Depression - The Basics

Depression: Defined

Depression is often confused with sadness. Everyone feels sad or "down in the dumps" at times in their lives. Sadness is a natural reaction to something upsetting or painful. It is also a transient feeling that typically passes when someone comes to term with his troubles. Depression, on the other hand, can linger for weeks, months or even years. It is a mood disorder in which feelings of sadness, or lack of pleasure interfere with everyday life for an extended period of time. In addition to either extreme sadness and/or loss of interest or pleasure for two weeks or more, people who experience a depressive episode also experience 5 or more of the following symptoms nearly every day (as defined by the Diagnostic and Statistical Manual of Mental Disorders IV):

(1) depressed mood most of the day
(2) markedly diminished interest or pleasure in activities
(3) significant weight loss when not dieting, or weight gain
(4) insomnia or hypersomnia
(5) psychomotor agitation or retardation
(6) fatigue or loss of energy
(7) feelings of worthlessness or excessive or inappropriate guilt
(8) diminished ability to think or concentrate, or indecisiveness
(9) 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.

Source: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994.

Depression: Causes

There are many factors that can contribute to depression. The diathesis-stress model of illness is a helpful way to understand depression. Someone might have a predisposition to depression (the "diathesis" component) because of temperament, hormones, or genetic factors. For example, there might be a family history of a mood disorder such as unipolar depression or bipolar disorder (also known as manic depression). It is not inevitable that a person with this familial history will develop depression. However, if there is a stressor in his/her life (e.g., a divorce), the strain might exacerbate the potential for depression.

Not everyone who has a predisposition to depression will develop depression. And many people without this predisposition will have a depressive episode, perhaps brought about by a loss, identity crisis, major life change or interpersonal situation. Depressive episodes can be triggered not only by "negative" life changes or stressors but by positive ones as well. For example, an upward career move or getting married can also trigger a depression.

Depression: Types

There are many types of mood disorders, from recurrent depressions, to a single depressive episode, to a cluster of depressive symptoms, to dysthymia (which is a lower level of depression that can last for longer periods of time such as a year or more), to bipolar depression, (which includes periods of elevated or extremely happy mood, often described as feeling "on top of the world" or feeling very agitated or irritable). To learn more about the various subtypes of mood disorders, you can visit http://www.nimh.nih.gov (National Institute of Mental Health).

Depression: Treatment

Depression can be treated through therapy and/or medication. Therapy modalities range from cognitive-behavioral therapy, which helps individuals change their negative thoughts and behaviors to more realistic thoughts and actions, to psychodynamic therapy, which helps individuals identify and reverse their long-standing unhealthy repetitive patterns that can lead to depression and other psychological symptoms. When therapy alone is not sufficient, medication is often used to aid in the treatment of depression. There is a wide range of medications that can alleviate depression, from SSRI's to atypical antidepressants. You should consult a psychiatrist to find out which, if any, medication would be most helpful for you.

Research studies have found group therapy to be one of the most effective treatments for depression. A psychotherapy group is a safe and confidential place to address and work through relational issues such as intimacy, isolation, assertiveness, anger and loss that might contribute to depression. Though group provides many opportunities for personal growth, the main goal for group members' is to understand how and why they react the way they do to different interpersonal situations. Group members' insights into how they "tic" leads them to experiment with new ways of interacting. Growth in group invariably leads to growth in the "real world". In group, clients have reactions to each other that replicate their experiences to people in the "real world". Under the watchful eye of an experienced group therapist, group members:

* Learn new ways of interacting and dealing with people in their life. For instance, they can become more intimate or assertive. They learn to communicate in a more open and authentic way, and become less fearful about the impact on other people when they are honest -- even with expression of angry emotions. They get to witness the impact of their behaviors on others and get feedback from the group.

* Get in touch with experiences of loss, envy, longing, and desire for intimacy. Often, members in the group represent client's family or origin, and so they have the opportunity to project these feelings onto other members and "work through" their early experiences in a safe environment.

Another powerful aspect of group therapy is the experience you have that you are not alone in the world. Group is a place where you feel connected to, and get support, empathy and validation from people who have shared experiences.

Depression: Action Time

If you suspect that you are depressed, let friends and/or family members know that you need their support. Consult your primary doctor or another medical practitioner to find a therapy referral. You can also get a referral from someone who has had a successful experience with a therapist. If you can't find a therapist through these means then you can find a therapist online such as through psychologytoday.com or through your insurance company. You should seek immediate attention if you are having any thoughts about dying or suicide.

If you suspect that a friend or family member is suffering from depression, you can:
* Educate yourself about depression and it's symptoms.
* Engage in conversation with your friend, and start by saying that you care about him. Make it clear that you're not trying to judge him but that you can see that he is struggling and you want to help. You can simply ask, "what can I do for you?". Allow him to vent without offering advice or solutions unless he specifically asks for such advice.
* Try to spend time with him and encourage him to engage in life and not isolate. Most importantly, encourage him to see a professional.