While everyone feels sad from time to time, if that occurs most days for more than two weeks, it could mean that clinical depression is occurring. Major depression is a period of sadness, irritability, or low motivation that occurs with other symptoms, lasts at least two weeks in a row, and is severe enough to negatively affect one's life. Depression is not a sign of weakness or a character flaw. It is a real and treatable medical illness.
These PET scans of the brain indicate low activity in a person suffering from depression compared to someone who is not depressed.
The most prominent symptoms of depression are usually a sad or irritable mood and/or loss of interest in all or most activities that used to be pleasurable. Patients may also experience guilt despite having done nothing wrong, as well as feeling worthless, hopeless, and/or have recurring thoughts of wanting to die, kill, or otherwise harm themselves, as in cutting or burning themselves¬¬.
Depression can sometimes be associated with physical symptoms. Examples may include the following:
- Tiredness and low energy level
- Trouble sleeping, particularly early morning waking
- Sleeping too much
- Aches or pains, especially headaches, muscle cramps, or digestive problems (for example, stomachaches, diarrhea, or constipation) that do not improve even with pain focused treatment
- Feeling or seeming slowed down or agitated
Depression can worsen many other medical problems, especially those that cause chronic pain. Certain brain chemicals affect pain and mood, and treating depression tends to improve the symptoms and outcomes of many physical illnesses.
Some individuals with depression experience an increase or decrease in appetite, which may lead to substantial loss or gain in weight.
Left untreated, the symptoms of depression can negatively impact the sufferer's activities, relationships, and career. Depressed people often have trouble concentrating and making decisions. They may stop participating in activities they used to enjoy, including sex, as well as no longer spending time with loved ones. In severe cases, depression can be fatal as the result of homicide or suicide.
People with depression are at risk for trying to commit suicide. Warning signs may include talking about suicide or dying, threatening to hurt others, becoming irritable or taking excessive risks, giving away personal belongings, or otherwise settling personal affairs. Any warning signs for suicide should be taken very seriously and immediate help should be sought, either through the closest emergency room or in discussion with a suicide hotline. Two suicide hotlines include 800-SUICIDE (800-784-2433) and 800-273-TALK (800-273-8255).
While anyone can develop depression, it is widely thought that a family history of depression is a risk factor for the illness. For example, being the child or sibling of a depressed person increases one's risk of developing a depressive disorder. Women are twice as likely as men to have this condition at some point in their lives. How often depression occurs may be difficult to determine since symptoms of this illness can vary somewhat based on gender, age, and ethnic background.
While it is not clear what specifically causes depression, a widely accepted theory is a change in brain structure and chemistry. Specifically, substances called neurotransmitters are out of balance in depressed people. Possible causes for the imbalance include certain medications, alcohol or substance abuse, hormonal or seasonal changes, or enduring a traumatic event, like being the victim of abuse or losing a loved one or a job.
If someone has a pattern of feeling depressed in a particular season, he or she may have a type of depression called seasonal affective disorder (SAD). Although SAD may occur in any season, it is most likely to occur fall and winter, when the daylight hours are shorter. Research shows that SAD occurs in about 3%-20% of all people, depending upon where they live.
What people commonly call the "baby blues" afflicts up to 75% of new mothers. More than 10% of those women experience more severe and persistent sadness even if their baby is healthy. That condition, called postpartum depression, has symptoms that are very similar to the symptoms of major depression. However, in postpartum depression, the baby's well-being may become at risk since a depressed mother may have trouble enjoying, bonding with, and caring for her infant. In rare instances, the mother may become a danger to herself or her infant.
Depression afflicts about 2% of children in grade school and about 10% of teens In the United States. It can impair the child or adolescent's friendships and school performance. Many of the symptoms are similar to those in depressed adults, but depression can be harder to diagnose in children, partly because they may revert to earlier behaviors (regress), seem angry, or engage in risky behaviors.
A specific blood test for depression has yet to be developed. Therefore, doctors must use the sufferer's description of their symptoms in order to diagnose this condition. Other information that is usually gathered as part of the assessment include information about medical history, substance abuse, and medication use since these issues may contribute to symptoms of depression. Understanding someone's family medical and mental-health history can help determine what he or she is at risk for developing. Discussing moods, behaviors, and daily activities can help the mental-health professional assess the severity and type of depression the person is experiencing. Gathering all this information is important to the professional in order to provide the best treatment.
