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Depression
Depression is a "whole-body" illness, involving your body, mood, and thoughts. It
affects the way you eat and sleep, the way you feel about yourself, and the way you
think about things. A depressive disorder is not the same as a passing blue mood. It
is not a sign of personal weakness or a condition that can be willed or wished away.
People with a depressive illness cannot merely "pull themselves together" and get
better. Without treatment, symptoms can last for weeks, months, or years.
Appropriate treatment, however, can help most people who suffer from depression.
The symptoms of depression may vary from person to person, and also depend on
the severity of the depression. Depression causes changes in thinking, feeling,
behavior, and physical well-being.
• Changes in Thinking - You may experience problems with concentration
and decision making. Some people report difficulty with short term memory,
forgetting things all the time. Negative thoughts and thinking are
characteristic of depression. Pessimism, poor self-esteem, excessive guilt,
and self-criticism are all common. Some people have self-destructive
thoughts during a more serious depression.
• Changes in Feelings - You may feel sad for no reason at all. Some people
report that they no longer enjoy activities that they once found pleasurable.
You might lack motivation, and become more apathetic. You might feel
"slowed down" and tired all the time. Sometimes irritability is a problem, and
you may have more difficulty controlling your temper. In the extreme,
depression is characterized by feelings of helplessness and hopelessness.
• Changes in Behavior - Changes in behavior during depression are reflective
of the negative emotions being experienced. You might act more apathetic,
because that's how you feel. Some people do not feel comfortable with other
people, so social withdrawal is common. You may experience a dramatic
change in appetite, either eating more or less. Because of the chronic
sadness, excessive crying is common. Some people complain about
everything, and act out their anger with temper outbursts. Sexual desire may
disappear, resulting in lack of sexual activity. In the extreme, people may
neglect their personal appearance, even neglecting basic hygiene. Needless
to say, someone who is this depressed does not do very much, so work
productivity and household responsibilities suffer. Some people even have
trouble getting out of bed.
• Changes in Physical Well-being - We already talked about the negative
emotional feelings experienced during depression, but these are coupled with
negative physical emotions as well. Chronic fatigue, despite spending more
time sleeping, is common. Some people can't sleep, or don't sleep soundly.
These individuals lay awake for hours, or awaken many times during the
night, and stare at the ceiling. Others sleep many hours, even most of the
day, although they still feel tired. Many people lose their appetite, feel slowed
down by depression, and complain of many aches and pains. Others are
restless, and can't sit still.
Now imagine these symptoms lasting for weeks or even months. Imagine feeling
this way almost all of the time. Depression is present if you experience many of
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these symptoms for at least several weeks. Of course, it's not a good idea to
diagnose yourself. If you think that you might be depressed, see a psychologist as
soon as possible. A psychologist can assess whether you are depressed, or just
under a lot of stress and feeling sad. Remember, depression is treatable. Instead of
worrying about whether you are depressed, do something about it. Even if you don't
feel like it right now.
Types of Depression:
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).
Major Depressive Disorder (also known as Major Depression, Clinical Depression)
– 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:
• significant weight loss / weight gain or decrease / increase in appetite
• difficulty sleeping or increase in sleeping
• excessive movement or slowing down associated with mental tension
(observed by others)
• fatigue or loss of energy
• feeling worthless or excessive guilt
• difficulty thinking, concentrating or making decisions
• repeatedly thinking about death or suicide, trying to attempt suicide or
having a specific plan to commit suicide
Dysthymic Disorder (or also referred to as Dysthymia) – Nearly constant
depressed mood for at least 2 years accompanied by at least two (or more) of the
following:
• decrease or increase in eating
• difficulty sleeping or increase in sleeping
• low energy or fatigue
• low self-esteem
• difficulty concentrating or making decisions
• feeling hopeless
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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.
Manic Depression (now known as Bipolar Disorder) – 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:
• inflated self-esteem or self-importance
• decreased need for sleep
• more talkative than usual or compelled to keep talking
• experiencing racing thoughts or ideas
• easily distracted
• increase in goal-oriented activity (social, work, school, sexual) or excessive
movement
• excessive involvement in potentially risky pleasurable behavior (e.g. over
spending, careless sexual activity, unwise business investments)
Symptoms can be severe enough to warrant hospitalization to prevent harm to self
or others or include psychotic features (e.g. hallucinations, delusions).
Other Types of Depressive Categories
• 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.
• 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).
• 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:

