Depression
 

Overview

Everyone feels sad or low sometimes, but these feelings usually pass with a little time. Depression (also called Major Depressive Disorder) is different. It can cause severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. It is an illness that can affect anyone regardless of age, race, income, culture, religious beliefs, or education. 

1 in 6 people (16.6%) will experience depression at some time in their life. Depression can occur at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. There is a high degree of heritability (approximately 40%) when first-degree relatives (parents/children/siblings) have depression. 

Depression may occur with other mental disorders and other illnesses, such as diabetes, cancer, heart disease, and chronic pain. Depression can make these conditions worse, and vice versa. Sometimes medications taken for these illnesses cause side effects that contribute to depression symptoms. 

There are a number of possible causes of depression. Like many other mental illnesses, some people have a genetic predisposition to depression, which can then be triggered by a stressful situation in life. Depression can be part of an illness like bipolar disorder in which the person experiences extreme moods – very high and very excited or very low and depressed. 

Symptoms & Signs

Common symptoms of depression include:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness or pessimism
  • Feelings of irritability, frustration‚ or restlessness
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies or activities
  • Decreased energy, fatigue, or being “slowed down”
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early morning awakening, or oversleeping
  • Changes in appetite or unplanned weight changes
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and that do not ease even with treatment
  • Suicide attempts or thoughts of death or suicide

Risk Factors for Depression

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances. Several factors can play a role in depression: 

  • Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression. 
  • Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 % chance of having the illness sometime in life.
  • Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression. 
  • Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression. 

Treatments

Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plan can include any or a combination of the following:

  • Psychotherapy: including cognitive behavioral therapy, family-focused therapy and interpersonal therapy.
  • Medications: including antidepressants, mood stabilizers and antipsychotic medications.
  • Brain stimulation therapies: Those can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.


Questions & Answers
 

Once you begin treatment, you should gradually start to feel better. Go easy on yourself during this time. Try to do things you used to enjoy. Even if you don’t feel like doing them, they can improve your mood. Other things that may help:

  • Try to get some physical activity. Just 30 minutes a day of walking can boost mood.
  • Try to maintain a regular bedtime and wake-up time.
  • Eat regular, healthy meals.
  • Do what you can as you can. Decide what must get done and what can wait.
  • Try to connect with other people, and talk with people you trust about how you are feeling.
  • Postpone important life decisions until you feel better.
  • Avoid using alcohol, nicotine, or drugs, including medications not prescribed for you.

If someone you know has depression, the most important thing you can do is help them see a psychiatrist. You also can:

  • Offer support, understanding, patience, and encouragement.
  • Invite them out for walks, outings, and other activities.
  • Help them stick to their treatment plan, such as setting reminders to take prescribed medications.
  • Make sure they have transportation to therapy appointments.
  • Remind them that, with time and treatment, the depression will lift.

Everyone experiences a range of emotions over the course of days and weeks, typically varying based on events and circumstances. When disappointed, we usually feel sad. When we suffer a loss, we grieve. Normally these feelings subside and flow. They respond to input and changes. By contrast, depression tends to feel heavy and constant. People who are depressed are less likely to be cheered, comforted or consoled. People who recover from depression often welcome the ability to feel normal sadness again, to have a “bad day,” as opposed to a leaden weight on their minds and souls every single day. 

Of people diagnosed with major depressive disorder, who are treated and recover, at least half are likely to experience a recurrent episode sometime in their future. It may come soon after or not for many years. It may or may not be triggered by a life event. After several episodes of major depression, a psychiatrist may suggest long-term treatment.

Total openness is important. You should talk to your doctor about all of your symptoms, important milestones in your life and any history of abuse or trauma. Also tell your doctor about past history of depression or other emotional symptoms in yourself or family members, medical history, medications you are taking — prescribed or over-the-counter, how depression has affected your daily life and whether you ever think about suicide.

If your symptoms are mild, do not impair your work or home life, or adversely affect your health, and you do not think about suicide or self-harm, you could wait a week or two before visiting a professional to see if the symptoms may improve on their own. But more serious symptoms need immediate attention.