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Overview of Depression

By Elaine Pomfrey

NY CityEveryone feels sad or blue sometimes. But when those feelings continue for more than two weeks and interfere with your work and social life, you are experiencing depression. Depression is a serious disorder that affects the brain. It is surprisingly common. About 20 million Americans currently experience depression. That is a little more than the population of the New York metropolitan area (18.8 million in 2007) and roughly 6.7% of the nation's population.

One of the hallmarks of depression is anhedonia – the inability to enjoy activities that normally bring pleasure. Depression is also characterized by loss of energy and feelings of hopelessness. Other common symptoms include guilt, emptiness, appetite changes, sleep problems, disordered thinking, and depression may lead to suicidal thoughts or behaviors.

The three main types of depression are

  1. Major depression – a combination of the above symptoms that inhibits your ability to work or interact in a normal way.
  2. Dysthymia – mild depression that is long-lasting with less severe symptoms than major depression.
  3. Bipolar disorder (manic depressive disorder) – periods of depression alternating with periods of mania (high energy and increased, and often bizarre or imbalanced, activity).

Depression may be caused by one or many factors. The most common factors are genetic, biochemical and environmental. Several research studies indicate that depression runs in the family. This finding has inspired scientists to search for a “depression gene” which may or may not exist. Biochemical factors include changing hormones, neurotransmitters (brain chemicals that are linked to mood) and actual physical changes in the brain during depression brought to light by SPECT imaging. And finally, examples of environmental causes of depression are changes in relationships (a break-up or death of a loved one), illness or intense stress.

Most depression typically goes untreated because people do not often seek professional help when feeling down. A 2010 study published in the Archives of General Psychiatry of over 15,000 people found barely half (51%) of those who experienced symptoms of major depression received treatment for it.

Now, some good news: Depression, even severe depression, is treatable. The earlier the treatment starts, the better the response and the decreased probability of recurrence. A physician or psychologist can diagnose depression after interviewing the patient about family history of depression and hearing an account of his or her symptoms, drug or alcohol use and any suicidal thoughts. Certain illnesses such as thyroid disorder or viruses exhibit the same symptoms as depression so a lab test can rule out those possibilities. It's important to encourage someone who seems depressed to see a mental health professional. Although it is not a substitute for a doctor's visit, some websites offer free depression screening.

pillsMost physicians recommend antidepressants as the primary solution. Antidepressants affect chemicals in the brain that are known to influence mood. Although these medications may be helpful, it's important to understand possible side effects and heed the warnings from the U.S. Food and Drug Administration (FDA) issued in 2007 that certain antidepressants can increase the risk of suicidal thinking in young adults 18-24. This labeling update followed similar changes made in 2005 when the FDA asked drug companies to add a black box warning stating that there is a risk of suicidal thinking and behavior in children and adolescents who use antidepressants.

Psychotherapy is also a popular treatment, in particular, cognitive-behavioral therapy (CBT). Psychologists using CBT do not analyze why the depression occurred, but rather focus on changing distorted thoughts and behavior patterns associated with depression. A combination of medication and psychotherapy is preferred in most cases.

Many depressed patients augment their treatment with self-help steps such as exercise, change in diet, consulting with a clergy member or spiritual advisor, prayer or meditation, such as Transcendental Meditation.

Understanding depression is the first step to curing it. The next is seeking professional help. Proper treatment can alleviate depression and reawaken hope and happiness.

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