Normal Depressed Mood and Grief 

Adjustment Disorder with Depressed Mood

Mild Depression or Dysthymia

Major Depression

Bipolar Disorder

Seasonal Affective Disorder

ANTI- DEPRESSANT DRUGS

NON-DRUG THERAPIES

Cognitive therapy

Exercise

Psychotherapy

Support groups

Phototherapy

Electro- convulsive Therapy

FINDING HELP

DEPRESSION is one of the most common mental illnesses. On any given day, about 15 million Americans—more than five percent of the population—are suffering from clinical depression. About 17 percent of people experience a serious depressive episode at some time in their lives.

DEPRESSION IS CAUSED by biochemical imbalances in the brain involving the hormone cortisol and the neurotransmitters serotonin, dopamine and norepinephrine. The tendency toward this chemical imbalance can be inherited, causing depression to run in families. A deep emotional loss may also trigger biochemical changes that cause depression. Or the brain chemistry can change for no apparent reason.

Other diseases, including thyroid conditions, lupus, rheumatoid arthritis, hormonal imbalances, multiple sclerosis and some forms of cancer, can cause depression. Usually, treating the underlying diseases relieves the depression.

People suffering from chronic illnesses such as arthritis or heart disease may develop depression. For them, treating the depression often makes it easier to cope with the other chronic illness.

While virtually anyone can develop depression, the people most likely to do so include—

• Relatives of depressed people, who are about twice as likely as average to become seriously depressed themselves

• Women, who suffer depression about twice as often as men

• The baby boom generation, currently considered at greatest risk of all age groups

• The elderly, often as a reaction to physical deterioration and the loss of friends, families and rewarding activities

• Children who have suffered abuse or losses or who have a seriously depressed parent

• Chronically ill people

• Drug and alcohol abusers

TREATMENTS FOR DEPRESSION typically have high success rates, especially when they include a combination of drug and non-drug therapies. While only a third of people suffering from depression seek treatment, about 85 percent of those who receive adequate treatment have good results.

Normal Depressed Mood and Grief are natural reactions to losses in life characterized by sadness and lethargy. In more serious cases, symptoms include despair, anger, insomnia, poor appetite or weight gain, obsessive thoughts about the loss and a deep sense of guilt. "Normal" depression is always related to a specific life event and will eventually lift on its own.

Adjustment Disorder with Depressed Mood relates to a triggering life change. Coping with major changes in life—moving to a new city, starting a new job—can be overwhelming, but most people are able to adjust within a reasonable period of time. Those who remain gloomy, angry and unable to cope for an unusually long time or whose depression seems out of proportion to the change that triggered it may be suffering from adjustment disorder with depressed mood.

Mild Depression or Dysthymia is a chronic depressed mood. People with dysthymia can still function, but they usually have low self-esteem and suffer mild symptoms of major depression all or most of the time. Dysthymia may be triggered by a life event, but symptoms can also appear for no apparent reason.

Major Depression causes deep despair, hopelessness and a loss of interest in life. To be classified as major depression, the illness must have caused at least two weeks of deep despair, along with at least four of these symptoms:

• Sleep problems—insomnia or oversleeping

• Loss of appetite or major weight gain

• Lack of energy, apathy, lethargy

• Feelings of worthlessness, hopelessness and/or terrible guilt

• Difficulty concentrating or unusual indecisiveness

• Suicidal thoughts or suicide attempts

An episode of major depression can occur with or without a triggering life event. Besides the suffering it causes, major depression can be deadly. About one in four people who suffer an episode of major depression attempt suicide within five years of the episode.

Bipolar Disorder causes major depressive episodes alternating with periods of high energy and elevated mood.

Seasonal Affective Disorder is a reaction to a lack of sunlight in winter in which mild or major depression develops in late fall and clears up in early spring. As distance from the equator increases, seasonal affective disorder becomes increasingly common.

ANTIDEPRESSANT DRUGS help 60 to 80 percent of people with moderate to severe depression by changing the balance of chemicals in the brain. Antidepressants don’t cause a "high" and are not addictive, but they may cause significant side effects and should be monitored closely by an experienced doctor.

The types of antidepressants being prescribed today, in order of their development, include monoamine oxidase or MAO inhibitors, tricyclics, tetracyclics, Wellbutrin, Desyrel, selective serotonin reuptake inhibitors or SSRIs, Effexor and Serzone. All are about equally effective, but some work better than others in treating certain combinations of symptoms. The newer drugs are safer for most people and usually cause fewer unwanted side effects.

Your doctor may prescribe an antidepressant alone or in combination with other drugs to increase effectiveness. For most drugs, it takes two to four weeks to feel any benefit. You may need to try several different antidepressants before finding the one that works best for you.

Most people take antidepressants for at least six months, but many need to continue for a year or more. Even though symptoms lessen or disappear, it is important to keep taking antidepressants daily, as prescribed. Before you stop taking your antidepressant, ask your doctor and be sure to follow instructions for reducing your dosage over time.

NON-DRUG THERAPIES can lessen symptoms of mild depression when used alone and, when combined with antidepressant drugs, can help treat moderate to severe depression with greater success than can be achieved using drug therapies alone.

Cognitive therapy helps people with depression recognize and correct patterns of thinking that contribute to their depressed state. In one study, the National Institute of Mental Health found 51 percent of those with mild to moderate depression reported significant improvement after 16 weeks of cognitive therapy.

Exercise—particularly regular, strenuous aerobic exercise—has been shown in numerous studies to help normalize the chemical imbalances in the brain linked to depression.

Psychotherapy, a term used to describe a variety of "talk therapies," originally referred to long-term psychoanalysis based on Freudian psychology. Today, psychotherapy is based on a variety of theoretical approaches and tends to happen over a period of months rather than years. Alone, psychotherapy can be effective in treating mild to moderate depression. For moderate to severe depression, psychotherapy can be combined with drug therapy to help alleviate symptoms.

Support groups can be particularly helpful for depression associated with drug or alcohol abuse.

Phototherapy can help people suffering from seasonal affective disorders by exposing them to bright artificial light. In one study, a daily half-hour of exposure to a bright-light appliance helped relieve symptoms for 60 to 80 percent of participants with winter depression.

Electroconvulsive Therapy has been shown to help 80 to 90 percent of people who are unable to tolerate antidepressant drugs or whose severe depression did not improve with drug therapy. While ECT may cause short-term memory loss, the procedure is generally safe and effective when used properly.

If a family member or friend is suffering from depression:

• Encourage your friend or relative to seek professional help. Depression produces pervasive feelings of hopelessness, often making its victims reluctant to get help. But with proper diagnosis and treatment depression is among the most treatable of all psychiatric disorders.

• Be supportive, but avoid making suggestions to "cheer up" or "snap out of it."

• Be patient. Most antidepressants take several weeks to become fully effective, and complete recovery can require a number of months.

• Be alert for suicide threats and treat them seriously. If your friend or relative begins giving away prized possessions or saying things like, "I won’t be around to bother you much longer," get help immediately. Educate yourself. The more you know about depression’s causes and treatments, the more you can help.

• Join NAMI North Carolina and participate in its programs for support, education and advocacy. To find out if there is an affiliate in your community, call the NAMI North Carolina Helpline.