Depression

Overview
The term depressive illness refers to a broad range of mood disorders. Rather than a single phenomenon, depression is a complex, multidimensional clinical syndrome. Depression may be mild or severe, obvious or masked, episodic or chronic. Although specific symptoms vary, depression affects your thoughts, feelings and behavior, as well as your body. Depression can have a major impact on the lives of both the person who is depressed and his or her family.

Causes/associated factors
Depression is one of the most common psychiatric conditions. In any given one-year period, about 10 percent of the U.S. population experience a depressive illness. On average, depression begins in the mid-20s. Some people may have isolated episodes of depression, while others have clustered episodes or increasingly frequent episodes as they grow older. Depression costs an estimated $12 billion in workdays each year.
There are multiple theories about the causes of depression, including physical, biochemical or genetic factors; environmental stress; social or relational issues; and cognitive or psychological factors. Major depressive episodes may also be related to severe psychological stress, such as the death of a loved one, a divorce or a job loss. It may also be a response to any major change, even if the change is considered positive.

Sex and depression
Nearly twice as many women as men are affected by a depressive illness each year. Depression in men may be underreported, however, since fewer men seek treatment for depressive symptoms. Men who have depression report more drug and alcohol abuse than women experiencing depression. Depression in men may manifest itself as anger, irritability or negative behavior patterns.


Characteristics
A person who is depressed may feel hopeless, angry, irritable, helpless or powerless. The person may have an inability to take pleasure in things ordinarily enjoyed. He or she may have low self-esteem, apathy or pessimism. Loss of motivation, difficulty concentrating, difficulty focusing or forgetfulness may occur.
A person who is depressed may have crying spells and a diminished ability to cope. The person may become withdrawn or isolated. He or she may neglect routine activities and pay less attention to personal hygiene or self-care. The person may engage in aggressive or destructive behavior. Self-harm is possible. People who have major depression are at an increased risk for suicide.

Depression can have physical symptoms as well, including sleep or appetite changes, decreased energy level, disturbance in sexual function, and fatigue or slowed thinking.

As with all physical symptoms, consult a medical health care provider to rule out a medical condition. If these or any other symptoms cause distress that doesn't seem to improve, seek additional help and support from a mental health care professional.

Children and depression
The essential features of depression in children are similar to those in adults. Children are more likely to have physical complaints, irritability and social withdrawal, however. Comparatively, adolescents and adults are more likely to have slowed reactions, an excessive need to sleep and delusions.


Treatment
Depression is one of the most successfully treated mental health disorders. See your primary care doctor to identify or rule out any medical conditions that may be contributing to the depression. Sadly, despite the effectiveness of treatment, less than half of those who have depression will seek help.
Mental health treatment will depend on the type of depression you have and the extent of your symptoms.

Medication alone may be sufficient for mild forms of depression. For moderate to severe depression, drug intervention in the context of supportive therapy and education about depression is the preferred form of treatment. Fifty percent of people who are depressed will have at least a 50 percent decrease in symptoms with the first choice of antidepressant medication. Of these, one-third to half attain full remission of symptoms. For those not experiencing full remission, switching to another antidepressant, adding a mood stabilizer, or combining antidepressants may be effective.

Psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy or brief individual therapy with an interpersonal focus may be helpful for some cases of depression. Inpatient hospitalization may be needed for cases involving suicidal thoughts, psychotic episodes, physical debilitation or concurrent severe medical illness (such as severe cardiovascular illness). Electroconvulsive therapy (ECT) is considered the most effective treatment if severe depression is resistant to medication. Light therapy may be helpful for depression with a seasonal pattern.

Self-care strategies
While you're dealing with depression, remember the importance of self-care. Keep a journal to become better aware of your feelings and behavior patterns. Break tasks into smaller components so they feel less overwhelming, prioritize them, and do the most important ones first. Because inactivity can deepen depression, it's seldom helpful to stay out of school or away from work. Maintain social connections and a regular pattern of daily activities (such as sleeping, eating, physical activity, seeking emotional support, going to work and keeping appointments). Because alcohol is a depressant, it's essential to monitor and reduce any alcohol use. Many health care providers recommend avoiding alcohol when you're taking certain antidepressants. Finally, maintain hope for the future.


Complications
Untreated depression is a serious risk factor for suicide. Other complications include the continued poor quality of life for the depressed person and its effect on family and friends.

Prevention
If your doctor prescribes antidepressants, you can prevent relapses by taking the medication properly. If a friend or loved one shows signs of depression, encourage him or her to seek professional help. If you must, take him or her for treatment yourself. Remember, with effective treatment, depression can be overcome.