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 be motivated to get out of bed in the morning.

Depression is so common that over 1 in 5 people can expect to get some form of depression in their lifetime. Over 1 in 20 people have a depressive disorder every year. Women are almost twice as likely as men to experience a depressive episode throughout their lives. Those who seem to be most likely to experience depression are married women, women in poverty, adolescents, and unmarried men. Fortunately, there are many highly effective treatments for depression today that alleviate much of the suffering associated with depressive symptoms.

We are able to treat depression much more effectively because we have a better understanding of the causes of (clinical) depression. Many people begin to feel depressed as the result of some recent, notable event or events, which occurred in one's life. We also now know that family history and genetics play a part in the greater likelihood of someone becoming depressed in their lifetime. Increased stress and inadequate coping mechanisms to deal with that stress may also contribute to depression. We know that there are biological and psychological components to every depression, it is not a purely biochemical or medical disorder.

When people talk about having depression they are typically referring to what is known as Major Depression. This type of depression is when a person experiences the characteristics of depression with a certain degree of intensity either in a single episode or that keep recurring over time. Another common type of depression is called Dysthymia, which is characterised by chronic, low-grade symptoms. People with Dysthymia go through life usually feeling mildly depressed, which can greatly impair their ability to enjoy the positives in life.

Less common forms of depression, but still just as disruptive to a person's overall functioning, are the depressions related to Bipolar Disorder and Seasonal Affective Disorder. Bipolar Disorder, or what was commonly known as manic-depression, involves cyclical periods of severe depression with periods of extremely elevated or irritable mood known as mania.

Seasonal Affective Disorder

Seasonal Affective Disorder is a popularised name given to describe depression that happens during particular seasons of the year, but it is not an actual DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis. The diagnosis a person would receive who experiences depression during the autumn or winter months would be Major Depressive Disorder, recurrent, with Seasonal Pattern. To keep it simple we will call this form of depression Seasonal Affective Disorder. This diagnosis involves symptoms of depression that occur during the autumn and winter seasons when the days are shorter and there is less exposure to natural sunlight. When the spring and summer seasons begin and there is greater exposure to longer hours of daylight, the symptoms of depression disappear.

Major Depression

A person who suffers from a major depressive disorder must have either a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2-week period. This mood must represent a change from the person's normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one that is caused by a general medical condition. Major depressive disorder cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusion or psychotic disorder.

This disorder is characterised by the presence of the majority of these symptoms:

• depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterised as an irritable mood.)
• markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
• insomnia or hypersomnia nearly every day
• psychomotor agitation or retardation nearly every day
• fatigue or loss of energy nearly every day
• feelings of worthlessness or excessive or inappropriate guilt nearly every day
• diminished ability to think or concentrate, or indecisiveness, nearly every day
• recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterised by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Dysthymic Disorder

This disorder is characterised by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2 years. (In children and adolescents, mood can be irritable and duration must be at least 1 year.) The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:

• poor appetite or overeating
• insomnia or hypersomnia
• low energy or fatigue
• low self-esteem
• poor concentration or difficulty making decisions
• feelings of hopelessness

The symptoms are not due to the direct physiological effects of the use or abuse of a substance (alcohol, drugs, and medications) or a general medical condition. The symptoms must also cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

We have not discussed here the deeper forms of Depression known as Bi-Polar, Cyclothymic, or Hypomanic disorders which require specific Psychiatric intervention