Depression
More than 19 million Americans suffer from depression each year, and women are twice as likely as men to experience a major depressive episode. Psychiatric researchers continue to investigate how biological factors (such as puberty, pregnancy and perimenopause) and social factors (trauma, substance abuse, relationships and gender roles) might contribute to women's vulnerability.
Depression is a medical condition that affects mind and body. Many sufferers go undiagnosed, either because they think the condition is untreatable or because they don't realize they are truly ill. Physicians classify depression as mild, moderate or severe by the degree of anguish and the length of time episodes last. The condition may come and go quickly, or it can last months or years if untreated. Common forms include:
- Dysthymic disorder. While not as severe as major depression, dysthymic disorder lasts longer. The sufferer may function less well or not feel good about things. The condition can afflict people who have personality and anxiety disorders as well as substance abusers.
- Major depression. Severely disabling, major depression negatively affects working, sleeping, eating and other normal activities. The pleasures of life hold almost no appeal. Episodes usually occur several times in a lifetime for affected individuals.
- Bipolar disorder, or manic-depression. Patients experience extreme mood cycles, swinging gradually from highs to lows. During manic phases, individuals are over-energized and excessively elated. When the high (mania) mood switches to low, sufferers plunge into severe depression and may become isolated, lethargic, and uninterested in pleasurable activities. Over three million Americans suffer from bipolar disorder. The condition commonly begins between ages 15 and 24, but is often not recognized until later.
Symptoms
Very often, individuals do not realize they are depressed. They blame their hopeless feelings on just "being down" and therefore fail to get treatment. Physicians sometimes have difficulty diagnosing depression because symptoms can be vague and mimic those of other illnesses.
Benchmarks of depression are episodes of sadness and loss of pleasure in most activities that last for more than two weeks. In addition, clinically depressed people will exhibit at least four of the following:
- Appetite changes. Eating too much or too little.
- Changes in sleep patterns. Insomnia, early-morning awakening, oversleeping, constant feeling of being tired.
- Rate of activity changes. Can't-sit-still restlessness or lethargy that makes moving about seem too hard.
- Feeling unworthy or guilty without reason
- Lack of concentration. Also, difficulty remembering things and making decisions.
- Thoughts of death or suicide
- Physical ailments, such as headaches, body pain, constipation or diarrhea
- Lack of interest in sex; inability to perform sexually
- Anxiety or worry without an obvious cause
- Blaming yourself or others for your depression
- Not moving or talking for long periods
- Overeating and weight gain
- Oversleeping
- Increased periods of crying, anger, anxiety, tension
- Heaviness in the arms and legs
- Sensitivity to rejection
Treatment
Persons who suspect they are suffering from depression should seek professional care as soon as possible. The earlier the intervention, the better the chances for a positive outcome. Treatment plans may include one or a combination of the following options:
- Antidepressants. Several types of medication help rebalance brain chemicals and stabilize moods. Included are tricyclics, lithium, and anticonvulsants. Antidepressant drugs take from four to eight weeks to be fully effective.
- Antianxiety drugs, amphetamines and sedatives. These are not antidepressants, but may be used in tandem with antidepressants.
- Psychotherapy. Talking with a therapist has proven to have a positive effect on overcoming depression. Interpersonal psychotherapy focuses on the patient's disturbed personal relationships. Cognitive/behavioral therapists concentrate on changing negative styles of thinking. Psychodynamic therapies are used to resolve patients' conflicted feelings.
- Electroconvulsive therapy (ECT). For this treatment, the patient is briefly put under anesthesia. Electrodes attached to the head deliver mild electrical impulses to the brain. This treatment is often used when patients can't or won't take medication.
Resources at Cedars-Sinai
Department of Psychiatry and Behavioral Neurosciences
