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Depression
Depression is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and
sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not the same as a passing
blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive
illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks,
months, or years. Appropriate treatment, however, can help most people who suffer from depression.
The symptoms of depression may vary from person to person, and also depend on the severity of the depression. Depression
causes changes in thinking, feeling, behavior, and physical well-being.
* Changes in Thinking - You may experience problems with concentration and decision making. Some people report difficulty
with short term memory, forgetting things all the time. Negative thoughts and thinking are characteristic of depression. Pessimism,
poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during a
more serious depression.
* Changes in Feelings - You may feel sad for no reason at all. Some people report that they no longer enjoy activities
that they once found pleasurable. You might lack motivation, and become more apathetic. You might feel "slowed down"
and tired all the time. Sometimes irritability is a problem, and you may have more difficulty controlling your temper. In
the extreme, depression is characterized by feelings of helplessness and hopelessness.
* Changes in Behavior - Changes in behavior during depression are reflective of the negative emotions being experienced.
You might act more apathetic, because that's how you feel. Some people do not feel comfortable with other people, so social
withdrawal is common. You may experience a dramatic change in appetite, either eating more or less. Because of the chronic
sadness, excessive crying is common. Some people complain about everything, and act out their anger with temper outbursts.
Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal appearance,
even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity
and household responsibilities suffer. Some people even have trouble getting out of bed.
* Changes in Physical Well-being - We already talked about the negative emotional feelings experienced during depression,
but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping, is common.
Some people can't sleep, or don't sleep soundly. These individuals lay awake for hours, or awaken many times during the night,
and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose
their appetite, feel slowed down by depression, and complain of many aches and pains. Others are restless, and can't sit still.
Now imagine these symptoms lasting for weeks or even months. Imagine feeling this way almost all of the time. Depression
is present if you experience many of these symptoms for at least several weeks. Of course, it's not a good idea to diagnose
yourself. If you think that you might be depressed, see a psychologist as soon as possible. A psychologist can assess whether
you are depressed, or just under a lot of stress and feeling sad. Remember, depression is treatable. Instead of worrying about
whether you are depressed, do something about it. Even if you don't feel like it right now.
Causes of Depression
You may have heard people talk about chemical imbalances in the brain that occur in depression, suggesting that depression
is a medical illness, without psychological causes. However, all psychological problems have some physical manifestations,
and all physical illnesses have psychological components as well. In fact, the chemical imbalances that occur during depression
usually disappear when you complete psychotherapy for depression, without taking any medications to correct the imbalance.
This suggests that the imbalance is the body's physical response to psychological depression, rather than the other way around.
Some types of depression do seem to run in families, suggesting a biological vulnerability. This seems to be the case
with bipolar depression and, to a lesser degree, severe major depression. Studies of families, in which members of each generation
develop bipolar disorder, found that those with bipolar disorder have a somewhat different genetic makeup than those who are
not diagnosed.
However, the reverse is not true. Not everybody with the genetic makeup that causes this vulnerability to bipolar disorder
develops the disorder. Additional factors, such as stress and other psychological factors, are involved in its onset as well.
Likewise, major depression also seems to occur, generation after generation, in some families, but not with a frequency that
suggests clear biological causes. Additionally, it also occurs in people who have no family history of depression. So, while
there may be some biological factors that contribute to depression, it is clearly a psychological disorder.
A variety of psychological factors appear to play a role in vulnerability to these severe forms of depression. Most likely,
psychological factors are completely responsible for other forms of mild and moderate depression, especially reactive depression.
Reactive depression is usually diagnosed as an adjustment disorder during treatment.
People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed
by stress are more prone to depression. Psychologists often describe social learning factors as being significant in the development
of depression, as well as other psychological problems. People learn both adaptive and maladaptive ways of managing stress
and responding to life problems within their family, educational, social and work environments. These environmental factors
influence psychological development, and the way people try to resolve problems when they occur. Social learning factors also
explain why psychological problems appear to occur more often in family members, from generation to generation. If a child
grows up in a pessimistic environment, in which discouragement is common and encouragement is rare, that child will develop
a vulnerability to depression as well.
A serious loss, chronic illness, relationship problems, work stress, family crisis, financial setback, or any unwelcome
life change can trigger a depressive episode. Very often, a combination of biological, psychological, and environmental factors
are involved in the development of depressive disorders, as well as other psychological problems. When you feel depressed,
and don't know where to turn, talk to someone who can help.... a psychologist.
Diagnostic Evaluation for Depression
The first step to getting appropriate treatment, for depression or any emotional problem, is a complete psychological
evaluation to determine whether you have a depressive illness, and if so, what type of depression. Consultation with a psychologist
will include a review of your physical health history. Some medications as well as some medical conditions can cause symptoms
of depression, so your psychologist will ask your family physician to rule out these possibilities if other physical symptoms
are evident.
However, physicians often focus only on the physical aspects of depression, and may prescribe medication without referring
you for psychological treatment or evaluation. If you experience the symptoms of depression, as described on this website,
you should talk to a psychologist, to assess whether psychological treatment is indicated, even if it not suggested by your
physician. As a general rule, you should never take antidepressant medication alone, without also beginning psychotherapy,
or at least seeing a psychologist for an evaluation.
A good psychological diagnostic evaluation will include a complete history of your symptoms, i.e., when they started,
how long they have lasted, how severe they are, whether you've had them before and, if so, whether you were treated and what
treatment you received. Your psychologist should ask you about alcohol and drug use, and if you have had thoughts about death
or suicide. Further, a history should include questions about whether other family members have had depression and if treated,
what treatments they may have received and which were effective.
Lastly, the psychological diagnostic evaluation will include a mental status examination to assess the full range of psychological
symptoms and problems. This will help identify any other psychological problems that might be present, and will help determine
the most appropriate treatment for you.
Treatment choice will depend on the outcome of the evaluation. Most people do well with psychotherapy, but some require
treatment with antidepressants in addition to psychotherapy. Medication can allow you to to gain relatively quick symptom
relief, if you are experiencing severe and disabling symptoms. However, medication does not "cure" the depression,
it only treats the symptoms. If you are depressed, you need psychotherapy to help you to learn more effective ways to deal
with life's problems, and to change the negative thoughts and attitudes that have caused you to develop depression.
Types of Depression
Depressive disorders come in different forms. There are several different diagnoses for depression, mostly determined
by the intensity of the symptoms, the duration of the symptoms, and the specific cause of the symptoms, if that is known.
Psychology Information Online provides information on the following depressive disorders. Follow the title link for more
information about each type of depression:
* Major Depression - This is the most serious type of depression, in terms of number of symptoms and severity of symptoms,
but there are significant individual differences in the symptoms and severity. You do not need to feel suicidal to have a
major depression, and you do not need to have a history of hospitalizations either, although both of these factors are present
in some people with major depression. There is no official diagnosis of "moderate depression."
* Dysthymic Disorder - This refers to a low to moderate level of depression that persists for at least two years,
and often longer. While the symptoms are not as severe as a major depression, they are more enduring and resistant to treatment.
Some people with dysthymia develop a major depression at some time during the course of their depression.
* Unspecified Depression - This category is used to help researchers who are studying other specific types of depression,
and do not want their data confounded with marginal diagnoses. It includes people with a serious depression, but not quite
severe enough to have a diagnosis of a major depression. It also includes people with chronic, moderate depression, which
has not been present long enough for a diagnosis of a Dysthymic disorder. (You get the idea!)
* Adjustment Disorder, with Depression - This category describes depression that occurs in response to a major life
stressor or crisis.
* Bipolar Depression - This type includes both high and low mood swings, as well as a variety of other significant
symptoms not present in other depressions.
Major Depression
This is the most severe category of depression. In a major depression, more of the symptoms of depression are present,
and they are usually more intense or severe. A major depression can result from a single traumatic event in your life, or
may develop slowly as a consequence of numerous personal disappointments and life problems. Some people appear to develop
the symptoms of a major depression without any obvious life crisis causing it. Other individuals have had less severe symptoms
of depression for a long time (such as Dysthymic disorder), and a life crisis results in increased symptom intensity.
Major depression can occur once, as a result of a significant psychological trauma, respond to treatment, and never occur
again within your lifetime. This would be a single episode depression. Some people tend to have recurring depression, with
episodes of depression followed by periods of several years without depression, followed by another episode, usually in response
to another trauma. This would be a recurrent depression. In general, the treatment is similar, except that treatment usually
is over a longer time period for recurrent depression.
Professional debate continues regarding whether some people develop "endogenous depression" without any identified
psychological causes. An endogenous depression is a biologically caused depression, due presumably to either genetic causes
or a malfunction in the brain chemistry. But, all depression involves some changes in brain chemistry, even when the cause
is clearly a psychological trauma. After psychological treatment and recovery from depression, the brain chemistry returns
to normal, even without medication. To date, there is no hard research evidence to support the notion of endogenous depression.
Sometimes this term is used to describe people who do not respond well to treatment, and sometimes it is a rationale to prescribe
medication alone, and not to offer any psychological treatment for the depression. In general, the majority of people who
require antidepressant medication for their depression respond to treatment better when psychotherapy, particularly cognitive-behavioral
psychotherapy, is provided in addition to the medication. Medication treats the symptoms of depression, and is often a vital
part of the treatment program, but it is essential to treat the psychological problems that caused the depression.
Research has shown that cognitive therapy is the best treatment for depression, as compared to medication and other forms
of psychotherapy. However, many people respond better to a combination of medication and cognitive therapy. It does not make
sense to only prescribe medication, without offering psychotherapy as well, because of the added benefits shown in research
studies. There are some people who respond positively to psychotherapy, but plateau at a mild level of depression, without
complete recovery from all of the symptoms. Often, these individuals are maintained on antidepressant medication after they
have completed psychological treatment. Remember, only physicians are qualified to prescribe medication. Your psychologist
will refer you to your primary care physician, or to a psychiatrist, for a medication evaluation, if it appears to be indicated.
