What is Major Depression
The following information is provided by the
National Institute of Mental Health.
Unfortunately, many people do not recognize that depression is a treatable
illness. If you feel that you or someone you care about is one of the
many undiagnosed, depressed people in this country, the information presented
here may help you take the steps that may save your own or someone else's
In any given one-year period, 9.5 percent of the
population, or about 18.8 million American adults, suffer from a depressive
illness. The economic cost for this disorder is high, but the cost
in human suffering cannot be estimated. Depressive illnesses often
interfere with normal functioning and cause pain and suffering not
only to those who have a disorder, but also to those who care about
them. Serious depression can destroy family life as well as the life
of the ill person. But much of this suffering is unnecessary. Most
people with a depressive illness do not seek treatment, although the
those whose depression is extremely severe—can be helped. Thanks
to years of fruitful research, there are now medications and psychosocial
therapies such as cognitive/behavioral, "talk" or interpersonal
therapies that ease the pain of depression.
What is Depressive Disorder?
A depressive disorder is an illness that involves the body, mood, and thoughts.
It affects the way a person eats and sleeps, the way one feels about oneself,
and the way one thinks about things. A depressive disorder is not the same as
a passing blue mood. It is not a sign of personal weakness or a condition that
can be willed or wished away. People with a depressive illness cannot merely "pull
themselves together" and get better. Without treatment, symptoms can last
for weeks, months, or years. Appropriate treatment, however, can help most people
who suffer from depression.
Types of Depression
Another type of depression 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, over-talkative,
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.
Depressive disorders come in different forms, just as is the case
with other illnesses such as heart disease. This pamphlet briefly describes
three of the most common types of depressive disorders. However, within
these types there are variations in the number of symptoms, their severity,
and persistence. Major depression is manifested 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.
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.
Symptoms of Depression and Mania
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.
- 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
- Difficulty concentrating, remembering, 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
- 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
Causes of Depression
Some types of depression run in families, suggesting that a biological vulnerability
can be inherited. This seems to be the case with bipolar disorder. Studies of
families in which members of each generation develop bipolar disorder found that
those with the illness have a somewhat different genetic makeup than those who
do not get ill. However, the reverse is not true: Not everybody with the genetic
makeup that causes vulnerability to bipolar disorder will have the illness. Apparently
additional factors, possibly stresses at home, work, or school, are involved
in its onset.
In some families, major depression also seems to occur generation
after generation. However, it can also occur in people who have no family history
of depression. Whether inherited or not, major depressive disorder is often associated
with changes in brain structures or brain function.
People who have low self-esteem,
who consistently view themselves and the world with pessimism or who are readily
overwhelmed by stress, are prone to depression. Whether this represents a psychological
predisposition or an early form of the illness is not clear.
In recent years,
researchers have shown that physical changes in the body can be accompanied by
mental changes as well. Medical illnesses such as stroke, a heart attack, cancer,
Parkinson's disease, and hormonal disorders can cause depressive illness, making
the sick person apathetic and unwilling to care for his or her physical needs,
thus prolonging the recovery period. Also, a serious loss, difficult relationship,
financial problem, or any stressful (unwelcome or even desired) change in life
patterns can trigger a depressive episode. Very often, a combination of genetic,
psychological, and environmental factors is involved in the onset of a depressive
disorder. Later episodes of illness typically are precipitated by only mild stresses,
or none at all.
Depression in Women
A recent NIMH study showed that in the case of severe premenstrual syndrome
(PMS), women with a preexisting vulnerability to PMS experienced relief
from mood and physical symptoms when their sex hormones were suppressed.
Shortly after the hormones were re-introduced, they again developed symptoms
of PMS. Women without a history of PMS reported no effects of the hormonal
women are also particularly vulnerable after the birth of a baby. The
hormonal and physical changes, as well as the added responsibility of
a new life, can be factors that lead to postpartum depression in some
women. While transient "blues" are common in new mothers, a
full-blown depressive episode is not a normal occurrence and requires
active intervention. Treatment by a sympathetic physician and the family's
emotional support for the new mother are prime considerations in aiding
her to recover her physical and mental well-being and her ability to
care for and enjoy the infant.
Women experience depression about twice as often as men.1 Many
hormonal factors may contribute to the increased rate of depression
in women—particularly such factors as menstrual cycle changes,
pregnancy, miscarriage, postpartum period, pre-menopause, and menopause.
Many women also face additional stresses such as responsibilities both
at work and home, single parenthood, and caring for children and for
Depression in Men
Although men are less likely to suffer from depression than women,
3 to 4 million men in the United States are affected by the illness.
Men are less likely to admit to depression, and doctors are less likely
to suspect it. The rate of suicide in men is four times that of women,
though more women attempt it. In fact, after age 70, the rate of men's
suicide rises, reaching a peak after age 85.
Depression can also affect the physical health in men differently
from women. A new study shows that, although depression is associated
with an increased risk of coronary heart disease in both men and women,
only men suffer a high death rate.2
Men's depression is often masked by alcohol or drugs, or by the socially
acceptable habit of working excessively long hours. Depression typically
shows up in men not as feeling hopeless and helpless, but as being
irritable, angry, and discouraged; hence, depression may be difficult
to recognize as such in men. Even if a man realizes that he is depressed,
he may be less willing than a woman to seek help.
Encouragement and support from concerned family members can make a difference.
In the workplace, employee assistance professionals or worksite mental
health programs can be of assistance in helping men understand and accept
depression as a real illness that needs treatment.
Depression in the Elderly
Some people have the mistaken idea that it is normal for the elderly
to feel depressed. On the contrary, most older people feel satisfied
with their lives. Sometimes, though, when depression develops, it may
be dismissed as a normal part of aging. Depression in the elderly,
undiagnosed and untreated, causes needless suffering for the family
and for the individual who could otherwise live a fruitful life. When
he or she does go to the doctor, the symptoms described are usually
physical, for the older person is often reluctant to discuss feelings
of hopelessness, sadness, loss of interest in normally pleasurable
activities, or extremely prolonged grief after a loss.
Recognizing how depressive symptoms in older people are often missed,
many health care professionals are learning to identify and treat the
underlying depression. They recognize that some symptoms may be side
effects of medication the older person is taking for a physical problem,
or they may be caused by a co-occurring illness. If a diagnosis of
depression is made, treatment with medication and/or psychotherapy
will help the depressed person return to a happier, more fulfilling
life. Recent research suggests that brief psychotherapy (talk therapies
that help a person in day-to-day relationships or in learning to counter
the distorted negative thinking that commonly accompanies depression)
is effective in reducing symptoms in short-term depression in older
persons who are medically ill. Psychotherapy is also useful in older
patients who cannot or will not take medication. Efficacy studies show
that late-life depression can be treated with psychotherapy.4
Improved recognition and treatment of depression in late life will make
those years more enjoyable and fulfilling for the depressed elderly person,
the family, and caretakers.
Depression in Children
The National Institute of Mental Health (NIMH) has identified the use
of medications for depression in children as an important area for research.
The NIMH-supported Research Units on Pediatric Psychopharmacology (RUPPs)
form a network of seven research sites where clinical studies on the
effects of medications for mental disorders can be conducted in children
and adolescents. Among the medications being studied are antidepressants,
some of which have been found to be effective in treating children with
depression, if properly monitored by the child's physician.
Only in the past two decades has depression in children
been taken very seriously. The depressed child may pretend to be sick, refuse
to go to school, cling to a parent, or worry that the parent may die.
Older children may sulk, get into trouble at school, be negative, grouchy,
and feel misunderstood. Because normal behaviors vary from one childhood
stage to another, it can be difficult to tell whether a child is just
going through a temporary "phase" or is suffering from depression.
Sometimes the parents become worried about how the child's behavior
has changed, or a teacher mentions that "your child doesn't seem
to be himself." In such a case, if a visit to the child's pediatrician
rules out physical symptoms, the doctor will probably suggest that
the child be evaluated, preferably by a psychiatrist who specializes
in the treatment of children. If treatment is needed, the doctor may
suggest that another therapist, usually a social worker or a psychologist,
provide therapy while the psychiatrist will oversee medication if it
is needed. Parents should not be afraid to ask questions: What are
the therapist's qualifications? What kind of therapy will the child
have? Will the family as a whole participate in therapy? Will my child's
therapy include an antidepressant? If so, what might the side effects