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There are times when depression
is an absolutely sane behavior. A year ago my mother in law suffered
a stroke, lost her job and had a leg amputated in matter of weeks.
When the nursing facility sent her to a $10K /week facility until her
insurance ran out.. the expert solemnly told my wife IN PRIVATE "Your
mother is depressed." Such profundity...
Depression: An Overview
Gary Goldberg
PhD, Private Practice,
Brooklyn, NY and South Orange, NJ
The Numbers
Whether you know it or not, you have firsthand knowledge of depression.
You may work with someone that is depressed, have a friend or family
member that is depressed, or you may be depressed yourself. How can I be
so sure? Let’s look at the facts.
Right now, there are more than 25 million depressed people living in the
United States. There is a depressed person in one of every five American
homes. Major depression (the more serious category of depressive illness)
will probably affect 40 million Americans at least once in their lifetime.
If you are a woman or older than the age of 40, you are more likely to
report
that you are depressed. If you are a depressed male, there is a good
chance that you will suffer in silence. This is why the statistics on
depression probably underestimate the number of people who are suffering.
In addition, more people are now developing depression at a younger age.
For the baby-boomer generation (those born after 1940), the number of
people that were depressed by the age of 25 is in the tens of millions!
Depression is a very costly affliction in both economic and human terms.
Every year businesses in this country lose 15 to 35 billion dollars due to
depression. This includes medical treatment, missed workdays, decreased
productivity, and increased worker turnover. While businesses lose huge
sums of money, people probably lose more, especially if their depression
continues untreated. Depression leads to substance abuse, destroys careers
and relationships, and wrecks a person’s self-esteem.
As mentioned above, the depression statistics are almost certainly
under-estimates. This is because many cases of depression are unreported
or misdiagnosed. It has been estimated that as many as two-thirds of
people who have depression fail to seek treatment. The symptoms of the
condition itself often prevent a person from finding help. Difficulty
making decisions, feelings of hopelessness and helplessness, self
loathing, and extreme fatigue are all symptoms of depression that can
interfere with a person’s motivation to seek treatment.
Another reason that many people do not seek treatment is because
depressive illness is misunderstood. These people experience their
depression as a sign of weakness. They expect that they should be able to
“snap out of it” themselves. In a substantial number of cases these
feelings of self-reproach are reinforced by the attitudes of family
members or close friends. The truth is that depression is no more a
personal failure than cancer, diabetes, or any other medical condition.
You cannot “snap out of it” at will. In fact, without proper treatment,
depression can last for many months, or even years.
The bad news is that the longer the illness goes undiagnosed and
untreated, the more difficult it is to treat. Serious, untreated
depression can result in suicide. People whose depression has developed to
the extent that they require hospitalization, have a suicide rate of
approximately 15 to 20 percent.
The good news is that with new discoveries and treatment techniques,
depression is a highly treatable illness. With proper care administered by
trained professionals, the symptoms of depression can be reduced or cured
for 80 percent of patients treated.
What is Depression?
Depression is a type of mental disorder that affects a person’s mood.
Normal feelings fall along a continuum from mild to intense, and the same
is true of depression. It is normal to respond to losses in one’s life
with sadness and gloom. But when these feelings block a person from
performing their everyday activities or are out of line with the reality
of a person’s life, they are considered symptoms of a depressive disorder.
Depression is a term that is often used to describe periods of intense
sadness. Everyone experiences down times. However, when you experience an overwhelming and long-lasting feeling of debilitating sadness that
interferes with your everyday ability to function, you are said to have a
condition known as major depression. People who are sad or "have the
blues" due to the loss of a loved one, a job, or even a fight with a
girlfriend or a boyfriend may have difficulty functioning for a short
period of time. But these people are usually able to continue their
activities without professional assistance. They can live their everyday
lives despite their sadness. However, when these symptoms do not readily
fade and continue to block you from thinking and acting in a functional
manner, you are depressed and usually need to undergo professional
treatment to resume your normal lifestyle.
What Causes Depression?
Experts are still not sure about the causes of depression. This is because
they are complicated and not completely understood. In the past, doctors
believed that depression was the result of thoughts or emotions that were
troubling for a person. More recently, experts realize that there can be
several factors working together that will lead a person to become
depressed. The three most important of these are biological, genetic, and
environmental factors.
Biological causes are due to changes in the chemistry of the brain, such
as
fluctuations in the levels of important hormones. Genetic causes are the
result of what you inherit from your parents. If one or both of your
parents have a vulnerability to depression, then it can be transmitted to
you. Environmental factors (also called emotional factors) result from
stressful emotional situations, such as a lack of loving parents or the
death of a parent during childhood. To make it even more complicated,
depression can also occur as a result of a combination of the three
factors just mentioned. If you inherited a vulnerability to depression
from one of your parents, your brain may react to a stressful event in a
way that causes you to get depressed.
