What is Depression?
Most everyone experiences feelings of sadness at one point or another. When symptoms become persistent or troublesome and interfere with normal activities, it may be more serious.
Major depression or major depressive disorder is one of the most common mental health conditions in the U.S. Every year, an estimate of 16 million adults in the U.S. have one or more episodes of major depression. Left untreated, major depression can sometimes lead to more serious mental health concerns including an increased risk of suicide or episodes of psychosis.
Signs and Symptoms of Depression
Symptoms of major depression go beyond the occasional feeling of the “blues”. Major depression can interfere with normal activities and may lead to serious complications. Symptoms include:
- Persistent feelings of sadness
- Feelings of hopelessness and worthlessness
- Irritability without cause
- Difficulty sleeping or sleeping too much
- Changes in appetite (increase or decrease)
- Lack of energy, lethargy, and fatigue
- Lack of self-care such as bathing
- Loss of interest in pleasurable activities
- Social withdrawal
- Difficulty concentrating
- Unexplained aches, pain or illness
- Thoughts of suicide or death
Depression is often an underdiagnosed illness. Many people do not realize that they are depressed and do not seek help. In addition, many people cover up or are unwilling to discuss symptoms of depression. Increased awareness is helping to reduce the stigma of mental health disorders and encourage physicians and patients to have discussions about symptoms of depression and other conditions.
Beyond the first discussion, in order to receive a diagnosis and treatment for depression, patients will be asked to undergo procedures such as:
- A physical exam to eliminate medical reasons for symptoms
- Laboratory testing to rule out conditions such as a hypothyroid disorder or hormonal problems
- Depression questionnaires or inventories
- Interview with a mental health professional
- Comparison of symptoms with the requirements of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Types of Depression
Depression can be a complex condition. It may also be part of another mental disorder and can be classified into categories including:
Major Depressive Disorder (MDD) or Clinical Depression
The most common type of depression, MDD is a depression in which symptoms are present most of the time for two or more weeks. Symptoms not only reduce enjoyment in life, but they are also severe enough to interfere with the ability to perform normal activities such as work and may impact the ability to sleep or eat. About 8.5% of women and 4.7% of men have experienced an episode of major depression in the last year.
Persistent Depressive Disorder or Dysthymia
The persistent depressive disorder was formerly known as dysthymia and has symptoms of depression which may be milder but occur over a long period of time. It is diagnosed after symptoms have persisted for two years in adults or one year in children. As symptoms may not be as severe, this disorder is often overlooked and may go undiagnosed. In many cases, people with persistent depression simply believe it is simply a part of who they are.
Occurs when major depressive disorder develops in someone who already has a persistent depressive disorder. It may be difficult to diagnose as people with double depression may believe their “normal” dysthymia has simply worsened and are reluctant to seek help.
May begin during pregnancy but typically occurs after childbirth. Hormonal changes, nutritional deficits, sleep deprivation, and exhaustion contribute to the condition, but the actual cause of postpartum depression is not well-defined. It is characterized by symptoms of depression along with high anxiety symptoms which make it difficult for new mothers to care for a new infant and themselves.
Read more about Postpartum Depression
Seasonal Affective Disorder
Most often occurring during fall and winter, seasonal affective disorder (SAD) causes symptoms of depression during certain seasons. After the season has passed, symptoms subside but return at the same time of year for more than one year. Experts believe SAD may be caused by levels of melatonin, serotonin and Vitamin D which fall during the winter months or when one spends more time without natural light. SAD is often helped by exposure to sunlight in the mornings but may also require medication.
Read more about SAD
Also called depressive psychosis or depression with psychotic features is a condition that develops when major depression has become severe and the patient begins to have psychotic symptoms. These include delusions (abnormal or unreal beliefs), hallucinations (abnormal or unreal visions, smells, voices or sounds) and illusions (a real thing that appears to be something else).
In many cases, particularly when they are a danger to themselves or others, individuals with psychotic depression will require hospitalization. This type of depression is generally treated with antipsychotic medication in addition to antidepressants.
Treatment of Depression
Symptoms of a major depressive disorder can be debilitating but the condition is treatable. Major depression is generally treated with a combination of therapy, medication and self-management strategies.
Therapy for Depression
Many of those with depression will benefit from “talk therapy” to help them understand the disorder and deal with the impact that it has on daily activities. Therapy sessions can be conducted on an “individual” basis which involves the patient and a counseling professional or may be conducted in a group setting which can involve other people suffering from the same disorder. In some cases, family therapy may also be recommended.
Cognitive Behavioral Therapy (CBT) is a type of talk therapy used for patients with depression. CBT focuses on the role of “automatic thoughts” or “self-talk” which are often negative in depression can affect feelings and patterns of behavior. CBT encourages positive self-talk and thoughts to reduce the symptoms over time and may help to prevent recurrence.
Medication for Depression
A major depressive disorder is generally treated with antidepressant medications. These work by increasing the activity of chemical messengers or neurotransmitters in certain areas of the brain. Different types of antidepressants work in different ways but all of them act to increase the activity of one or more important neurotransmitters including serotonin, norepinephrine or dopamine.
Read more about medications used for depression
In some cases, additional treatments may be needed. These may include hospitalization for patients whose depression has become severe and who may be a danger to themselves or others, brain stimulation therapies such as Electroconvulsive Therapy (ECT) or other medications including antianxiety agents, antipsychotics or anticonvulsants when depression is accompanied by other symptoms.
Management of Depression Symptoms at Home
In addition to seeking professional help, improvement may be seen or maintained with some self-management strategies. These activities may be difficult at first, but over time may have a significant impact on symptom reduction. Family members and friends should also help by encouraging the individual to participate in activities such as:
- Regular exercise
- Social activities
- Spending time outdoors
- Healthy eating
In many cases, it is important for the person with depression to simply start getting up. Even when he or she does not feel like doing so. Starting with something as small as a walk to the mailbox can ultimately lead to improvement over time.
Finding Treatment for Depression
In most cases, a primary care physician will be able to refer patients to a mental health professional and may participate in a team approach to treatment. In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) has an online locator service which can help people suffering from mental illness locate facilities or professionals in their own area.
Suicide Prevention Hotline
Individuals or loved ones of those who are considering suicide should be encouraged to call the National Suicide Prevention Lifeline at 1-800-873-8255. National Suicide Prevention Lifeline also maintains an online chat and has Facebook (800273talk) and Twitter (@800273TALK) pages.
If a suicide attempt has been made, call 911.