• significant weight gain or increase in appetite

• over sleeping
• heavy feeling in arms or legs
• long standing pattern of sensitivity to rejection
• Chronic Depression – Major depressive episode that lasts for at least two
years.
• Double Depression – Someone who has Dysthymia (chronic mild
depression) and also experiences a major depressive episode (more severe
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depressive symptoms lasting at least two weeks). See above for definitions
of these two categories of depression.
• Endogenous Depression – Endogenous means from within the body.
This type of depression is defined as feeling depressed for no apparent
reason.
• Situational Depression or Reactive Depression (also known as
Adjustment Disorder with Depressed Mood) – Depressive symptoms
developing in response to a specific stressful situation or event (e.g. job
loss, relationship ending). These symptoms occur within 3 months of the
stressor and lasts no longer than 6 months after the stressor (or its
consequences) has ended. Depression symptoms cause significant distress
or impairs usual functioning (e.g. relationships, work, school) and do not
meet the criteria for major depressive disorder.
• Agitated Depression – Kind of major depressive disorder which is
characterized by agitation such as physical and emotional restlessness,
irritability and insomnia, which is the opposite of many depressed
individuals who have low energy and feel slowed down physically and
mentally.
• Psychotic Depression – Major depressive episode with psychotic
symptoms such as hallucinations (e.g. hearing voices), delusions (false
beliefs).
• Melancholic Depression (Sub-type of Major Depressive Disorder) - Main
features of this kind of depression include either a loss of pleasure in
virtually all activities or mood does not temporarily improve in response to
a positive event. Also, three (or more) of the following are present:

• 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
• Catatonic Depression - (Sub-type of Major Depressive Disorder) – This
type of depression is characterized by at least two of the following:
• Loss of voluntary movement and inability to react to one's
environment
• Excessive movement (purposeless and not in response to one's
environment)
• Extreme resistance to instructions/suggestions or unable/unwilling
to speak
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• Odd or inappropriate voluntary movements or postures (e.g.

repetitive movements, bizarre mannerisms or facial expressions)
• Involuntarily repeating someone’s words or movements in a
meaningless way
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.

Causes of Depression
Depression has no single cause; often, it results from a combination of things. You
may have no idea why depression has struck you.
Whatever its cause, depression is not just a state of mind. It is related to physical
changes in the brain, and connected to an imbalance of a type of chemical that
carries signals in your brain and nerves. These chemicals are called
neurotransmitters

Some of the more common factors involved in depression are:

• Family history. Genetics play an important part in depression. It can run in

families for generations.

• Trauma and stress. Things like financial problems, the breakup of a relationship,
or the death of a loved one can bring on depression. You can become depressed
after changes in your life, like starting a new job, graduating from school, or getting
married.

• Pessimistic personality. People who have low self-esteem and a negative outlook
are at higher risk of becoming depressed. These traits may actually be caused by
low-level depression (called dysthymia).

• Physical conditions. Serious medical conditions like heart disease, cancer, and
HIV can contribute to depression, partly because of the physical weakness and
stress they bring on. Depression can make medical conditions worse, since it
weakens the immune system and can make pain harder to bear. In some cases,
depression can be caused by medications used to treat medical conditions.

• Other psychological disorders. Anxiety disorders, eating disorders,

schizophrenia, and (especially) substance abuse often appear along with
depression.

Do not accuse the depressed person of faking illness or of laziness. Do not expect
him or her "to snap out of it." Eventually, with treatment, most depressed people do
get better. Keep that in mind. Moreover, keep reassuring the depressed person that,
with time and help, he or she will feel better.
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Treatment for depression includes:

