Psych-Net Mental Health, Depression FAQ-2

Eating Disorders
Profile of Abuse
Narcissism FAQ

DSM IV Mental Disorders
Domestic Violence
Stress
Stress Reduction
Dissociation
Anger and Rage
Test Yourself

Frequently Asked Questions

Psych-Net Library
Articles
Booklist
Crisis Hotlines
Daily Affirmations
Daily Thoughts
About The Author
Psych Links
Mental Health Articles

Send a friend this page... click here

Depression FAQ page 2

Q. What is depression?

A. Being clinically depressed is very different from the down type of feeling that all people experience from time to time. Occasional feelings of sadness are a normal part of life, and it is that such feelings are often colloquially referred to as depression. In clinical depression, such feelings are out of proportion to any external causes. There are things in everyone's life that are possible causes of sadness, but people who are not depressed manage to cope with these things without becoming incapacitated.

As one might expect, depression can present itself as feeling sad or having the blues. However, sadness may not always be the dominant feeling of a depressed person. Depression can also be experienced as a numb or empty feeling, or perhaps no awareness of feeling at all.

A depressed person may experience a noticeable loss in their ability to feel pleasure about anything. Depression, as viewed by psychiatrists, is an illness in which a person experiences a marked change in their mood and in the way they view themselves and the world. Depression as a significant depressive disorder ranges from short in duration and mild to long term and very severe, even life threatening.

Depressive disorders come in different forms, just as do other illnesses such as heart disease. The three most prevalent forms are major depression, dysthymia, and bipolar disorder.

Q. What is major depression?

A. Major depression is manifested by a combination of symptoms (see symptom list below) that interfere with the ability to work, sleep, eat; and enjoy once-pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.

Q. What is dysthymia?

A. A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at "full steam" or from feeling good. Sometimes people with dysthymia also experience major depressive episodes.

Q. What is bipolar depression (manic-depressive illness)?

A. Another type of depressive disorder is manic-depressive illness, also called bipolar depression. Not nearly as prevalent as other forms of depressive disorders, manic depressive illness involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can have any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when in a manic phase.

Q. What is Seasonal Affective Disorder (SAD)?

A. SAD is a pattern of depressive illness in which symptoms recur every winter. This form of depressive illness often is accompanied by such symptoms as marked decrease in energy, increased need for sleep, and carbohydrate craving. Photo therapy - morning exposure to bright, full spectrum light - can often be dramatically helpful.

Q. What is Post Partum Depression?

A. Mild moodiness and "blues" are very common after having a baby, but when symptoms are more than mild or last more than a few days, help should be sought. Post part depression can be extremely serious for both mother and baby.

Q. How is bereavement different from depression?

A. A full depressive syndrome frequently is a normal reaction to the death of a loved one (bereavement), with feelings of depression and such associated symptoms as poor appetite, weight loss, and insomnia. However, morbid preoccupation with worthlessness, prolonged and marked functional impairment, and marked psychomotor retardation are uncommon and suggest that the bereavement is complicated by the development of a Major Depression. The duration of "normal" bereavement varies considerably among different cultural groups.

Q. What is Endogenous Depression?

A. A depression is said to be endogenous if it occurs without a particular bad event, stressful situation or other definite, outside cause being present in the person's life. Endogenous depression usually responds well to medication. Some authorities do not consider this to be a useful diagnostic category.

Q. What is atypical depression?

A. "Atypical depression" is not an official diagnostic category, but it is often discussed informally. A person suffering from atypical depression generally has increased appetite and sleeps more than usual. An atypical depressive may also be able to enjoy pleasurable circumstances despite being unable to seek out such circumstances. This contrasts with the "typical" depressive, who generally has reduced appetite and insomnia, and who is often unable to find pleasure in anything. Despite its name, atypical depression may in fact be more common than the other kind.

Q. What are the diagnostic criteria for depression?

A. Depression comes in many forms and in many degrees. Below, you will find some of the most common depressive types, along with some of the diagnostic criteria from the DSM-IV (the official diagnostic and statistical manual for psychiatric illnesses).

About Major Depression

What is Major Depression?

This is a very serious type of depression. Many people with a major depression can not continue to function normally. The treatments for major depression are medication, psychotherapy and, in extreme cases, electroconvulsive therapy (ECT).

Diagnostic criteria:

At least five of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either:

A. (1) depressed mood, or
(2) loss of interest or pleasurable activities. (Do not include symptoms that are clearly due to a physical condition, mood-incongruent delusions or hallucinations, incoherence, or marked loosening of associations.)

