It is not uncommon during the winter months, when there is less daylight and we are often stuck indoors, to experience a case of the “blues.” As a result, we look forward to spring’s arrival. But if those “down” feelings persist for more than a few weeks and/or you are having difficulty functioning in daily life, you may be experiencing more than just a seasonal bout of the blues. You may be suffering from a common yet serious medical illness called clinical depression.
One-fourth of all women and one-eighth of all men will suffer at least one episode or occurrence of depression during their lifetimes. The Medical Society of the State of New York is, therefore, passing on the following information from the National Institute of Mental Health (NIMH), to connect those in need of treatment to the mental health care system.
What is depression?
Depression is more than the blues or the blahs; it is more than the everyday ups and downs. When that down mood, along with other symptoms, lasts for more than a couple of weeks, the condition may be clinical depression. Clinical depression is a serious health problem that affects the total person. In addition to feelings, it can change behavior, physical health and appearance, academic performance, social activity and the ability to handle everyday decisions and pressures.
What causes clinical depression?
Although all the causes of depression are not yet known, there seem to be biological and emotional factors that may increase the likelihood that an individual will develop a depressive disorder. Research over the past decade strongly suggests a genetic link to depressive disorders; depression can run in families. Difficult life experiences and certain personal patterns, such as difficulty handling stress, low self-esteem or extreme pessimism about the future, can increase the chances of becoming depressed.
Are all depressive disorders alike?
There are various forms or types of depression. Some people experience only one episode of depression in their whole life, but many have several recurrences. Some depressive episodes begin suddenly for no apparent reason, while others can be associated with a life situation or stress. Sometimes people who are depressed cannot perform even the simplest daily activities – such as getting out of bed or getting dressed; others go through the motions, but it is clear they are not acting or thinking as usual.
The following are the most common symptoms of depression:
• Persistent sad, anxious, or “empty” mood;
• Feelings of hopelessness, pessimism;
• Feelings of guilt, worthlessness, helplessness;
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex;
• Decreased energy, fatigue, being “slowed down”;
• Difficulty concentrating, remembering, making decisions;
• Insomnia, early-morning awakening, or oversleeping;
• Appetite and/or weight loss or overeating and weight gain;
• Thoughts of death or suicide; suicide attempts;
• Restlessness, irritability; and
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.
What is involved in a physical examination?
According to the NIMH, the first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications, as well as some medical conditions such as a viral infection, can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation should be done, either by the examining physician or by a psychiatrist or psychologist.
A good diagnostic evaluation will include a complete history of symptoms, i.e., when they started, how long they have lasted, how severe they are, whether experienced before and, if so, whether the symptoms were treated and what treatment was given. The doctor should ask about alcohol and drug use, and if there are thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective.
Last, a diagnostic evaluation should include a mental status examination to determine if speech or thought patterns or memory have been affected, as sometimes happens in the case of a depressive or manic-depressive illness.
How is depression treated?
Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life’s problems, including depression. Depending on the patient’s diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have proved effective for depression.
To learn more about clinical depression, visit the website of the National Institute of Mental Health at www.nimh.nih.gov.