Frequently Asked Questions about Depression

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What is depression?

Depression is a mood disorder characterized by a range of symptoms that may include feeling depressed most of the time, loss of pleasure, feelings of worthlessness, and suicidal thoughts, as well as physical states that may affect eating and sleeping and other activities.

What are the signs of depression?

Some of the symptoms of depression are:
1. Loss of appetite. Weight gain or loss.
2. Depressed affect. Children & Adolescents: cranky, irritable, angry/explosive outbursts.
3. Diminished interest in or enjoyment of activities.
4. Psychomotor agitation or retardation.
5. Sleeplessness or hypersomnia.
6. Lack of energy.
7. Poor concentration and indecisiveness.
8. Social withdrawal.
9. Suicidal thoughts and/or gestures.
10. Feelings of hopelessness, worthlessness, excessive or inappropriate guilt.
11. Low self-esteem.
12. Unresolved grief issues.
13. Hallucinations or delusions.

What are the causes of depression?

Depression is usually the result of one or more of the following: self-worth, stress, spiritual, anger, guilt and physical problems; false beliefs, loss or grief reactions.

I only have four symptoms. Does that mean I don’t have major depression?

The DSM-IV is meant to be a guideline, and is not cast in stone. Moreover, your doctor or psychiatrist is likely to consider other factors in making a determination.

What do you mean by other factors?

The next edition of the DSM is scheduled for 2010, and there are bound to be many changes, based on what we have learned about depression since the DSM-IV came out in 1994 and the revised edition of the DSM-III which is very similar, which came out in 1987, and the original DSM-III on which modern psychiatry is based in 1980. For example, most people with depression also suffer from anxiety or panic. Anxiety used to be thought of as a separate illness, but psychiatry is reassessing that position, so the next DSM for depression is likely to have some kind of anxiety component. Also, most people with depression suffer from unexplained physical pain, which should arguably be included as an optional symptom (but is is unlikely to be). In fact, most people with depression go to their primary care physicians complaining of physical symptoms instead of saying they are depressed.

Are there any other physical aspects of depression?

Yes. Mind and body are very much connected. The risk of heart disease is doubled in people with depression, and a previous depression is often the greatest risk factor for heart disease and other ills, over smoking, drinking, high blood sugar, and previous heart attacks. Depression has also been connected to diabetes, bone loss, stroke, irritable bowel syndrome, and possibly cancer. In addition, people with depression have much higher rates of alcohol and substance use than the general population.

What is the connection between depression and physical illness?

There are a number of possible smoking guns. One, people who are depressed are less likely to take care of themselves, more likely to engage in risky behavior such as bad diet, smoking, alcohol, and drugs, and are less likely to be compliant with treatment for their physical ills. Two, some of the body’s mental and physical processes are regulated by the same neurotransmitters. For example, serotonin plays a role in both mood and digestion, while substance P is implicated in mood and pain. But the key intermediary between depression and physical ills is probably stress. Stress can be both a cause and a product of depression, and the stress hormone cortisol that floods the system during a depressive episode plays a key role in cell damage.

Just how serious a problem is depression?

According to the National Institute of Mental Health, approximately 18.8 million American adults, or about 9.5 percent of the US population age 18 and older in a given year, have a depressive disorder. According to the World Health Organization, depression is presently on track to becoming the world's second-most disabling disease (after heart disease) by the year 2020. In addition, depression is responsible for some $87 billion a year in lost productivity in the US (a conservative estimate), and according to Bank One, is responsible for most lost work days in its employees after pregnancy and childbirth. Additionally, one million people worldwide die by their own hand, most as a result of a mood disorder. Finally, the linkage between depression and a host of physical illnesses makes it arguably the world's greatest killer.

What are the symptoms of mania?

Some people who experience depression have alternating or sporadic periods of feeling inappropriately high, elevated, expansive, or euphoric—words that convey the meaning of mania. Manic episodes are extraordinary highs that far exceed the ordinary experience of being healthfully up.

Mood disorders characterized by cycles between extreme highs and extreme lows are called bipolar disorders. Bipolar disorders are episodic conditions marked by depression punctuated by at least one episode of mania (exceptionally extreme highs) or hypomania (moderately extreme highs).

Bouncing between the poles of high–high (mania) and low–low (depression) is the very essence of the diagnosis of bipolar disorder. Bipolar disorder contrasts with mild-to-moderate depression and major depression, disorders characterized by deep lows without intervening manic highs.

To be diagnosed as having manic episodes, a person must experience manic symptoms—feeling unusually high, euphoric, elevated or expansive—for at least one week and also experience three or more of the following symptoms:

What are the first steps toward dealing with depression?

Depression is an illness that allows a person to participate actively in his or her medical care. These are the simple steps for dealing with this condition:

• Recognize the symptoms of depression.


• Realize that depression is treatable. Available therapies are proven to be effective for more than 80% of people with a diagnosis of depression.


