Understanding Depression

Depression can range from a mild funk to self-destructive or suicidal behavior. It's important to understand the various types of depression so you can recognize them.

Depression Basics

Depression occurs at all ages, although major depressive episodes peak between the ages of 55 and 70 in men and 20 and 45 in women. On average, major depressive episodes last eight months, but in about 20 percent of cases, the condition may linger for two years or more. About half of those who experience an episode of major depression will have another within two years. For some people, episodes of depression are separated by several years, while others suffer groups of episodes over a short time span. Between episodes, such individuals feel well.

Major depressive disorder affects approximately 14.8 million American adults -- or 6.7 percent of the U.S. population aged 18 years and older -- in a given year. An additional 3.3 million, or about 1.5 percent of U.S. adults, suffer from a milder but longer-lasting (two years or more) form of depressions called dysthymic disorder. Major depressive disorder is more common in women than in men. Although treatment can help more than 80 percent of people with severe depression, most people with depression do not seek treatment.

Mental health professionals have categorized several types of depression, each with its own treatment. Reading the following descriptions may help you identify your situation and the treatment that is best for you:

Reactive depression.

This type of depression is a reaction to stressful events -- divorce, death of a loved one, a chronic illness, a personal tragedy, or even social isolation, which the elderly frequently experience. The person is unable to recover normally from the feelings associated with the event. Common feelings include self-pity, pessimism, and loss of interest in life. It affects people of all ages.

Seasonal Affective Disorder (SAD).

If you live in the northern latitudes and suffer depression during the winter months, you may suffer from seasonal affective disorder caused by a lack of exposure to sunlight. Doctors aren't sure exactly what physiological mechanisms are at work in SAD, but they speculate that depressed feelings and other symptoms may be due to an increase in the release of the hormone meltonin. SAD sufferers feel lethargic and irritable. They may also suffer from chronic headaches, increased appetite, weight gain, and an increased need for sleep. For unknown reasons, SAD is truly a "woman's depression," in that women make up 70 percent to 80 percent of those affected. Since about half of all SAD sufferers have relatives who also suffer from SAD or other emotional problems, researchers speculate that the problem may be inherited.

Biochemical depression.

Doctors aren't sure why, but some people develop a biochemically based depression sometime during midlife. It's likely that this type of depression is caused by biochemical problems within the brain. The problem usually responds well to antidepressant medication. You may be more likely to develop this type of chemical depression if other members of your family have also suffered from this problem.

A special class of biochemical disorder is manic depression, known as bipolar disorder. The person experiences severe mood swings and intense, alternating periods of activity and despair. This requires professional intervention.

Disease or drug-related depression.

Some diseases such as AIDS, hepatitis, stroke, chronic pain, and hypothyroidism can cause depression. In hypothyroidism, the thyroid gland malfunctions, leading to too little or no thyroid hormone circulating in the bloodstream. In addition to depression, other symptoms of hypothyroidism include fatigue, weakness, weight gain, impaired memory, constipation, and shortness of breath. Fortunately, the depression and other symptoms of hypothyroidism can be effectively treated with adequate doses of thyroid hormone.

Certain drugs such as alcohol, tranquilizers, and heart and blood pressure medications, as well as withdrawal from some street drugs like cocaine, can cause drug-related depression. Some women who take birth control pills find the drugs make them irritable, anxious, and depressed. And a deficiency in some nutrients, such as folate and omega-3 fatty acid, has been linked to depression.

Teenage depression.

Recognizing depression in children is important. Depression in teenagers may appear somewhat different from adult depression. The teenage years are a period of complicated conflicts that lead many young people to develop negative self-esteem, anxieties, and fears about their future. Some young people become overwhelmed by peer pressures and feelings of isolation and powerlessness. Social expectations may be unrealistic, and doing poorly in school can lead to a feeling of rejection. The young person may have experienced a lack of support from family and other significant people and a decrease in his or her ability to cope effectively. (As is the case for adults, treatment for depression in teenagers may involve a combination of therapies.)

Special Concerns for Women

Postpartum depression.

