Depression - Spotlight on Depression
Depression, a very common problem, is a treatable medical condition. The treatment is as successful as those found with other medical problems. According to the National Institutes of Mental Health, in a given year, 10% of the U.S. population experiences symptoms of depression. Depression is not a moral failing or a sign of psychological weakness. It is not the same as the very common feeling of being temporarily “down in the dumps” on a rainy afternoon or feeling “blue” for a day or two. Instead, depression is a serious, potentially fatal illness that can affect all areas of a person’s life: body, mind, work, family, friendships, and hobbies.
Symptoms
The name “depression” actually refers to a family of related medical conditions, including major depression, dysthymia, and bipolar disorder (manic depressive illness). This article is limited to a discussion of major depression. Major depression can bring about one or more recognizable symptoms, including:
Feelings of hopelessness or pessimism about the future
Thoughts of suicide
Feelings of guilt, worthlessness or helplessness
Loss of interest in enjoyable activities
Feelings of fatigue or decreased energy
Difficulty concentrating and/or making decisions
Sleep disturbance (insomnia, waking up too early, sleeping too much)
Appetite disturbance (weight loss or weight gain)
Restlessness
Irritability (easily upset or angered)
Physical symptoms (including headaches, digestion problems, and chronic pain) that do not respond to other treatment
Risk Factors
In some cases, major depression can occur in several generations of the same family. However, major depression can also strike people with no family history of the disease. Other risk factors for depression include low self-esteem, a pessimistic view of the world, and difficulty coping with stress. Certain medical conditions, including stroke, heart disease, cancer, and Parkinson’s disease can also lead to major depression. Finally, a significant event or events, including job loss, death of a loved one, the end of a relationship, or financial difficulties, can trigger an episode of major depression. A person’s first episode of major depression often results from a combination of genetic, psychological and environmental causes. It is not uncommon for victims of an episode of major depression to experience two or more episodes throughout their life. Later episodes of major depression may be triggered by the same combination of issues that triggered the first episode, or a later episode may develop without any noticeable cause.
Twice as many women as men experience major depression. The reasons for this disparity are not completely clear. Women’s bodies experience unique hormonal changes, associated with events such as menstruation, pregnancy, new motherhood, and menopause, that help account for women’s increased rates of major depression. While men are less likely than women to suffer an episode of major depression, the National Institutes of Mental Health estimates that 3 to 4 million men in the U.S. do experience major depression at any given time. This is especially troubling because men are less likely than women to admit and report symptoms of major depression, and 4 times more likely than women to commit suicide.
Major depression also occurs in older adults, but symptoms are often mistaken for normal signs of aging. Also, some symptoms of depression in older adults can result from certain medical conditions or medications an older adult is taking to treat medical conditions. Major depression strikes children as well as adults. Symptoms of major depression in children may be mistaken for “growing pains” which the child will “grow out of”, and so the disease may go undiagnosed and untreated.
Diagnosis
Proper diagnosis of major depression begins with a physical examination by a physician. As mentioned, certain medications and physical illnesses can lead to symptoms of depression. If a physical problem is ruled out, the patient is often referred to a mental health professional, such as a psychiatrist or psychologist, for special testing. Psychiatrists are physicians with advanced training in mental illness and brain disorders. Psychologists do not have a medical degree, and cannot prescribe medication, but they do have advanced training in counseling psychology and psychotherapy. Psychiatric social workers and Advanced Practice Nurses are other mental health practitioners who can be helpful. Once major depression is properly diagnosed, the care provider(s) decide on a course of treatment.
Treatment
Psychotherapy alone can be very helpful for persons with mild depression. A psychotherapist helps depressed patients identify and, wherever possible, change the behaviors, thoughts, and feelings that helped cause or can worsen a depressive episode. The form, type, and length of the psychotherapy should always be discussed with the practitioner.
Antidepressant medication is generally prescribed for persons with moderate to severe depression. Patients must take the prescribed dose of antidepressant medication for at least 3 or 4 weeks, and perhaps as many as 8 weeks, before feeling the medication’s full effects. Antidepressants, like other prescription medications, may cause mild, temporary side effects in some patients. Patients should report any side effects to their physician. Physicians typically direct patients to take their antidepressants regularly for up to 9 months in order to prevent a relapse. Regardless of any side effects or an improvement in their condition, patients should never stop taking an antidepressant, or change the dosage, without first speaking to their physician.
Depressed patients typically receive a combination of psychotherapy and antidepressant medication. Electroconvulsive therapy, commonly known as electroshock therapy, may be prescribed for patients with severe depression who do not respond to or cannot tolerate medication. Although sometimes misrepresented in the popular media, ECT has been shown to be particularly helpful and even life-saving for some individuals.
What is most important is that the disorder be diagnosed and treated. Appropriate treatment can help most persons dealing with major depression. Untreated, symptoms can last for weeks, months or even years. Moreover, untreated depression effects and is painful both to the person with it and to his/her family, friends, work associated.
Major depression itself is not a fatal disease, but severely depressed persons may feel so hopeless that they consider or even attempt suicide. Patients should discuss any suicidal thoughts, feelings or actions with their mental health care provider. If a patient poses an immediate danger to themselves or someone else, they should call 911 or go to mental health crisis center or hospital emergency room immediately.
Depression is more than just “feeling blue.” If you or someone you know shows signs of major depression, talk with your healthcare provider. Help is out there.
Edited by George M. Wohlreich, MD, Director and CEO, The College of Physicians of Philadelphia