Everyone feels sad now and then, but depression is far more serious than an occasional low mood. It lasts longer, it interferes with daily life and it can even cause physical aches and pains.
Many people who suffer from depression feel like there’s no hope for recovery, but nothing could be further from the truth. Depression is a treatable mood disorder, and the sooner it’s addressed, the sooner you can begin to restore your happiness and well-being.
Depression, also known as major depressive disorder or clinical depression, is a common mood disorder with serious symptoms. These symptoms affect nearly every aspect of your life, from how you feel and think to how you go about your daily activities, such as eating, sleeping, working, attending to personal hygiene and taking care of your family.
Depression is a real illness. It’s not a sign of weakness or a flaw in character, and you can’t just “snap out of it.” Just as other major illnesses require medical intervention, overcoming depression typically requires treatment.1
Depression is not a sign of weakness or a flaw in character, and you can’t just “snap out of it.”
Signs and Symptoms of Depression
Signs of depression are those that other people may notice, while symptoms are what an individual feels. Not everyone who suffers from depression experiences all of the signs and symptoms, which include:2
- Persistent feelings of sadness or emptiness
- Feelings of hopelessness, helplessness, worthlessness or guilt
- A loss of interest or lack of pleasure in activities and hobbies you used to enjoy
- Low energy or fatigue
- Feelings of restlessness
- Talking or moving more slowly than usual
- Difficulty with memory, concentration or decision-making
- Insomnia or oversleeping
- A lack of motivation
- Changes in appetite and weight
- Aches and pains, headaches or digestive problems that have no clear cause and don’t go away with treatment
- Thoughts of death or suicide
Three Main Types of Depression
Major depression is diagnosed when at least five symptoms are present for a duration of at least two weeks. Major depression can be disabling, interfering with your ability to perform your normal activities of daily living. An episode of major depression may occur just once in your lifetime, or you may experience frequent episodes. An episode may onset gradually, or it may occur spontaneously as the result of a devastating life event such as a divorce or a death in the family.
Persistent depressive disorder is diagnosed when an episode of depression lasts two or more years. The symptoms of persistent depressive disorder are milder than those of major depression and typically include a loss of appetite or overeating, insomnia or oversleeping and low energy.
Bipolar disorder is characterized by alternating cycles of intense highs, known as mania, and severe depression. During the manic phase, an individual may experience feelings of euphoria, a reduced need for sleep and a marked increase in energy. Symptoms of the depressive phase are the same as those for major depression.
The Scope of Depression in the U.S.
Around 24 million American adults, or 7.6 percent of the population aged twelve and over, suffer from some form of depression in any given two-week period. Additionally, 14.8 million Americans over the age of 18 experience an episode of major depression in any given year.4 Women are nearly twice as likely as men to suffer from depression.5
14.8 million Americans over the age of 18 experience an episode of major depression in any given year.
Causes of Depression
Depression can occur at any age, but it most often begins in the late teens or early 20s or 30s. Although it’s not known exactly what causes depression or how it affects brain function, a number of factors are known to play a role in developing depression.
These include brain chemistry, genetics and environmental factors like trauma, stress, a troubled relationship or the loss of someone you love. Childhood stress or trauma is a major factor for depression later in life.6
Depression often co-occurs with a medical illness, and each tends to worsen the symptoms of the other. According to the Depression and Bipolar Support Alliance, 25 percent of cancer patients, up to 27 percent of stroke patients and one-third of heart attack survivors are diagnosed with depression.7
Depression often co-occurs with a medical illness, and each tends to worsen the symptoms of the other.
Depression and Stress
Stress is a major risk factor for depression. The Brain and Behavior Research Foundation cites clinical studies finding that people with depression have higher levels of the hormone corticotropin-releasing factor upon which the stress hormone cortisol acts.8
How Depression Affects the Family System
Depression doesn’t just affect the person suffering from it. Watching someone you love suffer from depression can cause feelings of loss and hopelessness, and it leads to a considerable amount of stress within the family system.9
Family therapy is often highly beneficial for helping families learn to cope with depression as a unit. It helps family members who have never experienced depression learn about the condition and the best ways to support their loved one. A strong support system can make a big difference in the lives of people who suffer from depression by giving them encouragement and offering reminders to practice coping techniques and other skills and strategies they’ve learned in therapy.
Depression and Substance Abuse
Mood and anxiety disorders commonly co-occur with substance abuse and addiction. It’s difficult to determine which onset first, because anxiety and depression often lead to substance abuse as a form of self-medication, and drugs and alcohol almost always worsen a mental illness and can even cause its onset.
Around 32 percent of people who have a mood disorder also have a co-occurring substance use disorder and are twice as likely as people without a mood disorder to suffer from depression.10 Up to 67 percent of people seeking treatment for alcohol dependence have suffered from an episode of depression in their lifetime.
When depression and a substance use disorder co-occur, dual diagnosis treatment is absolutely essential for successful, long-term recovery. Treating just the depression won’t have an effect on the substance use disorder, which will continue to worsen the depressive symptoms. Conversely, treating just the substance use disorder won’t have an effect on the depression, which will likely lead back to self-medication with alcohol or drugs.
Integrated dual diagnosis treatment is a collaboration among treatment teams for each disorder. The substance use disorder and the mood disorder are treated at the same time, each in the context of the other. This increases engagement in treatment and vastly improves the treatment outcome.
Due to the high prevalence of co-occurring disorders and the importance of integrated treatment, the intake process in most psychiatric treatment settings and addiction treatment programs utilize an integrated screening and assessment process to determine if those with a substance use disorder also have a mental illness, and vice versa.
Medications for Depression
A number of different kinds of medications are used to successfully treat depression. Not every medication works effectively for every individual, and it may take some time to find the right medication or combination of medications that work for you.11
It’s important to be patient and continue trying alternatives if the first medication doesn’t work as well for you as you’d like after around six weeks of treatment.
The most effective medications used to treat depression are known as reuptake inhibitors. Reuptake is the process that occurs when neurotransmitters are reabsorbed into nerve cells after being released to send a message. Reuptake inhibitors prevent the chemical from being reabsorbed so that it stays in the synapse longer, improving communication among nerve cells. The most commonly prescribed reuptake inhibitors include:
- Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs include Prozac, Lexapro and Zoloft and work by blocking the reabsorption of serotonin in the brain. They’re safe and effective and have fewer side effects than other types of antidepressants.
- Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs). Wellbutrin is the only NRDI on the market. It works by preventing the reuptake of norepinephrine and dopamine.
- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). SNRIs include Cymbalta, Pristiq and Effexor, which block the reabsorption of norepinephrine and serotonin.
- Serotonin Antagonist and Reuptake Inhibitors (SARIs). SARIs include nefazodone and trazodone, which prevent the reuptake of serotonin but also direct serotonin to specific receptors that improve communication among nerve cells directly within mood circuits.
- Tetracyclics. Drugs like Asendin, Ludiomil and Remeron are tetracyclics, which don’t prevent the reuptake of brain chemicals but rather stop the neurotransmitters norepinephrine and serotonin from binding with specific nerve receptors. Instead, they build up between the nerve cells, and their levels rise.
Talk Therapy for Depression
A combination of therapy and medication is typically the most effective way to treat depression. While medication is effective for treating symptoms, using medicine alone results in higher rates of relapse than using a combination of medication and talk therapy.
Talk therapy, also known as psychotherapy, is highly effective for helping people overcome depression. Through various types of therapy like cognitive-behavioral therapy and interpersonal therapy, people with depression learn to:
- Identify and solve the underlying issues and problems that contribute to the depression
- Identify ways in which they feel stuck in life and learn to set realistic goals to enhance their emotional well-being
- Identify and address negative or distorted patterns of thinking to combat feelings of hopelessness
- Develop skills to improve their symptoms and help prevent them from returning
Brain Stimulation Therapies for Depression
- Electroconvulsive therapy (ECT) is conducted while a patient is under general anesthesia and involves passing electrical currents through the brain. Although scientists aren’t certain why it works, it appears to change brain chemistry and improve brain functioning.
- Repetitive transcranial magnetic stimulation (rTMS) is similar to ECT, but it targets more specific areas in the brain and can be done without anesthesia. An electromagnetic coil is held against the head, and small electrical currents stimulate nerve cells in the affected area.
- Vagus nerve stimulation (VNS) alters brain chemicals associated with mood, including norepinephrine, serotonin, GABA and glutamate. A device is implanted under the skin and sends electrical pulses through the left vagus nerve every five minutes.
Other Ways to Help Combat Depression
While medication and therapy are often essential for treating depression, a number of lifestyle changes can have a dramatic impact on the severity of symptoms.
Exercise has a profound effect on depression. A Duke University study found that 90 minutes of exercise each week is as effective as antidepressants for reducing symptoms of depression, and it can even prevent it from returning later on.12 Harvard University points out that exercise is highly effective for relieving stress, a major risk factor for depression.13 Physical activity increases the production of endorphins, which are brain chemicals that promote feelings of well-being and relaxation, and it reduces the amount of the stress hormone cortisol in the blood.
