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Depression is an umbrella term used to describe conditions that are characterized by long-term mood irregularity and/or sadness. There are several types of depressive disorders. These are:
People who suffer from all types of depressive disorders can experience persistent feelings of sadness, loss of interest, fatigue, and are at a higher risk for debilitating physical ailments such as heart disease, obesity, and stroke. Depressive disorders can change thought patterns, behavior, physical appearances, and interfere with marriages, relationships with family and friends, and performance in the workplace.
Depression affects women almost twice as often as men – 1 in 5 women will be affected by depressive disorders during their lifetime, compared to 1 in 10 men. Among the most famous depression sufferers are Angelina Jolie, Owen Wilson, Uma Thurman, and Cheryl Crow. Though such a large number of Americans are affected by depression, only few will receive treatment. Over 80% of people experiencing symptoms of clinical depression do not seek help for their condition
According to the Centers for Disease Control, an estimated one in 10 U.S. adults suffers from depression, a mental illness that can adversely affect the course and outcome of common chronic conditions, such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity. Depression also can result in increased work absenteeism, short-term disability, decreased productivity, and suicide. The American Association of Suicidology reports that if left untreated, depression can lead to co-morbid mental disorders such as alcohol and substance abuse, higher rates of recurrent episodes, and higher rates of suicide.
The World Health Organization (WHO) estimates that by the year 2020, depression will be the number two cause of “lost years of healthy life” worldwide. The most recent data compiled by the Centers for Disease Control, from 1988–1994 through 2005–2008, shows that the rate of antidepressant use in the United States among all ages increased nearly 400%. About one in 10 Americans aged 12 and over takes antidepressant medication. Antidepressants were the most frequently used prescription drugs by persons aged 18 to 44 years and the third most common prescription drug taken by Americans of all ages in 2005–2008.
In addition, the CDC reports that only about one-third of people with severe depressive symptoms take antidepressant medication. The U.S. Preventive Services Task Force recommends that health-care providers screen adults for depression when programs are in place to ensure that accurate diagnosis and effective treatment can be provided with careful monitoring and follow-up. The Task Force on Community Preventive Services recommends collaborative care, an approach that involves the collaboration of primary care providers, mental health specialists and other providers to improve disease management for adults with major depression on the basis of strong evidence of effectiveness in improving short-term depression outcomes.
Depression is a complex disease with multiple causes that are still being investigated by researchers. Currently, it is believed that depression is caused by a combination of factors.
These include:
There are many factors that can put you at an increased risk for developing depression. These are:
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may also do a mental health evaluation and search for physical causes of depression. These findings will be used to make the diagnosis. There is no blood test or specific diagnostic test for depression.
Depression is often diagnosed based on the following:
Initial assessment
Your doctor will ask about your symptoms:
Physical exam
Your doctor will give you a thorough physical exam. Certain medications, as well as some medical conditions, such as viral infection, can cause the same symptoms as depression. Your doctor can rule out these possibilities through a physical exam, interview, and lab tests. The physical exam may include a mental status exam to determine if your speech, thought patterns, or memory have been affected. This may indicate a neurologic cause of depression.
Psychological evaluation
A psychiatrist, psychologist, social worker, or mental health counselor can give you a psychological exam. You may take a special screening test for depression, such as the Beck Depression Inventory or the Hamilton Rating Scale. These tests have limitations, however, and must be interpreted in the context of your symptoms and personal situation.
Evaluation for other conditions that may coexist with depression, such as alcohol abuse and alcoholism, drug abuse and drug addiction, anxiety, and personality disorders, will be done as well.
Not everyone who suffers from depression will experience each symptom outlined below, however if you are experiencing 5 or more of these symptoms on a daily basis, you may be depressed.
