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Depression is a physical, medical illness with a very strong genetic basis.  Depression usually profoundly affects your feelings, moods, productivity and behavior, and can cause physical problems as well.  Depression is a relatively common illness that affects all ages, and can occur once in a lifetime, or be on a chronic basis.

The symptoms in depression vary widely.  There is usually a depressed mood, with feelings of helplessness, sadness, and hopelessness.  Decreased motivation and loss of interest in the usual pleasurable activities often occurs.  There may be sleep disturbances, either sleeping too much, not enough, difficulties falling asleep, or easy awakening during sleep.  Concentration problems are seen, with a difficult time making decisions, often along with agitation, irritability, fatigue, and feelings of worthlessness.  There may be no interest in sex, and weight can be increased or decreased due to appetite changes.  A serious side effect of depression is suicidal thoughts, or actually committing suicide.

Some people have a “major depression”, where they ahve at least 2 weeks of serious depression, while others have ongoing mild or moderate chronic depression.  Depression may be worse in certain seasons, such as Seasonal Affective Disorder-depression in winter primarily related to a lack of sunlight.  Stressful life events may trigger depression or it may cycle in and out of people’s lives regardless of stress.  Chronic medical illnesses, sickness in one’s family, financial difficulties, and hormonal changes (particularly with postpartum depression) all may trigger depression.

The two primary treatments are medication and psychotherapy.  Exercise may help.  The combination of meds plus therapy is ideal.

Approximately 10-15% of people have strong features of a personality disorder.  General characterisitcs of personality disorders include: lack of insight, poor response to psychotherapy or other therapeutic interventions, difficulty with attachment and trusting, sense of entitlement, the creation of a great deal of chaos and distress in family and friends and co-workers around the person, etc. 

Personality disorders have a wide range of severity, from mild to very severe.  They often flip between victim, rescuer, and persecutor.  Personality disorder patients often create chaos and drama and comorbid substance abuse is common.

In general, therapy only helps people with personality disorders over long periods of time (5-7 years).  The concept of “plasticity” of the brain is very important, as some people can improve naturally over time.  However, our goals and expectations are limited.  The following is a description of some of the more severe personality disorder types.  Many people do not fit neatly into any of these categories, but have features of two or three personality disorder types.

Paranoid Personality Disorder: They tend to be non-trusting, suspicious, very secretive, and see the world as dangerous and themselves as constantly being mistreated.  They doubt the loyalty of anybody around them, are reluctant to confide in others, and believe they are being exploited or harmed.  They become angry very easily and can become violent and dangerous, as most spree killers are examples of paranoid personality disorder.

Antisocial Personality Disorder: These people generally have no regard for the rights of others; they are exploitative, they see themselves as superior, and are very opportunistic.  They are deceitful, steal from people around them, and often have trouble with the law.  They frequently engage in fraudulent activities, make very good ‘scam artists’, and generally have no remorse.

Bordlerline Personality Disorder: They have instability of mood, poor self image, and pervasive abandonment fears.  There is an identity disturbance and major boundary issues.  Borderlines usually demonstrate suicidal behavior, very quick shifts from depression to anxiety to irritability, and paranoia under stress.  They tend to split, which is, they see people as wonderful or as terrible, with nothing in between.  suicide becomes more likely as patients get into their high 20′s and 30′s.

Narcissistic Personality Disorder: This is less common, and the people see themselves as being above others, they are grandiose, have a lack of empathy, and have a true sense of entitlement.  They may be very vain and require constant attention.

Many patients do not have all of the characterisitics of one particular personality disorder, but it is a spectrum with several characteristics of a number of personality disorders.  Treatment consists of maintaining limits and boundaries on the person, encouraging long-term weekly therapy, and medications (mood stabilizers/antidepressants) to reduce the anxiety and depression aspects of personality disorder.