The ThriveTalk Starter Guide to Depression

Depression is a complex and serious mental condition which many people will suffer from to some degree at some time in their lives. It is expressed in severe mood changes where the person feels overwhelmingly sad and lacking in positive emotions.

What is Depression?

All of us suffer moments when we feel sad, discouraged or demotivated, and we may say that we feel depressed. Depression, however, is when this feeling of sadness is overwhelming and affects all aspects of our daily life. Sadness is a normal emotional reaction to a loss or a painful event which goes away with time. Depression is a state of mental shutdown, where normal thought processes do not function. People with depression are unable to think in a positive and productive way.

Types of Depression

Depression is divided into different categories based on symptoms, cause, and duration. Depression can be described as mild, moderate, or severe. Some types of depression only last a short period of time, while others may extend over long periods or be recurring.

Major Depressive Disorder

A Major Depressive Disorder is also known as a clinical depression, and it is the most serious of the depressive conditions. Sufferers experience feelings of extreme sadness and hopelessness often accompanied by expressions of guilt and worthlessness. They frequently have recurrent thoughts about death or committing suicide. They can exhibit many different symptoms which cause a total disruption of their normal activities and which, if left untreated, can extend over a long period of time.

Situational Depression

Situational depression is the term used when a person reacts in an abnormal way to an unexpected stressful event. This could be a death in the family, a loss of employment, or some other traumatic occurrence. They often exhibit extreme anxiety and may present reckless behavior. They have a high suicide and self-damaging risk. Symptoms appear within three months of the precipitating stressful event and do not last more than six months after the event has ended.

Medical Condition Related Depression

About 10-15-percent of depressions are thought to be related to medical conditions. Thyroid imbalance and heart disease are two of the most common medical conditions that are linked to depression. Others include cancer, stroke, and erectile dysfunction in men. Certain types of viruses and infections, immune system diseases, nutritional deficiencies, endocrine disorders, and degenerative neurological conditions are also associated with mood disorders and depression.

Melancholia

Melancholia used to be classified as a separate mental illness, but it is now considered to be a specifier of a major depressive disorder subtype. It is characterized by a profound inability to find pleasure in anything or to respond positively to agreeable stimuli. Sufferers often experience disrupted sleep patterns, waking up much earlier than usual, and feeling at their worst first thing in the morning. Frequently, they have a decreased appetite, and so lose weight, and their movements may be slowed or agitated.  Their depression is not related to any identifiable cause.

Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (DMDD) is an extreme form of premenstrual syndrome which is thought to affect between 3-8-percent of menstruating women.  Sufferers exhibit irritability and severe depression one or two weeks before menstruation begins. These go away one or two days after the arrival of the menstrual period but return again on the next cycle.

Substance/Medication-Induced Depressive Disorder

Depression can sometimes be caused by medications such as steroids or blood pressure and heart medications. Antibiotics, antifungals, antimicrobials, and antivirals can also produce depression, as can tranquilizers, sedatives, and insomnia aids. Depression is also common in people who are withdrawing from amphetamines and cocaine.

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) is the name given to a kind of depression which occurs during the winter months. It affects between 1-2-percent of the population and is more common in young people and women.  As the hours of daylight decrease, sufferers tend to spend more time asleep, they gain weight, they are unable to concentrate, and they reduce their social activities. As spring arrives they begin to feel less depressed and start to resume their normal activities. This kind of depression responds well to light therapy.

Related Diagnoses

Other kinds of depressive disorders include-

Persistent Depressive Disorder- where the person experiences a mild level of depressive symptoms for a period longer than two years.

Bipolar disorder -where the sufferer experiences periods of high-energy or manic activity interspersed with periods of depression.

Depression with Psychotic Features- where the depression is accompanied by psychotic symptoms such as hallucinations, delusions, and paranoia.

Peripartum (Postpartum) Depression- many women experience a mild form of depression – “baby-blues”- after giving birth, but this is a more serious and debilitating depression.

Take This Short Quiz to Find Out if You’re Depressed

Stats: How Many Suffer from this Disorder?

It is estimated that 6.9-percent of the adult US population (or 16-million people) live with major depression and just over 10-million will have experienced a severe depressive period within the last year. Women are nearly twice as likely to suffer from depression as men.

