Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness. Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat peoplebwith depression.
There are several forms of depressive disorders.
Major depressive disorder, or major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep,study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. Some people may experience only a single episode within their lifetime, but more often a person
may have multiple episodes.
Dysthymic disorder, or dysthymia , is characterized by long-term (2 years or longer) symptoms that may not be severe enough to disable a person but can prevent normal functioning or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
Minor depression is characterized by having symptoms for 2 weeks or longer that do not meet full criteria for major depression. Without treatment, people with minor depression are at high risk for developing major depressive
disorder.
Some forms of depression are slightly different, or they may develop under unique circumstances. However, not everyone agrees on how to characterize and define these forms of depression. They include:
- Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
- Postpartum depression , which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of womenexperience postpartum depression after giving birth.
- Seasonal affective disorder (SAD) , which is characterized by the onset of depression during the winter months, when there is less natural sunlight.
The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g.,depression).
Causes
Most likely, depression is caused by a combination of genetic, biological,
environmental, and psychological factors.
Depressive illnesses are disorders of the brain. Brain-imaging technologies,
such as magnetic resonance imaging (MRI), have shown that the brains of
people who have depression look different than those of people without
depression. The parts of the brain involved in mood, thinking, sleep, appetite,
and behavior appear different. But these images do not reveal why the
depression has occurred. They also cannot be used to diagnose depression.
Some types of depression tend to run in families. However, depression can
occur in people without family histories of depression too. Scientists are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results from the influence of several genes acting together with environmental or other factors.
In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.
Signs & Symptoms
"It was really hard to get out of bed in the morning. I just wanted to hide under the covers and not talk to anyone. I didn't feel much like eating and I lost a lot of weight. Nothing seemed fun anymore. I was tired all the time, and I wasn't sleeping well at night. But I knew I had to keep going because I've got kids and a job. It just felt so impossible, like nothing was going to change or get better."
People with depressive illnesses do not all experience the same symptoms.
The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.
Signs and symptoms include:
Persistent sad, anxious, or "empty" feelings
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions
Insomnia, early-morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Aches or pains, headaches, cramps, or digestive problems that do not
ease even with treatment.
Who Is At Risk?
Major depressive disorder is one of the most common mental disorders in the United States. Each year about 6.7% of U.S adults experience major depressive disorder. Women are 70 % more likely than men to experience depression during their lifetime. Non-Hispanic blacks are 40% less likely than non-Hispanic whites to experience depression during their lifetime. The average age of onset is 32 years old. Additionally, 3.3% of 13 to 18 year olds
have experienced a seriously debilitating depressive disorder.
Diagnosis
"I started missing days from work, and a friend noticed that something
wasn't right. She talked to me about the time she had been really depressed
and had gotten help from her doctor."
Depression, even the most severe cases, can be effectively treated. The earlier
that treatment can begin, the more effective it is.
The first step to getting appropriate treatment is to visit a doctor or mental
health specialist. Certain medications, and some medical conditions such as
viruses or a thyroid disorder, can cause the same symptoms as depression. A
doctor can rule out these possibilities by doing a physical exam, interview,
and lab tests. If the doctor can find no medical condition that may be causing
the depression, the next step is a psychological evaluation.
The doctor may refer you to a mental health professional, who should discuss
with you any family history of depression or other mental disorder, and get a
complete history of your symptoms. You should discuss when your symptoms
started, how long they have lasted, how severe they are, and whether they
have occurred before and if so, how they were treated. The mental health
professional may also ask if you are using alcohol or drugs, and if you are
thinking about death or suicide.
Other illnesses may come on before depression, cause it, or be a consequence
of it. But depression and other illnesses interact differently in different people.
In any case, co-occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-
compulsive disorder, panic disorder, social phobia, and generalized anxiety
disorder, often accompany depression. PTSD can occur after a person
experiences a terrifying event or ordeal, such as a violent assault, a natural
disaster, an accident, terrorism or military combat. People experiencing PTSD
are especially prone to having co-existing depression.
Alcohol and other substance abuse or dependence may also co-exist with
depression. Research shows that mood disorders and substance abuse
commonly occur together.
Depression also may occur with other serious medical illnesses such as heart
disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease. People
who have depression along with another medical illness tend to have more
severe symptoms of both depression and the medical illness, more difficulty
adapting to their medical condition, and more medical costs than those who
do not have co-existing depression. Treating the depression can also help
improve the outcome of treating the co-occurring illness.
For more visit. www.nimh.nih.gov/health/topics/depression/index.shtml
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