Depression

Depression is Common

If you are suffering from clinical depression, you are not alone. Clinical depression is very common. Over nine million Americans are diagnosed with clinical depression at some point in their lives. Many more people needlessly suffer from clinical depression because they do not seek treatment. In fact depression is as common as hypertension, also known as high blood pressure (Peden, 1996). People may feel that depression is a personal weakness, or try to cope with their symptoms alone. Some turn to drugs or alcohol to try and deal with their symptoms. This usually makes depression worse in the long run.

On the other hand, some people are comfortable with admitting their symptoms and seeking help. Such a discrepancy may account for the differences in reported cases of depression between men and women, which indicate that more than twice the number of women than men are clinically depressed. According to the numbers of reported cases of depression, 25% of women and 10% of men will have one or more episodes of clinical depression during their lifetimes.

Depression may have physical symptoms such as low energy or weight gain/loss. This makes it important to first check and see if your symptoms are due to a physical problem.

What is depression?

There is a difference between feeling "down in the dumps" and having clinical depression. The type of clinical depression called Major Depression is probably what most people think of when they think about depression. This common type of depression is characterized by a number of symptoms, the main symptoms being depressed mood and loss of interest or pleasure in doing things.

Depression that is the result of medication side effects or a medical condition is not considered to be clinical depression. Also, normal grief - which occurs after the death of a loved one, for instance - is not clinical depression.

For some people, an episode of depression may occur just once; however, more often depression is recurrent, which means it occurs more than once – maybe once a month, or once a year, or even several times in a lifetime.

To be diagnosed with Major Depression, a person must have at least one of the two main symptoms (depressed mood and/or loss of interest in doing things) and five or more other symptoms, such as loss of energy, trouble concentrating, weight loss or gain, feelings of worthlessness, sleep problems, thoughts of death, and restlessness.

A diagnosis is made when these symptoms are present every day (and almost all day long) for two weeks or more. The symptoms must impact a person's ability to function normally (for example, the symptoms interfere with relationships or work) or cause significant distress in the person's life. For more information on what depression is.

What is Depression Like?

Clinical depression is often confused with "the blues," or feelings of grief following the death of a loved one. But clinical depression is quite different, it has distinct symptoms, and can devastate a person. If left untreated, it can lead to death. Everyone with depression experiences the illness slightly differently, but there are certain common experiences.

People with depression feel down and just can't snap out of it, no matter what they do. They may feel guilty because they can't get motivated, even though they shouldn't because depression is not their fault. And they often feel guilty for many things that aren't their fault at all.

They may not enjoy things that should be pleasurable. Every day seems gray and flat. Concentrating on things may seem unimportant or impossible. Sometimes, people with depression feel slowed down and become lethargic or, alternatively, hyperactive and anxious.

People with depression often sleep or eat too little or too much. Sometimes, food doesn't taste good anymore. And sometimes, people with depression say they eat just to kill time or to fulfill the empty feelings inside them. They may lie in bed and not be able to fall asleep, wake many times in the night, and not want to get out of bed in the morning.

Depression in Older Adults

The Size of the Problem:

Depression in people over 65, or late-onset depression, is a significant problem in this country. Studies indicate that the percentage of people over 65 living in the community who suffer from symptoms of depession is between 8% and 20%. The percentage is even greater among seniors living in nursing homes.

Depression in Older Adults is Underdiagnosed

Studies suggest that depression in seniors often goes unrecognized and untreated. This is a serious problem because studies also show that when depression is not diagnosed there are serious consequences:

- Depression is a primary risk factor for suicide in older adults. Seniors have the highest rates of suicidein the U.S. population. White men over the age of 85 have a rate of suicide up to six times that of the general population.
- Depression in older adults causes significant distress and suffering
- Depression leads to impairments in physical, mental, and social functioning
- Treatment is available and is effective in most cases

Why is depression Underdiagnosed?

Depression is not an normal part of aging. Although, a significant number of seniors suffer from symptoms of depression, the majority do not.Yet many people, including seniors, believe that depression is a normal part of getting older. One study found that only 38% of older adults believe that depression is a “health” problem. About 58% believe that it is “normal” for people to get depressed as they grow older.

In older adults, the symptoms of depression are often thought to be the result of “normal aging,” atherosclerosis, Alzheimer’s disease, or any number of physical illnesses. For example, confusion or difficulty concentrating caused by depression can sometimes look like Alzheimer's disease or other brain disorders.

Depression in older people often presents differently than in younger people. In older people, symptoms of depression are more common than full-fledged major depression. Nonetheless, they cause significant suffering and disability.

