DEPRESSION AND DEPRESSIVE DISORDERS
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PSYCHOLOGICAL SYMPTOMS
Depressed Mood
Feelings of:
- Apathy and lethargy
- Aloneness
- Depletion
- Emptiness Guilt
- Helplessness
- Hopelessness
- Irritability, touchiness
- Sadness
- Shame
- Self-reproach
Mental Effects of Depression
- Concentration & memory are impaired
- Indecision
- Interests are reduced
- Loss of initiative & motivation
- Self-esteem/self-worth fall, worthless feelings
- Suicidal thinking or urges
- Withdrawal from others
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PHYSICAL SYMPTOMS
- Agitation
- Appetite reduced (sometimes appetite increases substantially)
- Constipation
- Energy sapped/reduced
- Fatigue most of the time
- Gastro-intestinal distress
- Sexual interest & urges reduced
- Slowed speech and thinking
- Unable to feel enjoyment of life, loss of pleasure in life, unheeding
- Sleep disturbance (unusual difficulty falling asleep, waking during the night 2-3 times, or frequently getting up earlier than intended) or desire to sleep most of the time.
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Depression is one of the most common emotional problems. A large percentage of people will experience depression at some time in life, as many as 15% of the population. There is no stigma or weakness in getting depressed; all of us are vulnerable to depression.
In essence, depression means a sad, down, or imitable mood, lasting for a week or more, which is impairing the ability to enjoy life, to work, to sleep, or to interact with others. Depression can be brief or can last two or more years. Depression can stop for a while or for a long time and then can return intermittently. Depression is not the same as grieving, although prolonged mourning can turn into depression.
Depression often occurs after a loss, disappointment, or emotional hurt, or when feelings of guilt, shame, aloneness, emptiness, or depletion become dominating or overwhelming over days, weeks, or months. Also depression varies widely in severity. At one end of the spectrum, you may be able to follow your daily routines, while experiencing fatigue, sleeping poorly, or feeling guilt or other painful emotions. In the middle of the spectrum are more significant feelings of sadness, difficulty working, having trouble accomplishing routine tasks, loss of interest in sex or other usual activities, and spending a lot of time dwelling on \the depression. At the most severe end of the spectrum, depression involves many of the symptoms all occurring together and a great deal of distress, along with a great deal of difficulty in daily life. At the most severe end of the spectrum, thought processes can become distorted or out of touch with reality.
What are some causes of depression?
- Loss. Reactions to a loss can precipitate a depression. The loss can be of a loved one, a job, loss of health, whatever you experience as a loss. The sadness of a loss usually resolves over time. However, ambivalent feelings about the loss can lead to prolong or deeply depressed reactions.
- Guilt. Self-reproach leads to turning angry feelings against oneself, blaming oneself, and a loss of ones selfworth.
- Emptiness and shame. Sometimes ones sense of self feels fragile and one feels anxious about experiencing abandonment. This leads to feelings of aloneness and emptiness.
- Biological Factors. Genetic causes in families with a history of depression may be associated with a reduced amount of the brain chemicals serotonin, dopamine, and norepinephrine, or inefficient use of those chemicals. These are the chemicals which regulate mood and feelings of satisfaction or reinforcement.
Psychotherapy has proven to be effective with most depressions, even severe depressions. If the depression is in reaction to an event, change, or loss, therapy helps you understand how coping with that loss is bringing you down and how to cope more effectively.
Cognitive Behavioral Therapy is one of the most effective methods. The therapist looks at your thought processes, known as catastrophizing, personalizing, black-and-white thinking, and over generalizing, which are known to produce depressed mood, and at various beliefs about life, which, when they change, will help you recover.
Psychodynamic [Psychoanalytic] Therapy helps resolve emotional conflicts which have led to ineffective ways of relating to others and coping with internal emotions and impulses. Interpersonal Therapy helps resolve the ways of relating to others which have caused unsatisfying relationships and negative emotional states.
Marriage and Family Therapy is often used to help you change the environment and interactions in your life, and these changes often help change moods.
Any of these methods can be used in the context of EMDR (Eye Movement Desensitization and Reprocessing) and other kinds of psychotherapy..
Medications have proven effective with depression. [Note, all drugs have a generic name and a brand name, so the name of your medication may be different from the ones we list here.] For Bipolar Disorders, some form of lithium or of valproic acid is used as a mood stabilizer, which helps prevent the extremes of mood. Neurontin and Tegretol have also been used for Bipolar disorder. For depression alone, older medications and newer ones are about equally effective, but the newer ones have fewer side effects and work faster. Amitriptyline, Doxepin, Imipramine, Desipramine, Nortriptyline, and Trazadone can be used in order to promote sleep or reduce depression. Some of these medications need several weeks in order to produce optimal results. Newer medications such as Prozac, Pazil, Effexor, Serzone, Zoloft, Remaron, Wellbutrin, and Celexa tend to work more quickly, with fewer side effects, so they are the first to be prescribed. Despite TV commercials suggesting medication is the answer, medication alone is rarely the best choice, and psychotherapy is important for recovery. Furthermore, many people can be treated by psycho-therapy alone and do not require medications.
Because the care of people with depression is highly individualized, please be open to guidance from our staff on the best treatment or combination of treatments for your benefit.
What are the types of depression?
Actually there are many kinds of depression.
Depressive Adjustment Disorder. Depressed mood for 1-12 weeks after a loss or painful event.
Diethylamide. Depressed mood lasting almost continuously for two or more years, not usually so severe as to prevent work or most daily activities.
Major (Clinical) Depression. Depression which includes difficulty handling daily life and severe emotional distress, lasting at least a week or more. Chronic Major Depression can be long lasting with few breaks from the blue moods or it can be Recurrent.
Cyclothymia. Alternating periods of depressed mood and elevated mood. Although one's moods rarely feel stable and normal, the swings are not extreme and the impairment in daily life is not usually too handicapping as it would be in Bipolar Disorder.
Bipolar I Disorder. Alternating periods of depressed mood and elevated mood which can be quite extreme, with despondent moods on the one hand and manic, elevated moods on the other. These moods can shift slowly over a period of months or rapidly over a period of hours or days. In Bipolar II Disorder, the lows can be very low, but the manic moods are not extreme.
Atypical. In most depressions, a loss of appetite or interrupted sleep occur, but sometimes increased appetite, increased desire for sleep, or agitated mood predominate. We call this Atypical.
Recurrent. Major Depression can return periodically through one's life.
Masked Depression which is channeled into physical symptoms, such as headaches, or into increased alcohol or drug consumption
Treatment Resistant. Depression which does not improve despite treatment with several courses of medication therapy and psychotherapy.
Child and Adolescent Depression. Young people can experience depression in the same way as adults, but often we observe restlessness, physical complaints, school avoidance or truancy, adolescent promiscuity, running away, loneliness, feeling friendless and unloved.
Geriatric Depression. Sometimes in older people, depression includes confusion, memory impairment, loss of energy, and lethargy.
Grieving. In Grief, sadness and crying, which are normal and expected, occur. But grief can lead to depression when the symptoms persist, preoccupation with the loved one lingers for weeks or longer, and the sense of normal life and mood do not return.
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