What is Depression?
So many people casually talk about being depressed, when what they are feeling is sad. A case of the blues, something everyone has experienced, is not depression in the clinical sense. Sadness eventually fades, while depression does not.
Depression is an intense feeling of hopelessness, an overwhelming despair that lasts for several weeks and interferes with all aspects of daily life.
Societal attitudes toward mental health have improved, but there is still a stigma associated with depression. As a result, many of those who are suffering do not seek treatment for this very manageable condition. Research findings indicate that those who do are extremely successful in the recovery process.
Who Does Depression Affect?
About 1 in 10 Canadians experience a major-depressive episode at some point in their lifetime. Depression is one of the leading causes of disability globally. Individuals who have a family history are more susceptible to developing the disorder, as are those with a chronic illness.
In the United States, that number is approximately 17.3 million Americans, or 7.1 % of adults. The Centers for Disease Control and Prevention (CDC) report that women are twice as likely as to be diagnosed with depression than men.
About 80% of individuals suffering with depression report challenges with work, at home, and in social interactions, due to their condition.
Forms of Depression
There are several types of depression. They have many characteristics in common, but each has its own unique qualities that direct diagnosis and treatment by mental health professionals. Anyone displaying these symptoms should consult a medical practitioner immediately.
Major Depressive Disorder
As research into mental illness has continued, understanding has evolved. What was once referred to as depression is now known as major depressive disorder, or major depression, and is the most common form.
Typically, patients suffer feelings of hopelessness, on a daily basis, for most of the day, and for a relatively lengthy period of period of time (at least two weeks). Symptoms include despondency, difficulty sleeping or sleeping too much, fatigue, eating problems, chronic pain, loss of interest in activities, difficulties with memory or concentration, anxiety and constant worry.
Suicidal thoughts are of particular concern, and require immediate intervention. 90% of individuals who take their own lives have a mental illness, so it is crucial for friends and family members to take suicidal behaviour seriously.
Persistent Depressive Disorder
A major depression that lasts for more than two years is known as pervasive depressive disorder. It is sometimes referred to as dysthymia, or chronic depression. This condition makes all aspects of daily life challenging, particularly relationships.
Symptoms include deep sadness or hopelessness, low self-esteem, lack of interest in activities previously enjoyed, changes in appetite, disruption to sleep patterns, concentration or memory problems, difficulties at school or work, loneliness and social isolation.
This is a long-term condition, but the severity of symptoms can change for months a time, improving for a while, then worsening again. Individuals suffering from this type of depression can begin to feel as though their illness is just a normal part of life. It is important to seek help from a mental health care provider, like a psychologist or psychiatrist.
A treatment plan including a combination of counselling, therapy, and/or medication can significantly improve quality of life and prevent symptoms from worsening.
Bipolar disorder is characterized by periods of mania, or hypomania, alternating with depressive episodes. It was formerly known as manic depressive disorder, which is now regarded as an outdated term.
For diagnosis, patients must experience a manic episode that lasts seven days or longer, unless they are hospitalized. A depressive period may follow or precede the manic episode.
The symptoms experienced during a depressive episode are similar to those of a major depression. These may include feelings of hopelessness, fatigue, changes in sleeping or eating patterns, difficulty concentrating, low energy, loss of interest in activities, and suicidal thoughts.
In stark contrast, during a manic period, patients have high levels of energy, insomnia, irritability, racing thoughts or speech, increased self-esteem and confidence, unusual risky behaviour, and feelings of euphoria. If the episode is severe, it may also include hallucinations or delusional thoughts.
Bipolar disorder requires ongoing treatment by a medical professional who can provide the appropriate medications and therapy to manage this very serious, potentially life-threatening condition.
Sometimes, individuals with major depression will experience episodes of psychosis, hallucinations, and delusional thinking, and they lose touch with reality. When this happens, it is known as major depressive disorder with psychotic features. Another term for this condition is depressive psychosis, or psychotic depression.
