What is Depression?

Depression is a disturbance of mood and is characterized by a loss of interest or pleasure in normal everyday activities. People who are depressed may feel “down in the dumps” for weeks, months, or even years at a time. Depression should not be confused with the passing feelings of unhappiness and dissatisfaction that everyone experiences from time to time. However, when these feelings continue for more than a few weeks, depression may be the cause.

What causes Depression?      

Depression is caused by a combination of genetic, environmental, and psychological factors. Important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different. Some types of depression tend to run in families. In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. 

What are some symptoms of Depression?

  • sadness or emptiness
  • hopelessness
  • worthlessness
  • low energy and fatigue
  • difficulty concentrating
  • missing work/school
  • loss of interest in normal activities, including sex
  • sleep disturbances (insomnia or oversleeping)
  • appetite and weight changes
  • physical aches and pains
  • thoughts of death or suicide
  • sudden changes in routine or friends
  • irritability

How is Depression diagnosed and treated?

Depression is highly responsive to treatment. In fact, most people with depression report feeling better within a few weeks of starting treatment. The first step to getting appropriate treatment is to visit with a doctor and a Psychologist. Certain medications, and some medical conditions such as a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation. Your Psychologist will discuss with you any family history of depression or other mental disorder, and get a complete history of your symptoms. You should discuss when your symptoms started, how long they have lasted, how severe they are, and whether they have occurred before and if so, how they were treated. The Psychologist may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide. Once diagnosed, a person with depression can be treated in several ways. The most common treatments are medication and psychotherapy. Although medication may help to control it, individuals must learn to recognize their own patterns of depression and develop more effective ways to cope with them. 

What are the different forms of Depression?

  • Major Depressive Disorder (MDD):  Is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. Some people may experience only a single episode within their lifetime, but more often a person may have multiple episodes.
  • Dysthymic Disorder:  Is characterized by long-term (2 years or longer) symptoms that may not be severe enough to disable a person but can prevent normal functioning or feeling well. People with Dysthymia may also experience one or more episodes of major depression during their lifetimes.
  • Seasonal Affective Disorder (SAD):  Is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms.
  • Bipolar Disorder:  Also referred to as manic-depressive illness and is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression). 

What is Bipolar Disorder?     

Bipolar Disorder causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of Bipolar Disorder are severe and are different from the normal ups and downs that everyone goes through from time to time. Bipolar Disorder symptoms can result in damaged relationships, poor job or school performance, substance abuse, and even suicide. Bipolar Disorder often develops in a person’s late teens or early adult years.

What are the symptoms of Bipolar Disorder?

People with Bipolar Disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression.  This is called a mixed state.  People with Bipolar Disorder also may be explosive and irritable during a mood episode. Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. A person may be having an episode of Bipolar Disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.

Symptoms of mania include mood changes such as a long periods of feeling “high,” or an overly happy or outgoing mood and extremely irritable mood, agitation, feeling “jumpy” or “wired.” There are also behavioral changes such as:

  • Talking very fast, jumping from one idea to another, having racing thoughts
  • Being easily distracted
  • Increasing goal-directed activities, such as taking on new projects
  • Being restless
  • Sleeping little
  • Having an unrealistic belief in one’s abilities
  • Behaving impulsively and taking part in a lot of pleasurable,
    high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Symptoms of hypomania include a person having increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week. A person having a hypomanic episode may feel very good, be highly productive, and function well.

Symptoms of depression include mood changes such as a long period of feeling worried or empty and loss of interest in activities once enjoyed, including sex. There also are behavioral changes such as:

  • Feeling tired or “slowed down”
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Thinking of death or suicide, or attempting suicide.

How is Bipolar Disorder treated?

Because Bipolar Disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.

Psychotherapy:  In addition to medication, psychotherapy can be an effective treatment. Some psychotherapy treatments used to treat Bipolar Disorder include:

  1. Cognitive behavioral therapy (CBT): Can help to change harmful or negative thought patterns and behaviors.
  2. Family-focused therapy: Can help enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy can improve communication and problem-solving.
  3. Interpersonal and social rhythm therapy: Can help to improve relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
  4. Psychoeducation: Can teach people with Bipolar Disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs.  
  5. Electroconvulsive Therapy (ECT): For cases in which medication and/or psychotherapy does not work, ECT may be useful. 

Medications:  Sometimes several different medications may need to be tried before the best course of treatment is found. Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively.

Mood Stabilizing Medications:  These are usually the first choice to treat Bipolar Disorder.

Antipsychotic Medications:  

  • Olanzapine (Zyprexa):  When given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis.  
  • Aripiprazole (Abilify):  Is also approved for treatment of a manic or mixed episode.  
  • Quetiapine (Seroquel):  Relieves the symptoms of severe and sudden manic episodes.  
  • Risperidone (Risperdal) and Ziprasidone (Geodon):  Can also be prescribed for controlling manic or mixed episodes.

Antidepressant Medications:  These work on brain chemicals called neurotransmitters, especially serotonin, norepinephrine, and dopamine. All antidepressants must be taken for at least 4 to 6 weeks before they have a full effect. You should continue to take the medication, even if you are feeling better, to prevent the depression from returning. Medication should be stopped only under a doctor’s supervision because suddenly stopping a medication may lead to “rebound,” or worsening of symptoms. People with Bipolar Disorder who take antidepressants often take a mood stabilizer too.  

FDA Warning on Antidepressants:  Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults.  The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations.