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I. Meaning of Depression
Depression is one of the most common and most serious mental health problems facing
people today. While it is only human to experience feelings of sadness, gloominess, or
melancholy every now and then, clinical depression occurs when these feelings endure for long
periods of time that can last for several weeks to several years if left untreated. Depression can
interfere with a person's ability to function effectively throughout the day or even to have the
motivation to get out of bed in the morning.
A. Psychological Explanation
Depression is best understood as a state of psychological exhaustion. This exhaustion limits our
capacity to respond emotionally, intellectually, and creatively to our lives. Just as physical
exhaustion prevents an energetic physical response to life, psychological exhaustion prevents an
energetic emotional and intellectual response to life.
Psychological exhaustion can have many possible causes. Life situations that are emotionally
demanding, long term and seemingly unending can drain us. Each of us must at sometime cope
with a painful life situation that is not easily remedied a painful marriage, no marriage,
unfulfilling or stressful work, lack of a supportive community, illness, personal loss, a lack of
financial resources. Psychological stress is intensified if we feel powerless to change our
circumstances. Over time, a pervasive sadness, anger or loneliness can result in emotional
depletion. The situation itself does not cause the depression. Many people live in stressful
situations and are not depressed. Beliefs that give meaning and purpose to painful or stressful
experiences can sometimes provide an emotional immunity from depletion. Nonetheless, living
with chronic situational stressors and emotional pain puts us at risk for psychological depletion
and depression.
B. What is depression?
Depression is an illness that causes a person to feel sad and hopeless much of the time. It is
different from normal feelings of sadness, grief, or low energy.
Anyone can have depression. It often runs in families. But it can also happen to someone who
doesn't have a family history of depression. You can have depression one time or many times.
If you think you may be depressed, tell your doctor. There are good treatments that can help you
enjoy life again. The sooner you get treatment, the sooner you will feel better.
C. Basics
Depression is an illness that can affect thoughts, mood, and physical health. It is characterized by
overwhelming feelings of sadness, emptiness, and worthlessness. With depression, these feelings
are severe enough that they interfere with work and relationships [Table 1].
Depression is a long-term condition involving several symptoms that can negatively affect work,
relationships, and the quality of life of those that suffer from it. About 17% of the U.S.
population experiences depression at some time in their lives. Depression is more common in
women but can happen to anyone, regardless of race, income, or education.
Depression is classified as a psychiatric illness. The term “psychiatric illness” is a general term
that covers a wide range of disorders. In the past, ignorance and fear contributed to a social
stigma regarding psychiatric illness. It is becoming more widely known that psychiatric
problems such as depression are common.
Many people misunderstand depressive disorders. Depression is not just “feeling blue.” It is not a
sign of weakness or lack of character. A person cannot “just snap out of” being depressed. These
misinformed attitudes can harm depressed people by causing them to avoid acknowledging their
illness and seeking treatment. Without treatment, depression can last for months, or even years.
The causes of depression are not entirely understood. Things that may trigger depression include:
Major events that create stress, such as childbirth or a death in the family.
Illnesses, such as arthritis, heart disease, or cancer.
Certain medicines, such as steroids or narcotics for pain relief.
Drinking alcohol or using illegal drugs.
These and other factors can cause certain brain chemicals to get out of balance. As soon as the
imbalance is corrected, symptoms of depression generally go away.
If you have a close relative with a history of depression, you are 1.5 to 3 times more likely to
become depressed than someone with no family history of depression. This is likely due at least
in part to heredity. For example, adopted children whose biological parents have a history of
depression have an increased risk for depression, even if the children's adoptive family has no
history of depression. However, nongenetic factors within the environment of some families may
also increase the risk of depression. Learned behavior, social environment, and economic
conditions may contribute to the development of depression.
Disturbances in brain chemistry often occur with depression. The brain requires certain
chemicals to function. These chemicals are called neurotransmitters. Antidepressant drugs that
increase levels of certain neurotransmitters, especially serotonin and norepinephrine, are most
effective in treating depression.
Some women regularly experience depression associated with their menstrual cycle, with
symptoms improving after their period begins (when estrogen levels drop). The phenomenon of
sadness following birth (postpartum depression) is also well known, and seems to be at least
partly hormonally triggered.
While much more common for women, hormonally driven episodes of depression can occur in
men as well. For example, teenagers (both male and female) can become moody as a result of the
hormonal fluctuations of adolescence. In addition, men who take testosterone for bodybuilding
can become depressed when they stop taking the hormone. Adrenal, thyroid, and growth
hormone dysfunction have also been cited as causes for depression in both men and women.
Injury to the brain (such as head injury or stroke) can cause changes in mood and personality,
including depression. Tests such as magnetic resonance imaging (MRI), positron emission
tomography (PET), and single photon emission computed tomography (SPECT) can be useful in
detecting abnormalities of the brain that may cause depression.
In the past, psychiatrists theorized that depression was caused by unconscious anger toward
oneself, feelings of childhood loss, or frustration about reality not measuring up to one's
aspirations. Current theories state that depression results from persistent negative thoughts about
oneself or from stress caused by interpersonal conflicts.
Psychotherapy that focuses on changing persistent negative thoughts about oneself and others
(cognitive-behavioral therapy), improving relationships (interpersonal therapy), and stress
reduction techniques can be effective in treating mild to moderate depression. Such
psychotherapy can both relieve depression and prevent it from recurring. Psychotherapy may be
used alone, or with antidepressant medication.
Both men and women are particularly at risk for depression after the death of a spouse. Many
remain depressed for a year after their loss. Unemployment, divorce, and serious health crises
can also trigger depressive episodes. Once someone has experienced an initial episode of
depression, they are at higher risk of having depression again in the future
There are several different types of depression. Often they are distinguished by their prevalent
features, duration and severity of symptoms. Most of these kinds of depression are defined by the
Diagnostic and Statistical Manual of Mental Disorders (DSM), an American Psychiatric
Association publication which describes the standard criteria for different types of psychiatric
disorders.
The following three different kinds of depression are distinct depressive disorders described in
the DSM. A common criteria is that their symptoms either cause 1) significant distress or 2)
impair one’s functioning (e.g. work, school, relationships). Also, these depressive symptoms are
not caused by a medical condition or substance (e.g. medication, drug).
– A major depressive episode occurs with symptoms that last for most of the day, nearly
every day for at least two weeks. A symptom must either be 1) depressed mood or 2) a
noticeable decrease in interest or pleasure in all or most activities. At least four (or more)
additional symptoms are present:
– Nearly constant depressed mood for at least 2 years accompanied by at least two (or more)
of the following:
Symptoms do not occur for more than two months at a time. Generally, this type of depression is
described as having persistent but less severe depressive symptoms than Major Depression.
– This kind of depression includes periods of mania and depression. Cycling between these
two states can be rapid or only mania can be present without any depressive episodes. A
manic episode consists of a persistent elevated or irritable mood that is extreme, which lasts
for at least one week. At least three (four if only irritable mood) other features are also
present:
Symptoms can be severe enough to warrant hospitalization to prevent harm to self or others or
include psychotic features (e.g. hallucinations, delusions).
B. Other Types of Depressive Categories
B.1 Post Partum Depression – Major depressive episode that occurs after having a baby.
Depressive symptoms usually begin within four weeks of giving birth and can vary in
intensity and duration.
B.2 Seasonal Affective Disorder (SAD) – A type of depressive disorder which is
characterized by episodes of major depression which reoccur at a specific time of the year
(e.g. fall, winter). In the past two years, depressive periods occur at least two times without
any episodes that occur at a different time.
B.3 Anxiety Depression - Not an official depression type (as defined by the DSM).
However, anxiety often also occurs with depression. In this case, a depressed individual
may also experience anxiety symptoms (e.g. panic attacks) or an anxiety disorder (e.g.
PTSD, panic disorder, social phobia, generalized anxiety disorder).
B.4 Atypical Depression (Sub-type of Major Depression or Dysthymia) - Characterized by
a temporary improvement in mood in reaction to positive events and two (or more) of the
following:
• Depressed mood that has a distinct quality (e.g. different from feeling
depressed when grieving)
• Depression is consistently worse in the morning
• Waking up earlier than usual (at last 2 hours)
• Noticeable excessive movement or slowing down
• Significant decrease in appetite or weight loss
• Feeling excessive or inappropriate guilt
Treatment will differ depending on the type of depression based on its severity and various
symptoms. For example, the focus of therapy may vary or different antidepressants may be
prescribed targeting certain symptoms.
All of these symptoms can cause a problem with your quality of life. If you have had a few of
these symptoms for at least 2 weeks, talk to your doctor. You may have depression that requires
treatment
A. Effects of Depression
The effects of untreated clinical depression are experienced not only by the person suffering
from depression, but also by immediate family members and friends. Being around depressed
people can be extremely challenging, mainly because extreme cases of depression sometimes
result in attempted suicides and life-threatening situations.
Since they are experiencing an altered state of mind, it becomes extremely difficult to predict
what they are capable of doing from one minute to the next. Certain situations, memories,
remarks, etc, can drive them to the depths of self-loathing and self-punishment that they will not
only contemplate suicide, but very often take to drugs and alcohol.
Numerous issues can get affected as a direct result of depression, and some of the common but
serious effects of depression are on:
One of the first signs and effects of depression one notices is lack of sleep and poor quality of
sleep. Insomnia and sleep deprivation then start taking a toll on the person’s physical health
because it is easy to feel stressed and tired when one isn’t sleeping well for days on end.
Constant headaches, irritability, crying spells, feelings of helplessness, etc, increase during nights
when one isn’t able to sleep and certain thoughts keep playing in one’s head over and over again.
This is followed by another classic sign of depression, which is deterioration in personal hygiene.
Depressed people often refuse to wash up, comb their hair, wear fresh clothes, or even eat on
time.
Most adolescents and young adults take to alcohol and drugs to escape troubling and disturbing
thoughts, thereby creating a dependency on substance abuse and alcohol, which again creates
severe damage both physically and emotionally. Indeed, the negative effects of depression can
sometimes spiral out of control. Therefore, it becomes extremely important for parents, spouses,
or children of depressed people to be extremely patient and to persuade their loved ones to seek
professional help.
Depression can be completely cured, the ill effects of depression can be reversed, and people can
get back to normalcy quickly. But this requires regular follow up, lots of love, affection, and
support from family and friends.
One of the most common mistakes most people very often make is to refuse to accept that their
loved ones are experiencing clinical depression, neglecting the issue completely and feeling that
it is just a phase and the patient will get over it. Such negligence can prove fatal, mainly because
the person suffering from depression will be sinking deeper and deeper into the problem with
every passing day. Never underestimate the powerful adverse effects of depression.
This is due to their self confidence and self esteem being at an all time low. They are going to
feel incapable, incompetent, and inept, which will result in poor performance, thereby causing
further damage to their already low morale.
At a personal level, too, people suffering from depression cannot fulfil their responsibilities in
various roles and / or situations. A depressed parent cannot take responsibility for his or her
children and will not take care of their physical or emotional needs. Similarly, a depressed
spouse will not be able to relate to his or her spouse at a physical or emotional level, and can
become the cause of serious worry and tension for the entire family.
Therefore, it becomes extremely important that children and spouses take an active interest in
getting the person treated for clinical depression at the earliest. While it takes immense hardship
to ensure that people suffering from depression face the problem, accept it, and go through the
entire treatment, one must not lose hope during the course of the treatment mainly because there
is light at the end of the tunnel and clinical depression is completely curable.
People will certainly be able to overcome the ill effects of depression and get back to normalcy
once they receive effective treatment. If not cared for adequately, depressed children,
adolescents, and adults can end up committing suicide, mainly because they will not be able to
overcome the fears and challenges in their minds and ultimately want to put an end to their
suffering by terminating their lives.
Adolescents, especially the ones under the influence of alcohol or drug abuse, tend to think along
these lines when they suffer from depression, mainly because they lack the confidence to face
life, overcome challenges, or express their innermost fears and feelings with friends or family.
They often feel that they are worthless and will be laughed at by others. Certain traumatic
experiences such as being abused as children, teenagers or even as adults stay in their psyche and
they are often unable to share these experiences with others and thereby end up hating and
punishing themselves.
Loved ones must make it a point to help encourage depressed people to talk about their feelings
and experiences, and make it a point to give them a patient hearing and convince them to seek
professional help if necessary. This will help them to deal with, fight and ultimately beat the bad
effects of depression.
B.4 Relationships
Most primary relationships, however strong, go through trying times during the course of normal
life even when everyone is in the best possible state of mind. Therefore, one can only imagine
the difficulties and setbacks experienced by people suffering from depression.
It is also equally challenging and difficult for the other person or people in such relationships,
because, as part of the negative effects of depression, depressed people often fail to see reason,
do not want to believe there is hope, and ultimately give up any and all effort towards making
relationships work.
Feelings of remorse, guilt, and self hatred will override all other positive emotions and, with the
first sign of failure or rejection, they sink further into depression. Therefore, making
relationships survive and progress depends mainly on the other person, which is certainly not an
easy task.
At times like this, one should not start believing and agreeing with the person who is depressed,
but talk them into facing and overcoming challenges slowly. One should draw their attention to
the fact that there is more to life than clinging to one’s fears, past memories, and convince them
to seek professional help. Otherwise, along with the patient, the rest of the family members, too,
will begin to experience negative feelings and emotions associated with the undesirable effects
of depression.
Depression is an illness that causes more disability than diabetes, coronary artery disease, or
arthritis. The World Health Organization estimates that depression will be the second-leading
cause of disability by the year 2020.
• Decreased productivity.
• Job-related injuries.
• Poorer-quality work.
• Lost jobs.
If you have mild or moderate depression, you may be diagnosed and treated by your family
doctor and a therapist or psychologist. If you have severe depression or do not respond to
treatment, it may be helpful to see a psychiatrist. This is a medical doctor who specializes in
mental health problems. Severe cases of depression may need to be treated in the hospital.
Let your doctor know if you believe you are depressed, because depression is often overlooked.
If you are diagnosed with depression, you and your doctor can decide on the best treatment. The
earlier you are treated, the more quickly you will recover.
• Planning to, or saying they want to, kill themselves or someone else.
• Being out of touch with reality, having severe anxiety, or thinking they hear voices giving
them commands.
• Talking, writing, or drawing about death. This includes writing suicide notes and talking
about items that can cause physical harm, such as pills, guns, or knives.
If a suicide threat seems real, with a specific plan and a way to carry it out, the following
guidelines may help:
• Call 911 , a suicide hotline, or the police.
• Stay with the person, or ask someone you trust to stay with the person, until the crisis has
passed.
• Encourage the person to seek professional help.
• Don't argue with the person ("It's not as bad as you think") or challenge him or her ("You're
not the type to commit suicide").
• Tell the person you don't want him or her to die. Talk about the situation as openly as
possible
Sources:
http://health.yahoo.com/depression-overview/depression-topic-overview
http://www.csoinc.org/depression.htm
http://www.informationondepression.org/70/effects-of-depression/
http://www.pdrhealth.com/disease
http://www.all-on-depression-help.com/effects-of-depression.html