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Depression and Mood Disorders

What is depression and what to do about it.

Most of us have felt sad or low at some point in our adult lives but have learned coping strategies that have kept us from becoming overwhelmed by these feelings. Some of us, however, have reached an unusual point in our lives marked by a depressed mood most of the day.

As I walk through the mall, I often wonder how many people are struggling with depression. I wonder how many are constantly sad or burdened or have lost interest in activities that they usually enjoy. Are you one of these people?

What is depression?

One person’s experience of depression often differs from another’s. The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-V) addresses three main categories of depression: major depression, dysthymia, and bipolar disorder. However, these terms don’t begin to describe the variation of people’s experience.

Major Depression. This form of depression happens in relatively short episodes separated by spans of time. During these episodes, you feel constantly sad or burdened and lose interest in activities previously enjoyed. During this time, you may experience a change in appetite, insomnia, restlessness, problems concentrating, feelings of worthlessness or guilt, thoughts of death or suicide.

Dysthymia. This type of depression is low-level, lasting for at least two years in adults or one year in children and teens. It is persistent keeping you from feeling good and intruding upon your work and social life. Major depression can be equated to the color black while dysthymia is likened to a dim gray. It is experienced in short episodes of time but lasting for an average of at least five years. Treatment can ease the grasp of dysthymia in about four out of five people.

Bipolar. Bipolar disorder always includes episodes of mania characterized by a high mood, grandiose thoughts, and erratic behavior with episodes of depression. Between episodes, a person can feel completely normal for months or even years. Bipolar disorder usually starts in early adulthood. It is equally common among men and women.

How common is depression?

If you include the three categories of depression, they affect 20.9 million American adults each year. That is almost 10 percent of the U.S. population ages 18 and older.

Major depression affects 14.8 million Americans ages 18 and older which translates to 6.6 percent of the population. Bipolar disorder affects 5.7 million American adults annually which is 2.6 percent of the U.S. population ages 18 and older. Dysthymia is the least common affecting 3.3 million American adults or 1.5 percent of the population. However, there may be many people with dysthymia who are never diagnosed.

What causes depression?

Depression has many causes. Researchers are learning a great deal about the biology of depression. That is to say; they have identified genes that make individuals more vulnerable to mood swings and how individuals respond to drug therapy. With the sophistication of brain imaging scientists have a better view of how the brain works. We know more about which regions of the brain regulate mental functions and depression.

A goal of gene research is to find out why certain people are vulnerable to depression. For example, scientists know which genes influence the stress response. The best way to grasp the power of genetics is to look at families. For example, depression and bipolar disorder run in families. The goal of genetics research is to learn the specific function of each gene hopefully leading to why some people become depressed, and others do not.

Seasonal Affective Disorder (SAD) is a form of depression that affects about 1 to 2 percent of the population, particularly women and young people. It seems to be triggered by limited exposure to daylight, typically during fall and winter months. Symptoms are similar to general depression. Doctors suggest outdoor exercise. Light therapy, called phototherapy, is also recommended.

When should a person seek therapy?

There are a number of signs and symptoms that you look for. Some of the symptoms are persistent empty feelings; feelings of hopelessness and pessimism; loss of interest in activities and hobbies; fatigue and decreased energy; difficulty concentrating; and insomnia. Depression can leave a person with feelings of emptiness and despair.

One person wrote, “I started missing days from work, and a friend noticed that something wasn’t right. She talked to me about the time she had been really depressed and had gotten help from her doctor.” The earlier that treatment can begin, the more effective it is.

The first step is to talk to your doctor. The doctor can rule out medical conditions that might trigger the same symptoms as depression. Your doctor can prescribe the appropriate antidepressants that can regulate mood and treat your depression as well as refer you to counseling or psychotherapy.

What can a person expect from therapy?

Several types of psychotherapy can help you. The two main types of psychotherapy are cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).

Cognitive-behavioral therapy (CBT) helps you restructure negative thought patterns. You are taught how to recognize distorted and critical self-talk. For example, some people are quick to say to themselves, “I always screw up”; “People don’t like me”; “It’s all my fault.” You will learn to judge the truth of these statements and work to change these persistent ways of looking at yourself. You may be assigned tasks by your therapist that will reinforce new learning. For example, you may be expected to keep a log of your thoughts that interfere with developing a more positive view of yourself.

Interpersonal therapy (IPT) focuses on how life events and current relationships affect your feelings and choices. You and your therapist may identify ways that you deal with your painful thoughts and emotions. You will become aware of the link between past and present experiences and how you may have reached faulty conclusions about your self-perception.

You may wish to be in group therapy. You may join a group of 6 to 8 other adults who have similar issues. The power of the group rests in being able to share your feelings and receive candid feedback from other members.

Measure your progress.

I recommend that you keep a journal. Journaling helps you record your progress and make modifications along the way. You may wish to share your journal with your therapist as a way to get an objective assessment of how well you are doing.