Causes of Depression

Depression is believed to be caused by a mixture of psychological, biological, environmental, and genetic factors. A chemical imbalance in the brain, an abnormal reaction precipitated by an external cause, or a genetic predisposition can all produce depression.

Signs and Symptoms of Depression

People with depression can exhibit a wide range of different symptoms which interfere with their day-to-day activities. They often have problems in their relationships, at their job or school, and in their social activities. No two people experience depression in the same way.

Sadness, Hopelessness, and Other Emotions

Depressed people are profoundly sad. They are often tearful and express feelings of guilt, worthlessness, and emptiness. They have trouble concentrating and making decisions and often become forgetful. People with depression are unable to make future plans or to see any hope of a better time to come. They may be irritable and have angry outbursts over seemingly unimportant issues. This is frequently due to the frustration that they feel at their inability to regain control of their emotions.

Anhedonia

Anhedonia means that a person is unable to find pleasure in positive things. A person with depression is often totally incapable of reacting in a cheerful or positive way to any kind of pleasurable situation. For example, when they receive a visitor, they do not smile or express any positive visible emotion.

Fatigue

Most people with depression experience a chronic fatigue that makes doing anything an insurmountable effort. This causes them to stop participating in activities such as hobbies, sports, and sex. Their body movements, speech, and thought process are all sluggish, although sometimes they can have periods of agitation and outbursts of anger. Their sleep pattern is often altered, with some sleeping less than normal, and others sleeping more. Often sufferers of depression have unexplained pains such as headaches, and back, or leg pain.

Weight and Appetite Changes

Depressed people usually have little interest in food and can not be bothered to prepare regular meals, so leading to weight loss. Occasionally, the opposite occurs, and the person craves certain foods and eats excessively. This is considered a clinical symptom if the change is more than 10% total body weight either gained or lost within a one month period.

Helplessness

Sufferers of depression can feel that they have completely lost all control of their life and of their emotions which gives them a feeling of total helplessness.

Self-Harm and Suicide

Some people with depression may try to take their own life or to physically harm themselves. The expression of suicidal thoughts or talking about death and dying should always be taken very seriously and people in this condition should always be accompanied by a caring person. They should also not be exposed to situations where they could complete their intent.

Depression in Adults/Children

Depression can occur to anyone and at any age. Often the symptoms of depression can be missed in children, but it is estimated that over 3-million youngsters aged between 12 and 17, in the US, have experienced one, or more, major depressive episode over the last twelve months. It is thought that as many as 3-percent of younger children in the 6-12 years range may have a serious depression.

Depression

Example Case of Depression

Victor was described by his wife as a friendly, fun-loving guy with no history of mental illness in the family. He worked as a building laborer, enjoyed an active lifestyle, and was in good health. He was a devoted father and husband.

His wife noticed a gradual deterioration in his condition over a period of nearly three years. She describes how slowly he seemed to lose his interest and enthusiasm for things that he had always enjoyed doing.  At first, she put this down to his long hours of hard physical work. However, when Victor no longer wanted to play with his young kids and received their artwork and presents without even a smile, she suggested he went to a doctor. He reacted angrily to this idea and moved out of their joint bedroom to sleep alone in the spare room. He refused to join the family at meal times and would spend hours wandering aimlessly around the house during the day and night. Eventually, he stopped going to work and was fired. He seemed indifferent to this and would just spend long hours sitting staring into space. He spoke little and had a profound air of sadness and despair.

Finally, his wife decided to call in a doctor who made a home visit and on assessing the situation, managed to convince Victor to admit himself into hospital for some tests. He was placed on a suicide watch and immediately started on a course of anti-depressants.

He responded quickly and positively to the treatment and within a short time was able to return to his home and family. He and his family attend regular therapy sessions and he has managed to find a new job. He continues to take a small dose of an antidepressant to control the chemical imbalance thought to have been the cause of his depressive episode.

How to Deal/Coping with Depression

Depression responds well to treatment, so seeking medical help as soon as symptoms are noticed can prevent the development of the condition. Often the person suffering from depression is unaware that they have a treatable condition, or they do not even have the motivation to seek help. For this reason, it is vitally important that family and friends support and guide the person to find the necessary medical treatment to alleviate their suffering.

Look out for These Complications/Risk Factors

If there is a history of depression in the family the person is more likely to develop the condition.