Physical symptoms include an inability to sit still, or slowed movements.
Again, this is a very serious condition that requires psychotherapy, counselling, and/or medication, ideally as part of an in-patient treatment program.
Perinatal depression is major depressive disorder that has its onset during pregnancy. Postpartum depression begins after the baby is born, typically within four weeks of giving birth.
The changes in hormone levels during and following a pregnancy are profound enough to alter the chemical make-up of the mother’s brain. This often leads to severe mood changes. Lack of sleep during this time exacerbates this effect.
Other signs to watch for are sadness, anxiety, anger or rage, exhaustion, and extreme worry about the baby’s well-being. Individuals who have major depressive disorder prior to pregnancy are at greater risk, but anyone can develop this condition.
Perinatal or postpartum depression are cause for great concern because they can lead to suicide attempts, or to harming the newborn. They are also very often undiagnosed or dismissed as a normal reaction to pregnancy or childbirth. Seeking medical help is crucial if a loved one is struggling with any of these symptoms.
Also referred to as seasonal affective disorder (SAD), seasonal depression is a major depressive disorder that is associated with a lack of daylight. The symptoms come and go with the seasons, typically worsening in winter, and lessening in spring.
Individuals suffering from this form of depression often experience loneliness, social withdrawal, increased need for sleep and feelings of hopelessness.
Suicidal thoughts are very common and should be taken very seriously by friends and family members. Waiting for spring for them to subside may be leaving it too long. Treatment by a mental health care provider is essential.
Officially known as adjustment disorder with depressed mood, situational depression is triggered by specific events. Situations that often result in this particular type of depression may include the death of a loved one, a serious illness, getting divorced, being in an abusive relationship, or having financial difficulties or legal problems.
While feelings of sadness and anxiety are a normal response to a major life change, situational depression occurs when those feelings are out of proportion to the circumstances, and significantly impact daily living. Symptoms can include anxiety, feelings of hopelessness, frequent crying, increased or decreased appetite, sleep disruptions, aches and pains, fatigue, and withdrawal from social activities.
Typically, there is an onset within 3 months of the traumatic event and improvement within 6 months, so this condition is not permanent. Support groups and/or counselling can be extremely helpful for managing symptoms.
Atypical depression is often referred to as major depressive disorder with atypical features. It is characterized by periods when depression symptoms subside temporarily, as a reaction to positive life events.
Signs to watch for may include increased appetite, weight gain, sleeping too much, fatigue, a heavy feeling in the limbs, and oversensitivity to criticism or rejection. Challenges at work, school, and with relationships are very common.
Feeling suicidal is another, very serious, symptom of this type of depression, as it is with the other forms. It is extremely important to be under the care of an expert in mental health care in order to proactively manage the fluctuations in mood, and their effects.
What Causes Depression?
It is unclear what causes depression or other mood disorders. Research has identified a variety of predictors that an individual may be more likely to develop this illness.
One of the risk factors associated with all forms of depression is family history. The National Alliance on Mental Illness (NAMI) reports that approximately 30% of individuals diagnosed with depression have a genetic predisposition to this condition.
A chemical imbalance in the brain is another cause of depression that has been well documented in the research. Serotonin and norepinephrine are two naturally occurring neurotransmitters. Low levels of these are linked to major depressive disorder. Many anti-depressants include chemicals to boost their levels. When used as prescribed, these can be very effective in lessening the symptoms of depression.
Personality traits can also be a factor. The way an individual sees the world can impact how they perceive life events. Some people have a tendency to not appreciate good things, and to become easily overwhelmed by challenges. They have a negative viewpoint all of the time. This can determine whether or not they become depressed.
Childhood experiences, particularly traumatic events, can affect the way a person responds to outside events. A pattern of negative thinking develops at a young age that eventually results in developing a depressive personality style.
