Common Characteristics of Depression
Depression is our most common mental disorder. It afflicts an estimated 50 million Americans, 35 million of whom receive some form of treatment. All of us can be affected, regardless of age and social or economic status. Although it is generally assumed that the disorder is more prevalent among women than men, it may well be that men are equally affected, but that women are more likely to seek help.
Now and then, everyone feels down; differentiating normal sadness from clinical depression is sometimes difficult. In response to life circumstances--for example, the loss of a loved one or job, or an illness--all of us become sad, and some of us become depressed--a condition commonly referred to as reactive depression. Others, particularly people with a family history of depression, seem to have an inherited tendency for depression and may become depressed in the absence of obvious external distress or upset.
Diagnosis of Depression
The American Psychiatric Association has defined depression, in part, as "loss of interest or pleasure in all or almost all usual activities and pastimes." As a clinical condition, depression is usually identified by the extent to which its symptoms interfere with normal functioning. In contrast, the feelings of melancholy that are a natural consequence of stressful or sorrowful life events are more transitory. Grief is dealt with more or less philosophically, the sense of self remains intact and the daily round of involvements is resumed.
Stressful circumstances that can result in depression may occur at any age from infancy through old age. Hereditary depression also may occur at any age, and it tends to recur. Very often, it alternates with periods of extreme euphoria--a condition often referred to as manic-depression.
In diagnosing depression, at least four of the following symptoms must be present most of the time for a minimum of two weeks (except in children under 6 years of age, in which case at least three of the first four must be noted): (1) altered eating habits, manifested by marked increase or decrease in appetite and significant change in weight; (2) insomnia or excessive sleepiness; (3) hyperactivity or slowed movement; (4) loss of interest or pleasure in usual activities or decrease in sexual drive; (5) loss of energy or fatigue; (6) feelings of worthlessness, guilt or self-reproach; (7) reduced ability to concentrate or think, and (8) recurrent thoughts of death or suicide or attempted suicide.
Some symptoms of depression, such as feelings of guilt or inadequacy, may be apparent only to the person experiencing them. But these feelings in turn bring about changes in attitudes and behavior that are noticeable to friends, family, colleagues: a withdrawal from the usual relationships; an inability to find pleasure in the normal joys of living; overreacting to the minor irritations of daily life; emotional instability and inexplicable mood swings; impaired concentration; crying spells, anxiety attacks and an increasing inability to get out of bed in the morning to face the day's responsibilities.
Physical symptoms also may appear--insomnia, headaches, gastrointestinal disturbances and, in some cases, a change in appetite or sexual function.
A child of any age may be sending out signals for help in dealing with a depression when he or she complains of headaches and cramps with no physical cause; refuses to see friends; has raging tantrums for no reason; neglects schoolwork, and is self-destructive.
A transitory post-partum depression--also known as "after-the-baby blues"--is a common and normal condition that may affect both parents. However, if the new mother's feelings of helplessness or entrapment and resentment persist to the point where she keeps losing sleep or is afraid to handle the baby because she thinks she might harm it, professional help is needed.
Depression may also manifest itself as a reaction--probably biochemical--to such infectious diseases as hepatitis, mononucleosis and tuberculosis. A number of drugs, particularly central nervous system depressants, or "downers," especially alcohol and barbiturates among others, also may be responsible for feelings of depression.
Treatment of Depression
Some people with a genetic tendency to recurrent sieges of mild depression are able to deal with the problem without medication. They find relief in working at meaningful and productive tasks, in spending time with friends who enhance their self-esteem or in regularly scheduling strenuous exercise, which may be alternated with periods of relaxation or medication.
In many patients, antidepressant drugs along with or followed by counseling may be required. Most studies have shown that psychotherapy and medication are complementary and additive in value. The medication seems to affect the specific symptoms and the psychotherapy affects the problems of living. The most commonly prescribed types of drugs are:
Tricyclic antidepressants. These drugs work through the central nervous system to relieve the symptoms. Most take several days or even up to four to six weeks to have their full effect. Some tricyclic antidepressants are combined with anti-anxiety agents if anxiety is present.
Monoamine oxidase (MAO) inhibitors. These drugs block the action of an enzyme that aids in the breakdown of certain chemicals in the brain. They are faster acting than the tricyclic antidepressants, usually working within several days. People taking MAO inhibitors must be careful not to eat foods containing tyramine--for example, certain types of ripe cheese or red wine--because the combination may lead to dangerously elevated blood pressure. They should obtain a diet sheet from their physician with details of foods to be avoided.
Lithium salts. These are naturally occurring crystalline salts, used to treat manic depression, a disorder marked by extreme mood swings from exhilaration to deep depression. They may be given in combination with an anti-depressive drug during the acute phase, and then be taken alone to prevent the mood swings. The lithium dosage should be carefully monitored by a doctor, since even a slight overdose may have toxic effects.
Other non-drug treatments are also available, and may be recommended, depending upon the severity and duration of the depression.
Depression can be a serious illness that interferes with one's ability to function and cope with life's adversities. Fortunately, a number of effective treatments for depression have been developed, and most people now recognize that telling a depressed person to "buck up" is not likely to do any good. Most cases of depression improve within a few months of treatment. Even when symptoms continue beyond that time, they are likely to be sufficiently alleviated so that the patient can resume most normal activities; at the same time, he can learn how to avoid unnecessarily stressful situations and achieve an increasing level of equanimity through an individually prescribed combination of self-awareness, suitable medication and--where indicated--a program of counseling, psychotherapy or other treatments.