Depression can also develop due to a physical illness, a reaction to a
medication that you are taking, or as an outcome of substance abuse. In
these cases, when the cause is successfully treated, the depression will
end.
Different Types of Depression
Major depression
Jim cannot believe the change in his personality. Ever since he lost his
job
and started another lower paying one, he has not been the same person. He
finds himself walking around without energy to do any of the things that
he used to enjoy. Previously a hearty eater who may have been a few pounds
overweight, food now has no meaning for him and he has seen his pants size
diminish two sizes. His wife has also noticed the change. He no longer has
any interest in sex, she has to goad him to pay attention to the kids, and
he never has the energy to socialize with their friends. He spends most of
his weekends sleeping now. Jim is finding it harder and harder to get up
for work and his superiors have warned him about his absentee rate. Jim
often finds himself questioning the reason for going on. He believes that
if it were not for his family he would seriously consider ending it all.
Jim is suffering from the more serious form of depression known as major
depression. Major depression is also known as clinical depression,
unipolar
depression, and major depressive disorder. People who experience major
depression feel persistently sad. They do not take pleasure in activities
that were once enjoyable. Other physical and mental problems often
experienced include sleep problems, loss of appetite, inability to
concentrate, memory problems, and aches and pains. People who suffer from
this condition often feel worthless, helpless, and hopeless about their
ability to fix things. They often welcome sleep and experience their
waking life as a living nightmare. No matter how hard they try to snap out
of it, they feel as though they are falling into an abyss with nothing to
hold on to.
Major depression usually strikes people between the ages of 25 and 44,
although it can affect any person at any age. For most people, episodes of
major depression last from six to nine months. Sometimes, even if major
depression goes untreated, it will run its course and leave by itself.
Doctors are not sure why this happens, but it is often attributed to the
body’s tendency to correct abnormal situations.
Dysthymia (minor depression)
Jill is now 42 years old and she reports never really feeling happy. She
says that there were times when she felt that her life was going better
than other times, but she never really remembers getting any joy out of
her life. Jill reports that she is always negative about anything new that
is suggested to her by others. She never really felt that any man was
right for her and, as a result, Jill has been single all of her life. It
is hard for her to laugh and Jill says that she’s never had a sense of
humor. She sighs often and always has the feeling that she is carrying the
weight of the world on her shoulders. She also has a chronic problem with
her weight. Jill is forever on a diet, but her weight has always gone up
and down like a yo-yo. She reports the need to sleep a great deal, but at
times she has insomnia and walks around feeling tired all day. Jill blames
this on her chronic low level of energy. She has always agonized over what
for others would be simple decisions. Jill states that she hates her
indecisiveness. Other people are always accusing her of spending half her
day disagreeing with herself. As far back as junior high school, her
guidance counselor told her that she needed to work on her low
self-esteem. Jill feels that at her age, it is too late to change and she
has accepted that she will always be unhappy and unfulfilled.
Jill is suffering from the milder, but longer lasting form of depression
known as dysthymia. Dysthymia is also known as minor depression and is
characterized by its long-lasting quality. People often suffer from this
condition all of their lives. Dysthymia is typically diagnosed in people
who have been experiencing its symptoms almost all day every day for two
years with no greater than a two month span without the symptoms. In
children and adolescents, the primary symptom is different from that of
adults. Adults primarily have sadness, whereas children and adolescents
often display irritability and defiance. Children also tend to do worse in
school during times of depression. Besides feeling depressed, two of the
following symptoms must be present for dysthymia to be diagnosed: poor
appetite or overeating, problems sleeping or oversleeping, low energy, low
self-esteem, poor concentration, difficulty making decisions, and feelings
of hopelessness.
Dysthymia affects two to three women for every man, and is thought to
begin in childhood and adolescence. Left untreated, dysthymia will usually
continue through a person’s life. People who have dysthymia often have
other disorders such as a phobia, anxiety disorder, or a personality
disorder.
Bipolar depression
Joseph is feeling on top of the world. He has just come off a period where
it
was so difficult for him to do anything that he wanted to do. In fact, for
a few months, he didn’t do anything. He just stayed in the house, most of
the time sleeping. It is certainly different now. In fact, Joseph is
almost always out of the house. He only needs two to three hours sleep a
night and he feels that he has the energy of a bull. Joseph is spending
most of his time on a new
project. He is working on a new business venture that he knows is going to
make him a fortune. Somewhere in the back of his mind he remembers that he
has tried to start new businesses on numerous occasions and they have
always resulted in financial disaster. However, those failures are in the
back of Joseph’s mind now because he knows that this idea is a sure
winner. He is spending most of his days trying to convince banks to lend
him the money. He cannot understand why the banks that he has visited so
far seem so negative, but Joseph is sure that he will find a bank soon
that will advance him the large sum of money that he needs. He has spared
no expense in this effort. Joseph has gone to the best stores and
purchased a new wardrobe. He has ordered the latest in computer equipment.
He also has hired a commercial realtor to find him modern offices. Joseph
has not told his family about his new idea because they always rain on his
parade. They are negative about all of his ideas. But he knows that they
do not have the vision that he has and that they will eat their words when
they see the millions that he is going to make with his new venture.
Joseph is suffering from a condition called bipolar depression. Bipolar
depression is also called bipolar disorder,manic-depression, and manic-depressiveillness.
When a person has bipolar disorder, his moods shift between two extremes.
For a period of time the person experiences the symptoms of depression
(the depressive phase), then his mood will shift into a period of mania
(euphoria). In between these extremes, there may be a period of normal
functioning. Mania is characterized by extreme elation and
self-importance. During a manic phase a person will feel extreme
irritability for people and occurrences that are felt to stand in his way.
Energy, joy, and self-esteem are raised to irrational levels and a
delusional pattern often follows.
Two to three million people suffer from bipolar depression. It usually
begins
during adolescence or early adulthood. Substance abuse and other mental
illnesses are common in people with this disorder. In some people, bipolar
disorder will follow a long course of major depression. On average, people
diagnosed with bipolar disorder will experience roughly four episodes of
mania or depression the ailment over the course of their lifetime.
Atypical depression
Gillian remembers that her first bout of depression occurred in early
adolescence. She states that her childhood was relatively normal and
uneventful. It was marked only by her mother acting in ways that she now
understands are symptoms of depression. Gillian is now 48 and she states
that she has been depressed since she was 13. She states that her feeling
of depression will get better for a period and then worsen again. When
they do get better, she is able to enjoy the pleasures of life. During the
up times she will enjoy speaking to people, going out with her husband,
and eating. She states that she especially enjoys going to good
restaurants, where she will frequently overeat. Gillian states that one of
her worst traits is being late for appointments due to oversleeping. When
her depression worsens, Gillian will experience a general lack of energy,
show little or no initiative, and be overly sensitive to rejection by
others. Gillian also reports that she is prone to panic attacks. These
attacks first occurred in early adolescence and they continue to this day.
She states that her level of anxiety has increased as she has gotten
older.
Gillian is suffering from an atypical depression. This type of depression
is
very common in women. The symptoms of oversleeping, overeating,
hypersensitivity to rejection (especially romantic rejection), and
intermittent panic attacks, are characteristic of atypical depression.
This type of depression usually begins in adolescence and, if untreated,
will often continue throughout life.
Less Common Depressive Disorders
Psychotic depression
Approximately 15 percent of people who suffer from major depression also
show symptoms of psychotic depression. These symptoms include hearing
voices inside one’s head (auditory hallucinations), having visions of
people or things that are not actually there (visual hallucinations), and
delusional thinking. People who suffer from this extreme form of major
depression are in need of immediate attention. Because they cannot
rationally judge the consequences of their actions, they are in serious
danger of killing themselves.
Postpartum depression
Postpartum depression is thought to be a form of major depression. This is
due to the similarity of symptoms in the two conditions. About 10 percent
of new mothers develop postpartum depression. It is most common in women
who have already experienced some form of depressive illness. Most women
suffer from a down feeling the first few days after giving birth. However,
those with postpartum depression experience symptoms that are more
prolonged, severe, and disabling. If not treated, postpartum depression
can last for months or years.
Premenstrual dysphoric disorder
This condition is experienced by approximately four percent of
menstruating
women. Different from premenstrual syndrome (PMS), women who suffer from
premenstrual dysphoric disorder have more severe symptoms of deep
depression or irritability for a week or two prior two or during
menstruation.
Seasonal affective disorder (SAD)
As its name indicates, people who suffer from SAD experience symptoms of
depression at certain times during the year. Typically this condition will
start
in the late fall and continue until the early spring. People who live in a
geographical area that is frequently cloudy, have vision problems, or work
in a dark place are more prone to experience the symptoms of SAD. These
people will have low energy during the fall and the winter or at the time
of onset. Other symptoms of this condition are an increase in appetite and
cravings for carbohydrates. These people can gain as much as 20 pounds
before their symptoms subside. For children, problems with irritability, a
sudden decline in school performance, and difficulty awakening in the
morning may indicate the presence of SAD.
Conclusion
Depression is an extremely common and potentially devastating condition.
Its economic and personal costs are enormous in scope. For those affected,
it is important to remember that depression is medical condition just like
diabetes or cancer. And just as for all medical conditions, it is
important for a doctor to know what form of depression you have before
deciding on a treatment strategy.
Where to Find Help
Resources for Coping With Depression
If you are having an immediate psychiatric crisis
call the American Federation for Suicide Prevention 1-800-SUICIDE or
1-800-784-2433.
For non-crisis situations and general information on depression as well as
other mental illnesses, consult the organizations and Web sites below.
The National Mental Health Association
www.nmha.org
The National Institute for Mental Health
The American Psychiatric Association
www.psych.org/public_info
The American Psychological Association
www.apa.org
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