Depression is an illness that involves the body, mood, and
thoughts. It affects the way a person eats and sleeps, the way one feels about
oneself, and the way one thinks about things. A depression is not the
same as a passing blue mood. It is not a sign of personal weakness or a
condition that can be willed or wished away. People with a depression
cannot merely "pull themselves together" and get better. Without treatment,
symptoms can last for weeks, months, or years. Appropriate depression treatment, however,
can help most people who suffer from depression.
Types of Depression
Depression comes in different forms, just as is the case with other
illnesses such as heart disease. This pamphlet briefly describes three of the
most common types of depression. However, within these types there are
variations in the number of symptoms, their severity, and persistence.
Major depression is manifested by a combination
of symptoms (see symptom list) that interfere with the ability to work, study,
sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of
depression may occur only once but more commonly occurs several times in a
lifetime.
A less severe type of depression, dysthymia,
involves long-term, chronic symptoms that do not disable, but keep one from
functioning well or from feeling good. Many people with dysthymia also
experience major depressive episodes at some time in their lives.
Another type of depression is bipolar disorder,
also called manic-depressive illness. Not nearly as prevalent as other forms of
depressive disorders, bipolar disorder is characterized by cycling mood changes:
severe highs (mania) and lows (depression). Sometimes the mood switches are
dramatic and rapid, but most often they are gradual. When in the depressed
cycle, an individual can have any or all of the symptoms of a depressive
disorder. When in the manic cycle, the individual may be overactive,
overtalkative, and have a great deal of energy. Mania often affects thinking,
judgment, and social behavior in ways that cause serious problems and
embarrassment. For example, the individual in a manic phase may feel elated,
full of grand schemes that might range from unwise business decisions to
romantic sprees. Mania, left untreated, may worsen to a psychotic state.
Symptoms of Depression and Mania
Not everyone who is depressed or manic experiences every symptom. Some people
experience a few symptoms, some many. Severity of symptoms varies with
individuals and also varies over time.
Depression
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once
enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain
Mania
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
Causes of Depression
Some types of depression run in families, suggesting that a biological
vulnerability can be inherited. This seems to be the case with bipolar disorder.
Studies of families in which members of each generation develop bipolar disorder
found that those with the illness have a somewhat different genetic makeup than
those who do not get ill. However, the reverse is not true: Not everybody with
the genetic makeup that causes vulnerability to bipolar disorder will have the
illness. Apparently additional factors, possibly stresses at home, work, or
school, are involved in its onset.
In some families, major depression also seems to occur generation after
generation. However, it can also occur in people who have no family history of
depression. Whether inherited or not, major depressive disorder is often
associated with changes in brain structures or brain function.
People who have low self-esteem, who consistently view themselves and the
world with pessimism or who are readily overwhelmed by stress, are prone to
depression. Whether this represents a psychological predisposition or an early
form of the illness is not clear.
In recent years, researchers have shown that physical changes in the body can
be accompanied by mental changes as well. Medical illnesses such as stroke, a
heart attack, cancer, Parkinson's disease, and hormonal disorders can cause
depression, making the sick person apathetic and unwilling to care for
his or her physical needs, thus prolonging the recovery period. Also, a serious
loss, difficult relationship, financial problem, or any stressful (unwelcome or
even desired) change in life patterns can trigger a depression episode. Very
often, a combination of genetic, psychological, and environmental factors is
involved in the onset of a depressive disorder. Later episodes of illness
typically are precipitated by only mild stresses, or none at all.
Depression Treatment
The first step to getting appropriate treatment for depression is a physical
examination by a physician. Certain medications as well as some medical
conditions such as a viral infection can cause the same symptoms as depression,
and the physician should rule out these possibilities through examination,
interview, and lab tests. If a physical cause for the depression is ruled out, a
psychological evaluation should be done, by the physician or by referral to a
psychiatrist or psychologist.
A good diagnostic evaluation will include a complete history of symptoms,
i.e., when they started, how long they have lasted, how severe they are, whether
the patient had them before and, if so, whether the depression symptoms were treated and
what depression treatment was given. The doctor should ask about alcohol and drug use, and
if the patient has thoughts about death or suicide. Further, a history should
include questions about whether other family members have had a depressive
illness and, if treated, what treatments they may have received and which were
effective.
Last, a diagnostic evaluation should include a mental status examination to
determine if speech or thought patterns or memory have been affected, as
sometimes happens in the case of a depressive or manic-depressive illness.
Depression treatment choice will depend on the outcome of the evaluation. There are a
variety of antidepressant medications and psychotherapies that can be used to
treat depression. Some people with milder forms may do well with
psychotherapy alone. People with moderate to severe depression most often
benefit from antidepressants. Most do best with combined depression treatment: medication
to gain relatively quick symptom relief and psychotherapy to learn more
effective ways to deal with life's problems, including depression. Depending on
the patient's diagnosis and severity of symptoms, the therapist may prescribe
medication and/or one of the several forms of psychotherapy that have proven
effective for depression.
Electroconvulsive therapy (ECT) is useful, particularly for individuals whose
depression is severe or life threatening or who cannot take antidepressant
medication. ECT often is effective in cases
where antidepressant medications do not provide sufficient relief of symptoms.
In recent years, ECT has been much improved. A muscle relaxant is given before
treatment, which is done under brief anesthesia. Electrodes are placed at
precise locations on the head to deliver electrical impulses. The stimulation
causes a brief (about 30 seconds) seizure within the brain. The person receiving
ECT does not consciously experience the electrical stimulus. For full
therapeutic benefit, at least several sessions of ECT, typically given at the
rate of three per week, are required.
How to help yourself if you have depression?
Depression make one feel exhausted, worthless, helpless, and
hopeless. Such negative thoughts and feelings make some people feel like giving
up. It is important to realize that these negative views are part of the
depression and typically do not accurately reflect the actual circumstances.
Negative thinking fades as depression treatment begins to take effect. In the meantime:
- Set realistic goals in light of the depression and assume a reasonable
amount of responsibility.
- Break large tasks into small ones, set some priorities, and do what you can
as you can.
- Try to be with other people and to confide in someone; it is usually better
than being alone and secretive.
- Participate in activities that may make you feel better.
- Mild exercise, going to a movie, a ballgame, or participating in religious,
social, or other activities may help.
- Expect your mood to improve gradually, not immediately. Feeling better takes
time.
- It is advisable to postpone important decisions until the depression has
lifted. Before deciding to make a significant transition-change jobs, get
married or divorced-discuss it with others who know you well and have a more
objective view of your situation.
- People rarely "snap out of" a depression. But they can feel a little better
day-by-day.
- Remember, positive thinking will replace the negative thinking that
is part of the depression and will disappear as your depression responds to
treatment.
- Let your family and friends help you.
How Family and Friends Can Help Person with Depression
The most important thing anyone can do for the depressed person is to help
him or her get an appropriate depression diagnosis and depression treatment. This may involve
encouraging the individual to stay with treatment until symptoms begin to abate
(several weeks), or to seek different treatment if no improvement occurs. On
occasion, it may require making an appointment and accompanying the depressed
person to the doctor. It may also mean monitoring whether the depressed person
is taking medication. The depressed person should be encouraged to obey the
doctor's orders about the use of alcoholic products while on medication. The
second most important thing is to offer emotional support. This involves
understanding, patience, affection, and encouragement. Engage the depressed
person in conversation and listen carefully. Do not disparage feelings
expressed, but point out realities and offer hope. Do not ignore remarks about
suicide. Report them to the depressed person's therapist. Invite the depressed
person for walks, outings, to the movies, and other activities. Be gently
insistent if your invitation is refused. Encourage participation in some
activities that once gave pleasure, such as hobbies, sports, religious or
cultural activities, but do not push the depressed person to undertake too much
too soon. The depressed person needs diversion and company, but too many demands
can increase feelings of failure.
Do not accuse the depressed person of faking illness or of laziness, or
expect him or her "to snap out of it." Eventually, with treatment, most people
do get better. Keep that in mind, and keep reassuring the depressed person that,
with time and help, he or she will feel better.
Source: National Institute of Mental Health