Stressful life events and significant change may trigger the onset or worsening of depression. Ongoing challenges at work or school, and in relationships with others, can take a toll on mental and physical health. Stressors such as financial difficulties, retirement, job loss, having a baby, and the death of a loved one are all a normal part of life. However, in a vulnerable person, they are often enough to worsen a depressive illness.
Physical illness, or the medications to manage it, can be another risk factor associated with both depression and substance abuse. Conditions like hepatitis, influenza, diabetes, and anemia can all cause symptoms of depression, as can the prescription drugs used to treat them. Those medications are often misused, and frequently lead to addiction.
Depression and Substance Use Disorder
Mental illness is strongly linked to addiction, as one in four people suffering from depression also has a substance use disorder. It is a complex relationship – it is nearly impossible to determine whether substance abuse is caused by a mental health condition, or if the opposite is true.
Many individuals turn to drugs and alcohol when they are struggling, and when their condition is not well managed.
Tragically, alcohol use can trigger depression symptoms like sadness, lethargy and feelings of hopelessness, because it affects the central nervous system. The depressed person then consumes more to suppress those emotions, triggering more symptoms. A vicious cycle is begun that is not easy to end.
Major depression puts individuals at great risk for suicide, self-harm, or accidental injury. It can also weaken the immune system, making them more susceptible to contracting a serious physical illness. Alcohol or drug abuse increases the impact on mental and physical well-being dramatically.
Research findings indicate again and again that many people with an addiction also have a mental health condition. This is known as a dual diagnosis. It is critical to treat the illnesses with an integrated approach, simultaneously.
Depression can have such a devastating impact on quality of life, and on the ability to function at work, home and in social interactions. It has a profound impact on both mental and physical health, robbing its victims of the enjoyment of favourite activities and major events. Many individuals suffer without ever seeking help.
This is so unfortunate, as depression is highly manageable.
The most effective treatment often involves a combination of counselling and anti-depressant medication. As part of a comprehensive plan, lifestyle changes in diet, exercise, and sleep patterns, as well as connecting more with loved ones may also help alleviate symptoms.
There are many counselling approaches available, and the most appropriate for each individual is chosen in consultation with a medical professional. Cognitive Behaviour Therapy (CBT) is a type of psychotherapy that is often used with patients suffering from depression, with great success. Therapists help patients analyze their thought patterns, feelings and behaviours, and develop new strategies for managing emotional upset, and stressors.
Treating a Dual-Diagnosis
This can be challenging, as each disorder can trigger and intensify the other. Addiction and mental illness is strongly linked, and must be treated together. Failing to do so can make each condition worse.
Treating an individual with a dual diagnosis must be done by an expert in both mental health and substance abuse. Participation in a rehab program that includes therapy, counselling, peer support groups, medically supervised detox, and an aftercare plan offers the best chance of ongoing, sustainable recovery.
Coping With Depression
With depression, seeking professional help is crucial. That is the first step toward freedom from this crippling condition.
Today, treatment involves a plan personalized to the unique needs of every individual, in consultation with a medical practitioner. Taking an active role in this process may help to ensure its effectiveness, and may even speed up recovery.
However, none of that can happen until medical intervention is sought. This probably seems overwhelming, but may be life altering.
Depression The Centre for Addiction and Mental Health (CAMH), Copyright 2019
Depression The World Health Organization (WHO), Article Date: December 4, 2019
Depression Psychology Today, November 14, 2019
Depression Centres for Disease Control (CDC), Article Date: November 28, 2018
How Depression Has and Hasn’t Become Normalized National Alliance on Mental Illness (NAMI), Article Date: February 26, 2017
Depression Care Among Depressed Adults With and Without Co-morbid Substance Use Disorders in the United States Substance Abuse and Mental Health Services Administration (SAMHSA), February 2, 2017
What is Depression? American Psychiatric Association (APA), Physician Review: January 2017
Picture Credit: NBC News – Am I Depressed or Just Sad?