DEPRESSION

Sadness is something we all experience. It is a normal reaction to difficult times in life and usually passes with a little time. When a person has depression, it interferes with daily life and normal functioning. It can cause pain for both the person with depression and those who care about him or her. Doctors call this condition “depressive disorder,” or “clinical depression.” It is a real illness. It is not a sign of a person’s weakness or a character flaw. You can’t “snap out of” clinical depression. Most people who experience depression need treatment to get better.


SYMPTOMS

Sadness is only a small part of depression. Some people with depression may not feel sadness at all. Depression has many other symptoms, including physical ones. If you have been experiencing any of the following signs and symptoms for at least 2 weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood

  • Feelings of hopelessness, pessimism

  • Feelings of guilt, worthlessness, helplessness

  • Loss of interest or pleasure in hobbies and activities

  • Decreased energy, fatigue, being “slowed down”

  • Difficulty concentrating, remembering, making decisions

  • Difficulty sleeping, early-morning awakening, or oversleeping

  • Appetite and/or weight changes

  • Thoughts of death or suicide, suicide attempts

  • Restlessness, irritability

  • Persistent physical symptoms


Factors that play a role in depression:

Many factors may play a role in depression, including genetics, brain biology and chemistry, and life events such as trauma, loss of a loved one, a difficult relationship, an early childhood experience, or any stressful situation.

Depression can happen at any age, but often begins in the teens or early 20s or 30s. Most chronic mood and anxiety disorders in adults begin as high levels of anxiety in children. In fact, high levels of anxiety as a child could mean a higher risk of depression as an adult.

Depression can co-occur with other serious medical illnesses such as diabetes, cancer, heart disease, and Parkinson’s disease. Depression can make these conditions worse and vice versa. Sometimes medications taken for these illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Research on depression is ongoing, and one day these discoveries may lead to better diagnosis and treatment. To learn more about current research, visit the NIMH website at www.nimh.nih.gov.


TYPES OF DEPRESSION:

Major depression: Severe symptoms that interfere with the ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.


Persistent depressive disorder: A depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.


Some forms of depression are slightly different, or they may develop under unique circumstances:

Psychotic depression: Occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).


Postpartum depression: which is much more serious than the “baby blues” that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.


Seasonal affective disorder (SAD): which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.


Bipolar disorder is different from depression. The reason it is included in this list is because someone with bipolar disorder experiences episodes of extreme low moods (depression). But a person with bipolar disorder also experiences extreme high moods (called “mania”).   You can learn more about many of these disorders on the NIMH website at www.nimh.nih.gov.


Depression affects people in different ways.

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms. Some people have many. The severity and frequency of symptoms, and how long they last, will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.


Women: Women with depression do not all experience the same symptoms. However, women with depression typically have symptoms of sadness, worthlessness, and guilt. Depression is more common among women than among men. Biological, lifecycle, hormonal, and psychosocial factors that are unique to women  may be linked to their higher depression rate.  For example, women are especially vulnerable to developing postpartum depression after giving  birth, when hormonal and physical changes and  the new responsibility of caring for a newborn  can be overwhelming.


Men: Men often experience depression differently than women. While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping. Men may turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men may throw themselves into their work to avoid talking about their depression with family or friends, or behave recklessly. And although more women attempt suicide, many more men die by suicide in the United States.


Children: Before puberty, girls and boys are equally likely to develop depression. A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary “phase” or is suffering from depression. Sometimes the parents become worried about how the child’s behavior has changed, or a teacher mentions that “your child doesn’t seem to be himself.” In such a case, if a visit to the child’s pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a mental health professional specializing in the treatment of children. Most chronic mood disorders, such as depression, begin as high levels of anxiety in children.


Teens: The teen years can be tough. Teens are forming an identity apart from their parents, grappling with gender issues and emerging sexuality, and making independent decisions for the first time in their lives. Occasional bad moods are to be expected, but depression is different.  Older children and teens with depression may sulk, get into trouble at school, be negative and irritable, and feel misunderstood.


If you’re unsure if an adolescent in your life is depressed or just “being a teenager,” consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self. Teens with depression may also have other disorders such as anxiety, eating disorders, or substance abuse. They may also be at higher risk for suicide.


Children and teenagers usually rely on parents, teachers, or other caregivers to recognize their suffering and get them the treatment they need. Many teens don’t know where to go for mental health treatment or believe that treatment won’t help. Others don’t get help because they think depression symptoms may be just part of the typical stress of school or being a teen. Some teens worry what other people will think if they seek mental health care.


Quick Tips for talking to your depressed child or teen:

• Offer emotional support, understanding, patience, and encouragement.

• Talk to your child, not necessarily about depression, and listen carefully.

• Never discount the feelings your child expresses, but point out realities and offer hope.

• Never ignore comments about suicide.

• Remind your child that with time and treatment, the depression will lift.


Older People:

Having depression for a long period of time is not a normal part of growing older. Most older adults feel satisfied with their lives, despite having more illnesses or physical problems. But depression in older adults may be difficult to recognize because they may show different, less obvious symptoms.


Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Confusion or attention problems caused by depression can sometimes look like Alzheimer’s disease or other brain disorders. Older adults also may have more medical conditions such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or they may be taking medications with side effects that contribute to depression.


Some older adults may experience what doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. The hardening of vessels prevents normal blood flow to the body’s organs, including the brain. Those with vascular depression may have or be at risk for heart disease or stroke.


Sometimes it can be difficult to distinguish grief from major depression. Grief after loss of a loved one is a normal reaction and generally does not require professional mental health treatment. However, grief that is complicated and lasts for a very long time following a loss may require treatment.


Older adults who had depression when they were younger are more at risk for developing depression in late life than those who did not have the illness earlier in life.


Depression is treatable.

Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Most adults see an improvement in their symptoms when treated with antidepressant drugs, talk therapy (psychotherapy), or a combination of both.


If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary doctor or a health provider who specializes in diagnosing and treating mental health conditions (psychologist or psychiatrist).


Certain medications, and some medical conditions, such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation.


If you still need to make an appointment, here are some things you could say during the first call: “I haven’t been myself lately, and I’d like to talk to the provider about it,” or “I think I might have depression, and I’d like some help.”


TREATMENT

Depression is treated with medicines, talk therapy (where a person talks with a trained professional about his or her thoughts and feelings; sometimes called “psychotherapy”), or a combination of the two. Remember: No two people are affected the same way by depression. There is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you. There are several types of psychotherapies that may be effective in treating depression:


Cognitive-Behavioral Therapy (CBT)

CBT can help an individual with depression change negative thinking. It can help you interpret your environment and interactions in a positive, realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse.


Interpersonal Therapy (IPT)

IPT is designed to help an individual understand and work through troubled relationships that may cause the depression or make it worse. When a behavior is causing problems, IPT may help you change the behavior. In IPT, you explore major issues that may add to your depression, such as grief, or times of upheaval or transition.


Problem-Solving Therapy (PST)

PST can improve an individual’s ability to cope with stressful life experiences. It is an effective treatment option, particularly for older adults with depression. Using a step-by-step process, you identify problems and come up with realistic solutions. It is a short-term therapy and may be conducted in an individual or group format.


For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back. Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years.


More information on psychotherapy is available on the NIMH website at www.nimh.nih.gov/health/topics/psychotherapies/index.shtml


Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. NOTE: Because information about medications is always changing, the following section may not list all the types of medications available to treat depression. Check the Food and Drug Administration (FDA) website (www.fda.gov) for the latest news and information on warnings, patient medication guides, or newly approved medications.


Types of antidepressants:

• Selective serotonin reuptake inhibitors (SSRI)

• Serotonin and norepinephrine reuptake inhibitors (SNRI)

• Tricyclic antidepressants (TCA)

• Monoamine oxidase inhibitors (MAOI)

There are other antidepressants that don’t fall into any of these categories and are considered unique, such as Mirtazapine and Bupropion.

Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has side effects that you can manage.


NOTE: Most antidepressants are generally safe, but the U.S. Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers, and young adults under age 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.


Common side effects listed by the FDA for antidepressants are:

• Nausea and vomiting

• Weight gain

• Diarrhea

• Sleepiness

• Sexual problems


Other more serious but much less common side effects listed by the FDA for antidepressant medicines can include seizures, heart problems, and an imbalance of salt in your blood, liver damage, suicidal thoughts, or serotonin syndrome (a life-threatening reaction where your body makes too much serotonin). Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff or rigid muscles.


If you are having suicidal thoughts or other serious side effects like seizures or heart problems while taking antidepressant medicines, contact your doctor immediately.


The National Suicide Prevention Lifeline is available at:

1-800-273-TALK (8255), or you can visit:  www.suicidepreventionlifeline.org


Beyond Treatment - Things You Can Do:

If you have depression, you may feel exhausted, helpless, and hopeless. It may be extremely difficult to take any action to help yourself. But as you begin to recognize your depression and begin treatment, you will start to feel better. Here are other tips that may help you or a loved one during treatment:

  • Try to be active and exercise.

  • Go to a movie, a ballgame, or another event or activity that you once enjoyed.

  • Set realistic goals for yourself.

  • Break up large tasks into small ones, set some priorities, and do what you can as you can.

  • Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself and let others help you.

  • Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.

  • Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

  • Remember that positive thinking will replace negative thoughts as your depression responds to treatment.

  • Continue to educate yourself about depression.

  • Remember you are not alone: You are not alone, so build a support system for yourself. Your family and friends are a great place to start. Talk to trusted family members or friends to help them understand how you are feeling and that you are following your doctor’s recommendations to treat your depression.

  • In addition to your treatment, you could also join a support group. These are not psychotherapy groups, but some may find the added support helpful. At the meetings, people share experiences, feelings, information, and coping strategies for living with mental illness. For more information, go to A peer support group on the NAMI Flagstaff website () under “Services.”

  • Remember: Always check with your doctor before taking any medical advice that you hear in your group.


If You Think a Loved One May Have Depression

If you know someone who is depressed, it affects you too. The most important thing you can do is to help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment or to seek different treatment options if no improvement occurs after 6 to 8 weeks.


To help your friend or relative:

  • Offer emotional support, understanding, patience, and encouragement.

  • Talk to him or her, and listen carefully.

  • Never dismiss feelings, but point out realities and offer hope.

  • Never ignore comments about suicide and report them to your loved one’s therapist or doctor.

  • Invite your loved one out for walks, outings, and other activities. Keep trying if he or she declines, but don’t push him or her to take on too much too soon.

  • Provide assistance in getting to doctors’ appointments.

  • Remind your loved one that with time and treatment, the depression will lift.


Caring for someone with depression is not easy. Someone with depression may need constant support for a long period of time. Make sure you leave time for yourself and your own needs. If you feel you need additional support, go to FAMILY SUPPORT GROUP on the NAMI Flagstaff website (www.NAMIflagstaff.com) under “Services.”

 

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