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Depression

Depression Depression can be defined as an affective, or mood disorder characterized by mood deviations that exceed normal mood fluctuations. At its most extreme, depression can describe a psychotic state where the individual cannot function on his or her own. Everyone can go through times of feeling down for a period of time after having suffered a loss, but for people with the illness known as depression, these feelings of sadness can go on for long periods of time. In fact, about 1 in every 10 of us will be seriously depressed during sometime in our lives. As viewed by psychiatrists, depression is an illness in which a person experiences a marked change in their mood and in the way they view themselves and the world. Sometimes, depression seems to happen because of a stressful event, sometimes it seems to happen for no reason at all. Depression as a significant depressive disorder ranges from short in duration and mild to long term and very severe, even life threatening. Depressive disorders come in different forms, just as do other illnesses such as heart disease. The three most prevalent forms of depression are major depression, dysthymia, and bipolar disorder. Depression is a sickness which involves ones body, mood and thoughts, it even affects the way you eat and sleep. Depression strikes people of all ages, backgrounds, and ethnic groups. Approximately 20 million adults suffer from depression each year in the U.S. Up to 25% of all women and up to 12% of all men in the U.S. will experience an episode of major depression some time in their lives. 15% of those who suffer from depression kill themselves and succeed, and sadly many more attempt it. Depressive disorders can appear in different forms, there can be many different diagnoses for depression which are mostly determined by the intensity of the symptoms, the duration of the symptoms, and the specific cause of the symptoms. One type of depression is known as major depression which is the most serious of all types of depression when speaking of the amount of symptoms and severity of symptoms. Some believe that one must feel suicidal or have a history of hospitalizations in order to be considered to have major depression, however this is not true. Bipolar depression usually occurs during ones early twenties, and is a disorder which involves mood switches which are dramatic and rapid, nevertheless most often they are gradual. It also deals with cycles of elation or mania which often affects thinking, judgment, and social behavior. Bipolar disorder almost always involves abnormal moods at both ends of the “emotional spectrum.” Those with bipolar depression can have extreme mood swings ranging from extreme euphoria to incapacitating depression called manic episodes. Manic episodes usually begin suddenly, and symptoms rise rapidly. During an episode of euphoria the persons self-confidence is inflated, throughout this the persons ability to function is verily impaired, they can run up bills or even disappear for weeks at a time. About 2 million Americans suffer from bipolar disorder annually. For both men and women the chances of getting bipolar disorder are equal. Another form of depression is dysthymic disorder which refers to a moderate to low level of depression that continues for at least two years or longer. Although the symptoms are not as severe as major depression, they are longer lasting and therefore more difficult to treat. In order for one to be diagnosed with dysthmic disorder they must have at least two of the following symptoms: (1) poor appetite or overeating, (2) insomnia or hypersomnia, (3) low energy or fatigue, (4) low self-esteem, (5) poor concentration or difficulty in making decisions, and (6) feelings of hopelessness along with two of these indications they must also have a sad mood. In previous diagnostic methods, dysthymia was sometimes called “neurotic” depression since it was implicit that the depressive symptomatology was an aspect of one’s personality structure. Some with dysthmic disorder experience something called double depression, which is when one goes through one or more episodes of major depression on top of their ongoing dysthmic disorder. Epidemiology of depression is basically one susceptibility to depression based on their sex, age, etc. Under the category of sex, there is a drastically higher rate of depression in women than in men. In diagnosed and treated cases there is a ratio of 2:1 in nonbipolar depressives, the female-male ratio for bipolar depressives however is 1.2:1. Weissman and Klerman reached the following conclusions: First, the male-female difference in rates of depression is real and not merely an artifact of corresponding sex differences in rate of help-seeking behavior, since women preponderate not only in studies of treated cases of depression but also in community surveys in which most of the "cases" have not sought help. Second, women do not appear to experience more stressful life events or consider specific life events to be more stressful than men, however, at similar levels of stress, women report significantly greater intensities of symptoms. One explanation of this finding is that women may be more willing than men to admit to symptoms or, not inconsistently, men may express their symptoms in different ways-through alcohol abuse or "acting out", for example. Third, there is some evidence to suggest that the postpartum and the premenstrual periods, with their associated biological and psychological changes, represent periods of increased risk of depression among women. However, the extent of the risk imparted by endocrine factors has yet to be determined. Latest community surveys show that there is a higher occurrence of depressive indications in young adults rather than in older adults, younger adults being ages 18 to 44. So far there seems to be no relationship between depression and race or religion. With marital status on the other hand, people who have been separated show the highest rates of depressive symptoms, and those who have never been married or are presently married show the lowest rates. Lastly, the rates of depressive symptoms are significantly higher in people of a lower social class than people of the higher social classes. There is also a higher rate of bipolar depressive disorder in men and women with higher educational achievement than those of middle and lower levels. Depression is a common medical condition with very specific symptoms. Symptoms of depression fall into several groups that are typically grouped into broad categories based on their similarities. Mood symptoms are the defining feature of affective disorders such as depression. Motivational symptoms include those behaviors that refer to goal directness. Depressed people often suffer a deficit in this area and some may find it extremely difficult to do even the smallest chore. Somatic symptoms refer to the physical changes that may accompany depression and include alterations in sleeping patterns, appetite, and sexual interest. Finally cognitive symptoms reflect peoples’ ability to concentrate and make decisions, and how they evaluate themselves. The symptoms of depression can vary from person to person. Some writers (Levitt & Lubin, 1975; Beck, 1973; Lewinsohn, 1975) have summarized the signs of severe depression: - Behavioral excess- complaints of money, job, housing, noise, poor memory, confusion, loneliness, lack of care and love, running away, rebellious, aggressive… obsessed with guilt and concern about doing wrong, about being irresponsible, about the welfare of others, crying, suicidal threats or attempts. - Behavioral deficits- socially withdrawn, doesn’t talk, indecisive, can’t work regularly, difficulty communicating, slower speech and gait, lost of appetite, weight change, stays in bed, less sexual activity, poor personal grooming, overall doing less for “fun”. - Emotional reactions- feeling sad, feeling empty or lacking feelings of all kinds, nervous or restless, angry and grouchy, irritable, overreacts to criticism, bored, apathetic, less interest in food, sex, relationships, music, feeling socially abandoned. - Lack of skills- poor social skills, frequent whining or boring, critical, lack of humor, indecisive, poor planning for future. - Attitudes and motivation- lack of self-confidence and motivation, pessimistic or hopeless, feelings of helplessness or restlessness, expecting the worst, self-critical, feelings of guilt, self-critical, self-blaming, suicidal thoughts. - Physical symptoms- difficulty sleeping, awaking early, hyperactivity or sluggishness, diurnal moods, low sex drive, loss of appetite, weigh loss or gain, ingestion, constipation, headaches, dizziness, pain, and other somatic problems or complaints. In order for a doctor to make a diagnosis of depression, these symptoms must have lasted for a minimum of two weeks, and be upsetting enough to cause a person distress or interfere with work, social life, or daily functioning. Sometimes even when depression is clearly expressed, physicians ignore it. In a group of 23 people that committed suicide all due to depression that had visited their physician within the last couple of weeks- and according to the doctors notes, 80% “showed clear evidence of depression.” However few were diagnosed as depressed and none were given anti-depressant medication. Many have heard that depression could possibly be due to a chemical imbalance in the brain, signifying that depression may be a medical illness that is, without psychological causes. But all psychological problems have some physical signs, and all physical illnesses have psychological components as well. Chemical imbalances that occur during depression usually disappear when one completes psychotherapy for depression, without having to take any medication to correct the imbalance. This suggests that the imbalance is the body’s physical response to psychological depression. There are some types of depression, such as bipolar depression, and severe major depression, which seem to run in families, which suggests biological vulnerability. In one study, it was found that in families in which members of each generation developed bipolar disorder, those with bipolar disorder have a somewhat different genetic makeup than those who were not diagnosed. Conversely, not everyone with the genetic makeup that causes this susceptibility to bipolar disorder actually develops the disorder. There are additional causes which are involved with the onset of the disorder, such as stress and other psychological factors. Similarly, it seems that major depression also occurs generation after generation, however it also occurs in those people who have no family history of depression. So while there may be some biological factors that contribute to depression, it is evidently a psychological disorder. Those people who are pessimist, and those who have low self-esteem are more prone to depression than someone who is positive and has a good self-confidence. People learn both adaptive and maladaptive ways of managing stress and responding to life problems within their family, educational, social and work environments. These environmental factors influence psychological development, and the way people try to resolve problems when they occur. If one grows up in a negative atmosphere, in which discouragement is common and encouragement is rare, that child will develop a vulnerability to depression as well. A chronic illness, relationship problems, family crisis, or any unwelcome life change can trigger a depressive episode. Quite often, a mixture of environmental, biological, and physiological factors are involved in the development of depressive disorders, as well as other psychological problems. There are many different types of treatment in aiding with depression, some of which include psychotherapy, medication, or a combination of both. In psychotherapy, the patient and therapist discuss the patient’s experiences, relationships, events, and feelings to identify the areas of difficulty. Psychotherapy, which is also known as the psychological treatment of depression helps the depressed individual in several ways. Supportive counseling helps to ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Cognitive therapy assists in changing the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. Thirdly, psychotherapy helps to change that certain area of the persons life that is causing stress and causative to the depression. Regrettably, there are many under qualified counselors who can do nothing beyond providing supportive counseling. This will not eliminate the depression, it will in fact continue with little improvement unless the depressed person makes critical life changes (these changes being both internal and external). Internal changes usual include self-evaluation along with the evaluation of others, and the expectations of the patient for themselves and others. External changes consist of stress management, problem solving skills, communication skills, life management skills, and the skills needed to develop and sustain relationships. With psychotherapy the time-span of the treatment varies due to the severity of the depression along with the number of “life problems” that are needed to be addressed. Most begin to experience relief within 6 to 10 sessions, and 70-80% of those notice significant improvement within 23-30 sessions. The other form of treatment for depression previously listed was medication. In most depressions with the exception of the severe depression, and bipolar depression, taking medication is an option. Antidepressant medication does not cure depression, but it helps one feel better. Currently there are over 20 antidepressants available. These antidepressants help with symptoms such as sleep and appetite disturbances, chronic fatigue, and significant concentration problems but they do not help problems such as difficulties with family members or children, etc. The most commonly prescribed class of antidepressants are medicines called selective serotonin reuptake inhibitors (SSRIs). The length of treatment for depression for each person is different, in general medications are taken from 6 months to a year. Studies show that in order to prevent depression from reoccurring, people should keep taking their medication for at least 4 to 9 months after they feel better. There are three phases of depression treatment: - Phase 1 lasts for the first 6 to 12 weeks that a person takes medicine for depression. During this time, the person should begin to feel better. But it’s still important for the person to keep taking the antidepressant medication because the depression can still come back during Phase1. - Phase 2 lasts for 4 to 9 months. The person should remain feeling better with continued treatment. Usually, the person will keep taking medication at the same dose during Phase 2. The person should not stop taking the antidepressant medication without talking to the doctor. - Phase 3 of treatment can last another year, or longer. How long it lasts depends on the depressed person’s medical history and on the advice of the doctor or other healthcare professional. Not all people need to take their medication during Phase 3. Thus, depression the “common cold” of psychological disorders, which affects about 12 million Americans each year, is treatable but sadly many don’t get the proper treatment and so live in a world where nothing can go their way. As one person stated when asked, “What is depression like?” they replied “Its hell…you doubt your own worth in society and in anyone’s life, you believe no one cares, you do not care about what happens to you or the world...and you’d wish everything would slow down so you can know what to think of everything.” Bibliography:

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