The Dark Cloud of Depression

What is depression?

According to the DSM-IV, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following nine symptoms at the same time: a depressed mood during most of the day, particularly in the morning fatigue or loss of energy almost every day feelings of worthlessness or guilt almost every day impaired concentration, indecisiveness insomnia or hypersomnia (excessive sleeping) almost every day markedly diminished interest or pleasure in almost all activities nearly every day recurring thoughts of death or suicide (not just fearing death) a sense of restlessness — known as psychomotor agitation — or being slowed down — retardation significant weight loss or gain (a change of more than 5% of body weight in a month)

How long do these signs have to be present before they are diagnosed as depression?

With major or clinical depression, one of the key signs is either depressed mood or loss of interest. For a diagnosis of depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. In addition, the depressive symptoms need to cause clinically significant distress or impairment. They cannot be due to the direct effects of a substance, for example, a drug or medication. Nor can they be the result of a medical condition such as hypothyroidism. Finally, if the symptoms occur within two months of the loss of a loved one, they will not be diagnosed as depression.

What are some common feelings associated with depression?

According to the National Institute of Mental Health, people with depressive illnesses do not all experience the same symptoms. How severe they are, how frequent, and how long they last will vary. It depends on the individual and his or her particular illness. Here are common symptoms people with depression experience:
difficulty concentrating, remembering details, and making decisions
fatigue and decreased energy
feelings of guilt, worthlessness, and/or helplessness
feelings of hopelessness and/or pessimism
insomnia, early morning wakefulness, or excessive sleeping
irritability, restlessness
loss of interest in activities or hobbies once pleasurable, including sex
no pleasure left in life any more
overeating or appetite loss
persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
persistent sad, anxious, or “empty” feelings
thoughts of suicide, suicide attempts

While these are common symptoms of depression, they may also occur in patterns. For example, a person may experience depression with mania or hypomania — a condition sometimes called manic depression. Or the symptoms may be seasonal as in the case of seasonal affective disorder.

There are several types of manic depression. People with bipolar II disorder have at least one episode of major depression and at least one hypomanic — mild elation or high — episode. People with bipolar I disorder have a history of at least one manic — extreme elation or high — episode, with or without past major depressive episodes. A patient with unipolar depression has major depression only but does not have hypomania or mania.
Is childhood depression common?

Childhood depression is different from the normal “blues” and everyday emotions that occur as a child develops. If your child is sad, this does not necessarily mean he or she has significant depression. It’s when the sadness becomes persistent — day after day — that depression may be an issue. Or, if your child has disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life, it may indicate that he or she has a depressive illness. Keep in mind that while depression is a serious illness, it is also a treatable one.

For more information, see WebMD’s Childhood Depression.
What about depression in teens?

It is common for teens to occasionally feel unhappy. However, when the unhappiness lasts for more than two weeks and the teen experiences other symptoms of depression, then he or she may be suffering from adolescent depression. Because as many as one in every 33 children and one in eight adolescents suffer with depression, talk to your doctor and find out if your teen may be depressed. There is effective treatment available to help teens move beyond depression as they grow older.

For more information, see WebMD’s Teen Depression.

Is depression difficult to diagnose?

It is estimated that, by the year 2020, major depression will be second only to ischemic heart disease in terms of the leading causes of illness in the world. But patients with depression sometimes fail to realize (or accept) that there is a physical cause to their depressed moods. As a result, they may search endlessly for external causes.

In the U.S., about 14.8 million adults suffer from major depression, according to the National Institute of Mental Health. The suicide risk in people with this type of depression is the highest rate for any psychiatric state. For people between the ages of 10 and 24, suicide is the third leading cause of death. Unfortunately, most people with clinical depression never seek treatment. Left undiagnosed and untreated, depression can worsen, lasting for years and causing untold suffering, and possibly suicide.

What are the warning signs of suicide?

Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) — or the deaf hotline at 1-800-4889. Or contact a mental health professional immediately.

Warning signs of suicide include:
thoughts or talk of death or suicide
thoughts or talk of self-harm or harm to others
aggressive behavior or impulsiveness

Previous suicide attempts increase the risk for future suicide attempts and completed suicide. All mention of suicide or violence must be taken seriously. If you intend or have a plan to commit suicide, go to the emergency room for immediate treatment.
Are there different types of depression?

There are a number of different types of depression including:
major depression
chronic depression (dysthymia)
bipolar depression
seasonal depression (SAD or seasonal affective disorder)
psychotic depression
postpartum depression
substance-induced mood disorder (SIMD)

Are there other types of depression?

Other types of depression that can occur include:
double depression — a condition that happens when a person with chronic depression (dysthymia) experiences an episode of major depression
secondary depression — a depression that develops after the development of a medical condition such as hypothyroidism, stroke, Parkinson’s disease, or AIDS, or after a psychiatric problem such as schizophrenia, panic disorder, or bulimia
chronic treatment-resistant depression — a condition that lasts over a year and is extremely difficult to treat with antidepressants and other psychopharmacologic drugs and psychotherapies
masked depression — a depression that is hidden behind physical complaints for which no organic cause can be found.

For chronic treatment-resistant depression, electroconvulsive therapy (ECT) is usually the treatment of choice.
Can depression occur with other mental illnesses?

Depression commonly occurs with other illnesses such as anxiety, obsessive compulsive disorder, panic disorder, phobias, and eating disorders. If you or a loved one has symptoms of depression and/or these other mental illnesses, talk to your doctor. Treatment is available to lift the depression so you or a loved one can regain your meaningful life.

For more information, see WebMD’s Depression and Other Mental Illnesses.
Can depression have physical symptoms?

Because certain brain chemicals or neurotransmitters, specifically serotonin and norepinephrine, influence both mood and pain, it’s not uncommon for depressed individuals to have physical symptoms. These symptoms may include joint pain, back pain, gastrointestinal problems, sleep disturbances, and appetite changes. The symptoms may also be accompanied by slowed speech and physical retardation. Many patients go from doctor to doctor seeking treatment for their physical symptoms when, in fact, they are clinically depressed.
Where can I get help for depression?

If you or someone you know is experiencing symptoms of depression, seek your health care provider’s advice for treatment or referral to a mental health professional.

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