A depressive disorder is a complex mind/body illness that is characterized by persistent sadness, feelings of worthlessness and lack of pleasure in everyday events and activities. It affects the way a person eats, sleeps and feels. Depression is much more than simply being unhappy or “blue”. People with a depressive illness are unable to overcome their feelings and attain normalcy.
According to the National Institute of Mental Health, close to 19 million American adults suffer from depression. The age at onset is typically the late teens to mid 20s. Without treatment, symptoms can last for weeks, months or years. Appropriate treatment, however, can alleviate symptoms in nearly 80 percent of cases.
Causes of Depression
Several risk factors for depression have been identified, including biochemical changes in the brain; genetic predisposition; certain personality traits such as low self-esteem and pessimism; and environmental factors such as exposure to violence, abuse or neglect and poverty.
Types of Depression
Depressive disorders have different forms, as do other illnesses such as heart disease. Three of the most common types of depression are the following:
- Major depression is a combination of symptoms 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 includes long-term, chronic symptoms that do not disable, but keep people from functioning at normal levels or from feeling good. Sometimes, people with dysthymia also experience major depressive episodes.
- Bipolar disorder (manic-depression), is a chronic, recurring disorder that includes cycles of elation or mania as well as depression
Within these depressive disorder types, the number of symptoms, severity and persistence are highly variable.
Depression in Women
Depression affects women about twice as often as men, possibly because of hormonal factors associated with menstrual cycle changes, premenstrual syndrome, pregnancy, miscarriage, postpartum period, perimenopause (time around onset of menopause) and menopause itself. Many women also have additional stressors such as responsibilities both at work and home, single parenthood and caring for children and aging parents.
Many women are particularly vulnerable to depression after the birth of a baby. Although transient "blues" are common in new mothers, a full-blown depressive episode is not normal and requires prompt diagnosis and treatment if present.
Symptoms of Depression
Signs and symptoms of depression vary, and each individual may experience symptoms differently. In general, nearly everyone with depression has ongoing feelings of sadness and may feel helpless, hopeless and irritable. A health care professional should be consulted if four or more of the following symptoms persist for more than two weeks:
- Recurring thoughts of death or suicide, wishing to die or attempting suicide. Individuals with this symptom should receive treatment immediately.
- Physical symptoms, such as headaches, digestive disorders and chronic pain
- 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
- Hopelessness, pessimism
- Restlessness, irritability
- Decreased energy, fatigue, being "slowed down"
- Inappropriate guilt
- Inability to concentrate or think, indecisiveness
Your doctor will perform a thorough physical exam, obtain a medical and social history and conduct a careful psychiatric evaluation. Laboratory tests may be needed to rule out any illnesses whose symptoms mimic those of depression; any of your regular medications that might contribute to depression will be considered.
Specific treatment for your depression will be determined by your individual circumstances:
- Your age, overall health and medical history
- The severity and extent of your disease
- Your tolerance for specific medications, procedures or therapies
- Your expectations for the course of the disease
- Your opinion or preference
Generally, treatment for depressive disorders includes medication or psychotherapy, or a combination of the two.
- Many antidepressant medications are used to treat depression, alone or in combination.
- Psychotherapy (‘talk’ therapy) can help by teaching new behaviors and changing habits that may result in depression.
You can also help yourself by taking some of the following steps.
- Set realistic goals in light of your 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 spend time with other people and to confide in someone rather than being alone and secretive.
- Participate in activities that may make you feel better.
- Do some mild exercise, go to a movie or ball game or participate in religious, social or other activities.
- Expect your mood to improve gradually, not immediately.
- Postpone important decisions until the depression has improved or ended and discuss them with someone you trust.
For more information on depression and mood disorders, consult the following resources:
- National Institute of Mental Health, National Institutes of Health
- Anxiety and Depression Association of America
- American Psychiatric Association
- American Psychological Association
Our physicians at Houston Methodist specialize in managing depression at the following convenient locations: