Depression

Depression affects all of us at one time or another, and unfortunately some people struggle with it for a lifetime. However, the average person knows very little about the different types of depression.

"Exogenous" depression Some depression is primarily the result of upsetting and disappointing circumstances. This depression tends to resolve as circumstances improve or as the individual adjusts to the circumstances. This type of depression is called exogenous (coming from without) depression.

"Endogenous" depression However, other forms of depression can be much more related to inherited body chemistry and are much less the result of circumstances. This can confuse individuals because their circumstances do not seem to warrant the depression they experience. These are called endogenous (coming from within) depressions.

Bipolar Disorder There is another type of depression that is also tied to body chemistry, and that is the depressive side of Bipolar Disorder. Bipolar Disorder used to be known as Manic-Depression. In this case the person's mood varies from being hyper-energetic to being extremely depressed. These swings in mood can last for weeks or days, or in some cases for hours. There are even individuals who have both ends of the spectrum (mania and depression) simultaneously.

Seasonal Affective Disorder And finally, there is a type of depression when a person's moods are unusually affected by periods of light and darkness. In the winter they are predictably depressed. In summer, their mood is much more positive. The treatment of choice for this includes phototherapy--sitting in front of a bright light for 20 minutes or so on dark days. The light apparently affects melatonin in the body and affects ones mood.

Depression can vary in intensity. A common distinction is made between a milder, more chronic depression that lasts for at least two years (called "Dysthymia") and a much more severe, shorter depression (called "Major Depression").

Symptoms of Depression

Here are the diagnostic criteria for Major Depression:

At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning. At least one of the symptoms is either (a) depressed mood or (b) loss of interest or pleasure in normal activities. (Do not include symptoms that are clearly due to a general medical condition or psychosis only.)

Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). In children and adolescents this may show up as irritability.

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. In children, consider failure to make expected weight gains.

Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

Fatigue or loss of energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

In addition, all of the following must be true

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

What about treatment?

Treatment for depression usually involves several components:

Cognitive-behavioral intervention When one is overwhelmed by sad and hopeless feelings, a focus on correcting specific distorted thinking can help reduce feelings and behaviors that contribute to being depressed.

Medication If the depression is serious enough, medication may be useful. This is often a temporary measure to keep one's feelings from "bottoming out" while working therapeutically to lessen depression. It is often difficult for us to accept that our feelings are as affected to our biochemistry as they are. Of course, biochemistry is only one factor.

Talking about ones concerns in therapy and gaining hope and practical help can reduce the effects on ones life of previous negative experiences.

Support--in a variety of forms. It can come from support groups, therapy groups, or friends. Isolation feeds depression. So does shame.

For More Information

David C. Bissette, Psy.D. Alexandria, VA 703-705-6161