*  Signs & symptoms  *  Causes  *  When to seek medical advice ?   *

Depression

     Overview

Throughout the course of our lives, we all experience episodes of unhappiness, sadness, or grief. Often, when a loved one dies or we suffer a personal tragedy or difficulty such as divorce or loss of a job, we may feel depressed (some people call this "the blues"). Most of us are able to cope with these and other types of stressful events.
Over a period of days or weeks, the majority of us are able to return to our normal activities. But when these feelings of sadness and other symptoms make it hard for us to get through the day, and when the symptoms last for more than a couple of weeks, we may have what is called clinical depression. The term "clinical depression" is usually used to distinguish "true" depression from the blues.
Clinical depression is not just grief or sadness. It is an illness that can challenge your ability to perform even routine daily activities. At its worst, depression may lead you to contemplate or commit suicide. Depression represents a burden for both you and your family. Sometimes that burden can seem overwhelming.

There are several different types of depression (mood disorders that include depressive symptoms):

• Major depression is a change in mood that lasts for weeks or months. It is one of the most severe types of depression. It usually involves a low or irritable mood and/or a loss of interest or pleasure in usual activities. It interferes with one's normal functioning and often include physical symptoms. A person may experience only one episode, but often there are repeated episodes over an individual's lifetime.

• Dysthymia is less severe than major depression but usually goes on for a longer period, often several years. There are usually periods of feeling fairly normal between episodes of low mood. The symptoms usually do not completely disrupt one's normal activities.

• Bipolar disorder involves episodes of depression, usually severe, alternating with episodes of extreme elation called mania. This condition is sometimes called by its older name, manic depression. The depression that is associated with bipolar disorder is often referred to as bipolar depression.

• Seasonal depression, which medical professionals call seasonal affective disorder, or SAD, is depression that occurs only at a certain time of the year, usually winter. It is sometimes called "winter blues." Although it is predictable, it can be very severe.

Adjustment disorder is distress that occurs in relation to a stressful life event. It is usually an isolated reaction that resolves when the stress passes. Although it may be accompanied by a depressed mood, it is not considered a depressive disorder.
Some people believe that depression is "normal" in people who are elderly, have other health problems, have setbacks or other tragedies, or have bad life situations. On the contrary, clinical depression is always abnormal and always requires attention from a medical or mental-health professional. The good news is that depression can be diagnosed and treated effectively in most people. The biggest barrier to overcoming depression is recognizing that someone is depressed and seeking appropriate treatment.

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     Signs and symptoms

• Loss of interest in normal daily activities

• Feeling sad or down

• Feeling hopeless

• Crying spells for no apparent reason

• Problems sleeping

• Trouble focusing or concentrating

• Difficulty making decisions

• Unintentional weight gain or loss

• Irritability

• Restlessness

• Being easily annoyed

• Feeling fatigued or weak

• Feeling worthless

• Loss of interest in sex

• Thoughts of suicide or suicidal behavior

• Unexplained physical problems, such as back pain or headaches

Depression symptoms can vary greatly because different people experience depression in different ways. A 25-year-old man with depression may not have the same symptoms as a 70-year-old man, for instance. For some people, depression symptoms are so severe that it's obvious something isn't right. Others may feel generally miserable or unhappy without really knowing why.

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     Causes

It's not known specifically what causes depression. As with many mental illnesses, it's thought that a variety of biochemical, genetic and environmental factors may cause depression:

• Biochemical. Some evidence from high-tech imaging studies indicates that people with depression have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. The naturally occurring brain chemicals called neurotransmitters, which are linked to mood, also may play a role in depression. Hormonal imbalances also could be a culprit.

• Genes. Some studies show that depression is more common in people whose biological family members also have the condition. Researchers are trying to find genes that may be involved in causing depression.

• Environment. Environment is also thought to play a causal role in some way. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems and high stress.

In some people, depression can be traced to a single cause, while in others, a number of causes are at play. For many, the causes are never known.

While we still don't know exactly how levels of these neurotransmitters affect mood, we do know that the levels can be affected by a number of factors.

• Heredity: Certain types of depression seem to run in certain families. Research is ongoing as to exactly which genes are involved in depression. Just because someone is your family has depression, however, doesn't mean you will. Sometimes, family members who were known to abuse alcohol or other drugs were unwittingly trying to improve their mood (often called "self-medication" by professionals). Likewise, you can become depressed even if no one else in your family is known to have depression.

• Personality: People with certain personality traits are more likely to become depressed. These include negative thinking, pessimism, excess worry, low self-esteem, over-dependence on others, and ineffective responses to stress.

• Situations: Difficult life events, loss, change, or persistent stress can cause levels of neurotransmitters to become unbalanced, leading to depression. Even happy events, such as childbirth, can be stressful and cause postpartum depression.

• Medical conditions: Depression is more likely to occur with certain medical conditions. These "co-occurring" conditions include heart disease, stroke, diabetes, cancer, hormonal disorders (especially peri-menopause or hypothyroidism, known as "low thyroid"), Parkinson disease, and Alzheimer disease. Clinical depression should not be considered a normal or natural reaction to illness.

• Medications: Some medications used for long periods, such as prednisone, certain blood pressure medicines, sleeping pills, and even birth control pills in some cases, can cause depression.

• Substance abuse: While it has long been believed that depression caused people to misuse alcohol and drugs in an attempt to make themselves feel better (self-medication), it is now thought that the reverse can also be the case; substance abuse can actually cause depression.

• Diet: Deficiencies in certain vitamins, such as folic acid and B-12, may cause depression.

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     When to seek medical advice ?

It's perfectly normal to occasionally feel sad or upset, or to be unhappy with situations in your life. But with depression, these feelings linger for weeks, months or even years. And these feelings also are much more intense than "just the blues" and can interfere with relationships, work and daily activities, and even your ability to eat and bathe. 
Feelings of depression can also lead to suicide. If you have any symptoms of depression, seek medical help as soon as possible. Depression usually doesn't get better on its own, and it may even get worse if left untreated. 
If you have a primary care doctor, talk to him or her about your depression symptoms. Or seek help from a mental health provider. If you're reluctant to seek treatment, try to work up the courage to confide in someone about your feelings, whether it's a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment of depression.

When you have suicidal thoughts
Suicidal thoughts and behavior are common among people with depression. If you're considering suicide right now and have the means available, talk to someone now. The best choice is to call 911 or your local emergency services number. If you simply don't want to do that, for whatever reason, you have other choices for reaching out to someone:

• Contact a family member or friend

• Contact a doctor, mental health provider or other health care professional

• Contact a minister, spiritual leader or someone in your faith community

• Go to your local hospital emergency room

• Call a crisis center or hot line

Helping a loved one with depression symptoms
If you have a loved one who you think may have symptoms of depression, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. 
You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help.

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