Depression includes a group of mental health disorders that affect approximately 18.8 million people, or 9.5% of adults, in the U.S. every year. While everyone is susceptible--men and women, adults, the elderly, adolescents, and children of all ages--nearly twice as many women as men are affected by a depressive disorder each year. Depression is more likely in persons who are divorced or separated, who are from Western countries, and who were born after World War II.
While no one has come up with a definite answer of what actually causes depression, and it's causes and treatments continue to be debated, scientists have learned much over the past decade about the biological and psychological factors that increase a person's chances of being affected by depression.
A large body of research supports the idea that depression has genetic underpinnings, making people who have close relatives with depression more susceptible, especially when life stresses come into play.
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Some of the life stresses that are associated with depression include:
- Life-changing events. Research supports the notion that life-changing events, whether negative, such as the loss of a loved one, financial setbacks, or marital separation, or positive, such as the birth of a child, promotion at work, or graduation from school, can give a shock to the system and encourage the development of depression in susceptible individuals.
- Long-term stress. Everyone's life has stresses and strains, but for some people, chronic stress, such as family conflicts, chronic financial troubles, health problems, or just being too busy on a long-term basis, can wear down the body's coping mechanisms and make them more prone to depression. This factor is especially important at times when larger factors, such as an economic recession or the threat of terrorism or war, add to already stress-filled lives.
- A history of trauma or abuse. Many people with histories of trauma or abuse, including children of alcoholics and victims of family abuse, or those whose trauma occurred later in life, such as war veterans, develop depression at some point in their lives. While they may function well in general, they just don't feel good about their accomplishments and the normal challenges that face them and they find it difficult to feel a sense of well-being.
- Seasonal factors. Changes in the seasons can trigger depression, as can additional stress related to holidays and family anniversaries.
Whether depression is caused by biological factors or by life stresses alone, the end result may be the same: altered brain chemistry with psychological and physical symptoms that vary how much they disrupt a person's life.
Physical symptoms are often the body's signal that what was a somber mood has changed into a true depression. However, any of the physical symptoms that go with depression can also be caused by other medical disorders, so a medical checkup is a good idea to rule out other problems.
Some of the physical symptoms that indicate that depression has set in include:
- Changes in sleep patterns. Some people have problems with falling asleep, or wake up in the middle of the night and can't get back to sleep. Others end up sleeping much more than they usually would. In either case, if sleeping patterns don't return to normal in a few weeks, it may be an indication of depression.
- Exhaustion. Whether or not they are sleeping enough, some people can't shake off a feeling of constant exhaustion. Everything just seems like too much effort.
- Changes in eating habits. Some people lose their appetites and subsequently lose weight, while others crave carbohydrates and sweets, or eat as a way to make themselves feel better temporarily, leading to weight gain. Usually, a sudden change in weight of 10 or more pounds in either direction, in the absence of dieting or trying to gain weight, is a signal that depression may be a factor.
Mental and Emotional Symptoms
Many of the torments of depression are a result of the mental and emotional symptoms that can accompany it. Some of these symptoms include:
- Thoughts of hopelessness, despair, or a feeling that things won't ever change for the better.
- Feeling worthless, inadequate, or empty inside; feeling all alone and like no one really understands what you're going through.
- Thoughts of suicide, which can be as subtle as “Wouldn't it be better if I weren't here,” or as pronounced as frequent, intrusive thoughts, images, or urges about harming or killing oneself. There are distinctive warning signs that indicate if a person is at risk for suicide and if any of these warning signs are present, help should be sought immediately.
- Feeling sad, with or without tearfulness. Being unable to cheer up no matter what you try.
- Being agitated and irritable with others, or feeling unable to cope with things that you used to take in stride. For example, one woman reported being upset with herself for yelling at her children over minor issues, when she used to pride herself on being patient with them.
- Loss of pleasure and interest in activities. Depression often robs a person of enjoying activities that over time have been enjoyable. For example, you may find yourself making excuses when friends invite you to social gatherings, when in the past you enjoyed the company of your friends. Or hobbies that used to absorb you now don't hold your attention.
- Trouble concentrating or feeling preoccupied and unable to pay attention to what's going on around you. For some people this also involves being more forgetful than usual.
If depression is part biological and part psychological, then what kind of treatment works best, medication or psychotherapy?
Researchers have studied different forms of treatment for how well they alleviate depression and keep it at bay. As with much in the mental health field, the findings sometimes have been contradictory. It turns out that both medication and psychotherapy have been proven to be effective in long-term studies. Recently, however, several interesting patterns have emerged.
- Especially for mild to moderate depression, psychotherapy can relieve symptoms and help the depressed person return to feeling normal. And in many cases, it doesn't take that long to work. According to the American Psychological Association, there is convincing evidence that most people who have at least several sessions of psychotherapy are far better off than untreated individuals. One major study showed that 50 percent of people in treatment noticeably improved after eight sessions, while 75 percent improved by the end of six months.
In addition, psychotherapy has been shown to lead to more and more satisfying social contacts and enhanced relationship skills, both of which are known to protect against depression. And since a person's depression is likely to affect others, psychotherapy can provide a forum for healing relationships that may have been hurt because of the depression.
