About Depression

What is Depression?

Everyone feels blue now and then; it’s part of life. But when an individual goes for a period of weeks, months, or years of feeling sad, blue, or loss of interest in enjoyable activities and having problems like difficulty concentrating or low energy. They may be suffering from what doctors call “clinical depression.”

Depression is one of the most common health issues causing disability and work loss for people in the United States and worldwide. About 20-25% of people will experience clinical depression at some point in their lifetime. Depression affects daily functioning and quality of life similar to other major chronic illnesses such as diabetes and heart disease. Depression is often described as a “silent killer” that brings the “double jeopardy” of illness coupled with social stigma and discrimination. Many people in our communities have been touched by the issue of depression. Whether directly as a suffering individual, or as a family member or loved one, work colleague, or friend.

For most people, depression can get better with treatment. “Talk therapy,” medicine, or other treatment methods can ease the pain of depression. The good news is that people who are depressed usually feel better with the right treatment.

PBS Special Program “Depression: Out of the Shadows. Part 1: The Many Faces of Depression.”

Causes and Symptoms

There is no one cause for depression. For some people, a single event can bring on the illness. Depression often strikes people who felt fine, but who suddenly find they are dealing with a death in the family or a serious illness. For some people changes in medications or the brain can affect mood and cause depression. Sometimes, those under a lot of stress become depressed. Others become depressed for no clear reason.

People with serious illnesses, such as cancer, diabetes, heart disease, stroke, or Parkinson’s disease may become depressed. Genetics can also play a role. Studies show that depression may run in families. Children of depressed parents may be at a higher risk for depression. Depression tends to be a disorder that occurs more than once. Many people who have been depressed in the past will be at an increased risk for becoming depressed again.

What to Look For (Symptoms)
How do you know if you are depressed? You may be facing problems that could cause anyone to feel depressed. Perhaps you are dealing with the death of a loved one or friend. Possibly, you have a chronic illness. Or, you might feel like you have lost control over your life.

After a period of feeling sad, people usually adjust and regain their emotional balance. But, if you are suffering from clinical depression, and don’t get help your depression might last for weeks, months, or even years. Here is a list of the most common signs of depression. If you have several of these and they last for more than 2 weeks, it is recommended that you see a doctor.

  • An “empty” feeling, ongoing sadness, and anxiety
  • Tiredness, lack of energy
  • Loss of interest or pleasure in everyday activities, including sex
  • Sleep problems, including trouble getting to sleep, very early morning waking, and sleeping too much
  • Eating more or less than usual
  • Crying too often or too much
  • Aches and pains that don’t go away when treated
  • A hard time focusing, remembering, or making decisions
  • Feeling guilty, helpless, worthless, or hopeless
  • Being irritable
  • Thoughts of death or suicide, a suicide attempt

If you are a family member, friend, or health care provider, watch for clues. Sometimes depression can hide behind a smiling face. A depressed person who lives alone may appear to feel better when someone stops by to visit. However, when someone is very depressed, the symptoms usually come back.

Don’t ignore the warning signs. If left untreated, serious depression can lead to self-harm or suicide. Listen carefully if someone of any age complains about being depressed or says people don’t care. That person may really be asking for help.

References & Resources:
NIMH: Depression Brochure
NIMH: Publications about Depression

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is not commonly known but is scientifically proven to relieve depression especially when combined with medications. CBT lasts for a shorter period of time compared to other types of psychotherapy, but is just as effective.

CBT is used to help patients deal with the emotions and thoughts that they are currently experiencing instead of the emotions and thoughts from their past. CBTs main focus is to change thought patterns, and the behaviors that result from these thought patterns, in order to alter emotional reactions that can occur in depression.

CBT has shown to have a great potential in helping depressed people avoid the idea or act of suicide. Not only has CBT proven in research to aid adults but adolescents as well.

For more information on CBT go to: NIH: Working It Out

Costs of Depression

People with diagnosed depression spent more money in different types of health categories than in mental health care services. Although participants spent a lot more money in other health care categories, they spent less that 1% in specialty mental health care.

With this research it was also theorized that the higher cost for health services can be prevent a patient from receiving necessary care. This is especially true with older people who prefer not to seek help if they notice a slight stigma associated with depression. An obstacle to receiving this mental health care can also come from the higher Medicare costs.

Researchers suggest that improving mental health care for this population of people who may not have the funds available can possibly decrease overall medical costs.

