Understanding Depression

Depression, affecting more than 121 million worldwide, is one of the most common health conditions in the world. In the 19th century, people saw it as an inherited weakness of temperament associated with guilt and conflict. Depression isn't a weakness, nor is it something that you can simply "snap out of." It’s more than just a feeling of being “down in the dumps” or “blue” for a few days. Feeling down from time to time or sad in response to a medical condition, frustration, disappointment, or loss is normal. These feelings are described by many as “depression,” but they are just situational depression (a normal reaction to events around us).

Depression (a.k.a. major depression, dysthymic disorder, major depressive disorder, unipolar depression, or clinical depression) is a medical illness that involves the mind and body. It is distinguished from situational depression by length and severity. Clinical depression is thought to be caused by a combination of biological, psychological and social factors. It affects how you think and behave and can cause a variety of emotional and physical problems. A person with severe depression has little or no interest in work or hobbies, and may even have trouble getting out of bed. It interferes with a person’s ability to study, have fun, work, eat, and even sleep. Depression can even make a person feel as if life just isn't worth living anymore- accounting for 850,000 fatal suicides each year.


Clinical depression can run in families, and usually starts between the ages of 15 and 30. Depression is the leading cause of disability and the 4th leading contributor to the global burden of disease. It affects people of every color, race, economic status, or age. According to the Nemours Foundation, as many as 1 in 8 persons in their teen years are affected by depression, and women are more affected than men. Symptoms can include:

• Feelings of helplessness and hopelessness: A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation

• Loss of interest in daily activities: No interest in or ability to enjoy former hobbies, pastimes, social activities, or sex

• Appetite or weight changes: Significant weight loss or weight gain—a change of more than 5% of body weight in a month

• Sleep changes: Either insomnia, especially waking in the early hours of the morning, or oversleeping

• Psychomotor agitation or retardation: Either feeling “keyed up” and restless or sluggish and physically slowed down

• Loss of energy: Feeling fatigued and physically drained. Even small tasks are exhausting or take longer

• Self-loathing: Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes

• Concentration problems: Trouble focusing, making decisions, or remembering things

Depression can be reliably diagnosed and treated. The best treatment for most people is a combination of self-help strategies, professional help (antidepressants and psychotherapy), and lifestyle changes. Antidepressant medications along with psychotherapy are effective for 60-80% of those affected. What works for one person may not work for another. One treatment is not appropriate for all cases, so all options should be explored. According to the WHO, fewer than 25% of those affected have access to effective treatments (in some countries fewer than 10%). Barriers to effective care include lack of trained providers, lack of resources, and the social stigma associated with depression and other mental health disorders. The risk of developing depression can be reduced by knowing the risk factors and making lifestyle changes. Risk factors include:

• Genetics: If you have family members who have suffered from depression, you may have a greater risk of developing depression yourself, although there is currently no direct gene that has been found to cause depression

• Early childhood trauma or abuse: Emotional trauma and abuse has a powerful effect on the psyche. If you had traumatic early life experiences, you may be more at risk to develop depression during or after a stressful life event

• Loneliness and lack of social support: A key risk factor for depression is isolation and loneliness. Lack of support, whether it is family, friends or colleagues, makes coping with stress all the more difficult. Having marital and relationship problems can also make you feel alone and frustrated

• Recent stressful or traumatic life experiences: Some events, like losing a loved one, are clearly stressful and cause enormous disruption and strain in our lives. However, anything that causes change can be a stressful life experience, even if it is normally considered a happy event such as a big work promotion, a wedding or childbirth

• Alcohol and drugs: Alcohol and drugs can cause strong depression symptoms on their own. They can also make you more vulnerable to depression even if you decide to stop using them. Some people try to treat themselves with alcohol and drugs to self medicate, but this only worsens the problem

• Finances and employment: Financial strain can be an enormous stressor. Struggling to pay the bills or mortgage, or suddenly becoming unemployed, is a very stressful life event. Being unemployed can be a blow to self confidence and can be a very difficult adjustment, especially for men

• Health problems or chronic pain: Health problems and chronic pain may reduce your mobility, your ability to work or your spare time. They can chip away at supportive relationships and make you feel hopeless and frustrated

Information on symptoms and risk factors retrieved from helpguide.org

10 Common Myths About Depression Debunked

It is all in your head. Only women get depressed. If you have depression, you are stuck with it for life. Do any of these statements sound familiar? For all the misconceptions about clinical depression, it seems that there’s a depression myth for every truth. Here are ten common depression myths, and the truth behind these misconceptions:

1. Myth: Depression is not a real medical illness.

Fact: Clinical depression is a serious medical condition that affects not only an individual’s mood and thoughts, but also the individual’s body. It is no different than diabetes or heart disease in its ability to impact someone’s life. The medical community has acknowledged the seriousness of depression and recognizes it as a disease. Research has shown that depression has genetic and biological causes. Individuals coping with depression have a higher level of stress hormones present in their bodies, and the brain scans of depression patients show decreased activity in some areas of the brain.

2. Myth: There is nothing that can be done about depression.

Fact: Depression is treatable, and more than 80 percent of individuals with depressive disorders improve with treatment. Both young people and adults who are depressed need professional treatment. The first step to finding effective treatment is to get a physical examination by a doctor to rule out other causes for your symptoms, such as thyroid problems.

Once you’ve been diagnosed with depression, you and your doctor will decide on a course of treatment, which will include medication, psychotherapy or a combination of both. A trained therapist or counselor can help people learn more positive ways to think about themselves, change behavior, cope with problems, or handle relationships. A physician can prescribe medications to help relieve the symptoms of depression. For many people, a combination of psychological therapy and medication is beneficial.

3. Myth: Depression doesn’t affect me.

Fact: According to a 2004 survey by the American College Health Association, nearly half of all college students report feeling so depressed at some point in time that they have trouble functioning, and 15 percent meet the criteria for clinical depression. This means that someone in your life that you care about (or maybe yourself) could face depression at some point in college or in adulthood.

4. Myth: Talking about depression only makes it worse.

Fact: While it is easy to understand why someone might be worried about discussing their depression, being alone with your thoughts is even more harmful when facing this disorder. Talking about your feelings to someone, like a psychologist, who can help is a step toward beating depression. A lot of people with mental health problems are stigmatized in our society, so the best thing a friend can do to help is be a good, supportive, and non-judgmental listener.

Talking through feelings with a close friend may help you to recognize the need for professional help. If you are hesitant to discuss difficulties you might be facing with a close family member or friend, think about other people in your life, like spiritual leaders or faculty members who would be willing to discuss your struggles. If at any point, you feel so overwhelmed by feelings of sadness and hopelessness that you are considering hurting yourself, call 1-800-273-TALK for help.

5. Myth: Depression is just the “blues” - only happening when something bad happens in your life

Fact: Depression is more than just having occasional sad thoughts. Equating depression with the blues is like saying that a common cold is the same as pneumonia. While everyone experiences ups and downs in life, and often will feel sad for some time after a serious loss or disappointment, developing depression does not require a specific negative event.

Depression, unlike the blues, can last a lifetime, and the illness is much more pervasive and disabling. Prolonged periods of hopelessness, sadness, and lack of interest in things someone usually enjoys are symptoms of depression. Depression can arise suddenly, even when things in life seem to be going well. No one commits suicide because they have the blues.

6. Myth: Depression will go away by itself - people with depression are weak and feel sorry for themselves.

Fact: No one chooses to be depressed, just like no one chooses to have any other health condition. Depression affects about 19 million people annually in the U.S. alone. Some of the most prominent and well-known individuals who have suffered from a depressive disorder include Alexander the Great, Napoleon Bonaparte, Abraham Lincoln, Theodore Roosevelt, Winston Churchill, George Patton, abolitionist John Brown, Robert E. Lee, Florence Nightingale, Sir Isaac Newton, Stephen Hawking, Charles Darwin, J.P. Morgan, Barbara Bush, Ludwig von Beethoven and Michelangelo. These people are not the type to just sit around feeling sorry for themselves.

While for some people, depression may go away without treatment, this is not usually the case. Depression can go away on its own, only to return in the future: once an individual has one episode of depression, they are predisposed to have more. Clinical depression is a potentially fatal disease – and suicide could be the end result of waiting for it to go away without any help. Suicide is the third leading cause of death for 18 to 24 years old, reinforcing the importance of seeking treatment. Given how much stigma is still attached to mental illness, seeking help for depression is an act of courage and strength – not weakness. The good news is that most people do get better with treatment.

7. Myth: Antidepressants will change your personality.

Fact: The thought of taking medicine that changes your brain chemistry can be scary. However, antidepressants are designed to change only certain chemicals that underlie the symptoms of depression, not to change your personality. Most people who take antidepressants are actually happy to feel like themselves again, rather than feeling like a different person. It is best to speak with your doctor about the effects that antidepressants can have.

8. Myth: Depression is a normal part of getting older and only affects women

Fact: Depression can affect people at any age or of any race, ethnic, or economic group. Depression is not a normal part of aging, but seniors do generally experience more of the events that can trigger depression. People over the age of 60 grew up in an era in which mental illness was not discussed, and they may feel more shame about asking for help than someone from a subsequent generation.

The highest rate of suicide of any age group occurs in that of people 65 and older, with men being more vulnerable than women. Men have a higher rate of successful suicide attempts than women. Although women report being affected by depression twice as much as men, depression certainly affects men as well. Often, clinical depression is under reported in men, particularly in cultures that discourage them from asking for help or showing any weakness.

9. Myth: Children and adolescents do not suffer from depression — their problems are just a part of growing up

Fact: Depression in children has long been an overlooked health problem. According to the National Institute of Mental Health, studies show that 1 in 33 children and 1 in 8 adolescents are depressed in any given year. Depression in children is a significant issue since it occurs during critical phases in child development and can interfere with the normal developmental processes of childhood.

Children are not as practiced at articulating their feelings as adults, so adults must take the initiative to look for and notice symptoms of depression in children. The most common symptoms of depression reported in children and adolescents were sadness, inability to feel pleasure, irritability, fatigue, insomnia, lack of self-esteem, and social withdrawal.

10. Myth: If someone in your family suffers from depression, you will inherit it.

Fact: In the same way that you can be genetically predisposed to high blood pressure or diabetes, you can be genetically predisposed to depression. This does not mean, however, that if a family member has a history of depression, you are fated to suffer from it as well. Just be aware that your chances of having depression are higher than if you had no family history of the illness, and seek treatment if you start to develop symptoms.

Information on the myths and facts of depression were gathered from healthcentral.com, psychologyinfo.com, nmha.org, medicinenet.com, and keepkidshealthy.com

Types of Depression

Different types of depression often have slightly different symptoms and may require different treatments. A number of disorders have depression as a key feature.

Major Depressive Disorder

This type is commonly referred to as “depression,” can severely disrupt your life, affecting your appetite, sleep, work, and relationships. A person suffering from major depressive disorder experiences a change in their mood that involves persistent low moods or sadness, or loss of interest or pleasure in most activities over at least two weeks.

People with major depressive disorder may feel despair and hopelessness, their energy levels may be extremely low and they might find it hard to motivate themselves to do even the simplest of daily tasks. They may also commonly experience low self-esteem and thoughts of death and suicide.

Dysthymia

People with dysthymic disorder is a long-term or chronic disorder where low mood is experienced for most of the day, on more days than not, over a period of at least two years. They have many symptoms resembling major depression, but with less severity. They may experience fatigue, sleeping and eating problems. They may also experience low self-esteem, negative thinking, and cognitive (thought-related) difficulties.

Bipolar Disorder (manic depressive illness)

A person with bipolar disorder has one or more episodes of mood disturbances that include distinct periods of extreme highs, where they feel invincible, or paralyzing lows where they feel complete despair. During the manic phase, the person is optimistic and buoyed by exaggerated feelings o f well-being.

Their mind is overactive and they need very little sleep but, while they have plenty of energy, they lack concentration. Work and study may suffer. People with this disorder also have major depressive episodes at other times. During the depressive phase, the person feels despairing and may contemplate suicide.

Seasonal Affective Disorder

It is the recurrence of the symptoms of any major depressive episode during certain seasons. Depression is more common in the winter months and in the Northern Hemisphere. Some studies have shown that light hitting the back of the eye (retina) stimulates the brain to make chemicals that lift a person’s mood. A person with this disorder usually comes out of their depressive state in the spring. People with seasonal affective disorder may eat more and gain weight, sleep excessively and withdraw from others.

Postpartum Depression

This type occurs in women who have recently given birth. Around one in eight new mothers experience depression following the birth of a child. It typically occurs in the first few months after delivery, but can happen within the first year after giving birth. Often, postpartum depression interferes with the mother’s ability to bond with her newborn.

Postpartum depression is different from the “baby blues,” which tend to occur the first few days after delivery ad resolve spontaneously. Some contributing factors include: physical exhaustion from broken sleep, lack of support, financial pressures, and a history (personal or family) of depression.

Cyclothymic Disorders

This type occurs when a person has mild and alternating mood swings of elation and depression occurring over a long time period (mild depressive symptoms mixed with hypomanic episodes). Because the mood swings are mild and the elation is often enjoyable, frequently people with cyclothymic disorder do not seek medical help. Often, a person with this disorder has a relative with bipolar disorder or they may develop bipolar disorder themselves.

Information retrieved from better health channel and depression.com

How Family and Friends Can Help With the Unrealistic Thoughts of Depression

Many psychological problems can be traced to negative thinking. When persons are stressed, it is not always as a result of situations that happen to them. Negative thoughts are especially likely to occur when persons are by themselves, in boring situations, or doing something that takes no effortful thinking. Automatic negative thoughts in depression seem absolutely realistic and true, but most of the time they are unrealistic.

It is important to realize that thoughts are not the same thing as reality. In depression, people tend to think in ways that exaggerate or otherwise distort situations. This is not done on purpose. It results from their strong emotions and from certain habitual ways of thinking. People with depression do not want to think negatively, but their brains tend to anyway. It is important for people suffering from depression not to deepen their depression by further blaming themselves for their illogical thinking.

It is also important that any distorted automatic negative thoughts not be allowed to swarm and create psychological havoc. Rather, they need to be confronted as being illogical. Simply avoiding them is not a useful strategy. If a person's depressive thoughts are overwhelming, it is important to challenge them when the person is feeling at their strongest, like during the day. In the middle of the night, when some persons feel most vulnerable, it may be better to use other strategies such as thought stopping.

People suffering from depression fixate on a cause and on a cure. The truth is the conscious depressed mind cannot, from within, determine either the cause or know the cure of depression. The need for immediate relief can become so strong that they may use physical pain in order to gain a small respite from the psychic pain of depression. People with depression want negative feedback.

They seek, remember and rationalize the negative and forget or discount the positive. If forced upon them, the positive will anger and/or hurt them. Those suffering from depression think that their problems and pain are unique; they feel that they are all alone, and many times when first becoming depressed the symptoms of depression make them feel as though they are going crazy. They can feel all alone in the midst of a supportive congregation at church, or in the midst of a loving family.

Family and friends wanting to help someone suffering from depression can be helpful in:

- Learning all they can about depression

- Learning all they can about the programs or aid for depression within their community

- Being a friend

- Learning to communicate with them

- Encouraging and help them to strengthen themselves physically, mentally and emotionally as much as possible

- Helping them explore options which will eventually get them the help they need

Other things family and friends can do include:

- Taking a walk with them

- Making eye contact with them – People suffering from depression have problems initiating and maintaining eye contact with others, make sure you do not initiate eye contact while making a strong point in the conversation as it might be viewed as confrontational, hostile, or even demeaning. Attempts to make eye contact should be made when you are showing that you understand and care about what they are going through.

- Giving them a hug – The hug should be comfortable for both of you, not strained or forced.

- Showing empathy – You cannot know what they are feeling or experiencing unless you genuinely listen to them without being judgmental or overly directive. Although their emotions and feelings might seem foreign to you, for them these feelings are real and can be justified given their experiences and the emotions caused by the depression.

- Helping with tasks - It will sometimes be difficult to convince your friend that you should help them with tasks procrastinated. Have a frank discussion of what needs to be done, possible underlying reasons why things remain undone, and what you might do to help them. Gentle reminders of upcoming events or commitments will be helpful if you take care not to badger or nag them into doing something.

Information gathered from drbeckham.com and have-a-heart.com