Depression: A hypothetical scenario

A woman (I’ll call June) wakes up to a beautiful spring morning. The sun is shining, birds are singing and there is no rain in the forecast. For a moment, she is excited to start the day but then her mood changes and she feels an overwhelming feeling of sadness. Memories of her friend’s death come into her mind. She wants to go out and garden on this lovely day but does not go out as she does not have the energy to do so. June has been invited to play tennis later in the day with a group of friends but does not answer the phone when they call to confirm the time. She cannot imagine what she would have of value to say to the women considering how she feels about herself and life. Besides, she did not sleep well last night and is exhausted. She feels guilty that she is not answering the phone but just lets it ring.

June has been feeling this way for about a month and is considering going to her physician for help. She picks up the phone to call for an appointment but puts it down. She thinks, “I can handle this on my own.” June is one of the many untreated depressed people in the world trying to “handle” it on their own. This technique can work for some people but for others seeking help from a professional is needed.

What is depression?

Most people become sad or have depressed feelings sometime during their lives. There are many events which cause one to temporarily feel down. Sadness, feeling down and a depressed mood are all a part of life. However, when a depressed mood lingers daily for more than two weeks and limits your daily functioning it may no longer be normal, but a diagnosable illness.

A depressive illness can be broken down into four clusters: how you think (a negative view of the self, the world and the future), how your body reacts (fatigue or loss of energy, trouble with sleep and/ or appetite), how you act (losing interest in previously enjoyed activities, withdrawing and isolating from others), and how you feel (depressed, guilty, worthless and/ or helpless, and perhaps suicidal). All people do not experience depression in the same way; however, when five of the above symptoms are experienced for two weeks or longer (a depressed mood or a lack of interest must be present) a major depression may be occurring. If a person is feeling this way, they are encouraged to contact their physician or a mental health professional to develop a course of action to manage the depression. Depression may develop rapidly or come on slowly over a period of weeks. When depression is mild, a person may be able to go through their everyday steps of life but they feel bad and lack energy. At other times, depression may be so severe that hospitalization is required.

Statistics

A depressive episode can be devastating to the depressed person and their family. Millions of people are affected by some form of depression. However, it has been estimated that 2/3 of those affected do not seek necessary treatment. On a positive note, 80% of all people who have received treatment have significantly improved their lives. The World Health Organization estimates that by the year 2020, major depression will be the number two cause of “lost years of healthy life” worldwide. The disorder is not only debilitating but a significant health and economic problem. Sadly, the economic cost of depression is estimated at over 30 billion dollars a year but the cost of human suffering cannot be estimated.

Depression is the leading cause of disability among those 14-44 in the United States. Several years ago, the average initial onset age was in the late 40s to early 50s. However, with the stressful 24/7 society in which we live and great concerns such as terrorism, environmental problems and often a lack of nuclear family support for young people, the average initial onset has dropped to the mid-20s. Women are diagnosed with depression at approximately twice the rate of men. This statistic may be due to the fact that women are more likely to seek treatment for the disorder. Depression is an equal opportunity condition that can and will occur independently of life status, religious beliefs, power or wealth.

Causes of depression

Depression can be inherited however the environment may either play an important causal role or enhance underlying genetic vulnerabilities. Some of the common causes of depression include: genetics, brain chemistry imbalance, female sex hormones, circadian rhythm disturbance (seasonal affective disorder), poor nutrition, medical illnesses, drugs (both legal and illegal), stressful life events and grief and loss.

Treatment options

Depression can be treated by medical and psychological treatment approaches. Often when a medical condition is addressed and there was a secondary condition of depression present, the depression will generally lesson or clear up. Depression can be a side effect of some drugs taken for medical issues. If depression occurs while taking a medication, the prescribing physician should be notified as there may be a medication without this side effect. Depression can also make one’s medical condition or recovery worse or difficult to manage. Just open a magazine today or turn on the television and antidepressants are being advertised as being helpful in reducing the symptoms related to depression. Often, people are afraid to take these medications because of stigmas associated with them. A depressed person is encouraged to discuss medication options with a physician or psychiatry professional to determine if drug therapy is right for them. There are also several methods of helpful psychological treatments available for the depressed person. Some examples are self-help books, support groups, online resources and group and individual therapy. If individual therapy is chosen, it is important that the therapist is empathic, helps to work on agreed upon goals and that a sense of rapport is felt with the therapist. Depression is a treatable condition - a person just needs to reach for help.

Debra Warner, MA, is a Licensed Psychologist who works at Range Mental Health Center in Virginia, MN.