• Get help. Talk with a primary healthcare physician about depression and get a full evaluation.


• Get a treatment plan and learn how to participate fully in the management of depression.


• Follow the treatment plan. When the doctor prescribes medications, take them as directed.

o If the medications don’t appear to be working, keep taking them on schedule. Medications will often take weeks to reach optimal effect. Note that the belief that nothing is working is itself a characteristic of depression.
o Once the medications are working well, there may be days of feeling fine and believing that medications can be skipped. Don’t stop taking medications; take them on schedule. The medications are one of the major lifelines.

• Track moods and record the medications and self-help strategies used. This will help track progress and identify any problems experienced while trying to gain control over depression.

In addition or as an alternative to medications, various forms of psychotherapy may be used to treat depression.



What are the scientifically supported self-care approaches for dealing with depression?

Antidepressant medication, psychotherapy, and a combination of the two are the most common treatments for depressive illness. However, in addition to adherence to the treatment plan that you develop with your doctor, there are several self-care approaches for managing depression. Several strategies have been rigorously evaluated, and scientific evidence supports their role in managing depression. Physical activity (both aerobic and anaerobic), relaxation therapy, and at least one herbal remedy (St.-John’s-wort) may contribute significantly to alleviating symptoms of depression. Of course, it is important to consult your physician before beginning any exercise program. It is also important to inform him or her about any nutritional supplements or herbs that you are taking so that you can avoid harmful drug interactions.

Exercise acts as a mood elevator for both depressed and healthy people. Evidence suggests that exercise may be as effective as antidepressant medication for reducing depression. In one study, the combination of exercise and psychotherapy was found to be more effective in alleviating depression than was psychotherapy alone. Exercise may prevent recurrent depressive episodes in people with a history of depression. Moreover, scientific evidence suggests that regular exercise may prevent depressive episodes in people with no prior history of mood disturbance.

Physical activity stimulates the release of endorphins, hormones that reduce pain and promote a general sense of well-being. Additionally, exercise increases blood flow to key areas of the brain. Psychological benefits of exercise may include increased self-esteem, discharge of hostility, increased feelings of skill mastery, and distraction from daily worries and negative thoughts. Physical activity also provides an opportunity for social interaction and support. Furthermore, exercisers often achieve a sense of accomplishment by making a commitment to a self-improvement program.

Relaxation therapy consists of techniques primarily aimed at decreasing physical and mental tensions. These include muscle relaxation, diaphragmatic breathing, autogenic training, guided imagery, meditation, biofeedback, hypnosis, Zen, yoga, and other mind–body therapies. Many studies suggest that relaxation techniques, although not normally used as an exclusive treatment for depression, may be as effective as antidepressants. Combination treatment (i.e., relaxation training along with antidepressant medication) may be more effective at relieving depression than antidepressants alone. Scientists believe that these relaxation therapies work to reduce depression by distracting the mind from negative thoughts, improving mental focus, promoting a sense of mastery and self-control, and by decreasing sympathetic nervous system activity.

St.-John’s-wort (Hypericum) is an herbaceous perennial weed used since the time of ancient Greece for its many medicinal properties. The plant contains several chemical compounds thought to elevate mood. It is believed that the herb achieves its effect by increasing levels of serotonin, an up neurotransmitter, in the brain.

What are the risk factors for depression?

The following are a number of risk factors associated with increased rates of depression:

Female Gender. The higher rate of depressive symptoms in women compared to men is one of the strongest findings in depression research. The ratio of 2 : 1 for both mild-to-moderate depression and major depression is commonly accepted. During their lifetimes, 20% (1-in-5) women will be diagnosed with depression compared to 10% (1-in-10) men.

Family History. Research has indicated a strong genetic contribution to depression, which is more common in people born to parents with depression and in people whose twins or siblings are diagnosed with depression.

Poor Mental Health. People with long-term mild-to-moderate depression are more likely to experience episodes of major depression. This condition is defined as double depression. Furthermore, there is a strong tendency for people with a diagnosis of depression to be diagnosed with other co-occurring psychiatric disorders such as anxiety disorder.

Poor Physical Health. High rates of depression are related to poor health in general and to having a co-occurring general (i.e., other than psychiatric) medical condition. As examples, depression is commonly diagnosed in people who are concurrently diagnosed with stroke, coronary heart disease, cancer, and diabetes.

Marital Status. People who are divorced or separated show higher rates of depressive symptoms compared to people who are married or single and never been married.

Substance Use or Abuse. Substance abuse frequently co-occurs with major depression. The prevalence of dual diagnoses (mild-to-moderate depression and substance abuse) is approximately 18%.

Are there specific types of depression?

Yes. There is dysthymia, melancholic depression, atypical depression, bipolar depression, psychotic depression, catatonic depression, seasonal affective disorder, and postpartum depression.

What is dysthymia?

Dysthymia is chronic mild to moderate chronic depression, as opposed to major depression. The DSM-IV mandates the same symptoms as for major depression, except for suicidality, but requires only three symptoms in all, so long as they have persisted over two years. Mild to moderate is a misnomer, as dysthymia can make a person’s life as miserable as major depression.


What is melancholic depression?

Melancholic depression is major depression with an emphasis on lack of pleasure or lack of reactivity to pleasure. Other characteristics include (three or more): Depressed mood, depression at worst in the morning, early morning awakening, psychomotor agitation or retardation, significant weight loss, and inappropriate guilt.

What is atypical depression?

Atypical depression is a misnomer, as more outpatients suffer from atypical depression than from other forms of depression. Atypical depression is major depression that differs from melancholic depression in that patients react positively to external events, plus (two or more): Significant weight gain (as opposed to weight loss), hypersomnia (as opposed to insomnia), leaden paralysis, and sensitivity to personal rejection.

What is bipolar depression?

Bipolar depression is a feature of bipolar disorder, also known as manic depression, an illness characterized by mood swings from depression to mania. The diagnostic criteria for bipolar depression is the same as for major depression, but bipolar patients tend to have atypical features. Bipolar patients who rapid cycle can be up and down in a matter of minutes, and in mixed states depression and mania are present at once.

What is psychotic depression?

Psychotic depression is a rare form of depression characterized by delusions or hallucinations, such as believing you are someone you are not and hearing voices.

What is catatonic depression?

Catatonic depression is a rare form of major depression characterized by (at least two): Stupor, excessive motor activity, extreme negativism, peculiarities in voluntary movement, and repetition of other people's words or actions.

What is seasonal affective disorder?

Seasonal affective disorder is major depression that appears in the fall or winter and goes away in spring, thought to be caused by lack of sunlight.

What is postpartum depression?

Postpartum depression occurs within four weeks of a women giving childbirth. Most new mothers suffer from some form of the “baby blues.” Postpartum depression, by contrast, is major depression, thought to be triggered by changes in hormonal flows associated with childbirth.

How does depression affect women?

Clinical depression affects your physical well-being, resulting in chronic fatigue, sleep problems, and changes in appetite. It affects your mood, with feelings of sadness, emptiness, hopelessness and dysphoria. It affects the way you think, interfering with concentration and decision making. And, it affects your behavior, with increased irritability and loss of temper, social withdrawal, and a reduction in your desire to engage in pleasurable activities. Research indicates that in the United States more than 17 million people experience depression each year, and nearly two thirds do not get the help they need. Proper treatment would alleviate the symptoms in over 80 percent of the cases. Yet, because depression is often unrecognized, depressed individuals often continue to suffer needlessly.

Major depression and dysthymia affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. The same ratio has been reported in eleven other countries all over the world. Men and women have about the same rate of bipolar disorder (manic depression), though its course in women typically has more depressive and fewer manic episodes. Also, a greater number of women have the rapid cycling form of bipolar disorder, which may be more resistant to standard treatments.

Many factors unique to women are suspected to play a role in developing depression. Research is focused on understanding these factors, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. But, the specific causes of depression in women remain unclear. Many women exposed to these stress factors do not develop depression. Remember, depression is a treatable psychological problem, and treatment is effective for most women

Can't brain scans determine if a person has depression?

PET scans, fMRIs, and EEGs can show us spectacular images of how certain parts of the brain are affected during depression, but we are a far cry from using these technologies as failsafe diagnostic instruments.

Treating just the symptoms doesn't sound very satisfactory.

True, but this is the case for most physical illnesses as well, from heart disease to the common cold.

How do antidepressants work?

Broadly speaking, all antidepressants fall into the following classes: monoamine oxidase inhibitors (MAOIs), tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs). There are also several newer medications that are unique in their mechanism of action.

The monoamine oxidase inhibitors (MAOIs) were some of the first antidepressant medications developed. The neurotransmitters responsible for mood, primarily norepinephrine and serotonin, are also known as monoamines. Monoamine oxidase is an enzyme which breaks these substances down. Monoamine oxidase inhibitors, as the name implies, inhibits this enzyme, thus allowing a greater supply of these chemicals to remain available.

Tricyclics, also known as heterocyclics, came into broad use in the 1950's. These drugs inhibit the nerve cell's ability to reuptake serotonin and norepinephrine, thus allowing a greater amount of these two substances to be available for use by nerve cells.

SSRI stands for Selective Serotonin Reuptake Inhibitor. These medications work, as the name implies, by blocking the presynaptic serotonin transporter receptor. This drug differs from the tricyclics in that it's action is specific to serotonin only. It's effect on norepinephrine is indirect, through the fact that falling serotonin "permits" norepinephrine to fall so preserving serotonin preserves norepinephrine.

Five newer medications which do not fit into the above categories are: buproprion (Wellbutrin), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor), and mirtazapine (Remeron).