- A depressive disorder is a mood disorder that is characterized by a sad, blue mood that goes above and beyond normal sadness or grief.
- A depressive disorder is a syndrome, meaning a group of symptoms.
- Depressive disorders are feature not only negative thoughts, moods, and behaviors but also specific changes in bodily functions (like, eating, sleeping, energy and sexual activity).
- One in 10 people will have a depression in their lifetime.
- Because depression can lead to self-harm including suicide, it is important to note that one of every 25 suicide attempts results in death.
- Some types of depression, especially bipolar depression, run in families.
- While there are many social, psychological, and environmental risk factors for developing depression, some are particularly prevalent in one gender or the other, or in particular age or ethnic groups.
- There can be some differences in symptoms of depression depending on age, gender, and ethnicity.
- Depression is only diagnosed clinically in that there is no laboratory test or X-ray for depression. It is therefore crucial to see a health professional as soon as you notice symptoms of depression in yourself, your friends, or family.
- The first step in getting appropriate treatment is a complete physical and psychological evaluation to determine whether the person, in fact, has a depressive disorder.
- Depression is not a weaknss but a serious illness with biological, psychological, and social aspects to its cause, symptoms, and treatment. A person cannot will it away. Untreated or undertreated, it can worsen or return.
- There are many safe and effective medications, particularly the SSRIs, that can be of great help in the treatment of depression.
- For full recovery from a mood disorder, regardless of whether there is a precipitating factor or it seems to come out of the blue, treatments with medications, phototherapy and/or electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), as well as psychotherapy are necessary.
- In the future, through depression research and education, we will continue to improve our treatments, decrease society's burden, and hopefully improve prevention of this illness.
What is a depressive disorder?
Depressive disorders are mood disorders that have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his becoming clinically depressed.
In the 1950s and '60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job. In the 1970s and '80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive illness? Although these issues are sometimes disputed by experts, most agree on the following:
- A depressive disorder is a syndrome (group of symptoms) that is characterized by sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional problems than is normal.
- Depressive signs and symptoms not only include negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, excessive crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The changes in functioning associated with clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain are thought to cause many physical symptoms that result in a decreased or increased activity level and other problems with functioning.
- People with certain depressive disorders, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.
- Depressive illnesses are a huge public-health problem, due to its affecting millions of people. Facts about depression include that about 10% of adults, up to 8% of teens, and 2% of preteen children experience some kind of depressive disorder. Postpartum depression is the most common mental health disorder to afflict women after childbirth.Depression is usually first identified in a primary-care setting, not in a mental health professional's office. Moreover, it often assumes various disguises, which causes depression to be frequently underdiagnosed.
- The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism from work or school.
- Adolescents who suffer from depression are at risk for developing and maintainingobesity.
- In a major medical study, depression caused significant problems in the functioning (morbidity) of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in some ways as often as coronary artery disease.
- Depression can increase the risks for developing coronary artery disease andasthma, contracting the human immunodeficiency virus (HIV) and many other medical illnesses. Other complications of depression include its tendency to increase the morbidity (illness/negative health effects) and mortality (death) from these and many other medical conditions.
- Depression can coexist with virtually every other mental health condition, aggravating the status of those who suffer the combination of both depression and the other mental illness.
- Depression in the elderly tends to be chronic, has a low rate of recovery, and is often undertreated. This is of particular concern given that elderly men, particularly elderly white men have the highest suicide rate.
- In spite of clear research evidence and clinical guidelines regarding treatment, depression is often undertreated. Hopefully, this situation can change for the better.
- For full recovery from a mood disorder, regardless of whether there is a precipitating factor or it seems to come out of the blue, treatment with medication, phototherapy, electroconvulsive therapy (ECT) and/or transcranial magnetic stimulation, (see discussion below) as well as psychotherapy are necessary.
What are myths about depression?The following are myths about depression and its treatment. It is a weakness rather than an illness. If the sufferer just tries hard enough, it will go away. If you ignore depression in yourself or a loved one, it will go away. Highly intelligent or highly accomplished people do not get depressed. Poor people do not get depressed. People with developmental disabilities do not get depressed. People with depression are "crazy." Depression does not really exist. Children, teens, the elderly, or men do not get depressed. There are ethnic groups for whom depression does not occur. Depression cannot look like (present as) irritability. People who tell someone they are thinking about committing suicide are only trying to get attention and would never do it, especially if they have talked about it before. People with depression cannot have another mental or medical condition at the same time. Psychiatric medications are all addicting. Psychiatric medications do not work; any improvement felt is in the sufferer's imagination. Psychiatric medications are never necessary to treat depression. Medication is the only effective treatment for depression. Children and teens should never be givenantidepressant medication.
