Major Depression
What
Is It?
There is a tendency today to
use the word "depression" to describe the
inevitable periods of sadness that each of us experience
from time to time. And indeed, for many, during these
periods, it is not always easy to discern where normal
sorrow ends and clinical depression begins. Yet, anyone
who has ever experienced a major depression knows -- at
least after the depression has lifted -- that what they
feel is more than just persistent sadness.
Clinical depression is an
illness characterized by a cluster of feelings,
thoughts, and behaviors that are strikingly distinct
from a person's normal range of feelings and
functioning. Caused by a complex interaction of
biological, social, and psychological factors, a major
depressive disorder can make a person exquisitely
sensitive to life circumstances, the least of which can
throw him into total black despair.
During a major depression, a
person becomes enveloped by feelings of sadness,
emptiness, and worthlessness. Like an impenetrable
curtain descending, these feelings distort every thought
and experience, rendering life meaningless and hopeless.
Feelings of being deeply, continually deprived,
insignificant, inadequate, and guilt-ridden build on
feelings of sadness. At the same time, a depressed
person may feel chronically irritated, occasionally
erupting in frustration and anger.
While a major depression may be
triggered by some life circumstance or event, the mood
reaction seems greatly exaggerated. In all likelihood,
depression has less to do with events that occur than
with a individual's inherent vulnerability to the
condition.
In rare cases, a person may
experience a major depression as a single episode.
However, in most instances, clinical depression tends to
recur periodically, reactively or cyclically. A major
depression may last up to two years.
Milder depressive states are
called dysthymic disorders. It is likely that these
low-grade, intermittent or chronic depressive states
form in some people the temperamental basis from which
major depressions arise. For those with dysthymic
disorder, certain life circumstances -- the end of a
relationship, the loss of a job, going away to college,
for example -- might provoke a deeper depression.
For some people, there is a
seasonal aspect to their depression. Seasonal affective
disorder (SAD) is a form of reactive depression that is
more prevalent in northern parts of the country where
the climatic extremes are greater. Typically affecting
people in the fall or winter, seasonal affective
disorder is characterized by fatigue, sugar craving,
overeating and oversleeping. While the exact cause of
the disorder is not certain, it may be related to the
way in which the light-responsive pineal gland in the
brain functions.
Symptoms
· An
acute or lasting sense of despair, hopelessness, and
guilt that seems to have little or exaggerated
relation to life circumstances
· A
lack of interest or pleasure in most activities
· Deep
feelings of sluggishness, fatigue, or agitation
· Certainty
that everything is worthless and hopeless
· Preoccupation
with thoughts of suicide or death
· A
precipitous change in appetite and/or weight
· Difficulties
in sleeping or a tendency to oversleep
· Diminished
ability to concentrate and make decisions
· Dramatic
changes in working and social patterns.
What
The Doctor Looks For
A sustained and pervasive
change in mood. Loss of interest in normal pleasures of
life: food, sex, friends, work, family, sports, hobbies;
a family or personal history of depression or suicide
attempts, alcohol or drug use; a change in the way one
thinks about oneself; a pattern of negative,
pessimistic, self-blaming, or self-critical thinking;
suicidal thoughts and behavior.
What
You Can Do
During the time that you feel
despondent, seek the emotional support of family and
friends. For milder depressions of short duration, the
support of loved ones may help you through. But in most
cases you will not be able to fight depression on your
own, and you should not try to. Like asthma or
hypertension, depression is an illness and requires
medical attention so that it can be managed effectively.
If you are suffering from a depression, it is important
that you seek professional help.
If you suffer from SAD you may
respond to spending at least an hour a day outdoors,
even in winter. Increase the amount of natural light in
your house. Whenever possible, take trips in winter to
warmer and sunnier climates.
Treatment
Mild depression can be
effectively treated through psychotherapy. Even
short-term therapy can help you understand your natural
inclination towards more negative and somber moods. In
addition, you can learn to cope better with life's upset
and triumphs. When depression is triggered by seasonal
change, light therapy, which extends exposure to bright
light for measurable periods of time, may work to
relieve symptoms.
In cases of more severe
depression, medication will provide the main venue for
treatment. At the same time, psychotherapy is usually an
important complement to medication. By restoring
chemical balances within the brain, psychotropic
medication will lift the veil of sorrow. The most
commonly prescribed antidepressant medications are SSRIs
(selective serotonin reuptake inhibitors) -- fluoxetine
(Prozac), sertraline (Zoloft), paroxetine (Paxil), and
fluvoxamine (Luvox) -- and TCAs (tricyclic
antidepressants) -- imipramine (Tofranil), nortriptyline
(Pamelor), amitriptyline (Elavil), and desipramine
hydrochloride (Norpramin). Despite the fact that general
practitioners can prescribe these medications, it is
probably wisest to consult a psychiatrist or
psychopharmacologist who is specially trained to
evaluate and monitor the need for and use of
antidepressant medication.
For many different reasons,
treatment with antidepressants takes time to work.
Because every person and his depression differ, finding
the most effective drug is often a process of trial and
error. While the process may be frustrating, you and
your doctor will eventually find the right treatment.
During a severe episode, there
may be severe paranoid, persecutory delusions or even
hallucinations. There may be suicidal behavior. When
these occur, hospitalization, antipsychotic medication,
and/or electroconvulsive therapy may be necessary. After
the acute phase has subsided, psychopharmacological
treatment should be continued to decrease the likelihood
of relapse or future recurrence.
Unlike medications for physical
illness, psychotropic medications do not work to cure
the depressive illness; rather they work to relieve
acute episodes and prevent recurrences. For many, drugs
work most effectively in conjunction with psychotherapy.
Insight-oriented therapy can allow you to consider how
such contributing factors as early experiences of loss
and cumulative negative life circumstances and
disappointments have colored your disposition. Cognitive
techniques can also provide significant relief insofar
as they address the negative and distorted thinking that
typically characterizes depression.
When
To Seek Treatment
If you are in the throes of
depression, you may well believe that you are beyond
help. Yet depression can be effectively treated and
managed. If your state of gloom persists more two weeks,
you find that you can't get out of bed, you are
increasingly isolated from family and friends, and you
have lost any sense of enjoyment or interest in your
usual activities, call your physician. Also, if you find
yourself ruminating about death and the meaningless of
life, and you are considering suicide, seek help
immediately.
Prognosis
Good. Recent progress in the
development of new drugs that act directly on specific
parts of the brain make the treatment of depression even
more promising. Seasonal affective disorder responds
well to light therapy.
In some instances, one course
of treatment is sufficient to manage or remedy major
depressive illness. However, for many others, depression
is a chronic, life-long condition that requires
continued or episodic intervention. Even after a
successful round of treatment, it is important that you
remain sensitive to stresses that are likely to trigger
a depression. If you are able to recognize early signs,
you will be able to contact your clinician before you
find yourself deep into another depressive episode.
Learning to manage depression through therapy,
medication, and life-style will lessen the likelihood
that it will overshadow your life.
Last updated June 01, 1998(Intelihealth-John's Hopkins Health
Information)
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