Depressive Disorders



Depressive Disorders 2307
Photo by: Frédéric Prochasson

Depressive (de-PRES-iv) disorders are mental disorders that cause long periods of excessive sadness and affect a person's feelings, thoughts, and behavior.

Jodie's Story

Even when the sun shines brightly, Jodie feels darkness everywhere she looks. She used to sleep so soundly that her father said he needed a cannon blast to wake her. In recent weeks, however, she rises unexpectedly in the gray light before dawn. She lies awake, staring at shadows from the headlights of passing cars and crying as the shapes slowly cross her ceiling.

Why would Jodie cry over a thing like that? Lately, so many odd things bring tears to her eyes. She is tired constantly. She cannot concentrate. Sometimes when she tries to solve a simple math problem in class or decide what to have for lunch, it seems as if her brain will not work. Jodie used to love to go with her friends to get a soda after school. Now all she wants to do is get home to her room and be alone. Nothing is fun, not her favorite books or television shows or even foods. Sometimes Jodie is annoyed at things and people, but she cannot explain why. Mostly, she feels sadder than she ever has felt.

For weeks, Jodie's friends have told her to snap out of it. She thinks to herself, "I want to, but what would the point be? I wish I knew what was wrong!"

What Are Depressive Disorders?

Jodie has depression (de-PRESH-un), a disorder that affects more than 17 million people in the United States. Although people often say that they are "depressed" when they feel down, this is not the same thing as the mental disorder called depression. Award-winning author William Styron, who wrote the book Sophies Choice, suffered from depression. In Darkness Visible, Styron's book about his depression, he calls the disorder a "veritable howling tempest in the brain." He compares depression to a storm that blows away all of a person's usual feelings and abilities to cope with life.

All children and adults, and even apparently some animals, feel sad at times. Perhaps it is because a relative has died or a person's favorite team has lost an important game. For most people, the mood passes after a while. Within a short time, they find themselves getting excited about a day at the beach, a visit from a favorite aunt, or a good grade on a test. They even might forget what made them so sad. If someone breaks a promise or has an argument with a friend, the sadness may return, but only for a few hours or a couple of days. These are all examples of the regular ups and downs of life.

However, people with depression have long periods when nothing seems to make their mood better. It affects their whole body and mind: how they feel, think, and behave. The good news is that, if they get professional help, more than 80 percent of people with depression will feel better, often within a few weeks.

KEYWORDS

for searching the Internet and other reference sources

Bipolar disorder

Dysthymia

Major depression

Mental disorders

Mood disorders

Suicide

Did You Know?

  • As many as 1 in 33 children may have depression, according to the Center for Mental Health Services, a U.S. government agency.
  • For teenagers, the rate of depression maybe as high as 1 in 8.
  • The majority of people who commit suicide have a depressive disorder.

Depression and Creativity

Many famous writers, composers, and artists suffered through periods of depression. These include the writers Herman Melville (Moby-Dick) and Mary Shelley (Frankenstein) and the artists Vincent van Gogh and Michelangelo.

Manic depression, with its swings between intense sadness and extreme happiness, has been a particular problem for many people with great creative talent. One reason artists sometimes are called "temperamental" may be because many have struggled with a disorder that made them seem extremely moody. Of course, not all writers, artists, and musicians experience depression. Still, some studies suggest that people in these careers are more likely to show signs of depressive disorders than people in other fields.

  • Does the depression of creative people put them in touch with feelings that they then express creatively in books, poems, music, and art?
  • Does creative talent make a person more likely to act or to seem depressed?
  • Do healthy creative people simply act differently from the rest of society?

Different people have different answers for these questions. The discussion about the possible link between depression and creativity goes on.

Major depression

Depression comes in many forms. One is called major depression, also known as clinical (KLIN-i-kal) depression. This type involves excessive sadness and/or loss of interest in activities. The symptoms must last for at least two weeks and go along with other mental and physical symptoms. In some cases, the down period lasts for many weeks or months. At times, a person with major depression may feel as if the disease has gone away on its own. "Normal" feelings return, like the ones they used to experience. But like a tide that moves in and out at the beach, the suffering usually comes back if the person does not get treatment. About 8 percent of people experience this type of depression at some point in their lives.

Doctors and researchers use computer-generated positron emission tomography (PET) scans to study how the brain functions. Here a PET scan (top) shows the brain of a healthy person in contrast to the brain of a person with untreated depression. ASAP/Photo Researchers, NIH/Science Source, Photo Researchers, Inc.
Doctors and researchers use computer-generated positron emission tomography (PET) scans to study how the brain functions. Here a PET scan (top) shows the brain of a healthy person in contrast to the brain of a person with untreated depression.
ASAP/Photo Researchers, NIH/Science Source, Photo Researchers, Inc.

Chronic depression

Chronic (KRON-ik) depression, also known as dysthymia (dis-THI-me-a), is a form of depression that lasts for two years or more. People with chronic depression do not experience the severe down feelings of someone with major depression. Instead, they suffer from a nagging feeling of emptiness that never seems to go away. They often are said to have a negative view of life or to feel "down in the dumps." About 15 to 20 percent of people who get a depressive disorder have chronic depression.

Major depression and chronic depression also are called unipolar depression (yoo-ni-PO-lar de-PRESH-un). Unipolar means the person experiences one type of feeling; in this case, sadness.

Bipolar disorder (manic depression)

Manic (MAN-ik) depression is another type of depressive disorder. People with manic depression have periods of almost unlimited energy, wild happiness, and hyperactivity that are followed by periods of depression. The mood extremes may be mild or severe, and the mood changes may occur slowly or quickly. Because this type of depression involves two different feelings, it is called bipolar (by-POL-ar) depression, to distinguish it from unipolar depression. Only about 1 percent of people with a depressive disorder have bipolar disorder.

What Causes Depressive Disorders?

Researchers learned much about the causes of depression in the 1980s and 1990s. It seems that many different factors about a person's biological makeup and life experience can trigger the start of depression. It also seems that a combination of factors often must exist together, both within a person's body and during day-today activities, for depression to occur. Unlike a cold, this illness cannot be caught from another person.

Researchers studying depression and the brain have found links between depression and an imbalance in certain chemicals in the nervous system, known as neurotransmitters * . These chemicals let brain cells communicate with each other and, therefore, allow the brain to function normally. In people with depression, the nervous system may have either too much or too little of these chemicals.

Researchers also know that depression and manic depression can occur in several members of the same family. This is because certain genes * that are passed from parent to child might increase the chance of getting the disorder. Even if someone's parent, brother, or sister has depression, however, it does not mean that the person will. For example, identical twins have the same genes, but sometimes one gets depression and the other does not.

* neurotransmitters are chemicals in the nervous system that transmit nerve impulses.

* genes are chemicals in the body that help determine a person's characteristics, such as hair or eye color. They are inherited from a person's parents and are contained in the chromosomes found in the cells of the body.

Certain situations a person faces in life also can cause depression or make it worse. One of the toughest experiences for anyone is loss of a loved one, such as a grandparent who dies or a parent who moves away because of a divorce. It is natural to feel sadness on such occasions. For some people, however, the sadness does not go away. Instead, it develops into depression. There are many other situations that are linked with depression. For children and young adults, there could be school-related problems, difficulties with friends or family, or physical or sexual abuse. For adults, there could be money problems, separation or divorce, or the loss of a job.

Researchers say that certain people seem more vulnerable to depression because of how they think about themselves and their lives. For example, people with low self-esteem might be more likely to develop depression. They might think that they are ugly, stupid, or always saying the wrong things, even if family and friends tell them differently. Also, people who are always pessimistic can become overwhelmed by depressed feelings. Such people see the negative in almost every situation. They think that it does not matter what they do or how hard they try, because nothing will work out right anyway.

Any one of these factors might lead to depression. Often, however, depression occurs for a combination of reasons. For example, it is normal for a teenager who loses a parent to feel sad. However, if the teenager already thinks that the world is a terrible place and nothing good ever happens, the stress of the loss might be worse for this teenager than for other people. If the teenager also inherited a gene linked to depression, it might be difficult to bounce back from the loss without treatment.

How Do People Know They Have a Depressive Disorder?

Unipolar disorders

Major depression and chronic depression involve a variety of symptoms. Some people experience only a few symptoms, while others feel most of them. Possible symptoms include:

  • Ongoing feelings of sadness, hopelessness, or emptiness. In children, the mood can appear more as irritability than as sadness.
  • Loss of interest in family, friends, favorite hobbies, and other things that usually make the person happy.
  • Crying easily or frequently.
  • Change in sleeping habits. Some people have trouble sleeping. Others find themselves sleeping too much.
  • Change in eating habits. Some people lose their appetite or lose weight without dieting. Others overeat or gain weight.
  • Extreme fatigue or a feeling of slowness.
  • Inability to concentrate or make decisions.
  • Increased interest in death or thoughts of suicide.

