Depression

What is depression?

Everyone feels "down" or "blue" from time to time. Feeling discouraged or sad is a normal reaction to adversity. Yet, for some people, the depressed mood persists. When symptoms last two weeks or longer and are severe enough to interfere with daily living, a person is said to have depression. You should note, however, that the presence of symptoms doesn't necessarily mean a person is clinically depressed. A thorough assessment by a mental health professional is necessary for accurate diagnosis of depression.

Most common in adults between the ages of 24 and 44, depression is estimated to affect 1 in every 10 people. Nearly twice as many women as men are diagnosed with depression.

While clinical depression usually occurs in adulthood, it can also affect children, teenagers, and the elderly.

Signs and symptoms of depression

Adults

As mentioned above, a person doesn't have to exhibit all of the signs or symptoms to be clinically depressed. However, to be diagnosed with clinical depression, symptoms need to be persistent. Some people experiencing the symptoms below could simply be experiencing a temporary and short-lived sadness.

• feeling sad most of the time, most days
• marked lack of interest or apathy towards pleasurable activities or sexual activity
• withdrawal from friends, family, and social activities
• increase or decrease in appetite; weight loss or weight gain
• difficulty falling asleep, sleeplessness or insomnia, waking early, sleeping more than normal
• restlessness and moving slower than usual
• fatigue or loss of energy; difficulty getting out of bed or going to work
• feelings of guilt, helplessness, or low self-esteem
• decreased ability to concentrate, remember things, or make decisions
• Suicidal ideation

Although the signs and symptoms of depressive illness may be somewhat different, depression can also affect children, teenagers, and the elderly.

Children

Generally, children don't express their thoughts and feelings as clearly as adults. As a result, their depression may not be as obvious. The following may indicate a child may be depressed:

• loss of appetite; refusal to eat favorite foods
• sleep disturbances or nightmares
• problems at school including behavioral problems and/or poor grades where before there were no (significant) problems
• significant changes in behavior such as withdrawal, aggression, or sulking

Teenagers

The teen years are a difficult time even for well-adjusted adolescents. These upheavals make it difficult to distinguish between serious depression and normal "growing pains" that often occur during this stage of life. The following might indicate a teenager may be depressed:

• Alcohol or drug use
• problems at school including poor grades, poor attendance, or behavioral problems
• withdrawing from friends and family
• chronic and serious conflicts with parents after long-standing good relations
• anti-social behavior
• problems with the law
• attempts to run away

Older adults

As our population ages, depression among the elderly is a growing concern. Though not unique to this age group, factors contributing to depression may include:

• personal loss such as the death of a spouse or friend
• declining physical health which can result in mood changes
• reactions to medications prescribed to treat physical ailments
• isolation from others

Types of depression

The two basic types of depression are major depression and the depressive phase of bipolar disorder. Each of these is described in greater detail below.

Major depression

Also called major depressive disorder, clinical depression, endogenous depression, biochemical depression or biological depression, major depression involves a severely depressed mood that persists for at least two weeks. Depressive episodes may start suddenly or slowly and can occur several times over the course of a lifetime.

There are several sub-types of major depression:

A very severe condition, melancholia is characterized by a number of major physical symptoms including appetite and sleep disturbances, weight loss, and withdrawal.

In addition to physical symptoms like those above, psychotic depression is a severe condition whose symptoms also include hallucinations or delusions.

People suffering from atypical depression experience a great deal of anxiety and frequent panic attacks.

Dysthymic disorder (also known as chronic depressive symptoms) describes a long-term mild depression that lasts at least two years. This type of depression usually begins in adolescence and spans several decades. It can adversely affect personality.

Bipolar disorder

Often called manic depression, bipolar disorder is a cyclical illness in which moods can fluctuate between mania — extreme happiness and frantic activity — and profound depression.

What causes depression?

While a specific cause for depression has not yet been identified, a number of factors are believed to play a role.

Heredity

The tendency to develop depression is likely genetically linked and inherited. Depression does tend to run in families, although a person's developing depressive disorders is also dependent on the factors that follow.

Physiology

Depressive illnesses are believed to be caused by changes or imbalances of neurotransmitters—key chemicals— in the brain. How do these neurotransmitters work? Brain activity involves electrical charges that fire across the synapses—or spaces—between brain cells. Brain cells consist of two main parts: the axon and the neuron. With the help of neurotransmitters, electrical charges pass from the axon of one brain cell, across the synapse, to the neuron of another brain cell. When neurotransmitters are improperly balanced, electrical activity in the brain becomes disturbed.

Other brain chemicals, such as serotonin, play a key role in controlling mood. Reduced daylight is believed to affect the production of serotonin, resulting in Seasonal Affective Disorder, or SAD, a condition that primarily affects people living at northern latitudes. SAD involves depression in the winter and normal mood in the summer. Increased exposure to special, full-spectrum artificial light is used to reduce the symptoms of depression in patients affected by SAD.

Psychological factors

Distorted thinking, self-defeating attitudes and behaviors, and low self-esteem are often associated with depression. People affected by depression may view the world as threatening, the future as hopeless, and themselves as unable to deal with life's challenges. Cognitive and behavioral therapy—therapies designed to correct these faulty styles of thinking—can result in improved mood and self-esteem.

Early experiences

Events or circumstances in early childhood which may increase the likelihood of depression later in life may include:

• Death or prolonged absence of a parent, sibling, or other close relative
• Being abandoned or rejected
• Neglect or lack of loving care
• Chronic illness and/or lengthy hospitalization
• Severe psychological, physical, or sexual abuse

Often affecting people who have suffered psychological, physical, or sexual abuse, depression is also common among individuals who have experienced job loss, financial difficulties, long periods of unemployment, loss of family members, divorce, or marital/family difficulties.

Medical conditions

There are a number of illnesses, including influenza, hepatitis, mononucleosis, thyroid, and stroke which are often thought to contribute to depression. Prescription medications such as oral contraceptives, steroids, and blood pressure medications are also though to contribute to depression.

Childbirth

Post-partum depression, a form of major depression which typically begins about three weeks after a woman has given birth, affects an estimated 10 percent of new mothers and its symptoms may persist for several months. It's believed that two of every one thousand will experience depression so severe as to cause hallucinations or delusions.

Living with a depressed person

Living with a chronically or severely depressed person undoubtedly causes worry, distress, and family disruption. All of these increase the possibility that others in the family may also become depressed.