Depression affects over 17 million Americans- or one in 10 adults each year. Depression impairs social, physical and emotional functioning and is oftentimes a precipitating factor in suicide. Depression is twice as common in women as it is in men.
To meet the diagnostic criteria for major depression, at least five of the following symptoms must be present for at least two weeks and must represent a change from previous functioning. These symptoms include:
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness or pessimism –For example, thinking “why bother, nothing will change”.
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, or feeling "slowed down"
- Difficulty concentrating, remembering, or making decisions
- Changes in sleep- including insomnia, early-morning awakening, or oversleeping
- Appetite changes- such as eating too much or too little
- Thoughts of death, suicide or a suicide attempt
- Feeling Restlessness or irritability
And, persistent physical symptoms that do not respond to treatment. Such as headaches, digestive disorders, and chronic pain.
Keep in mind that having some symptoms of depression does not mean that you are clinically depressed. For example, the death of a loved one or a sudden illness can cause symptoms of sadness, loss of interest and changes in appetite. It is only when these symptoms persist for an unusually long period of time that depression may be an underlying cause. If you are experiencing these symptoms, please see your physician, psychiatrist, or psychologist for a full assessment.
Causes of Depression
There are many risk factors for developing depression including genetics, environmental stressors, brain chemical changes, and psychological factors.
Research suggests that depression may have a genetic component, as those with a depressed family member are at an increased risk of experiencing depression. However, not everybody with a family history of depression experiences this disorder. Likewise, many people with no family history also develop depression.
Environmental stressors such as experiencing financial difficulties, loss of a relationship or loved one, developing a chronic illness or experiencing a major life change have all been associated with depression.
Brain chemical changes have also been implicated in the development of depression. Specifically, brain chemicals called neurotransmitters have been found to be different in those with depression. Anti-depressant medications work on these neurotransmitters to relieve symptoms.
Finally, psychological factors, such as low self-esteem, feeling unable to control life events, and frequent worry all increase the likelihood of experiencing depression.
Women may experience depression due to hormonal changes as well. Specifically, some women experience symptoms of depression close to the time of their menstruation cycle. Researchers are actively studying this to examine the role of estrogen and other hormones on depression.
Age and Depression
Depression has been found to effect women differently at different ages. Depression is the leading emotional illness of women in their childbearing years and it is not uncommon for women to experience depression during pregnancy. Women depressed during pregnancy are more likely to have postpartum depression, and are more likely to experience premature labor. The majority of women experience some symptoms of depression following childbirth. However, 10 to 20% of women are diagnosed with Major Depression after birth.
Depression is also the most common psychiatric illness in late life and make up 25% of all suicides. Elderly adults are less likely to endorse experiencing symptoms of depression, oftentimes due to the stigma associated with mental illness. Instead, the elderly are more willing to express feelings of anxiety, fatigue, and memory problems.
Depression is Treatable
If you notice symptoms of depression in yourself or a loved one, it is important to ask for help. Depression is a highly treatable illness. Unfortunately, only 1/3 of those with depression receive treatment despite the fact that treatment can alleviate symptoms in over 80% of cases. Some women hold the belief that if they try hard enough they can “snap out” of depression. This is simply not true. Depression is a serious illness which can worsen without treatment.
There are many different types of treatment including antidepressant medication, psychotherapy, or a combination of both. Medication is particularly helpful in cases of moderate to severe depression. There are a variety of antidepressant medications and your physician or psychiatrist can help you identify the right one for you. Generally speaking, antidepressant medications take approximately four to eight weeks to bring symptom relief. To prevent a relapse of depression, medication must be taken regularly for six to 12 months and this requires physician monitoring.
Psychotherapy is useful in identifying the factors that led to depression and learning new ways to effectively deal with these causes. There are many different approaches to therapy including cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. For example, with cognitive behavioral therapy the individual learns to identify their distorted and negative thoughts and how to replace these thoughts with more realistic and positive beliefs.
How to Get Help
There are a number of different ways to begin the process of receiving help. Your family physician can be a good starting place to rule out any potential physical causes for your symptoms.
Through your insurance you can access a list of qualified therapists. This list may include psychologists, social workers, or masters level therapists. If you do not have insurance or feel you cannot afford to pay out-of-pocket deductibles, community mental health centers are available in your community. These centers offer counseling on a sliding scale fee.
Many universities offer treatment by graduate students who are supervised by licensed therapists. Finally, ask your employer if an employee assistance program, or EAP, is available in which short-term counseling is available free of charge to employees.
Special thanks to the American Psychological Association and National Institute of Mental Health for their contribution to this information.