Depression
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.
MAJOR
DEPRESSION
- 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.
POST-PARTUM
DEPRESSION
- 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.
Suicide
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.
- Biology: 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.
Psychological therapy
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.
- Cognitive-Behavioral Therapy: 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.
- Interpersonal Therapy: Examines the person’s
relationships with others. It helps identify relationships and
interpersonal problems that cause or worsen depression.
- Family Therapy: 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.
Medication
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.
Find distractions: Watch a funny movie and laugh
out loud. Read a good book. Volunteer.
Get smart: 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.
Forgive yourself: 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.
For
more information on depressive disorders:
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.
www.apa.org/ppo/issues/pwomenanddepress.html:
Info on women and depression
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.
Crisis/Suicide
Hotlines (24 hours a day, 7 days a week)