It is common for women to feel down a few days after giving birth. This is often referred to as the "baby blues." New mothers may be weepy, insecure, and confused, wondering how they could be feeling this way when they are simultaneously so happy about having had the baby. The "blues" pass in a few days. Postpartum depression, in contrast, may begin days or even weeks after a baby is born and is a potentially more serious condition.

A woman may become very withdrawn, anxious, and agitated. She may have frightening thoughts about hurting herself or her baby and may be afraid to tell anyone what she is feeling. Whenever a woman has any of these frightening feelings, she should seek help immediately. Current medical treatments for postpartum depression are very effective.

Doctors say there are several reasons why so many new mothers experience this after-pregnancy depression: a sudden shift of hormones after birth that affects one's moods; a sense of anticlimax after the excitement of pregnancy and birth; fatigue from the rigors of late pregnancy and birth; fear and insecurity about one's ability to handle the duties of motherhood; and feelings that one's horizons have shrunk, especially if the woman has previously worked outside the home.

 

The premenstrual period.

The mood shifts, tension, anxiety, irritability, and depression many women feel during the week or days before the onset of menstruation are related to a woman's shifting hormones. Fortunately, the dark moods of women's premenstrual periods are transitory and usually lift with the first menstrual blood. This type of cyclical depression is not related to "clinical" depression that generally requires medical intervention.

The reproductive years. There's some evidence that taking birth control pills is related to depression. Some women report feelings of anxiety, sadness, and lethargy when they use certain types of the Pill.

The menopausal years.

Menopause does not necessarily mean you're going to be plunged into depression. Research does not support that women are at greater risk for depression during menopause. However, some women do experience depressive feelings during menopause. Mental health and aging experts speculate that this may be due to negative feelings some women have about aging and loss of fertility rather than to hormonal changes.

Now that you know the various types of depression, it's time to learn about the causes of the condition. We'll cover the risk factors of depression in the next section.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Depression may be related to many factors, including a family history of depression, medical illnesses, alcohol, drugs, gender, and age. Additionally, an individual's self-confidence, personality traits -- such as dependency on others or perfectionism -- and unrealistic expectations may lead to depression. Stressful events, such as death of a spouse or loss of a job, also contribute to depression. Many people with major depression also suffer from intense anxiety.

Theories of Depression

There are many theories about the causes of depression. The social learning theory suggests that lack of positive reinforcement from others may lead to negative self-evaluation and a poor outlook for the future. The psychoanalytic theory suggests that a significant loss (such as of a parent) or a withdrawal of affection in childhood (whether real or perceived) may lead to depression in later life. Interpersonal theory emphasizes the importance of social connections for good mental health. Other theories suggest that unrealistic expectations of oneself and others and loss of self-esteem are essential components leading to depression.

Some individuals may be biologically predisposed to depression; in other words, they may have been born with a tendency to develop depression. Researchers continue to investigate chemical reactions in the body that are controlled by these genes. Depression often runs in families. For example, if one identical twin suffers from depression or manic-depression, the other twin has a 70 percent chance of also having the illness.

Research indicates that some people suffering from depression have imbalances of neurotransmitters (natural body chemicals that enable brain cells to send messages to the rest of your body). Biochemicals that often are out of balance in depressed people are serotonin, norepinephrine, and dopamine. Several neurotransmitter imbalances may be involved; researchers are seeking other neurotransmitters that may be important in clinical depression.

Environmental Influences

Researchers view depression as the result of interaction between environmental and biological factors. Depression can be endogenous (internally caused) or exogenous (related to outside events). Major changes in one's environment, such as a move or job change, or any major loss, such as a divorce or death of a loved one, can bring on depression. Feeling depressed in response to these changes is normal, but when it becomes a severe long-term condition (longer than one month) and interferes with effective functioning, it requires treatment.

Some environmental factors relating to depression include being unemployed, poor, elderly, or alone. Depression changes one's way of looking at ordinary life circumstances. A depressed person tends to exaggerate negative aspects, which leads to feelings of hopelessness, helplessness, and being overwhelmed.

