Defining Depression

Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better. Many people with a depressive illness never seek treatment. However, the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies and other methods to treat people with this disabling disorder.

What are the different forms of depression?

There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder:

  • Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person’s lifetime, but more often, it recurs throughout a person’s life.
  • Dysthymic disorder, also called dysthymia, is characterized by long-term (2 years or longer) but less severe symptoms which may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include the following:

  • Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
  • Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within 1 month after delivery (It is estimated 10-15% of women experience postpartum depression after giving birth.1)
  • Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.2
  • Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression).

What are the symptoms of depression?

People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness. Symptoms include the following:

  • Persistent sad, anxious or “empty” feelings
  • Feelings of hopelessness and/or pessimism
  • Feelings of guilt, worthlessness and/or helplessness
  • Irritability and restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Insomnia, early morning wakefulness or excessive sleeping
  • Overeating or appetite loss
  • Thoughts of suicide or suicide attempts
  • Persistent aches or pains, headaches, cramps or digestive problems that don’t ease with treatment

What illnesses often coexist with depression?

Depression often coexists with other illnesses. Such illnesses may precede the depression, cause it, and/or be a consequence of it. It is likely the mechanics behind the intersection of depression and other illnesses differ for every person and situation. Regardless, these other co-occurring illnesses need to be diagnosed and treated:

  • Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia and generalized anxiety disorder often accompany depression.3,4 People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat. People with PTSD often relive the traumatic event in flashbacks, memories, or nightmares.

Other symptoms include irritability, anger outbursts, intense guilt and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH)-funded study, researchers found more than 40% of people with PTSD also had depression at 1- month and 4-month intervals after the traumatic event.5

  • Alcohol and other substance abuse or dependence may also co-occur with depression. In fact, research has indicated the coexistence of mood disorders and substance abuse is pervasive among the U.S. population.6
  • Depression also often coexists with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes and Parkinson’s disease. Studies have shown people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have coexisting depression.7 Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co-occurring illness.8

We can help.

If you or someone you love seems overly sad, isolated or falling into depression, call us at 800.383.1908 — any time, day or night — for a free, confidential consultation. There’s no limit to the number of times you or your family members can call. Our counselors can help you evaluate any issues you or your family members are facing over the phone. We can also schedule free face-to-face counseling at a time and place convenient for you. We encourage you to call whenever you’re feeling sad, angry, discouraged or overwhelmed. Sometimes a sympathetic ear, a change in perspective or tips on how to meet a life-challenge more effectively can help resolve issues that might lead to depression.

Call VITAL WorkLife at 800.383.1908 any time, day or night, for the support you and your family need.

Sources:

1 Altshuler, L.L., Hendrich, V., & Cohen, L.S. (1998). Course of mood and anxiety disorders during pregnancy and the postpartum period. Journal of Clinical Psychiatry, 59, 29.

2 Rohan, K.J., Lindsey, K.T., Roecklein, K.A., & Lacy, T.J. (2004). Cognitive-behavioraltherapy, light therapy and their combination in treating seasonal affective disorder. Journal of Affective Disorders, 80, 273-283.

3 Regier, D.A., Rae, D.S., Narrow, W.E., Kaebler, C.T., & Schatzberg, A.F. (1998). Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry, 173(Suppl. 34), 24-28.

4 Devane, C.L., Chiao, E., Franklin, M., & Kruep, E.J. (2005, October). Anxiety disorders in the 21st century: Status, challenges, opportunities, and comorbidity with depression. American Journal of Managed Care, 11(Suppl. 12), S344-353.

5 Shalev, A.Y., Freedman, S., Perry, T., Brandes, D., Sahar, T., Orr, S.P., et al. (1998). Prospective study of post- traumatic stress disorder and depression following trauma. American Journal of Psychiatry, 155(5), 630-637.

6 Conway, K.P., Compton, W., Stinson, F.S., & Grant, B.F. (2006, February). Lifetime comorbidity of DSM-IV [Diagnostic and Statistical Manual of MentalDisorders, 4th ed.] mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcoholand Related Conditions. Journal of Clinical Psychiatry, 67(2), 247-257.

7 Cassano, P., & Fava, M. (2002). Depression and public health, an overview. Journal of Psychosomatic Research, 53, 849-857.

8 Katon, W., & Ciechanowski, P. (2002). Impact of major depression on chronic medical illness. Journal of Psychosomatic Research, 53, 859-863.

9 U.S. Department of Health and Human Services, National Institutes of Health (NIH), National Institute of Mental Health. (Updated 2008, April 3). Depression (NIH Publication No. 07-3561). Retrieved September 16, 2008, from http://www.nimh.nih.gov/

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