In any given 1-year period, 9.5 percent of
the population, or about 18.8 million American adults, suffer from a depressive
illness5 The economic cost for this disorder is high, but the cost in
human suffering cannot be estimated. Depressive illnesses often interfere with
normal functioning and cause pain and suffering not only to those who have a
disorder, but also to those who care about them. Serious depression can destroy
family life as well as the life of the ill person. But much of this suffering is
Most people with a depressive illness do not seek
treatment, although the great majority—even those whose depression is extremely
severe—can be helped. Thanks to years of fruitful research, there are now
medications and psychosocial therapies such as cognitive/behavioral, “talk” or
interpersonal that ease the pain of depression.
Unfortunately, many people do not recognize that
depression is a treatable illness. If you feel that you or someone you care
about is one of the many undiagnosed depressed people in this country, the
information presented here may help you take the steps that may save your own or
someone else’s life.
WHAT IS A DEPRESSIVE DISORDER?
A depressive disorder is an illness that involves the
body, mood, and thoughts. It affects the way a person eats and sleeps, the way
one feels about oneself, and the way one thinks 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.
TYPES OF DEPRESSION
Depressive disorders come in different forms, just as is
the case with other illnesses such as heart disease. This pamphlet briefly
describes three of the most common types of depressive disorders. However,
within these types there are variations in the number of symptoms, their
severity, and persistence.
Major depression is
manifested by a combination of symptoms (see symptom list) that interfere with
the ability to work, study, sleep, eat, and enjoy once pleasurable activities.
Such a disabling episode of depression may occur only once but more commonly
occurs several times in a lifetime.
A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not
disable, but keep one from functioning well or from feeling good. Many people
with dysthymia also experience major depressive episodes at some time in their
Another type of depression is bipolar
disorder, also called manic-depressive illness. Not nearly as prevalent
as other forms of depressive disorders, bipolar disorder is characterized by
cycling mood changes: severe highs (mania) and lows (depression). Sometimes the
mood switches are dramatic and rapid, but most often they are gradual. When in
the depressed cycle, an individual can have any or all of the symptoms of a
depressive disorder. When in the manic cycle, the individual may be overactive,
overtalkative, and have a great deal of energy. Mania often affects thinking,
judgment, and social behavior in ways that cause serious problems and
embarrassment. For example, the individual in a manic phase may feel elated,
full of grand schemes that might range from unwise business decisions to
romantic sprees. Mania, left untreated, may worsen to a psychotic state.
SYMPTOMS OF DEPRESSION AND MANIA
Not everyone who is depressed or manic experiences every
symptom. Some people experience a few symptoms, some many. Severity of symptoms
varies with individuals and also varies over time.
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once
enjoyed, including sex
- Decreased energy, fatigue, being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
CAUSES OF DEPRESSION
Some types of depression run in families, suggesting that a biological
vulnerability can be inherited. This seems to be the case with bipolar disorder.
Studies of families in which members of each generation develop bipolar disorder
found that those with the illness have a somewhat different genetic makeup than
those who do not get ill. However, the reverse is not true: Not everybody with
the genetic makeup that causes vulnerability to bipolar disorder will have the
illness. Apparently additional factors, possibly stresses at home, work, or
school, are involved in its onset.
In some families, major depression also seems to occur generation after
generation. However, it can also occur in people who have no family history of
depression. Whether inherited or not, major depressive disorder is often
associated with changes in brain structures or brain function.
People who have low self-esteem, who consistently view themselves and the
world with pessimism or who are readily overwhelmed by stress, are prone to
depression. Whether this represents a psychological predisposition or an early
form of the illness is not clear.
In recent years, researchers have shown that physical changes in the body can
be accompanied by mental changes as well. Medical illnesses such as stroke, a
heart attack, cancer, Parkinson’s disease, and hormonal disorders can cause
depressive illness, making the sick person apathetic and unwilling to care for
his or her physical needs, thus prolonging the recovery period. Also, a serious
loss, difficult relationship, financial problem, or any stressful (unwelcome or
even desired) change in life patterns can trigger a depressive episode. Very
often, a combination of genetic, psychological, and environmental factors is
involved in the onset of a depressive disorder. Later episodes of illness
typically are precipitated by only mild stresses, or none at all.
Depression in Women
Women experience depre