Who is at Risk For Gestational Diabetes?

Any woman who is pregnant may suffer from Gestational Diabetes. Those who are at a higher risk are:

* Women who are obese
* Have a family history of diabetes
* Previously had gestational diabetes
* Gave birth to a stillborn
* Gave birth to a 9lb baby
* Have glucose in the urine
* Those with Ethnic backgrounds of African American, Native American, Hispanic and Asian

Symptoms of Gestational Diabetes

The symptoms of Gestational Diabetes are often the same as other forms of diabetes. These symptoms include:

• Excessive Thirst
• Excessive Urination
• Increased Appetite
• Unusual weight gain or weight loss
• Fatigue
• Blurred Vision
• Dry Mouth
• Slow Healing Sores
• Nausea, vomiting

Causes of Gestational Diabetes

The natural increase of hormones during pregnancy has an effect on the blood glucose levels of the mother. As the blood glucose levels rise her pancreas should naturally increase production of insulin. If this does not occur then Gestational Diabetes sets in.

Complications Due To Gestational Diabetes

In early pregnancy this can be fatal to the fetus resulting in miscarriage or birth defects. In the second and thrid trimester it can result in large growth of the fetus. The baby can become rather large and this can cause complications during delivery. The larger the baby becomes, the more apt the mother will be to enter labor early in the pregnancy. Early labor beginning before the 26th week of gestation can lead to severe complications for the fetus and possibly death.

Over the Counter Treatments for Gestational Diabetes

While there are no over the counter treatments for gestational diabetes, there are foods and testing devices that can be utilized to control blood glucose levels. These include low sugar food options, zero sugar food options, low carbohydrate options and blood glucose testing devices and supplies.

Alternative Treatments for Gestational Diabetes

By following a proper diet and exercise program Gestational diabetes can be controlled. It is important to eat three small meals a day and two to three snacks per day. These meals and snacks should be high in fiber and low in fatty acids. It is also important to drink at least 8 cups of liquid a day. Low impact exercise can also help control blood glucose levels.

When is Medical Advice Necessary?

During pregnancy it is always important to get the best health care possible. Prenatal care is vital to a healthy pregnancy. Gestational Diabetes will be discovered through regular examinations but if you begin showing signs of Gestational Diabetes immediately contact your doctor.

Medical Treatments for Gestational Diabetes

While some women can control their Gestational Diabetes with diet and exercise some may require insulin to reduce blood glucose levels. It is important to test often and follow your doctors instructions. Nutritional classes are available to help you learn how to properly take care of yourself and your baby during your pregnancy.

Type 2 Diabetes is also known as adult onset diabetes. This does not mean that young adults or teenagers can not develop this type of diabetes. In the last few years there has been a increase in the number of younger people developing Type 2 Diabetes due to poor diets and lack of exercise. It is not completely clear why one person develops diabetes over another. It has been linked to genetic factors but these are not the only risk factors for developing diabetes. Here is a list of factors associated with who is at risk of developing diabetes.

Some ethnic groups are at higher risk of developing type 2 Diabetes. This can be due to cultural differences and genetic dispositions. The groups that are at the most risk include African Americans, Native Americans, Hispanic Americans and also Japanese Americans.

Age also plays an important factor in your risk for developing diabetes. Since 90% of all diabetes are associated with type 2 diabetes those who are over 45 years of age are at greater risk. Those who are over age 65 are at the greatest risk for developing diabetes.

What are the Symptoms of Type 2 Diabetes?

Type 2 Diabetes is a gradual onset of symptoms. Many people who have diabetes type 2 have had the condition for years without knowing it. Here are a few of the symptoms associated with Diabetes:

• Fatigue
• Unexplained Weight Loss
• Excessive Thirst
• Excessive Urination
• Excessive Eating
• Poor Wound Healing
• Infections
• Blurry Vision
• Altered Mental Status

What are the Causes of Type 2 Diabetes?

Type 2 Diabetes has a high genetic factor. Type 2 Diabetes tends to run in families. Studies have already discovered certain genes that are related to type 2 diabetes. Other risk factor for type 2 diabetes include:

• High Blood Pressure
• High Fat diet
• High alcohol intake
• Inactive lifestyle
• Obesity
• High Triglyceride levels
• History if Gestational Diabetes

  

Over the Counter Treatments for Type 2 Diabetes

While there are no over the counter treatments for Type 2 diabetes, the market of lower sugar and zero sugar foods has grown by leaps and bounds. Foods created especially for the diabetic as well as diabetic testing supplies can help to regulate blood glucose levels within a safe range daily.

Alternative Treatments for Type 2 Diabetes

There are many alternative treatments for diabetes especially type 2 diabetes. Improving diet and exercise are the two key components to improving ones health and lowering the risk of developing diabetes it also can help control diabetes.

A diet low in fat, starches and complex sugars and high in fiber is vital to controlling diabetes. It is also important to test your glucose levels often and also add exercise into your lifestyle.

When is Medical Treatment necessary for Type 2 Diabetes?

It is important to get your symptoms checked by a physician if you suspect you have diabetes. While Diabetes can be controlled through diet and exercise it should be monitored a doctor.

Medical Treatment for Type 2 Diabetes

Medical treatments for Type 2 Diabetes consist of controlling blood sugar through diet and exercise. If this does not significantly control your diabetes than medications can be give to assist with your new lifestyle. Doctors will help treat symptoms of diabetes. The more controlled the diabetes stays the less likely you are to have complications from Diabetes.

Who Can Get Dry Skin?

Dry skin tends to occur when the skin lacks vital moisture and this happens with advancing age or to other causes, which will be explained here. Anyone can get dry skin at any time when his or her skin is not getting the required moisture.

Causes of Dry Skin

The causes of dry skin are numerous. Skin is very susceptible to losing its normal state of moisture with the changing of the seasons. The season, which does cause the driest skin issues, is the winter. This can happen because of being constantly exposed to central heating in your home or in other buildings.

Some of the other causes of dry skin can range from taking a bath and towel drying to using the wrong kind of soap to a moisturizing lotion that traps moisture. Other factors can also cause dry skin and some of these are attributed to diseases such as Psoriasis and Thyroid disorders. Alcohol and drugs can cause dry skin and Dehydration.

Symptoms of Dry Skin

The symptoms of dry skin vary and depend on a person’s age, the specific location you live in, the cause of the problem, and so forth. But some of the most classic symptoms of dry skin do include the following:

• Redness
• Cracks that may bleed
• Skin tightness
• Frequent itching
• Skin that is rough and not smooth

Alternative Treatments for Dry Skin

There are numerous oils, lotions, and creams available over the counter as treatments for dry skin. The best products to look for are those that contain humectants and emollients. Some recommendations include Eucerin lotion, Aqua Care therapeutic lotion, Neutrogena and Cetaphil lotion.

There are several alternative treatments for dry skin. The treatment that you decide to choose depends on you. Some of the alternative treatments for dry skin are taking milk baths, using a humidifier in your home, herbs for dry skin, diet recommendations, wearing certain materials, and so forth.

When Is Medicinal Treatment Necessary for Dry Skin?

Most dry skin conditions can be healed by taking care of them yourself. However, if you suffer any of the following, it is highly advisable to see a doctor for help. They are:

• Constant itching that keeps you awake
• The appearance of infection or open sores from scratching
• Your skin doesn’t get better despite your efforts

Medical Treatments for Dry Skin

The specific medical treatments for dry skin may vary according to the dry skin condition that you have. Some doctors will recommend home care in the form of non-prescription creams and moisturizers and not taking long baths and showers. Nevertheless, it depends on how serious your dry skin is. They may also prescribe prescription creams, ointments, and hydrocortisone lotions.

Who Should Get Dental Care

It is important for everyone to practice good oral hygiene but it is also important for everyone to get dental care to prevent gum diseases and tooth decay. Small children are at great risk for having tooth decay. It is important for them to receive dental care to properly teach them good oral hygiene and to identify any possible problems related to their baby teeth or adult teeth coming in. The sooner a problem is identify the less drastic measures maybe use to treat any potential problems. Adults should also get dental care to prevent tooth decay and gum diseases. It is important to have regular teeth cleaning and x-rays to identify problem with oral health. This can also be an indicator to more dangerous illnesses.

