The DA Guide to Depression

Depression (also called clinical depression, major depression, unipolar depression, or major depressive disorder) is a common mood disorder that is both serious and treatable. It is characterized by a prolonged period of low mood that impacts how you think, feel, and act on a daily basis. This article provides a complete overview of depression, including symptoms, causes, statistics, treatments, a self-assessment, and things you can do to start getting back on the path to wellness today.

What is Depression?

Depression is not the same as sadness. While both conditions are defined by periods of sadness, gloominess, or low mood, symptoms of depression are much more severe.

Sadness is a natural emotional reaction to the loss of something valuable. For example, you may feel sad after the death of your pet and this sadness may last for a period of time. Depression, though, is a serious mental health condition that interferes with your ability to function from day-to-day and may last for many years if left untreated. While sadness involves the emotional processing of a loss or failure, depression describes a prolonged psychological state where you are unable to identify or experience anything positive or productive.

Depression is the leading cause of disability worldwide. Many health professionals adopt a medical model of depression and classify the condition as a disease of the brain. However, some experts have suggested alternate models of depression. Two of these suggestions are the behavioral shutdown model (BSM) and the unified model of depression.

Supporters of the behavioral shutdown model and the unified model believe depression is an evolved defensive strategy. Depressive symptoms are viewed as natural reactions to chronic danger, stress, and failure (behavioral shutdown model) or the loss of social support (unified model).

These reactions are thought to be useful in conserving energy and resources when the potential gain is outweighed by the required effort. This can be seen as similar to the physical sensation of pain, where pain draws attention to an injury or inability to accomplish a task. Like physical pain, depression could be viewed as an alert to struggles in the social or emotional environment.

Types of Depression

There are different types of depression. Some forms develop under specific circumstances and have disabling symptoms that vary in severity. Developing an awareness of the range of depressive conditions increases the likelihood of early identification and treatment.

Depressive and Related Disorders

Depression is linked to many other mental disorders. Some mental health issues are believed to be precursors to depression, while others often coexist with depression. A thorough understanding of major depressive disorder helps therapists to accurately diagnose the condition even in the presence of co-occurring concerns with similar symptoms.

Situational Depression

Situational depression (also called adjustment disorder with depressed mood) develops when you experience emotional symptoms that are similar to those in clinical depression in response to a specific major life adjustment. The depressive symptoms must occur within three months of the adjustment occurring.

Symptoms of situational depression include crying, low mood, and hopelessness. However, they do not meet the full criteria for major depression. These symptoms are a response to a known stressor (such as chronic illness, divorce, a natural disaster, a new baby, a new job, or marital strife) and may disappear if the stressor is removed or you are able to accept and adapt to the adjustment.

Medical Condition Related Depression

Certain medical issues and drugs are linked with mood issues. Up to 15% of depression cases are associated with medical illnesses or medications. For example, an estimated 50% of heart attack survivors are affected by low mood or clinical depression. Depression is linked with future cardiovascular issues, a slower rate of recovery, and a higher risk of dying in six months. Older depression medications (tricyclic antidepressants) may impact the cardiac rhythm of heart patients.

Other medical related issues that are associated with depression include:

• Hypothyroidism – a lack of thyroid hormone
• Degenerative brain diseases – such as Alzheimer’s disease, Huntington’s disease, or Parkinson’s disease
• Endocrine issues
• Male erectile dysfunction
• Viruses – such as hepatitis, HIV, and mononucleosis
• Cancer
• Stroke
• Nutritional deficiencies

When treating medical conditions and coexisting depression, it is important to find out which issue developed first. If the stress of a chronic medical illness resulted in depression, depressive symptoms may disappear if the medical condition is effectively treated. However, depression may be present before other health problems develop and may even contribute to them. In most cases, depression is an independent health concern that must be addressed separately

Comorbid Depression

Comorbid depression refers to depressive symptoms that coexist with at least one other physical or psychological ailment. Many people with mental health issues have comorbid conditions. In the case of major depression, there is a particularly strong link with anxiety disorders such as panic disorder, generalized anxiety disorder, and social phobia. Comorbid depression and anxiety may account for up to 4% of all medical disability worldwide.

Roughly 85% of people with depression also have symptoms of anxiety. Comorbid depression occurs in approximately 90% of people with anxiety issues. Therapy is generally less effective among individuals with comorbid depression and anxiety. This is because symptoms overlap between both conditions and this usually makes it more difficult for mental health professionals to diagnose, research, and treat each issue.