1. depressed mood most of the day, nearly every day, as indicated either by subjective account or observation by others
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation by others of apathy most of the time)
3. significant weight loss or weight gain when not dieting (e.g. more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self- reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. (1) It cannot be established that an organic factor initiated and maintained the disturbance (2) The disturbance is not a normal reaction to the death of a loved one
C. At no time during the disturbance have there been delusions or hallucinations for as long as two weeks in the absence of prominent mood symptoms (i.e..- before the mood symptoms developed or after they have remitted).
D. Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder

Dysthymia

A. This is a mild, chronic depression which lasts for two years or longer. Most people with this disorder continue to function at work or school but often with the feeling that they are "just going through the motions." The person may not realize that they are depressed. Antidepressants or psychotherapy can help.

Diagnostic criteria:

A. Depressed mood (or can be irritable mood in children and adolescents) for most of the day, more days than not, as indicated either by subjective account or observation by others, for at least two years (one year for children and adolescents)
B. Presence, while depressed, of at least two of the following:

1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficult making decisions
6. feelings of hopelessness
C. During a two-year period (one-year for children and adolescents) of the disturbance, never without the symptoms in A for more than two months at a time.
D. No evidence of an unequivocal Major Depressive Episode during the first two years (one year for children and adolescents) of the disturbance.
E. Has never had a Manic Episode or an unequivocal Hypo manic Episode.
F. Not superimposed on a chronic psychotic disorder, such as Schizophrenia or Delusional Disorder.
G. It cannot be established that an organic factor initiated or maintained the disturbance, e.g., prolonged administration of an antihypertensive medication.

**Adjustment Disorder with Depressed Mood:**

A. This is the type of depression that results when a person has something bad happen to them that depresses them. For example, loss of one's job can cause this type of depression. It generally fades as time passes and the person gets over what ever it was that happened.

Diagnostic criteria:

A. A reaction to an identifiable psycho social stressor (or multiple stressors) that occurs within three months of onset of the stressor(s).
B. The maladaptive nature of the reaction is indicated by either of the following:
1. impairment in occupational (including school) functioning or in usual social activities or relationships with others
2. symptoms that are in excess of a normal and expectable reaction to the stressor(s)
C. The disturbance is not merely one instance of a pattern of overreaction to stress or an exacerbation of one of the mental disorders previously described (in the DSM).
D. The maladaptive reaction has persisted for no longer than six months.

Helping a Friend

Q. How can family and friends help the depressed person?

A. The most important things anyone can do for depressed people is to help them get appropriate diagnosis and treatment. This may involve encouraging a depressed individual to stay with treatment until 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 the doctor. It may also mean monitoring whether the depressed person is taking medication.

The second most important thing 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 doctor. 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 laziness or expect him or her to "snap out of it." Eventually, with treatment, most depressed people do yet better. Keep that in mind, and keep reassuring the depressed person that with time and help, he or she will feel better.

Choosing a Doctor

Q. What should you look for in a doctor? How can you tell if he/she really understands depression?

A. If you are looking for a psychopharmacologist to prescribe medications to help control your depression there are a number of things to check. If you are in psychotherapy, it is important to ask prospective doctors about their opinions on the psychotherapeutic treatment of depression. Psychopharmacologists who are hostile to psychotherapy are difficult to deal with while you are in therapy.

A. It is always legitimate to ask any professionals you are thinking about seeing regularly about their understanding of depression, their beliefs about the causes of depression and their philosophy of treatment. You might ask about how often the prospective doctor has worked with people who have had your particular variety of depression. If you have a rapidly cycling Bipolar depression, for example, you should seek a doctor who has much experience dealing with people who have this problem. Prior to the first visit it is important to clarify with the doctor or the secretary the fee of the initial and subsequent visits, the doctor's policy regarding missed and changed appointments, whether the doctor will accept assignment from insurance companies. If you have Medicare or Medicaid it is important to make sure that the doctor sees people with these forms of medical coverage.

Another aspect of the style of doctors is the extent to which they include their patients in the decision-making process. You might ask "How do you go about deciding which treatment is right for me?" See if you are comfortable with the method the doctor describes. Much can also be learned from how doctors respond to questions such as these. There is much difference between a doctor who welcomes such questions and answers them fully and one who is annoyed by them and answers them superficially.

Self-care

Q. How may I measure the effects my treatment is having on my depression?

A. If you complete the depression quiz each week, and keep track of the scores, you will have a detailed record of your progress.

Click Here for More FAQ

Sign My Guestbook View My Guestbook