October 24, 2012

Depression: Not Your Ordinary Blues

by Edel Jarboe

Depression is more common than one would think. According to the US Department of Health & Human Services, clinical depression affects 15% of Americans at one point in their lives. In fact, depression is the number one cause of disability in women, states a report by the World Health Organization. In 1990, approximately 7 million women in the United States suffered from clinical depression (roughly twice the rate of men), according to the American Psychological Association (APA). Most disturbing, and according to the APA, almost 15% of those suffering from clinical depression will commit suicide.

Who is at Greatest Risk for Depression?

Women are twice as likely to become depressed as men due to the fact that women naturally have lower levels of the brain chemical serotonin. Moreover, hormonal changes (menstruation, pregnancy, childbirth, infertility, and/or oral contraceptives) also affect mood. According to a 1997 National Institute of Mental Health report, another reason why women have higher rates of depression is that we are under greater stress from work and family responsibilities, the many roles and expectations of women, and even the increasing rates of sexual abuse and poverty.

The elderly are also more likely to become depressed due to decline in physical health, loss of friends, family, and events to look forward to. Those who have been diagnosed as chronically ill are also most likely to be depressed. Yet, receiving treatment for depression greatly improves the outcome of a chronic illness.

Depression is not common in young children, however. Physical, sexual, and emotional abuse, parental losses, and having a seriously depressed parent increases the risk. In addition, because teenagers are experiencing hormonal changes as well as establishing their individuality they are also at greater risk for depression. Signs to watch out for include problems at school, unusual irritability or aggressiveness, or an inability to bounce back after disappointments.

What is Depression?

Emotional ups and downs are a normal part of life. Our feelings paint the landscape of our lives- red for anger, blue for sadness, and yellow for happiness. In fact, it is normal to feel depressed after a major life change or bereavement. We all need time to adjust to life changes- both good and bad.

But what if your blues aren't the ordinary, everyday ones? What happens if you don't "snap out of it" in a reasonable amount of time, if your depression is out of proportion to the event, or if there is no event triggering your depression at all? According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, you may be clinically depressed.

Clinical depression seriously impairs behavior, physical well-being and appearance, work performance, social activity, and the ability to handle everyday decisions and pressures. Symptoms of clinical depression include 2 weeks of persistent sadness, anxiety, and deep despair plus 5 or more of the following symptoms:

- Sleep disturbances (insomnia or sleeping too much)

- Weight loss/gain

- Lack of energy

- Feelings of hopelessness, worthlessness, and/or terrible guilt

- Physical symptoms than don't respond to treatment (headaches, chronic pain, or digestive problems)

- Chronic indecisiveness

- Irritability

- Loss of interest in activities once enjoyed, including sex

- Inability to function (eat, get out of bed, etc.)

- Suicidal thoughts and/or attempts

(Note: If you are depressed for at least two weeks and are experiencing 5 or more of these symptoms, please see your doctor.)

The 3 Different Types of Depression

Clinical depression, which affects approximately 15 million people a year, is characterized by great difficulty in functioning in all areas of life and is most likely to be associated with suicidal thoughts and/or attempts. Clinical depression typically has a pattern of repeated episodes of depression followed by a return to normal functioning after each episode.

The second type of depression, dysthymia affects almost 10 million Americans and is not characterized by episodes of depression. Rather, persistent low-level symptoms of clinical depression can last for years. Sufferers are able to function but constantly feel as if they aren't functioning at their best.

Bipolar depression is most commonly known as manic-depressive disorder and is characterized by extreme "up" periods (mania) and "down" periods (clinical depression). Of the three types of depression, bipolar disorder is much less common, affecting about 1% of the U.S. population.

What Causes Depression?

Scientists aren't quite sure what causes depression. It is commonly thought that there is an imbalance of certain chemical messengers in the brain, specifically the neurotransmitters serotonin, dopamine, and norepinephrine. Because of this, scientists suspect a genetic connection- but to date no depression gene has been discovered. In the meantime, studies have shown that people who have a family member who has been or is seriously depressed have a 1 in 4 chance of having an episode of depression in their lifetimes versus a 1 in 14 chance for the general population.

