Depression is a serious mood disorder that affects about 300 million people worldwide. While depression is not curable, it can be successfully managed, enabling those with depression to live happy, productive lives. Sadly, about 35 percent of those struggling with depression never receive the treatment they need.
According to National Alliance on Mental Health (NAMI) statistics, severe depression, also known as major depressive disorder or clinical depression, affects over 19 million adults in the United States. Young people are not immune to depression, either. NAMI data finds about 3.1 million children aged 12 to 17 suffered at least one depressive episode in the previous year.
What is Depression?
Depression is a mental health disorder in which the individual feels a constant sense of sadness, hopelessness, and loss of interest in their normal activities. They often struggle to function well in their daily lives.
There are several types of depression with differing levels of severity, but all are mood disorders. The most commonly diagnosed forms of depression are:
- Major depressive disorder (MDD), also known as clinical depression
- Persistent depressive disorder (PDD), formerly called dysthymic disorder
People with either disorder struggle with low mood, although symptoms may not be as severe in PDD. The major difference between MDD and PDD is the duration of symptoms.
Those diagnosed with MDD have experienced at least one major depressive episode lasting two weeks or longer and may experience several such episodes throughout their lives. To fit the diagnosis of MDD, two months must separate multiple depressive episodes. To be diagnosed with PDD, symptoms must have continued for at least two years.
Both disorders are more common in women than men. Although depression affects males and females of any age, women aged 18 to 25 years old are most commonly diagnosed with MDD. Women receive a diagnosis of PDD at almost twice the rate as men, according to the National Institute of Mental Health.
Other serious, but less commonly diagnosed, forms of depression include:
- Psychotic depression: Severe depression combined with hallucinations or delusions.
- Postpartum depression: May occur during pregnancy or after giving birth.
- Premenstrual dysphoric disorder: A severe form of premenstrual syndrome, resulting in extreme mood shifts.
- Situational depression: Triggered by a traumatic event like the death of a loved one, divorce, job loss, or accident. It usually develops within three months of the traumatic event. This form of depression does not meet the diagnostic criteria for clinical depression and is usually present short term.
- Seasonal affective disorder: This is a subset of depression because it is seasonal, typically beginning and ending at the same time each year.
Bipolar disorder is also a mood disorder but differs from those above because the person experiences periods of low mood alternating with periods of very high mood. Typically, those with depression do not experience an elevated mood during depressive episodes.
Symptoms of Depression
Major Depressive Disorder is one of the most common mental health disorders in the U.S., but the signs and symptoms of all forms of depression are similar, as are treatment approaches.
Anyone who is suffering from some or all of the following symptoms, most of the day, nearly every day, for at least two weeks, should contact their physician or mental health provider for help.
Symptoms of depression may include:
- Persistent sadness, tearfulness, anxiety, hopelessness
- Feeling empty, without purpose
- Pessimism, feeling nothing will get better
- Angry outbursts, feeling worthless or helpless
- Feeling restless, irritable, or edgy
- Feeling guilty and focusing on failures
- Loss of interest in people, hobbies, and activities they once enjoyed
- Fatigue, loss of energy, moving and talking slowly
- Changes in appetite or weight changes
- Difficulty with memory, concentration, and decision making
- Sleeping too much or too little
- Unexplained physical pain, like back pain, headaches, or digestive problems
- Thoughts of death or suicide, or suicide attempts
What Causes Depression?
While experts do not fully understand what causes depression, many believe it does not stem from a single factor like a chemical imbalance. Depression more likely stems from a combination of biological, genetic, environmental, and emotional components.
Any of the following factors may contribute to depression:
Faulty mood regulation. Certain centers and functions of the brain regulate mood. Constantly fluctuating levels of brain chemicals and neurotransmitters like serotonin, dopamine, glutamate, and norepinephrine may contribute to depression.
Nerve circuits. Researchers believe dysfunction in nerve circuits may contribute to depression.
Genes. Scientists have identified certain genes in those with mood disorders that may increase the risk of developing depression.
Personality. People with low self-esteem and those with a negative or pessimistic outlook may be more at risk of depression.
Trauma. If symptoms caused by trauma do not subside over time, they can increase the risk of depression. Physical or emotional abuse, a serious accident, assault, loss of a loved one, conflict with family or friends, natural disaster, or other trauma may contribute to depression.
Major life event. Losing a job, divorcing, retiring, or even a positive major event can cause stress, which may trigger depression.
Substance abuse. Misuse of drugs or alcohol can increase feelings of loneliness, sadness, and hopelessness, all emotions that are associated with depression. Substance abuse and depression frequently co-occur.
Medications. Some drugs prescribed for acid reflux, allergies, anxiety, sleep, and other conditions may trigger depression as a side effect.
Medical problems. A serious illness, injury, disability, or other medical problem can trigger depression.
Risks of Untreated Depression
Many people have more than one serious depressive episode in their life. If untreated, MDD or any depressive disorder is serious. Not only does the condition cause needless suffering, but it can also contribute to risky behavior, work or school problems, substance abuse, damaged relationships, serious physical illnesses, and more. Without professional interventions, depression can last for years.
Untreated depression takes a serious toll on all facets of an individual’s mental and physical well-being. Not only does untreated depression affect their quality of life, but it can also contribute to life-threatening conditions or actions.
Effects of depression on the body and mind may include:
Mental health. Studies find individuals with Major Depressive Disorder have higher levels of inflammation in the areas of the brain regulating reasoning, concentration, and other functions, which may cause cognitive decline.
