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Depression can affect anyone. Once identified, most people diagnosed with clinical depression are successfully treated. Unfortunately, depression is not always diagnosed because many of the symptoms mimic other illnesses.
Recognizing depression is the first step in treating it.
What is Depression?
A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Depression is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things.
It is natural and normal to be sad after a breakup of a relationship, a death or other stressful event. The difference between normal sadness and depression is the duration and intensity. Someone can be sad without being depressed just like someone can have the sniffles without having pneumonia.
Occurs when feelings of extreme sadness or despair last for at least two weeks or longer and when they interfere with activities of daily life.
Manic-Depression or Bipolar Disorder
Extreme mood swings, from overly high or irritable to sad and hopeless. Although the highs may feel good, they can cause dangerous and reckless behavior, such as overspending, risky sex or violent arguments.
Dysthymia (Mild Depression)
Long-term, chronic depressive symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Cyclothymia (Milder Form of Manic-Depression)
Chronic bipolar disorder consisting of short periods of mild depression and short periods of hypomania (lasting a few days to a few weeks), separated by short periods of normal mood. Symptoms are never absent for more than two months at a time.
Depressive symptoms that last for weeks or months after a woman gives birth.
Seasonal Affective Disorder (SAD)
SAD is a disorder in which sufferers show seasonal changes of mood and/or behavior. Depressive symptoms usually begin in fall and end in spring or summer because people with SAD have a difficult time adjusting to the shortage of sunlight in the winter months.
Symptoms of Depression
- Persistent sad or empty mood
- Feeling worthless or excessively guilty
- Loss of interest/pleasure in your usual activities
- Decreased energy and chronic fatigue
- Difficulty making decisions or concentrating
- Irritability, restlessness or feeling “slowed down”
- Difficulty sleeping or sleeping too much
- Loss of appetite, and weight loss or overeating, with weight gain
- Recurring thoughts of death, or suicidal thoughts or actions
Features of a Manic Episode
Everyone has been through times where they have felt “hyper” or full of energy. Just as with clinical depression, the difference between being “hyper” and experiencing a manic episode is the duration and intensity. Lasting at least a week, manic episodes are marked periods of unusual, even bizarre, behavior with significant risk-taking and poor judgment.
They include at least three of the following:
- Exaggerated self-esteem or unrealistic belief in one's own abilities
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
- More talkative than usual or pressure to keep talking
- Feeling like thoughts are racing
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
- Increase in goal-directed activity (either socially, at work or school, or sexually) or restlessness
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, risky sex or foolish business investments)
A hypomanic episode is similar to a manic episode, but is less severe. Some of the impulsivity and increased energy may result in spending sprees or other activities that, while not bizarre, are not what the individual would normally do.
About two-thirds of people who commit suicide have a depressive disorder at the time of their death. The suicide rate for people those who have been hospitalized for depression varies between 2 and 9 percent. For young people 15 to 24 years old, suicide is the third leading cause of death.
Ironically, it is when you are starting to recover from depression that you are most at risk for suicide. Many suicidal people are too depressed to hurt themselves before starting treatment, and the risk goes up when they get a little more energy. It is crucial at this time to continue with treatment, keep away from weapons and spend time with others as much as possible. Ask for help when you need it. There are other ways besides death to stop your pain.
If at any time you feel like you might try to harm yourself, call 911 immediately. If you just want to talk to someone and Counseling Services is closed, call a suicide hotline. Numbers are listed on the last page.
What Causes Depression?
Causes of depressive disorders are complex and can involve biological, psychological and cognitive factors.
Research has suggested that clinical depression is caused by a chemical imbalance. Symptoms are often relieved by medications that alter levels of these chemicals in the brain. Also, both depression and bipolar disorder seem to run in families. However, not everybody with the genetic makeup that causes this vulnerability develops the disorder.
Psychological Causes/Stressful Life Events
Some individuals may be predisposed to depression due to early losses, rejections, frustration or even early overindulgence by caretakers. A failure to establish a sense of a good, consistent relationship with a caretaker may also be important. A discrepancy between ideals and reality (e.g. not living up to standards you set for yourself) may also contribute to depression. Finally, stressful life events, such as a death in the family, a divorce or birth of a child, can lead to clinical depression if sad feelings linger and interfere with daily living beyond a reasonable time.
Women and Depression
Regardless of nationality or socioeconomic level, women have significantly higher rates of depression than men. There are various reasons for this, including biological, social and economic factors. Higher incidence of depression in women may also be due to the particular stresses that many women face, which include major responsibilities at home and work, single parenthood, and caring for children and aging parents.
Other possible causes include certain illnesses, medications and alcohol/drug use. Research in these areas is continuing.
Deciding to Seek Help
Clinical depression is a very common psychological problem affecting men, women, the elderly and even children. However, most people never seek proper treatment. With proper treatment, nearly 80% of those with depression can make significant improvement in their mood and life adjustment. Early intervention is encouraged to reduce the length of the depressive episode and help the person enjoy life again.
