While sadness touches all of our lives at different times, the illness of depression can have enormous depth and staying power. Even the ancient Greeks noted how disabling it could be, and that it was more than a passing bout of sadness or dejection, or feeling down in the dumps. If you have ever suffered from depression or been close to someone who has, you know that this illness cannot be lifted at will or wished or joked away. A man in the grip of depression can't solve his problems by showing a little more backbone. Nor can a woman who is depressed simply shake off the blues.
Being depressed has nothing to do with personal weakness. Scientists' developing knowledge of brain chemistry and findings from brain imaging studies reveal that changes in nerve pathways and brain chemicals called neurotransmitters can affect your moods and thoughts. These neurological changes may bubble up as symptoms of depression — including derailed sleep, suppressed appetite, agitation, exhaustion, or apathy. In addition, genetic studies show that although no single gene prompts depression, a combination of genetic variations may heighten vulnerability to this disease.
Nerve pathways, chemistry, and genetics aren't the whole story, though. Depression could be described as a lake fed by many streams. Its tributaries include traumatic or stressful life events, such as the death of a loved one, and psychological traits, such as a pessimistic outlook or a tendency toward isolation. An episode of depression may result from one particularly powerful experience or from a confluence of several factors. According to the National Institute of Mental Health, during a given year approximately 1 in 10 adults will suffer from some form of depression. Each episode usually affects a chain of people. It can fray bonds between you and your family and friends by spoiling intimacy, sapping emotional resources, and stealing the joy of shared pleasures.
Thankfully, years of research and breakthroughs have made this serious illness easier to treat. Early recognition of the signs of depression is more common than in the past. Newer treatments, such as drugs targeted at specific changes in brain chemistry, can cut short otherwise crippling episodes. A variety of drugs and therapies can also be combined to boost the likelihood of a full remission.
Just like a rash or heart disease, depression can take many forms. Definitions of depression and the therapies designed to ease this disease's grip continue to evolve. These shifts will continue to percolate through the field as more research flows in.
What Is Major Depression?
Major depression may make you feel as though work, school, relationships, and other aspects of your life have been derailed or put on hold indefinitely. You feel constantly sad or burdened, or you lose interest in all activities, even those you previously enjoyed. This holds true nearly all day, on most days, and lasts at least two weeks. During this time, you also experience at least four of the following signs of depression:
Being depressed has nothing to do with personal weakness. Scientists' developing knowledge of brain chemistry and findings from brain imaging studies reveal that changes in nerve pathways and brain chemicals called neurotransmitters can affect your moods and thoughts. These neurological changes may bubble up as symptoms of depression — including derailed sleep, suppressed appetite, agitation, exhaustion, or apathy. In addition, genetic studies show that although no single gene prompts depression, a combination of genetic variations may heighten vulnerability to this disease.
Nerve pathways, chemistry, and genetics aren't the whole story, though. Depression could be described as a lake fed by many streams. Its tributaries include traumatic or stressful life events, such as the death of a loved one, and psychological traits, such as a pessimistic outlook or a tendency toward isolation. An episode of depression may result from one particularly powerful experience or from a confluence of several factors. According to the National Institute of Mental Health, during a given year approximately 1 in 10 adults will suffer from some form of depression. Each episode usually affects a chain of people. It can fray bonds between you and your family and friends by spoiling intimacy, sapping emotional resources, and stealing the joy of shared pleasures.
Thankfully, years of research and breakthroughs have made this serious illness easier to treat. Early recognition of the signs of depression is more common than in the past. Newer treatments, such as drugs targeted at specific changes in brain chemistry, can cut short otherwise crippling episodes. A variety of drugs and therapies can also be combined to boost the likelihood of a full remission.
Just like a rash or heart disease, depression can take many forms. Definitions of depression and the therapies designed to ease this disease's grip continue to evolve. These shifts will continue to percolate through the field as more research flows in.
What Is Major Depression?
Major depression may make you feel as though work, school, relationships, and other aspects of your life have been derailed or put on hold indefinitely. You feel constantly sad or burdened, or you lose interest in all activities, even those you previously enjoyed. This holds true nearly all day, on most days, and lasts at least two weeks. During this time, you also experience at least four of the following signs of depression:
- a change in appetite that sometimes leads to weight loss or gain
- insomnia or (less often) oversleeping
- a slowdown in talking and performing tasks or, conversely, restlessness and an inability to sit still
- loss of energy or feeling tired much of the time
- problems concentrating or making decisions
- feelings of worthlessness or excessive, inappropriate guilt
- thoughts of death or suicide, or suicide plans or attempts.
Although these symptoms are hallmarks of depression, if you talk to any two depressed people about their experiences, you might well think they were describing entirely different illnesses. For example, one might not be able to summon the energy to leave the house, while the other might feel agitated and restless. One might feel deeply sad and break into tears easily. The other might snap irritably at the least provocation. One might pick at food, while the other might munch constantly. On a subtler level, two people might both report feeling sad, but the quality of their moods could differ substantially in depth and darkness. Also, symptoms may gather over a period of days, weeks, or months.
Despite such wide variations, depression does have certain common patterns. For example, women are almost twice as likely as men to suffer from depression. And while major depression may start at any time in life, the initial episode occurs, on average, during the mid-20s.
Depression or hopelessness may feel so paralyzing that you find it hard to seek help. Even worse, you may believe that treatment could never overcome the juggernaut bearing down.
Yet nothing could be further from the truth. The vast majority of people who receive proper treatment rebound emotionally within two to six weeks and then take pleasure in life once again. When major depression goes untreated, though, suffering can last for months.
Furthermore, episodes of depression frequently recur. About half of those who sink into an episode of major depression will have at least one more episode later in life. Some researchers think that diagnosing depression early and treating it successfully can help forestall such recurrences. They suspect that the more episodes of depression you've had, the more likely you are to have future episodes, because depression may cause enduring changes in brain circuits and chemicals that affect mood (see The Problem of Recurrence). In addition, people who suffer from recurrent major depression have a higher risk of developing bipolar disorder than people who experience a single episode.
What Is Dysthymia?
Mental health professionals use the term dysthymia (dis-THIGH-me-ah) to refer to a low-level drone of depression that lasts for at least two years in adults or one year in children and teens. While not as crippling as major depression, its persistent hold can keep you from feeling good and can intrude upon your work, school, and social life. If you were to equate depression with the color black, dysthymia might be likened to a dim gray. Unlike major depression, in which relatively short episodes may be separated by considerable spans of time, dysthymia lasts for an average of at least five years.
If you suffer from dysthymia, more often than not you feel depressed during most of the day. You may carry out daily responsibilities, but much of the zest is gone from your life. Your depressed mood doesn't lift for more than two months at a time, and you also have at least two of the following symptoms:
- overeating or loss of appetite
- insomnia or sleeping too much
- tiredness or lack of energy
- low self-esteem
- trouble concentrating or making decisions
- hopelessness.
Sometimes an episode of major depression occurs on top of dysthymia; this is known as double depression.
Dysthymia often begins in childhood, the teen years, or early adulthood. Being drawn into this low-level depression appears to make major depression more likely. In fact, up to 75% of people who are diagnosed with dysthymia will have an episode of major depression within five years.
It's difficult to escape the grasp of untreated dysthymia. Only about 10% of people spontaneously emerge from it in a given year. Some appear to get beyond it for as long as two months, only to spiral downward again. However, proper treatment eases dysthymia and other depressive disorders in about four out of five people.
What Is Bipolar Disorder?
Bipolar disorder always includes one or more episodes of mania, characterized by high mood, grandiose thoughts, and erratic behavior. It also often includes episodes of depression. During a typical manic episode, you would feel terrifically elated, expansive, or irritated over the course of a week or longer. You would also experience at least three of the following symptoms:
- grandiose ideas or pumped-up self-esteem
- far less need for sleep than normal
- an urgent desire to talk
- racing thoughts and distractibility
- increased activity that may be directed to accomplishing a goal or expressed as agitation
- a pleasure-seeking urge that might get funneled into sexual sprees, overspending, or a variety of schemes, often with disastrous consequences.
Bipolar disorder usually starts in early adulthood. It's equally common among women and men, although certain variations of it strike one sex more than the other. Hypomania, for example, occurs more often in women. Women are also more likely to experience major depression as their first episode and to have more depressive episodes over all. Men, on the other hand, typically experience manic episodes first and tend to have more of them than depressive cycles.
Bipolar disorder is a recurring illness. Nine out of 10 people who have a single manic episode can expect to have repeat experiences. Suicide rates in people who have bipolar disorder are higher than average. Successful treatment, however, can cut down on the number and intensity of episodes and reduce suicide risk.
Thanks to Waterfront Media, Inc.
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