Posted by: Raj Mali | June 19, 2007

12 things you should know about depression

Find out about depression and how it manifests itself.

1. How many people have depression?
Very many people — about five to 10 per cent of the population — have a major depression at any given point in time, and it is estimated that 15 per cent of people will develop a major depression some time in their lives.

2. When does feeling blue cross the line into depression?
When you feel so low that you cannot concentrate on anything else, such as work or family obligations, or if you are feeling suicidal, then the line has been crossed. You are also likely to be depressed if low mood lasts for over two weeks or if your sleep, appetite, energy, and thoughts are affected for that long, as well as your mood.

3. Is sadness a characteristic of depression?
Sometimes. However, sadness is different from depression. Sadness does not imply feeling disinterested, whereas depression often does. In fact, when someone is sad, he or she is often
quite interested in what led to the sadness. The same goes for grief. As painful as it is, grief — as well as its less intense counterpart, bereavement — does not imply depression. Some grieving or bereaved people may develop depression, but this is generally not the case. To understand depression it is just as important to know what it is not, as what it is.

4. What makes one person’s depression different from another’s?
Depressions differ in terms of their intensity, duration, and the breadth of symptoms involved. There are also different types of depression — some are more biological in origin, while others are more related to stressful life events.

5. What are the different types of depression?
You may become depressed in reaction to a stressful event in your life, such as losing your job or a relationship. This type of depression is described as an adjustment disorder with depressed mood (or reactive depression). Its symptoms tend to be comparatively few or mild, but nevertheless, they can sometimes include intensely depressed mood or suicidal behaviour, which means this depression should not be ignored. Another type of depression is major depressive disorder (previously called major affective disorder or unipolar depression), which is more biological in origin. Major depressive disorder is characterized by major depressive episodes. The symptoms of this disorder tend to be greater and more severe than those of adjustment disorder (see below).

6. Are there any other types?
There are other types of depressions with major depressive episodes, and these include depression in bipolar disorder (previously called manic-depressive disease) and postnatal depression. Major depressive disorder and other depressions with major depressive episodes are the types of depression that are most responsive to antidepressant medication.

7. Which kind of depression is the most common?
Adjustment disorder with depressed mood is the most common type of depression. This condition is triggered by stress, usually due to a sudden event, such as the loss of a job or breakup of a relationship. The death of a loved one can also trigger adjustment disorder with depressed mood. However, this is far from inevitable — many people experience normal states of grief and bereavement without becoming depressed.

8. What makes depression come and go?
The cause of a condition is generally something that eliminates it if reversed. The trigger is generally a final event. If you are vulnerable to depression, various factors can trigger it. For example, in postnatal depression (depression following childbirth), the trigger is labour and delivery; in major depressive disorder, the trigger can be social or psychological stress — even quite mild stress — in combination with a person’s biology. Depression usually resolves with time, with treatment, or with a lessening of the stress or life event that triggered the depression in the first place. Sometimes, however, depressive episodes don’t go away and depression becomes chronic. There might be ways to lessen the pain, there might be good and bad days, but overall, in these cases the bulk of the depressive symptoms remain.

9. Does stress always trigger depressive episodes?
Not always. Even a clear, intense source of stress can lead to different reactions in different people and it is hard to predict exactly how an individual will react to stress. Someone with major depressive disorder might react by having a major depressive episode. Someone else might react with an adjustment disorder with depressed mood. Yet another person might react by feeling depressed for a matter of days only. There are various reasons why a given source of stress leads to different reactions in different people. For example, a person who lost a parent at an early age might perceive a current loss as more severe than someone without an early loss. However, unless someone has major depressive disorder, his or her reaction does not tend to result in a major depressive episode.

10. I’ve heard of a condition called dysthymia. What is it?
Dysthymia is a condition that lies somewhere between adjustment disorder with depressed mood and major depressive disorder. It is a low-grade, toned-down form of major depressive disorder. The symptoms are less numerous and less intense than those of a major depressive episode, and the condition must last for about two years to be considered dysthymia. In previous years, dysthymia was sometimes called chronic depression. People with dysthymia generally do not feel as bad as those with major depressive disorder. Dysthymia is not as biological in origin as major depressive disorder, and it does not respond so well to antidepressants.

11. Isn’t depression genetic?
Depression does tend to run in families. There are even some detailed family tree studies showing a genetic pattern. What is inherited appears to be a vulnerability to major depressive episodes, whether the depressed person is stressed or not. Once the depressive episode is triggered, it tends to have a life of its own until treated. In any case, most doctors consider major depression and bipolar depression to be inherited conditions; other forms of biological depression might be inherited too. However, reactive depressions are not considered to be genetic. They might also run in families, but with less clear patterns. In these cases, it may be family child-rearing traditions that predispose its members to reactive depression. Remember, not everything that runs in families is genetic; poverty often runs in families, as does interest in certain careers. The genetics of depression is much more complicated than, for example, that of eye colour.

12. Do you have to feel depressed to be depressed?
Even during a major depressive episode, one does not actually have to feel depressed. Feeling depressed (depressive mood) is only one of the two essential criteria used in diagnosing depression. The other essential criterion, disinterest, is sufficient for the diagnosis of a major depressive episode. That is, a person must have either depressive mood or diminished interest in things that were previously of interest to him or her. Then three or more minor criteria must be present (decreased energy; change in sleep, appetite, activity or self-esteem; decreased concentration; or preoccupation with detail).


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