Research shows that different forms of talk therapy (psychotherapy) can help alleviate depression that is of mild to moderate severity. The goal of cognitive behavioral therapy is to help the individual alter ways of thinking and behaving that may lead to depression. Interpersonal therapy works with the depressed person to understand how his or her ways of interacting with others can contribute to depression. Psychodynamic therapy helps the depression sufferer understand and come to terms with how issues from their past may unconsciously affect their current moods and actions. Studies indicate that most people who are having their first episode of major depression need at least six months of treatment to resolve the depressive episode.
Many medications, antidepressants, are effective for the treatment of depression. These medications affect the levels of brain chemicals, like serotonin and norepinephrine. It may take some weeks to feel the positive effect of these medications, so it is important to remain vigilant in taking them and working with a doctor in the process. Studies show that people suffering from depression tend to get better faster and more robustly when treated with a combination of psychotherapy and medication compared to treatment with either medication or therapy alone.
Studies show that moderate exercise can be an important part of alleviating mild to moderate depression because it causes the release of chemicals called endorphins. In addition to the medical benefits of exercise, the release of endorphins tends to elevate mood and self-esteem, decrease stress, increase energy level, and improve sleep. Engaging in just 30 minutes of activity that elevates heart rate three to four times per week is enough for anyone to reap the benefits of exercise.
Light therapy, also called phototherapy, can be an effective treatment for SAD and other types of depression. This form of treatment involves sitting in front of a medical light box that emits a specific kind of light for several minutes per day. Phototherapy should only be used when recommended by a doctor and is often used with psychotherapy or medication to achieve the best effects.
St. John's wort is an herbal supplement that has been found to be a potential help for mild depression, but two large studies have shown it is ineffective against moderate or severe depression. Also, St. John's wort can interact poorly with other medications. It is therefore important to ask a doctor before taking this or any other supplement.
While loving pets cannot take the place of psychotherapy and medication in treating depression, these family members can be helpful for many people who suffer from mild depression. Pets relieve stress by providing love and companionship. Research shows that animal-assisted therapy can also decrease agitation that often goes with depression.
Since loneliness often accompanies depression, having good relationships and social support can be an important part of recovery from this illness. Joining a support group, either in person or online, having regular contact with loved ones, or joining a club can help ward off becoming socially isolated. Spiritual connectedness, either with other people at a place of worship or just believing in a power bigger than oneself, can help decrease depression as well.
Vagus nerve stimulation (VNS) helps patients who suffer from chronic treatment-resistant depression that does not improve with the combination of psychotherapy and medication. VNS requires the surgical insertion of an electrical device that alleviates depression by inducing a normal electrical pattern in the brain by sending electrical pulses through the vagus nerve in the neck. However, it may take several months of treatments before any improvements in depression are noted.
Electroconvulsive therapy (ECT) is another treatment option for people who struggle with severe treatment-resistant depression. This treatment involves administering electric impulses to create a controlled seizure while the patient is under sedation. ECT helps 80% to 90% of people who receive it, which is significant, given that most of those individuals would otherwise continue to suffer. While this form of treatment has a history of stigma attached to it, changes in the way it was implemented decades ago have significantly decreased side effects and improved its effectiveness.
Repetitive transcranial magnetic stimulation (rTMS) is another option for people with severe depression that does not respond adequately to medication and psychotherapy. With rTMS, physicians aim electromagnetic currents at the skull to stimulate a small electrical current in a part of the brain linked to depression. In contrast to ECT, rTMS does not cause a seizure and seems to have few side effects. However, not many doctors have the training and experience to implement this form of treatment.
While afflicted with the symptoms of major depression, one might feel hopeless and unable to function. However, this condition is quite treatable and as much as 80% of people with the condition recover with the help of medication, talk therapy, or both forms of treatment. For those who do not improve with those traditional treatments, interventions like VNS, ECT, or rTMS can bring significant relief for many people.
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