These symptoms must last for at least two weeks and be present every day for most of the day before depression is diagnosed. If the person has recently experienced a major loss, the symptoms must last for two months or longer before it is considered depression. For people with major depression, the symptoms might occur once, or they might return over and over. For those with chronic depression, the symptoms linger for a long time.

Diagnosing Depression

In 1952, the American Psychiatric Association created a book that helps psychiatrists and others determine if someone has depression and other mental disorders. It is called the Diagnostic and Statistical Manual. As psychiatrists and researchers learn more about mental disorders, the manual is revised and updated. The fourth edition, called DSM-IV for short, was released in 1994.

Bipolar disorder

Manic depression also involves periods during which the person has the symptoms described above. However, the bouts of depression take turns with manic periods that last for a week or longer. Possible signs of a manic period include:

  • Exaggerated increase in happiness. At first, the person may feel better than ever, but the elated mood is not connected to a special event, such as getting a good grade or winning a big game. The person may be wildly happy just "because it's Tuesday."
  • Boundless energy and restlessness. The person might seem to be moving or fidgeting constantly.
  • Decreased need for sleep. The person might be awake for most of the night or even for days on end without feeling tired.
  • Rapid or racing thoughts. The person might jump from one topic of conversation to the next, often without an apparent connection between the thoughts. In addition, the person might talk a lot more than usual and become distracted easily.
    A counseling session. Psychiatrists, psychologists, and mental health counselors often play important roles in the diagnosis and treatment of depression. Michael Newman/PhotoEdit.
    A counseling session. Psychiatrists, psychologists, and mental health counselors often play important roles in the diagnosis and treatment of depression.
    Michael Newman/PhotoEdit.
  • Inappropriate behavior, such as abuse of drugs and alcohol.
  • Poor judgment. The person might spend lots of money or run up high debts using credit cards.
  • Increased sexual desires that can become abusive or inappropriate.
  • Unreasonable feelings of power over events and people.

How Are Depressive Disorders Diagnosed?

Depression is not always an easy condition to diagnose. When a person cannot move one arm after a fall, the doctor can order an x-ray to check for a broken bone. However, the symptoms of depression may not be so obvious.

Often, people with depression do not realize that they have the disorder. They might sense that things are wrong, but often it is a family member, friend, coworker, family doctor, or teacher who notices the problem. That is when a professional who specializes in mental health, such as a psychiatrist * or clinical psychologist * , should be consulted. Such professionals are trained to observe how a person acts and talks. They look for symptoms of depression and decide what to do based on what they see and hear from the person and the person's family.

How Are Depressive Disorders Treated?

Almost all people who get depression can be helped. Statistics show that about 8 of every 10 people who get help find that their symptoms improve.

Depressed people may benefit from talking with a psychiatrist, clinical psychologist, or other mental health counselor. Mental health counseling * can help them learn how to cope better with stressful situations, such as moving to a new town or experiencing problems at home. Counseling also can help a person understand how current situations or past experiences might be causing the depression or preventing its relief. Family members sometimes also take part in counseling.

There are several antidepressant medications * that psychiatrists and other physicians can prescribe to affect the way that neurotransmitters work in the brain. These medications correct the imbalance that causes the symptoms of depression and allow a person to feel better. The drugs usually start working within a few weeks, although people often need to keep taking them to prevent the symptoms from returning. If one medication does not work in a matter of weeks or has side effects, another can be tried. Medications work best when used with counseling.

Medications and mental health counseling do not work for everyone. About 20 percent of people with the worst symptoms of depression do not respond well to these treatments, either used alone or in combination.

* psychiatrist refers to a medical doctor who has completed specialized training in the diagnosis and treatment of mental illness. Psychiatrists can prescribe medications, diagnose mental illnesses, and provide mental health counseling and therapy.

* clinical psychologist refers to a mental health professional who has earned a non-medical doctoral degree. Clinical psychologists can do psychological evaluation and provide mental health counseling and therapy.

* mental health counseling, also known as psychotherapy, involves talking about feelings with a trained professional. The counselor can help the person change thoughts, actions, or relationships that play a part in the illness.

* antidepressant medications are used for the treatment and prevention of depression.

* electroconvulsive therapy, popularly known as "shock therapy," involves sending small, carefully controlled pulses of electric current to the brain, which leads to brief seizures. It is a fast treatment for severe depression.

Some severe cases of depression require the person to spend time in a hospital for more intensive observation and treatment. In addition, psychiatrists sometimes treat such severe cases with electroconvulsive therapy * . This involves passing a small amount of electricity through the brain after the person has been put to sleep with a drug. Although a controversial procedure, many who receive the treatment report feeling better.

Some people have claimed that their depressed feelings improved after they took an herb called St. John's wort * , which is sold over the counter in many stores. Although physicians prescribe the herb in Europe, the National Institute of Mental Health in the United States says that not enough scientific studies have been done to know if the herb really works and is safe. In the late 1990s, NIMH began a large-scale, three-year study to help answer these questions. Until the study is completed, the institute does not recommend that people use the herb.

Many people with depression and their family members have found that joining a support group helps them cope with the problems caused by depression. It often helps to know that other people are going through the same things.

* St. John's wort is the common name for hypericum, an herb that is being studied as a possible treatment for depression.

Living with a Depressive Disorder

About two-thirds of the people with symptoms of depression do not seek or get the proper help. The disorder often makes it hard for them to

Nerve cells (neurons) use chemicals called neurotransmitters to send messages. The message (neural signal) travels in a specific direction from one cell to the next across a connecting synapse (SIN-aps), often transmitted from the axon terminal of one cell (the presynaptic neuron) across the synapse to the dendrites of the next (the postsynaptic neuron). Some antidepressant medications work by targeting levels of serotonin and other neurotransmitters in the synapses.
Nerve cells (neurons) use chemicals called neurotransmitters to send messages. The message (neural signal) travels in a specific direction from one cell to the next across a connecting synapse (SIN-aps), often transmitted from the axon terminal of one cell (the presynaptic neuron) across the synapse to the dendrites of the next (the postsynaptic neuron). Some antidepressant medications work by targeting levels of serotonin and other neurotransmitters in the synapses.
recognize what is wrong. Some people try to mask depression by using alcohol or illicit drugs, but such "self-medication" usually just makes their depression worse. Other people might believe that their mood problem is a sign of weakness and think that they can overcome it without outside help.

Such people need to understand that depression is an illness, not a character flaw. Just as something can go wrong with the heart or lungs, people can have something go wrong in their brain. This makes them ill, not "crazy.

For anyone who has a long period of sadness or other symptoms of depression, it is important to seek help. A young person should talk with parents, relatives, teachers, school counselors, or a close adult friend about these feelings, especially if they include thoughts of suicide. In most cases, people with depressive disorders can be helped with proper treatment.

Depression-Fighting
Drugs

Among the medications prescribed for depression, one of the best-known is Prozac (the brand name for fluoxetine). Prozac became the most widely prescribed antidepressant in the world soon after it was introduced in the late 1980s. It was the first in a new class of antidepressants known as selective serotonin reuptake inhibitors (called SSRIs for short). Such drugs work by acting on a neurotransmitter, or brain chemical, called serotonin. Other SSRIs have been introduced since Prozac.

Other classes of antidepressants include heterocyclic antidepressants (once called tricyclic antidepressants) and monoamine oxidase inhibitors (called MAOIs for short). The most widely prescribed drug for treating the manic period in bipolar disorder is lithium carbonate (called lithium for short).

Depression in History

Ancient Egyptians and Greeks described a disorder that sounds like depression 4,000 years ago. In past centuries, people tried treatments that seem cruel today, such as removing parts of the brain or dropping depressed people into freezing water to "shock" them.

Resources

Books

Jamison, Kay Redfield. An Unquiet Mind: A Memoir of Moods and Madness. New York: Knopf, 1995. A clinical psychologist writes about her lifelong struggle with manic depression.

Smith, Linda Wasmer. Depression: What It Is, How to Beat It. Berkeley Heights, NJ: Enslow, 2000. A book for teenagers about depression and manic depression.

Styron, William. Darkness Visible: A Memoir of Madness. New York: Random House, 1990. An excellent short book about the well-known author's battle with depression.

Organizations

American Psychiatric Association, 1400 K Street Northwest, Washington, DC 20005. A professional organization that provides information about depressive disorders on its website.
http://www.psych.org

National Depressive and Manic Depressive Association, 730 Franklin Street, Suite 501, Chicago, IL 60610. A national support organization for people with depressive disorders and their families.
Telephone 800-82-NDMDA
http://www.ndmda.org

U.S. National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. A government institute that provides information about depressive disorders.
Telephone 800-421-4211
http://www.nimh.nih.gov

See also
Alcoholism
Mental Disorders
Substance Abuse



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