Why is Dental Care Important

• Prevents Tooth Decay – Prevents damage to the tooth and loss of teeth.
• Prevents Gum Disease – Gum disease can damage tissue and bone that supports the teeth.
• Easier Continuing Care – Makes dental appointments easier and less time consuming.
• Saves Money – By preventing the need for filling and other dental treatments you will save money.

• Prevents bad breath
• Makes teeth stronger and able to last a lifetime
• Improves health in general

Home Dental Treatments

Good dental care begins at home. By brushing your teeth and flossing at least twice a day can help prevent tooth decay and gum diseases. You should also consider using mouth wash along with brush and flossing. To take care of stains on the teeth discuss teething whiting systems with your dentist.

Fluoride is an important tool in promoting healthy, strong teeth. Children should drink water that contains fluoride. Fluoride can help children form health teeth. I can be toxic in large doses so products containing fluoride such as mouthwash and tooth paste should be kept out of children’s reach.

Dental care should begin when children are infants or at least by the time the have their first tooth come in. The earlier dental care begins the better their dental care outlook will be. Children must learn how to take care of their teeth at an early age.

When is Professional Dental Care Required

A Dentist should be seen for regular cleanings and if there is any tooth pain. A Dentist should also be consulted for foul smelling breath and bleeding gums. This could be a sign of gum disease.

Medical Dental Treatments

There are many medical treatments for dental care. These treatments include:

• Tooth Extractions
• Root Canals
• Fillings
• Braces
• Gum Disease Treatments
• Crowns
• Dentures
• Oral Surgery
• Cleanings
• Tooth Whitening

Some of these treatments are considered cosmetic while others are required for dental health and prevention of other diseases.

Who is at Risk for Type 1 Diabetes?

It is still unsure who is at risk for Type 1 Diabetes. There is evidence that Type 1 Diabetes maybe genetic while other information says it comes from an illness of the autoimmune system. It is almost always discovered in childhood. It’s symptoms comes on quickly.

Symptoms of Type 1 Diabetes

The symptoms for Type 1 diabetes are the same as all other types of diabetes but they also come on much more quickly. The sudden onset of these symptoms often associated with an illness such as a virus or urinary tract infection. Here are a list of the common symptoms of diabetes:

• Fatigue
• Unexplained Weight Loss
• Excessive Thirst
• Excessive Urination
• Excessive Eating
• Poor Wound Healing
• Infections
• Blurry Vision
• Altered Mental Status

Causes of Type 1 Diabetes

The cause of type one diabetes is thought to be associated with an autoimmune disease. This autoimmune disease attacks the pancreas causing it no longer create the hormone insulin needed to convert sugar into energy.

Over the Counter Treatments for Type 1 Diabetes

While there are no over the counter treatments for type 1 diabetes, there are a growing number of foods and products aimed at glucose regulation. Patients can also purchase many diabetic testing supplies over the counter.

Alternative Treatments for Type 1 Diabetes

The alternative treatments for type 1 diabetes is still a health diet and increased exercise. Type 1 diabetes is a little different though than type 2 diabetes. Type 1 diabetes cannot be treated through alternative treatments alone, it requires medical interventions.

When is Medical Advice Needed for Type1 Diabetes?

Type 1 Diabetes requires the patient to take shots of insulin for the rest of their lives to maintain proper blood glucose levels. A medical doctor should be active in the patient’s treatment plan and be updated of any changes. If any of the signs or symptoms associated with diabetes should be discussed with your medical professional so that Diabetes can quickly be diagnosed and treatments and life style changes can begin as soon as possible.

Medical Treatment for Type 1 Diabetes

Patients that suffer from Type 1 diabetes will have to take shots of insulin several times a day for life. It is important that they are able to give the shots to themselves and check their blood sugar often. Patients that suffer from Type 1 Diabetes will also have to be monitored for other conditions that can be associated with diabetes such as vision problems, sores that will not heal and other conditions that can posse life threatening issues.

When the insulin is insufficient or non existent or just does not perform it’s job that the levels of blood glucose in the blood remain high. It is the job of the insulin to lower the blood glucose after one eats or at anytime the blood glucose levels rise. Diabetes is a chronic medical condition that currently has no cure but can be lived with successfully with proper medical attention.

Who is at Risk of Diabetes?

While it is still not known 100% why children or young people develop type 1 diabetes it has been linked to an autoimmune disease. This is also a disease that may have genetic risk factors, but more research is needed to find who will be most likely affected.

Ethnicity plays a factor particularly when a close relative had type 2 diabetes or gestational diabetes. Certain ethnic groups, such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans, have a greater risk of developing type 2 diabetes.

Aging: Those who are 45 and over are at a greater risk of developing Type 2 Diabetes. Those over 65 are at an even great risk.

What are the Symptoms of Diabetes?

Symptoms of diabetes depend on the type of diabetes you are experiencing. The following symptoms are related to all types of diabetes.

• Fatigue
• Unexplained Weight Loss
• Excessive Thirst
• Excessive Urination
• Excessive Eating
• Poor Wound Healing
• Infections
• Blurry Vision
• Altered Mental Status

For those who have type 1 diabetes the symptoms come on quickly and can be in association with another illness such as a viral infection or urinary tract infection. For those who have type 2 Diabetes the symptoms are more gradual. A patient with type 2 diabetes can have the symptoms for years before it is diagnosed.

What Are the Causes of Diabetes?

Type one diabetes is due to an autoimmune disease. It is also possible for this type of Diabetes to run in the family and therefore have a genetic disposition.

Type 2 Diabetes also has a high genetic factor. Type 2 Diabetes tends to run in families. Studies have already discovered certain genes that are related to type 2 diabetes. Other risk factor for type 2 diabetes include:

• High Blood Pressure
• High Fat diet
• High alcohol intake
• Inactive lifestyle
• Obesity
• High Triglyceride levels
• History if gestational Diabetes

Alternative Treatments For Diabetes

While there are no over the counter treatments for diabetes, there are several low sugar or zero sugar products that can help to keep glucose levels regulated in a diabetic body. Blood glucose montiors and strips are also available over the counter. There are a lot of alternative treatments to help prevent and even treat diabetes once it is diagnosed. You should consider altering your diet and exercise to promote a diet high in fiber, low fat and low in starches and other complex sugars. Diet is one of the most important factors in preventing and later treating diabetes at least for type 2 diabetes. You should lose weight if you are obese which can help reduce your risk factors. You should not smoke since smokers have a higher risk of developing diabetes.

Increasing exercise is also important to help manage diabetes. It can also help you lose weight which is important to diabetic patients. It is also important to keep track of your glucose levels. You should be testing by glucose levels everyday. Keeping a diet diary is also an important tool for you to share with your physician.

When is Medical Interventions necessary for Diabetes?

Diabetes is a very dangerous disease which should be closely monitored by a doctor. It is important that you see your family physician if you suspect you have or at risk of developing diabetes. While Diabetes can be successful managed at home without the use of medication or insulin it is important to seek medical attention if diabetes is suspected.

Medical Treatments for Diabetes

Currently there is no quick fix cure for diabetes. Diabetes medical treatment is created on an individual basis. You should work with your doctor to create a plan to control your diabetes. For those with type 1 Diabetes an injection of insulin must be given usually by the individual several times a day to control glucose and insulin levels. Type 2 Diabetes can usually be controlled through diet and exercise. In some circumstances medication is also required to help control the diabetes. These options should be discussed with a doctor.

The most important thing that a person can do for their bodies is to have proper diet and nutrition. If you eat a healthy diet and get all the right vitamins and nutrient each day, you will be able to live a long, healthy life. Not only does diet and nutrition make you feel better, but you will also be able to stay healthy and prevent disease.

Fad Diets

A major mistake that people make when they want to get healthy and lose weight is that they succumb to the appeal of a fad diet. While many people can show true results from these diets, not everything is explained in the commercial. First, many celebrities that used the same fad diet you were thinking of also had a personal trainer at their disposal, as well as the time to work out. Plus, no one will let you in on the way that fad diets work. Most of them are dangerous if you use them for more than the recommended time because they are depriving your body of the nutrients it needs to function.

Getting Your Vitamins

A healthy diet is important to everyone, but even with the right diet, you may still need a vitamin supplement to get the recommended daily dose of vitamins that may be lacking in your diet. For instance, if you are eating healthy but are still not eating enough foods that are rich in vitamin C, you will want to look of a vitamin C supplement that can boost your immune system and make you feel healthier.

Most doctors recommend a multivitamin to cover all the basis without getting to many of a certain vitamin each day.