The following topics are presented on this page:
Symptoms of Depression
First Person Description of Major Depression
Differences Between Major Depression and Other Depressions
Links to Other Psychological Topics
Symptoms of Depression
A Major Depression is marked by a combination of symptoms that occur together, and last for at least two weeks without
significant improvement. Symptoms from at least five of the following categories must be present for a major depression,
although even a few of the symptom clusters are indicators of a depression, but perhaps not a major depression.
* Persistent depressed, sad, anxious, or empty mood
* Feeling worthless, helpless, or experiencing excessive or inappropriate guilt
* Hopeless about the future, excessive pessimistic feelings
* Loss of interest and pleasure in your usual activities
* Decreased energy and chronic fatigue
* Loss of memory, difficulty making decisions or concentrating
* Irritability or restlessness or agitation
* Sleep disturbances, either difficulty sleeping, or sleeping too much
* Loss of appetite and interest in food, or overeating, with weight gain
* Recurring thoughts of death, or suicidal thoughts or actions
This list is a guide to help you understand depression. It is not offered for you to diagnose yourself. If you have some
of these symptoms, don't focus on how many symptoms you have. Instead, talk to a psychologist about how you have been feeling,
to see if he/she can
Bi-Polar
What is Bipolar Disorder?
The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least
one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have
one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average,
without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression
and manic episodes, that is specific to that individual, but predictable once the pattern is identified. Research studies
suggest a strong genetic influence in bipolar disorder.
Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized
as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without
treatment.
Effective treatment is available for bipolar disorder. Without treatment, marital breakups, job loss, alcohol and drug
abuse, and suicide may result from the chronic, episodic mood swings. The most significant treatment issue is noncompliance
with treatment. Most individuals with bipolar disorder do not perceive their manic episodes as needing treatment, and they
resist entering treatment. In fact, most people report feeling very good during the beginning of a manic episode, and don't
want it to stop. This is a serious judgment problem. As the manic episode progresses, concentration becomes difficult, thinking
becomes more grandiose, and problems develop. Unfortunately, the risk taking behavior usually results in significant painful
consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties. Many
individuals with bipolar disorder abuse drugs or alcohol during manic episodes, and some of these develop secondary substance
abuse problems.
Facts About Bipolar Illness
* More than 2 million Americans have manic-depressive illness. It is extremely distressing and disruptive to their
lives.
* Like any serious illness, bipolar disorder also creates problems for spouses, family members, friends, and employers.
* Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild
spending sprees) and the lasting consequences of these behaviors.
* Bipolar disorder tends to run in families, and there is strong evidence that it is inherited. However, despite ongoing
research efforts, a specific genetic defect associated with the disease has not yet been identified.
* Bipolar illness has been diagnosed in children under age 12, although it is not common in this age bracket. The
symptoms can be confused with attention-deficit/hyperactivity disorder, so careful diagnosis is necessary.
What is a manic episode?
A manic episode is an abnormally elevated, expansive or irritable mood, not related to substance abuse or a medical condition,
that lasts for at least a week, and includes a number of disturbances in behavior and thinking that results in significant
life adjustment problems. Chronic behavior that appears somewhat similar to manic behavior is more likely ADHD or evidence
of personality problem.
It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At
one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many
people call "the blues," then normal mood, then hypomania (a mild form of mania), and then mania.
Some people with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar
II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of
mania and depression may be mixed together in a single "mixed" bipolar state.
What is Bipolar Disorder?
The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least
one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have
one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average,
without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression
and manic episodes, that is specific to that individual, but predictable once the pattern is identified. Research studies
suggest a strong genetic influence in bipolar disorder.
Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized
as a psychological problem, because it is episodic. Consequently, those who have it may suffer needlessly for years without
treatment.
Effective treatment is available for bipolar disorder. Without treatment, marital breakups, job loss, alcohol and drug
abuse, and suicide may result from the chronic, episodic mood swings. The most significant treatment issue is noncompliance
with treatment. Most individuals with bipolar disorder do not perceive their manic episodes as needing treatment, and they
resist entering treatment. In fact, most people report feeling very good during the beginning of a manic episode, and don't
want it to stop. This is a serious judgment problem. As the manic episode progresses, concentration becomes difficult, thinking
becomes more grandiose, and problems develop. Unfortunately, the risk taking behavior usually results in significant painful
consequences such as loss of a job or a relationship, running up excessive debts, or getting into legal difficulties. Many
individuals with bipolar disorder abuse drugs or alcohol during manic episodes, and some of these develop secondary substance
abuse problems.
Facts About Bipolar Illness
* More than 2 million Americans have manic-depressive illness. It is extremely distressing and disruptive to their
lives.
* Like any serious illness, bipolar disorder also creates problems for spouses, family members, friends, and employers.
* Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild
spending sprees) and the lasting consequences of these behaviors.
* Bipolar disorder tends to run in families, and there is strong evidence that it is inherited. However, despite ongoing
research efforts, a specific genetic defect associated with the disease has not yet been identified.
* Bipolar illness has been diagnosed in children under age 12, although it is not common in this age bracket. The
symptoms can be confused with attention-deficit/hyperactivity disorder, so careful diagnosis is necessary.
What is a manic episode?