Psychotherapy
Psychological treatment of depression (psychotherapy) assists the depressed
individual in several ways. First, supportive counseling helps ease the pain of
depression, and addresses the feelings of hopelessness that accompany
depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic
expectations, and overly critical self-evaluations that create depression and sustain
it. Cognitive therapy helps the depressed person recognize which life problems are
critical, and which are minor. It also helps him/her to develop positive life goals, and
a more positive self-assessment. Third, problem solving therapy changes the areas
of the person's life that are creating significant stress, and contributing to the
depression. This may require behavioral therapy to develop better coping skills, or
Interpersonal therapy, to assist in solving relationship problems.
Unfortunately, many poorly trained counselors never move beyond providing
supportive counseling. This alone will not eliminate the depression. As a result, the
depression, and the therapy, continues indefinitely, with little improvement.
Supportive counseling "feels" helpful, and as part of the overall treatment plan does
help. But, unless the depressed person makes critical life changes, the depression
will continue. These changes are both internal and external. Internal changes are
usually needed in problem assessment, self-evaluation, the evaluation of others,
and the expectations the depressed person has for himself/herself, others and
about life. External changes may be needed in problem solving skills, stress
management, communication skills, life management skills, and the skills needed to
develop and sustain relationships.
The length of treatment will vary, according to the severity of the depression, and
the number and kind of life problems that need to be addressed. Most people will
begin to experience some relief with 6 to 10 sessions, and approximately 70-80% of
those treated notice significant improvement within 20-30 sessions. Mild
depression may be treated in less sessions, and more significant depression may
require extended treatment. Treatment sessions are usually scheduled once per
week, although they may be scheduled more frequently initially, or if the person is
experiencing significant life crises.
Medication
Except in the more severe depressions, and bipolar depression, medication is
usually an option, rather than a necessity. Antidepressant medication does not cure
depression, it only helps you to feel better by controlling certain symptoms. If you
are depressed because of life problems, such as relationship conflicts, divorce, loss
of a loved one, job pressures, financial crises, serious medical problems in yourself
or a family member, legal problems, or problems with your children, taking a pill will
not make those problems go away.
However, some symptoms of depression, such as sleep and appetite disturbances,
significant concentration problems, and chronic fatigue, interfere with your ability to
make the life changes necessary to eliminate the depression. In more serious
depression, suicidal thoughts and urges, and preoccupation with death, may require
medication in addition to psychotherapy. Antidepressant medication can help
relieve those symptoms, and allow you to make needed life changes. The decision
to take medication, in addition to participating in psychological treatment, should
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be discussed with your treating psychologist and your primary care physician. Your
thoughts and feelings regarding medication, after considering information about
both the benefits and risks involved, are an important part of a collaborative
treatment approach between psychologist and client. If medication is part of your
treatment, either your primary care physician or a psychiatrist will supervise the
medical part of your treatment, while you continue psychotherapy with a
psychologist. If you have a chronic medical condition or a serious illness, and you
are taking medication for that condition, then the medical specialist treating that
problem should be involved in your treatment. The medical specialist may supervise
all of your medications, or coordinate the medical treatment with the physician
providing the antidepressant medications.
How can someone help a person who is depressed
Family and friends can help! Since depression can make the affected person feel
exhausted and helpless, he or she will want and probably need help from others.
However, people who have never had a depressive disorder may not fully
understand its effect. Although unintentional, friends and loved ones may
unknowingly say and do things that may be hurtful to the depressed person. It may
help to share the information in this article with those you most care about so they
can better understand and help you.
The most important thing anyone can do for the depressed person is to help him or
her get an appropriate diagnosis and treatment. This help may involve encouraging
the individual to stay with treatment until symptoms begin to go away (usually
several weeks) or to seek different treatment if no improvement occurs. On
occasion, it may require making an appointment and accompanying the depressed
person to the doctor. It may also mean monitoring whether the depressed person is
taking medication for several months after symptoms have improved. Always report
a worsening depression to the patient's physician or therapist.
The second most important way to help is to offer emotional support. This support
involves understanding, patience, affection, and encouragement. Engage the
depressed person in conversation and listen carefully. Do not disparage feelings
expressed, but point out realities and offer hope. Do not ignore remarks about
suicide. Always report them to the depressed person's therapist.
Invite the depressed person for walks, outings, and to the movies and other
activities. Be gently insistent if your invitation is refused. Encourage participation in
activities that once gave pleasure, such as hobbies, sports, or religious or cultural
activities. However, do not push the depressed person to undertake too much too
soon. The depressed person needs company and diversion, but too many demands
can increase feelings of failure.
Do not accuse the depressed person of faking illness or of laziness. Do not expect
him or her "to snap out of it." Eventually, with treatment, most depressed people do
get better. Keep that in mind. Moreover, keep reassuring the depressed person that,
with time and help, he or she will feel better.