Mark Hillman, Ph.D., (Psy) LMHC
Everyone gets blue now and then in response to life's disappointments, but when feelings such as sadness, loneliness, exhaustion, hopelessness, and irritability persist and prevent a person from functioning normally, they may be suffering from depression. Depression can be devastating to all areas of a person's everyday life, affecting their relationships with family and friends, impeding their ability to work or go to school, and even disrupting their normal eating and sleeping patterns. Depression is not a sign of personal weakness; people with a depressive illness cannot merely "pull themselves together" and get better. If left untreated, symptoms can last for weeks, months, or even years, causing needless pain and suffering, not only to the person who is depressed, but also to those who care about them. Untreated, depression can even lead to suicide. Depression can afflict anyone, regardless of age, race, class, or gender. Nearly 20 million Americans suffer from depression each year, but only one out of ten seeks out and receives adequate treatment, even though the great majority of people with depression--including those whose illness is extremely severe--can be helped to full recovery.
Depressive disorders come in different forms, just as in the case of many other illnesses. Two of the most common depressive disorders--major depressive disorder and dysthymia--are detailed below.
Major Depressive Disorder (often referred to as clinical depression) is manifested by a combination of symptoms that severely interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities. A diagnosis of major depressive disorder is made if an individual has five or more of the depression symptoms listed below, and at least one of the first two, during the same two-week period. Disabling episodes of major depression affect 15% of Americans and can occur one or more times in a person's lifetime.
Dysthymia (sometimes called minor or chronic depression) does not strike in episodes like major depression; rather it is characterized by less intense, more persistent symptoms that may last for years (at least two years in adults, and at least one year in children or adolescents). Typically, there are no disturbances in appetite or sexual drive. Severe agitation, sedentary behavior, and suicidal thoughts are also not usually present in dysthymia. While the symptoms of dysthymia are not as disabling as those for major depression, people who suffer from this depressive disorder do experience decreased energy, general negativity, and an overall sense of dissatisfaction and hopelessness that pervades most, if not all, areas of their life. Many people with dysthymia also experience major depressive episodes; in such cases, the condition is known as double depression. Almost 10 million Americans suffer from dysthymia each year.
While major depressive disorder and dysthymia are considered the two most common depressive disorders, there are other types of depression, including adjustment disorder, complicated grief, and seasonal affective disorder.
Adjustment disorder is an abnormal and excessive reaction to a life stressor, such as starting school, getting divorced, or grief.
Complicated or unresolved grief may appear as a complete absence of grief and mourning, an ongoing inability to experience normal grief reactions, delayed grief, conflicted grief, or chronic grief. Complicated grief is identified by the extended length of time of the symptoms, the interference caused by the symptoms, or by the intensity of the symptoms.
Seasonal Affective Disorder (SAD) refers to a mood disorder in which a person has depression that worsens in the fall and winter, when the amount of sunlight per day lessens.
Not everyone who is depressed experiences every symptom listed below. The severity of symptoms also varies with individuals. A person's diagnosis depends on the number of symptoms they have, how strong those symptoms are, and how long they last.
The sooner depression is treated, the sooner recovery can begin. The American Psychiatric Association reports that "80% to 90% of all people with depression-even those with the severest cases-improve once they receive appropriate treatment." Basic ways to treat depression include therapy, medication, and a combination of the two.
There are therapists who are especially skilled at helping people who are suffering from depression. Therapy provides a safe, comforting, and confidential setting in which to receive the kind of help and understanding that can best assist in first relieving, then understanding, and finally recovering from the effects of depression. Therapy provides the kind of care and professional monitoring that can relieve symptoms, help to change the negative styles of thinking and behaving often associated with depression, and work through any distressing personal relationships that may be contributing to the individual's condition.
Antidepressant medication is often the first step in treating cases of depression because of the relatively quick relief it can bring to physical symptoms. Once medication treatment begins, minor improvement is usually seen in one to two weeks and the full effect of relief becomes evident approximately three to four weeks later.
In some cases, neither therapy alone nor medication alone may treat depression as quickly or thoroughly as the patient or the therapist would like. For these cases, both types of treatment used together can have very successful results. For those who suffer from chronic depression, combination therapy is especially helpful in dealing with the condition and how it affects their lives.
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