Read the Nutrition Facts

When you are searching the grocery store for healthy foods to feed your family, the most important thing that you can do is pick up the package and read the nutrition facts that are printed right there. This will tell you a lot about the foods that you are putting into your body. While calories and fats are important to notice, you will also want to notice the serving size. If the serving size is small to make the calories and fats look smaller, then you will need to recognize that most people will probably eat two servings or more. You can also count your daily vitamin intake from these packages, so start reading.

When is Medicinal Treatment Necessary for Diet and Nutrition?

Medical treatment for diet and nutrition may be necessary for those who are severely overweight or who are having trouble getting the right amounts of vitamins in minerals in their diet. Most of the time, it is not necessary to see a doctor, but you can work with a nutritionist in order to get your diet and nutrition back on track.

Medical Treatments for Diet and Nutrition

If you are suffering from a vitamin deficiency, your doctor or nutritionist will be able to recommend a supplement that will meet your needs. And if you are looking to change your eating habits and lifestyle, a nutritionist can counsel you on how to change eating habits, what foods to buy, and what to avoid the next time that you are at the grocery store.

Who Can Get Digestive Disorders?

Almost anyone can get digestive disorders such as diarrhea and constipation. These are often signs that let you know there is something wrong with your body. You could be fighting an infection, virus, or you could have a lot of stress built up and this could be a symptom of that. Diarrhea and constipation should be closely monitored in young children because this can lead to dehydration and other serious medical problems.

Causes of Digestive Disorders

There are many different causes for digestive disorders. It can be caused by an infection (most typically in the form of food poisoning), eating certain foods that can upset the digestive system, allergies to foods, medications, radiation therapy, cancer, diabetes, and even competitive running can cause bouts of diarrhea.

Constipation can be caused by an inadequate amount of fiber or water in your diet, traveling, eating a lot of dairy products, stress, overuse of laxatives, medication, depression, pregnancy, or IBS (irritable bowel syndrome).

Symptoms of Digestive Disorders

The symptoms of constipation are a lack of the urge to have a bowel movement, or the difficulty in having one. Diarrhea is the opposite effect. You will have to go often, and the bowel movement is usually in a liquid state rather than solid like a normal bowel movement. You can also get stomach cramps or painful gas with these conditions.

Over the Counter Treatments for Digestive Disorders

There are many over the counter treatments for digestive disorders. You can get a laxative in order to get your bowel movements going again, or you can get a stool softener to make difficult bowel movements easier. For diarrhea, hydration is important. You will want to get plenty of water back into your system. And for children with diarrhea, you can give them a product such as Pedialite that will restore hydration and important electrolytes be into their body.

Alternative Treatments for Digestive Disorders

Many digestive disorders are problems that irritate or inflame the bowels. This can be helped by taking a supplement of probiotics. Probiotics work to restore the balance of good bacteria in your intestines and get them working at their best again. You can also add plenty of fiber to your diet in order to get your bowels working normally again. Fiber is what many people lack in their diets and this can sometimes be the cause of certain digestive problems.

When is Medicinal Treatment Necessary?

If diarrhea does not subside within a day or two, you will want to see your doctor so that she can check to see what else could be wrong. If you are constipated for more than a few days and laxatives have not helped, you will want to consult your doctor.

Medical Treatments for Digestive Disorders

There are many different medical treatments for these conditions, depending on how severe they are and if these conditions are a symptom of a more serious problem. Constipation can often be resolved by an enema prescribed by your doctor. Diarrhea will have to monitored, but can clear up with fluids. If these are symptoms of underlying problems, you will want to consult your doctor for further, more specialized treatment.

The general population experiences some form of dizziness from time to time, or about 20-30% of the time. Dizziness accounts for many visits to physicians and emergency services. In most cases, the cause is benign. The condition limits itself and an individual suffers no consequences. Some causes of dizziness are common while other causes are rare. Some causes are minor, other causes are serious and even life threatening. Vestibular systems, neurological and cardiovascular conditions can produce dizziness. Migraine headaches, benign positional paroxysmal vertigo (BPPV), and Meniere’s disease are the most commons causes of dizziness.

The Sensation

Dizziness usually passes on its own; however, it may be a sign of more serious problems like an underlying cardiac or neurological problem. A physician should be consulted for severe or repeated bouts of dizziness. Identifying the cause can be problematic and treatment may not be satisfactory to the patient. Describing and defining the sensations accurately may be very helpful in helping the physician identify the cause.

Dizziness of a vertigo type is characterized by a spinning or moving sensation. The identifiable feature is movement related. The person may feel like they are moving or the world is moving around them. The other type of dizziness is a fainting sensation where the central nervous or proper sense of the body is lost. Vertigo type dizziness is usually vestibular system related. Faintness is related to the cardiovascular system, infection or metabolism. Some of the ways that people describe dizziness:

• Faintness – lightheadness before fainting or nearly fainting. Low blood pressure and not eating can cause a feeling of faintness. A drop attack or syncope may occur after feeling faint.
• Spinning – a rotary, tilting, or floating sensation in the patient or surroundings. Vertigo is a spinning sensation.
• Imbalance – an unsteady feeling with trouble maintaining an erect posture. Inner ear disturbances and imbalance may lead to an increase in falls. Lack of coordination may feel like dizziness but without the spinning from vertigo. The sensations, which orient the person in space, may be misinterpreted by the brain.

Other descriptions used to describe dizziness:

• Weak
• Confused
• Swinging
• Swaying
• Spacey
• Foggy
• Rocking
• Floating
• Swimming sensations
• Light and free
• Seeing stars
• Double vision

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Balance and Orientation

The normal system for keeping a person oriented in space is the brain, eyes, and ears. The muscles, nerves, and skin of the movement systems also feed information to the brain. The brain is constantly interpreting the body’s position in space with these data-gathering organs and systems. When the head moves, the labyrinth fluid in the ear helps to control balance and sense of consciousness. The labyrinth sends messages to the brain through the vestibular nerve. Even if the eyes are closed, the brain knows what position the head occupies. When the labyrinth or vestibular nerve malfunctions, the signals cause conflicts in the brain, causing the movement or disorientation called dizziness.

The peripheral or central vestibular system is responsible for most cases of dizziness. These sensorineural disturbances are common. Peripheral vertigo is when the inner ear, the vestibular labyrinth, semicircular canals or the vestibular nerve malfunction and incorrect signals are sent to the brain. Central vertigo occurs in the brain stem or the cerebellum. The vestibular system is also responsible for hearing loss. Hearing loss can be due to old age, noise exposure, and infection. Other cases of dizziness are cardiovascular or neurological in nature.

Types of Dizziness

The mechanical, physical and biochemical functions of the human body are categorized into systems which describe their function. Systems are further defined by anatomy, including the organs, and the cells and tissue of which they are composed. Many systems overlap and share biological pathways and function. For instance, labyrinthitis is a common cause of dizziness and is part of the vestibular system. However, communication with the neurological system is achieved through electrical and chemical means. Reception and transmission of signals that integrate the systems and functions, depend on interactions with the whole organism. The main biological systems and their medical conditions known to cause dizziness include:

Vestibular

• BPPV (benign paroxysmal positional vertigo)
• Menieres disease
• Vestibular neuritis (neuronitis)
• Vestibulopathy
• Labyrinthitis
• Perilymph Fistula
• Bilateral vestibular loss
• Superior semi-circular canal dehiscence
• Middle-ear disease
• Acoustic neuroma
• Bone fracture
• Syphilis
• Hypothyroidism
• Cogan’s syndrome
• Mondini’s dysplasia

Neurological

• Stroke
• Migraine
• Seizure
• Multiple sclerosis (MS)
• Cerebellar degeneration
• Chiari malformation
• Cerebellar stroke
• Vertebrobasilar ischemia
• Wallenberg’s syndrome
• Normal pressure hydrocephalus
• Paraneoplastic cerebellar degeneration
• Hereditary ataxias
• Benign intracranial hypertension
• Posterior fossa tumors
• Mal de Debarquement syndrome

Cardiovascular

• Syncope
• Orthostatic (or postural) hypotension
• Autonomic dysregulation
• Presyncope
• Psychogenic dizziness
• Low blood pressure including syncope, orthostatic hypotension, cardiac arrhythmia
• Medication side effect

Psychological

• Psychophysiological dizziness
• Anxiety and panic disorder
• Malingering
• Phobia
• Somatization syndrome post-traumatic dizziness
• Psychogenic dizziness

Metabolic

• Diabetes mellitus
• Hypothyroidism

Autoimmune

• Systemic lupus erythematosus
• Rheumatoid arthritis
• Cogan’s syndrome
• Wegener’s granulomatosis
• Behcet’s disease

Medications or Substances

• Ototoxic drugs
• Chemotherapeutic drugs
• Alcohol
• Other drugs
• Second-generation antiepileptic drugs

Traumatic or surgical

• Post-traumatic vertigo
• Post-surgery dizziness

Infectious

• Lyme disease
• Syphilis
• Cytomegalovirus (CMV)
• Herpes simplex virus 1 (HSV-1)
• HIV

Idiopathic

• Unknown causes or multi-faceted causes

Different Health Conditions Causing Dizziness

Dizziness can be caused by a number of different health conditions. In some cases, the condition will overlap and be a part of one or more biological systems. For instance, aging is associated with dizziness. Aging is a complex process which affects almost all systems including the neurological, cardiovascular and metabolic systems. Conditions which are associated with dizziness include:

• Acoustic neuroma – this rare condition is caused by a benign or non-cancerous tumor growing on the acoustic nerve, which joins the ear and the brain. Tinnitus, dizziness and hearing loss are the usual symptoms. The pressure on the nerve is ongoing and may get worse. Surgery is successful for a majority of cases. Surgeons are able to remove the tumor in 95% of cases. Slow growing tumors behind the ear can also cause facial paralysis and even be fatal. Microsurgery and radiation therapy are other alternatives.
• Aging – the normal process of aging may produce vestibular problems, hearing loss (Presybyacusis), frailty, weakness, lack of coordination and a combination of factors that cause dizziness.
• Alcohol – indulging in alcoholic beverages may induce dizziness depending on the volume, sensitivity, or the ability to metabolize alcohol. Morning after symptoms may include headache and dizziness.
• Anemia – oxygen poor blood in the brain can cause lightheadness. Increasing dietary iron, zinc, vitamin A, and vitamin D may be helpful.
• Anxiety – general anxiety, and anxiety with panic attacks, may trigger dizziness, either real or imagined. Heart rate and ventilation may increase rapidly and cause lightheaded sensations.
• Auditory cortex – abnormal neural networks between the vestibular cortical area and the auditory cortex can cause dizziness. Normal auditory cortex response declines with advanced age. However, musicians seem to be protected from these age related diminishments. Musical training may have a positive effect in maintaining the auditory cortex.
• Autonomic dysregulation – when doing physical activities or exerting oneself, a person may get dizzy. Swimming, running, and sexual activities can lead to a feeling of disconnection from the body or a feeling of spaciness.
• Bacterial otitis media – acute onset of dizziness with fever, irritability and B12 deficiency. When this condition becomes chronic, hearing can become impaired which may limit acquiring verbal interactions and education especially in children.
• B12 deficiency – a common cause of dizziness may be due to genetic factors or a problem absorbing B12.

• Behcet’s disease – a systemic disease affecting the vascular and neurological pathways. Symptoms include ulcers on the mouth and genital, hearing impairment, tinnitus, and dizziness.
• Benign intracranial hypertension – pseudotumor cerebri causes an increase in cranial pressure. A mass lesion is not present. Dizziness, headache, poor vision, imbalance, nerve palsy and tinnitus may be the common symptoms.
• Benign positional paroxysmal vertigo – the most common cause of vertigo, caused by loose particles in the ear canals. The posterior and the lateral canal is the most common site for otoconia particles. The Dix-Hallpike test is performed first. A negative test should be followed by a supine roll test for horixonatal canal BPPV. About 20% of all cases of dizziness are due to this condition. Older people with dizziness due to BPPV, account for 50% of all dizziness cases. Episodes can last for seconds or minutes.
• Cardiovascular – dizziness with fainting is indicative of cardiopulmonary disease. Myocardial ischemia, obstructive hypertrophic cardiomyopathy, pulmonary embolism, or hypertension merits urgent physician care.
• Cogan’s syndrome – inner ear inflammation with plasma cell and lymphocyte infiltration. Demyelization of the cranial nerves also occurs. Patients often have photophobia, ocular discomfort, ocular redness, fluctuating sensorineural hearing loss, and imbalance or vertigo.
• Cytomegalovirus (CMV) – both the mother and child may experience dizziness when the mother is exposed to this virus while pregnant. Some children may have indicators of the disease, others may have severe hearing loss, and other children may experience hearing loss and dizziness later. CMV virus is one of the leading causes of hearing loss in children. A new method to take a sample of an infant’s saliva correctly found CMV 97 percent of the time.
• Diabetes mellitus – hypoglycemia may provoke dizziness. Those patients with peripheral neuropathies may have increased rates of dizziness.
• Heart conditions – abnormal heart rhythms where the heart beats too fast or too slowly are caused by various factors. An arrhythmia may cause fainting or lightheadness. The blood supply to the brain is hampered and causes dizziness. Supraventricular tachycardia and bradycardia, and cardiomyopathy are other causes of dizziness.
• Hereditary ataxias – a genetic disorder that usually is found before a person is 20 years of age. The nervous system malfunctions and muscle movements may be uncoordinated.
• Herpes simplex virus 1 (HSV-1) – this virus inhabits nerve cells and ganglia in an active or dormant stage. The infection may cause audiovestibular symptoms including dizziness. HSV is also known for causing eye problems. The systemic infection invades all the sensory nerve structures. Anti viral medications may reduce nerve damage.
• High blood pressure – hypertension is often found when an individual complains of headache, nausea, or dizziness.
• HIV – central nervous system changes can cause dizziness and lack of coordination. Positional vertigo, labyrinthitis and Meniere’s disease are the most common culprits for HIV patients. Cardiovascular disease, stroke and brain tumors are sometimes the cause.
• Hypothyroidism – inner ear disturbances and Meniere’s disease is more likely for those with this condition.
• Labyrinthitis – viral or bacterial infection in the vestibular system. Trauma can also lead to labyrinthitis. An ear infection or upper respiratory infection may lead the patient to seek help. Mild hearing loss may accompany this condition. Viral labyrinthitis may be accompanied by flu like symptoms like a sore throat or cold symptoms. This condition can last for days or weeks. Vision problems or unnatural eye movements or nystagmus may accompany traumatic labyrinthitis.
• Lyme disease – caused by tick-borne spirochete Borrelia burgdorferi, and other Borrelia species.
• Mal de Debarquement syndrome – sensory inputs from the vestibular system and the visual systems may conflict. The parietal cortex and the cerebellum are involved and lead to a feeling of unnatural movement sensations. Travelers with a history of sea, air, or train travel, or who have traveled in space may have this condition. The symptoms are unlike motion sickness with no nausea or vomiting and can last for years.
• Medication
  • anesthetic medication
  • anti-arrhythmic medication
  • high blood pressure medications
  • sedatives and tranquilizers
  • antidepressants
  • pain relievers
  • diuretics
  • antiepileptic drugs
  • ototoxic drugs
    • aminoglycoside
    • antibiotics such as gentamicin and neomycin
    • chemotherapeutic drugs such as cisplatin
• Meniere’s disease – episodes of vertigo, tinnitus, hearing loss and a full ear canal feeling. The cause is not known, but is associated with endolymphatic hydrops. One percent of the population, of all ages, has this condition. Episodes last from minutes to hours. Permanent hearing loss and the ringing or buzzing from tinnitus may occur.
• Middle-ear disease – labyrinthitis and otitis media, infection or fluid in the middle ear. Those who have had mastoid surgery can have dizziness with an ear infection. Cholesteatomas usually have a malodorous ear discharge, hearing loss and/or tinnitus.
• Migraine-related vestibulopathy – migraine headache are often accompanied by vertigo and dizziness. Migraine sufferers have over activated neuronal systems and vascular dilation. Central nervous system and vasospasm can affect auditory artery and neuropeptide release during a migraine. Patients often have migraine aura, visual disturbance, photophobia, or phonophobia.
• Multiple sclerosis – about 50 percent of MS patients will experience vertigo at some point. Dizziness is a common first symptom for MS cases. Dizziness may be prolonged as demylinating plaque can occur at the entry to the vestibular nerve. There may be an associated hearing loss.
• Normal pressure hydrocephalus – lack of coordination, urinary incontinence and cognitive difficulties are the symptoms. Intracranial pressure is normal but the ventricles may be enlarged.
• Orthostatic hypotension – systolic and diastolic blood pressure decreases. Vasoconstriction occurs or intravascular volume is impaired. People often feel dizzy when standing or sitting up. Blood pressure falls and the person may feel dizzy. This condition may get worse as the person gets older.
• Paraneoplastic cerebellar degeneration – cancer of the ovaries breast or lung increase and antibodies attack neurons in the brain.
• Perilymph Fistula – vertigo, imbalance, hearing loss, and/or tinnitus are seen in people with head trauma, undersea divers, or surgery patients. Exploratory surgery is the method to find this condition.
• Post-traumatic vertigo – accidents, sports injuries, falls and violence induce traumatic injury. Blunt head trauma patients have vertigo, tinnitus, headache and imbalance.
• Pregnancy – first trimester dizziness during pregnancy is common and may occur at any time during pregnancy. Hormones and blood pressure are usually the causes.
• Presyncope – experienced as lightheadedness immediately preceding a loss of consciousness. The patient can also feel this sensation with a near fainting episode. Blurred vision, nausea, vomiting, weakness, giddiness, and paralysis may also precede fainting. Problems with blood supply to the brain are nearly always the cause. Physical positions, conditions or circumstances may cause fainting.
• Psychogenic dizziness – certain situations may provoke those with personality disorders, panic, anxiety, agoraphobia, and depression to experience dizziness.
• Psychophysiological dizziness – dizziness may persist after a real injury. The patient may continue to experience dizziness even when the medical condition is no longer there. Stress, fatigue, and life changes may make complaints worse. Dementia, malingering, depression, phobia and panic disorders are common causes for dizziness.
• Rheumatoid arthritis – patients with this condition may have normal hearing but they may have perceptions of hearing loss and dizziness.
• Spinning around – amusement rides, spinning around in a chair, recreational games and similar activities produce a temporary spinning sensation.
• Superior semi-circular canal dehiscence – loud sounds, ear pressure and vertigo is usually caused by trauma or concussion. Diagnosis is made with a CT scan.
• Surgery – middle ear surgery, cochlear implants and related vestibular surgeries can be followed by dizziness and balance disturbances immediately after surgery or some time later.
• Syncope – a drop attack, or sudden loss of consciousness followed by a spontaneous recovery. Hypotension, medications, stroke, and cardiac events lead to syncope. Fear of needles, blood or other triggers may initiate a fainting episode. Researchers say that 50 percent of the population will faint in their lifetime.
• Syphilis – congenital or secondary syphilis is known to cause inner ear problems with vertigo and hearing loss or fluctuating hearing loss.
• Systemic lupus erythematosus – an autoimmune disorder with symptoms of vertigo and vision abnormalities. There may be an associated hearing loss.
• Trauma – inner ear dysfunction may arise from a fall, an accident, a violent incident or sports injury. A skull fracture or concussion may induce vertigo, headaches and dizziness.
• Vertebrobasilar ischemia – clumsiness and a drop attack with vertigo lasting one to fifteen minutes is characteristic of a stroke in the cerebellar artery.
• Vertigo – central vertigo in inner ear dysfunction happens when the labyrinth or vestibular nerve is inflamed or damaged. Patients have the sensation that they are spinning around, or the world is spinning around them. Nausea and vomiting often accompany vertigo. Lying down often helps vertigo symptoms. Blood vessels dilation and inflammation in the brain and nerves can cause vertigo.
• Vestibular neuritis (neuronitis) – a viral infection, usually herpes, inflames the vestibular ganglion, vestibular nerve, and labyrinth. The vestibular nerve coming from the inner ear becomes inflamed, but usually clears when the infection is treated. An early diagnosis and treatment is important for long-term functioning.
• Wallenberg’s syndrome – vertigo that can last for several days due to a lateral medullary infarction, a sudden blockage or clot in a vertebral artery that supplies a cerebral artery.
• Wegener’s granulomatosis – symptoms of vertigo, hearing loss and facial palsy.

