Depression

Depression is a mood disorder. It affects the way a person behaves related to how they perceive, think, and feel about themselves, their environment, situations, and interpersonal relationships.

People with depression tend to experience a specific set of symptoms and require treatment to reduce or eliminate those symptoms and improve the ability to participate in activities of daily life.

They generally experience a continually low mood that persists for an extended period of time and are often unable to just “snap out of it and feel better.”

There are several types of depression than can affect a person. Most forms of depression share similar symptoms but vary in how and why they develop, or their duration. The most common types of depression are major depressive disorder (major depression) and persistent depressive disorder (dysthymia).

Major depression is the most common form of depression and is the main disorder under which Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists all other forms of depressive disorders. It is defined as having a depressed mood or loss of interest in hobbies or activities along with four other diagnostic symptoms that are present most of the time and occur within the same two-week period, causing disruption in life function. People who suffer from major depression tend to experience multiple episodes over their lifetime.

Dysthymia is characterized as a low or gloomy mood that persists most days and lasts most of the day, for a period of two or more years. Symptom-free episodes must not last longer than two months. People who suffer from dysthymia usually have two of the other main diagnostic symptoms in addition to depressed mood.

Other forms of depression include the following:

• Perinatal depression. Perinatal depression occurs during pregnancy, right after childbirth, or up to a year after delivery. It shares the same signs and symptoms of major depression but is brought on by physiological/hormonal changes in the brain and body related to pregnancy.
• Seasonal affective disorder (SAD). SAD is associated with changes in seasons and/or the length of daylight hours. It tends to be related to exposure, or lack thereof, to the sun. Usually, signs and symptoms of SAD occur in the winter, when days are shorter and exposure to sunlight is limited. Symptoms of SAD are similar to major depression but tend to only occur seasonally.
• Psychotic depression. Psychotic depression generally occurs when psychosis is present along with severe depression as a co-occurring disorder. Symptoms include those associated with major depression along with delusions—a firmly held belief in something that is untrue or not based in reality—and hallucinations—seeing or hearing disturbing things that others cannot see or hear.
• Premenstrual dysmorphic disorder (PMDD). PMDD is a severe extension of premenstrual syndrome (PMS). PMDD is characterized by extreme sadness, hopelessness, moodiness, anxiety, tension irritability, and/or anger. The emotional and mood changes that occur with symptoms of PMDD can disrupt important life functions such as employment, and social interaction. Symptoms often occur seven to 10 days before the start of menstruation and continue through the first few days.

• In 2016, about 16.2 million adults had a least one episode of major depression. And over 3 million adolescents between the age of 12 and 17 had a least one episode of major depression. It is the leading cause of disability in America.
• Depression in men manifests as tiredness, irritability, anger, substance abuse, and risky behavior. Oftentimes, men who suffer from depression may be aware of their symptoms but are unaware those symptoms are related to depression.
• More women experience depression than do men. In women, depression appears as feelings of sadness, guilt, and worthlessness. About 13 percent of women suffer from perinatal or postpartum depression.
• Kids who suffer from depression often show signs as a constant refusal to go to school, excessive worry about parents dying, and separation anxiety.
• Adolescents and teens tend to manifest symptoms as irritability, behavioral issues (particularly at school). And symptoms often appear with body dysmorphia, eating disorders, and substance abuse.

Symptoms of depression are generally present most of the time. Multiple episodes can occur over the course of an individual’s lifetime. Symptoms are usually severe enough to cause disruption in daily life. Even simple tasks can take great energy to complete. Many people who suffer from depression feel unhappy or miserable and do not know why.

To be diagnosed with depression, the DSM-5 requires five or more, of nine, specific symptoms be present over the same two-week period. At least one of the symptoms must be depressed mood or loss of interest in pleasurable activities. The symptoms must occur on most days and last the majority of the day, causing significant disruption in work, school, interpersonal relationships, and other areas of daily life function.

The nine specific symptoms include:

1. Depressed mood
2. Loss of interest in pleasurable activities
3. Sleep disruptions, including sleeping too much or not enough
4. Reduced ability to concentrate or make decisions
5. Observable psychomotor problems, including sluggish movement and restless body movement
6. Feeling guilty or worthless
7. Loss of energy or fatigue
8. Significant weight loss or gain without dieting
9. Recurrent thoughts of suicide, suicide attempts, or creating a plan for suicide

Other symptoms of depression can include:

• Anxiousness and irritability
• Pessimism
• Emptiness or hopelessness
• Feelings of helplessness or fixating on past negative experiences
• General body aches and pains that are unexplained and/or can’t be resolved with treatment

It is not clear what causes depression, but many factors can influence its development and the severity of symptoms. The following issues alone, or in combination, may play a role in the development of depression:

• Brain chemistry. Dysfunction in neurotransmitters in the brain, can affect mood stability. Neurotransmitters regulate mood and emotion. Disruption in how they interact might significantly interfere with the ability to maintain balance and stability of mood and emotions, triggering symptoms of depression.
• Hormonal changes. The body’s hormonal balance can also trigger symptoms of depression. Many women experience depression during pregnancy and in the months after childbirth, when the body’s hormonal balance is significantly altered. Women and teens can be more at risk for developing depression due to respective hormonal changes that take place during pregnancy, menstruation, and puberty.
• Genetics. People with a history of depression in the family are at greater risk for developing the disorder themselves. Additionally, people who suffer from depression often have physical changes that occur in the brain that deviate from what typically is observed. While the significance is unclear, those changes may be connected to causes of depression.
• Medical illness. Medical illness, especially serious or chronic conditions, can trigger depression.
• Significant stress or trauma. Stressful or traumatic experiences such as the death of a loved one, abuse, or experiencing a significantly disturbing event, can affect the development of depression in an individual.
• Medications. Medications such as those for high blood pressure, diabetes, insomnia, and other conditions often list depression as a side effect. Some medications can trigger, or make worse, symptoms of depression. It is important to speak with a doctor about the risks.

Depression can be triggered by other mental health and medical illnesses or it can lead to other medical and mental health conditions. Serious medical conditions such as diabetes, heart disease, cancer, and other chronic or debilitating illnesses often co-occur with depression. Depression can make these conditions worse or vice versa.

The most common mental health disorders that co-occur with depression include anxiety disorders and substance abuse disorders.

Depression can be a devastating and even life-threatening condition. It won’t “just go away” without treatment. However, it is highly treatable. And even in the most severe cases of depression, treatment can be very effective. Depression is usually treated with psychotherapy, medication, or a combination of both.

Residential treatment programs can provide individualized intensive plans in a therapeutic environment. Residential programs can be very helpful for people who have suffered from chronic depression for a prolonged period of time, or where symptoms are acute. Depression treatment plans can include:

• Psychotherapy
• Medication
• Exercise
• Brain stimulation
• Light therapy, which uses exposure to light to regulate hormones like melatonin
• Alternative medicine, such as yoga, meditation and faith based approaches

Often, the earlier treatment begins the more effective it can be in a shorter amount of time. But even if treatment is not obtained early on, it is still essential and can help reduce or eliminate symptoms and improve daily function and quality of life.

Depression Treatment at Bridges