Depression Support Journal

Depression is a disorder that affects your thoughts, moods, feelings, behavior and physical health. People used to think it was "all in your head" and that if you really tried, you could "pull yourself out of it." Doctors now know that depression is not a weakness, and you can't treat it on your own. It's a medical disorder with a biological or chemical basis.

Sometimes, a stressful life event triggers depression. Other times depression seems to occur spontaneously with no identifiable specific cause. Whatever the cause, depression is much more than grieving or a bout of the blues.

Depression may occur only once in a person's life. Often, however, it occurs as repeated episodes over a lifetime, with periods free of depression in between. Or it may be a chronic condition, requiring ongoing treatment over a lifetime. The disorder affects more than 18 million Americans of all ages and races.

Medications are available that are generally safe and effective, even for the most severe depression. With proper treatment, most people with serious depression improve, often within weeks, and can return to normal daily activities.

Two hallmarks of depression — symptoms key to establishing a diagnosis — are:

• Loss of interest in normal daily activities. You lose interest in or pleasure from activities that you used to enjoy. This is called anhedonia.
• Depressed mood. You feel sad, helpless or hopeless, and may have crying spells.

In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present most of the day, nearly every day for at least two weeks:

• Sleep disturbances. Sleeping too much or having problems sleeping can be a sign you're depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.
• Impaired thinking or concentration. You may have trouble concentrating or making decisions and have problems with memory.
• Significant weight loss or gain. An increased or reduced appetite and unexplained weight gain or loss may indicate depression. <LICLASS=DOUBLESPACE>Agitation or slowing of body movements. You may seem restless, agitated, irritable and easily annoyed. Or you may seem to do everything in slow motion and answer questions slowly in a monotonous tone of voice.
• Fatigue. You feel weariness and lack of energy nearly every day. You may feel as tired in the morning as you did when you went to bed the night before.
• Low self-esteem. You feel worthless and have excessive guilt.
• Less interest in sex. If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.
• Thoughts of death. You have a persistent negative view of yourself, your situation and the future. You may have thoughts of death, dying or suicide.

Depression can also cause a wide variety of physical complaints, such as generalized itching, blurred vision, excessive sweating, dry mouth, gastrointestinal problems (indigestion, constipation and diarrhea), headache and backache.

Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions.

The main types of depression include:

• Major depression. This type of mood disturbance lasts more than two weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.
• Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but a more continuous form of depression. It lasts for at least two years and often more than five years. Signs and symptoms usually aren't disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression.
• Adjustment disorders. If a loved one dies, you lose your job or you receive a diagnosis of cancer, it's perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some don't. This is what's known as an adjustment disorder —when your response to a stressful event or situation causes signs and symptoms of depression. Some people develop an adjustment disorder in response to a single event. In others, it stems from a combination of stressors. Adjustment disorders can be acute (lasting less than six months) or chronic (lasting longer). Doctors classify adjustment disorders based on the primary signs and symptoms of depression or anxiety.
• Bipolar disorder. Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it's called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.
• Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.

Many people with depression have symptoms of anxiety as well. Anxiety that develops after age 40 is often related to depression rather than being an independent problem.

There's no single cause for depression. The illness often runs in families. Experts believe a genetic vulnerability combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters, resulting in depression. Imbalances in three neurotransmitters — serotonin, norepinephrine and dopamine — seem to be linked to depression.

Scientists don't fully understand how imbalances in neurotransmitters cause signs and symptoms of depression. It's not certain whether changes in neurotransmitters are a cause or a result of depression.

Factors that contribute to depression include:

• Heredity. Researchers have identified several genes that may be involved in bipolar disorder, and they're looking for genes linked to other types of depression. But not everyone with a family history of depression develops the disorder.
• Stress. Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger depression.
• Medications. Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills or, occasionally, birth control pills, may cause symptoms of depression in some people.
• Illnesses. Having a chronic illness, such as heart disease, stroke, diabetes, cancer or Alzheimer's disease, puts you at higher risk of developing depression. Studies reveal an as-yet-unexplained link between depression and heart disease. Depression occurs in many people who've had heart attacks. Left untreated, depression may put you at a higher risk of death in the early years after a heart attack. Having an underactive thyroid (hypothyroidism), even mildly, also can cause depression.
• Personality. Certain personality traits, such as having low self-esteem and being overly dependent, self-critical, pessimistic and easily overwhelmed by stress, can make you more vulnerable to depression.
• Postpartum depression. It's common for mothers to feel a mild form of distress that usually occurs a few days to weeks after giving birth. During this time you may have feelings of sadness, anger, anxiety, irritability and incompetence. A more severe form of the baby blues, called postpartum depression, also can affect new mothers.
• Alcohol, nicotine and drug abuse. Experts once thought that people with depression used alcohol, nicotine and mood-altering drugs as a way to ease depression. But using these substances may actually contribute to depression and anxiety disorders.
• Diet. Deficiencies in folate and vitamin B-12 may cause symptoms of depression. Low levels of both nutrients are linked to a poorer response to antidepressant medications.

Depression affects all ages and all races. Depression rates are lower among married people, especially married men, and people in long-term, intimate relationships. It's higher among divorced people and those who live alone. Depression is more likely to go unrecognized in older adults.

Twice as many women experience depression as men do. Although men are less likely to become depressed than women are, depression affects between 3 million and 4 million American men. Gender differences may be due in part to biological causes, such as hormones and different levels of neurotransmitters.

If you show little interest in once enjoyable activities, if you feel sad, helpless, tired or worthless, and if your eating and sleeping habits have changed greatly, see your doctor to determine if you have depression. If you know someone who exhibits the characteristics of depression, encourage him or her to seek professional help.

To diagnose depression, your doctor may perform a physical examination, including tests to rule out conditions that can cause symptoms that mimic depression.

If your doctor sees signs of severe depression or suspects the possibility of suicide, he or she may refer you to a medical doctor who specializes in mental illness (psychiatrist) or even recommend immediate hospitalization.

Your doctor or psychiatrist diagnoses depression based on the hallmark signs and symptoms of the disease, plus the presence of other signs and symptoms that typically accompany depression.

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. The rate of suicide is four times greater in men than in women, although more women attempt suicide. After age 70, the suicide rate for men increases, occurring most often after age 85.

Certain warning signs may indicate serious depression and the possibility of suicide. Take any threat of suicide seriously, even if the person is already being treated for depression. If you see any of the following danger signs, call a doctor, mental health clinic or suicide hot line immediately:

• Pacing, agitated behavior, frequent mood changes and sleeplessness for several nights
• Actions or threats of assault, physical harm or violence
• Threats or talk of death or suicide, such as "I don't care anymore," or "You won't need to worry about me much longer"
• Withdrawal from activities and relationships
• Putting affairs in order, such as saying goodbye to friends, giving away prized possessions or writing a will
• A sudden brightening of mood after a period of beingdepressed
• Unusually risky behavior, such as buying or handling a gun or driving recklessly

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• #2 Comment from redpoppy007 
  1/19/06 11:52 PM | Permalink

  Good information, Thank you.
• #1 Comment from artloner 
  1/19/06 11:34 PM | Permalink

  Thank you for such an astute rundown of the facts.  I've struggled with it for a long time, and am controlled with medication, although it never really goes away.  I try to look for the good days.  
  
  Knowledge is power.  :)
  
  andi