Depression

A mood disorder causing a persistent feeling of sadness and loss of interest.

What is Depression?

Sadness is something we all experience, and is a normal reaction to difficult times in life.

When a person is depressed, it interferes with his/her daily life and functioning. It can cause pain for both the person with depression and those who care about him or her. Depression is not a sign of weakness or a character flaw; someone cannot “snap out of” clinical depression. Most people who experience depression need treatment to recover.

People who are diagnosed as depressed are often actually bipolar. This can cause major complications that increase one’s risk of suicide. To learn more, please see bottom of page or click here.

Symptoms

Sadness is only a small part of depression. In fact, some people with depression may not feel sad at all. Depression has many other symptoms, including physical ones. If an individual has been experiencing any of the following signs and symptoms for at least 2 weeks, he or she may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood

  • Feelings of hopelessness or pessimism

  • Feelings of guilt, worthlessness, or helplessness

  • Loss of interest or pleasure in previously enjoyed hobbies and activities

  • Decreased energy and fatigue; feeling“slowed down”

  • Difficulty concentrating, remembering, and making decisions

  • Difficulty sleeping, early-morning awakening, or oversleeping

  • Appetite and/or weight changes

  • Thoughts of death or suicide; suicide attempts

  • Restlessness or irritability

Types of Depression

There are several types of depressive disorders.

Major depression. Severe symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy life. An episode may occur only once in a person’s lifetime, but more often, a person will experience several episodes.

Persistent depressive disorder. A person diagnosed with Persistent Depressive Disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.

Psychotic Depression. Occurs when a person has severe depression in addition to some form of psychosis, such as having false beliefs or a break with reality (delusions), or hearing and seeing things that others cannot hear or see (hallucinations).

Postpartum depression. A depressed mood that is more severe than the “baby blues” that many women experience after giving birth (due to hormonal and physical changes and the new responsibility of caring for a newborn). It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Seasonal Affective Disorder (SAD). Characterized by the onset of depression during winter months, when there is less sunlight. This type of depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or combined with light therapy.

Bipolar Disorder. Bipolar disorder differs from depression, but it is included in this list because someone with Bipolar Disorder often experiences episodes of extreme low moods (depression). However, a person with Bipolar Disorder also experiences extreme high moods (called “mania”).

Depression Affects People in Different Ways

Women

Not all women with depression experience the same symptoms. However, women with depression often have symptoms of sadness, worthlessness, and guilt.

Depression is more common among women than men. Biological, life cycle, hormonal, and psychosocial factors that are unique to women may be linked to this higher rate of depression. For example, women are especially vulnerable to developing Postpartum Depression after giving birth.

Men

Men often experience depression differently than women. Men with depression are more likely to be over-tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping. They also might become frustrated, discouraged, irritable, angry, or abusive. Some men may throw themselves into their work or behave recklessly to avoid talking about their depression with family or friends.

Teenagers

Older children and teens with depression may sulk, get into trouble at school, act irritably, and feel misunderstood. If you are unsure if an adolescent in your life is depressed, consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her “usual” self. Teens with depression may also have other disorders such as anxiety, eating disorders, or substance abuse. They may also be at higher risk for suicide.

Children and teenagers usually rely on parents, teachers, or other caregivers to recognize their suffering and get them the treatment they need. Many teens don’t know where to go for mental health treatment or believe that treatment won’t help. Others don’t get help because they think depression symptoms may be just part of the typical stress of school or being a teen. Some teens worry what other people will think if they seek mental health care.

Depression often persists, recurs, and continues into adulthood, especially if left untreated. If you suspect a child or teenager in your life is suffering from depression, seek help right away.

Children

Before puberty, girls and boys are equally likely to develop depression. A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. It is often difficult to tell whether a child is just going through a temporary “phase” or is suffering from depression. If a visit to the child’s pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a mental health professional who specializes in the treatment of children. Most chronic mood disorders, such as Depression, begin with high levels of anxiety in children.

Quick Tips for Talking to Your Depressed Child or Teen

  • Offer emotional support, understanding, patience, and encouragement.

  • Talk to your child and listen carefully.

  • Never discount the feelings your child expresses, but point out realities and offer hope.

  • Never ignore comments about suicide.

  • Remind your child that with time and treatment, the depression will lift.

Treatment

Even the most severe cases of depression can be treated. The earlier treatment begins, the more effective it is. Most adults see an improvement in their symptoms when treated with antidepressant drugs, talk therapy (psychotherapy), or a combination of both.

