Division of Mental Hygiene

Depression

Points to Consider | Signs and Symptoms | Treatment

Serious depression is an important public health problem. More than 19 million adults in the United States will suffer from a depressive illness this year, and many will be unnecessarily incapacitated for weeks or months, because their illness goes untreated. The cost to the Nation in 1990 was estimated to be between $30 - $44 billion. The suffering of depressed people and their families is immeasurable.

Depressive disorders are not the normal ups and downs that everyone experiences. They are illnesses that affect mood, body, behavior, and mind. Depressive disorders interfere with individual and family functioning. The person with a depressive disorder is often unable to fulfill the responsibilities of spouse or parent, and may be unable to carry out usual job responsibilities.

Available medications and psychological treatments, alone or in combination, can help 80 percent of those with depression. With adequate treatment, future episodes may be prevented or reduced in severity. Yet, current evidence indicates that nearly two out of three depressed people do not seek treatment and suffer needlessly.

Depression can be devastating to all areas of a person's everyday life, including family relationships, friendships, and the ability to work or go to school. Many people still believe that the emotional symptoms caused by depression are "not real," and that a person should be able to shake off the symptoms if only he or she were trying hard enough. Because of these inaccurate beliefs, people with depression either may not recognize that they have a treatable disorder or may be discouraged from seeking or staying on treatment because of feelings of shame and stigma. Too often, untreated or inadequately treated depression leads to suicide.

Studies indicate that depression often co-occurs with medical conditions (e.g., stroke, heart disease, cancer, diabetes, etc.); other psychiatric disorders (e.g., anxiety disorders, eating disorders, etc.); and alcohol and other substance abuse. In such cases, there can be added health benefits from treating the depression.

Depression affects nearly 10 percent of adult Americans ages 18 and over in a given year, or more than 19 million people in 1998.

Unipolar major depression is the leading cause of disability in the United States and worldwide. Nearly twice as many women (12 percent) as men (7 percent) are affected by a depressive illness each year.

Research has also shown that stress in the form of loss, especially death of close family members or friends, may trigger major depression in vulnerable individuals.

Points to Consider

• • Clinical depression is a common illness that usually goes unrecognized. When identified, it can be treated.
• • There are effective medications and psychological treatments which often are used in combination. In serious depression, medication is usually required.
• • The majority of clinical depressions, including the most severe, improve with treatment, usually within weeks.
• • Continued treatment will prevent recurrence.
• • Depression is often unrecognized when it co-occurs with other medical, psychiatric, or substance abuse disorders.
• • Depression is a serious medical illness. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, clinical depression is persistent and can interfere significantly with an individual's ability to function.

Signs and Symptoms

Symptoms of depression include sad mood, loss of interest or pleasure in activities that were once enjoyed, change in appetite or weight, difficulty sleeping or oversleeping, physical slowing or agitation, energy loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide. A diagnosis of unipolar major depression (or major depressive disorder) is made if a person has five or more of these symptoms and impairment in usual functioning nearly every day during the same two-week period. Major depression often begins between ages 15-30 or even earlier. Episodes typically recur.

Some people have a chronic but less severe form of depression, called dysthymia (or dysthymic disorder), that is diagnosed when depressed mood persists for at least two years and is accompanied by at least two other symptoms of depression. Many people with dysthymia also have major depressive episodes. While unipolar major depression and dysthymia are the primary forms of depression, a variety of other subtypes exist.

Treatment

Antidepressant medications are widely used, effective treatments for depression. Existing antidepressant drugs are known to influence the functioning of certain neurotransmitters (chemicals used by brain cells to communicate), primarily serotonin, norepinephrine, and dopamine, known as monoamines. Older medications - tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) - affect the activity of both of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions. Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients to adhere to treatment. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another. Medications that take entirely different approaches to treating depression are now in development.

Electroconvulsive therapy (ECT), although not generally used as a first-line treatment, is an effective and safe treatment for severe depression.

Psychotherapy is also effective for treating depression. Certain types of psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80 percent of people with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination.

For help and information in New York City, call: 1-800-LIFENET.

This information has been excerpted from material developed by the National Institute for Mental Health.