Most people would say they have been depressed at one point or another in their lifetime. But we use the word depression to mean more than one thing. Everyone has been sad or depressed temporarily about losing a friend or loved one, a job loss, or some other distressing event in life. Clinical depression is much more than that. Clinical depression, sometimes called major depression or major depressive disorder, is a mood disorder characterized by a persistent feeling of sadness and loss of interest that interferes with daily functioning. It can affect people of any age or any gender in any walk of life. Some people experience clinical depression once in their life, for others, it becomes chronic. Major depressive disorder is believed to affect 17.3 million adult Americans (National Institute of Mental Health “Major Depression”, 2017), and about 1.9 million children have been diagnosed with depression according to the CDC (Centers for Disease Control “Data and Statistics on Children’s Mental Health”, 2018).
million adults with depression
million children with depression
There is no blood test for major depression, so doctors diagnose the disorder from symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, includes the following list for doctors to use as criteria for diagnosis.
Signs and symptoms of clinical depression may include:
- Feelings of sadness, tearfulness, emptiness or hopelessness
- Angry outbursts, irritability or frustration, even over small matters
- Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
- Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy, so even small tasks take extra effort
- Reduced appetite and weight loss or increased cravings for food and weight gain
- Anxiety, agitation or restlessness
- Slowed thinking, speaking or body movements
- Feelings of worthlessness or guilt, fixating on past failures or self-blame
- Trouble thinking, concentrating, making decisions and remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
For a diagnosis of clinical depression, at least 5 of these symptoms must persist for two weeks or longer. Clinical depression can be difficult to identify because many of the symptoms above are also symptoms of other things. Bi-polar disorder is commonly misdiagnosed as depression, and vice versa, because they share so many symptomatic attributes. Self identification is difficult as well. Often we just think we are worn out, or being lazy, or grumpy and dismiss the signs. Depression is not a character failing. It is a medical condition that should be taken seriously and can be treated.
Don’t be afraid, ashamed or embarrassed to speak with your doctor about your depressive symptoms. You are worth more than you might realize. Your mental health is important.
Antidepressant medications and talk therapy, sometimes called psychotherapy, have helped many people with their depression. Several types of antidepressant medications are available, and since each individual is different, one medication or combinations of medications works for some and not for others. There are also a variety of psychotherapy methods that are employed by psychologists and psychiatrists.
Although we still don’t know exactly what causes depression, research has shown that imbalances in the brain chemicals serotonin, norepinephrine, and dopamine are associated with depression. Most antidepressant medications relieve depression symptoms by affecting these neurotransmitters that are key to the communication between brain cells. Each type, or class, of antidepressant affects these chemical messengers in a slightly different way. The Mayo Clinic published the following list and descriptions of antidepressant medications that are available today:
- Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples of SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and levomilnacipran (Fetzima).
- Atypical antidepressants. These medications don’t fit neatly into any of the other antidepressant categories. More commonly prescribed antidepressants in this category include trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd) and bupropion (Wellbutrin SR, Wellbutrin XL, others). Bupropion is one of the few antidepressants not frequently associated with sexual side effects.
- Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin and desipramine (Norpramin) — tend to cause more side effects than newer antidepressants. So tricyclic antidepressants generally aren’t prescribed unless you’ve tried other antidepressants first without improvement.
- Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, often when other medications haven’t worked, because they can have serious side effects. Using an MAOI requires a strict diet because of dangerous (or even deadly) interactions with foods — such as certain cheeses, pickles and wines — and some medications, including pain medications, decongestants and certain herbal supplements. Selegiline (Emsam), an MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs. These medications can’t be combined with SSRIs.
- Other medications. Your doctor may recommend combining two antidepressants, or other medications may be added to an antidepressant to enhance antidepressant effects.
“Depression is not a character failing. It is a medical condition that should be taken seriously and can be treated.”
Be patient with new medications. It can take between 2 and 8 weeks before feeling the benefits of antidepressants. But, if you don’t feel any benefits, contact your doctor because you might need a medication adjustment. These medicines do not cure depression, but do treat the symptoms until the depression passes or another treatment is effective. Many people, once the right medicine or combination of medicines are found, continue taking them for many months or years. It also isn’t uncommon for antidepressants to lose their efficacy after months of benefit, at which time your doctor will suggest a different medication or treatment option.
Several different types of psychotherapy are available as well. According to the American Psychological Association, there are five types of psychotherapy. This list with explanations is from the APA website:
Approaches to psychotherapy fall into five broad categories:
- Psychoanalysis and psychodynamic therapies. This approach focuses on changing problematic behaviors, feelings, and thoughts by discovering their unconscious meanings and motivations. Psychoanalytically oriented therapies are characterized by a close working partnership between therapist and patient. Patients learn about themselves by exploring their interactions in the therapeutic relationship. While psychoanalysis is closely identified with Sigmund Freud, it has been extended and modified since his early formulations.
- Behavior therapy. Focuses on developing healthier behaviors. Correcting abnormal behaviors and reinforcing good ones. An example of an abnormal behavior for a depressed person: oversleeping, avoiding social encounters. A good behavior: using family and friends as a support network instead of isolating yourself.
- Ivan Pavlov made important contributions to behavior therapy by discovering classical conditioning, or associative learning. Pavlov’s famous dogs, for example, began drooling when they heard their dinner bell, because they associated the sound with food.
- “Desensitizing” is classical conditioning in action: A therapist might help a client with a phobia through repeated exposure to whatever it is that causes anxiety.
- Another important thinker was E.L. Thorndike, who discovered operant conditioning. This type of learning relies on rewards and punishments to shape people’s behavior.
- Several variations have developed since behavior therapy’s emergence in the 1950s. One variation is cognitive-behavioral therapy, which focuses on both thoughts and behaviors.
- Cognitive therapy. Cognitive therapy emphasizes what people think rather than what they do.
- Cognitive therapists believe that it’s dysfunctional thinking that leads to dysfunctional emotions or behaviors. By changing their thoughts, people can change how they feel and what they do.
- Major figures in cognitive therapy include Albert Ellis and Aaron Beck.
- Humanistic therapy. This approach emphasizes people’s capacity to make rational choices and develop to their maximum potential. Concern and respect for others are also important themes.
- Humanistic philosophers like Jean-Paul Sartre, Martin Buber and Søren Kierkegaard influenced this type of therapy.
- Three types of humanistic therapy are especially influential. Client-centered therapy rejects the idea of therapists as authorities on their clients’ inner experiences. Instead, therapists help clients change by emphasizing their concern, care and interest.
- Gestalt therapy emphasizes what it calls “organismic holism,” the importance of being aware of the here and now and accepting responsibility for yourself.
- Existential therapy focuses on free will, self-determination and the search for meaning.
- Integrative or holistic therapy. Many therapists don’t tie themselves to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each client’s needs.
For those who do not respond well to medications, Transcranial Magnetic Stimulation (TMS) , Electroconvulsive Therapy (ECT), and Ketamine Infusion Therapy are other treatments currently being used to treat major depressive disorder successfully. Each is often applied in conjunction with some form of medication and/or talk therapy. TMS therapy , the newest FDA approved therapy for treatment resistant depression has an excellent rate of reducing or eliminating depression symptoms. ECT has been around for many years and requires a hospital stay after the therapy, but has been effective for many. Ketamine Infusion therapy is not FDA approved at this time, but has been used successfully in many clinics.
TMS therapy has an excellent rate of reducing or eliminating depression symptoms
What Causes Depression?
Although exactly what causes depression is not fully understood, we do know it is a complex issue. Depression comes in many different forms and is different for everybody. Depression can be triggered by a single event, such as the death of a family member or friend, or be a result of cumulative factors, such as a stressful career, tumultuous relationships, and the pressure of financial burdens. For some there seems to be a genetic component, but not for everyone. If your family tree has a history of battling depression, then you may be genetically predisposed to depression. Other people sustain traumatic life experiences without developing major depression. Since causes are often complex and not easily identified, recognizing the symptoms begins the journey to finding relief. Finding a psychiatrist who can provide that help is the next step.
Do you need a Psychiatrist or a Psychologist?
What is the difference between a psychiatrist and a psychologist? A psychiatrist received training in medical school, and is therefore qualified to prescribe medication. After med school, a psychiatrist spends four years in a residency program observing and gaining experience in developing treatment plans for various mental disorders. Many go on to fellowship programs where they are further trained in specialty areas such as pediatric, adolescent, adult, and geriatric psychiatry. A psychologist is not a medical doctor, but has a Doctor of Philosophy (Ph.D.) or Doctor of Psychology (Psy.D.) degree, and specializes in psychological therapies. If a psychologist has a Master of Science degree only, he or she will be working under the supervision of a psychologist with a doctoral degree. Often psychologists and psychiatrists collaborate to coordinate psychological and medical diagnoses as well as medications and therapies.
Do Anxiety and Depression always accompany each other?
Like depression, anxiety is experienced by nearly every person at some point. Anxiety can move into the area of disorder when it persists for a long time, causes out-of-proportion reactions to situations, and requires extreme behaviors to reduce the anxiety, leading to both physical and emotional problems for an individual. Major depressive disorder often accompanies anxiety disorders such as panic disorder or generalized anxiety disorder. When anxiety is the central aspect of depression it is called an anxious or agitated depression.
Anxiety and depression are often experienced together, but not always. They have different clinical definitions, but share some symptoms, such as irritability, decreased concentration, and impaired sleep. Treatments for anxiety disorders and depression are often similar or overlapping. When people self-medicate through drinking alcohol, smoking, or using recreational drugs, the disorders often become worse.
Depression is the leading cause of disability worldwide according to the World Health Organization. Major depressive disorder is the most common of the neuropsychiatric disorders that are the leading cause of disability in the United States according to the National Institute of Mental Health (“U.S. Leading Categories of Diseases/Disorders,” 2013). Depression is a serious mental illness. But it isn’t a hopeless one.
Has the isolation of COVID-19 triggered depression symptoms for you or a loved one? Maybe you are just noticing symptoms because you have been forced to slow down. Reach out to a mental health professional for help. Social media makes this possible in new ways even in our isolation.