Many older patients deny they are suffering symptoms of depression or refuse to accept the diagnosis because of stigma. Older adults are more likely than any other group to “handle it themselves.” Only 42% would seek help from a health professional. This appears to be particularly the case with older men, who also have the highest rates of suicide in later life (Hoyert et al., 1999).

Risk Factors

- widowhood
- physical illness
- less than a high school education
- impaired functional status
- heavy drinking of alcohol
- persistant insomnia or problem sleeping

Causes

There is no single cause of depression. In older people, depression is sometimes linked to medications or certain illnesses. In particular, some medications used to treat arthritis, heart problems, high blood pressure, or cancer can cause depression as a side effect. These side effects may not happen immediately. It is also thought that some illnesses can cause depression. These include Parkinson's disease, stroke, and hormonal disorders. Circumstances in a person's life also can sometimes can trigger depression, such as social isolation, loss of independence, loss of a loved one.

Symptoms

Older people are often reluctant to discuss feelings of sadness, loss of interest in activities, or prolonged grief with their doctor. Usually, the symptoms described are physical. Anxiety and a general loss of ability to feel pleasure are also common. Other things that may point to underlying depression include slowness of movement and lack of interest in personal care.

If you or someone you know has been suffering from some of these symptoms for more than two weeks, the symptoms should be discussed with a doctor.

- Unexplained physical complaints
- Hopelessness
- Helplessness
- Anxiety and worries
- Memory problems
- Loss of feeling of pleasure
- Slowed movement
- Irritability
- Lack of interest in personal care, such as not taking medications on time and not eating properly

Types of Depression

There are different types of depression, each with different symptoms and different ways of affecting a person's life. Information about the most common types of depression is provided in this section of the website. The information is based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which is a manual that is used by doctors and mental health experts to diagnose mental illnesses including depression.

Click on a link below to learn about the types of depression:

• Major Depression (the most common type)
• Dysthymia (chronic depression)
• Minor Depression
• Premenstrual Dysphoric Disorder (similar to severe PMS)
• Postpartum Depression (following childbirth)
• Seasonal Depression

Click on a link below to learn about disorders similar to depression:

• Depression Occurring with Physical Illness
• Bipolar Disorder

Bipolar disorder is often grouped with depression because patients often develop depressive episodes. However, it is different because of its manic component and the severe mood swings that characterize the illness.

Research on Biology and Depression

Scanning Techniques

New technology allows researchers to take pictures of the brain that show activity levels in the brain. These imaging techniques such as f-MRI (functional magnetic resonance imaging) and PET scan (positron emission tomography) actually create images of how active different parts of the brain are.

Some studies with these kinds of techniques have suggested that the patterns of activation in the brains of depressed people are different than those who are not. These tests can help doctors and researchers learn more about depression and other mental illnesses. Since this research is fairly new, it is not yet used to diagnose clinical depression.

Heredity Studies

Strong evidence suggests that clinical depression runs in families. Still, just because a person has family members with clinical depression does not guarantee that he or she will develop it. Similarly, you may get it even if no one else in your family has.

Basic Ways to Treat Depression

Basic ways to treat depression include medication, psychotherapy, and a combination of the two. In severe cases, a hospital stay may be necessary.

Medication

Medication is used in most cases of depression, and is essential for the treatment of severe cases of depression. If you take an antidepressant medication, you will meet regularly with your doctor to discuss your progress. You may start to see some minor improvement in 1 to 2 weeks but you will not see the full effect until 4 to 6 weeks. The drawback to medications is that there are some side effects and risks. Some people might have another medical condition that would interfere with antidepressants. To learn more detailed information about different medications.

Therapy

Some people prefer to try therapy instead of starting with medication. Some of these therapies have been shown to be effective as antidepressants in treating mild and moderate cases of depression (Mental Health: A Report of the Surgeon General, 265).

Interpersonal psychotherapy and cognitive-behavioral therapy are both types of therapy that have been used in treating depression. Both of these therapies focus on the present and on the patient becoming more actively involved in understanding their illness (Mental Health: A Report of the Surgeon General, 265). Marital and family treatment may also be helpful for specific solutions.

It usually takes 6-8 weeks for people to receive relief from symptoms with therapy. Therapy is an excellent option if you cannot or prefer not to take medication. The drawbacks to therapy are that it can be time-consuming (depending on the type of therapy) and expensive.

Combination of Both

In some cases, neither medication nor psychotherapy may treat depression as quickly or thoroughly as you and your doctor would like. In these cases, both types of treatment used together may have successful results. Some people suffer from chronic depression; combination therapy may help these people deal with the illness and how it affects their lives.

What if Neither Medication or Therapy Works?