Diagnosis

Dizziness is diagnosed with a patient history and physical evaluation. Diagnostic and laboratory tests are often unnecessary except for serious symptoms of cardiovascular or neurological origin. A detailed history and a catalogue of the patient’s symptoms can provide important information. Describing the attacks according to their nature, duration and concurring symptoms, especially auditory symptoms can help the physician to make a diagnosis. Examination of the ear, eyes and throat is an important step. Serious cases of dizziness are uncommon and most likely a diagnosis will be made according to vestibular causes.

Diagnostic Approach

Physicians will take a medical history and ask questions such as:

• What happens when you feel dizzy? What are the signs of the episode?
• What does it feel like? Is it spinning or do you feel lightheaded?
• How long does the episode last?
• What position are you in when you feel dizzy? Standing? Sitting?
• Do you hear a buzzing noise? Is your hearing worse?
• Do you feel weak or have problems walking?
• Do you have panic or anxiety?
• Have you had recent surgery or a head trauma?
• Do you have any other illnesses?
• Does your family have a history of illnesses?
• What medications do you take?
• Are you using drugs or alcohol?

Testing

• Acoustic reflex assessment – a loud noise test for the muscle that protects the ear.
• Audiometric confirmation – tests for sensorineural hearing loss, tinnitus, and aural fullness.
• Blood glucose monitoring – for possible diabetes.
• BP – lying down and standing up BP check.
• Computerized dynamic post-urography testing – assesses balance with a computerized platform.
• Dix-Hallpike test – if BPPV is suspected. The patient sits on a bed and the physician moves the head and the body in an attempt to replicate the patient’s symptoms. The procedure may be surprising or painful to the patient.
• Electrocochleography – useful in the diagnosis of Meniere’s disease.
• Computed tomography (CT) – useful in identifying bone fractures.
• MRI scans -can find fluid in the middle ear. Patients with acute vertigo and cardiovascular symptoms often require urgent MRI.
• Observation of eye movements – nystagmus and visual acuity can give clues to the diagnosis.
• Pure-tone audiogram – for the discovery of hearing loss.
• Romberg and Unterberger (Fukuda) tests – balance and coordination tests with eyes closed.
• Screening for depression and anxiety disorders.
• Supine roll test – the patient lies on his back while the physician examines the eyes as the head is rolled from side to side.
• The head impulse test – the patient is asked to keep their eyes on a target in the distance while the physician turns the head from side to side.

Dizziness Treatment

Treatment for dizziness will vary as widely as the causes and conditions which cause the dizziness. Urgent treatment may be necessary for cardiovascular conditions including surgery for pulmonary embolisms, anticoagulation medications to prevent stroke and emergency revascularization procedures. Observation of neurological symptoms may be necessary on an emergency basis. The goals of increasing vestibular function include decreasing dizziness, increasing balance and increasing activity levels. Medication commonly prescribed:

• Aspirin
• Corticosteroids
• Motion sickness pills
• Anti-emetics
• Anticholinergics
• Antihistimines
• Benzodiazapines
• Anti-viral
• Antibiotics

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Emerging Possibilities

Artificial Vestibule

An implanted device could improve the quality of life for vestibularly damaged patients. An implantable prosthesis is being investigated that would restore proper sensation in the vestibular system. The device is designed to interpret all three dimensions of head rotation. The neuroelectronic prosthesis would interpret head rotation and encode the branches of the vestibular nerve

Vestibular Hair

Vestibular function loss is often related to vestibular hair cell loss for diseases processes such as vestibular neuronitis, aminoglycoside ototoxicity, and aging. Recovery of inner ear hair may improve balance. Regeneration of hair provides a way to stimulate local tissue healing. One study demonstrated that mice treated with Admath 1.11D recovered their vestibular neuroepithelium within 8 weeks. Genetic testing is also underway to find a way to grow new hair using DNA.

Modified Cochlear Implant

The Nucleus® cochlear implant has been changed to adapt it for vestibular therapy. Three leads are implanted in three sites in the semicircular canals of the inner ear. This device helps the brain to decode 3D rotational information.

Physical Therapy

Patients can use specialized exercises that seek to restore function by improving balance, inner ear function and eye reflexes. Exercises can be performed with a therapist or at home. Multisensory integration and integration of the central nervous system is critical to restore a whole and functional vestibular system.

