Depression

WHAT IS A DEPRESSIVE DISORDER?

A depressive disorder 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 depressive disorder 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 depressive illness cannot merely "pull themselves together"
and get better. Without treatment, symptoms can last for weeks, months, or
years. Appropriate treatment, however, can help most people who suffer
from depression.

TYPES OF DEPRESSION

Depressive disorders come in different forms, just as is the case with other
illnesses such as heart disease. This text briefly describes three of the most
common types of depressive disorders. 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 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

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.

·        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.  

CAUSES OF DEPRESSION

Some types of depression run in families, suggesting that a biological
vulnerability can be inherited. Apparently additional factors, possibly
stresses at home, work, or school, are involved in its onset.

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.

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 depressive illness, 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 depressive 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.

DIAGNOSTIC EVALUATION AND TREATMENT

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 depressive disorders. 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
treatment: medication to gain relatively quick symptom relief and
psychotherapy to learn more effective ways to deal with life's problems,
including depression.

Questions about any antidepressant prescribed, or problems that
may be related to the medication, should be discussed with the
doctor.


PSYCHOTHERAPIES

Many forms of psychotherapy, including some short-term (10-20 week)
therapies, can help depressed individuals.

"Talking" therapies help patients gain insight into and resolve their
problems through verbal exchange with the therapist, sometimes combined
with "homework" assignments between sessions.

"Behavioral" therapists help patients learn how to obtain more
satisfaction and rewards through their own actions and how to unlearn the
behavioral patterns that contribute to or result from their depression.

Cognitive/behavioral therapists help patients change the negative
styles of thinking and behaving often associated with depression.





(Source: NIMH, National Institute for Mental Health.)