What is depression?

A depressive disorder is a whole-body illness—involving the body, mood, and thoughts—that affects the way a person eats and sleeps, feels about himself or herself, and thinks about things. It is not the same as being unhappy or in a blue mood. Nor is it 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.

Without treatment, symptoms can last for weeks, months, or even years. However, appropriate treatment can help most people who suffer from depression. During a given year, nearly 21 million American adults suffer from depressive illness. The good news? in most cases, treatment can alleviate symptoms and help people feel better about themselves and their lives.

Depression in women

Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women—particularly factors such as menstrual cycle changes, premenstrual syndrome (PMS), pregnancy, miscarriage, the postpartum period, perimenopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and aging parents.

Many women are particularly vulnerable after the birth of a baby. The hormonal and physical changes—as well as the added responsibility of caring for a new life—can be factors that lead to postpartum depression in some women. While transient blues are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Combining treatment by a sympathetic health care provider with the family’s emotional support can help a new mother recover physical and mental well-being, and can help foster her desire and ability to care for and enjoy the new infant.

Different types of depression

Like other illnesses, depressive disorders come in different forms. Three of the most prevalent types of depressive disorders include the following:

  • Major depression
    Major depression is marked by a combination of symptoms (see symptom list below) that interfere with a person’s ability to work, sleep, eat, and enjoy once pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.
  • Dysthymia
    Dysthymia tends to include long-term, chronically depressed mood and other symptoms that are not as severe or extensive as those in major depression, but still keep people from functioning at full steam, or from feeling good. People with dysthymia can also experience major depressive episodes.
  • Bipolar disorder (manic-depression)
    Bipolar disorder is a chronic, recurring condition that includes cycles of depression and hypomania or mania.

Within these types of depression are variations in the number of symptoms, their severity, and persistence.

Symptoms of depression

The following are the most common symptoms of depression. However, each individual may experience symptoms differently. In general, nearly everyone suffering from depression has ongoing feelings of sadness, and may feel helpless, hopeless, and irritable.

The American Psychiatric Association suggests that professional help is advisable for those who have four or more of the following symptoms continually for more than two weeks:

  • Noticeable change of appetite, with significant weight loss not attributable to dieting, or weight gain
  • Noticeable change in sleeping patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much
  • Loss of interest and pleasure in activities formerly enjoyed
  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness, pessimism
  • Restlessness, irritability
  • Decreased energy, fatigue, being slowed down
  • Feelings of worthlessness
  • Persistent feelings of hopelessness
  • Feelings of inappropriate guilt
  • Inability to concentrate or think, indecisiveness
  • Recurring thoughts of death or suicide, wishing to die, or attempting suicide
    Note: Individuals with recurring thoughts of death or suicide should seek treatment immediately!
  • Melancholia (defined as overwhelming feelings of sadness and grief), accompanied by the following:
  • Waking at least two hours earlier than normal in the morning
  • Feeling more depressed in the morning
  • Moving significantly more slowly
  • Disturbed thinking—for example, severely depressed people sometimes have beliefs not based in reality about physical disease, sinfulness, or poverty
  • Physical symptoms, such as headaches, digestive disorders, and chronic pain

Causes of depression

The key to understanding depression—and, in fact,  any mental disorder—lies in the fact that we still do not know exactly what causes these mental disorders. It is generally believed that all mental disorders are caused by a complex interaction and combination of biological, psychological, and social factors. This theory is called the bio-psycho-social model of causation and is the most generally accepted theory of the cause of disorders such as depression by professionals.

Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true. Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson’s disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder.

Treatment for depression

Specific treatment for depression will be determined by your health care provider based on:

  • Your age, overall health, and medical history
  • Extent of the depression
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disorder
  • Your opinion or preference

Generally, based on the outcome of evaluations, depressive disorders are treated with medication or either psychotherapy or cognitive behavioral therapy, or a combination of medication and therapy.

You can also help yourself. Depressive disorders can make a person feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime, consider the following:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities, and do what you can as you can.
  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
  • Participate in activities that may make you feel better.
  • Mild exercise, going to a movie, a ball game, or participating in religious, social, or other activities may help.
  • Expect your mood to improve gradually, not immediately. Feeling better takes time.
  • It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with others who know you well and have a more objective view of your situation.
  • People rarely snap out of a depression. But they can feel a little better day-by-day.
  • Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
  • Let your family and friends help you.