Women suddenly thrust into "surgical menopause" by hysterectomy don't have more severe mood symptoms than women going through gradual, natural menopause, a new study suggests.

Researchers who followed nearly 2,000 middle-aged women for 10 years found that those who had hysterectomies, with or without ovary removal, were as likely as women who went through natural menopause to experience depression or anxiety -- and for all women, those symptoms declined steadily within a few years.

"At least among women in midlife... mood symptoms don't seem to be a worry to take into consideration when making treatment decisions around hysterectomy and oophorectomy," said the study's lead author Carolyn Gibson, a researcher in the Department of Psychology at the University of Pittsburgh.

Although past studies have shown a link between hysterectomy and risk for depression, Gibson and her fellow researchers say it's still hard to tell whether the procedure is to blame. Also unknown is whether the symptoms of surgically-induced menopause are any different from those of women who go through menopause naturally.

Gibson told Reuters Health the topic is important, because hysterectomies are very common. About 600,000 women in the United States have their uterus removed during a hysterectomy every year, according to the U.S. Centers for Disease Control and Prevention.

The researchers say between 55 percent and 80 percent of women who undergo hysterectomy also have their ovaries removed -- a procedure known as oophorectomy. Because a woman's ovaries generate estrogen, removing them induces menopause almost immediately.

Whether natural or induced, the change in a woman's hormone levels leading up to menopause, and in the years immediately afterward, often contributes to a range of symptoms, from anxiety and depression to insomnia and hot flashes.

To see whether a quick transition to menopause through surgery changes women's experience of the associated symptoms, Gibson's team turned to a database containing information on women's progression to, and through, the process. They tracked about 2,000 women who were between 42 and 52 years old in 1996 and 1997, and were followed for more than ten years.

Over that period, 1,793 of the women went through menopause naturally, 76 had an elective hysterectomy and 101 had an elective hysterectomy and their ovaries removed. All of the women were premenopausal at the beginning of the study and scored about the same on a scale that measures depression.

That scale goes from zero to 60 and, with higher scores representing more severe depression. A person with a score below 16 is not considered to be depressed. For all three groups of women, depression scores decreased from the time they entered menopause to the end of the study period, and at about the same rates.

For those going through natural menopause, scores fell from 8.6 to 7.8. Those who had a hysterectomy saw their scores fall from 9.37 to 9.08, those who also had their ovaries removed went from 10.96 to 8.91.

Overall, the study shows depression symptoms in women who had a hysterectomy "declining in a very similar way as women who had a natural menopause," said Ellen Freeman, a research professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine.

Freeman, who was not involved with the new study, told Reuters Health that it's important to know that the new study does not mean women will not be depressed after menopause -- just that the symptoms do decrease, and at about the same rate among women in each group.

Gibson and her colleagues write in the journal Obstetrics & Gynecology that this suggests symptoms of depression and anxiety improve as women enter their postmenopausal years. The authors note, however, that the results may not be applicable to the general population, such as those with a history of mood disorders.

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Researchers have found that single mothers and those with symptoms of depression are more likely to add cereal to bottles while feeding their babies, which may increase their children's risk of obesity. The researchers say efforts to prevent obesity among low-income infants should focus not only on what babies are being fed but also the reasons behind unhealthy feeding practices.

Adding cereal to bottles is one unhealthy practice that is discouraged by the American Academy of Pediatrics because it may lead to overfeeding and excess weight gain in infants. The researchers sought to determine factors associated with putting cereal in bottles among low-income, primarily Latino households in which the risk for child obesity is high.

Mothers of 254 infants were asked if they ever added cereal to bottles to help their babies sleep longer or stay full longer. The researchers also collected information on mothers' age, language, country of origin, marital status, education and income; whether the mother had symptoms of depression; and infants' age, gender and whether the infant was felt to have strong emotional reactions (a high intensity temperament).

The data were collected as part of the larger Bellevue Project for Early Language, Literacy and Education Success (BELLE Project). Funded by the National Institutes of Health/National Institute of Child Health and Human Development, the BELLE Project is following infants from birth to first grade to study issues related to parenting and child development.

Results showed that 24 percent of mothers put cereal in bottles. Those with depressive symptoms were 15 times more likely to add cereal than mothers who did not have symptoms of depression.

"Depression is very common in low-income mothers and makes it more difficult to engage in beneficial parenting practices in general," said lead author and general academic pediatrics fellow Candice Taylor Lucas, MD, MPH, who also is the Alan Mendelsohn, MD, principal investigator and associate professor of pediatrics, New York University School of Medicine and Bellevue Hospital Center.

"Our results are especially concerning because they suggest that depressed mothers may be more likely to add cereal to the bottle, which may increase their children's risk of obesity."Data also showed that mothers who were single were significantly more likely to add cereal to bottles.

"This suggests that mothers' support systems and family dynamics may influence feeding practices," said obesity researcher and fellow investigator Mary Jo Messito, MD, FAAP. Mothers who felt that their children had intense emotional reactions to daily routines were 12 times more likely to add cereal to bottles.

"Overall, these findings demonstrate that stressors prevalent in low-income households, such as depression, single parenthood and associated infant behavioral challenges, influence feeding practices likely to promote obesity," Dr. Lucas said.

"It is important to provide support for parents related to healthy feeding practices if we are to end the epidemic of childhood obesity," it concluded. The finding is being presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

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Eating too much junk food may increase risk for depression, a large study suggests.  In a cohort study of almost 9000 adults in Spain, those who consistently consumed "fast food," such as hamburgers and pizza, were 40% more likely to develop depression than the participants who consumed little to none of these types of food. In addition, investigators found that the depression risk rose steadily as more fast food was consumed.

Participants who often ate commercial baked goods, such as croissants and doughnuts, were also at significant risk of developing this disorder. "We were not surprised with the results. Several studies have analyzed the association between fast food and commercial bakery consumption and physical diseases, such as obesity or coronary heart disease," Almudena Sánchez-Villegas, PhD, from the Department of Clinical Sciences at the University of Las Palmas de Gran Canaria and the Department of Preventive Medicine and Public Health at the University of Navarra in Pamplona, Spain, told Medscape Medical News.

"With these results, a relatively new line of research is open. Limiting trans fatty acids content in several foods, avoiding the consumption of fast food and bakery, and increasing the consumption of other products such as vegetables, legumes, and fruits should be a primary goal for clinicians and public health makers," she added.

Croissants, Doughnuts, and Muffins, Oh My! According to the investigators, depression affects around 121 million people throughout the world.

Although "little is known about the role of diet in the development of depressive disorders," past studies have suggested that olive oil, B vitamins, and omega-3 fatty acids may play a preventative role, write the researchers.

As reported by Medscape Medical News, Dr. Sánchez-Villegas and colleagues published a study last year in PLoS One that linked consumption of trans unsaturated fatty acids (TFA) to a significantly increased risk for depression.

