Depression is more than feeling sad. Intense feelings of sadness and other symptoms, like losing interest in things you enjoy, may last for a while. Depression is a medical illness, not a sign of weakness. And it’s treatable. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness. Many people with a depressive illness never seek treatment. But the majority, even those with the most severe Depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with Depression.
Forms of Depressive Disorders
There are several forms of depressive disorders.
- Major depressive disorder, or major depression, is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. Some people may experience only a single episode within their lifetime, but more often a person may have multiple episodes.
- Dysthymic disorder, or dysthymia, is characterized by long-term (2 years or longer) symptoms that may not be severe enough to disable a person but can prevent normal functioning or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
- Minor depression is characterized by having symptoms for 2 weeks or longer that do not meet full criteria for major depression. Without treatment, people with minor depression are at high risk for developing major depressive disorder.
- Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
- Postpartum depression, which is much more serious than the “baby blues” that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.1
- Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
Causes of Depression
It’s not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:
- Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
- Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.
- Hormones. Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result from thyroid problems, menopause or a number of other conditions.
- Inherited traits. Depression is more common in people whose biological family members also have this condition. Researchers are trying to find genes that may be involved in causing depression.
- Life events. Certain events, such as the death or loss of a loved one, financial problems, and high stress, can trigger depression in some people.
- Early Childhood Trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause permanent changes in the brain that make you more susceptible to depression.
Signs and Symptoms of Depression
Symptoms of depression may include the following:
- difficulty concentrating, remembering details, and making decisions
- fatigue and decreased energy
- feelings of guilt, worthlessness, and/or helplessness
- feelings of hopelessness and/or pessimism
- insomnia, early-morning wakefulness, or excessive sleeping
- irritability, restlessness
- loss of interest in activities or hobbies once pleasurable, including sex
- overeating or appetite loss
- persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
- persistent sad, anxious, or “empty” feelings
- thoughts of suicide, suicide attempts
Warning Signs of Suicidal Depression
Warning signs of suicide with depression include:
- A sudden switch from being very sad to being very calm or appearing to be happy
- Always talking or thinking about death
- clinical depression (deep sadness, loss of interest, trouble sleeping and eating) that gets worse
- Having a “death wish,” tempting fate by taking risks that could lead to death, like driving through red lights
- Losing interest in things one used to care about
- Making comments about being hopeless, helpless, or worthless
- Putting affairs in order, tying up loose ends, changing a will
- Saying things like “It would be better if I wasn’t here” or “I want out”
- Talking about suicide (killing one’s self)
- Visiting or calling people one cares about
Remember, if you or someone you know is demonstrating any of the above warning signs of suicide with depression, either call your local suicide hot line, contact a mental health professional right away, or go to the emergency room for immediate treatment.
Risk Factors of Depression
Depression often begins in the teens, 20s or 30s, but it can happen at any age. Twice as many women are diagnosed with depression as men, but this may be due in part because women are more likely to seek treatment for depression. Although the precise cause of depression isn’t known, researchers have identified certain factors that seem to increase the risk of developing or triggering depression, including:
- Having biological relatives with depression
- Being a woman
- Having traumatic experiences as a child
- Having family members or friends who have been depressed
- Experiencing stressful life events, such as the death of a loved one
- Having few friends or other personal relationships
- Recently having given birth (postpartum depression)
- Having been depressed previously
- Having a serious illness, such as cancer, diabetes, heart disease, Alzheimer’s or HIV/AIDS
- Having certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic
- Abusing alcohol, nicotine or illicit drugs
- Taking certain high blood pressure medications, sleeping pills or certain other medications (Talk to your doctor before stopping any medication you think could be affecting your mood).
Depression in Women
Rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphonic disorder (PMDD), postpartum depression, and premenopausal depression. As for signs and symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.
Depression in Teens
While some depressed teens appear sad, others do not. In fact, irritability rather than depressionis frequently the predominant symptom in depressed adolescents and teens. A depressed teenager may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains are also common symptoms of depression in young people. Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing even irreversible tragedy such as homicidal violence or suicide. But with help, teenage depression is highly treatable.
Treatment of Depression
The first step to getting appropriate treatment is to visit a doctor or mental health specialist. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation.
The doctor may refer you to a mental health professional, who should discuss with you any family history of depression or other mental disorder, and get a complete history of your symptoms. You should discuss when your symptoms started, how long they have lasted, how severe they are, and whether they have occurred before and if so, how they were treated. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide.
Once diagnosed, a person with depression can be treated in several ways. The most common treatments are medication and psychotherapy.
Medication for Depression
Antidepressants primarily work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work.
Some of the newest and most popular antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are some of the most commonly prescribed SSRIs for depression. Most are available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta).
Patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The families and caregivers should also be told of the need for close monitoring and report any changes to the doctor.
Help to your Depressed Friend or Relative
- Offer emotional support, understanding, patience, and encouragement.
- Talk to him or her, and listen carefully.
- Never dismiss feelings, but point out realities and offer hope.
- Never ignore comments about suicide, and report them to your loved one’s therapist or doctor.
- Invite your loved one out for walks, outings and other activities. Keep trying if he or she declines, but don’t push him or her to take on too much too soon.
- Provide assistance in getting to the doctor’s appointments.
- Remind your loved one that with time and treatment, the depression will lift.
Self Help for Yourself
- Do not wait too long to get evaluated or treated. There is research showing the longer one waits, the greater the impairment can be down the road. Try to see a professional as soon as possible.
- Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.
- Set realistic goals for yourself.
- Break up large tasks into small ones, set some priorities and do what you can as you can.
- Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
- Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
- Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
- Remember that positive thinking will replace negative thoughts as your depression responds to treatment.
- Continue to educate yourself about depression.