Depression

Understanding Depression

Mental illnesses come in many forms and with a variety of symptoms that are manifested by millions of people all over the world. Oftentimes, a mental disorder can strike a person even if he or she is used to living a normal life.

Definition of Depression

Depression is an everyday term referring to recession in mood. It is relatively a psychological shift and has generally nothing to worry about. It is completely different from a clinical depression, and if unattended can interfere with your daily living. In psychiatric terms the depression refers to a state of mental illness which has reached a state which requires a diagnosis. The depressed state of a person leaves him discouraged and hopeless.

Situational Depression/Reactive Depression

Situational depression, also known as reactive depression, is depression brought on by event's and situation in one's life. It is the general feeling of "being down" one feels at bad times. The causes of the depression could be factors such as the loss of a loved one, loss of job etc. Although in this sense it is different from clinical depression (explained later), it is every bit as painful as clinical depression. It is a milder type of emotional depression.

Endogenous Depression

Endogenous means occurring from within and similarly, endogenous depression implies depression that occurs seemingly without any cause of depression. However, the main cause of depression here is chemical imbalances in the brain. It is believed that this type of depression is more likely to be passed on to future generations, since it is considered to be genetic in origin.

Clinical Depression

Clinical depression however, is not just “feeling down” or “the blues” or temporary sadness that almost everyone experiences at from time to time in their lives. Clinical depression is a major depressive disorder. It is a popular psychiatric disorder which can be distinguished as the specific lowering of mood and lack of interest in day to day activity. It is a serious medical condition that affects a person’s everyday life, impacting his/her day to day activities such as sleeping and dietary habits and timings, working, relationships and even how the person thinks of himself/herself. This is found to occur gradually or a sudden occurrence and can turn to be a life long mental disorder. There are ways by which a friend or family member can determine if someone they care about is likely to have a mental disorder, such as anxiety, phobia, and mental depression. A person who is clinically depressed need medical attention since this is not a condition that one can simply “snap out of” and if left untreated, depression can continue for weeks , months or even years, sometimes leading to catastrophic consequences.

The good news about clinical depression is that there are effective treatments, easily available. However only, a small percentage of patients actually receive treatment. The reasons for this unfortunate state can be attributed to a variety of factors:

  • Some people associate depression with personal weakness or flaw in one’s character.

  • Some people do not recognize the signs or symptoms.

  • Some people are not comfortable with the fact that others such as colleagues, relatives or friends might come to know if they are consulting a mental health professional.

Additional Statistics and Depression Information

Depression affects so many people that it is often referred to as the "common cold" of mental illness. It is estimated that depression exacts an economic cost of over $30 billion each year, but the cost of human suffering cannot be measured. Depression not only causes suffering to those who are depressed, but it also causes great difficulty for their family and friends who often do not know how to help.

• According to WHO (The World Health Organization), clinical depression is one of the leading causes of disability worldwide.
• Approximately 121 million people in the world suffer from depression.
• In America, this disease affects nearly 19 million people every year.
• Women are more prone to depression than men.
• Almost 10%- 25% of women become clinically depressed at some point in their lives, while for men the percentage is 5%-12%.
• According to the WHO, approximately 5.8% men and 9.5% women world wide experience depression every year.

Causes of Depression

What causes depression? The causes of depression vary from person to person and it is generally the result of many causing factors. The main cause found common in many individuals are any form of losses, material or loss of a loved one that leaves the person down on his spirits. It can also include other trivial factors like the working conditions or the environment and financial factors and family disputes. Not with standing these apparently visual factors, it can also be due to other internal psychological factors. There are many physical illnesses like cancer, AIDS etc or even genetic factors which lead to depression.

Depression Causes

1. Loss of someone or something
2. Genetic
3. Childhood events.
4. Environmental or Biological factors.
5. Medical condition
6. Pre Disposition to Depression etc.

Unfortunately it is not clearly known what causes clinical depression. It might be any of the above factors or a combination of all two or more of them. We do not as yet know for sure.
The common methods of treating a depression are to use anti depressants, magnesium taurate and coffee. Other than these clinical methods some people use the help of drugs like marijuana and alcohol to suppress depression, however its side effect is worse than the depression itself.