Melancholia

Melancholia is a type of depression that is marked by severe symptoms, a comprehensive loss of pleasure in everyday activities, as well as slowed thought, speech, and movement. Individuals with melancholia have a nonreactive mood and produce blunted emotional responses even when circumstances improve. Other symptoms include lack of focus, impaired working memory, loss of appetite, sleep issues, and reduced libido.

Melancholia is linked to distinct biological changes. People with the condition have high amounts of circulating cortisol (hypercortisolemia), reduced REM latency, increased REM time, and reduced deep sleep.

Individuals with melancholia do not respond well to psychotherapy or social interventions. However, tricyclic antidepressants and electroconvulsive therapy have produced good results in treatment.

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Depressive and Related Disorders

Depression comes in many forms. You may develop a particular type of depression based on a variety of factors such as your genetics, physiology, or environment. Depression may be described as severe, moderate, or mild, as well as melancholic or psychotic. The ability to distinguish between types of depression is vital to the development of faster, more effective treatments.

Major Depressive Disorder

Major depressive disorder is another name for clinical depression or major depression. The condition is defined by a persistent low mood and other symptoms that interfere with daily life. Symptoms of major depressive disorder are experienced on most days for at least two weeks.

Approximately 6.9% of adults in the United States live with major depression.

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is mental health condition in which females experience intense symptoms of depression, tension, and irritability before menstruation. The symptoms of PMDD are more severe than those associated with premenstrual syndrome (PMS).

Substance/Medication-Induced Depressive Disorder

Certain drugs such as blood pressure medication and steroids may trigger symptoms of depression as a side effect. Low mood may also result from changing the dosage of your medication, taking a new medication, or interactions between the medications you are taking.

Some medications that may induce depressive disorders include:

• Antibiotics, antivirals, and antimicrobials
• Blood pressure and heart medication
• Sleeping pills, tranquilizers, and sedatives
• Hormones
• Cancer medication
• Anti-seizure medication
• Narcotic pain medication

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is characterized by depressive symptoms, irritability, sleep issues, loss of focus, and lethargy during fall and winter months. The condition may be triggered by limited exposure to sunlight. Seasonal affect disorder affects up to 2% of the population. Young people and women are more likely to develop this form of depression.

Symptoms of SAD tend to subside in spring and summer months. However, there are several ways to treat the condition during winter. Effective methods include outdoor activities or exercise, light therapy, and medication.

Stats: How Many Suffer from this Disorder?

Approximately 6.9% of adults in the United States live with major depression. This figure corresponds to more than 16 million people. The condition is more common among adult females (8.5%) than males (4.8%). Young adults who are 18-25 years old are at higher risk of major depression (10.9%).

Causes of Depression

Although depression is one of the most prevalent mental health issues in the world, the specific causes of the condition are not known. Current research suggests depression may be caused by a combination of psychological, biological, genetic, chemical, and environmental factors.

Signs and Symptoms of Depression

There are many signs and symptoms of depression. At least five depressive symptoms must be present most of the day, for nearly every day over the course of two weeks for you to be diagnosed with the condition.

Common symptoms of depression include:

• Pessimism or hopelessness
• Chronic sadness, emptiness, or worry
• Worthlessness, helplessness, or guilt
• Slowed speech or movement
• Irritability
• Changes in appetite or weight
• Fatigue
• Loss of interest in pleasurable activities
• Restlessness
• Sleep issues
• Inability to concentrate
• Physical pains, headaches, or digestive issues
• Suicidal ideation or suicide attempts

If you have been diagnosed with depression you may not experience every symptom. The frequency and intensity of symptoms may also vary from one person to another.

Sadness, Hopelessness, and Other Emotions

Sadness, hopelessness, guilt, emptiness, worthlessness and other related feelings are natural emotional reactions to negative life events. However, when these emotions are excessive, out of keeping with the situation at hand, and persist for more than two weeks, they may indicate the onset of depression.

Anhedonia

Individuals with anhedonia have a reduced ability to experience pleasure and lose interest in activities they previously enjoyed. There are two main types of anhedonia:

• Social anhedonia – a lack of interest in social contact, social situations, or relationships
• Physical anhedonia – a reduced ability to experience tactile pleasures such as touching, eating, or sex

Anhedonia is a classic symptom of clinical depression, but not everyone with depression has anhedonia. Anhedonia may also be a symptom of other mental disorders. Some people with anhedonia do not have a mental disorder.

Individuals with chronic stress, anxiety, or substance addiction are at increased risk of developing anhedonia. People with social anhedonia more likely to develop schizophrenia than their peers.