For the current study, they sought to specifically examine the role that consumption of fast food and processed food may play in the development of this disorder.

The researchers examined data on 8964 adults from the Seguimiento Universidad de Navarra (SUN) Project, an ongoing diet and lifestyle tracking study that started in 1999. None of the SUN participants had been diagnosed with depression or had taken antidepressants before the start of the study.

Exposures and outcomes were gathered through surveys mailed out biennially to the participants. A food frequency questionnaire was used to assess dietary intake. Fast food consumption was defined as total consumption of hamburgers, pizza, and hot dogs/sausages. Commercial baked goods consumption was defined as total consumption of croissants, doughnuts, and muffins.

Incident depression and/or self-reported physician-made diagnosis of depression, antidepressant use, and demographic and lifestyle data were recorded on other questionnaires.

Curb the Junk Food
Results showed that 493 of the participants were diagnosed with depression after a median follow-up of 6.2 years. Those who were found to have the highest levels of consumption of fast food showed a significantly higher risk of developing depression compared with those who had the lowest levels of consumption (adjusted hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.05 - 1.86; P = .01).

"Moreover, a significant dose-response relationship was found (P for trend = .001)," report the researchers. However, the researchers note that even small quantities of fast food were linked to a significantly higher risk for depression.

Participants who often consumed commercial baked goods were also at increased risk of developing this disorder (adjusted HR, 1.43; 95% CI, 1.06 - 1.93). The investigators also found that the study participants with the highest consumption of fast food and of commercial baked goods were more likely to be single, less active, smoke, work more than 45 hours per week, and eat less fruits, vegetables, nuts, fish, and/or olive oil.

"Although more studies are necessary, the intake of this type of food should be controlled because of its implications on both health (obesity, cardiovascular disease) and mental well-being," said Dr. Sánchez-Villegas. The researchers add that the legally permitted content of TFA in these foods "should be reviewed."

Dietary Assessment "Prudent"
"This Spanish team conducted very good, quality research and took considerable care to consider multiple possible causes of confounding, such as other factors that may explain both dietary habits and risk for depression," Felice Jacka, PhD, research fellow at Deakin University in Melbourne, Australia, told Medscape Medical News.

"For example, they take into account many variables that may be proxies of health consciousness or overall health lifestyle, such as the use of seat belts, frequency of medical and dental checkups, and drunk driving, as well as marital status, smoking, alcohol consumption, and intake of nutrient-dense foods. The study sample is also large and well described, and the prospective cohort design affords the potential for investigating cause-effect relationships," she added.

Dr. Jacka noted that the results support a previous study that she and her colleagues published recently in the American Journal of Psychiatry, which showed that women who consumed a diet higher in unhealthy and processed food were likely to be depressed. In a study published in the Australian and New Zealand Journal of Psychiatry, they reported the same results in a cohort of adolescents.

The results of the current study "are also concordant with the two prospective studies in this field, in both adults and adolescents, reporting that unhealthy diets are associated with an increased risk for mental health problems over time," she reported.

She added that although this study was rigorously conducted and is methodologically sound, "it is perhaps a shame that [it] does not have data on diagnoses of depression ascertained via clinical assessments. However, this is rare in large epidemiological studies, and the measures they have used have been shown to be valid."

Dr. Jacka noted that because diet and mental health research is relatively new, it is often uncommon for clinicians to consider diet as an intervention target in clinical care. "However, this study adds to the rapidly growing and highly consistent body of literature suggesting that depression is another common, noncommunicable illness with a significant lifestyle component," she said.

"As such, it is prudent for clinicians to assess and address the dietary as well as exercise habits of their patients, in addition to pharmacological and other established treatments."The study was supported by the Spanish Government Instituto de Salud Carlos III, Fondo de Investigaticiones Sanitarias, and the Navarra Regional Government. The study authors and Dr. Jacka have disclosed no relevant financial relationships.

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Depression is a mood disorder (mood) that cause children and adolescents to feel sad or irritable to be a long time. A young person who is depressed, no longer enjoys school, and play with friends and may be lacking in energy or have other symptoms. As adults, symptoms range from mild depression to severe and one person to another. Depression can last a long time and may have a cyclic evolution, with periods of illness followed by periods without symptoms. Chronic depression, dysthymia and mild form called, occurs when a child feels defeated most of the time period of one year or more. Both the mild form and severe form of depression can be treated with efficiency.

Until recently it was believed that only adults suffer from depression, while children and teens do not. We now know that even young children can have serious forms of depression that require treatment for healing. However, symptoms of depression in children and adolescents are difficult to recognize. Symptoms range from abdominal pain and boredom can be confused with symptoms of other diseases. Many children and teenagers with depression do not receive proper treatment for the symptoms is not known. Variations of mood and emotional changes caused by depression can go unnoticed, considered unimportant or assigned normal growth.

Children and adolescents with depression and other disorders and often have anxiety, hyperexcitability similar behavior (hyperactivity) with attention deficit disorder, eating disorders and the serious process of learning and behavior problems (disorderly conduct). These symptoms may occur before being diagnosed with depression in children.

In the past, consider that depression is "all in the mind" and that a depressed person is able to recover by itself. Today we know that depression is an illness that requires treatment and is not a flaw or weakness. Childhood and adolescence can be difficult for children with depression and family members, especially when the disease is not treated. If untreated, severe depression may last a year or more. Severe or prolonged depression can cause problems such as difficulty in making friends with others and maintaining friendships, difficulties in school, drug abuse, suicidal behavior and other problems that may extend into adulthood. Have turned to professional help if your parents found this behavior in childhood depression.

Causes
Depression is considered to be an imbalance of certain chemicals called neurotransmitters that transmit messages between brain nerve cells. Some of these chemicals, like serotonin helps regulate mood. If these chemicals that regulate mood, cause imbalance in the brain nerve cells, resulting depression or other mood disorders. Experts do not currently have set up the neurotransmitter imbalance that occurs. They believe that this change can occur as a consequence of stress or disease, but it can occur without clear cause.

Risk Factors
Depression in family members: children and adolescents who have a parent with depression are three times higher risk of depression than do those whose parents do not have depression. Experts believe that both inherited family traits (genetic) and living with a parent who has depression may increase risk to the child's depression.
Depression in children and adolescents may be due to stress, unresolved social problems and family conflicts. It may also be associated with trauma such as violence, abuse or neglect.
Children and adolescents who have serious medical conditions prolonged learning problems or behavior problems may be more easily depressed.
Some medications can trigger depression, such as steroids or narcotics for pain relief administered. Once the drugs are discontinued, symptoms usually disappear.