Different Types of Depression

Some of the different kinds of depression are listed below:

1. Major Depressive Disorder/ Unipolar Depression/ Major Depression Disorder

Other names of major depressive disorder are major depression, clinical depression and unipolar depression. It is called unipolar because this disorder is like having just one pole or one extreme mood- the depressed mood. This is therefore, different from bipolar depression which is explained later. Major depression can be very upsetting and disabling affecting a person’s day to day activities, and may occur several times in a person’s life.

Symptoms of Major Depression

Different people exhibit different major depression symptoms.

1. Some people have trouble sleeping, experience weight loss and a lingering feeling of irritation and agitation.
2. Some people start sleeping more, eat a lot
3. A person might be plagued by feelings of worthlessness or guilt.
4. Some people display a happy exterior in the work place or in the presence or others while deep down they are depressed and sad.
5. Almost everyone however, display a general loss of interest in activities they once enjoyed and have an “off” mood.
6. Depressed people also have physical symptoms such as fatigue, body aches and headaches.
7. Difficulty in concentrating and remembering, a sense of hopelessness and helplessness.
8. In extreme depression conditions, thought of suicide.

Major depression can affect a person at any age. However, the average age for developing clinical depression is when a person is in his/her mid 20’s. But this average age, seems to be decreasing. Those with a family history of major depression are 1.5 to 3 times more prone to this illness than those who do not.

The effects of major depression vary from person to person. Some patients experience episodes of depression separated by months or even years in which there are no symptoms. Others may have several bouts of depression frequently. In some the frequency of depression increases with age. Also in certain patients, as the number of depressive episodes increases, the interval between these episodes decreases. Almost 50%-60% of people who have had been depressed at least once are likely to develop a second depressive bout again. This likelihood of developing another bout of depression increases with the number of depressive episodes one has already experienced.

Risk Factors

1. About 10%-25% of people with major depression have previously had dysthymic disorder.
2. About 10% of those with dysthymic disorder are likely to develop major depression. The presence of both dysthymic disorder and major depression is also called “double depression”.
3. Development of major depression is also related to medical illnesses such as cancer, stroke or diabetes
Major depression should be taken seriously and treated immediately since as high as 15% of those with this disease commit suicide.

2. Dysthymic Disorder/ Neurotic Depression/ Chronic depression

This is a type of mild depression, but is more enduring. People with this condition appear to be mildly depressed but it is a moderate depression, so chronic that it becomes difficult to distinguish it from their personality. A person might be suffering from dysthmic disorder for a number of years without realizing it. Dysthymic depression diagnosis occurs for a person if he/she has had been in a continuously depressed mood for two years at least. In case of children, this period is considerably less – one year and they might be more irritable rather than sad or depressed.

Dysthymia might develop early in a person’s life, and therefore, it not uncommon for someone to think that this condition is a normal. They often do not realize that always feeling depressed is not ordinary and their illness goes unnoticed and therefore left untreated.

Symptoms of Dysthymic Depression

1. A person has been depressed for most parts of two years. Children and adolescents might be irritable more than sad.
2. Loss of appetite or over eating.
3. Sleeping more or loss of sleep.
4. Fatigue
5. Low self esteem and hopelessness.
6. Difficulty in concentrating and decision making.
7. A person has always had these symptoms for the two years
8. During this time there has not been a major depressive episode or maniac, mixed or hypo manic episode.

Risk Factors

About 3% of the population maybe affected by dysthymia at any given point of time.
1. People with a family history of this disease are more likely to develop dysthymia.
2. Medical illness such as AIDS, hypothyroidism, and multiple sclerosis.

Effects of Dysthmic Depression

1. Personality disorders such as avoiding people,
2. Effect relationships.
3. Lead to substance use.
4. In children it might cause ADHD, misconduct or in extreme cases mental retardation.

3. Atypical Depression/ Moderate Depression

Atypical Depression (AD) is a type of dysthymia and Major Depression. It is characterized by a person's mood being reactive to good things. A person suffering from AD has his /her mood uplifted in response to positive events. This is in contrast to melancholic depression where there is no reaction of a positive stimuli to a person's mood.

Symptoms of AD

1. Over Eating
2. Over Sleeping

4. Bipolar Depression Disorder/ Manic Depression

This is a type of severe depression and is also known as manic-depression or manic-depressive disorder. It is called bipolar because this disorder is like alternating between two poles of emotional extremes – depressive periods of sadness and euphoria of mania. These two extremes are interspersed by periods of complete normalcy. When a person is in the depressive phase, he/she exhibits the symptoms of major depression while in the maniac phase, a person might be extremely elevated, expansive, or irritable.

There are two types of bi polar disorder:

Bipolar I Disorder : A person is diagnosed with Bipolar I Disorder when a person has had at least one maniac or mixed depression bout accompanied by a major depressive episode.

Bipolar II Disorder: A person is diagnosed with Bipolar I Disorder when a person has had at least one major depressive bout accompanied by at least one hypomanic episode.

Mania can seriously impair one's normal judgment. When manic, a person is prone towards reckless and inappropriate behavior such as engaging in wild spending sprees or having promiscuous sex. He or she may not be able to realize the harm of his/her behavior and may even lose touch with reality.

5. Manic Depression Symptoms

The symptoms of bipolar disorder depends on the phase the person is in. If the person is in a major depressive state, he/she experiences the same symptoms as in the case of major depression. In cases of acute depression, if a person feels suicidal, he/she might need to be hospitalized or put under observation for the patients own safety.

Symptoms of Manic Depression

1. A persons mood and spirits lighten, he/she becomes euphoric.
2. A person is filled with ideas so fast that they find it hard to concentration.
3. A person becomes more energetic , more outgoing, and have more self esteem.
4. A person might behave recklessly, lose touch with reality and experience delusion and hallucinations.
5. A person might go on wild spending spree or engage in promiscuous sex.
6. A severely manic person might become abusive or violent.
7. Performance in school in affected and problems with relationships crop up.

People who are depressed or manic may not experience all of the sign of depression The cycles of bipolar depression varies from person to person. One might first experience depression followed my mania, in repetition. Others might undergo many depressive episodes, with infrequent mania or even frequent mania accompanied by the occasional depression.
Bipolar I disorder affects both male and females. However, while males foremost experience mania, women are more prone to a first episode of depression.

Bipolar Depression and Pregnancy

Women with a history of bipolar disorder are at a higher risk of experiencing bipolar disorder within several months of giving birth.

6. Cyclothymic Disorder

Cyclothymic disorder is a milder form of bipolar disorder. A person’s mood alternates between hypomania (a less severe type of mania) and depression but the bouts depression and mania are less severe than in the case of bipolar disorder. Cyclothymic disorder is more enduring than bipolar disorder.

Cyclothymia affects both men and women. It typically affects a adolescents or young man and the condition is chronic. Almost 15%- 50% of people with cyclothymia eventually develop bipolar disorder.

7. Mood Disorder Due to a General Medical Condition/ Co morbid Depression

Depression is known to be a side effect of certain medical conditions especially painful or chronic conditions such as cancer, hypothyroidism, spinal cord injury, head injury AIDS etc. Having mood disorders alongwith a medical condition complicates a person’s recovery from his/her disease. A mood disorder with a serious medical condition decreases a person’s determination to fight the disease and increases his/her risk of attempting to commit suicide.

8. Substance-Induced Mood Disorder

Depression may also be caused by the abuse of substances such as drugs, alcohol, certain medications or toxins. A person is diagnosed with substance-induced mood disorder or within a few weeks of withdrawal or administration of the substance. The mental health professional must ascertain that the mood disorder occurs as a result of the substance and is not just a coincidence.

9. Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder is not really a depression type, separate from major depression and bipolar disorder. Instead it is a term used to describe the regular pattern of the cycles of depressive episodes associated with major or bipolar depression. For example a person might be diagnosed with the following seasonal affective disorder:

  • Major Depressive Disorder,

  • Recurrent Episode,

  • Moderate,

  • With Seasonal Pattern

However, since people often refer to this type of depression as "Seasonal Affective Disorder" or "SAD" we will use that terminology here. SAD is a condition that affects a person during specific times or seasons of the year. Typically the depressive symptoms of this condition begin during fall or winter, and end when spring arrives. At other months during the year a person's mood will be normal, or at least will not meet criteria for clinical depression.