Debilitating diseases can severely restrict usual life-style, resulting in depression. Illnesses that affect brain functioning and impair blood flow to the brain can produce depression. Such illnesses may include malfunctions of the thyroid or parathyroid gland, diseases that affect the nerves, nutritional disorders, and infectious diseases. Depression can also occur as a side effect of certain medications.

Unhappy feelings aren't necessarily bad. In fact, some are downright healthy. For example, when someone you care about dies, mourning is a healthy form of sadness, a natural reaction to loss. Over time (sometimes a year or more), these feelings of grieving progress from bad to better.

The "downs" most people feel from the normal stresses of life usually last a few days to a week, and then resolve. In depression, however, a person often becomes stuck in the blues. There is no progression of feelings. Emotions become trapped in a repeating loop. If you feel depressed for more than a couple of weeks or if your depression interferes with your daily life, you should seek professional assistance.

After reading about the causes of depression, perhaps you suspect you or someone you know could be suffering from the condition. In the next section, we will show the symptoms of depression that you should look for.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How do you recognize symptoms of depression in yourself and others? People who suffer from depression have a number of symptoms nearly every day, all day, for at least two weeks. Depressed people have feelings of extreme sadness, hopelessness, despair, low self-worth, and helplessness. For some people, depression is marked by anxiety, withdrawal from others, loss of sleep or excessive need for sleep, constant fatigue, loss of appetite or compulsive eating, loss of sexual desire, either lethargy or agitation, an inability to concentrate and make decisions, and possibly exaggerated feelings of guilt.

Many depressed individuals have mental and physical symptoms that seem endless and do not get better with happy events or good news. Some depressed people are so disabled by their condition that they don't have enough energy to call a friend, relative, or medical professional for help. If another person calls for them, these people may refuse to go because they have no hope that they can be helped. However, family and friends should keep trying to get the depressed person to seek help, because up to 15 percent of those who suffer from severe clinical depression commit suicide.

If you're feeling depressed, you're probably having some of these symptoms:

While these symptoms might sound serious, there is hope. Depression, fortunately, is the most common and most treatable of all mental health problems. We'll learn about some treatments for depression in the next section.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Early treatment may keep the depression from becoming more severe or chronic. Many types of psychotherapies and medications are available.

Psychotherapy for Depression

Popular types of psychotherapies include:

Therapists try to understand an individual's personal and social relationships that may have caused or contributed to the depression. Depression, in turn, may make these relationships more difficult. A therapist can help an individual understand his or her illness and the relationship between depression and conflicts within a person's life.

Depression usually responds best to a treatment of both therapy and medicine.

Depression can result when individuals constantly scold themselves, expect to fail, make inaccurate assessments of what others think of them, and have negative attitudes toward the world. Psychotherapy helps many people replace negative beliefs and thought patterns with more positive ones.

In many instances, psychotherapy is combined with prescription medication. This treatment will help patients during their therapy and is very important when depression has caused a loss of work or has affected daily activities. Since medication may require several weeks to be effective, electro-convulsive shock therapy may be used when there is a high risk of suicide. Electroshocks have been viewed negatively by the media, but they are still useful in select individuals.

Medications for Depression

It takes two to six weeks for most antidepressant medications to have their full effect (in some cases, eight to ten weeks may be required), although side effects from the drug may begin immediately. The time before the drug becomes effective varies with the drug and with the individual. Antidepressants may have to be taken regularly for months, even years, for gains to continue. A full course of treatment should be taken in order to avoid relapse.

Your doctor may have you try several medications to determine which works best for you. And recent research has shown increased effectiveness in the treatment of depression when drugs from two classes of antidepressants are used together. The major types of medication used to treat depression include:

Newer Antidepressants:

Over the past 20 to 30 years, many new antidepressant drugs have become available. They act primarily by increasing the availability of individual neurotransmitters, such as norepinephrine, serotonin, or dopamine. These medications are safer in overdose situations (they're less likely to be fatal if someone takes more than the prescribed dose) than their older counterparts, and their side effects (diarrhea, digestive problems, stimulation, insomnia, weight loss) tend to be fewer, better tolerated, and more likely to fade than those of earlier antidepressants.

One of the first of these newer antidepressants to hit the market was fluoxetine (Prozac), which belongs to a type, or class, of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Other SSRIs include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft). SSRIs have become the most commonly prescribed antidepressant medications.

Other newer antidepressants that affect specific neurotransmitters are the serotonin and norepinephrine reuptake inhibitors (SNRIs), which include duloxetine (Cymbalta) and venlafaxine (Effexor), and the norepinephrine and dopamine reuptake inhibitor (NDRI) bupropion (Wellbutrin).

Tricyclic antidepressants:

From the 1960s through the 1980s, the tricyclics were the first-choice medication for the treatment of depression. Although they have been replaced by the SSRIs as the typical first-line drug treatment, they are still prescribed today for more severe cases of major depression. The side effects commonly caused by tricyclic antidepressants include weight gain, drowsiness, and constipation, which tend to be less acceptable to patients than the side effects caused by the newer antidepressants.

Monoamine oxidase inhibitors:

Monoamine oxidase inhibitors (MAOIs), an older class of antidepressants, are sometimes prescribed for those who do not respond to SSRIs or tricyclic antidepressants. MAOIs may also be prescribed for individuals who have bipolar disorder (also known as manic-depressive illness), generalized anxiety and phobic disorders, and panic attacks.

One problem with the MAOIs is that they may lead to unpredictable and occasionally serious interactions with some foods and other medications. Individuals taking MAOIs must follow a special diet, avoiding tyramine (an amino acid); otherwise, they may experience a dangerous rise in blood pressure. Tyramine is present in many foods, including fermented cheese, liver, lima beans, red wines, and beverages containing caffeine and chocolate.

Lithium:

Lithium has long been prescribed for people who have bipolar disorder (also known as manic-depressive illness), which is discussed next. Lithium, however, is also prescribed for a small number of people who suffer from depression without mania. The people most likely to respond to lithium therapy are depressed individuals whose family members have manic-depression or whose depression is recurrent rather than constant.

Lithium acts without causing sedation (drowsiness), but it requires a period of use before it becomes effective and must be used cautiously, since the difference between a safe, effective dose and a toxic one is relatively small.

Medication and therapy are not the only treatments for depression. On the next page, we will explore some alternative therapies for depression.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

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When you're depressed, you wonder whether you'll ever feel good again. You can often beat mild to moderate feelings of depression with home remedies. Here are some simple remedies you might try:

Talk about It. Often when we feel depressed, we isolate ourselves, not wanting to talk with anyone. If you're feeling down, force yourself to reach out to others. Have lunch with a sympathetic friend. Invite a close relative over for tea. Talking out your feelings is cathartic, can make you feel less isolated and alone, and can help you gain new insights into your situation.

If friends or relatives can't provide enough support, seek out a qualified mental health therapist or pastoral counselor, or look for a support group. Various support groups are available (many of them free) for a wide range of needs, including bereavement and chronic illness.

Get out and move.

When depression knocks on your door, it's easy to want to pull up the covers and hide in bed all day. That's the worst thing you can do. Mild to moderate exercise is one of the best home remedies available for fighting the blues. It's been shown to be as effective against certain types of depression as antidepressant medications (without the side effects).

Regular exercise releases endorphins, the body's own "feel good" chemicals, and can also help you feel more empowered and in charge. Any exercise helps, but aerobic exercise that gets your pulse up to between 70 and 80 percent of the maximum recommended for your age group (220 minus your age, multiplied by .7 or .8), four or five times a week, works best. If you haven't been exercising before, start with a brisk 15 or 20 minute walk three times a week. Even if you can't do that much, just get out and engage in some type of physical activity.

Try a change of scenery.

Depression caused by being stuck in a routine or by stressful life events can often be eased by taking a vacation for a few days. Don't think of a change of scenery as running away from your troubles. Instead, consider it a way to give yourself a much-needed break from your obligations and perhaps get a fresh perspective on your problems.