Physical health. Studies of patients with severe depression who have coronary artery disease, or are recovering from stroke or heart attack, have a more difficult time following doctors’ orders and making positive health care choices than those who are not struggling with depression.
Heart Disease. Many studies support the link between depression and an increase in blood pressure, insulin, and cholesterol levels, irregular heart rhythms, and an increase in stress hormones. These factors increase an individual’s risk of heart disease.
Diabetes. A meta-analysis of 23 studies published in the Journal of Clinical Psychiatry found a significantly higher incidence of diabetes in participants with depression than those without depression.
Low bone density. Research has found a correlation between depression and lower bone density, including a higher rate of osteoporosis. Experts believe depression causes an increase in the activity of cells that break down bone.
Migraines, chronic pain, and gastrointestinal problems also occur more frequently in those with depression. These issues may be of unexplained origin or may be chronic conditions that worsen the symptoms of depression.
Risk of suicide. While most people with severe depression do not attempt suicide, over 90 percent of those who die by suicide have “a diagnosable mental disorder” like depression, a substance use disorder, or a combination of disorders, according to the National Institute of Mental Health.
Factors That May Increase the Risk of Suicide
There are certain factors that may increase the risk of suicide in those with untreated depression, including:
- A previous suicide attempt
- Family history of suicide, or the suicide of a friend
- History of physical or sexual abuse, or other trauma
- Post-traumatic stress disorder (PTSD)
- A co-occurring substance use disorder (alcohol or drugs)
- Access to a firearm
- Lack of support system
- Being elderly
Suicide rates in American senior citizens are higher than in the general population and closely tied to depression. Some researchers estimate forty percent of all suicide victims in the U.S. are over the age of 60, and statistics find the rate of suicide increases as people age beyond 60.
Warning Signs a Person is Seriously Considering Suicide
Certain behaviors, comments, actions, and moods may serve as warning signs that a person is considering suicide. If a person exhibits any of the warning signs listed below, it is vital that family, friends, or the person themselves take immediate action by contacting a physician, mental health professional, or suicide hotline.
Warning signs of suicide include:
- Focusing on death. Talking, writing, or thinking about it much of the time. Talking about suicide and about others who have committed suicide.
- Exhibiting symptoms of depression, including deep sadness, apathy, hopelessness, angry outbursts, tearfulness, and severe mood swings.
- Risky behavior, including driving while under the influence of drugs or alcohol, and engaging in activities that could be fatal.
- Increased use of alcohol or drugs.
- Making plans. Putting affairs in order, giving away belongings, writing a will or suicide letter. Suddenly interrupting a period of isolation from others to visit people they care about as if to say goodbye.
- Exhibiting despair. Saying it would be better for others if they were no longer around, or that they simply no longer wanted to be alive.
- Conducting online searches for ways to commit suicide
- Purchasing a gun or pills.
Remember, if you or a loved one are struggling with suicidal thoughts, help is available. Call the National Suicide Prevention Lifeline at 800-273-8255.
Are You in Treatment or Seeking Treatment for Depression?
Depression is highly treatable. In fact, according to the American Psychiatric Association, “depression is among the most treatable of mental disorders.” Although it may take time, 80 to 90 percent of people who undergo treatment for depression respond well and notice significant improvements in symptoms.
Experts find a combination of psychotherapy, prescribed medications, avoidance of alcohol and recreational drugs, stress management, regular exercise, adequate sleep, and a long-term support system delivers the most effective long-term results for treating depression.
Psychotherapy, also called “talk therapy,” is an essential component of the treatment for depression. The goal of psychotherapy is to help you understand issues underlying your depression, change negative thought patterns, and teach you coping skills to better manage depressive triggers. Antidepressant medications may be part of your treatment plan.
The most commonly used therapeutic approaches include individual therapy, family or couples therapy, and group therapy. Depending on your situation, you may benefit from one or more of these approaches.
Studies have identified several therapeutic techniques that are particularly effective in the treatment of depression. Some of the most common techniques include:
Cognitive-behavioral therapy (CBT). Helps you identify and change negative thought and behavioral patterns into more positive ones.
Psychodynamic or psychoanalytic therapy. Helps you become aware of and learn to reframe negative emotions, which may stem from childhood conflicts and trauma.
Interpersonal therapy (IPT). Helps you improve personal and social relationships.
Besides therapeutic approaches, there are many steps you can take to improve and manage your symptoms of depression. These include:
- Attend sessions and appointments as scheduled, and complete any assignments suggested by your therapist.
- Take medications as prescribed. If a medication is not working, notify the doctor. Never abruptly stop taking an antidepressant.
- Avoid illegal drugs and alcohol.
- Practice stress management and relaxation skills. This may include practices like yoga, mindfulness, meditation, journaling, and reading inspirational stories.
- Commit to a nutritious diet, avoiding processed food and sugar. Drink the recommended amount of water each day.
- Exercise regularly. This could be as simple as walking for 30 minutes while connecting with nature. Exercise triggers the brain to increase levels of chemicals that improve mood.
- Get sufficient sleep. Guidelines suggest adults need between seven and nine hours of sleep each night.
Don’t go through depression and treatment alone. Having a support system can make a tremendous difference in your recovery journey.
While the support of family and friends is helpful, unless they have been treated for depression, they may not have the same depth of understanding as others who have experienced the disorder.
It is important to find a depression support community that feels right for you. If you are in treatment, your mental health treatment center may have a support group in place, or your doctor or therapist may have a local or online recommendation.
At Rising Phoenix Wellness Services, we help individuals manage substance use and mental health challenges. If you are struggling with depression and need support, we may be able to help. Contact us today for a free consultation.