What is Depression?

Everyone gets blue now and then in response to life''s disappointments, but when feelings such as sadness, loneliness, exhaustion, hopelessness, and irritability persist and prevent a person from functioning normally, they may be suffering from depression.

Depression can be devastating to all areas of a person''s everyday life, affecting their relationships with family and friends, impeding their ability to work or go to school, and even disrupting their normal eating and sleeping patterns.

Depression is not a sign of personal weakness; people with a depressive illness cannot merely "pull themselves together" and get better. If left untreated, symptoms can last for weeks, months, or even years, causing needless pain and suffering, not only to the person who is depressed, but also to those who care about them. Untreated, depression can even lead to suicide.

Depression can afflict anyone, regardless of age, race, class, or gender. Nearly 20 million Americans suffer from depression each year, but only one out of ten seeks out and receives adequate treatment, even though the great majority of people with depression--including those whose illness is extremely severe--can be helped to full recovery.

Types of Depression

Depressive disorders come in different forms, just as in the case of many other illnesses. Two of the most common depressive disorders--major depressive disorder and dysthymia-are detailed below.

·        Major Depressive Disorder (often referred to as clinical depression) is manifested by a combination of symptoms that severely interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities. A diagnosis of major depressive disorder is made if an individual has five or more of the depression symptoms listed below, and at least one of the first two, during the same two-week period. Disabling episodes of major depression affect 15% of Americans and can occur one or more times in a person''s lifetime.

·        Dysthymia (sometimes called minor or chronic depression) does not strike in episodes like major depression; rather it is characterized by less intense, more persistent symptoms that may last for years (at least two years in adults, and at least one year in children or adolescents). Typically, there are no disturbances in appetite or sexual drive. Severe agitation, sedentary behavior, and suicidal thoughts are also not usually present in dysthymia. While the symptoms of dysthymia are not as disabling as those for major depression, people who suffer from this depressive disorder do experience decreased energy, general negativity, and an overall sense of dissatisfaction and hopelessness that pervades most, if not all, areas of their life. Many people with dysthymia also experience major depressive episodes; in such cases, the condition is known as double depression. Almost 10 million Americans suffer from dysthymia each year.

While major depressive disorder and dysthymia are considered the two most common depressive disorders, there are other types of depression, including adjustment disorder, complicated grief, and seasonal affective disorder.

Symptoms of Depression

Not everyone who is depressed experiences every symptom listed below. The severity of symptoms also varies with individuals. A person''s diagnosis depends on the number of symptoms they have, how strong those symptoms are, and how long they last.

·        Persistent sad, anxious, or empty mood.

·        Loss of interest or pleasure in hobbies and activities that were once enjoyed, even sex.

·        Feelings of hopelessness, pessimism.

·        Feelings of guilt, worthlessness, helplessness.

·        Insomnia, early-morning awakening, or oversleeping.

·        Significant change in appetite or body weight.

·        Decreased energy, fatigue, feeling "slowed down."

·        Recurrent thoughts of death or suicide; suicide attempts.

·        Restlessness, irritability.

·        Difficulty concentrating, remembering, making decisions.

·        Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

For a child or adolescent, symptoms of depression also include such youth-specific considerations as performance in school and interaction with classmates.

Causes of Depression

There are many possible factors that can contribute to depression. For some people, depression is the result of a combination of factors, while for others, a single cause can be responsible for the onset of depression. Common contributing factors include the following:

Stressful Life Events

Catastrophic illness or death of a close family member or friend, divorce, career crisis, moving to a new place, financial problems, or any unwelcome change in life patterns can be risk factors for depression. Research also indicates that stressors in the form of social isolation or early-life deprivation can lead to permanent changes in brain function that increase susceptibility to depressive symptoms. For some individuals, stressful life events can contribute to recurrent episodes of depression.

Severe or Chronic Illness

Severe or long-term illness can bring on or aggravate depression. Up to 60% of chronic pain patients suffer from some degree of clinical depression. There are also illnesses that may be directly related to depressive disorders, such as strokes, heart disease, certain types of cancer, thyroid disease, diabetes, Parkinson''s disease, Alzheimer''s disease, and hormonal abnormalities. When it occurs with other illnesses, depression is frequently unrecognized and goes untreated. This can lead to unnecessary suffering since depression is highly treatable, even when it occurs with other disorders. Individuals or family members with concerns about the occurrence of depression with another illness should discuss this issue with their physician.

Medication Side-Effects

Some medications cause depressive symptoms as side effects; among them are pain relievers for arthritis, cholesterol-lowering drugs, certain medications for high blood pressure and heart problems, and bronchodilators used for asthma and other lung disorders. In addition, different drugs can interact in unforeseen ways when taken together. It is important that each physician and pharmacist knows all the different types and dosages of medicine being taken and discusses the possible side effects with the patient.

Biological Factors

Genetics research indicates that vulnerability to depression results from the influence of brain chemistry imbalance acting together with environmental factors. Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters-chemicals used by nerve cells to communicate-are out of balance.

Co-Occurrence of Depression and Anxiety

Research has revealed that depression can co-exist with anxiety disorders (e.g., panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social phobia, or generalized anxiety disorder). Studies have shown an increased risk of suicide attempts in people with co-occurring depression and panic disorder, the anxiety disorder characterized by unexpected and repeated episodes of intense fear and physical symptoms, including chest pain, dizziness, and shortness of breath. Rates of depression are especially high in people with post-traumatic stress disorder, a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Substance Abuse and Addictions

It is estimated that 25% of people with substance abuse suffer from major depression.

Family History

Evidence suggests that depression runs in families. Still, just because a person has family members with depression does not guarantee that he or she will develop it. Similarly, a person may get depression even if no one else in their family has experienced it.

Treating Depression

The sooner depression is treated, the sooner recovery can begin. The American Psychiatric Association reports that "80% to 90% of all people with depression-even those with the severest cases-improve once they receive appropriate treatment." Basic ways to treat depression include therapy, medication, and a combination of the two.

Therapy

There are therapists who are especially skilled at helping people who are suffering from depression. Therapy provides a safe, comforting, and confidential setting in which to receive the kind of help and understanding that can best assist in first relieving, then understanding, and finally recovering from the effects of depression. It can take as few as one to two weeks for people to receive relief from their symptoms with therapy.

Medication

Antidepressant medication is often the first step in treating cases of depression because of the relatively quick relief it can bring to physical symptoms. Once medication treatment begins, minor improvement is usually seen in one to two weeks and the full effect of relief becomes evident approximately three to four weeks later.

Combination of Therapy and Medication

In some cases, neither therapy alone nor medication alone may treat depression as quickly or thoroughly as the patient or the therapist would like. For these cases, both types of treatment used together can have very successful results. For those who suffer from chronic depression, combination therapy is especially helpful in dealing with the condition and how it affects their lives.

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