Factors that increase risk of depression in young
Several factors increase the risk of depression in young people:
- If a parent or an immediate family member has depression: it is the most important risk factor for depression (children or adolescents who have a parent with depression are three times more likely to be depressed)
- If they had a depressive episode, especially if the first depressive episode occurred at a young age
- If you have chronic medical conditions such as diabetes or epilepsy
- The presence of other psychiatric disorders, such as disorderly conduct or anxiety (anxiety, fear)
- Death of a family member or close friend
- Physical or sexual abuse
- Abuse of alcohol or drugs.
Other risk factors and situations that lead to depression are:
- Girls in early puberty (girls and boys before puberty have the same risk for depression but after puberty and adulthood, women are 2 times more prone to depression than men do)
- Domestic violence
- Lack of social relations with persons of the same age
- The victim of aggression or aggression.

Symptoms
Depression in childhood or adolescence is to develop gradually or suddenly. The child may seem irritable rather than sad or feeling tired or hopeless. Entourage child in the child with apparent slowness in movements depression, insomnia or agitation. The child may be self-critical or have a feeling that others are too critical of him.

The symptoms of depression are often subtle at first. At this stage it is difficult symptoms associated with depression and it's hard to believe that it is depression in children.

Children with depression may have these symptoms:
- Irritability
- Violent temper
- Unexplained pain such as headaches or stomach
- Difficulty in thinking and decision making
- Drowsiness sauinsomnie
- Changes in eating habits that can lead to growth, absence of weight loss or weight gain, expected to increase child
- Loss of self-esteem (low self confidence)
- Feelings of guilt or hopelessness
- Lack of energy or constant fatigue
- Withdrawal from social life, such as lack of interest in friends
- The thought of death and suicidal thoughts.

Untreated depression can lead to suicide. Carefully for signs of suicide change with age. Signs of attention to child and adolescent suicide include preoccupation with death or suicide or the recent termination of the relations of friendship.

Many children with depression have symptoms of anxiety (anxiety) such as permanent and unfounded concerns and fears of separation from a parent. Sometimes these symptoms appear before depression is diagnosed.

Other less common symptoms can occur in children with severe depression and hearing voices that are not there (auditory hallucinations) or blind belief in a false idea (illusion, anger). Hallucinations are common in childhood, while delusions are more common in adolescence.

Differentiate between various normal mood and symptoms of depression is often difficult. Occasional feelings of sadness or irritability are normal. They allow the child to understand the grief and cope with obstacles in life. For example, deep sorrow (heavy loss) is a normal response to a loss such as death of family pet, the loss of a friend or divorce of parents. After a tough loss, the child may stay sad for a long time. However, if these emotions do not disappear after a while and begin to interfere with the private life of the young child can develop symptoms of mood disorder like depression or dysthymic disorder (depression during long nonsevere) requiring treatment.

Approximately 15% of children and adolescents diagnosed with depression develop bipolar disorder (this contradictory symptoms: alternating between depression and mood exaggerated). Children and adolescents with bipolar disorder have extreme events which alternates between bouts of manic depression (children are energetic, restless or irritable). The common symptoms of depression may be common to other diseases.

It is sometimes difficult to differentiate bipolar disorder from depression. It is common for a child diagnosed with bipolar disorder to be diagnosed with depression for the first time that after his first manic episode is diagnosed with bipolar disorder. Although depression is part of bipolar disorder, they require different treatment from that of depression. Like depression, bipolar disorder may be familial, hence the need to inform the family doctor about a family that there are other cases of bipolar disorders .

Patofisiologiese meganisme
Depression in childhood and adolescence may be manifested first by irritability, sadness by crying or sudden unexplained. Children may lose interest in activities that they once used to enjoy, can not feel loved or they may feel hopeless. They may have problems at school, may become careless or rude.
Often children may have depression and other disorders associated with depression and other manifestations of anxiety (anxiety), behavioral disorders similar to hyperexcitability (hyperactivity) with attention deficit disorder, eating disorders and the process of learning, and serious behavior problems (conduct disordered). These disorders can occur before a young person to become depressed. Some children with depression develop serious behavior problems (disorderly conduct), usually after they became depressed. If your child has this disorder should be instituted when necessary treatment for depression.

The child or teen with depression is more prone to drug abuse, alcohol, smoking than those who do not have depression. About 30% of young people with depression will have problems with alcohol or drugs. They are much more difficult to treat depression, increase the treatment time required to become efficient and increase the risk of suicide. An early diagnosis and treatment accompanied by good communication with your child can help prevent substance abuse.

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“Going for a brisk stroll could play an important role in fighting depression,” BBC News has reported. Current evidence suggests that physical activity can be useful for reducing the symptoms of depression, but previous examinations of research have not specifically looked at the benefits of walking for depression. In order to improve our understanding of the issue, Scottish researchers conducted a systematic search for all relevant medical trials on the subject, combining their results into a single analysis.

The researchers found eight relevant studies featuring a total of 341 people. Overall, the combined results of these trials suggested that walking reduced the symptoms of depression. However, the trials were small, and they varied in the types of people they included, the walking programmes they used and what they compared walking to. This limits the strength of the conclusions that can be drawn about the effects of walking in specific groups of people with depression.

However, this is not the first research to have suggested that physical activity is beneficial for depressive symptoms. The National Institute for Health and Clinical Excellence (NICE) currently recommends considering structured group physical activity programmes as a treatment option for some forms of depression.

As the authors of the review note, walking is a form of physical activity that most people can take part in safely and at minimal cost. More research is now needed to determine exactly what duration and frequency of walking is most effective for depressive symptoms.

Where did the story come from?
The study was carried out by researchers from the Universities of Stirling and Edinburgh. Sources of funding were not reported. The study was published in the peer-reviewed journal Mental Health and Physical Activity. The study was reported appropriately by the BBC.

What kind of research was this?
Physical activity has been found to reduce depressive symptoms, but the researchers behind this study say that it is not known whether walking specifically has the same effect. They say, however, that walking can be easily undertaken by most people, fits into our daily schedules, is low-cost and comes with little risk of adverse effects. The researchers set out to conduct a systematic review of the evidence on the effects of walking on depression. They also set out to perform a meta-analysis, which is a pooling of the results of the individual studies.

A systematic review is the best way to summarise all of the existing research on the question of interest, as, during a systematic review, researchers should rigorously search for and analyse all relevant high-quality studies available on a subject. Systematic reviews include relevant studies regardless of their results, rather than just focusing on those that support or contradict a particular theory. The results of the studies in a systematic review may be statistically pooled if the studies are similar enough in method to produce meaningful results. Pooling very different types of studies (for example those with very different study populations) will produce results that don’t improve the researchers’ understanding of the effect of an intervention.

What did the research involve?
The researchers searched 11 literature databases to identify randomised controlled trials of walking as a treatment for depression. They then statistically pooled the results of eligible studies to assess whether walking reduced depressive symptoms compared with a control treatment that did not involve walking.

