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
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.
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,
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
- withdrawing from friends and family
- chronic and serious conflicts with parents after long-standing
- anti-social behavior
- problems with the law
- attempts to run away
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.
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.
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.
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.
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.
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.
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
- 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
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
steroids, and blood pressure
medications are also though to contribute to depression.
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
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.