In cases of severe depression, therapy and medications may take effect too slowly or may not work at all. In these rare cases of severe depression, electroconvulsive therapy or ECT be be considered.

Hospital Stay

A hospital stay offers support in a safe environment for the small percentage of people with severe symptoms of clinical depression. It is especially helpful for those who:

- have lost the ability to function in their daily lives.
- have lost hope and have persistent thoughts of harming themselves or suicide.
- are severely suffering from their symptoms.

A hospital stay keeps people safe and provides time for treatment to start reducing their symptoms. Once symptoms improve, patients' day to day functioning and thinking improve. Hospitals can give patients a lot of support by providing a team of health care professionals to work with a single patient.

During a hospital stay, patients may go to supportive and educational groups to learn about their illness and treatment. The staff can learn about patients and their symptoms in a small amount of time and find the right treatment for them. The doctor can also adjust medications fast and bring quick relief to patients during a hospital stay.

Today, hospital stays are used to reduce the severity of symptoms so patients can manage their illnesses safely outside of the hospital. Hospital stays generally last from a few days up to a few weeks. Considering the months or years of productive living that can be lost to clinical depression, a few days in a hospital may be a valuable investment of time and effort.

Sometimes patients are treated in a partial hospital. In these situations, the patients go to the hospital 4 to 8 hours a day, 1 to 5 days a week. A partial hospital stay can be an excellent way for patients to get the intense treatment they need while continuing their usual daily activities.

Getting Help

Why do many people refuse to see a doctor for their symptoms?

People are reluctant to seek professional help for their depression because they believe they should be able to shake themselves out of it, or that the depressed feelings will disappear as mysteriously as they came.

But for many people, the symptoms remain. And when a person has clinical depression, everyday neutral or negative events that we usually let "roll off our backs" become magnified into catastrophes.

Many people don't seek help because they simply lack the energy to get help (one of the classic symptoms of clinical depression is constant fatigue). Meanwhile, family members watch their loved ones suffer, often feeling helpless or blaming themselves for the changes they see.

In some instances individuals don't even realize that they are suffering from depression. They think they are simply "down in the dumps" without realizing that their feelings are not normal.

People might also avoid seeking treatment for depression because they are embarassed. They are concerned about confidentiality and fear that others will find out about their condition and think differently of them.

The fear of the cost of depression treatment is also often mentioned. Worries over whether or not one's insurance company will pay for mental health related conditions can be a concern.

What's so important about seeing a doctor for symptoms of depression?

Clinical depression is a real medical illness. It's as real and legitimate as a twisted ankle or diabetes. Treatment by a medical doctor can mean all the difference in the world, just as it would for the twisted ankle or diabetes.

In the Workplace

Depression is not only a serious mental health problem, it costs a significant amount of money and time. In 1990, depression cost American companies 43.7 billion dollars, 12 billion for absenteeism alone. Depression is more costly than cancer, heart disease, and AIDS. Depression can affect a person's ability to be a productive, capable, and satisfied member of society.

Signs to look for in the workplace

People sometimes exhibit signs and symptoms that hint at depression. If a coworker or employee shows these signs, steps should be taken to provide assistance. A manager can make the suggestion that the person's health has affected his work and that he should see his doctor. A coworker can show concern, mentioning that seeing a doctor could help, and offer any assistance needed. Remember, these signs may not necessarily signal depression but may suggest other problems. Only a doctor should diagnose someone. This list should be used only as a guide.

Low morale, always seems "down in the dumps", has low motivation to complete work
Decrease in productivity or interest in projects; does not cooperate in group settings
May be absent from work more than the average employee or coworker
Shows signs of excessive fatigue and loss of energy; listless and lack of concentration common

What can be done in the workplace for people with depression?

If a worker is suspected of being depressed or is known to be recently diagnosed with depression, there are several things coworkers and managers can do to assist the person and eliminate the need for future, costly treatment and intervention.

Peer support may be one of the best ways in which people in the office can help a person with depression. Many people with this disorder suffer alone without any assistance. Kind words and compliments, offers to spend time with the person, even just being there if the person needs to talk can make the person feel better about himself or herself and his or her relationships.

Managers can do a lot to relieve the pressure work can bring. Giving the person accomplishable goals can increase self esteem and can increase the person's belief that he or she has control over his or her life. Also, if the manager can minimize late hours and time crunches, undue stress can be avoided. Make sure employees are aware of the resources available to them, such as employee assistance programs.

Remember that depression is a treatable condition just like a broken bone or heart problem. If the person is treated early and with care, recovery is probable and excessive cost ( financial and emotional ) can be avoided.