The researchers included any studies in adults with any form of depression, excluding those in which depression was being examined as part of bipolar disorder or where all the participants were recruited because they had a specific medical condition, such as cancer. Studies of any kind of structured or semi-structured walking programmes were included. Studies where other types of exercise were also part of the activity programme were excluded. Stretching to warm up or cool down before walking was permitted. The comparison group in eligible trials could be those receiving no treatment, usual depression care or a treatment that was also given to the walking group (for example, cognitive behavioural therapy). Depressive symptoms could be assessed using any symptom scale.

Information on the study characteristics and results was extracted from eligible studies, and the quality of the trials was assessed. Results were pooled using standard methods. The researchers looked at the effect of walking overall, and also at indoor and outdoor walking and group walking specifically.

What were the basic results?
The researchers identified seven trials that fully matched their inclusion criteria. They also included an additional trial that included people who either had moderate depression or who had a high body mass index (BMI). They did this as the trial was relatively large, and included a considerable number of people with depression. The trials were generally quite small, with between 11 and 127 people in each trial. The trials included 341 people in total. They varied in their quality, with only one trial reporting on, and meeting, all four of the quality indicators used by the reviewers.

There was a lot of variability between these trials, including differences in the types of people that were recruited, the settings in which they were treated, how severe their depression was and how it was diagnosed. The trials also varied in the types of walking programmes they used: whether they were supervised; indoor (for example, on a treadmill) or outdoor; whether they were group walks; and the duration and frequency of the walks performed. The walks ranged from 20 to 50 minutes, and the programmes lasted up to six months. The control groups were assigned therapies including usual care, stretching and relaxation exercises, social contact or other kinds of support (talking to a researcher or a support group).

Pooling the results of these studies showed that, overall, walking did significantly reduce depressive symptoms. There was a high level of variability across the results of the studies, however, with one finding a better outcome with the control treatment, one finding no significant benefit of walking, and the other studies finding varying levels of benefit. The researchers then conducted a further two separate analyses – one including only the four best trials and one excluding the study that had recruited people with high BMIs. Both of these still found that walking significantly reduced depressive symptoms.

The researchers also found that walking had a significant effect in trials of indoor walking, outdoor walking and group walking if these were looked at separately. The researchers noted that the variability in the designs of these studies meant that the pooled results may not be directly applicable to specific groups of people.

How did the researchers interpret the results?
The researchers concluded that walking significantly reduced the symptoms of depression in some populations. However, they say that there are limitations to the existing studies and suggest that further research is needed to determine exactly what type of walking programmes (frequency, intensity, duration) would be best for people with depression being treated in primary care, such as by a GP.

Conclusion
Physical activity is already thought to have a beneficial effect on depressive symptoms, and the UK’s National Institute for Health and Clinical Excellence (NICE) currently recommends considering a structured group physical activity programme as a treatment option for people with mild-to-moderate depression and persistent ‘subthreshold’ depressive symptoms:

subthreshold depression is defined as a person meeting fewer than five symptoms on an accepted set of diagnostic criteria for identifying depression mild depression is defined as having five of the symptoms (or a few more) required to make a diagnosis, but only minor functional impairment moderate depression is when symptoms or functional impairment are between mild and severe NICE recommends that structured group physical activity is delivered in groups that are supported by a competent practitioner, and that it should typically consist of three sessions per week (lasting 45 minutes to 1 hour) over 10–14 weeks.

This new study suggests that walking is an activity that can help to reduce the symptoms of depression. It is a systematic review, the form of study considered to be the best way to determine what all the relevant research available says about a particular question. However, there are some limitations to this review, because the available studies are small and vary in their methods and results. This means that it is difficult to be certain exactly what level of benefit certain types of people with depression will get from walking. As the authors of the review state, more research is needed to determine which type of walking programme is best for people with depression being treated in primary care.

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Many adults are surprised when told that children and adolescents can and do become clinically depressed. We often think only adults have the type and severity of life stressors that can result in depression. After all, we adults have to deal with careers, financial concerns, marital issues, parenting challenges, tax season, home repairs, health problems, and more. Children and adolescents have little to worry about in their relatively stress-free lives. Children simply have to do their best in their fun classes at school, play with their friends, enjoy all the toys they've accumulated, and put up with Mom and Dad when told it's time to go to bed so they can rest up for another fun-filled, stress-free day.

Adolescent boys and girls have lives filled with Friday night football games, sleepovers at friends' houses, weekends at the mall, movie dates with their exciting new boyfriend or girlfriend. They enjoy group outings at local fast food restaurants where talk is friendly and no one is teased or ostracized. Life is good as a child and adolescent. School is fun, home is stable, friends are true, and bodies are healthy. Depression can wait until the real stressors of adulthood. Right? Well…not exactly.

As much as we may want the above scenarios to be true, the fact is the time of our lives from childhood through adolescence can be an emotionally tumultuous time. It can be filled with uncertainty, insecurity and confusion caused by difficult peer-relational issues, heart-breaking dating experiences, academic stressors, health problems and conflictual home environments. This is a time of transition from the relative protection of young childhood to the significant challenges of adulthood. The demands placed on children and adolescents by society, parents, peers, and the girls and boys themselves can be staggering.

Depression can and does occur in children and adolescents and is more prevalent in our culture than previously thought. The U.S. Center for Mental Health Services (CMHS) reports as many as one in every 33 children and one in every eight adolescents may be experiencing depression at some level. Two-thirds of children with mental health problems do not get the help they need. CMHS also reports that once a young person has experienced a major depression, he or she is at risk for developing another depression within the next five years. Plus, children or adolescents who have a family history of depression are more likely to struggle with it. Depression can significantly impact the life of a child or adolescent (and their families) through the disruption of peer relationships, academic performance and development, self-image and selfesteem. Thoughts of suicide or other self-destructive behaviors can occur with depression, which places further stress on the child or adolescent and increases the risk of physical harm or even death.

There is help for the depressed child or adolescent. Before help can be provided, however, the signs and symptoms of depression within the child and adolescent age range must be understood so parents and other caregivers can better determine when outside intervention is needed.

SIGNS AND SYMPTOMS

There are a number of signs and symptoms of childhood and adolescent depression, some of which are readily observable by others. Some others require questioning of the child or adolescent and/or deliberate monitoring of his or her moods and behaviors. Parents cannot count on their child or adolescent to openly state they are feeling depressed or are struggling in various areas of their lives. It is important that parents pay close attention to changes in their child or adolescent's general level of functioning in areas such as academics, peer relations, physical appearance and grooming, and involvement in usual areas of recreation. Significant and lasting declines in one or more of these areas may be an indication of depression, and should prompt further investigation. Parents must also listen for words indicating feelings of low self-worth and watch for observable moods that suggest chronic sadness, irritability or discouragement.