References

http://www.ncbi.nlm.nih.gov/pubmed/12413656

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2767263/

http://www.ncbi.nlm.nih.gov/pubmed/17255891

http://neurotechzone.com/posts/58

http://www.nature.com/gt/journal/vaop/ncurrent/full/gt201133a.html

http://www.vestibular.org/vestibular-disorders/treatment/medication.php

http://calder.med.miami.edu/pointis/tbiprov/MEDICINE/sense2.html

http://www.scientificamerican.com/article.cfm?id=what-are-vestibular-migraines

http://www.tchain.com/otoneurology/treatment/drugrx.html

http://www.eurekalert.org/pub_releases/2011-01/nioa-abt011111.php

http://www.sciencedaily.com/releases/2008/01/080124173806.htm

http://www.washington.edu/news/archive/id/60968

http://www.sciencedaily.com/releases/2010/12/101207121433.htm

http://www.sciencedaily.com/releases/2010/11/101116100320.htm

http://www.asm.org/index.php/news-room/new-understanding-of-chronic-otitis-media-may-inform-future-treatment.html

http://www.sciencedaily.com/releases/2011/06/110601171608.htm

http://www.eurekalert.org/pub_releases/2010-09/jaaj-ata090910.php

http://www.sleepreviewmag.com/news/2011-04-13_01.asp

http://tuebingen.mpg.de/en/kybernetik-neuigkeiten/detail.html?tx_ttnews%5Btt_news%5D=217&tx_ttnews%5BbackPid%5D=118&cHash=3f6bad25df

5-10% of the worldwide population is having an episode of depression right now, approximately 121 million people. Individuals have a one in five chance of getting depression, and women are two times as likely to get depression as men. The World Health Organization predicts that the leading cause of disability by 2020 will be depressive disorder. The current annual economic burden of major depression in America is $100 billion.

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The causes of depression are not completely understood. Some say that we have organized society away from a collective, or group living experience and this spawns loneliness and depression. Early life experiences of neglect, abuse or stress may make some people vulnerable. Genes and heredity play a part. Negative life events, physical illnesses, and substance abuse may trigger an episode of depression. Sometimes no identifiable cause is evident and this fact itself may cause a deepening of symptoms, as people want to find the cause and cannot. Depression can strike for no apparent reason.

Depression is clinically characterized by:

• chronic sad mood
• reduced energy
• loss of enjoyment in formerly positive activities
• guilt
• low self-worth
• disturbed sleep or appetite
• low energy
• poor concentration
• anger

The severity of symptoms, the duration of symptoms and other issues inform physicians as they attempt to make an accurate diagnosis, begin effective treatment, and follow-up carefully. Suicidal ideation is a tangible possibly before, during, or after treatment, as depression claims 850,000 lives every year due to suicide. Many more attempt suicide. Most, but not all, patients benefit from psychotherapy and antidepressants. Since not all patients recover, no cure is considered to be found. Scientists are stilling uncovering causes and trying new treatments.

Negative and Positive Effects of Depression

Depressed people seem to get stuck and preoccupied in hopelessly distorted views and suffer from a lack of perspective. Faulty inferences are drawn through obsessional doubt and alienation from others’ thoughts and feelings. A hopeless and overwhelming reasoning process chips away at the ability to correctly perceive positive vs. negative conditions. Getting stuck on negative thoughts limits a person’s ability to find new and positive mindsets. Systematic cognitive negativity also impacts non conscious thoughts and behaviors.

However, negative moods also have value. A down mood may help people be less gullible and improve judgment in demanding and complex situations. Happy people tend to believe everything they are told but depressed people pay more attention, think more carefully, make less snap decisions and have better analytical reasoning and persistence. A positive mood is not always desirable.

Consequences

Severe depression though, destroys the quality of life. A person’s ability to work and form relationships is hampered, and life may be cut short with depression causing physical illness and suicide. More consequences of depression include:

• Memory – deficits in activity in medial temporal and prefrontal lobe structures involved in memory retrieval.
• Risky Behaviors – promiscuity, improper condom use, and relationship violence is found in depressed people, including controlling relationships, rape, pregnancy and HIV.
• Relationships – individuals with depression do not make healthy partners in intimate situations as they are often withdrawn or even hostile. They show reduced ability to empathize with their partners.

Causes of Depression

The Brain

Brain inflammation is strongly indicated in depression according to researchers. This new view adds to the current view and may oppose it. The current view states that serotonin and noradrenaline deficiencies cause the symptoms associated with depression. Since serotonin-based medicines do not cure all patients, another mechanism must be involved, study authors theorized. They found that patients with the highest levels of inflammation-related substances (cytokines) in their spinal fluid had been diagnosed with depression or had made suicide attempts. Efforts are underway to treat depressed patients with anti-inflammatory medications.

Authors believe that inflammation in the brain is the first step in a downward spiral of hormone depletion, including adrenaline and cortisol. People’s capacity to respond to stress is thereby lowered causing the emotional symptoms of depression. Inflammation causes a disruption in the natural self-regulating stress hormone activity. Some depressed people have higher than normal stress hormone levels while others have much lower levels. Researchers believe that this inconsistency is explained by looking at the long term. Chronic and long-term depressed people may have lower cortisol levels due to a ‘breakdown’ in the stress system.

In support of this new theory, recent studies have shown that leptin, a hormone secreted by adipose tissue or fat cells, and other locations, is less bio-available in obese people, indicating an inflammatory condition. Leptin also has effects on mood and stress pathways. After controlling for body weight, meaning that researchers discounted body weight data in their results, they found that women with the highest leptin levels also had the least severe symptoms of depression and anxiety. Leptin is considered an important mediator in modulating mood and those with high circulating concentration had decreased symptoms of anxiety and depression. Leptin therapy is in its infancy, with studies in leptin injections in humans underway.

Brain morphometry, or the shape and volume of the brain, shows deficits in certain brain regions in Bipolar disorder, which is remarkably similar to depression. Non-invasive neuroimaging techniques with Magnetic Resonance Imaging (MRI), CT scans, Magnetic Resonance Spectroscopy (MRS), Positron Emission Tomography (PET), and functional imaging (fMRI and fMRS) take 3D images of the brain.

Brain regions involved in mood regulation have reductions in size in bipolar patients. Bipolar is characterized by predominately depressive moods, with occasional manic moods. Bipolar patients had brain structure differences with cerebral volume reduction in the hippocampal and amygdala regions. Bipolar patients also show dysfunction in the prefrontal cortex, the region of the brain involved in emotion-processing and regulation, higher thought processing and goal planning. The work load that the prefrontal cortex can handle is therefore decreased. These areas of the brain do not work as “hard” as normal brains. Medications to increase volume deficits have shown significant results.

Disruptions in the biochemical substrates that help regulate mood is also seen in glutamate, myoinositol and choline. These substrates help with emotional expression and behavior. The body has a system of regulating and self-regulating the stress response. When inflammation disrupts the serotonin or 5-HT system, other helping bio-chemicals are disrupted downstream.

Genetic Influences

One study examined over 15,000 individuals and found a susceptibility gene for depression. SLC6A15, a gene that codes for a neuronal amino acid transporter protein, showed lower expression in majorly depressed patients. Researchers theorize that the low functioning gene conferred a risk and perturbed neuronal circuits. The circuit system in the brain neurons lacked integrity and had transmission deficits. Scientists say that this gene may be targeted with new pharmacological approaches.

Another gene called MKP-1 gene has recently been shown to be a major regulator of depressive symptoms. This gene showed two times the expression in the brain tissues of depressed patients. When researchers knocked out the gene in mice, the mice became resilient to stress. Since the gene may be overactive in depression, new drugs may be developed to block it or reduce the gene’s expression.

Physical Conditions

Chronic disease conditions can trigger depression, and depression may cause other debilitating conditions, slow recovery and lead to early death. People with chronic or acute diseases and depression show increased use of healthcare resources, including more physician visits, medication use, absenteeism from work and poor productivity.

• Stroke – depression develops in as many as a third of people who have had a stroke. Recovery from stroke is slowed as patient’s show functional deficits including bathing, getting dressed, eating and other tasks. Those who develop depression after a stroke are more likely to become dependent.
• Diabetes – the relationship between diabetes may work both ways as depression may cause diabetes and vice versa. Patients with both ailments face twice the risk of early death.
• Menopause – transitioning into the menopausal phase in life for women is known to be a high-risk period for major depression.
• Alzheimers – several studies have shown that having depression doubles the risk for developing dementia.
• Skin Conditions – the emotional strain of having a skin condition like psoriasis has adverse effects on mental health, initiating major depression and even suicide.
• Heart Disease – having depression and heart disease is a lethal combination. Depressed patients are more likely to develop heart conditions, and are five times more likely to die early.
• Postpartum – parents of either gender can develop depression after the birth of a child and women who have difficulties breastfeeding, or have urinary incontinence are more likely to develop depression. Parents who had an episode of postpartum depression also are more likely to have depressed children.