If they have suffered a major, traumatic, stressful change in their lives, this can cause a depressive period.

If they are suffering from certain medical conditions or taking certain medicines these can contribute to the development of depression.

Always take seriously any talk by the person about death, dying, or suicide, and call one of the national hotlines for support and help.

Depression Treatment

Depression is normally treated with medication, psychotherapy, or, most commonly, with a combination of both. In extreme cases or those which do not respond to other treatments, brain stimulation therapies such as electroconvulsive therapy (ECT) may bring about a recovery. Depending on the causes, and on the response to treatment, many people can make a full and complete recovery.

Possible Medications for Depression

Antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) are normally used to treat Depression. These include citalopram, escitalopram, paroxetine, fluoxetine, and sertraline. SSRIs have fewer side-effects than other kinds of antidepressants. They usually take 2-4-weeks to have a noticeable effect and patients should be encouraged to keep taking their tablets even if they don’t immediately notice an improvement in their condition. Sometimes it is necessary to try several different medicines to find the one best suited to the person.

Home Remedies to Help with Depression

There are several herbs and supplements that may help to treat depression. These include St. John’s Wort, SAMe, Omega-3 fatty acids, Saffron, 5-HTP, and DHEA. None of these are approved by the FDA, but some people have found them to be effective. Always consult with your doctor before taking any home remedy, and do not stop taking your prescribed medication. As with all mental illnesses, people suffering from depression will benefit from the support, patience, and love of their friends and family.

Insurance Coverage for Depression

Depression is covered by most medical health insurance policies, but the extent of coverage may vary depending on your location.

Ketamine Trials for Depression

Treatment using Ketamine has been found to be helpful in patients who have not found symptom relief from other treatments. It has not been approved by the FDA yet, but many sufferers have found relief in clinics offering off-label treatment. Find out more about Ketamine trials here.

Hospitalization

Hospitalization is often required for people with severe depression or without family support available. This allows medical staff to ensure that medicines are taken correctly and to monitor the patient’s response to medication and to observe for side effects.  In cases of severe depression, the sufferer may occasionally be more prone to attempt suicide once treatment has begun.  For this reason, close observation of depressed patients should always be maintained.

How to Find a Therapist

Many types of depression respond well to therapy and your healthcare provider will be able to advise you as to what kind of therapist would be most helpful for you. Cognitive-behavioral therapy (CBT), problem-solving therapy, or interpersonal therapy (IPT) may be recommended.

What Should I be Looking for in an LMHP?

Look for a therapist who has relevant current qualifications, and experience in dealing with depression. Choose someone who you feel that you will be comfortable talking to. Successful therapy depends on a strong patient-therapist relationship based on trust.

Questions to Ask a Potential Therapist

How long will I need to receive therapy for?

Will I come alone or with my family?

How often will we meet for therapy?

Will having therapy mean that I can stop taking medication?

Stigma and Societal Problems with Depression

As our knowledge about the brain’s functioning and mental illnesses increases, there is much less stigma and social negativity attached to having depression or another mental illness. People are now beginning to accept mental illness just as they do physical illness.

Depression is a very common mental illness, and with an early diagnosis and the correct treatment program, the chances of a complete recovery and a return to normal life, are very good.

Emergency Resources and Support Helpline

US Suicide Prevention Lifeline 1-800-273-8255

Crisis Chat or Crisis Text Line Text HOME to 741741

NDMDA Depression Hotline – Support Group 800-826-3632

Suicide Prevention Services Crisis Hotline 800-784-2433

Suicide Prevention Services Depression Hotline 630-482-9696

Suicide & Depression Hotline – Covenant House 800-999-9999

Resources

  1. https://www.nimh.nih.gov/health/topics/depression/index.shtml
  2. https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf
  3. https://www.health.harvard.edu/mind-and-mood/what-causes-depression
  4. https://www.psychologytoday.com/us/blog/theory-knowledge/201610/three-kinds-depressive-episodes
  5. https://psychcentral.com/lib/telephone-hotlines-and-help-lines/
  6. https://www.psychologytoday.com/us/conditions/adjustment-disorder
  7. https://www.goodtherapy.org/learn-about-therapy/issues/melancholia
  8. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770
  9. https://www.webmd.com/health-insurance/health-reform-depression-treatments
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