Common signs and symptoms of depression among children and adolescents include:
• Frequent sadness, tearfulness, or crying
• Relationship problems
• Feelings of hopelessness or helplessness
• Threats or attempts to run away from home
• Frequent complaints of various physical ailments
• Frequent school absences and/or poor school performance
• Low energy or restlessness
• Alcohol and/or drug use
• Persistent boredom
• Decline in activity level or interest in previously enjoyed activities
• Communication difficulties
• Social isolation
• Excessive guilt or low self-esteem
• Significant changes in eating and/ or sleeping patterns
• Increased levels of anger, irritability, or hostility
• Increased sensitivity to rejection or failure
• Concentration problems
• Thoughts or threats of suicide or other self-destructive behaviors

Not all children or adolescents will share the same signs and symptoms of depression. Some may appear sad, while others may act angry or irritable. One child may sleep excessively while another may have difficulty falling or staying asleep. It is important to look for changes in the typical moods, behaviors or physical functioning to determine whether depression may be present.

Also, it is important to remember that each individual sign or symptom above is not necessarily an indication of depression (although suicidal thoughts, threats or attempts do require immediate intervention). It is the combination of the various signs and symptoms that determines whether a depression diagnosis is made.

It is important that parents pay close attention to changes in their child or adolescent's general level of functioning... It is important to look for changes in typical moods, behaviors or physical functioning to determine whether depression may be present. It is also important to remember the above changes in moods, behaviors, physical symptoms and general functioning must be present on a fairly consistent basis for at least two weeks before a depression diagnosis should be considered. Children and adolescents will occasionally experience emotional turmoil that may mimic depression, but be resolved within a few days. This is not considered depression, but rather a temporary emotional upheaval that does not require the same type of intervention. This is not to say parents should wait two weeks to seek help if serious concerns exist. Rather, the depression diagnosis itself requires two consecutive weeks of impairment.

What About the Threat of Suicide?

Unfortunately, there is a risk of suicide with depressed children and adolescents, especially when the depression is severe, stressors are significant, and social support is perceived by the child as minimal or non-existent. Suicide has been identified as the third leading cause of death within the 15 - 19 year-old age range and the sixth leading cause of death with 5 - 15 year olds. Parents should always take threats of suicide seriously. Seek immediate intervention to determine the level of risk and develop a plan of action to prevent the child from harming him or herself.

If it appears a risk of suicide exists, measures need to be taken to make the home as safe as possible by denying easy access to firearms, razor blades, potentially dangerous medications, etc. Studies show girls are more likely than boys to attempt suicide, but boys are more likely to succeed given the fact they often choose more lethal methods such as guns. Again though, all threats need to be taken seriously. Parents should seek immediate help if it appears their child is in imminent danger of self-harm. Options for getting assistance include calling 911, contacting suicide prevention hotlines, and reporting concerns through the crisis lines at inpatient facilities.

TREATMENT OPTIONS

Medications

Treatment options for the depressed child or adolescent have improved dramatically over the past few decades. Much has been learned about the physiological and psychological nature of depression, which has prompted both medical and therapy advances. It is now known that clinical depression involves declines in neurotransmitter functioning within the brain, which can be alleviated through the use of a wide assortment of antidepressant medications. These medications can be prescribed through the child's physician or psychiatrist following a thorough review of the history and nature of the specific evidence of depression. Side effects can occur with antidepressant medications and should be discussed with the prescribing physician prior to beginning the medication treatment. Intolerable or overly-concerning side effects may require a change in medication, however many side effects tend to be temporary and relatively mild. Any concerns need to be promptly addressed with the prescribing physician.

Therapy

In most cases, therapy should be a part of the treatment plan when medication is prescribed, in order to determine whether underlying issues are contributing to the depression. If a child or adolescent relies entirely on an antidepressant medication to alleviate depression symptoms, the symptoms may return once medication treatment is completed. Working with a qualified therapist can help the child or adolescent identify and resolve the issues and problems that may have caused the depression. These issues may be social in nature, prompting a therapy focus on building and maintaining effective peer relationships.

Or perhaps they may be associated with specific family issues that can be addressed through family therapy with an emphasis on family dynamics, communication styles and individual roles. Specific trauma events can result in depression including emotional, physical and sexual abuse, loss of a loved one (pets included) through death or other means, or serious health concerns with the child or another family member. Significant transitions such as changing residences, schools or peer groups, changes in the family structure, or parental divorce can also contribute to the onset of depression.

Entering a new phase of life such as middle school or high school, enduring the challenges of puberty, or experiencing new responsibilities through employment or extracurricular school activities can create emotional turmoil as the child or adolescent struggles to establish and maintain a sense of confidence, competence, and control.

Whatever the underlying issue(s) may be, therapy can help alleviate contributing self-defeating thoughts, perspectives, and behaviors. Therapy can help the child or adolescent respond to his or her daily challenges and circumstances in ways that are both realistic and productive. Therapy that emphasizes proactive problem-solving, monitoring and modifying selfdefeating thoughts and behaviors, and building effective communication and relational skills can be very helpful in treating depression. This assumes therapy efforts take into account, and consistently honor, the individuality of the child or adolescent in treatment.

Hospital Treatment

Sometimes intervention beyond medication and therapy is needed, especially when the risk of suicide or other self-destructive behaviors exist. Admission to a child and adolescent inpatient facility may be considered as a means to provide immediate safety and initiate medication treatment and therapy intervention. Admissions are typically brief (a few days), can help stabilize the child, and significantly lower the risk of self-harm behaviors. Partial program admissions are also available at some facilities. These programs are typically held from morning until late afternoon and provide more intense interventions than traditional outpatient therapy, while allowing the child to return home to his or her family until the program resumes the following morning. Continuation of schoolwork is encouraged, so that additional stressors are not placed on the child upon discharge from the program.

Support Groups

In cases of identified trauma or various issue-specific problems contributing to depression, support groups within the community may be available. The child's therapist, physician, or psychiatrist may be able to assist in identifying some of these resources.

The issue of which intervention to seek can be a challenge. In cases when the child's depression is strictly biological (although that's difficult to determine), medication treatment may be sufficient. At other times, it may be best to forego medication treatment until a course of therapy has been tried. This is especially true in cases when the child or adolescent is struggling with grief/loss issues. In these types of cases, medication treatment may mask the issues causing the depression, resulting in the continuation of the contributing issues and the return of the child's symptoms when termination of medication treatment is attempted. Parents may seek advice regarding the various treatment options from any of the above professionals.

PRACTICAL TIPS

What Can Parents Do To Help?

There are many things parents can do to help their child or adolescent recover from depression. Conversely, there are also many things parents sometimes do that can actually create more difficulties for the child and perhaps even worsen the depression. Below is a list of some of the ways parents may support and assist their child or adolescent, as well as a number of reactions to avoid.