Don't junk out.

Often when we're stressed, we eat high-fat, high-sugar junk foods, but foods that run down your physical condition certainly don't help depression. Be sure to eat a balanced, low-fat, high-fiber diet. In particular, be sure to get an adequate amount of folate-400 milligrams to 800 milligrams per day-and omega-3 fatty acids, which can be found in tuna, salmon, and mackerel. A deficiency in those nutrients has been linked to depression. Also, avoid caffeine. It can interfere with sleep (which can make you feel run down), and insomnia has been linked to depression.

Accept and feel your feelings.

Often we feel depressed because we resist negative feelings like sadness. In order for healing to take place, mental health experts say we have to be willing to accept a loss and experience all the accompanying feelings without shame or guilt.

Get a balance of rest.

People who are depressed either sleep too much or have difficulty sleeping and become exhausted, which can further contribute to depression. If you find yourself oversleeping, set your alarm, get up, and exercise instead of sleeping late. If you're having difficulty sleeping, stay away from caffeinated beverages, don't exercise right before bed-time, and try a soothing night-cap such as hot milk or an herbal tea (not alcohol).

Write it down.

There's something powerful about writing down how you feel. It gives you an outlet for your emotions and can help you to assess your fears, feelings, and options a little more objectively.

Say goodbye.

One of the difficulties of losing a loved one is accepting the death and saying goodbye. Death and dying experts suggest writing letters to departed loved ones, telling them everything you wanted to say when they were here. Another healthy way to say goodbye and honor loved ones is with private rituals of commemoration on the anniversary of their death or at other special times like holidays. It doesn't matter how small the ceremony is. Light a candle. Say a prayer. Write a poem. Give yourself permission to re-experience those feelings of grief and say goodbye as many times and in as many ways as you need.

Reconsider your birth control.

If you're taking birth control pills and you think your depression may be related to them, ask your physician for a different formulation or try another form of birth control. If you change your birth control and you're still feeling depressed, you may want to seek professional help.

Try Saint-John's-wort.

There is some evidence that shows Saint-John's-wort, an herbal supplement, is effective in treating mild depression. However, studies show that it is not effective in treating major depression. Talk with your doctor about side effects. Saint-John's-wort can interfere with some medications, such as antidepressants, birth control pills, and drugs to treat cancer and HIV.

Use laughter.

Of course, the last thing you feel like doing when you're depressed is laughing. But research has shown that laughter is a powerful antidepressant. Rent funny movies, listen to comedy albums, or check out a comedy club.

Nix the alcohol.

Many people reach for an alcoholic drink when they feel down. Resist the urge! Alcohol makes you feel worse, since it's a depressant.

Go for the relaxation.

Try stress-reducing techniques like meditation, deep "belly" breathing, progressive relaxation, biofeedback, etc.

Ask for practical help.

If you've just given birth and you find yourself feeling depressed and overwhelmed, get help coping with the new baby. When friends and family aren't available, consider hiring some professional help, especially at first.

Try SAD lights.

If your problem is winter depression, high-intensity, full-spectrum lights have been shown to be very effective for eight out of ten SAD sufferers. Individuals who are exposed to these special lights usually experience relief within seven to ten days. You can purchase or lease these lights through mental health professionals; use them only under a professional's care.

Consider professional support.

While mild to moderate depression can often be helped with home remedies, it's important to get help when you need it. If you've tried self-care strategies and they haven't helped, if your depression lasts for several weeks, or if you're having suicidal thoughts or fantasies, don't be afraid to get professional help.

Depression can be a very serious condition. While in the midst of depressive cycle your tendency might be to close your self off from the world. However, depression will not just simply go away and there are some steps you can take to hasten its departure.

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About the Author:

Betty Burrows, Ph.D.:

Dr. Betty Burrows received her doctorate in clinical psychology from DePaul University in Chicago where she coordinates the counseling program. She also maintains a private practice specializing in stress management and related issues.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.