A manic episode is an abnormally elevated, expansive or irritable mood, not related to substance abuse or a medical condition,
that lasts for at least a week, and includes a number of disturbances in behavior and thinking that results in significant
life adjustment problems. Chronic behavior that appears somewhat similar to manic behavior is more likely ADHD or evidence
of personality problem.
It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At
one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many
people call "the blues," then normal mood, then hypomania (a mild form of mania), and then mania.
Some people with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar
II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of
mania and depression may be mixed together in a single "mixed" bipolar state.
Descriptions of Mood States
Here are some first-person accounts of the various mood states associated with bipolar disorder:
Depression:
I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to
the point of being virtually useless. I am haunted with the desperate hopelessness of it all. Others say, "It's only
temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are
certain they do. If I can't feel, move, think, or care, then what on earth is the point?
Hypomania:
At first when I'm high, it's tremendous...ideas are fast...like shooting stars you follow until brighter ones appear...all
shyness disappears, the right words and gestures are suddenly there...uninteresting people, things, become intensely interesting.
Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings
of ease, power, well-being, omnipotence, euphoria...you can do anything...but, somewhere this changes.
Mania:
The fast ideas become too fast and there are far too many...overwhelming confusion replaces clarity...you stop keeping
up with it--memory goes. Infectious humor ceases to amuse. Your friends become frightened...everything is now against the
grain...you are irritable, angry, frightened, uncontrollable, and trapped.
Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective
treatment and avoid the harmful consequences of the disease, which include destruction of personal relationships, loss of
employment, and suicide.
Features of a Depressive Episode
* Persistent sad, anxious, or empty mood
* Feeling helpless, guilty, or worthless
* Hopeless or pessimistic feelings
* Loss of pleasure in usual activities
* Decreased energy
* Loss of memory or concentration
* Irritability or restlessness
* Sleep disturbances
* Loss of or increase in appetite
* Persistent thoughts of death
Features of a Manic Episode
* Extreme irritability & distractibility
* Excessive "high" or euphoric feelings
* Sustained periods of unusual, even bizarre, behavior with significant risk-taking
* Increased energy, activity, rapid talking & thinking, agitation
* Decreased sleep
* Unrealistic belief in one's own abilities
* Poor judgment
* Increased sex drive
* Substance abuse
* Provocative or obnoxious behavior
* Denial of problem
Factors Preventing Early Detection of Bipolar Disorder
An early sign of manic-depressive illness may be hypomania--a state in which the person shows a high level of energy,
excessive moodiness or irritability, and impulsive or reckless behavior. Hypomania may feel good to the person who experiences
it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is
wrong. In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first
appear as alcohol or drug abuse, or poor school or work performance. If left untreated, bipolar disorder tends to worsen,
and the person experiences episodes of full-fledged mania and clinical depression.
Treatment of Bipolar Disorder
Psychological treatment often focuses on the life adjustment problems that develop because of the manic episodes, and
in helping the individual recognize the onset of a manic episode and take corrective action. Supportive counseling is needed,
to help the individual accept that he/she has a chronic psychological problem that will have a major impact on life management.
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in its diagnosis and treatment, as well as
a psychologist. Psychologists provide the individual and his/her family with support, education, coping skills training, They
also help monitor the symptoms and encourage the individual to continue medical treatment. The psychiatrist monitors the medication
that is usually required with this disorder.
Most people with manic depressive illness can be helped with treatment.
Almost all people with bipolar disorder--even those with the most severe forms--can obtain substantial stabilization of
their mood swings. One medication, lithium, is usually very effective in controlling mania and preventing the recurrence
of both manic and depressive episodes. Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate have
also been found useful, especially in more refractory bipolar episodes. Often these medications are combined with lithium
for maximum effect.
Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process
in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even
in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that
carbamazepine and valproate act later. Children and adolescents with bipolar disorder are generally treated with lithium,
but carbamazepine and valproate are also used. Valproate has recently been approved by the Food and Drug Administration for
treatment of acute mania. The high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia.
Thyroid augmentation may also be of value. For depression, several types of antidepressants can be useful when combined with
lithium, carbamazepine, or valproate. Constructing a life chart of mood symptoms, medications, and life events may help the
health care professional to treat the illness optimally. Because manic-depressive illness is recurrent, long-term preventive
(prophylactic) treatment is highly recommended and almost always indicated.
Treatment Issues
Symptoms of bipolar disorder may prevent those affected from recognizing that they have an illness. Family, friends,
and primary care physicians should provide encouragement and referrals for treatment. Psychological treatment can help the
person and his/her family cope with the life management problems created by bipolar disorder. Medical treatment is usually
needed to control mood swings with medication. To ensure proper treatment and personal safety, commitment to a hospital may
be necessary for a person in a severe episode. Hospital commitment, which is placing a person in the hospital against their
will, is sometimes necessary with bipolar disorder because of the effects of manic episodes. While the person is "high"
he/she is not rational, and may engage in activities that are a threat to themselves or others. The person cannot understand
the need for hospitalization because of the disturbance that occurs to his/her judgment. Suicidal thoughts, remarks, or behaviors
should always be given immediate attention by a qualified professional. It is not true that if a person talks about suicide,
they will not kill themselves. Self-destructive thoughts are sometimes acted out indirectly. For example, a person may drive
excessively fast, or take drugs, or start confrontations with others, as a way to harm himself/herself. With appropriate treatment,
the suicidal thoughts and behavior can be controlled and eliminated.
Bipolar disorder is a lifetime illness. To keep his/her mood stable, ongoing treatment is needed, even when the person
is feeling better. It may take time to discover the best treatment regimen for an individual. It is very important for both
the person with bipolar disorder, and his/her family, to work with a psychologist and physician to develop the most appropriate
treatment plan. In addition to treatment, mutual support self-help groups can benefit patients and their families. National
Depressive and Manic Depressive Association (NDMDA) and National Alliance for the Mentally Ill (NAMI) sponsor such groups.
Dysthymic Disorder
Dysthymic Disorder is characterized by chronic depression, but with less severity than a major depression. The essential
symptom for dysthymic disorder is an almost daily depressed mood for at least two years, but without the necessary criteria
for a major depression. Low energy, sleep or appetite disturbances and low self-esteem are usually part of the clinical picture
as well.
People who have dysthymic disorder will often report that they don't recall ever not feeling depressed, but they may be
relatively functional in managing their life, although the symptoms are severe enough to cause distress and interference with
important life role responsibilities. It is important to have a complete physical to rule out any physical illnesses that
might be causing the depression. Also, if the person has a chronic medical condition that appears to be the cause for the
depression (such as any chronic debilitating condition), then the correct diagnosis might be a Mood Disorder due to a general
Medical Condition, even if all the criteria for dysthymic disorder are met. The question is whether the medical condition
is physically causing the depression, rather than creating chronic psychological distress that is causing the depression.
Despite the long term nature of this type of depression, psychotherapy is effective in reducing the symptoms of depression,
and assisting the person in managing his/her life better. Some individuals with dysthymic disorder respond well to antidepressant
medication, in addition to psychotherapy, so an evaluation for medication may be appropriate. You should consult your psychologist
if you have questions about treatment.
Identifying Dysthymic Disorder
Depression causes changes in thinking, feeling, behavior, and physical well-being.
Changes in Thinking - Many people experience difficulty with concentration and decision making. Some people report problems
with short term memory, forgetting things all the time. Negative thoughts and thinking are characteristic of depression. Pessimism,
poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during more
serious depression.
Changes in Feelings - Many people report feeling sad for no reason. Others report that they no longer enjoy activities
that they once found pleasurable. You might lack motivation, becoming more apathetic. You might feel "slowed down"
and tired all the time. Sometimes irritability is a problem, and more difficulty controlling your temper. Often, dysthymic
disorder leads to feelings of helplessness and hopelessness.
Changes in Behavior - You might act more apathetic, because that's how you feel. Some people do not feel comfortable with
other people, so social withdrawal is common. Some people experience a change in appetite, either eating more or less. Because
of the chronic sadness, excessive crying is common. Some people complain about everything, and act out their anger with temper
outbursts. Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal
appearance, even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity
and household responsibilities suffer. Some people have trouble getting out of bed.
Changes in Physical Well-being - We already talked about the negative emotional feelings experienced during depression,
but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping is common.
Some people can't sleep, or don't sleep soundly. These individuals lay awake for hours, or awaken many times during the night,
and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose
their appetite, feel slowed down by depression, and complain of many aches and pains.
Now imagine these symptoms lasting for months. Imagine feeling this way almost all of the time. This may be dysthymic
disorder, if several of these symptoms are present most of the time, for the past two years. Remember, all of the symptoms
do not need to be present! Of course, it's not a good idea to diagnose yourself. If you think you might be depressed, talk
to a psychologist for a consultation. A licensed psychologist can assess whether you are depressed, and can determine the
proper treatment for your depression. Remember, depression is treatable.
Treatment for Dysthymic Disorder
Psychotherapy is the treatment for choice for this psychological problem. Often, antidepressant medication is also recommended
because of the chronic nature of the depression in Dysthymia. Psychotherapy is used to treat this depression in several ways.
First, supportive counseling can help to ease the pain, and can address the feelings of hopelessness. Second, cognitive therapy
is used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression
and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are
minor. It also helps them to learn how to accept the life problems that cannot be changed. Third, problem solving therapy
is usually needed to change the areas of the person's life that are creating significant stress, and contributing to the depression.
Behavioral therapy can help you to develop better coping skills, and interpersonal therapy can assist in resolving relationship
conflicts.
Other Types of Depression
Following the diagnostic explanations for different types of depression as a way to self-diagnose is not recommended.
There are many factors that go into identification and treatment of depression and other psychological problems, and only
a qualified mental health professional, such as a psychologist, should diagnose psychological problems. The information provided
on this web site is intended to help you determine whether you, or a friend or family member, should consult a psychologist
for an evaluation and treatment. Psychologists complete a four year college degree, and then complete an average of five
to seven years of graduate professional training, resulting in either a Ph.D., Psy.D. or Ed.D. degree in psychology, plus
additional experiential training, prior to becoming licensed to practice. The information presented here is general, and simplified.
When you need to talk to someone who can help with depression, consult a psychologist.
Depression, Not otherwise specified
Some professionals portray this category as a "garbage pail" diagnostic category for depression. If someone
is obviously depressed, but does not fit into any of the other categories, then this diagnosis is made. However, it is not
a garbage pail, but provides a valuable way to categorize depression that does not fit into the other categories. The alternative
would be to have several additional diagnostic categories. That is not useful, unless the different diagnoses require different
treatment. This category includes people with serious depression, but not quite severe enough for a diagnosis of a major depression,
so moderate depression would be included here. This would include people with mild to moderate depression, who have not been
depressed long enough to be diagnosed with dysthymic disorder, which requires depressive symptoms for two years. It also includes
those individuals who continue to be depressed, in response to some traumatic event, but the depression has lasted longer
than expected for an adjustment disorder with depression. In an adjustment disorder, the expectation is that the depression
will last no more than about six months after the stressor has ended.
The treatment plan remains the same as for other depressive disorders. Cognitive psychotherapy is effective in reducing
depressive symptoms, and the cognitive distortions that appear to cause the mood problem. Interpersonal psychotherapy is used
to help the individual resolve relationship problems that are causing the depression. If the symptoms are severe, the individual
may be referred for a medical evaluation to assess the need for medication, but in most cases medication is not necessary.
The different diagnostic categories of depression are sometimes more useful for research purposes than for treatment purposes.
When making distinctions between different categories within a particular class of disorders, such as depression, psychologists
are looking for differences that may indicate different causes, or that require different treatment.
Also, in completing research on treatment for a specific category of depression, the differences become important in measuring
the results of treatment. For example, if a study is comparing different treatments, it is important that the treatment groups
are similar. We would not want one treatment group to include mostly people with a major depression and another group to include
mostly people with an adjustment disorder. If that happened, the research results would be tainted. Generally, moderate depression
requires less treatment, and responds better to treatment, than severe depression. If we are comparing different types of
treatment, the different treatments must be applied to similar problems.
To some extent then, the use of a diagnosis helps the psychologist predict the expected duration of treatment, or to anticipate
possible issues that might arise in treatment. The history of symptoms, especially the duration of the depression, can help
a psychologist understand the overall impact of the depression on a person's life. Someone who has been depressed for many
years, either with dysthymic disorder or recurrent major depression, will have a multitude of issues related to how the disorder
has taken over his/her life. This is very different than the clinical picture presented when a person becomes depressed initially
after a specific trauma, and recovers.
Adjustment Disorder, with depressed mood
This is also called a "reactive depression." The diagnosis of an adjustment disorder implies that specific psychological
symptoms have developed in response to a specific and identifiable psychosocial stressor. However, this diagnostic group (adjustment
disorders) is a "last resort" category. If the symptom picture suggests that the person meets the diagnostic criteria
for another psychological disorder, than this diagnosis is not used. For example, if a person experiences a trauma, and develops
the symptoms of a major depression, then the diagnosis of adjustment disorder is not used, even though the depression developed
in response to a psychosocial stressor. So, adjustment disorder with depression is used to categorize mild to moderate depression,
following a stressful event.
Also, the depressive symptoms related to an adjustment disorder should be treated and dissipate within six months following
the end of the stress that produced the reaction. If the symptoms last longer, then the above diagnosis of Depression, not
otherwise specified, is probably more appropriate. There is an exception to this rule, as some stressors continue over a long
period of time, rather than occurring as a single event. For example, if a person is harassed on the job, that can continue
for months. In such a case, the depression may not be severe enough for a diagnosis of major depression, but it would continue
for more than six months. But, since the stress is continuing, then the adjustment disorder diagnosis could still be used.
The symptom picture is similar to other depressive disorders, and the recommended treatment is still cognitive-behavioral
therapy and/or interpersonal therapy. However, because of the relationship between the symptoms and a specific stressor, there
is more emphasis put on resolving the problem that created the stress. This may involve making concrete changes in the way
the person manages his/her life, and may require specific action and decision making. (e.g. If job stress is resulting in
depression, the person may need to decide whether changing jobs is the most appropriate solution.) Often people become depressed
in reaction to psychosocial stressors when they don't believe a solution exists to their problem. In such cases, helping the
person develop a reasonable solution is a key part of the treatment process.
Helping Yourself
Depressive disorders make you feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make
some people feel like giving up. You should realize that these negative views are part of depression, and typically do not
accurately reflect your life situation. Negative thinking fades as treatment begins to take effect. Psychotherapy, especially
cognitive psychotherapy, is specifically designed to change the negative thinking associated with depression.
In the meantime:
* Do not set difficult goals for yourself, or take on additional responsibility.
* Break large tasks into small ones, set some priorities, and do what you can as you can.
* Do not expect too much from yourself too soon, as this will only increase your feelings of failure.
* Try to be with other people; it is usually better than being alone.
* Force yourself to participate in activities that may make you feel better.
* Try engaging in mild exercise, going to a movie, a ball-game, or participating in religious or social activities.
* Don't overdo it or get upset if your mood is not greatly improved right away. Feeling better takes time.
* Do not make major life decisions, such as changing jobs, getting married or divorced, without consulting others
who know you well and who have a more objective view of your situation. In any case, it is advisable to postpone important
decisions until your depression has lifted.