• Seek help from a qualified mental health professional as soon as it appears the child or adolescent may be depressed. Do not hesitate to take emergency measures (crisis line, 911, etc.) if it appears the child is at immediate risk of self-harm.
• Stay involved throughout the course of the child's treatment whether it involves medication, therapy, or both. Ask questions of the mental health professionals regarding treatment plans, medication issues, and ways you can assist with treatment through necessary changes in the home environment and/or ways you respond to the child.
• Proactively address any concerns or reasonable suspicions of drug or alcohol use. Drug and alcohol use can intensify the downward spiral of depression and can be a significant obstacle to effective treatment.
• Monitor the depressed child or adolescent's moods and behaviors without "suffocating" him/her with outward concern or questions.
• Maintain home rules and expectations concerning the child as consistently as possible, except in cases when specific changes have been discussed and identified as part of the treatment plan. Parents sometimes become overaccommodating to a depressed child or adolescent, which can actually encourage the continuation of the depression due to the perceived "benefits" of being depressed.
• Monitor and encourage healthy nutrition and sleep habits with the depressed child. Clinical depression has a biological dimension that can be affected by the consistency and quality of physical self-care.
• Encourage the depressed child to maintain reasonable physical, recreational, and social activity levels. These activities will provide opportunities for emotional respite from the depression and help maintain much-needed social contacts.
• Make it clear that you are available to the child to assist in any reasonable way possible, but don't be surprised if he or she rarely takes you up on your offer. Simply sensing you as an available quiet strength can sometimes be enough to help the child feel your support.
• Allow the depressed child some "space," but discourage prolonged isolation.
• Do not be overly critical of your depressed child, or suggest they "snap out of it." They probably would if they could and what they really need from you is nonjudgmental support, encouragement, and understanding. But remember, reasonable expectations should continue in most areas of the child's life, including academics, behavior, and household responsibilities.

SUMMARY
Children and adolescents can, indeed, become depressed. Contributing factors vary among individuals, as do specific signs and symptoms. But risk factors apply to all, including the potential for social problems, academic impairment, family disruption, selfesteem problems, self-abuse, and even death through the act of suicide. Children and adolescents cannot be counted on to openly point out they are struggling with depression. Often they are not even aware they are depressed or that help is possible. Parents and other caregivers must be aware of the signs and symptoms of child and adolescent depression in order to determine when professional intervention may be needed. They also should be knowledgeable of area resources available for the diagnosis and treatment of depression for their children, or for addressing immediate crises. Traditional treatment for depression includes therapy and/or medication, as well as support groups and other options when deemed necessary and beneficial. The period of childhood through adolescence can be a time of excitement, happiness and growth. It can also be a time of uncertainty and despair as significant challenges and transitions are negotiated. If and when depression occurs, help is available. Parents should seek help through qualified mental health professionals and become knowledgeable about depression and the issues specific to their child's struggles. They should remain involved in the treatment process and be willing to make reasonable changes in the home environment and in the ways they respond to their child. Finally, they should consistently provide support, encouragement and stability to the child.

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“No more worry for me-no more regret about what happened in the past –no more dread of the future.”Do you know that you are a victim of your mind! Do you realize that all the suffering you experience (worry, anxiety, stress and depression) comes from the delusions in your mind? Are you really aware that your mind set up those entire traps and you eventually fell into them? Now, I think you realize your enemy is inside of you not outside.

One of the philosophers reveals a shocking truth that “most worry is a lie.” You worry about money, your health, your family. You worry about the future which hasn’t born yet. You worry about what happened in the past which is already done. But, you forget to concentrate all your time, energy and enthusiasm on the present moment. “The Dalai Lama, when asked what surprised him most about humanity, answered, ‘Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

As a result, the feeling of worry begins gradually to grow into your subconscious mind which is basically programmed to be worried all the time. What happened then? You can’t sleep well, you can’t eat, and you can’t enjoy life. You keep visiting one doctor to another doctor, taking more and more pills to end your pain without any result! Do you know why? It’s because you make the biggest mistake when you try to treat your body without trying to treat your mind. In fact, both body and mind are connected together. You can’t cure your body and ignore your mind!

Listen, what you are facing in your life can’t be changed by any amount of worry. Because all types of life’s problems are actually created by your thoughts! Your thoughts create your life! I’m sure you don’t know about this truth. When you think negatively, you will create the negative things in your life (e.g. situations, circumstances and people). And when you think positively; you will create the positive things in your life. Let me explain, when you begin to think negatively, focus on what you don’t want, your subconscious will respond to your thoughts, therefore you just attract more negative situations. On the contrary, as you start to think positively, focus on what you want, you actually send a new direction to your subconscious and you’ll begin to make incredible changes, improvements, and be able to accomplish anything you desire. So please take this point into your consideration.

Finally, you have to know you are stronger than you imagine. You have a miracle power in subconscious mind that breaks any type of obstacles. When you release your subconscious mind power, you can achieve anything you desire: money, health and happiness. Just you have to learn how to calm your mind and get rid of worry, anxiety, stress and depression. So I am going to show you a powerful program that includes many tips to relieve your worry, anxiety, stress and depression as well as to unleash the subconscious mind power. This program won’t cost you any cent and the result will be incredible!

Believe me, if you follow this program, you no longer need to go to doctors; you no longer need to take more pills. You will find astonishing results. You will feel eventually your life getting better, and you will have a greater sense of inner peace you haven’t experienced before.

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Even among psychiatric disorders, depression is a difficult disease to diagnose. Its causes remain a mystery, its symptoms can't be defined with precision, and treatments are spotty at best.

But that may soon change. Scientists are looking for ways to identify patients with depression as reliably as they diagnose cardiovascular disease, diabetes and cancer. A new study takes a significant, though preliminary, step in that direction by demonstrating that a simple blood test can distinguish between people who are depressed and those who are not.

The test examined a panel of 28 biological markers that circulate in the bloodstream and found that 11 of them could predict the presence of depression at accuracy levels that ranged from medium to large. And if that were not remarkable enough, researchers pulled off this feat in a group of teenagers, whose angst often defies all efforts at classification.

The study, published online Tuesday in the journal Translational Psychiatry, offers hope that doctors can do a better job of helping adolescents whose mood difficulties go beyond those of typical teens, and whose lifelong prospects could be greatly improved by early treatment. What's more, by using objective data to diagnose mental pain, researchers hope to remove the stigma that often prevents patients from reaching out to doctors.

"Once you have a measurable index of an illness, it's very difficult to say, 'Just pull yourself together,' or 'Get over it,' " said study leader Eva Redei, a professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine in Chicago. A federal report released last year estimated that as many as two-thirds of the nation's 2 million depressed teens are too embarrassed or ashamed to get help.

The study drew responses of praise and caution from other researchers seeking better ways to diagnose and treat major depressive disorder.