What are the types of depression, and what are depression symptoms and signs?Depressive disorders are mood disorders that come in different forms, just as do other illnesses, such as heart disease and diabetes. Three of the most common types of depressive disorders are discussed below. However, remember that within each of these types, there are variations in the number, timing, severity, and persistence of symptoms. There are sometimes also differences in how individuals express and/or experience depression based on age, gender, and culture.The pattern of symptoms may fit a pattern within any type of depression. For example, a person who suffers from persistent depressive disorder, major depressive disorder, bipolar disorder, or any other illness that includes depression can have prominently anxious, melancholic, mixed, psychotic, or atypical features. Such features can have a significant impact on the approach to treatment that may be most effective. For example, for the person whose depression includes prominent anxiety, a focus of treatment is more likely to be effective if the sufferer's pattern of repeatedly going over thoughts is a major focus of treatment, versus an individual with melancholic features, who may need more intensive support in the morning when the intensity of depression tends to be worse, or versus a person with atypical features, whose tendency toward weight gainand excessive sleeping may require nutritional counseling to address dietary issues.
Major depressive disorderMajor depression, also often referred to as unipolar depression, is characterized by a combination of symptoms that lasts for at least two weeks in a row, including sad and/or irritable mood (see symptom list), that interferes with the ability to work, sleep, eat, and enjoy once-pleasurable activities. Difficulties in sleeping or eating can take the form of excessive or insufficient of either behavior. Disabling episodes of depression can occur once, twice, or several times in a lifetime.
Persistent depressive disorder (dysthymia)Persistent depressive disorder, formerly referred to as dysthymia, is a less severe but usually more long-lasting type of depression compared to major depression. It involves long-term (chronic) symptoms that do not disable but yet prevent the affected person from functioning at "full steam" or from feeling good. Sometimes, people with persistent depressive disorder also experience episodes of major depression. This combination of the two types of depression often is referred to as double-depression.
Bipolar disorder (manic depression)Another type of depression is bipolar disorder, which encompasses a group of mood disorders that were formerly called manic-depressive illness or manic depression. These conditions often show a particular pattern of inheritance. Not nearly as common as the other types of depressive illnesses, bipolar disorders involve cycles of mood that include at least one episode of mania or hypomania and may include episodes of depression, as well. Bipolar disorders are often chronic and recurring. Sometimes, the mood switches are dramatic and rapid, but most often they are gradual, in that they usually take place over several days, weeks, or longer.When in the depressed cycle, the person can experience any or all of the symptoms of a depressive condition. When in the manic cycle, any or all of the symptoms listed later in this article under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, indiscriminate or otherwise unsafe sexual practices or unwise business or financial decisions may be made when an individual is in a manic phase.A significant variant of the bipolar disorders is designated as bipolar II disorder. (The usual form of bipolar disorder is referred to as bipolar I disorder.) Bipolar II disorder is a syndrome in which the affected person has repeated depressive episodes punctuated by what is called hypomania (mini-highs). These euphoric states in bipolar II do not completely meet the criteria for the full manic episodes that occur in bipolar I.
Symptoms of depression and maniaNot everyone who is depressed or manic experiences every symptom. Some people suffer from a few symptoms and some many symptoms. The severity of symptoms also varies with individuals. Less severe symptoms that precede the more debilitating symptoms are often called warning signs.
Depressive symptoms of major depression or manic depression
- Persistent feelings of sadness, anxiety, anger, irritability, discontent, or "emptiness"
- Feelings of hopelessness or pessimism
- Feelings of worthlessness, helplessness, or excessive guilt
- Loss of interest or inability to feel pleasure in hobbies and activities that were once enjoyed, including sex
- Apathy/lack of motivation
- Social isolation, meaning the sufferer avoids interactions with family or friends
- Sleep changes, like insomnia, early morning awakening, restless sleep, excess sleepiness, or oversleeping
- Appetite changes, like loss of appetite and/or weight, or excessive hunger, overeating, and/or weight gain
- Fatigue, decreased energy levels, slowness in activity or thought
- Crying spells
- Thoughts of death or suicide, suicide attempts
- Restlessness, agitation, irritability
- Inability to concentrate, remember things, or make decisions
- Persistent physical symptoms that do not respond to treatment, such as repeated headaches, digestive disorders, and/or chronic pain
Mania symptoms of manic depression
- Inappropriate or excessive elation
- Inappropriate or excessive irritability or anger
- Severe insomnia or decreased need to sleep
- Grandiose notions, like having special powers or importance
- Increased talking speed and/or volume
- Disconnected thoughts or speech
- Racing thoughts
- Severely increased sexual desire and/or activity
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior.