Clinical depression (also called major-depressive disorder or unipolar depression) is a common psychiatric disorder, characterized by a persistent lowering of mood, loss of interest in usual activities and diminished ability to experience pleasure.
Although the term "depression" is commonly used to describe a temporary depressed mood when one "feels blue", clinical depression is a serious illness that involves the body, mood, and thoughts that cannot simply be willed or wished away. It is often a disabling disease that affects a person's work, family and school life, sleeping and eating habits, general health and ability to enjoy life. The course of clinical depression varies widely: depression can be a once in a life-time event or have multiple recurrences, it can appear either gradually or suddenly, and either last for a few months or be a life-long disorder. Having depression is a major risk factor for suicide; in addition, people with depression suffer from higher mortality from other causes.
What are the Different Types of Depressions
Major depression is a change in mood that lasts for weeks or months. It is one of the most severe types of depression. It usually involves a low or irritable mood and/or a loss of interest or pleasure in usual activities. It interferes with one's normal functioning and often include physical symptoms. A person may experience only one episode, but often there are repeated episodes over an individual's lifetime.
- Major Depression - Major depression is characterized by a persistent sad mood and/or an inability to experience pleasure. These symptoms are constant, interfering with the ability to lead a productive and enjoyable life. Left untreated, a major depressive episode typically lasts for about six months. Some people may experience just a single episode of depression in their lifetime, but more commonly, major depression is a recurring disorder.
- Atypical Depression - Atypical depression is a common subtype of major depression. It features a specific symptom pattern, including a temporary mood lift in response to positive events. You may feel better after receiving good news or while out with friends. However, this boost in mood is fleeting. Other symptoms of atypical depression include weight gain or significant increase in appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection.
- Dysthymia - Dysthymia, or dysthymic disorder, is a type of “low-grade” depression that lasts for at least two years. Dysthymia is less severe than major depression, but the chronic symptoms prevent one from leading life to the fullest. If you have dysthymic disorder, you are mildly to moderately depressed on more days than not, although you may have brief periods of normal mood. Many people with dysthymia also experience major depressive episodes, a condition known as “double depression”.
- Seasonal Affective Disorder (SAD) - Some people who experience recurring episodes of depression show a seasonal pattern known as seasonal affective disorder (SAD). SAD is a major depression that occurs in the fall or winter when the amount of sunlight is limited. In SAD, the depression goes away once the seasons turn again in the spring. SAD is more common in northern climates and in younger people.
- Postpartum Depression - Many new mothers suffer from some fleeting form of the “baby blues.” Postpartum depression, in contrast, is a longer lasting and more serious depression thought to be triggered by hormonal changes associated with having a baby. Postpartum depression usually develops soon after delivery, but any depression that occurs within six months of childbirth may be postpartum depression.
Some people believe that depression is "normal" in people who are elderly, have other health problems, have setbacks or other tragedies, or have bad life situations. On the contrary, clinical depression is always abnormal and always requires attention from a medical or mental-health professional. The good news is that depression can be diagnosed and treated effectively in most people. The biggest barrier to overcoming depression is recognizing that someone is depressed and seeking appropriate treatment.
Signs and Symptoms
Clinical depression can present with a variety of symptoms, however almost all patients display a marked change in mood, a deep feeling of sadness, and a noticeable loss of interest or pleasure in favorite activities. Other symptoms include:
- Persistent sad, anxious, or "empty" mood
- Loss of appetite and/or weight loss, or conversely overeating and weight gain
- Insomnia, early-morning awakening, or oversleeping
- Restlessness or irritability
- Feelings of worthlessness, inappropriate guilt, helplessness
- Feelings of hopelessness, pessimism
- Difficulty thinking, concentrating, remembering, or making decisions
- Thoughts of death or suicide or attempts at suicide
- Loss of interest or pleasure in hobbies and activities that
were once enjoyed, including sex
- Decreased energy, fatigue, feeling "slowed down" or sluggish
- Persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain
Not all patients will present every symptom, and the severity of symptoms will vary widely among individuals. Symptoms must, however, persist for at least two weeks before being considered a potential sign of depression, with the exception of suicidal thoughts or attempts.
Diagnosis of clinical depression in children is more difficult than in adults and is often left undiagnosed, and thus untreated, because the symptoms in children are often written off as normal childhood moodiness. Diagnosis is also made difficult because children are more likely than adults to show different symptoms depending on the situation.
Diagnosis of Evaluation for Depression
The first step to getting appropriate treatment, for depression or any emotional problem, is a complete psychological evaluation to determine whether you have a depressive illness, and if so, what type of depression. Consultation with a psychologist will include a review of your physical health history. Some medications as well as some medical conditions can cause symptoms of depression, so your psychologist will ask your family physician to rule out these possibilities if other physical symptoms are evident.
A good psychological diagnostic evaluation will include a complete history of your symptoms, i.e., when they started, how long they have lasted, how severe they are, whether you've had them before and, if so, whether you were treated and what treatment you received. Your psychologist should ask you about alcohol and drug use, and if you have had thoughts about death or suicide. Further, a history should include questions about whether other family members have had depression and if treated, what treatments they may have received and which were effective.
Lastly, the psychological diagnostic evaluation will include a mental status examination to assess the full range of psychological symptoms and problems. This will help identify any other psychological problems that might be present, and will help determine the most appropriate treatment for you.
Treatment choice will depend on the outcome of the evaluation. Most people do well with psychotherapy, but some require treatment with antidepressants in addition to psychotherapy. Medication can allow you to to gain relatively quick symptom relief, if you are experiencing severe and disabling symptoms. However, medication does not "cure" the depression, it only treats the symptoms. If you are depressed, you need psychotherapy to help you to learn more effective ways to deal with life's problems, and to change the negative thoughts and attitudes that have caused you to develop depression.
Numerous treatments for depression are available. Standard depression treatment
- Electroconvulsive therapy (ECT)
- Brain stimulation
- Complementary and alternative treatments
In some cases, your Dr. Tapp may be about to treat your depression. In other cases, you may benefit from treatment with a qualified mental health provider, such as a psychiatrist, psychologist or social worker.
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