Contributing Causes

• Excess Body Weight – the overweight and obese are more likely to be depressed and losing weight can improve depressive symptoms. Also, treating depression may help increase a patient’s physical activity and help them lose weight.
• Cigarette Smokers – those with depression are not as able to quit smoking as much as non-depressed people. One in five depressed people quit smoking, whereas one in three non-depressed people succeed in abstaining from cigarettes.
• Body Dysmorphia – those with eating disorders, people undergoing plastic surgery and others with appearance dissatisfaction may have mental health problems. Anyone with a body tends to measure themselves against others, and a perceived low ranking may trigger depression.
• Internet Use – unreasonable use of the Internet is now identified as an addiction with psychiatric problems including relationship problems, aggressive behavior and poor physical health.
• Calorie Restriction – life longevity is increased when humans eat less than normal. However, some studies show calorie restriction can negatively affect mood.
• Bullying – victims of bullying, including children and adults, have elevated risk for depression and substance abuse in the short-term and long-term.
• Sexual Minority – orientation according to sexual preferences and preferences in intimate relationships can invite discrimination and victimization and lead to depression and suicide.
• Work – psychosocial job characteristics can trigger depression. Low ranking workers and workers in high risk jobs have higher rates of depression. 11% of firefighters are depressed which is higher than average.
• Temperments – certain personality traits and types may be more susceptible to affective disorders like depression.
• Perceived Powerlessness – perceptions of powerlessness or a lack of control over one’s environment may amplify depression.
• Unfullfilled Expectations – symptoms of depression may develop over the lifespan due to perceived inadequacies in educational attainment, employment, marriage, and parenthood.
• Circadian Preferences – professed “night persons” show more stress, depression, anxiety and substance abuse than “morning people.”
• Grief – loss of a partner is a main contributing factor to depression and this is true whether the loss is due to a breakup, divorce or death.
• Caregiving – emotional well-being is compromised in people who have to care for another due to physical or mental illness. In some cases, the stress may cause the caregiver to actually die before the person they are taking care of.
• Disasters – post disaster grief is common as people lose loved ones, property and experience powerlessness.
• Abuse – childhood abuse and abuse as an adult including physical violence, emotional abuse and neglect can trigger depression immediately or long after the events. The abuse negatively dominates expectations for the future.
• Night Eating – people with insomnia who get up and eat nocturnally have a high incidence of depression.
• Substance Abuse – depression may lead to substance abuse and/or struggles with street drugs, prescription drugs and alcohol. One study found that women with depression were four times more likely to use crack cocaine. Substance abuse and lack of success in quitting may lead to hopelessness and depression.

Gender Differences

While women have a higher reported incidence of depression, males are more likely to use alcohol indicating sex differences in responding to stress. The effect of mother’s depression is well known, but new studies regarding depressed men report significant differences in the way depressed men interact with their children. Depressed men are reported to spank their children more and read books to them less.

Socioeconomic Differences

The highest risk of depression is found in lowest income groups. The three psychopathologies of depression, suicidal ideation and suicidal attempt is more highly concentrated in low ranking socio-economic groups. Studies suggest that this risk is increasing over the past ten years, especially following recent economic crisis. Suicide especially is rising due to widening income inequalities.

Intercultural Differences

Depression incidence is found in all countries and is especially correlated with being separated, divorced or widowed. Depression is found in greater incidence in high income countries, suggesting that income disparities maybe contribute to depression. High income countries have a certain percentage of people with high income, but with a significant portion of people being less advantaged. Median income countries have a lower incidence of depression, suggesting that income equality prevents depression to a certain extent. Very high income countries like France, the Netherlands, and America have the highest rates with over 30%. China has the lowest incidence at 12%.

Age Differences

• Elderly – personality types play a role in the development of depression in later life. Researchers believe that some personality types may be more resistant to stress. Elderly patients may not complain as much about low mood, but rather express dissatisfaction in complaints about physical issues.
• Children – tempermental differences can also be found in children as they respond to deficient parenting. Children low in fear respond to parental negativity with more depression. However, children low in control respond to poor autonomy granting and guidance by the parent by developing more depression and anxiety.
• Adolescents – the neuroendocrine response to stress is altered in adolescents as they cope with their history of physical, sexual or emotional abuse in childhood. The stress hormone cortisol is elevated in adolescents who were maltreated. They have pessimistic thoughts and think of death and self-harm.

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Military & Veterans

Clusters of symptoms indicating post-traumatic stress disorder and depression is widely found in veterans of war and military service. These people re-experience trauma and react by avoidance, detachment, and numbing behaviors. Hopelessness and bodily disturbance symptoms are pervasive. Female veterans are more likely to seek treatment while African-Americans are more likely to seek religious counseling.

Depression Diagnosis

Treatment outcomes are better when depression is diagnosed in a timely fashion. While symptoms regarding mood are the most prominent method to diagnose depression, physical symptoms, especially in the young and old, may help find depression earlier. Declines in performance, difficulties in the tasks of daily living activities, verbal aggression, urinary incontinence, pain, and weight loss are significant clues as well.

Studies have indicated that health professionals are inadequately trained to spot mental health problems. One study found that nurses correctly identified depression only one quarter to one half of the time. This finding is also found in student health centers where one in four or five students have depressive symptoms that routinely go undiagnosed.

Screening

Researchers say that screening is simple, easy to do, and can save lives. People often have experienced a recent loss, trauma or other stressor. A family history of depression is easy to screen for as well as medical illnesses which are known to cause depression.

Biomarkers

In addition to mood reports and behavior changes, tests of the chemical systems in the brain may more adequately diagnose depression. Analysis of blood and saliva samples can discover inflammation and cortisol deficiencies. Scientists are working to develop more physical tests which can lead to early diagnosis, better treatments and improved outcomes.

Symptoms

Other symptoms indicating depression:

• Avoidance of other people
• Avoidance of activities
• Feeling tired often
• Difficulty sleeping
• Poor appetite regulation; losing or gain weight
• Sexual dysfunction
• Poor concentration
• Restlessness
• Difficulty making decisions
• Suicidal thoughts

Classification

Psychiatrists approach diagnosis with varying perspectives but generally use the Diagnostic and Statistical Manual (DSM) and the International Classification of Disease (ICD).

Primary Depression – not caused by any other medical or psychological cause.
Secondary Depression – caused by a medical condition or occurring with psychiatric illness.

Differentiating Diagnosis

Further differentiation includes separating mania, anxiety and psychosis (hallucinations and delusions). Some psychiatrists may further qualify depression due to hereditary factors or whether the depression was caused by a stressful life event. Many times a diagnosis of “mixed” depression is given when several factors are present.

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Depression Treatment

Antidepressant Medication

Antidepressants that influence the serotonin (5-HT) system in the brain such as the selective serotonin reuptake inhibitors (SSRIs) are most commonly prescribed for depression. When symptoms are mixed, physicians may prescribe antidepressants and antipsychotic medication together. If anxiety is present, the type of antidepressant prescribed may differ. Symptoms of mania must be discovered as well, as antidepressant medication is not at all indicated for bipolar disorder.

Antidepressant medication acts to correct the ‘low’ mood by manipulating the uptake of the neurotransmitter serotonin. They do not produce a “high” feeling, change personality and are not addictive. Taking medication regularly for the prescribed time period should show improvement in two to four weeks. The World Health Organization suggests taking medication for six months to prevent a recurrence of the illness. Some people may have to take medication for a long time. Gradually reducing the dose rather than stopping abruptly is recommended. Discussing stopping your treatment with your doctor is the best course.

Classes of antidepressants include new drugs that have fewer side effects than older drugs:

• Noradrenaline re-uptake inhibitors (NARIs)
• Noradrenergic and specific serotonergic antidepressants (NaSSAs)
• Reversible inhibitors of monoamine oxidase type A (RIMAs)
• Serotonin noradrenaline re-uptake inhibitors (SNRIs)
• Lithium
• Monoamine oxidase inhibitors (MOAIs)
• Selective serotonin re-uptake inhibitors (SSRIs)
• Tricyclic antidepressants (TCAs)

Non-Steroidal Anti-Inflammatory Medicines (NSAIDs)

Because the latest research shows that inflammation in the brain may be the first step in a cascade of negative physiological events, including deficits in serotonin, noradrenaline and cortisol, anti-inflammatory medications will likely see an increase in use.

Leptin Treatment

Leptin replacement with injections of recombinant-methionyl-human leptin may also stop the inflammation in the brain that leads to serotonin and other hormone deficiencies. Natural therapies to increase leptin include getting proper sleep and eating anti-inflammatory foods.

Barriers to Treatment

As many as 40 percent of patients do not respond to medication. Stopping medications or taking medication inappropriately may reduce positive outcomes and cause a return of the symptoms of depression. Follow-up with the physician is important as the dosage may need adjustment or a different medication may need to be prescribed. Hospitalization may be required and people are highly encouraged to seek help, especially with suicidal thoughts.

Sociodynamic Therapies

• Psychotherapy – Talking to a trained counselor, along with medication improves the faulty inferences and negative thoughts that depressed people commonly have. The counselor will help to sort out work and family issues, grieving and loss, and previous health or emotional problems. There are many different kinds of psychotherapy and different kinds of counselors and professionals including cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT) and dynamic psychotherapy or psychoanalysis. Patients are encouraged to persist in finding someone to talk to, that they feel comfortable with. If one counselor does not suit, finding another is recommended. One form of therapy is not better than another but rather depends on the personalities of the therapist and patient meshing together.

• Family Approach – as depression has a hereditary basis, and stresses often happen within families, an intervention with family members can be very helpful. When one partner in an intimate relationship has depression, bringing the other part of the duo into the therapeutic relationship can increase positive outcomes.

• Social Buffering – loss of relationships is a very common trigger for depression onset. Therefore, seeking relationships and friendships can provide a positive buffering effect for symptoms. Support from family members, co-workers, religious counselors and informal networks are natural helpers to meet life satisfaction goals, especially in major depression.

Electroconvulsive therapy (ECT)

Patients with severe depression may elect to undergo electroconvulsive therapy (ECT) because it may work faster than medication. A small electric current is passed through the brain while the patient is sedated. ECT is only administered with an anesthesiologist, a psychiatrist and nursing staff. 6 to 10 treatments are commonly prescribed although benefits may be seen with one or two treatments.

Natural Remedies

• Exercise – produces a natural lift in mood, offers improvement in self- esteem and increases a sense of mastery and self-control. Any type of body treatment, including balance exercise and massage reduces tension, fatigue and anxiety.
• Nutrition – fish oil and other anti-inflammatory foods like berries, grains, legumes and green vegetables may significantly reduce depressive symptoms by reducing brain inflammation that leads to hormone insufficiencies.
• Sleep – hormone replenishment happens oftentimes at night. When sleep is disrupted, people often have depressive symptoms.
• Homeopathy – St. Johns Wort, and zinc supplements have been shown to have some effect in treating depression.

Emerging Possibiliities

Online Care

Patients had a major reduction in symptoms when a psychiatric nurse managed their care online. Messaging online delivered follow-up care without the wasted time required in trying to reach patients by telephone. Patients reported being very satisfied with asynchronous communication, took their medications more appropriately and had significant reduction in depressive symptoms.

Autogenic Training (AT)

A mind body technique which promotes relaxation has been found to improve insomnia, depression and anxiety. These body awareness exercises mediate the stress response and help release suppressed emotions. Participants in an eight week program showed significant improvements in depression scores.

Freshwater Snakehead Fish

Channa striatus, a Malaysian fish, has an antidepressant-like effect. The pharmacological effect of the fish is not well understood, so more studies are underway.

Positivity Activity Interventions (PAI)

PAIs are activities like counting one’s blessing, performing kind acts for others and practicing optimism. This new approach has no side effects, costs little and is not time-consuming. Researchers say that even brief positive activities can set off long-lasting improvements in mood.

Information Technology

Early diagnosis of depression is important as depression may cause debilitating and long-term medical issues like diabetes and hypertension. Modern statistical techniques with computers are increasingly being used to collect data and reveal patterns otherwise unnoticed. These data mining techniques can give new insights and customized approaches to physicians and patients.

Related Conditions

Dysthymia – chronic mild depression distinguished by severity, number of symptoms, and the duration of symptoms. Dysthymia is diagnosed when symptoms do not rise to the level of a major depressive illness, but do have depressive symptoms for at least two years, with depression cycling a few days at a time. Full blown depression may develop and people should consider medication and psychotherapy.

Bipolar Disorder – this illness is characterized by mostly depressive symptoms and occasional or rapid cycling of manic episodes. Manic episodes are periods of elevated or “high” mood. Patients may behave irresponsibly, and engage in risky behaviors like gambling or promiscuity when in a manic phase. Many bipolar cases are misdiagnosed as depression because physicians fail to ask about moods that are opposite to depression. Treatment for bipolar does not include anti-depressant medication but instead anti-psychotic medications or hypnotic drugs.

Seasonal Affective Disorder (SAD) – a low mood in response to the onset of fall and winter seasons. Decreased sunlight is considered the main cause of this disorder, however decreased activities and social contacts in winter may also contribute to this transient depression. Sometimes, the holiday seasons in fall and winter may remind people of former losses they have experienced or lack of social support around the holidays. Antidepressants may help, along with counseling. Light therapy, or the use of a special lamp to approximate sunlight may help some cope.

Fatigue – a feeling of persistent tiredness may be confused with depression. Often, fatigue is due to physical or medical problems like infections, anemia, cancer and diabetes. Lack of exercise, diminishing muscle tone and poor diet can contribute to fatigue. Poor sleep and sleep apnea may produce a feeling of constant tiredness.

Dementia – confusion, poor memory and concentration difficulties may not be symptoms of depression, but rather cognitive deficits. Symptoms of dementia develop slowly over the years and the early stages of the disease may look a lot like depression.

Hypothyroidism – deficiencies in the hormones thyroxine (T4) and tri-iodothyronine (T3) secreted by the thyroid gland act to decrease metabolism. Lethargy and depression may result and is often misdiagnosed as primary depression. Blood tests should be ordered to rule out this disorder when depression is suspected.

Anxiety Disorder – persistent worrying or fearing, agitation, dread, irritability, racing heart, fast breathing and sweating are symptoms of anxiety. Anxious people may or may not be depressed as well.

Post-Traumatic Stress Disorder – people who have experienced or witnessed military combat, serious accidents, the violent death of others, torture, rape, or other crime can develop serious psychological problems. This disorder is distinguished from depression in that a triggering event is clearly evident.

Social Phobia – some individuals have trouble and anxiety related to socializing with others. They have irrational fears that everyone is looking at them and judging their performance. In response, they avoid social situations and fear those situations that they must engage in.

Conclusion

The main trigger for depression is loss of a relationship. When people lose friends, parents, grandparents, experience a romantic breakup, or become separated and divorced they can descend into sadness that cannot recover from by themselves. A loss of any kind, including job loss, having to drop out of school, an illness in loved one, or a loss of health in oneself can trigger a depressive episode. Changes in relationships, status or ranking also produce losses in a person’s sense of the future.

These losses induce changes in the way a person thinks. People perseverate or consistently reproduce negative thoughts that they play over and over again in their mind, like a broken record player. Their cognitive strategy becomes fixed and they find it difficult to break free. Their thoughts lead to maladaptive coping measures which cause further problems. They may withdraw from the people and activities which may be precisely the positive counteragents that they need. Relationships can become very strained as a depressed person shows decreased interest and misinterprets other’s emotions.

Pharmacological treatment to increase positive hormones, and psychological counseling can act to stop this downward spiral. Early diagnosis is important as chronic depression can cause serious medical problems, and many people end their lives with suicide. Prevention consists of forming strong social support to balance loss that everyone experiences in life. Natural prevention includes regular exercise, adequate nutrition and good sleep habits.

Depressive disorder is expected to become the leading cause of disability. Some social scientists believe that this epidemic is due to individualism or the lack of emphasis on group living. Humans are predominately social creatures, highly dependent on interactions with others. Lack of contact with others, superficial relationships, internet use, and disparity in socioeconomic status may explain the increasing incidence of depression.

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