Depression is a chronic illness. 50% of people who suffer from one episode of depression will suffer from another at some point during their lives, 70% of people who experience two episodes will experience a third, and 90% of those who experience three will experience a fourth. However with effective treatment, the relapse rate for depressive episodes can be much lower. The length of depressive episodes varies from person to person, and can span anywhere from a few weeks to a few years. Medications can be helpful to decrease symptoms as they appear with episodes, and therapies may be useful to help the patient identify personal patterns and warning signs of a depressive episode. The majority of patients (70-80%) report an improvement in symptoms after seeking treatment. However, only 80% of the total people affected will seek treatment in the first place.
In addition to the psychotherapy and medication treatments detailed below, there are strategies you can employ to improve your results and keep depression from recurring:
Take care of yourself. This includes:
Eating well. A study published in Archives of General Psychiatry in 2009 showed a link between consuming a Mediterranean diet and a reduced risk of depression. The diet consists mainly of vegetables, fruits, nuts, whole grains, fish, and olive oil. The research, done at University of Las Palmas de Gran Canaria and Clinic of the University in Spain, found that participants who followed the Mediterranean diet most closely had a greater than 30 percent reduction in the risk of depression compared to those who had the lowest Mediterranean diet scores. The association did not change when the results were adjusted for other markers of a healthy lifestyle.
Exercising. Exercise was shown to be an effective treatment for major depressive disorder according to a report in the May 2013 issue of the Journal of Psychiatric Practice. The authors of the article, based on research done at Texas Southwestern Medical Center in Dallas, report that aerobic exercise is the preferred form of exercise for patients with depression but that there is also support for resistance training. They recommend that patients participate in three to five exercise sessions per week, for 45 to 60 minutes per session. In terms of intensity, for aerobic exercise, they recommend achieving a heart rate that is 50 to 85 percent of the individual’s maximum heart rate (HRmax). For resistance training, they recommend a variety of upper and lower body exercises―three sets of eight repetitions at 80 percent of 1-repetition maximum (RM—that is, 80 percent of the maximum weight that the person can lift one time). Data suggest that patients may experience improvement in depressive symptoms as little as four weeks after starting exercise.
Getting enough sleep. A genetic study of 1,788 adult twins reported links between sleep duration and depression. The studies were published in the February 1st 2014 issue of Sleep, the journal of the American Academy of Sleep Medicine. Depressive symptoms increased to 53 percent among twins with a short sleep duration of five hours per night and 49 percent among those who reported sleeping 10 hours per night. A release from the academy quotes principal investigator Dr. Nathaniel Watson, of the University of Washington Medicine Sleep Center in Seattle as saying, ” “Both short and excessively long sleep durations appear to activate genes related to depressive symptoms.” According to Watson, the study suggests that optimizing sleep may be one way to maximize the effectiveness of treatments for depression such as psychotherapy.
Taking time to laugh and have fun. Research presented at the121st Annual Meeting of the American Physiological Society in 2008 in San Diego verified earlier work showing that the anticipation of “mirthful laughter” increased the level of beta-endorphins, the family of chemicals that alleviates depression, by 27 percent. There was no such increase among the control group who did not anticipate watching the humor film. Using a similar protocol, the 2008 research found that the same anticipation of laughter also reduced the levels of three stress hormones, epinephrine (also known as adrenaline), and dopac by39, 70 and 38 percent, respectively.
Avoiding self blame. A study done in 2010 at University Pierre & Marie Curie in Paris found that a dysfunction of the medial prefrontal region of the brain may explain why depressed patients engage in self-blame and rumination. Cognitive behavior therapy can help diminish these problems. Yet on a daily basis, simply recognizing the destructive thoughts as they being to form and distracting yourself with upbeat activities such as exercising or watching Comedy Central shows can help derail the negative emotions.
Focusing on feelings of gratitude. Research done at Kent State University in 2008 showed that writing a letter of gratitude every two weeks to thank someone who had positively impacted participants’ lives resulted in a decrease in depressive symptoms. After the study was completed, 75 percent of the participants said they planned to continue to write letters of gratitude.