In addition to a family history of depression, life changes such as relationship problems, financial difficulties, bereavement, social isolation, physical illness, or substance abuse can also trigger a depression episode. Moreover, seasonal changes such as Seasonal Affective Disorder (SAD), caused by lack of sunlight in the Winter, or extreme hormonal changes such as Post-Partum depression which affects mothers within 6 weeks of giving birth can also trigger depression.

While it was previously believed that depression was either biological (chemical imbalance) or reactive (life changes), it is now believed that it is a combination of these two factors.

Treating Depression

There are two psychological therapies used in treating depression. Cognitive behavior therapy focuses on replacing negative thoughts and attitudes with a more realistic world view and typically lasts about 10 weeks. Interpersonal psychotherapy, on the other hand, focuses on past and present relationships and how they affect current functioning.

It is not completely understood how antidepressant drugs work, but substantial evidence shows that they somehow restore the brain's chemical balance. Selective serotonin re-uptake inhibitors (SSRI's) are the most commonly prescribed medication for depression. Prozac, Paxil, Zoloft, and Luvox are the most commonly prescribed brand names of these antidepressants.

The good news is that about 70% of patients respond to antidepressant drug therapy. But it is a gradual process because antidepressants do not work immediately. It usually takes 4 to 8 weeks before symptoms can be controlled. Patients typically notice improved sleep and appetite, greater energy and a returning interest in the things they used to enjoy, and diminished feelings of hopelessness, guilt, and suicidal thoughts. Antidepressants are usually prescribed for 6 months to a year after you start to feel well again in order to guard against a reoccurrence.

While drug therapy is effective in relieving the biological component of depression, it is recommended that a combination of drug and psychological therapy be used. Instead of relying on drug therapy alone, sufferers need to learn how to cope with their life changes in a more positive and healthy manner.

In general, depression typically lasts about 10 months and treatment is necessary not only to resolve the individual episode but also to prevent future episodes. Studies show that the risk of recurrence is greater depending on the severity and number of previous episodes.

Other treatments for depression include moderate exercise, meditation and yoga. These activities provide for the release of the hormone norepinephrine, which helps the brain deal with stress that often leads to depression and anxiety.

Coping with Depression

The most important and most difficult step when coping with depression is to ask for help. Part of the problem is the inability to recognize the symptoms of depression in others or ourselves. Most sufferers assume their depression is due to a lack of sleep or a poor diet. In other words, the symptoms of depression are often mistaken for the cause.

Another reason why so many sufferers do not get the help they need are the social misconceptions and stigma attached to depression. For example:

- Depression is a sign of weakness.

- Depression can be overcome by willpower.

- Depression is a normal part of aging.

- Depression is only serious if it lasts for an extended period.

- People who talk about suicide never actually do it.

According to the 1996 National Mental Health Association Survey, only 1 out of every 3 women who experience clinical depression will ever seek treatment. Moreover, 41% of women surveyed cited embarrassment or shame as barriers to treatment while more than one half of women surveyed cited denial as a barrier to treatment.

What you should do if someone you know is suffering from depression:

  1. Encourage him/her to talk to a doctor about getting treatment. You may want to accompany them to the doctor for support.

  2. Listen carefully and give uncritical support. Encourage them to stick to the treatment plan, including taking prescribed medications. Remember that it can take 4 to 8 weeks for antidepressants to start having an effect on their depression.

  3. Always, always take the talk of suicide seriously and seek professional advice.
Clinical depression is a treatable illness. According to the American Psychiatric Association, 80% to 90% of all cases are treated effectively. No one has to accept depression as a normal part of his or her life. There is help available.

Edel Jarboe is the founder of Self Help for Her.com (now defunct), an online self-help magazine helping you create a better life. She also publishes a free weekly newsletter, which features advice on goal setting, stress management, coping with difficult people, and overcoming obstacles: Subscribe here and receive a FREE stress report.