Fatigue

Fatigue is defined by a lack of motivation and energy. It is a normal response to prolonged physical or mental activity. People who are fatigued tend to tire easily and have difficulty concentrating. Fatigue is different from drowsiness, which describes a need for sleep.

Fatigue can be alleviated by reducing the activity you are involved in. While fatigue is not a disease, it is a common symptom of many physical and mental health issues such as depression

Weight and Appetite Changes

If you have depression, you may experience changes in your appetite and body weight. The clinical standard is a change in body weight by 5% or more in one month. Some people gain weight when they are depressed. Other people with depressive symptoms may lose weight.

Depressed individuals tend to gain weight faster than people who are not depressed. Depressive symptoms that may worsen obesity include increased appetite, lack of motivation, and fatigue. No one knows whether people gain weight because they are depressed, or they become depressed because they gained weight. Depression and obesity may reinforce each other in a vicious cycle of deteriorating mental and physical health.

People with depression may also lose an unhealthy amount of weight. This is because individuals who have lost interest in pleasure may lose interest in food. Depression may also coexist with eating disorders. These eating issues may also cause people to gain or lose body weight.

Helplessness

Helplessness occurs when people are unable to act or react to a negative event. The feeling may be fueled by illness, stress, trauma, grief, isolation, mental disorders, or other issues. Individuals with depression may feel powerless when they encounter stressful situations and may believe nothing can be done to improve their circumstances. In some cases, they may still feel helpless even if their situation improves.

Self-Harm and Suicide

Individuals with depression are at higher risk of self-harming behaviors. Non-suicidal self-injury may involve deliberately cutting, scratching, piercing, hitting, or burning your own body in order to cope with anger, emotional pain, or frustration. While self-harming acts may temporarily relieve tension, it is often followed by shame, guilt, and the return of negative emotions. Although people who engage in self-harming behavior are usually not suicidal, increasingly extreme behaviors increase the likelihood of accidental suicide.

Depressed people are also more likely to have suicidal thoughts, attempt suicide, and commit suicide than their peers. Suicide is the third leading cause of death among young people ages 10-24. If you are thinking about taking your own life, call any of the following numbers immediately:

• 911 or your local emergency services number
• The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a trained therapist

Testing: How is Depression Assessed

Speaking with individuals is one of the best tools for diagnosing depression. Laboratory tests are far less effective as people with intense inner turmoil may have minimal observable symptoms. It can be challenging to make a depression diagnosis as the condition may manifest in many different ways. However, screening for depression by using a series of standard questions will help healthcare professionals learn much about presenting issues, moods, habits, and behaviors.

Standardized Psychiatric Interview

A mental health professional may conduct a standardized psychiatric interview with you to get a better idea of your symptoms, arrive at an accurate diagnosis, and develop an effective treatment plan. The therapist may ask you to speak freely and tell your story in any way you feel comfortable. Afterward, the therapist may ask questions to get more information on specific issues, test your mental status, and inquire if you have any other questions or concerns you would like him/her to address.

You may feel scared to do a standardized psychiatric interview, but it is designed to help you overcome issues like depression. A psychiatric interview is very different from a job interview or an academic exam. Some people may search online for possible interview questions and try to prepare “perfect” answers ahead of time but this is not recommended. Inconsistent answers may make it appear as if you have more mental health concerns than you really do.

Beck Depression Inventory

The Beck Depression Inventory (BDI) is a multiple choice, self-report rating inventory that measures your depressive symptoms and attitudes. The BDI has 21 questions and takes about 10 minutes for you to complete. It is designed for people age 13 or older and requires a fifth-grade reading level to understand the questions. The BDI is a widely used assessment tool in the treatment of depression.

MMPI, PAI, and other Testing

If you are experiencing symptoms of depression, your mental health provider may ask you to complete one or more psychological tests to aid in diagnosis and treatment. Common tests include:

• Minnesota Multiphasic Personality Inventory (MMPI-2) – the most used and researched psychological test in the world. Most therapists receive specific training with this test. It is a long test with 567 items but has high measures of validity.
• Personal Assessment Inventory (PAI) – used to assess a broad range of mental health issues, including depression. It has 344 items. The PAI subscales are useful for detailed analysis.
• Millon Clinical Multiaxial Inventory (MCMI-III) – has 175 items and assesses depressive disorders as well as other mental health conditions.
• Pain Patient Profile (P3) – used to identify people with chronic pain who also have emotional distress that may be interfering with treatment. The P3 has 45 items and may be used in conjunction with other tests.

