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Depression

During any 6-month period, 10 million American adults suffer from a depressive illness (approximately one in five women and one in ten men). The cost in human suffering cannot be estimated. Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them. Possibly the saddest fact about depression is that much of this suffering is unnecessary. Most people with a depressive illness do not seek treatment, although the great majority can be helped. Thanks to years of fruitful research, the medications and psychosocial therapies that ease the pain of depression are at hand. Unfortunately, many people do not recognize that they have a treatable illness. It is hoped that the information presented here may help you learn if you are one of the many undiagnosed depressed people in this country or if you know someone who is.

What is a Depressive Disorder?
A depressive disorder is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Types of Depression
Depressive disorders come in different forms, just as do other illnesses, such as heart disease. Following are three of the most prevalent types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at "full steam" or from feeling good. Sometimes people with dysthymia also experience major depressive episodes.

Another type is bipolar disorder, formerly called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can have any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase. Bipolar disorder is often a chronic recurring condition.

Depression Symptoms:

    • Persistent sad, anxious, or "empty" mood
    • Feelings of hopelessness, pessimism
    • Feelings of guilt, worthlessness, helplessness
    • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
    • Difficulty falling asleep, awakening before you want to in the morning, or oversleeping
    • Appetite and/or weight loss or overeating and weight gain
    • Decreased energy, fatigue, being "slowed down"
    • Thoughts of death or suicide; suicide attempts
    • Restlessness, irritability
    • Difficulty concentrating, remembering, making decisions
    • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Symptoms of Mania:

    • Inappropriate or unexplainable elation
    • Inappropriate irritability
    • Severe insomnia
    • Grandiose notions
    • Increased talking Disconnected and racing thoughts
    • Increased sexual desire
    • Markedly increased energy
    • Poor judgment
    • Inappropriate social behavior

Causes of Depression
Some types of depression run in families, indicating that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families, in which members of each generation develop bipolar disorder, found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder has the illness. Apparently additional factors, possibly a stressful environment, are involved in its onset.

Major depression also seems to occur, generation after generation, in some families. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with having too little or too much of certain neurochemicals.

Psychological makeup also plays a role in vulnerability to depression. People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression.

A serious loss, chronic illness, difficult relationship financial problem, or any unwelcome change in life patterns can also trigger a depressive episode. Very often, a combination of genetic, psychological and environmental factors is involved in the onset of a depressive disorder.

Psychotherapies
There are many forms of psychotherapy effectively used to help depressed individuals, including some short term (8-20 sessions) therapies. "Talking" therapies help patients gain insight into and resolve their problems through verbal "give-and- take" with the therapist. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to their depression.

Two of the short term psychotherapies that research has shown helpful for some forms of depression are Interpersonal and Cognitive/Behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, sometimes used to treat depression, focus on resolving the patient's internal psychological conflicts that are typically thought to be rooted in childhood.

In general, the severe depressive illnesses, particularly those that are recurrent, will require medication along with psychotherapy for the best outcome.

Anti-Depressant Medications
Several groups of antidepressant medications including but, not limited to the following: tricyclics, hetrocyclics, S.S.R.I.'s, MAO Inhibitors and lithium are most often used to treat depressive disorders. Lithium is the treatment of choice for bipolar disorder and some forms of recurring, major depression. Sometimes your doctor will try a variety of antidepressants before finding the medication or combination of medications most effective for you. Sometimes the dosage must be increased to be effective. Also, new types of antidepressants are being developed all the time, and one of these may be the best for you.

Patients often are tempted to stop medication too soon. It is important to keep taking medication until your doctor says to stop, even if you feel better beforehand. Some medications must be stopped gradually to give your body time to adjust. For individuals with bipolar disorder or chronic major depression, medication may have to become part of everyday life to avoid disabling symptoms.

Antidepressant drugs are not habit-forming, so you need not be concerned about that. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if you are getting the correct dosage. Your doctor will want to check the dosage and its effectiveness regularly.

If you are taking MAO inhibitors, you will have to avoid certain aged, fermented, or pickled foods. Be sure you get a complete list of foods you should not eat from your doctor and always carry it with you. Other forms of antidepressants require no food restrictions.

Never mix medications of any kind--prescribed, over-the- counter, or borrowed--without consulting your doctor. Be sure to tell your dentist or any other medical specialist who prescribes a drug that you are taking antidepressants. Some of the most benign drugs when taken alone can cause severe and dangerous side effects if taken with others. Some drugs, like alcohol, reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor.

Antianxiety drugs, such as Valium, are not antidepressants. They are sometimes prescribed along with antidepressants; however, they should not be taken alone for a depressive disorder. Sleeping pills and stimulants, such as amphetamines, are also inappropriate. Be sure to call your doctor if you have a question about any drug or if you are having a problem you believe is drug related.

Ways to Help Yourself
Depressive disorders make you feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect your situation. Negative thinking fades as treatment begins to take effect. In the meantime:

    • Do not set yourself difficult goals or take on a great deal of responsibility.
    • Break large tasks into small ones, set some priorities, and do what you can as you can.
    • Do not expect too much from yourself too soon as this will only increase feelings of failure.
    • Try to be with other people; it is usually better than being alone.
    • Participate in activities that may make you feel better.
    • You might try mild exercise, going to a movie, a ballgame, or participating in religious or social activities.
    • Don't overdo it or get upset if your mood is not greatly improved right away. Feeling better takes time.
    • Do not make major life decisions, such as changing jobs, getting married or divorced, without consulting others who know you well and who have a more objective view of your situation. In any case, it is advisable to postpone important decisions until your depression has lifted.
    • Do not expect to snap out of your depression. People rarely do. Help yourself as much as you can, and do not blame yourself for not being up to par.
    • Remember, do not accept your negative thinking. It is part of the depression and will disappear as your depression responds to treatment.

Ways to Help and be Helped by Others
Since depression can make you feel exhausted and helpless, you will want and probably need help from others. However, people who have never had a depressive disorder may not fully understand its effect. Although they won't mean to hurt you, they may say and do things that do. Therefore it may help to share information with those you most care about so they can better understand and help you.

The most important thing anyone can do for the depressed person is to help him or her get appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication.

The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the depressed person's therapist.

Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Ways to Obtain Further Information
Staff at the Counseling Center encourage you to call 765-285-1736 if you have further questions or would like to talk to someone about yourself or someone you know. Or, you may write to: 

        D/ART/Public Inquiries 
        National Institute of Mental Health 
        Room 15C-05; 5600 Fishers Lane 
        Rockville, MD 20857 

        The National Foundation for Depressive Illness 
        20 Charles Street 
        New York, NY 10014 

        National Depressive and Manic Depressive Association 
        53 West Jackson Boulevard Room 618 
        Chicago, IL 60604 

        Mental Health Association 
        1021 Prince Street 
        Alexandria, VA 22314-2971 

        The National Alliance for the Mentally Ill 
        2101 Wilson Boulevard Suite 302 
        Arlington, VA 22201