* Do not expect to snap out of your depression. People rarely do. Help yourself as much as you can, and do not blame
yourself for not being up to par.
* Remember, do not accept your negative thinking. It is part of the depression and will disappear as your depression
responds to treatment.
* Get help from a professional. No matter how much you want to beat it yourself, a psychologist can help you recover
faster.
Helping the Depressed Person
The most productive way to assist a depressed person, is to help him or her get appropriate treatment. This may involve
encouraging the individual to stay with treatment until the symptoms begin to abate (several weeks), or to seek different
treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person
to appointments with the psychologist. It may also mean monitoring whether the depressed person is taking medication, if prescribed.
The second most important way to help is to offer emotional support. This involves understanding, patience, affection,
and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed,
but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the depressed person's
psychologist.
Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation
is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural
activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and
company, but too many demands can increase feelings of failure.
Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it."
Eventually, with treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person
that, with time and help, he or she will feel better.
Depressed People May Need Help to get Help
The very nature of depression can interfere with a person's ability to get help. Depression saps energy and self-esteem
and makes a person feel tired, worthless, helpless, and hopeless. Therefore,
* Seriously depressed people need encouragement from family and friends to seek treatment to ease their pain.
* Some people need even more help, becoming so depressed, they must be taken for treatment.
* Don't ignore suicidal thoughts, words or acts. Seek professional help immediately.
Where to Get Help
A complete psychological diagnostic evaluation will help you decide the type of treatment that might be best for you.
You can consult the National Directory of Psychologists on this website to locate a psychologist near your home, or contact
the Psychological Association in your state to receive a referral. Contact information for all State Psychological Associations
can also be found in the National Directory of Psychologists.
Source: http://www.psychologyinfo.com/depression/
Teenagers and depression
Young people can feel depressed for all sorts of reasons and their depression can vary from feeling a bit blue, to feeling
overwhelming sadness and hopelessness. Some may even feel suicidal. Up to 24 per cent of teenagers will suffer a major depressive
illness some time during their adolescence. But depression in young people is often not recognised. Although it is often difficult
to communicate with someone who is feeling low and words may not come easily, it is important not to ignore a young person's
feelings. Knowing that family and friends really care and are willing to give support can be the first vital step in getting
better.
Different types of depression
The three main types of depression are:
* Depressed mood - feeling sad or blue is an emotion common to people of all ages. The feeling generally results from
minor problems or loss. People usually feel better after talking about the problem, or doing something they enjoy. A depressed
mood doesn't usually interfere with daily activities.
* Dysthymia - a mild type of depression that can last for over a year in young people. They may lose interest in things
they have enjoyed doing and appear down most of the time. They have less energy, find it difficult to concentrate, and have
trouble eating and sleeping. The most common factor is feeling bad about themselves and having less confidence and enjoyment
in their lives. Dysthymia is much more serious than a depressed mood.
* Major depression - this illness usually occurs rapidly and may be triggered by a major stressful event such as a
death or broken relationship; sometimes, however, it may have no obvious cause. Some of the signs of major depression include
severe sleeping problems, loss of enjoyment in usual activities, feeling hopeless or worthless, increasing drug and alcohol
use, neglect of personal appearance, excessive worry about health, complaints about constant physical pains like headaches,
carelessness about physical safety, behaviour problems and preoccupation with death and suicide.
Young people at risk
Depression can affect anyone, but some teenagers are more likely to become depressed if:
* They have a close relative who has suffered from depression.
* They have had a major life stress or several stresses. A major life stress can be family break-up, school failure,
experience of prejudice and social isolation because of sexual preferences, child abuse, loss of a parent, accident, broken
relationship or moving to another area.
Suicide risk factors
Stresses that sound small to adults may be very important to teenagers and should be taken seriously. Telling a person
who is upset that their worry is 'about nothing' only makes things worse. They feel no one understands and this increases
their sense of being alone in the world. The following things may mean that a teenager is seriously thinking about taking
their life:
* Talk or threats of suicide
* Hints such as 'I won't be a problem for you much longer'
* Previous attempts, especially if the person was alone at the time
* Careless risk-taking behaviour
* Sad or angry mood that doesn't go away
* Giving away personal possessions
* Suddenly clearing out belongings and getting them in order
* Becoming suddenly cheerful without reason after being depressed.
Ways of helping your depressed child
When teenagers are suffering with depression, they aren't always able to ask for help and may even refuse your help at
times. It is important that you:
* Take their depression seriously.
* Offer unconditional love and concern.
* Take time to listen when they want to talk about their feelings.
* Show them you are available without being 'pushy'.
* Encourage them to do things you know they enjoy.
* Notice the little things they are doing that you approve of.
* Support and encourage your child to get help without nagging.
* If your child won't go for help and you are worried, go by yourself first and get some advice on how to best handle
the situation.
* Take seriously any talk about suicide and actions such as giving away special things - do whatever is needed to
ensure their safety, even if it is against their wishes.
* Make sure you don't keep a gun in your home.
Taking care of yourself
Parenting a teenager who is suffering depression can be very stressful. When you find yourself getting angry or frustrated:
* Take a step back and think about what is happening before reacting.
* Remember that your relationship with your child is important and they need it to continue.
* Think about your own views: are you wondering why you should have to put up with the terrible behaviour (which will
only make the situation worse) or are you thinking, 'Something must be wrong for my child to be behaving like this' (which
will lead to a search for the cause)?
* Ask people close to you for support.
* Ask someone the young person is close to (such as another relative) to help provide support, but make sure your
child knows that you're not rejecting them.
* Make sure you do things for yourself - you need to take care of your own needs if you are to help your child.
* Get professional help if you need to.
Professional help
There is a range of different treatments for depression varying from anti-depressant medication to counselling and therapy,
or a combination of these. The right treatment depends on the individual needs and the situation of the teenager. It is important
to persist until the right treatment is found, as young people are often particular about who they will talk to.
Things to remember
* Up to 24 per cent of teenagers suffer a major depressive illness, but depression in young people is often not recognized.
* Stresses that sound small to adults may be very important to teenagers and should be taken seriously.
* When teenagers are suffering with depression, they aren't always able to ask for help and may even refuse your help
at times.
* If your child won't go for help and you are worried, go by yourself first to get advice on how to best handle the
situation.
source: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Teenagers_and_depression?OpenDocument
Depression in Childhood and Adolescence
Other Places To Get Help
Online Resources
American Academy of Child and Adolescent Psychiatry
Web Address: http://www.aacap.org
This organization assists parents and families in understanding the developmental, behavioral, emotional, and mental disorders
affecting children and adolescents. Services and advocacy groups are identified on this site as well.
KidsPeace
Web Address: http://www.kidspeace.org
KidsPeace, a private, not-for-profit organization, educates children, parents, and professionals about how to anticipate
and avoid crisis whenever possible. KidsPeace provides a comprehensive range of mental and behavioral health treatment programs,
crisis intervention services, and public education initiatives. It also acts as a national liaison for intervention services.
Teen Central Helpline
Web Address: http://www.teencentral.net
TeenCentral.Net is a Web site for teenagers created by teenagers and monitored by professionals. The vision behind TeenCentral.Net
is to help teens in crisis by giving them a private, anonymous place to receive sound, tested advice from professionals and
to relate with their peers in a safe, professionally counseled environment.
Organizations
National Institute of Mental Health (NIMH), Public Inquiries
6001 Executive Boulevard
Suite 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: (301) 443-4513
Fax: (301) 443-4279
E-mail: nimhinfo@nih.gov
Web Address: http://www.nimh.nih.gov
NIMH provides information to help people better understand mental health and mental disorders. NIMH does not provide referrals
to mental health professionals or treatment for mental health problems.
National Mental Health Association (NMHA)
1021 Prince Street
Alexandria, VA 22314-0297
Phone: (703) 684-7722
1-800-969-NMHA (1-800-969-6642). This also is a hot line for help with depression.
Fax: (703) 684-5968
Web Address: http://depression-screening.org
The NMHA has launched a Web site with a confidential depression screening exam available to anyone who would like to take
the test. The short test may help you decide whether or not your symptoms are related to depression.
National Mental Health Consumers' Self-Help Clearinghouse
1211 Chestnut Street
Suite 1000
Philadelphia, PA 19107
Phone: 1-800-553-4539
(215) 751-1810
Web Address: http://www.mhselfhelp.org/index2.html
The National Mental Health Consumers' Self-Help Clearinghouse is a consumer-run national assistance center committed to
helping mental health consumers improve their lives through self-help and advocacy. This clearinghouse helps consumers plan,
provide, and evaluate mental health and community support services. It supplies pamphlets, tool kits, manuals, and a newsletter
called The Key.
Worst Things to Say to Someone Who Is Depressed
Some people trivialize depression (often unintentionally) by dropping a platitude on a depressed person as if that is
the one thing they needed to hear. While some of these thoughts have been helpful to some people (for example, some find
that praying is very helpful), the context in which they are often said mitigates any intended benefit to the hearer.
Platitudes don't cure depression.
Here is the list from contributors to a.s.d.:
0. "What's *your* problem?"
1. "Will you stop that constant whining?
What makes you think that anyone cares?"
2. "Have you gotten tired yet of all this me-me-me stuff?"
3. "You just need to give yourself a kick in the rear."
4. "But it's all in your mind."
5. "I thought you were stronger than that."
Best Things to Say To Someone Who is Depressed
It is most tempting, when you find out someone is depressed, to attempt to immediately fix the problem. However, until
the depressed person has given you permission to be their therapist (as a friend or professional), the following responses
are more likely to help.
The things that didn't make me feel worse are words wich
1) acknowledge my depression for what it is (No 'it's just a phase')
2) give me permission to feel depressed (No 'but why should you be sad?')
Here is the list from contributors to a.s.d.:
1. "I love you!"
2. "I Care"
3. "You're not alone in this"
4. "I'm not going to leave/abandon you"
5. "Do you want a hug?"
---------------------------------------------
For the balance of these lists, please go to
http://www.blarg.net/~charlatn/depression/worst.things.html
and
http://www.blarg.net/~charlatn/depression/Best.things.html.
Compiled by bw@cv.hp.com
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