Depression in Adults/Children

Although depression is often linked with adults, children may also be affected by the condition. Approximately 2% of preschool and school-age children have depressive symptoms. Youths may experience fatigue, headache, insomnia, dizziness, apathy, weight issues, social withdrawal, substance abuse, alcohol abuse, and poor academic performance. Childhood depression may be effectively treated with psychotherapy, lifestyle adjustments, and medication.

Neurobiology of Depression

Many health experts believe depression is a brain disease. The brain plays a key role in regulating mood and areas such as the hippocampus, amygdala, and prefrontal cortex all play a role in depression. However, the presence of depressive symptoms is not a matter of having too much or too little of certain neurotransmitters. Neurobiological factors such as nerve cell growth, neural connections, and the functioning of neural circuits are all thought to have a major impact on the development of the condition.

Example Case of Depression

Jackie, 25, has been feeling down for a while and decides to visit a psychologist after a recommendation from her friend. In addition to strong feelings of sadness, hopelessness, and worthlessness, Jackie also has sleep issues and terrible headaches. The psychologist learns that Jackie has been struggling with these symptoms every day for the past two months. She has been unable to go to work and rarely meets up with her friends for their daily gym sessions. The psychologist diagnoses Jackie with clinical depression and recommends a combination of individual therapy, group therapy, and antidepressant medication. After six months of treatment, Jackie has better control of her emotions, increased productivity at work, and a closer relationship with her friends.

How to Deal/Coping With Depression

If you have depression, you need to take action. However, it may be difficult to even think about the things you should do to feel better. Activities such as going for a walk, dancing, exercising, or spending time with friends can do much to elevate your mood. While they may seem challenging, it is important to remember these activities are not impossible

Look out for These Complications/Risk Factor

People with anxiety issues are more likely to develop depression. Depression may also co-occur with other serious medical issues such as cancer, diabetes, Parkinson’s disease, and heart disease. In many cases, depression makes these medical issues worse. Medications for these ailments may also contribute to the onset of depression.

You are more likely to experience depression if you have:

• A family or personal history of depression
• Chronic stress or trauma
• Major life changes

Depression Treatment

While depression is a very serious and prevalent condition, it is also highly treatable. In most cases, a combination of psychotherapy and medication is effective in managing depressive symptoms. Types of psychotherapy that are typically used include:

• Cognitive behavioral therapy (CBT)
• Interpersonal therapy (IPT)
• Problem-solving therapy

As different people with depression may have different symptoms, there is no one-size-fits-all treatment. In severe cases where talk therapy and medication are ineffective, electroconvulsive therapy (ECT) or other types of brain stimulation therapies may be used.

Ways to cope with depression include exercising, eating healthy food, challenging negative thoughts, and staying connected with loved ones.

Possible Medications for Depression

Medications designed to treat depression are called antidepressants. They work by changing the way your brain uses neurotransmitters that influence mood. Antidepressants may alleviate symptoms such as low mood, loss of appetite, sleep issues, and poor concentration. These medications usually take 2-4 weeks to work.

There are five major classes of antidepressants. They include:

• Monoamine oxidase inhibitors (MAOIs)
• Tricyclic antidepressants (TCIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Atypical antidepressant

Roughly 12% of Americans (29 million people) are currently taking antidepressants. Even if your symptoms improve, you should not stop taking your antidepressant medication until instructed by your healthcare professional. Approximately 60% of children who use antidepressant medication experience symptomatic relief.

ECT and Depression

People with severe depression that does not respond to psychotherapy or medication may benefit from electroconvulsive therapy (ECT). ECT uses electric impulses to stimulate the brain. It is a safe, painless therapeutic procedure that may be used as a first-line intervention where an immediate response is necessary. Electroconvulsive therapy may be provided in both inpatient and outpatient settings.

ECT treatment requires a series of sessions, three times per week, for up to four weeks. Each session takes only a few minutes, however, it may take up to an hour before the anesthesia wears off. Although the treatment is safe for most people, there may be a few temporary side effects such as disorientation, confusion, and memory loss. In some cases, memory issues may linger during and after treatment.

Insurance Coverage for Depression

Depression is a common mental health issue. If you have depression, the Affordable Care Act provides ways you can receive free depression screening as well as psychotherapy and medication. Read the benefits of your plan to find out what is covered and what your share of the cost will be.

