Depression

We all feel sad or discouraged at times.  When these feelings last for more than two weeks and interfere with a person’s interest in or enjoyment of life, he or she may be suffering from a mood disorder.  Depression is a serious medical illness that can be successfully treated, usually with a combination of psychotherapy and medicine.

Common symptoms of depression include:

  • Feeling sad, blue, or tearful
  • Restlessness or irritability
  • Loss of energy or increased fatigue
  • Pessimistic, negative, and repetitive thinking
  • Loss of interest or pleasure in previously enjoyable activities
  • Feelings of guilt or worthlessness
  • Difficulty thinking, concentrating, or making decisions
  • Changes in appetite
  • Insomnia or oversleeping
  • Feelings of hopelessness
  • Thoughts of death or suicide

Causes

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances. But several factors can play a role in the onset of depression:

Biochemistry
Abnormalities in two chemicals in the brain, serotonin and norepinephrine, might contribute to symptoms of depression, including anxiety, irritability and fatigue. Other brain networks undoubtedly are involved as well; scientists are actively seeking new knowledge in this area.

Genetics
Depression can run in families.

Personality
People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be vulnerable to depression.

Environmental factors
Continuous exposure to violence, neglect, abuse or poverty may make people who are already susceptible to depression all the more vulnerable to the illness. Also, a medical condition (e.g., a brain tumor or vitamin deficiency) can cause depression, so it is important to be evaluated by a health care provider.

Treatment

Depression is among the most treatable of mental disorders; the majority of people with depression eventually respond well to treatment, and almost all patients gain some relief from their symptoms.

Medication
Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain. These medications are not sedatives, “uppers” or tranquilizers, and they are not habit-forming.

Antidepressants may produce some improvement within the first week or two of treatment. Full benefits may not be realized for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist will alter the dose of the medication or will add or substitute another antidepressant.

Psychotherapy
Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, it is often used in combination with antidepressant medications. Psychotherapy may involve only the individual patient, but it can include others. For example, family or couples therapy can help address specific issues arising within these close relationships.

(from HealthyMinds.org, the American Psychiatric Association’s online resource for anyone seeking mental health information)

Types of depression

There are several types of depressive disorders.  The—major depression, dysthymia, and bipolar disorder—can occur with any of the anxiety disorders.

Major depression involves multiple symptoms of depression which last for at least a two-week period. An episode of major depression is disabling and will interfere with the ability to work, study, eat, and sleep. Major depressive episodes may occur once or twice in a lifetime, or they may re-occur frequently. They may also take place spontaneously, during or after the death of a loved one, a romantic breakup, a medical illness, or other life event.

Dysthymia is a less severe, long-term, and chronic form of depression. It involves the same symptoms as major depression, mainly low energy, poor appetite or overeating, and insomnia or oversleeping. It can manifest as stress, irritability, and mild anhedonia, which is the inability to derive pleasure from most activities.

People with dysthymia might be thought of as always seeing the glass as half empty.

Bipolar disorder, once called manic-depression, is characterized by a mood cycle that shifts from severe highs (mania) or mild highs (hypomania) to severe lows (depression).

During the manic phase, a person may experience abnormal or excessive elation, irritability, a decreased need for sleep, grandiose notions, increased talking, racing thoughts, increased sexual desire, markedly increased energy, poor judgment, and inappropriate social behavior.

During the depressive phase, a person experiences the same symptoms as would a sufferer of major depression. Mood swings from manic to depressive are often gradual, although occasionally they can occur abruptly. Learn more about bipolar disorder.

Seasonal Affective Disorder
Some people experience a serious mood change during the winter months, when there is less natural sunlight. This condition is called seasonal affective disorder, or SAD.  Treatment of SAD often includes light therapy.

Post-partum depression
Up to 70 percent of all new mothers experience the “baby blues,” a short-lasting condition after childbirth that doesn’t impair functioning and doesn’t require medical attention.  For 13% of new mothers, the condition is more debilitating and long-lasting.  Symptoms can include a lack of interest in or fear of harming the baby.  These symptoms may cause new mothers to feel isolated, guilty, or ashamed. Getting treatment is important for both the mother and the child.
(Healthy Minds. Healthy Lives)

If you are concerned that you or a loved one may be suffering from depression, please contact BMC Employee Assistance office (for BMC employees) at 1-800-435-1986, or BU Faculty Staff Assistance Office (for BU employees) at 617-353-5381 to arrange an appointment.

Resources

BMC:
BMC EAP – confidential counseling via toll-free phone line or in person for BMC employees and eligible dependents.
Integrative medicine – patients and staff are offered a variety of integrative services at no charge or for a modest fee.

BU:
Faculty and Staff Assistance Office – free, confidential counseling and referral service for faculty, staff and their families with locations on both Medical and Charles River campuses

Online:
General information about depression, types of depression, co-existing conditions, and treatment:
WebMD Depression resources - WebMD doctors have selected the finest professional organizations that can help people gain a better understanding of living with depression and other mental health conditions.
Anxiety and Depression Association of America
Freedom from Fear Depression Overview
Healthy Minds. Healthy Lives.  American Psychiatric Association
CopeCareDeal: information on depression for teens
Samaritans Suicide Prevention Helpline
Samaritan’s State Wide Toll-Free: 877.870.HOPE