References and Resources:
NIMH: Health Care Costs Much Higher for Older Adults with Depression Plus Other Medical Conditions

Depression and Aging

Depression is not a normal part of aging. However, depression in older persons is not widely recognized and often goes untreated.

Depression often occurs at the same time as other serious illnesses, such as heart disease, stroke, diabetes, cancer, and Parkinson’s disease. Because many older adults face these illnesses as well as personal losses, social and economic difficulties they may mistakenly conclude that depression is a normal consequence of these problems.  Unfortunately, this is an attitude often shared by health care professionals as well.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression are much more varied than at younger ages. It can appear as increased tiredness, grumpiness, or irritability. Confusion or attention problems caused by depression can sometimes look like Alzheimer’s disease or other brain disorders. Mood changes and signs of depression can be caused by medicines older people may take for arthritis, high blood pressure, or heart disease.

These factors together contribute to the under-diagnosis, and under-treatment of depression in older people. Depression can and should be treated at any age, especially when it occurs with other illnesses. Untreated depression can delay recovery from, or worsen, the outcome of other illnesses.  However, no matter what the circumstances, depression is a treatable condition that should not be ignored especially in older people.

Resource: Film – “One Woman’s Experience with Depression”

Depression and Suicide

One of the major concerns about the outcomes of depression is suicide, particularly in older adults. Although this is true depression, it is usually undermined and under treated. Untreated depression can lead to the risk of suicide. Although many people do no necessarily commit suicide, thoughts of suicide or death are just as dangerous. The detection and treatment of depression needs to be improved in order to reduce the risk of suicide, especially among older adults.

Depression worsens in older individuals where there is another illness present. Another factor that can worsen depression is when the ability to function suddenly begins to degrade. Depression is commonly mistaken as a disorder that is a normal part of aging. Depression that interferes with the ability to function is not something that is a normal process of getting older.

Depression can also lead to suicide in other age groups as well. Statistics show that suicide as a cause of depression can occur in children, adolescents, young adults, and older people as well. Depression needs to be treated like any other illness to help prevent the action of suicide or any other act of danger.

Resources & References:
Call this toll-free number, available 24 hours a day, every day: 1-800-273-TALK (8255). You will reach the National Suicide Prevention Lifeline, a service available to anyone. You may call for yourself or for someone you care about. All calls are confidential.

Suicide information and resources from MedlinePlus (en Español)
NIMH: Older Adults: Depression and Suicide Facts (Fact Sheet)
allaboutdepression.com – Suicide and Depression

Getting Help

The first step is to accept that you or your family member needs help. You may not be comfortable with the subject of mental illness or you might feel that asking for help is a sign of weakness. You might be like many people, who believe that a depressed person can quickly “snap out of it” or that some people are too old to be helped. They are wrong.

If you are the relative or friend of a depressed person who won’t go to a doctor for treatment, try explaining that treatment may help the person feel better. In some cases, when a depressed person can’t or won’t go to the doctor’s office, the doctor or mental health specialist can start by making a phone call. A phone call can’t take the place of the personal contact needed for a complete medical checkup, but it might inspire the person to go for treatment.

A health care provider can help you. Once you decide to get medical advice, start with your family doctor. Your doctor should check to see if the depression could be caused by a health problem (such as hypothyroidism or vitamin B12 deficiency) or a medication. After a complete exam, the doctor may suggest talking to a mental health worker, for example, a social worker, mental health counselor, psychologist, or psychiatrist.

Don’t avoid getting help because you may be afraid of how much treatments might cost. Often, only short-term psychotherapy (talk therapy) is needed. Treatment for depression is usually covered by private insurance and Medicare. Also, some community mental health centers may offer treatment based on a person’s ability to pay.

Be aware that some family doctors may not understand about depression. If your doctor is unable or unwilling to help, consider talking to another health care provider.

References & Resources:
NIMH: Depression Brochure
NIMH: Publications About Depression

It is known that a person with depression can have a great impact on the people around them. It can be very difficult since there are many factors that come into play when a family member has depression.

They might start acting differently causing tension around the household. For example, some may begin to act like nothing in the world matters to them, and therefore try to alienate themselves.This may cause other family members to feel stressed, worried, frustrated, and even sad. There can also be the possibility that other family members start to feel guilty that there is nothing they can do help their loved one.

It is very important for family members to know that it is not their fault that their loved one is going through emotional disparities. Family members often feel that they are failing their loved one, but this is not the case. Family members must understand that depression symptoms causes up and down feelings that are inevitable.

Although it may be very difficult, it is necessary that family members of a depressed loved one be as encouraging and as positive as possible. There are other ways that family members can help, for example by reminding their loved ones of appointment times or other small details that depressed people may tend to forget. Most family members of depressed loved ones try and say encouraging phrases and try to everything possible to make their loved one better; it is best to speak to the family member’s doctor to know what you can say and not say. Little details like this can definitely make someone feel different.

References and Resources: Personal Stories of Depression and Treatment

Women and Depression

Women are at an increased risk for depression for various reasons including: genetics (having a family history of depression), chemical and hormonal imbalances (premenstrual dysphoric disorder, postpartum depression, menopause and stress). Women experiencing depression often report having feelings of sadness, worthlessness, and excessive guilt.

Often depression can coexist with serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, Parkinson’s disease, thyroid problems and multiple sclerosis, and may even make symptoms of the illness worse. Studies have shown that both women and men who have depression in addition to a serious medical illness tend to have more severe symptoms of both illnesses. They also have more difficulty adapting to their medical condition, and more medical costs than those who do not have coexisting depression.

For women, depression often coexists with other illnesses including: eating disorders (anorexia nervosa, bulimia nervosa), anxiety disorders (PTSD- post-traumatic stress disorder, OCD- obsessive compulsive disorder, panic disorder, social phobia, and GAD- generalized anxiety disorder). It is very important that women seek treatment for both illnesses in order to achieve wellness. Research has shown that treating the depression along with the coexisting illness will help ease both conditions.

References & Resources: NIMH: Women and Depression: Discovering Hope

Men and Depression

In the United States, approximately 6 million men suffer from a depressive disorder including major depression, dysthymia (less severe but chronic depression), bipolar disorder every year. Many men do not know that they are depressed, and if they do know they are not willing to accept it and ask for help.

Men who are experiencing depression tend to report feeling fatigued, irritable, losing interest in work or hobbies, and having sleep disturbances. It is tragic, but four times more men die by suicide than women, even though women make more suicide attempts during their lives.

Depression is a real illness; it can strike at any age and to anyone regardless of their educational, economic, social or cultural background. But the good news is that it is treatable and with proper diagnosis and treatment, the vast majority of men with depression can be helped.

References & Resources: NIMH: Men and Depression

Preventing Depression

What can be done to lower the risk of depression? There are a few steps you can take. Try to prepare for major changes in life, such as retirement or moving from your home of many years. Participating in church or social activities can help you feel less isolated. Friends can help ease loneliness if you lose a loved one. You can also develop a hobby. Hobbies may help keep your mind and body active. Stay in touch with family. Let them help you when you feel very sad. If you are faced with a lot to do, try to break it up into smaller jobs that are easy to finish.

Regular exercise may also help prevent depression or lift your mood if you are somewhat depressed. People who are depressed can gain mental as well as physical benefits from mild forms of exercise like walking outdoors or in shopping malls. Gardening, dancing, and swimming are other good forms of exercise. Pick something you like to do. Begin with 10-15 minutes a day, and increase the time as you are able. Being physically fit and eating a balanced diet may help avoid illnesses that can bring on disability or depression.

With treatment, most people will begin to feel better soon. Feeling better takes time, but it can happen.

References & Resources:
NIMH: Depression Brochure
NIMH: Publications about Depression

Treating Depression

Your doctor or mental health expert can often treat your depression successfully. Different therapies seem to work for different people. For instance, support groups can provide new coping skills or social support if you are dealing with a major life change. Several kinds of talk therapies are useful as well. One method might help you think in a more positive way. Always thinking about the sad things in your life or what you have lost might have led to your depression. Another method works to improve your relations with others to give you more hope about your future. See the page on Cognitive Behavioral Therapy (CBT) for more information about therapy.

Antidepressant drugs (medicine to treat depression) can also help. These medications can improve your mood, sleep, appetite, and concentration. There are several types of antidepressants available. Some of these medicines can take up to 12 weeks before you feel like they are working. Your doctor may want you to continue medications for 6 months or more after your symptoms disappear. See the page on Anti-Depressant Medications for more details.

Family and Friends
Family and friends can play an important role in treatment, even making the necessary appointments and offering to go along to the doctor, mental health expert, or support group. Friends and family can also help you get out and participate in activities that you once enjoyed, encouraging you to be active and busy (but not to take on too much at one time).

References & Resources:
NIMH: Depression Brochure
NIMH: Publications about Depression