Health & Nutrition
Depression: The Invisible Disease
Symptoms and Types
• Facts About Depression
• Treatments
Depression is a serious medical condition. In contrast to the
normal emotional experiences of sadness, loss, or passing mood states,
clinical depression is persistent and can interfere significantly with an
individual's ability to function. There are three main types of depressive
disorders: major depressive disorder, dysthymic disorder, and bipolar disorder
(manic-depressive illness).
Symptoms and Types of Depression
Symptoms of depression include sad mood, loss of interest or
pleasure in activities that were once enjoyed, change in appetite or weight,
difficulty sleeping or oversleeping, physical slowing or agitation, energy
loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or
concentrating, and recurrent thoughts of death or suicide. A diagnosis of
major depressive disorder is made if a person has 5 or more of these symptoms
and impairment in usual functioning nearly every day during the same two-week
period. Major depression often begins between ages 15 to 30 but also can
appear in children. Episodes typically recur.
Some people have a chronic but less severe form of depression,
called dysthymic disorder, which is diagnosed when depressed mood persists for
at least 2 years (1 year in children) and is accompanied by at least 2 other
symptoms of depression. Many people with dysthymia develop major depressive
episodes.
Episodes of depression also occur in people with bipolar
disorder. In this disorder, depression alternates with mania, which is
characterized by abnormally and persistently elevated mood or irritability and
symptoms including overly-inflated self-esteem, decreased need for sleep,
increased talkativeness, racing thoughts, distractibility, physical agitation,
and excessive risk taking.
Because bipolar disorder requires different treatment than
major depressive disorder or dysthymia, obtaining an accurate diagnosis is
extremely important.
Facts About Depression
• Major depression is the leading cause of disability in
the U.S. and worldwide.
• Depressive disorders affect an estimated 9.5 percent
of adult Americans ages 18 and over in a given year, or about 18.8 million
people in 1998.
• Nearly twice as many women (12 percent) as men (7
percent) are affected by a depressive disorder each year.
Depression can be devastating to family relationships,
friendships, and the ability to work or go to school. Many people still
believe that the emotional symptoms caused by depression are "not
real," and that a person should be able to shake off the symptoms.
Because of these inaccurate beliefs, people with depression either may not
recognize that they have a treatable disorder or may be discouraged from
seeking or staying on treatment due to feelings of shame and stigma. Too
often, untreated or inadequately treated depression is associated with
suicide.
Treatments
Antidepressant medications are widely used, effective
treatments for depression. Existing antidepressants influence the functioning
of certain chemicals in the brain called neurotransmitters. The newer
medications, such as the selective serotonin reuptake inhibitors (S-S-R-Is), tend
to have fewer side effects than the older drugs, which include tricyclic
antidepressants (T-C-As) and monoamine oxidase inhibitors (M-A-O-Is). Although both
generations of medications are effective in relieving depression, some people
will respond to one type of drug, but not another. Other types of
antidepressants are now in development.
Certain types of psychotherapy, specifically
cognitive-behavioral therapy (C-B-T) and interpersonal therapy (I-P-T), have been
found helpful for depression. Research indicates that mild to moderate
depression often can be treated successfully with either therapy alone;
however, severe depression appears more likely to respond to a combination of
psychotherapy and medication. More than 80 percent of people with depressive
disorders improve when they receive appropriate treatment.
In situations where medication, psychotherapy, and the
combination of these interventions prove ineffective, or work too slowly to
relieve severe symptoms such as psychosis (e.g., hallucinations, delusional
thinking) or suicidality, electroconvulsive therapy (E-C-T) may be considered.
E-C-T is a highly effective treatment for severe depressive episodes. The
possibility of long-lasting memory problems, although a concern in the past,
has been significantly reduced with modern E-C-T techniques. However, the
potential benefits and risks of E-C-T, and of available alternative
interventions, should be carefully reviewed and discussed with individuals
considering this treatment and, where appropriate, with family or friends.
One herbal supplement, hypericum or St. John's wort, has been
promoted as having antidepressant properties. Results from the first
large-scale, controlled study of St. John's wort for major depression, which
was funded in part by N.I.M.H., are expected in 2001.
Note: There is evidence that St. John's wort can reduce the
effectiveness of certain medications. Use of any herbal or natural supplements
should always be discussed with your doctor before they are tried.
National Institute of Mental Health, National Institutes of Health
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