Depression

Depression has become increasingly common in the United States with estimates of 13-14 million people experiencing clinical depression. ( See the last section of this article for information about the dangers of depression and current statistics).  I primarily use a CBT (Cognitive Behavioral Therapy) approach to treating depression.

Research has found that:

• It is one of the most effective treatments for conditions where anxiety or depression is the main problem.
• It is the most effective psychological treatment for moderate and severe depression.
• It is as effective as antidepressants for many types of depression.

The effective treatment of depression often includes the use of anti-depressant medications.  I try to work closely with your physician or other healthcare professional to integrate medications into the treatment.

WHAT IS DEPRESSION?

Confusion is commonplace about depression, for example, about what depression exactly is and what makes it different from just feeling down. There is also confusion surrounding the many types of depression (e.g., unipolar depression, biological depression, manic depression, seasonal affective disorder, dysthymia, etc.) that people may experience. There have been so many terms used to describe this set of feelings that I hope the following will add some clarity.

Depression is characterized by a number of common symptoms. These include a persistent sad, anxious, or “empty” mood, and feelings of hopelessness or pessimism. A person who is depressed also often has feelings of guilt, worthlessness, and helplessness. They no longer take interest or pleasure in hobbies and activities that were once enjoyed; this may include things like going out with friends or even sex. Insomnia, early-morning awakening, and oversleeping are all common.

Appetite and/or weight loss or overeating and weight gain may be symptoms of depression in some people. Many others experience decreased energy, fatigue, and a constant feeling of being “slowed down.” Thoughts of death or suicide are not uncommon in those suffering from severe depression. Restlessness and irritability among those who have depression is common. A person who is depressed also has difficulty concentrating, remembering, and trouble making decisions. And sometimes, persistent physical symptoms that do not respond to traditional treatments — such as headaches, digestive disorders, and chronic pain — may be signs of a depressive illness.

Do I Have Just The Blues… Or Something More?

Feeling down or feeling like you’ve got the blues is pretty common in today’s fast-paced society. People are more stressed than ever, working longer hours than ever, for less pay than ever. It is therefore natural to not feel 100% some days. That’s completely normal.

What differentiates occasionally feeling down for a few days from depression is the severity of the symptoms listed above, and how long you’ve had the symptoms. Typically, for most depressive disorders, you need to have felt some of those symptoms for longer than two weeks. They also need to cause you a fair amount of distress in your life, and interfere with your ability to carry on your normal daily routine.

Depression is a severe disorder, and one that can often go undetected in some people’s lives because it can creep up on you. Depression doesn’t need to strike all at once; it can be a gradual and nearly unnoticeable withdrawal from your active life and enjoyment of living. Or it can be caused by a clear event, such as the breakup of a long-term relationship, a divorce, family problems, etc. Finding and understanding the cause of depression isn’t nearly as important as getting appropriate and effective treatment for it.

Grief after the death or loss of a loved one is common and not considered depression in the usual sense. Teenagers going through the usual mood swings common to that age usually don’t experience clinical depression either. Depression usually strikes adults, and twice as many women as men. It is theorized that men express their depressive feelings in more external ways that often don’t get diagnosed as depression. For example, men may spend more time or energy focused on an activity to the exclusion of all other activities, or may have difficult controlling outbursts of rage or anger. These types of reactions can be symptoms of depression.

Depressive disorders come in many different types, but each type has its own unique symptoms and treatments.

Major depression, the most common type of a depressive disorder, is characterized by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Mental health professionals use this checklist of specific symptoms to determine if depression exists or not. Depression is also rated by your diagnosing physician or mental health professional in terms of its severity — mild, moderate, or severe. Severe depression is the most serious type.

A less severe type of depression,dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depressive disorder is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

DEPRESSION

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Symptoms of Mania (for Bipolar Disorder)

MANIA

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior

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