"This is definitely an encouraging study," said Dr. Andrew Leuchter, a UCLA psychiatrist who is researching ways to improve treatment with genetic testing and was not involved in the new work. Finding a way to intervene with teens would be particularly valuable since a bout of depression early in life makes repeat episodes more likely, and therefore more urgent to treat, he said.

The current study focused on teens and "early onset" depression, but the researchers said they hoped to include adults in future testing.

Redei's study takes a middle-of-the-road approach to the search for a "biomarker" of depression. Her team did not look for genetic variations that might predispose an individual to depression, nor did it use advanced MRI scans to home in on peculiarities in the way the depressed brain works. Instead, the team focused on the messenger molecules that carry out genetic instructions for producing or inhibiting proteins.

The researchers started out with rats, breeding some for their vulnerability to depression and raising others to serve as healthy control subjects. In an effort to tease out the long-term molecular consequences of childhood stress, some rats from both groups spent hours restrained and alone in their cages. After several generations, the researchers identified 11 distinct molecules that were often found in the blood and brains of depressed rats but were largely absent in the healthy animals.

The tests also turned up 15 molecules that distinguished rats who suffered from a combination of depression and severe anxiety from those whose depression resulted in listless, helpless behavior.

Then the researchers tested the predictive value of the same biomarkers in a group of 14 depressed teens between the ages of 15 and 19 and a group of 14 healthy control subjects. Sure enough, the teens with depression had significantly higher concentrations of the 11 targeted molecules in their blood. In addition, there were 18 biomarkers that could distinguish between adolescents who suffered from depression alone and those who had depression and anxiety.

Dr. Sidney Kennedy, a psychiatrist at the University of Toronto who is leading a project called the Canadian Depression Biomarker Network, said Redei's study was the first to use messenger molecules as biological signposts for depression. As other efforts to find biomarkers mature — including costly brain scans and genetic analyses — those could refine and strengthen a blood test to screen large populations, he said.

"There is merit in this work," Kennedy added. In the meantime, he praised the study for making a first attempt at one of the field's most ambitious goals: to explain, describe and distinguish among depression's many and varied forms.

Redei said her team hoped to perfect the blood panel by testing it in larger and more varied groups of subjects — including those with other psychiatric illnesses, including bipolar disorder, that are sometimes mistakenly diagnosed as major depression.

But before any such blood test could go into broad use, she cautioned, scientists would have to show that it could reliably detect the presence of illness without generating too many false positives.

"The probability that we will be able to put together a panel that's usable is rather high," she said. "This data at the moment truly proves that it can be done."

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“Going for a brisk stroll could play an important role in fighting depression,” BBC News has reported. Current evidence suggests that physical activity can be useful for reducing the symptoms of depression, but previous examinations of research have not specifically looked at whether walking can. In order to improve our understanding of the issue, Scottish researchers conducted a systematic search for all relevant medical trials on the subject, combining their results into a single analysis.

The researchers found eight relevant studies featuring a total of 341 people. Overall, the combined results of these trials suggested that walking reduced the symptoms of depression. However, the trials were small, and they varied in the types of people they included, the walking programmes they used and what they compared walking to. This limits the strength of the conclusions that can be drawn about the effects of walking in specific groups of people with depression.

However, this is not the first research to have suggested that physical activity is beneficial for depressive symptoms and the National Institute for Health and Clinical Excellence (NICE) currently recommends considering structured group physical activity programmes as a treatment option for some forms of depression.

As the authors of the review note, walking is a form of physical activity that most people can take part in safely and at minimal cost. More research is now needed to determine exactly what duration and frequency of walking is most effective for depressive symptoms.

Where did the story come from?
The study was carried out by researchers from the Universities of Stirling and Edinburgh. Sources of funding were not reported. The study was published in the peer-reviewed journal Mental Health and Physical Activity. The study was reported appropriately by the BBC.

What kind of research was this?
Physical activity has been found to reduce depressive symptoms, but the researchers behind this study say that it is not known whether walking specifically has the same effect. They say, however, that walking can be easily undertaken by most people, fits into our daily schedules, is low-cost and comes with little risk of adverse effects. The researchers set out to systematically review the evidence on the effects of walking on depression. This involves searching for  and analysing existing studies addressing this question. They also set out to perform a ‘meta-analysis’ – a pooling of the results of the individual studies.

A systematic review is the best way to summarise all of the existing research on the question of interest, as, during a systematic review, researchers should rigorously search for and analyse all relevant high-quality studies available on a subject. Systematic reviews include relevant studies regardless of their results, rather than just focussing on those that support or contradict a particular theory. The results of the studies in a systematic review may be statistically pooled if they are similar enough in method to produce meaningful results. Pooling very different types of studies (for example those with very different study population) will produce results that don’t improve the researchers’ understanding of the effect of an intervention.

What did the research involve?
The researchers searched 11 literature databases to identify randomised controlled trials of walking as a treatment for depression. They then statistically pooled the results of eligible studies to assess whether walking reduced depressive symptoms compared with a control treatment that did not involve walking.

The researchers included any studies in adults with any form of depression, excluding those in which depression was being examined as part of bipolar disorder or where all the participants were recruited because they had a specific medical condition, such as cancer. Studies of any kind of structured or semi-structured walking programmes were included. Studies where other types of exercise were also part of the activity programme were excluded. Stretching to warm up or cool down before walking was permitted. The comparison group in eligible trials could be those receiving no treatment, usual depression care or a treatment that was also given to the walking group (for example, cognitive behavioural therapy). Depressive symptoms could be assessed using any symptom scale.

Information on the study characteristics and results was extracted from eligible studies, and the quality of the trials was assessed. Results were pooled using standard methods. The researchers looked at the effect of walking overall, and also at indoor and outdoor walking and group walking specifically.

What were the basic results?
The researchers identified seven trials that fully matched their inclusion criteria. They also included an additional trial that included people who either had moderate depression or who had a high body mass index (BMI). They did this as the trial was relatively large, and included a considerable number of people with depression. The trials were generally quite small, with between 11 and 127 people in each trial. The trials included 341 people in total. The trials varied in their quality, with only one trial reporting on – and meeting all four of the quality indicators used by the reviewers.

There was a lot of variability between these trials, including differences in the types of people that were recruited, the settings in which they were treated, how severe their depression was and how it was diagnosed. The trials also varied in the types of walking programmes they used: whether they were supervised; indoor (e.g. on a treadmill) or outdoor; whether they were group walks; and the duration and frequency of the walks performed. The walks ranged from 20 to 50 minutes, and the programmes lasted up to six months. The control groups were assigned therapies including usual care, stretching and relaxation exercises, social contact or other kinds of support (talking to a researcher or a support group).

