Depression
Description
Depression covers an extremely wide spectrum of experience, from grief and bereavement to apparently inexplicable despondency and melancholy. Every year more than 18 million Americans suffer from some type of depressive illness such as major depression; bipolar disorder (often called manic depression); and dysthymia, a form of depression that is milder, but long lasting.
Untreated major depression seriously disrupts social relationships and productivity and can lead to risk of suicide. Yet depression is one of the most treatable of all mental illnesses. More than 80 percent of people with depression have successful results with medication, psychosocial therapies, or both. Early treatment decreases the likelihood of recurrences, and the sooner treatment begins, the greater its likely effectiveness.
Symptoms
Depression is indicated if any five of the following are present for more than two weeks; if suicide is a serious concern; or if symptoms interfere with daily activities.
- Insomnia; sleeping too much; awakening in early morning; interrupted sleep
- Fatigue or loss of energy
- Irritability and restlessness
- Reduced appetite and weight loss; or increased appetite and weight gain
- Indifference to very important situations
- Loss of interest or lack of pleasure in activities, including sex
- Difficulty concentrating, remembering, or making decisions
- Feelings of guilt and hopelessness; a sense of being worthless
- Thoughts of death or suicide
- Persistent physical symptoms that don't respond to treatment (such as chronic pain or digestive disorders)
Causes
- Diathesis-stress
This is a genetic predisposition interacting with stress, which can be biological processes, such as exposure to viruses, or psychosocial, such as loss of employment. - Chemical imbalances
In people with depression, certain brain chemicals, called neurotransmitters, are typically present in incorrect amounts. Changes in these chemicals may cause or contribute to clinical depression. - Cognition
People with negative thinking patterns are more likely to develop clinical depression. Typically, these are pessimistic individuals. They may have low self-esteem, worry to excess, or feel they have little control over their lives. - Medications
Some medications, such as for anti-hypertension can cause depression. - Genetics
A family history of clinical depression increases the risk for developing the disease, although it can occur in people with no family history of the illness. - Situational factors
Life events such as divorce, death of a loved one, financial problems, relocation or other significant factors can contribute to depression. Sadness due to these events is normal; however, sadness that continues over a long period of time may require professional help. - Additional considerations
For reasons that are unclear, women are twice as likely as men to experience major depression. Hormonal changes and/or stress may be involved. Women suffering from abuse or poverty may also have an increased risk of major depression.
Also, major depression is more likely to occur along with certain illnesses such as Alzheimer's disease, diabetes, cancer, heart disease, hormonal disorders, Parkinson's disease, and stroke. Depression can also co-occur with eating disorders and anxiety disorders, and with substance abuse.
Treatment
Treatment varies with individuals. It may include antidepressant medication, psychotherapy, behavior modification, or a combination. Support groups can be helpful in overcoming the illness. As with any disorder, treatment success is enhanced by exercise, stress reduction, balanced nutrition, and proper sleep.
Severe instances of depression should be treated with medication that acts on the brain chemistry, affecting the chemical pathways associated with mood. Monoamine oxidase inhibitors (MAOIs) have been prescribed for some time. Newer types of antidepressants include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), as well as aminoketones.
A variety of non-pharmacological therapies have been found to be effective in treating milder depressions and are used as important supplements to medication in major depressive disorder. These include psychotherapy, cognitive/behavioral therapy, interpersonal therapy and Electro-Convulsive therapy.
