Depression

Causes and Symptoms

Depression is a medical illness that involves the body and the mind, that can affect the way one eats and sleeps, the way one feels about oneself, and the way one thinks about things. About 12% of men and up to 25% of women suffer from depression as a medical disorder (often identified as “clinical depression”) during their lifetimes. It can be associated with chemical imbalances in the brain; at the same time, it can have organic and psychological causes. Confusing the matter further, depression often has physical manifestations. It has long been a difficult condition to define and identify. It has been repeatedly established that depressed patients who successfully complete psychotherapeutic processes often find that their chemical imbalances disappear with time and healing. This suggests that the imbalance is the body's physical response to psychological depression, rather than the other way around. Conversely, medication is often an effective means of correcting chemical imbalances, so as to enable the process of recovery.

Depression can be inherited, and some types of depression do seem to run in families. Studies of depression in families have generally found that the genetic makeup of afflicted members is somewhat different than those not diagnosed with depression. However, not everybody with the genetic makeup that causes this vulnerability develops a disorder. Additional psychological factors, such as stress and sadness, can also be involved. It must be understood, however, that depression also regularly occurs in those with no family history thereof; while in some cases there may be contributing biological factors, it remains a psychological disorder.

People who have low self-esteem, who consistently view themselves and the nihilistically, or who are easily overwhelmed by stress are more prone to depression. Psychologists often describe social learning factors as being significant in the development of depression. Environmental factors influence psychological development, and the way people try to resolve problems. Social learning factors also explain why psychological problems appear to occur more often in family members, from generation to generation. If a child grows up in an environment wherein discouragement is common, the child will generally be vulnerable to depression.

A serious loss, chronic illness, relationship problems, work stress, family crisis, financial setback, or any unwelcome life change can trigger a depressive episode. The symptoms of depression can include loss of interest in activities that were once interesting or enjoyable; loss of appetite with weight loss; overeating with weight gain; loss of emotional expression (known as “flat affect”); a persistently sad, anxious or empty mood; feelings of hopelessness, worthlessness, or guilt; social withdrawal; chronic fatigue; insomnia; oversleeping; recurrent physical problems like headaches or digestive disorders that do not respond to treatment; thoughts of death or suicide. Alcohol or drug abuse can also sometimes be signs of depression.

A depressive disorder is not the same as a passing mood. It’s not a sign of personal weakness or a condition that can be wished away. One with a depressive disease cannot merely “pull it together” and get better. Without treatment, symptoms can sometimes last for years. Appropriate treatment, however, can help most people with depression.

Diagnosis

Depression can affect anyone. Once identified, most people diagnosed with depression are successfully treated. Unfortunately, depression is not always diagnosed, because many of the symptoms mimic physical illness, such as sleep and appetite disturbances. Recognizing depression is the first step in treating it.

The first step to getting appropriate treatment for any emotional problem is a complete psychological evaluation to determine whether you have a depressive illness. Consultation with a psychologist will include a review of your physical health history. A good psychological diagnostic evaluation will include a complete history of your symptoms. Psychoptherapy has proved emminently successful in treating depression, although many patients require additional treatment with antidepressants. Medication can allow for relatively quick symptom relief, and will often be suggested for depressed patients with severe and disabling symptoms. However, it must be understood that no medication can “cure” depression; it can only treat the symptoms, making daily life more manageable and making it easier for the patient to address the true causes of a depressive disorder.

A diagnostic evaluation also includes a mental status examination to determine if the patient’s speech, thought pattern, or memory has been affected, as often happens in the case of a depressive or manic-depressive illness.

There is currently no laboratory test that can diagnose a mental disorder. Even the powerful scans which help diagnose other neurological disorders (i.e., stroke, brain tumor) cannot detect the subtle and complex brain changes in psychiatric illness.

Treatment

Because the causes, symptoms, and degrees of severity associated with depression are so widely varied, effective treatment can come in a number of different forms. The most common treatments for depression include psychotherapy, drugs, hospitalization, and electroconvulsive (or electroshock) therapy. Hospitalization is sometimes the recourse in the case of depressed patients who are suicidal. In less mortally compromising cases, psychotherapy is generally effective if the patient is willing to participate in the therapeutic process. A good psychotherapist attempts to develop, through speaking with the patient, childhood events that could foster vulnerability to depression, and any events that preceded the patient's current depression. In many cases a psychiatrist will prescribe medication to help balance the chemistry of the brain. As with all medications, antidepressants should never be taken except under the instruction of a qualified healthcare provider.

Nearly two-thirds of depressed people do not get proper treatment. Often, this is because the symptoms are not recognized as depression. In some cases, depressed people can appear simply weak or lazy. In other cases, the symptoms of clinical depression can be so disabling that one affected cannot reach out for help. Additionally, many symptoms are misdiagnosed as nothing more than physical problems, and individual symptoms are treated, rather than the underlying cause. There is also often a social stigma associated with depression and therapy that can cause someone to avoid essential treatment. Every person is biochemically unique. However, with proper treatment, nearly 80% of those with depression can make significant improvement.