An Overview of
While feeling happy and sad is part of everyday living, depression is different. When you’re depressed, you may feel helpless, hopeless, and functionless. Depression is very common among adults in the United States. One out of every ten adults experiences some level of depression. The good news is there is treatment, hope, and a ready path available to a normal, happy, and fully functioning life beyond this diagnosis.
What we casually call “depressed” is different from medically defined depression. Depression is a medical condition where a person feels sadness beyond control and requires medical intervention. Medicine defines the disease depression as a syndrome. This means that depression is actually a group of problems, not just a single problem or disease.
Depression may look and feel differently to everyone and can affect anyone at any time throughout his or her life. Depression appears in the following symptoms that may be noticed by others, or yourself.
- Depressed mood most of the day, nearly every day
- Diminished interest or pleasure in activities that were previously enjoyed.
- Significant weight loss or weight gain (a change of more than 5% of body weight in a month)
- Sleep problems nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death or suicide.
When these experiences are so distressing that they begin to affect your work, school, and relationships, it is time to get help.
Depression is not a sign of weakness and is not a normal process of aging. There are a variety of reasons why you may feel this way. Depression triggers may include:
- Significant Stress: This may include events such as the death or loss of a loved one, financial problems, or emotional trauma such as abuse.
- Hormones: Any significant change in hormone levels including menopause or thyroid disease can cause or trigger depression.
- Genetics: Depression is more common in people whose biological family members had depression.
- Biological and Brain Chemical Abnormalities: The human brain has billions of nerve cells called neurons and they communicate with one another through electrical and chemical signals. The brain chemicals that are produced by the nerve cells are known as neurotransmitters. The neurotransmitters most associated with mood disorders are norepinephrine and serotonin. When these neurotransmitters become depleted or altered, it can trigger depression. Therefore to correct the level of serotonin and have them functioning back at normal levels, antidepressant medications are given to patients.
Experts suspect that the abnormalities within the brain can happen at any of several levels:
- Problems with neurotransmitter production
- Problems with neurotransmitter transmission (release into the local brain area)
- Problems at the level of the receptor (neurotransmitter site of action) including abnormal number of receptors, or poorly responding receptors
- Problems at a post receptor level or the response of other cells to the neurotransmitter.
Depression is one of the most common medical illnesses in the country. According to the Centers for Disease Control and Prevention, one in every ten adults currently suffers from depression. The cases for women are drastically increased, nearly twice the rate of men. One in every eight women can expect clinical depression in her lifetime. Although women attempt suicide twice as often as men, males have a higher rate of death from suicide. Depression is the third most important cause of disease burden worldwide and is more common among those with other conditions such as obesity, heart disease, asthma, arthritis, and cancer.
Types of Depression
Depression can occur in various patterns and intensities so treatment plans vary accordingly. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), depression is classified into the following types:
- Major depressive disorder (a severe condition)
- Dysthymic disorder or Persistent Depressive disorder
- Premenstrual dysphoric disorder
- Substance-induced depressive disorder
- Depressive disorder due to another medical condition
- Depression not otherwise classified
- Disruptive mood dysregulation disorder.
Importance of Treatment
It is important to understand that depression is a treatable medical condition and it is essential to handle this illness rather than allow it to continue untreated. For women, untreated depression can affect maternal and fetal well-being in pregnancy. For children, it can affect the course of normal growth and development. Untreated depression can affect other chronic illnesses such as diabetes, heart disease, and arthritis, and can lead to premature death from medical conditions. It is also the most common cause of increased work absenteeism and disability. It affects the involved person as well as others, especially other family members. If left untreated, it can complicate drug and alcohol use, increasing the risk of suicide.
Treatment and Drugs
Various treatments are available for depression, depending on the patterns and intensity of your individual needs. Medications and/or counseling (psychotherapy) are generally very effective for most people. Mild cases of depression are sometimes managed well with counseling alone. Most cases call for a combination of medication and psychotherapy.
The medication most often prescribed for depression is called an antidepressant. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood. Types of antidepressants include:
- Selective Serotonin Reuptake Inhibitors (SSRIs) include Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa) and Escitalopram (Lexapro).
- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) include Duloxetine (Cymbalta), Venlafaxine (Effexor XR) and Desvenlafaxine (Pristiq).
- Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs) include Bupropion (Wellbutrin)
- Atypical antidepressants include Trazodone (Oleptro) and Mirtazapine (Remeron).
- Tricyclic antidepressants are an older generation drug still used to treat some forms of depression.
- Monoamine oxidase inhibitors (MAOIs) are useful in the treatment of atypical depression.
There are other options for treating depression, which do not involve medication. These include Electroconvulsive Therapy (ECT), Vagus Nerve Stimulation (VNS), and Transcranial Magnetic Stimulation (TMS),
- ECT: uses electrical stimulation to “reset” the activity of brain regions, and is quite effective in some cases.
- VNS: a surgically implanted pulse generator uses electrical impulses to affect mood centers of the brain by stimulating a specific nerve.
- TMS: A large electromagnetic coil is held against the scalp (near the forehead) to produce an electrical current in the brain which may alter brain activity.
There are some common risk factors for depression including genetic predisposition. For women, the risk of depression is double what it is for men. Drug and alcohol use increases this risk. The presence of a serious medical illness such as head trauma, heart attack, cancer, or seizures can increase the risk of depression.
Tests and Diagnosis
There is no test to diagnose depression. Routine lab tests may be used to exclude other diseases that sometimes share symptoms of depression, but a comprehensive medical evaluation is the only way to diagnose and properly treat depression. It is important to understand that depression can be seen with other disorders, and may show up in relation to another disorder or disease. Depression comes in various patterns and intensities and treatment plans are different for every case.
There’s no sure way to prevent depression. However, taking steps to control stress, maintaining a good support system, avoiding risk factors like drugs and alcohol, and keeping chronic medical illness in control can help manage the risk of depression. Treatment at even the earliest sign of a problem can help prevent depression from worsening. Once you have been treated for depression, maintain a long-term plan to prevent a relapse of symptoms.
You are already taking the right step in receiving treatment. Unfortunately, when depression goes untreated, it can negatively affect everything and everyone around you. There is a way to get better, a way to feel like you again and to get rid of the emotions that hold you down. Talk to your doctor.
- National Institute of Mental Health. Depression. http://www.nimh.nih.gov/health/publications/depression/what-is-depression.shtml – Accessed March 2013.
- Centers for Disease Control and Prevention. Depression. http://www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm – Accessed March 2013.
- Depression (major depression) Treatments and drugs – MayoClinic.com. http://www.mayoclinic.com/health/depression/DS00175/DSECTION=treatments-and-drugs – Accessed June 2013.
- CDC Data & Statistics. Feature: An Estimated 1 in 10 U.S. Adults Report Depression. http://www.cdc.gov/features/dsdepression/index.html – Accessed March 2013.
- Mental Health America. Depression in Women. http://www.nmha.org/index.cfm?objectid=C7DF952E-1372-4D20-C8A3DDCD5459D07B – Accessed March 2012.
- Mental Health America. Dealing with Treatment-Resistant Depression: What to Do When Treatment Doesn’t Seem to Work. http://www.mentalhealthamerica.net/index.cfm?objectid=C7DF95AB-1372-4D20-C85CA470535945CD – Accessed March 2013.