Having a support system. Surround yourself with people who care about you and who treat you well. As noted in the section on Prevention, both spiritual and social support are valuable in dealing with depression.
The U.S. Preventative Services Task Force asserts that screening improves the accurate identification of depression in adults. They recommend primary care physicians ask these two questions of patients at regular checkups, or patients who they believe might be suffering from depression:
1. “Over the past two weeks, have you felt down, depressed, or hopeless?”
2. “Over the past two weeks, have you felt little interest or pleasure in doing things?”
There are many risk factors (like genetics) for depression that you cannot control, however there are many strategies you can use to help reduce your
Reduce stress. Here are some relaxation techniques that can help lower your cortisol level.
Be aware of warning signs, including the desire to isolate. According to the National Institute of Mental Health, these are the red flags:
Develop and maintain healthy habits – eat well, get exercise and a good night’s sleep.
Have a strong support system, both spiritual and social:
Help others. Reaching out to others who are suffering enables you to put things in perspective.
Check up on yourself. Ask yourself if you have fallen into bad habits such as ruminating, constantly putting yourself down, or if you have you been feeling sad or hopeless.
See a mental health professional if you catch yourself falling into any depressive behaviors. The earlier your doctor knows about your condition, the sooner he or she will be able to help you.
It is commonly believed that depression is caused by a combination of biological, environmental and psychological factors. A complex disorder demands a multi-tiered treatment approach. This typically involves psychotherapy and sometimes medication . It is not recommended to just do medication. They stabilize you but don’t help you make lasting changes.
PSYCHOTHERAPY
Types of “talk therapy” that ultimately enable you to understand the triggers for your depression and offers effective coping strategies include:
No matter what type of therapy you choose, remember it is a collaborative process and the more pro-active you are in your treatment, the more effective treatment will be.
MEDICATION
Nearly every month, it feels as though promising new medications and treatments for depression are being announced. So don’t give up hope if the first treatment you try isn’t successful. Indeed, about 40 to 50 percent of people don’t respond to the
first anti-depressant they are prescribed. But if you persist (this involves working with a qualified and caring doctor), the right treatment can be found.
Most anti-depressants work by affecting the neurotransmitters associated with depression, in particular the neurotransmitters serotonin and norepinephrine. Each class of anti-depressants affects the neurotransmitters in slightly different ways.
The following medications are approved by the Federal Drug Administration (FDA):
Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains. These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine.
The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include:
Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include
Another antidepressant that is commonly used is bupropion (Wellbutrin). Bupropion, which works on the neurotransmitter dopamine, is unique in that it does not fit into any specific drug type.
SSRIs and SNRIs are popular because they do not cause as many side effects as older classes of antidepressants. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs).
There are a number of complementary practices that can help with depression and/or anxiety.
Stress and relaxation techniques can help reduce symptoms of depression and anxiety. Here are some stress and relaxation practices, which have been shown to help relieve symptoms in research studies.
Whether you have depression or you know someone who suffers from depression, stay mindful and aware of when and how depression presents itself.
Here are a few tips to avoid depression-triggering events and keep healthy:
The earlier you seek help, the sooner you can stop suffering. Visit a doctor if you:
If you have thoughts about death or suicide, immediately call your doctor or call one of several suicide helpline .
If you suspect you have depression, schedule a visit with your Primary Care Physician (PCP) for a complete physical to rule out other possible causes of your symptoms. Your doctor will then give you a referral to a counselor or therapist trained to deal with depression, who can help you feel better.
The following are a few questions you may want to ask your doctor during your visit:
General questions:
Questions about treatment:
Questions about lifestyle changes:
Questions about the future:
If you decide to try counseling, interview potential counselors and find one with whom you feel comfortable discussing your problems.
Ask the counselor such questions as:
For more information about types of depression, visit:
National Institute of Mental Health
National Alliance on Mental Illness
Mental Health America
Depression and Addiction Rehab
Depression and College Students
The College Student’s Guide to Depression
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