Depression

WHAT IS DEPRESSION?

Depression is a serious illness, not a harmless part of life. It is a complex disorder with a variety of causes. It is never caused by just one thing. It may be the result of a mix of factors, including genetic, chemical, physical, and sociological causes. It is also influenced by behavior patterns learned in the family and by cognitive distortions.

Depression affects thousands of people in this country. It is always troubling, and for some people it can be disabling. Depression is more than just sadness or “the blues.” It can have an impact on nearly every aspect of a person’s life. People who suffer from depression may experience feelings of despair and worthlessness, and these can have an enormous impact on both personal and professional relationships.

WHAT ARE THE SYMPTOMS OF DEPRESSION?

People who are diagnosed with clinical depression have a combination of symptoms from the following list:

• Feelings of hopelessness, even when there is reason to be hopeful
• Fatigue or low energy
• Greatly reduced interest or pleasure in most regular activities
• Low self-esteem
• Feelings of worthlessness
• Excessive or inappropriate guilt
• Reduced ability to think or concentrate
• Indecisiveness
• Thinking distorted thoughts; having an unrealistic view of life
• Gain or loss of weight without dieting
• Change in appetite
• Change in sleeping patterns
• Recurrent thoughts of death
• Suicidal thoughts
• A specific plan for committing suicide
• A suicide attempt
• Feelings of restlessness or being slowed down

When a person is suffering from depression, these symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. This means that the person’s family and social relationships and work life are impaired. When a person is suffering from depression, symptoms such as these are not the result of a chronic psychotic disorder, a general medical condition, or bereavement.

IS DEPRESSION THE SAME AS GRIEF OR SADNESS?

Depression may include feelings of sadness, but it is not the same as sadness. Depression lasts much longer than sadness. While depression involves a loss of self-esteem, grief, disappointment, and sadness do not. People who are depressed function less productively. People who are sad or disappointed continue to function.

WHAT CAUSES DEPRESSION?

Depression does not seem to be related to ethnicity, education, income, or marital status. It strikes slightly more women than men. Some researchers believe that depression strikes more often in women who have a history of emotional and sexual abuse, economic deprivation, or are dependent on others. There seems to be a genetic link. Depression is more common among parents, children, and siblings of people who are diagnosed with depression. The average age at the onset of a depressive episode is the mid-twenties. However, people born more recently are being diagnosed at a younger age.

PHYSICAL CAUSES

Many physicians believe that depression results from a chemical imbalance in the brain. They often prescribe antidepressant medication, and many people find relief as a result. However, there is no reliable test to identify such a chemical imbalance. It is unknown whether life experiences cause mood changes, which create changes in brain chemistry; or whether the process works in reverse. Depression may be associated with physical events such as other diseases, physical trauma, and hormonal changes. A person who is depressed should always have a physical examination as part of the assessment process to determine the role of physical causes.

WHEN IS PROFESSIONAL TREATMENT NEEDED?

If you or someone you know is depressed and exhibits any of the following signs, it is extremely important to seek the assistance of a medical or mental health professional:

1. Thoughts about death or suicide. This is always dangerous, and you should see a professional therapist immediately.
2. Symptoms of depression continue for a long time. When this occurs, you may need professional help. Acute responses to events are normal, but they should not last beyond a reasonable time.
3. Your ability to function is impaired by your depression. Seek help before your life situation deteriorates to a serious level.
4. You have become severely isolated. An isolated person has no one with whom to reality test. Seek someone out to share your thoughts and feelings with.
5. Depressive symptoms have become severe.

WHAT IS THE TREATMENT FOR DEPRESSION?

There are three basic ways to treat depression: psychotherapy, self-help, and medication. Many people respond best with a combination of two or more methods.

• Psychotherapy. Exploring one’s beliefs and ways of thinking, and learning new ways of thinking and behaving, with the guidance of a professional.
• Self-help. Exploring one’s beliefs and ways of thinking on one’s own.
• Medication. Altering one’s brain chemistry by taking antidepressant medication. A physician may recommend medication when four conditions exist:
  • The patient’s depression is severe.
  • The patient has suffered at least two previous depressive episodes.
  • There is a family history of depression.
  • The patient asks for medication only and refuses psychotherapy.
• There are four types of antidepressant medication available today:
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Structurally unrelated compounds

The TCAs and MAOIs have been used for decades. The SSRIs and structurally unrelated compounds are newer and are being prescribed more and more frequently today. They have fewer and less pronounced side effects than the TCAs and MAOIs.

CAN DEPRESSION BE TREATED WITHOUT MEDICATION?

One of the leading methods for treating depression is cognitive therapy. A cognitive therapist helps the  client feel better by identifying how faulty ways of thinking are making him or her feel bad. The client analyzes his or her thoughts and beliefs, and learns to substitute more healthy ways of thinking and believing.

Researchers at the University of Pennsylvania and Vanderbilt University found that cognitive therapy is just as effective as medication in treating severe depression. Their study concluded that cognitive therapy is a less expensive long-term treatment than medication, and it is at least as effective. Many mental health professionals believe that the ideal treatment of clinical depression is medication in conjunction with psychotherapy.

CAN DEPRESSION BE PREVENTED?

Depression can often be prevented. It is especially important to take preventive action if you are aware that you have predisposing factors. Here are some steps you can take to prevent depression:

• Identify your risk factors and be aware of where you are vulnerable. Each of has unique risk factors, such as things we were taught in our families of origin, values we have learned, and the presence or absence of a family history of depression.
• Learn to manage stress. You can learn proven techniques for calming and relaxing yourself. Consider taking a stress management class or downloading meditation apps like Calm.
• Learn problem-solving skills. Many people who develop depression never learned problem-solving skills. They need to develop the ability to view problems from many viewpoints and look for a variety of solutions.
• Build your life around things you can control.
• Learn to recognize what you can control and what you can’t. Avoid spending much effort on situations that won’t pay off for you.
• Learn self-acceptance. Instead of rejecting the parts of yourself you don’t like, learn to manage them more productively.
• Become aware of selective perception. Observe how you generate ideas and opinions about people and events. Remember that these are just your views, not necessarily objective facts.
• Focus on the future, not the past. Depressed people tend to be focused on the past. People who set goals and focus on the future tend to be more positive about life.
• Develop a sense of purpose. Many depressed people lack a sense of purpose or meaning. This means they have no goals and nothing in the future drawing them forward. To prevent depression, develop your sense of purpose and meaning.
• Strengthen your emotional boundaries and set limits. Boundaries define your role in a social situation. They determine how you will and will not behave in a given situation. Having clear, strong boundaries is empowering, while boundary violations make you feel victimized and helpless. Setting limits means having and enforcing rules for what behavior you expect in a relationship.

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