Pooling the results of these studies showed that, overall, walking did significantly reduce depressive symptoms. There was a high level of variability across the results of the studies, however, with one finding a better outcome with the control treatment, one finding no significant benefit of walking, and the other studies finding varying levels of benefit. The researchers then conducted a further two separate analyses – one including only the four best trials and one excluding the study that had recruited people with high BMIs. Both of these still found that walking significantly reduced depressive symptoms.

The researchers also found that walking had a significant effect in trials of indoor walking, outdoor walking and group walking if these were looked at separately. The researchers noted that the variability in the designs of these studies meant that the pooled results may not be directly applicable to specific groups of people.

How did the researchers interpret the results?
The researchers concluded that walking significantly reduced the symptoms of depression in some populations. However, they say that there are limitations to the existing studies and suggest that further research is needed to determine exactly what type of walking programmes (frequency, intensity, duration) would be best for people with depression being treated in primary care, such as by a GP.

Conclusion
Physical activity is already thought to have a beneficial effect on depressive symptoms, and the UK’s National Institute for Health and Clinical Excellence (NICE) currently recommends considering a structured group physical activity programme as a treatment option for people with mild-to-moderate depression and persistent ‘subthreshold’ depressive symptoms:

subthreshold depression is defined as a person meeting fewer than five symptoms on an accepted set of diagnostic criteria for identifying depression mild depression is defined as having five  of the symptoms (or a few more) required to make a diagnosis, but only minor functional impairment moderate depression is when symptoms or functional impairment are between mild and severe NICE recommends that structured group physical activity is delivered in groups that are supported by a competent practitioner, and that it should typically consist of three sessions per week (lasting 45 minutes to 1 hour) over 10–14 weeks.

This new study suggests that walking is an activity that can help to reduce the symptoms of depression. It is a systematic review, the form of study considered to be the best way to determine what all relevant research available says about a particular question. However, there are some limitations to this review, because the available studies are small and vary in their methods and results. This means that it is difficult to be certain exactly what level of benefit certain types of people with depression will get from walking. As the authors of the review state, more research is needed to determine which type of walking programme is best for people with depression being treated in primary care.

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With the summer wedding season now over, many brides are finding life after the big day a big let down as they struggle with feelings of sadness, frustration and even postnuptial depression. A look at online wedding forums reveals many brides hiding behind the anonymity of the internet and seeking advice for depression following the wedding, from the let down of no longer having the big wedding to focus on to feelings of loneliness after moving to be close to a new husband's family.

On Wedding Central's forum, one bride writes "for a couple of months after my wedding I suffered post wedding depression. It sounds ridiculous to say out loud, so you keep it to yourself and just feel sad inside and don't understand why. I had the wedding of my dreams. But after reality sunk in of the fact that I was never going to be a bride again. I have been with my now hubby for ten years so I'd been thinking about my dream wedding with him for a decade."

In Australia, statistics show that marriage continues to be the most common form of union, indeed the number of people tying the knot has been steadily increasing since 2001. Coupled with the high cost of the big day itself — the average cost of a wedding is $36,000 — the stakes could hardly be higher.

"It is not uncommon for newlyweds to experience emotional distress following the wedding," says Jacqueline Saad, principal psychologist at Jacqueline Saad & Associates in Sydney and "it may be that we are hearing about it more as people feel more comfortable discussing their emotional struggle," she adds. Of those brides who feel distress Saad estimates that less than ten per cent truly understand their unhappiness, how this unhappiness might impact their relationship and then go on to seek therapy. She believes this is because "they may not recognise the reasons behind the distress or may feel stigma attached to discussing the feelings of sadness, disappointment or depression following an event like a marriage."

Saad says there are many factors that may influence the onset of depression like symptoms following marriage. "For many individuals it may be due to the mismatch in expectations that they have of married life, where the reality of marriage does not fit in with their preconceived ideas on the union," as well as the lead-up to the wedding being an emotional draining time.

Pam Lewis, the director of clinical services for Relationships Australia, New South Wales, says it is normal to feel flat, sad or have feelings of loss after any event that has been highly exciting such as a holiday but "weddings are just a little more exaggerated because it has been such a big event". However, says Lewis, "some people who are actually clinically depressed might feel bad enough to think they might need to talk to someone about it. They've been in a state of excitement often for several months with the building crescendo leading up to the wedding and then they come back from their honeymoon and sometimes they look at each other and wonder what do we do now? How are we going to go on with the rest of our lives now that the spotlight is off us?"

US bridal counselor Sheryl Paul, an expert on the wedding transition, says brides often feel they have made a mistake but "in the absence of accurate information that can guide someone through the difficult feelings, this is the only logical conclusion. Sadly, the thought itself compounds the anxiety, and often leads to affairs and divorce".

And it's not just postnuptial depression affecting women, prenuptial stresses are also taking their toll. After the initial euphoria following her engagement, reality set in for Kara Rosenlund an interiors stylist from Brisbane when she felt her wedding plans had become hijacked by family members. "What was previously an exclusive independent union of two people for some years, across many continents had overnight become a union of many people with a lot of very different opinions, and for some reason our opinions were being deafened. I was left feeling particularly wounded and deflated. I just never saw this divide coming."

Paul believes the engagement period is the time a bride needs to focus on her emotional needs instead of the wedding planning. "The engagement is the time to grieve the old identity and lifestyle of being single in order to make room for the new identity and lifestyle of being married. It's the time to loosen ties with family of origin and grieve the change in allegiance from parents to partner. It's the time to grieve the shattering of the fantasy of perfect love and infatuation and learn what real love is all about. That's a lot of emotional work and if someone pushes all of those difficult feelings aside and attempts to find control by planning a 'perfect' wedding, everything that she ignored during her engagement will come crashing down on her after the wedding when there's nothing left to do and no way to distract any longer."

There are other preventative measures worth taking before the wedding such as investing in pre-marital counseling with an accredited professional says Saad. She also recommends having open conversations with your partner prior to the marriage. Exchanging values, ideas and beliefs can help to reduce conflict post-union. After the wedding she suggests taking time to reflect on what may be going on for you and talking to someone close that you trust about the feelings and experiences you are having.
"It's never too late to do the emotional work, so if post-bridal depression hits it means she needs to grieve the losses, feel her fears, and hunker down to do the hard work of transitioning from one way of life to another," says Paul. "As long as they can talk it through and they know each other well enough to trust each other I think that is a good basis for getting through this low after a wedding," agrees Lewis.

However, Saad recommends newlyweds who experience symptoms of depression such as a sense of hopelessness, feelings of sadness, changes in sleep patterns, a loss of pleasure in activities or interests or changes in mood, for example, feelings of irritability, should seek professional help.
Fortunately for Kara Rosenlund she is back on track with her wedding through her fiance's "strength, confidence and love". She is getting married on the 20th of July 2012 and, she adds, "we are doing it our way".

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