A depressive disorder is a whole-body illness, involving the body, mood, and thoughts, and affects the way a person eats and sleeps, feels about himself or herself, and thinks about things. It is not the same as being unhappy or in a blue mood. Nor is it 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. During any one year period, nearly 19 million American adults suffer from depressive illness. Yet, treatment can alleviate symptoms in nearly 80 percent of cases.
Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women--particularly such factors as menstrual cycle changes, premenstrual syndrome (PMS), pregnancy, miscarriage, postpartum period, perimenopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and aging parents.
Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient "blues" are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic health care provider and the family's emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being and her ability to care for and enjoy the infant.
Depressive disorders come in different forms, as do other illnesses, such as heart disease. Three of the most prevalent types of depressive disorders include the following:
- Major depression. A combination of symptoms (see symptom list) that interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.
- Dysthymia. Long-term, chronic symptoms that do not disable, but keep people from functioning at "full steam" or from feeling good. Sometimes, people with dysthymia also experience major depressive episodes.
- Bipolar disorder (manic-depression). A chronic, recurring condition that includes cycles of depression and elation or mania.
Within these types, there are variations in the number of symptoms, their severity, and persistence.
The following are the most common symptoms of depression. However, each individual may experience symptoms differently. In general, nearly everyone suffering from depression has ongoing feelings of sadness, and may feel helpless, hopeless, and irritable.
The American Psychiatric Association suggests that professional help is advisable for those who have four or more of the following symptoms continually for more than two weeks:
- Noticeable change of appetite, with either significant weight loss not attributable to dieting or weight gain
- Noticeable change in sleeping patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much
- Loss of interest and pleasure in activities formerly enjoyed
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Restlessness, irritability
- Decreased energy, fatigue, being "slowed down"
- Feelings of worthlessness
- Persistent feelings of hopelessness
- Feelings of inappropriate guilt
- Inability to concentrate or think, indecisiveness
- Recurring thoughts of death or suicide, wishing to die, or attempting suicide (Note: Individuals with this symptom should receive treatment immediately!)
- Melancholia (defined as overwhelming feelings of sadness and grief), accompanied by the following:
- Waking at least two hours earlier than normal in the morning
- Feeling more depressed in the morning
- Moving significantly more slowly
- Disturbed thinking--for example, severely depressed people sometimes have beliefs not based in reality about physical disease, sinfulness, or poverty
- Physical symptoms, such as headaches, digestive disorders, and chronic pain
Specific treatment for depression will be determined by your health care provider based on:
- Your age, overall health, and medical history
- Extent of the depression
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disorder
- Your opinion or preference
Generally, based on the outcome of evaluations, depressive disorders are treated with medication or either psychotherapy or cognitive behavioral therapy, or a combination of medication and therapy.
You can also help yourself. Depressive disorders can make a person feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime, consider the following:
- Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
- Break large tasks into small ones, set some priorities, and do what you can as you can.
- Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
- Participate in activities that may make you feel better.
- Mild exercise, going to a movie, a ball game, or participating in religious, social, or other activities may help.
- Expect your mood to improve gradually, not immediately. Feeling better takes time.
- It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition--change jobs, get married or divorced--discuss it with others who know you well and have a more objective view of your situation.
- People rarely "snap out of" a depression. But they can feel a little better day-by-day.
- Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
- Let your family and friends help you.
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