Psychotherapy

Several types of psychotherapy—or “talk therapy”—can be used to help treat people with depression. Examples include cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy.

Cognitive-Behavioral Therapy (CBT). CBT can help a depressed individual change negative thinking. It will help the person interpret environments and interactions in a positive, realistic way. It may also help an individual recognize things that may be contributing to the depression and change behaviors that may be making the depression worse.

Interpersonal Therapy (IPT). IPT is designed to help an individual understand and work through troubled relationships that may be causing the depression or making it worse. IPT helps an individual explore major issues that may contribute to the depression, such as grief, or times of upheaval or transition.

Problem-Solving Therapy (PST). PST can improve an individual’s ability to cope with stressful life experiences. It is an effective treatment option, particularly for older adults with depression. Using a step-by-step process, an individual will identify problems and come up with realistic solutions. It is a short-term therapy and may be conducted in an either an individual or a group format.

Medications

Antidepressants are medicines that treat depression. They help improve the way a brain uses chemicals that control mood or stress. Although medication is never mandatory, it is often a powerful counterpart when used in conjunction with talk therapy. Since depression is commonly connected to a chemical imbalance in the brain, medication can help a person return to a “level ground.”

Electroconvulsive Therapy And Other Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. There are a lot of outdated beliefs about ECT, but here are some facts:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.

  • ECT can be an effective treatment for depression.

  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short term, but sometimes they can linger. Talk to a doctor and make sure you understand the potential benefits and risks of the treatment.

Some people believe that ECT is painful or that they can feel the electrical impulses. This is not true. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses. The treatment session only takes a few minutes and the patient is awake and alert within an hour. Learn more.

How to Help a Loved One with Depression

If you know someone who is depressed, it can affect you too. The most important thing you can do is to help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment or to seek different treatment options if no improvement occurs after 6 to 8 weeks.

Additional quick tips to help your friend or relative:

  • Offer emotional support, understanding, patience, and encouragement.

  • Talk to him or her, and listen carefully.

  • Never dismiss feelings, but point out realities and offer hope.

  • Never ignore comments about suicide. Report any suicidal comments to your loved one’s therapist or doctor.

  • Invite your loved one out for walks, outings, and other activities. Keep trying if he or she declines, but don’t push him or her to take on too much too soon.

  • Provide transportation assistance to doctor appointments.

  • Remind your loved one that with time and treatment, the depression will lift.

Caring for someone with depression is not easy. Someone with depression may need constant support for a long period of time. Make sure you leave time for yourself and your own needs. If you feel you need additional support, there are support groups for caregivers too.

Risk of Suicide & Self-Harm

In some cases depression can lead to suicide and self harm. If someone you know is self harming or talking about suicide, remove dangerous things like knives, guns or other weapons and encourage them to see a health professional. If the person is having suicidal ideations, call 911.

If you have thoughts of suicide or plans to harm yourself, it's important to seek immediate help. Talk to someone you trust, such as a family member, friend or teacher and seek help from professionals. You can also call the suicide lifeline 1 (800) 273 - 8255, available 24 hours a day, every day. 

Bipolar Disorder and Depression

Bipolar Disorder is often misdiagnosed as depression. Many individuals with Bipolar Disorder seek treatment when they are in a depressive state. When they are experiencing mania, they might not realize it is connected to their depression.

Being misdiagnosed with depression is a serious problem because the treatment for Bipolar Disorder is very different than other depressive disorders. In fact, antidepressants can sometimes worsen symptoms of Bipolar Disorder.

According to Help Guide, the following are indicators that depression is really Bipolar Disorder:

  • An individual has experienced repeated episodes of major depression

  • An individual had his or her first episode of major depression before age 25

  • An individual has a first-degree relative with bipolar disorder

  • When an individual is not depressed, his or her mood and energy levels are higher than most people’s

  • When an individual is depressed, he or she oversleeps and overeats

  • An individual’s episodes of major depression are short (less than 3 months)

  • An individual loses contact with reality while depressed

  • An individual has had postpartum depression before

  • An individual has developed mania or hypomania while taking an antidepressant

  • An individual’s antidepressant stopped working after several months

  • An individual has tried 3 or more antidepressants without success

Source:  Headspace Australia,Paradigm Malibu,The International Bipolar Foundation, National Institute of Mental Health