Ketamine Trials for Depression

Ketamine, also called Ketaset, Ketalar, and Ketanest, is an FDA approved medication that is showing great potential as a treatment for severe depression. While antidepressants typically take weeks to work, ketamine may provide relief in hours. At the moment, doctors may only prescribe ketamine off-label because ketamine depression studies are relatively new. However, some health experts believe ketamine is one of the most important breakthroughs in depressant treatment in decades.

Hospitalization

More than 90% of people with depression are treated on an outpatient basis. However, severe depression that is resistant to treatment may require a short stay in a hospital. You may seek hospitalization on your own or you may be hospitalized under a doctor’s order. Staying at a hospital is recommended if you:

• Are at risk of hurting yourself or others
• Cannot function on your own
• Are trying a new medication that requires medical supervision
• Need care that can only be obtained at a hospital

Hospitals provide a safe, stable environment where you escape daily stressors and get the care you need. Some depressed individuals may be hospitalized against their will if they are at risk of harming themselves or other people.

Home Remedies to Help with Depression

Here are a few suggestions on how to cope successfully with depression:

• Stay connected with your loved ones
• Do things that make you feel good
• Spend more time in nature
• List the things you love about yourself
• Exercise
• Eat healthy food
• Challenge negative thoughts
• Get professional assistance

How to Find a Therapist

Speak with your doctor if you believe you have symptoms of depression. If your doctor is unable to find a physical cause for your issues, he/she may refer you to a licensed therapist who can provide effective mental health care.

What Should I be Looking for in an LMHP?

Your therapist should be trained and/or experienced in treating depressive disorders. Ask about his/her qualifications and expertise. As private, serious, or embarrassing topics may be discussed during treatment, it is important that you feel comfortable with your therapist. Other important qualities your therapist should have, include:

• Strong communication skills
• Good listening skills
• Empathy
• Warmth
• Encouraging approach
• Positivity
• A willingness to work with you

A strong therapeutic relationship is essential for successful treatment. If you do not feel comfortable with your therapist, it may be best to ask for a referral.

Questions to Ask a Potential Therapist

Questions you can ask your therapist include:

• Am I clinically depressed?
• Are my symptoms mild, moderate, or severe?
• What specific type of depression do I have?
• Are there any other co-occurring mental health conditions?
• What factors contributed to my developing this condition?
• Are there any long-term complications?
• What life adjustments may improve my mood?
• How long will these issues last?
• What treatment do you recommend?
• Is medication necessary for my condition?

Online Therapy

Recently, online therapy has begun to take a role in how people obtain treatment services. Websites such as Thrive Talk offer many of the same services as traditional brick and mortar practices. Many people take advantage of online therapy because of the benefits it provides in terms of convenience and confidentiality. These services may not be ideal for individuals who need some of the more intensive medical treatments outlined earlier, but they can provide a similar quality of care to what can be obtained from an in-office therapist.

Stigma and Societal Problems with Depression

There is a strong social stigma associated with depression and other mental health issues, particularly among males. People with depression may avoid seeking treatment to avoid being labeled as weak or crazy. Depressed individuals may try to hide their condition due to shame or concerns about their job security. Some individuals view hospitalization for depression as the same as being sent to an asylum.

7 Tips for Living with Depression

Although living with depression is challenging, there are things you can do to improve your quality of life. Here are a few helpful suggestions:

1. Educate yourself about depression
2. Set realistic treatment goals
3. Allow other people to help you
4. Stay active
5. Avoid making important decisions until you feel better
6. Do not isolate yourself
7. Join a depression support group

Emergency Resources and Support Helpline

If you are experiencing depression, there are many resources and treatment options available to you. If you have thoughts of harming yourself or committing suicide, please call:

• 911 or your local emergency services number
• The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
• US Suicide Prevention Lifeline at 1-800-273-8255
• NDMDA Depression Hotline – Support Group at 800-826-3632
• Suicide Prevention Services Crisis Hotline at 800-784-2433
• Suicide Prevention Services Depression Hotline at 630-482-9696

Other resources include:

Free literature

• Chronic Illness & Mental Health.
• Depression and College Students
• Depression and Older Adults
• Depression: What You Need to Know
• Postpartum Depression Facts
• Teen Depression

Federal Resources

• Depression and Older Adults
• Depression: MedlinePlus
• Moms’ Mental Health Matter: Depression and Anxiety Around Pregnancy

Research and Statistics

• Journal Articles
• Statistics: Major Depression

You are not alone in your fight against depression. Help is available! Other people are here to help you access the care and support you need to get through this difficult period. With professional care, you can overcome depression and regain control of your life.

Feel like we covered everything? Need more information? Want to share your story of hope and recovery? Reach out to us in the comments below.

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