests is not enough and in fact from my 25 years experience in the U.S., I found that the blood tests do not substitute for the clinical examination and in fact they do not even correlate with the clinical picture, therefore it is always essential to evaluate the blood tests in conjunction with the clinical examination.
- I also noticed that in Egypt, they order pelvic ultrasound before the history and clinical examination, this type of practice has no scientific basis, as no tests or x rays have any value without history and physical. Because emotions can affect the functions of the ovaries, this fact shows how the history is important in evaluating the ovarian function.Disturbance of the ovarian function can vary from benign tumors to malignant tumors which are fortunately rare, lack of the ovarian function and that happens usually by removing the ovaries unnecessarily resulting in multitude of symptoms including nervousness,mood swings, lack of restful sleep,hot flushes, severe headache, lack of sexual desire, dryness of the vagina, however the emotional system is far worse than the physical symptoms. The benign ovarian tumors are mainly benign cyst which can be treated medically ,and if there are multiple cysts the condition is called polycystic ovaries and this also is treated medically. Among benign tumors are hamengioma(usually present since birth) and fatty tumor on the surface of the ovaries and this tumor should be left alone. Malignant tumors of the ovaries are rare and if detected early it can be cured. Secreting tumors of the ovaries usually secrete testosterone and result in what is called musculinisation syndrome. If you have any questions regarding the above topic, please contact me at firstname.lastname@example.org, I shall be pleased to answer your questions Dr Tarek Lotfi