Psychotherapy also can combat some of the other problems-negative thinking, pessimism, difficulty with problem-solving-associated with depression.
For these reasons and more, people with mild to moderate depression who are treated with psychotherapy alone are less likely to see their symptoms return than those treated with medication alone.
But can psychotherapy really “cure” the depression? No one knows for sure, but with advances in brain imaging, researchers have demonstrated that psychotherapy alone--without medication--can lead to positive changes in brain chemistry. The changes are similar to those caused by medication, such as restoring the neurotransmitter serotonin to normal levels, and are associated with reduction of the physical and emotional symptoms of depression.
- For more severe or prolonged depression, or depression for which psychotherapy alone has not provided relief, consensus seems to be emerging that a combination of medication and psychotherapy is the strongest approach. In the past decade or so, new medications have been introduced that treat depression more effectively and have fewer side effects. These, combined with the benefits of psychotherapy, provide relief for most people with depression. If a person has tried medication in the past without success, often a different dosage, or a different medication or combination of medications, provides relief.
- Some psychiatrists are increasingly recommending ECT, or electroconvulsive therapy, as a treatment for more severe depressions and for patients who either cannot tolerate medication because of a medical condition or who are at immediate risk for suicide. This treatment should take place in a medical setting only. While ECT has been improved to make it a safer and more effective form of treatment, it still is highly controversial and people with depression should carefully review the potential benefits and risks associated with the procedure before consenting to it.
Sadly, even with safe, effective treatments that are widely available and cost-effective, it's estimated that only half of those with depression seek relief through professional help. Many attribute this reluctance to the pervasive stigma that continues to surround mental health disorders of any kind. It's difficult to imagine, let alone quantify, the staggering amount of suffering due to untreated depression, for both those with the disorder and those around them.
Depression tends to get worse if it isn't treated, and it's easiest to treat BEFORE your symptoms get serious. It's important to seek help when you first notice that your feelings are not clearing up on their own, are worsening, or are starting to affect your quality of life. Sometimes, a friend or family member will notice the depression before the depressed person does. In these cases, it's important to tell the person what you are noticing and offer to assist the person in getting help.
If you or someone close to you could be suffering from depression, I invite you to contact me.
Additional Sources of Information
These references are provided for your convenience in learning more about depression and in no way represents all the resources available on the world wide web. Listing them here in no way implies endorsement of their content. Site addresses change from time to time so if a link is no longer active, please contact the web master for this site so the link can be updated.
- National Mental Health Association - A national organization with state chapters, NMHA educates the public about mental illness and advocates for those with mental illness and their families.
- National Institutes of Mental Health - A government agency that does research and provides public education on mental illnesses and treatments.
- National Depressive and Manic Depressive Disorders Association - An educational and advocacy organization for people suffering from depressive and manic depressive disorders. Includes interactive questionnaires that can tell you confidentially whether you are suffering from a depressive disorder.
- National Alliance for the Mentally Ill - A national organization with state chapters, NAMI educates the public about mental illness and advocates for those with mental illness and their families. The site has a comprehensive database of medications used to treat mental illnesses and has a national toll-free hotline to provide information and guidance. Most state chapters run a network of local support groups to provide support, education, and assistance to people with mental illness and their families.
- American Association for Marriage and Family Therapy - A national professional association that educates the public about mental illnesses and their treatments, especially psychotherapy and family therapy. Also includes a therapist directory to assist in finding appropriately trained therapists by state, region, and zip code.
Suicide Warning Signs
More than 30,000 people in the United States die by suicide each year. It is this country's 8th leading cause of death, according to the American Federation for Suicide Prevention. Sixty percent of suicides are carried out using a firearm.
The National Mental Health Association urges families, coworkers, and friends of depressed individuals to be alert for warning signs of suicidal behavior, including:
- Talking about suicide. Talk of suicide or even an ineffective attempt at it should ALWAYS be taken seriously.
- Statements about hopelessness, helplessness, or worthlessness.
- Verbal threats such as, ``You'd be better off without me.''
- Preoccupation with death and/or methods of self-harm. Obtaining firearms or other means so that access is easy.
- Sudden change in attitude-- happier, calmer.
- Loss of interest in things previously cared about.
- Visiting or calling people one cares about-making peace, saying goodbye.
- Making final arrangements; setting one's affairs in order.
- Giving away possessions, including prized possessions.
- Lack of interest in the future-not making plans, making vague references to availability in the future.
If you or someone you know is showing any of these warning signs, GET HELP IMMEDIATELY. If you want to help a friend or family member who appears to be in danger, talk to them about the reasons you are concerned and ask them to be honest with you about how they feel. If you are still concerned after speaking with them, contact a mental health professional for advice and/or accompany the person to a medical or mental health clinic or hospital emergency room.
IN AN EMERGENCY, CALL 1-800-SUICIDE (1-800-784-2433) (A National Hotline) or DIAL 9-1-1 for access to emergency services IN YOUR AREA.
If you would like to explore how therapy could be helpful in alleviating the intense pain that leads one to consider taking one's life, or would like more information on how to help someone you love who may be at risk for depression or suicide, I invite you to contact us
for a consultation.
The information provided on this web site is for educational purposes only. It should NOT be used as a substitute for seeking professional care for the diagnosis and treatment of any mental health disorder.