Clinical Depression Overview

Public awareness of depression has grown in recent years - in part because of programs such as National Depression Awareness Day and in part because of ads run by pharmaceutical companies.

The focus has been on depression being caused by a chemical imbalance. This may be too simplistic. Depression is most likely caused by a combination of many factors.

* If you are severely depressed or are having thoughts of suicide, see a doctor immediately.

Recognizing Depression as a Mental Illness.

Despite all the publicity, some people are still not aware depression is an actual illness. This may be because we use the terms depressed and sad interchangeably. It’s normal to feel sad or ‘depressed’ now and again. But clinical depression is a medical condition, not just a passing mood, and has many physical and emotional symptoms that go along with it.

Sometimes it takes a while for a person to realize they are depressed. The symptoms may creep up gradually and sometimes have to reach a certain level before a person realizes something is wrong and, hopefully, seek help. For some people, the stigma of depression prevents them from seeking help. Some people with mild depression don’t even realize they suffer from a medical condition.

Depression is very common, affecting about 1 in 5 women and 1 in 10 men at some point in their lifetimes.

Benefits of Early Treatment:

Treating depression early may prevent years of suffering. Since the social consequences of depression (such as social isolation and job loss) are also risk factors for depression, treating depression early can prevent a vicious cycle of depression – isolation- depression.

Dangers of Lack of Treatment:

Many people resign themselves to living with the symptoms of clinical depression, which can adversely affect quality of life. People with severe depression or long lasting depression may even commit suicide - up to 15% of those with severe major depression. Others will develop substance abuse problems, which ends up worsening clinical depression.

Fear of Treatment:

Some clinically depressed people are reluctant to seek treatment because they fear their doctors will put them on medication. There has been a lot of controversy surrounding the use of antidepressant medication recently. Do antidepressants increase risk of suicidal behavior?

There are many ways to treat depression. While not every depressed person is in need of medication, many depressed people will not fare as well without it. Every person is different. The severity of clinical depression also varies greatly.

What is Clinical Depression?

Depression is a mood disorder, but much more than mood is affected. Depression manifests itself in many ways – emotionally, mentally, and physically. Clinical depression is considered to be a chronic or recurrent but treatable illness (though some people have only one episode of major depression). The risk of a reoccurrence gets higher with each episode of depression - some patients stay on long-term maintenance treatment, which may include medication or psychotherapy.

There are several types and subtypes of clinical depression – major depression, dysthymia (mild, long-term depression), bipolar disorder (also known as manic depression), atypical depression, SAD (seasonal affective disorder), postpartum depression, adjustment disorder with depression, and more.

Symptoms of Depression:

Diagnosing clinical depression is based upon a person's symptoms. Not all people have all the symptoms. The severity of the symptoms varies, ranging from minor suffering to downright disability. Common symptoms, in addition to an abnormal mood (depressed mood and/or loss of interest or enjoyment must be present for a diagnosis of clinical depression to be made), are lack of energy, lack of motivation, pessimism, changes in sleep & eating patterns. One may sleep or eat too little or too much. There may be a significant change in weight.

Not only sadness, but also feelings of emptiness, hopelessness, boredom, frustration, irritability, and anger are common. Feeling guilty (for no reason) is also common. Many depressed people suffer from low self-esteem and may have a distorted self-image.

Depression also can affect one's cognitive ability, causing difficulty in concentrating, memory, and making decisions. There may be unexplained physical aches and pains, e.g. headaches, back pain, stomachaches, chest pain. One depressed person may be lethargic, another on edge.

Most clinically depressed people suffer from some symptoms of anxiety. About one-third of people who suffer from depression have a full-blown anxiety disorder.

Symptoms must be present for at least two weeks before a diagnosis of depression is considered. Two weeks! - Yet many people suffer for years before seeking treatment and others never seek medical help.

Are There Outward Signs that a person is Clinically Depressed?

Usually, but not always. For more info on outward signs of depression, click here.

Social Consequences:

Work and relationships can suffer. With severe major depression one may not have the energy to get out of bed, never mind work. With minor depression, low energy and lack of motivation may affect performance at work. The low-self esteem that often accompanies depression may lead people with depression to believe they are less capable than they actually are and not live up to their full potential.

The depressed person may worry that other people will know that there is something wrong with them. People who are depressed may feel embarrassed or feel like a burden to others and they may isolate themselves as a result. They may also be too fatigued to go out with friends, or may feel it's not worth the effort since they are not going to enjoy themselves anyway. Withdrawing from friends and family will cause more depression and so a vicious cycle begins.

Causes of Depression:

Clinical Depression is most likely caused by a combination of many factors: Genetic susceptibility, stress, and low levels of certain neurotransmitters such as serotonin. Some medications and other medical conditions also cause depression.

Stress is a major trigger of depression, particularly in those predisposed to it. Divorce, a death of a loved one, or even a ‘personal crisis’ can cause extreme stress. (Normal bereavement is not clinical depression but major depression may co-exist with it) People suffering from chronic illness are at an increased risk of developing depression for both physical and psychological reasons. However, depression can occur without any apparent reason at all.

Hereditary tendencies play a major role, however, even people with no family history of depression may become depressed.

Treatments for Depression:

Antidepressant medication is often prescribed. Psychotherapy is considered just as effective as antidepressant medication and a combination of the two is usually the most effective. There are different forms of psychotherapy. Cognitive behavioral therapy helps break negative, distorted patterns of thinking.

Family problems or any relationship problems will exacerbate (or may trigger) depression. And depression itself can intensify or cause difficulties in relationships. Seeing a counselor or psychologist, family therapist, psychiatrist, etc. can help one learn to deal with relationship / family problems. An initial consultation with a therapist will help determine if he or she is compatible with the patient and allow the counselor to explain what to expect from therapy and answer any questions the patient has.

Regular aerobic exercise may be as effective as antidepressant medication but it may be too difficult for a person who is suffering severe depression to start exercising until they have had as least partial relief from their depression. There are many complementary treatments such as relaxation techniques to combat stress, supplements, massage therapy, etc. Motivating oneself with achievable goals can also be very effective.

A depressed person needs all the help they can get. A multidimensional approach may be necessary to banish depression.

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