Unfortunately, there is a shameful stigma attached to seeking psychological help in our culture. While we don’t hesitate to go to our family doctor if we have the flu or sprain an ankle, many people will resist talking to a counselor about their depression. There’s nothing wrong with a mental health checkup. If you are not sure you are depressed, talking to a counselor can help you rule out the possibility. It can also start you on the road to recovery. You don’t have to suffer. There are treatments that can help.
In addition to counseling, you may want to consider visiting your family physician as well. Sometimes depression can be a result of a hormonal imbalance or other physical illness.
Enrolled students at EMU can receive free counseling at Counseling Services.
Treatments for Depression
Every experience we have changes our brain chemistry. Chemicals called neurotransmitters use electrical impulses to constantly send messages to different parts of the brain about mood, pain, hunger and energy. If a person has been feeling depressed for several weeks, neurotransmitter levels change. When this happens, a depressed person cannot just “snap out of it”. The very chemistry in their brain is different. Both psychotherapy and medication have been shown to bring these levels back to normal.
More serious depression may require medication in addition to psychotherapy. Depressive symptoms such as fatigue and trouble concentrating can interfere with your ability to make the life changes necessary to eliminate the depression. Contrary to popular belief, antidepressants do not change your personality dramatically. They are not habit-forming, and do not make you feel euphoric. In essence, medication lifts the depression so you can focus on getting better instead of pain and sadness.
A therapist can help point out the life problems that contribute to your depression and help you understand which aspects of those problems you may be able to solve or improve. There is convincing evidence that most people who have at least several sessions of psychotherapy are far better off than untreated individuals with emotional difficulties. Several types of psychotherapy have been used successfully to address the symptoms of depressive disorders.
Helps the person identify and change patterns of thinking and habits that feed the depression. Theoretically, by developing better thinking habits, people “unlearn” negative patterns that cause their depression.
Examines the person’s relationships with others. It helps identify relationships and interpersonal problems that cause or worsen depression.
Can involve the whole immediate family and seeks to mend family conflicts and stresses that cause or intensify depression.
Depression Support Groups
Joining a support group allows the person to discuss depression with fellow sufferers. They can learn how others deal with depression, and gain a sense of community by realizing that he or she is not fighting depression alone.
Psychotherapy works best when you attend all scheduled sessions and give some forethought to what you want to discuss during each one.
It is important to note that taking a pill will not instantly cure depression. A doctor may try different antidepressants before finding the most effective medication. Although some improvements may be seen in the first few weeks, most antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs. Once the individual is feeling better, it is important to continue the medication for 6 to 9 months to prevent a recurrence of the depression.
Most people do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more about causes of your depression and effective ways to deal with life's problems.
What You Can Do Now to Cope With and Relieve Symptoms
Treat Your Body With Love
Exercise—especially outside. Eat nutritious food, get enough sleep and take good care of yourself. Use your senses to make your body feel good: listen to music, get a massage, eat chocolate, make your surroundings beautiful, wear velvet, take baths with scented oils. Hug a friend. Cuddle with a pet.
Increase Social Support
Surround yourself with loved ones. Attend a support group. If you can, try to talk to someone who has recovered from depression. If you don’t know anyone, the links below contain some web message boards and personal accounts of living with depression. Hearing someone’s recovery story gives you hope and perspective.
Watch a funny movie and laugh out loud. Read a good book. Volunteer.
Learn all you can about depression and its treatment. Knowledge is power.
Give Yourself Permission to Feel
Talk to a friend. Write in a journal. Express your feelings in therapy.
Look at Life Differently
Try to see life in shorter pieces and the pain as only temporary - getting through the next minute, the next hour, the next day, may be all there is for a while. Try not to take things personally; realize that hardly anything “always” or “never” happens.
Avoid Making Major Life Decisions
You may not be thinking clearly right now, so your decisions may not be the best ones for you.
It is not your fault. Depression is a serious illness. It is not a result of weakness or poor character. Admitting you have a problem is extremely brave—and working through depression takes strength. Don’t blame yourself for your depression; try to concentrate on working through it. Be patient and give yourself time to heal.
Remember that most people who suffer from depression have felt just as hopeless, scared and exhausted as you do. Many of them recover and go on to live rewarding lives. You probably will too.
More Information on Depressive Disorders
- http://www.nimh.nih.gov/publicat/depressionmenu.cfm More in-depth information on depressive disorders, including medication, treatment and helping a loved one.
- http://helping.apa.org/therapy/psychotherapy.html Explains how psychotherapy works and what you can do to make it work best.
- http://www.apa.org/ppo/issues/pwomenanddepress.html Info on women and depression
- http://www.postpartum.org More info on postpartum depression
- http://suicidal.com Web author’s perspectives from 30 years of experience of herself and other depressives. Features a treatment outline and help for family and friends.
- 734.487.1118 can handle emergencies between 8 a.m. and 5 p.m.
Suicide Prevention Center (Detroit)
- 1.800.273.TALK (Nationwide)
Psychiatric Emergency Services-University of Michigan
St. Joseph Mercy Hospital
Sources: Counseling Services Publications
- How Psychotherapy Helps People Recover from Depression (APA, 1998)