A healthy diet can help reduce symptoms of depression. Mayo Clinic cites a number of studies showing that people who eat a poor-quality diet of highly processed foods, unhealthy fats and sugar are more likely to report having suffered from depression, while those who eat a healthier diet that includes plenty of fruits, vegetables and fish are less likely to have experienced depression.14
Yoga relieves stress and promotes an overall sense of well-being to help combat depression. One type of yoga that involves cyclical breathing patterns, known as Sudarshan Kriya yoga, or SKY, has been shown to reduce feelings of depression by 75 percent, according to Harvard Medical School.15 In one study, four weeks of SKY, performed for 30 minutes, six days a week, led to a 67 percent remission rate for depression.
Acupuncture is known to help reduce stress and depression by promoting the release of endorphins and improving the circulation of blood and lymphatic fluids. The American College of Traditional Chinese Medicine cites a University of Arizona study that found acupuncture administered specifically for depression reduced symptoms in 43 percent of participants.16
Meditation has gained more steam as a mainstream complementary treatment for a wide variety of illnesses. A recent study by Johns Hopkins University School of Medicine found that 30 minutes of meditation daily provided as much relief for people suffering from depression as antidepressant medications.17
Will Your Insurance Plan Cover Mental Health Services for Depression?
There was a time when insurance companies could limit the amount of coverage for mental health services, which discouraged many people from seeking treatment for depression and other mental health disorders, including addiction.
With the passage of the Mental Health Parity and Addiction Equity Act of 2008, they can no longer do so. The act requires group health plans and health insurance providers to ensure that treatment limitations for mental health or substance abuse disorders are no more restrictive than coverage for medical benefits.18
Where to Find Help
If you’re unsure where to begin looking for a mental health provider, Rebos can help.
Rebos offers depression therapy treatment, which can help address and alleviate the symptoms of depression. Depression therapy can help you start taking control of your emotions, thoughts and actions and allow you to start living your life again.
The Bottom Line on Depression
If you or someone you love suffers from depression, seeking help now will dramatically improve your quality of life. With treatment, you will likely find inner peace and begin to feel joy once again. Treatment with medication, therapy or a combination of the two will help restore your mental well-being, improve your motivation and enable you to get the most out of your life.
- Depression: What You Need to Know. (n.d.). Retrieved from http://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml
- Depression. (2016, March). Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml
- Understanding the Facts: Depression. (2015, October). Retrieved from http://www.adaa.org/understanding-anxiety/depression
- Depression. (2016, February 3). Retrieved from http://www.cdc.gov/nchs/fastats/depression.htm
- Depression in Women: Understanding the Gender Gap. (2016, January 16). Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20047725
- Childhood Trauma and Depression. (2010, August). Observer, 23(6). Retrieved from http://www.psychologicalscience.org/index.php/publications/observer/2010/july-august-10/childhood-trauma-and-depression.html
- Depression Statistics. (n.d.). Retrieved from http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression
- Heim, C. M. (2012, December 17). Childhood Trauma: What Role Does It Play in Depression? Retrieved from https://bbrfoundation.org/discoveries/childhood-trauma-what-role-does-it-play-in-depression
- Understanding Depression and Effective Treatment. (2010, July). Retrieved from http://www.apa.org/helpcenter/understanding-depression.aspx
- Quello, S. B., Brady, K. T., & Sonne, S. C. (2005, December). Mood Disorders and Substance Abuse Disorder: A Complex Comorbidity. Science and Practice Perspectives, 3(1), 13-21. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/
- Depression: Treatments and Drugs. (2015, July). Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/basics/treatment/con-20032977
- Study: Exercise Has Long-Lasting Effect on Depression. (2000, September 22). Retrieved from https://today.duke.edu/2000/09/exercise922.html
- Exercising to Relax. (2011 February 1). Retrieved from http://www.health.harvard.edu/staying-healthy/exercising-to-relax
- Zeratsky, K. (2015, March 11). Depression: Can a Junk Food Diet Increase Your Risk of Depression? (March, 2015). Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/depression-and-diet/faq-20058241
- Yoga for Anxiety and Depression. (2009, April 1). Retrieved from http://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression
- Acupuncture Effective in Treatment of Mental Illness. (n.d.). Retrieved from https://www.actcm.edu/news/acupuncture-effective-in-treatment-of-mental-illness/
- Meditation for Anxiety and Depression? (2014, January 6). Retrieved from http://www.hopkinsmedicine.org/news/media/releases/meditation_for_anxiety_and_depression
- The Mental Health Parity and Addiction Equity Act of 2008.(2010, January29). Retrieved from http://www.dol.gov/ebsa/newsroom/fsmhpaea.html