Depression is a serious medical illness marked by feelings of profound sadness, grief, and general loss of interest and/or pleasure in daily activities. Not simply ‘the blues,’ sadness, or a bad mood, depressive disorders are severe and lasting, impairing the person’s ability to function socially or occupationally. For people suffering from depression, life can seem an exhaustive, overwhelming struggle.
According to the Diagnostic and Statistical Manual of mental disorders (DSM), the feelings of depression must represent a marked change in the person’s normal disposition, last for at least a two consecutive weeks, and negatively impair normal functioning. In addition, a clinical diagnosis of depressive is accompanied by the following symptoms:
- Profound sadness, feelings of hopelessness, helplessness
- Loss of interest/pleasure in daily activities
- Weight gain or weight loss due to a change in appetite
- Sleep problems (sleeping too much or too little)
- Feeling restless and agitated or slow and still
- Lack of energy, feeling tired all the time
- Feelings of worthlessness or guilt (warranted or unwarranted)
- Cognitive symptoms including diminished concentration, memory, ability to make decisions
- Recurrent thoughts of death or suicide
Everyone who experiences clinically significant depression will suffer from some of these symptoms, but not necessarily all of them.
There are many types of depression including major depression (or unipolar depression), dysthymia (mild or minor depression), double depression (combined major depression and dysthyma) bipolar depression (bipolar disorder, manic-depression), Postpartum depression, Seasonal Affective Disorder seasonal depression), and more. But the two main types of depression are major depression and dysthymia.
Major depression may be diagnosed if the above symptoms are present for two or more weeks and the mood represents a marked change in the person’s normal behavior. In addition, functioning and quality of life must also be negatively impaired.
Dysthymia is similar to major depression but the symptoms are said to be milder in that individual functioning is less impaired compared to major depression. However, the symptoms last longer; for a standard psychiatric diagnosis of dysthymia – the symptoms of depression must persist for at least two-years. Because dysthymia often develops early in life, the sufferer may believe that it is normal to always feel depressed and that it is just a part of their personality. In fact, they may not remember a time when they were truly happy.
Just what causes depression and who is at risk is still up for debate. However, researchers point to a complex fusion of factors including genetics (depression does run in families), biochemistry (brain chemicals called neurotransmitters; serotonin and/or norepinephrine deficiencies), personality (angry, pessimistic, low self esteem), as well as environment (poverty or exposure to abuse for example).
Depressive disorders affect nearly 19-million American adults in any given year; women are affected at twice the rate of men.
Depression is under-diagnosed and under-treated.
Depression commonly coexists with other disorders such as anxiety and substance abuse.
Depression can strike anyone at any age.
With treatment, the vast majority of people experience significant improvement in depression symptoms.
People with depression are four times more likely to have a heart attack than those with no history of depression.
It is estimated that depression costs American business over $50-billion annually.
In a study involving 90,000 women, depression in older women was linked to a higher risk of death from heart disease.
Some studies indicate that 35 to 45% of people who take antidepressants experience complete relief from their symptoms.
While the exact treatment will vary from person-to-person based on severity, and other individual factors, depression is typically treated with antidepressant medication, psychotherapy, or a combination of the two. The most important thing is to have trust in your physician and care team and work together to choose the best treatment option for you.
One form of psychotherapy used to treat depression is cognitive-behavioral therapy (CBT). CBT is simply an integration of the cognitive (thought) restructuring approach of traditional cognitive therapy and the behavior modification techniques of traditional behavioral therapy. CBT is a structured, short-term therapy that that is very goal oriented and conducive to change. It is an action-centered form of therapy based on the premise that bad or faulty thinking patterns cause negative emotions and negative behaviors. CBT teaches people to understand and change their thinking patterns so they can change their behavior and emotional state. CBT teaches the individual to think and respond differently in situations that cause anxiety and depression.
The length of psychotherapy treatment varies from person-to-person based on severity and other distinctive factors.
Any number of antidepressant medications may also be prescribed to balance brain chemistry, in particular neurotransmitters, to control symptoms of depression. Examples of typically prescribed antidepressants include tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants, so named due to the drugs’ molecular structure, are among the oldest class of antidepressants. MAOIs, as the name suggests, are a class of antidepressant drugs that block the enzyme monoamine oxidase which slows the breakdown of certain neurotransmitters in the brain. SSRIs inhibit the absorption of serotonin, a neurotransmitter that facilitates communication between nerves in the brain.
While antidepressants can be effective in treating depression, there are side effects associated with all antidepressant medications. Some general side effects from antidepressants include: dry mouth, blurred vision, constipation/urinary retention, sexual dysfunction (inability to achieve erection/orgasm), weight gain, headache, nausea, abdominal pain, sleep problems and more.
Just which antidepressant your physician will prescribe is based primarily on your symptoms. Dosage will depend on drug-type, body chemistry, body weight and other personal factors. It can take up to six weeks for antidepressant medication to become fully effective.
There are a number of lifestyle changes that you can institute on your own that often helps alleviate symptoms of depression.