“SAD” as seasonal affective disorder is also known affects a person during specific seasons or times of the year. A person might typically be depressed during fall or winter and becoming normal (not exhibiting any clinically depressed symptoms) with the onset of spring.

Risk factors

1. A large percentage of people suffering from SAD are women.
2. People living at higher altitudes are more prone to SAD.

10. Postpartum Depression

Postpartum depression is not really a type of mood disorder, separate from major depression and bipolar disorder. Instead it is a term used to describe the onset of the depressive period associated with major depression or bipolar disorder. For example a person might be diagnosed with the following seasonal affective disorder:

  • Major Depressive Disorder,

  • Single Episode,

  • Moderate,

  • With Postpartum Onset

Psychotic Depression
"With Postpartum Onset" is mostly related to depression with pregnancy and child birth. It is used to describe an uncommon depressive episode that starts within a few weeks, typically about 4 weeks, after giving birth to a child. It affects almost 10% of new mothers and is not the “baby blues” that women experience a few days (3-7 days) after delivery.

Signs of Postpartum Depression

1. Anxiety or even panic attacks
2. Crying
3. Difficulty sleeping and a disconnect with the child.
4. Inconsistency or fluctuating mood.
5. Agitation and difficulty in concentration
6. Sometimes even delusions and hallucinations.
7. Violent thoughts towards the child.
8. Suicidal thoughts
A woman might need hospitalization in extreme cases. A woman might have delusions making her believe that her child is evil or the child is doomed or blessed with extraordinary powers. The mother might even hear voices in her head prompting her to kill her child or harm him/her.
It is important to recognize postpartum depression symptoms since the mother herself, is reluctant to confide in anyone the negative or depressive thoughts, especially since she is supposed to be happy with the birth of the child. The mother feels guilty about harboring such negative thoughts about her child. Postpartum depression is treatable and if left untreated, it can affect the mother-child relationship.

11. Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder is an uncommon depression affecting menstruating women. Almost 3% - 5% of menstruating women experience this disorder. It is the condition in which women feel depressed and irritable about one or two weeks before their menstrual period each month. The symptoms disappear once the menstrual period begins.
Currently more research is going on in this field.

12. Anxiety Depression/ Anxious Depression

Please visit our section on anxiety

Effects of Depression

Persons with mental disorders like clinical depression, often feel like underachievers. They perform poorly at work or school, for no apparent reason at all. There is a sudden change in their scholastic or occupational performance, even if they seem to be very able to accomplish what they are asked to do. If they are given a task or responsibility, they immediately feel unable to accept nor complete it. Extreme pessimism and worthlessness are often felt by a depressed person.

Depression also triggers a person to become more distant to family members, friends, and co-workers. When there is an activity that he likes to do before, such as a hobby, he becomes disinterested in it and stops doing it altogether. Lack of interest in sexual activity is also a possible tell-tale sign of depression. A person with this condition may also experience mood swings and often has trouble sleeping.

Along with these depression affects, there are even greater health risks brought about by depression. This can cause a person to change his eating habits, either by eating too little or eating too much. This lack of nutrition can lead to further complications, often preventing the person from getting any better. Overeating may lead to obesity, which also poses a threat to the cardiovascular system. There are instances when a depressed individual wills himself to become sick, simply by thinking about it. Aside from that, the even greater danger of depression lies in the person’s possible suicidal tendencies, or the possibility of injuring others as well.

Help for Depression

It is common to wonder whether a person needs help with depression or not. Almost every one has heard some one say he or she is depressed when one has had a bad day at work or got into a fight or some other reason. Typically these “blues” pass or decrease within a few days or a short period of time. Such feelings are not clinical depression but rather normal feelings such as sadness, frustration or stress, not requiring any professional help. However, if such feelings continue for a longer period of time- two weeks or more or very distressing and upsetting, its advisable to consult a mental health professional.
One should not be hesitant about seeking professional help for depression. Left untreated, depression gets prolonged and worsen, thereby making treatment even more difficult. Untreated depression can also have catastrophic effects, almost 15% of people with depression (clinical) commit suicide.
 
Individuals or organizations such as below help in managing depression and avoid depression relapse.

  • Your family doctor or physician

  • Mental health professionals: psychiatrists, psychologists, counselors, social workers

  • Depression Support Groups.

  • depression clinics

  • Hospitals

  • University- or medical school-affiliated programs

  • State hospital outpatient clinics

  • Family service/social agencies

  • Treatment Centers for Depression

  • Local medical and/or psychiatric societies

How to Cope with Depression

Since depression is a mental disease, how to get over depression? How to get out of depression? Is there anything anyone one can do to stop depression? How to deal with depression? The following tips will help you in coping with depression:

  • Depression disorders make a person helpless and infuse a sense of hopelessness and worthlessness. These negative thoughts make a person lose his/her determination and wanting to give up. However, it is important to understand that this is an effect of depression and things are no as bad as this disease makes them seem to be.

  • The most important and first step in battling depression is to acknowledge it. Do not be afraid or ashamed to admit that you might be suffering from depression and seek medical help. Do not be embarrassed to take medications if you have been prescribed them.

  • Identify your moods and feelings pattern. Pay particular attention to events that change your mood. This will help overcome depression.

  • Do not try to do too many things at the same time. Set realistic goals, identify your priorities and break complex tasks into smaller pieces.

  • Fight depression and its negativity. Depressed people tend to dwell over things that have gone wrong while forgetting the good things in their lives. Do not think that you are not as good as others. Do not make any negative assumptions.

  • Another important point in getting over depression or getting out of depression is to share your thoughts with other. Depressed people normally tend to avoid others, since the negative thought prompt them to have low self esteem. However, if one sharing our fears or worries with some one you can trust is very relieving.

  • If you want to be successful in beating depression, take care of your self. Do not abuse your body by over eating, and leading a sedentary life. Rather eat healthy, do some mild exercises, go to a movie or participate in religious, social or other activities that please you.

  • Try to figure out if the thing that is worrying you is even important to you or not. Do not get involved in unnecessary, trivial things.

  • Do not expect you mood to change overnight. Depression wears off gradually even with help and medications.

  • Confide in your family and friends and let them help you in fighting depression.

Helping Someone with Depression

1. Help the person get a proper diagnosis and depression treatments. Make sure he/she stick to the treatments and do not quit midway. Seek or advice to seek alternate treatments for depression if the current one is not working. Make appointments or accompany the patient on his/her visits to the physicians if necessary. Make the person stick to the doctor’s advice such as abstaining from alcohol etc.
2. Offer emotional support to the depressed person. This is tough since you would require a lot of patience, understanding and affection. Talk to the person, listen patiently and try to point out the god things. Ever ignore any remarks about suicide, however lightly it may be made. Report them immediately to the patient’s therapist.
3. Help the depressed person lead a healthy life, go out for walks, movies or other activities. Encourage him/her to participate in activities he/she likes.
4. Do not overwhelm the depressed person with too many activities; it may increase the feelings of failure. Do not accuse him/her of being lazy or disinterested.
5. Keep assuring the depressed person that he/she would get better with time.

How to Treat Depression

When a close friend or relative is showing these symptoms on a regular basis, it is best to have him analyzed by a health professional. A psychologist, psychiatrist, or registered therapist can properly diagnose depression: what type of mental illness an individual may be experiencing.

One of the ways of treating depression is through therapy sessions, either individually or in groups. There are also prescribed medications like anti-depressants that help relax a patient and allow him to regain normal sleeping and eating habits. In case of children, the disease can cause a lack of interest in school and poor academic results. Before the diagnosing depression, the disease should be present for a minimum of two weeks to make sure the disorder is a clinical depression. Unlike in the adults, it is found that the children with clinical depression attempts or have suicidal thoughts at younger age of twelve years.

Normally diagnosis of depression should include a complete medical check up including the history of the patient which can relate to any cause of the depression. This can include the study of the family history to see if any of the family members had experience such a disorder in the past.

It is found that people diagnosed for depression once have more chances of experiencing it in the future. Therefore before the diagnose it is vital to consider whether it is a single episode or is a recurrent one. This will change the treatments of depression in terms of the quantity of anti depressants to be used. There could be other factors causing depression like continuous anxiety and hypomania, which can induce depression on a later part of the life. One of the main observation found is that the depression is genetically passed, making it hereditary.

The family also plays an important role in ensuring the recovery of a patient. Support groups for depression has been known to be a very effective remedy.

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