What is depression?

Depression is one of the most common and serious of the mood disorders which interferes with a person’s mood (the internal emotional state of a person). Today saying “I’m depressed” is as common as saying “I have a cold”. Depression can make its appearance as a normal mood, as a symptom and as an illness. Where people experience a normal wide range of moods there is usually a sense of control over their mood and behaviours. However, the person with a mood disorder has a clinical condition that is characterized by a loss of that sense of control and experiencing feelings of helplessness, hopelessness and worthlessness.

The essential and distinguishing feature of depression is persistent and extensive sadness which is usually accompanied with the person suffering from a loss of interest or pleasure in all or almost all usual activities and pastimes.

Depression affects approximately 10 in one hundred males and approximately 25 in one hundred females. Depression comes in many types and shows many faces, although in all types the illness effects the day to day functioning of the person.

Depression can begin from childhood through old age, but 50 percent of all patients experience an onset between 25 and 50 years, the average age is about 40 years.

Depression can affect all aspects of a person’s life including work, leisure, relationships and future goals and plans. Furthermore, there is a great impact on the family of the person suffering from depression as the person may find it difficult to communicate feelings and to concentrate. In general, the depressed person may find it very difficult to be involved and enjoy the company of others and activities, including sleeping and eating, as they did prior to the depression.

Patients may say that they feel blue, hopeless, in the dumps or worthless. For the patient, the depressed mood often has a distinct quality that differentiates it from the completely normal emotion of sadness. Patients often describe the symptom of depression as either agonizing emotional pain or a complete lack of feelings. This can be sometimes seen in the person’s inability to cry.

Depressive Episodes
A depressed mood and a loss of interest or pleasure are the key symptoms of depression. Although depression, like all other illnesses, has certain characteristic symptoms, the symptoms are not identical for each person. A diagnosis of depression is made when key symptoms are apparent.

Family and friends may notice other symptoms including:

– significant weight loss or weight gain
Many depressed persons have decreased appetite and weight loss. Some individuals, however, have increased appetite and weight gain.

– fatigue or loss of energy nearly every day.
Almost all depressed patients (97 percent) complain about reduced energy resulting in difficulty finishing tasks. Even the smallest task appears to require substantial effort.
Depressed persons can also experience a decreased interest and performance in sexual activities.

– disturbance in sleep.
About 80% of depressed persons complain of trouble sleeping, especially early morning awakening and multiple awakenings at night, during which they ruminate about their problems. Some individuals have increased sleep.

– anxiety
Anxiety is a common symptom of depression, affecting as many as 90 percent of depressed people. There is also the experience of agitation (inability to sit still) or the slowing of responsiveness (slowed speech, thinking, and body

– irritability
Often depressed persons become irritable, cranky and frustrated easily. Depressed individuals often display persistent anger, a tendency to respond to events with angry outbursts or blaming others or an exaggerated sense of frustration over minor matters.

– difficulty concentrating and making decisions
Depressed individuals often complain of an inability to concentrate and impairments in thinking.

– recurrent thoughts of death (not just fear of dying) or suicide.
Approximately two-thirds of depressed patients contemplate suicide, and 10-15% commit suicide.

– feelings of worthlessness or excessive/inappropriate guilt.
The sense of worthlessness or guilt includes unrealistic negative evaluations of one’s worth or guilty preoccupations over past events or minor past failings. Such individuals often misinterpret neutral or trivial day-to-day events as evidence of personal defects.

Depressed persons, however, sometimes appear unaware of their depression and do not complain of a mood disturbance even though they may exhibit withdrawal from friends, family and activities that previously interested them. Some individuals emphasize physical complaints such as bodily aches and pains rather than reporting feelings of sadness.

Symptoms of depression usually develop over days to weeks. Shortly prior to the depression a period of anxiety symptoms and minor depressive symptoms may be apparent and may last for weeks to months before the onset of a full major depression.

The duration of depression is variable. An untreated episode typically lasts 6 months or longer, regardless of the age of the person. In a majority of people there is complete recovery of symptoms and functioning returns to the normal state prior to the depression onset. Treated individuals usually have a complete recovery within 3 months on average, although, many recover earlier.

Family and friends may notice deterioration in areas such as:
– school and work
– relationships with others
– involvement in activities once enjoyed
– personal care and hygiene

The causes of depression are at present unknown and no single cause has been identified. However, a number of different factors are believed to be associated with depression onset. These are:

Biological Factors
Certain biochemical substances in the brain (i.e. neurotransmitters called the biogenic amines) are believed to be involved in this condition. It is suggested that some people may have a genetic predisposition to depression because of an imbalance in these brain chemicals. The antidepressant medications work to restore the imbalance in the brain chemicals.

Genetic Factors
A predisposition to depression is seen to run in families and is consistent with a biological cause, as well as a learned response to critical life events.

Life Events and Environmental Stress
Some clinicians believe that life events play the primary role in depression. For instance, one of the environmental stressors most associated with depression onset is the loss of a spouse. However, the triggering event can be from any cause and can also be due to a build-up of smaller events and little perceived support.

Personality Factors
To date, no single personality trait or type has been established as being uniquely predisposing to depression. All humans, of whatever personality pattern, can and do become depressed under appropriate circumstances; however, certain personality types might be at greater risk for depression.

It has been suggested that vulnerability for depression may exist with an interaction of these suggested causes rather than a single factor existing alone.

1. The family/others can help by being supportive and acknowledging the person’s emotions.
2. The person with depression will usually find it difficult to cope with normal activities. A demonstrated understanding of this by family/others is advisable and support for the depressed person with encouragement to engage in “fun” activities.
3. Reduce stressful events
4. Do not blame or try to help by suggesting that the depressed person “try harder”.
5. Try to not become over-involved or withdraw from the depressed individual.
6. Positively encourage and reward any signs of improvement in behaviours and/or mood.

Validate and express understanding of the person’s feelings. For example:
“From what you’ve been saying it sounds as though you see the future as hopeless”
Encourage the individual to take action to seek out professional help, including contacting EAP Assist.

Tell them that they shouldn’t feel that way or punish them for not demonstrating control of their depressive behaviours and feelings.

Tell them that they should think positively without first helping the person to learn how to acquire the necessary skills to achieve this goal.