Understanding Depression

Elizabeth is a 32-year-old mother of two young children with a professional career. Recently, Elizabeth noticed that she often feels fatigued, irritated, and, simply, unhappy. Elizabeth also notices that she no longer enjoys activities that once brought her joy, such as taking evening walks with her family. Additionally, Elizabeth feels like she does not have the energy necessary to complete her duties at work or play with her children when they ask.

Eventually, Elizabeth sits down with her husband, Richard, to discuss her feelings. Over cups of tea, Richard and Elizabeth speak openly about their happiness, their long-term goals, and how they are both coping with the rigors of their busy lives. As Elizabeth opens up about her feelings, Richard becomes concerned and begins to understand, for the first time, that his wife may be suffering from depression, and may need help. Richard's mind becomes flooded with thoughts about depression, and the portrayal of depression in popular culture. The more Richard thinks about depression the more he realizes that he may not have an accurate understanding of what depression really entails. Eventually, Richard asks himself the following question: what is depression, and how is it treated?

Unfortunately, the question posed by Richard in the scenario presented above is a common one among Americans in the current social climate. The good news is, that there is an answer to the question that can help individuals understand what depression truly is and how they can get help and treatment. In addition to the question posed by Richard, there are several other questions that can help individuals like Richard fully understand depression. Those questions and answers may be found below.   

What is depression?

Depression, or clinical depression, is a mood disorder characterized by a persistent depressed mood and a loss of interest in previously enjoyable activities, which interfere with daily life.

Is depression the same as sadness or grief?

Depression, or clinical depression, is not the same as sadness or grief. The main difference between depression and sadness/grief is that depression significantly interferes with daily life. For example, individuals suffering from depression may not be able to get out of bed in the morning to go to work, even if their job depends on it.

What causes depression?

Typically, for most individuals, there is not one specific cause of depression. That being said, there are specific risk factors that may lead to depression such as the death of a loved one, abuse, conflict, prolonged periods of tension, and/or significant life events.

A significant life event may refer to any major shift in an individual's life. Examples of significant life events include the following: marriage, divorce, moving to a new location, school graduation, and a new job.

It is interesting to note that depression may result from a significant life event that does not necessarily have negative connotations, such as getting the desired job.

For example, an individual may finally land his or her dream job in his or her most desirable place to live. However, after the individual relocates and begins the new employment opportunity, the individual finds himself or herself overwhelmed, tense, stressed, anxious, and, ultimately, depressed.

Are there different types of depression?

• Major depressive disorder - a type of depression that occurs most days of the week for a period of two weeks or longer leading to significant distress or impairment in social, occupational, or other important areas of functioning.¹   
• Persistent depressive disorder - is a chronic form of depression. Individuals suffering from persistent depressive disorder typically experience a depressed mood, most days of the week, over a two-year period.¹    
• Seasonal affective disorder - may refer to a type of depression characterized by a seasonal pattern.¹ For example, an individual may feel the onset of depression during the winter months.  
• Psychotic depression - is a type of depression that is accompanied by psychotic symptoms such as hallucinations, delusions, and paranoia.¹    
• Postpartum depression - is a type of depression that occurs after an individual gives birth to a child.¹  

What are the signs and symptoms of most types of depression?

The signs/symptoms of depression go beyond just feeling sad or a little down. Unfortunately, the signs/symptoms of depression can be more varied and more complex. Specific signs/symptoms of depression include the following:

• depressed mood most of the day, nearly every day
• a loss of interest in previously enjoyable activities
• feeling irritable‚ easily frustrated‚ or restless
• a slowing down of thought and a reduction of physical movement; fatigue or loss of energy
• significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
• feelings of worthlessness
• excessive or inappropriate guilt
• diminished ability to think or concentrate
• indecisiveness
• recurrent thoughts of death
• recurrent thoughts of suicide
• suicide attempts.

What to do if you experience signs and/or symptoms of depression?

If individuals experience any of the aforementioned signs/symptoms of depression, they should speak to a loved one, and a healthcare professional as soon as possible, especially if they are thinking about death or suicide.

If an individual is thinking about death or suicide he or she should consider calling 1−800−273−TALK (8255) to reach a 24−hour crisis center; 1−800−273−TALK is the National Suicide Prevention Lifeline, which provides free‚ confidential help to individuals in crisis.²

What to expect when you speak to a healthcare professional about depression?

When an individual speaks to a healthcare professional about depression, he or she may undergo an examination, screening process, specific testing, and, ultimately, receive a diagnosis from the healthcare professional. It is worth noting that an individual may receive a depression diagnosis if he or she displays five depression symptoms every day, nearly all day, for at least two weeks.  

Once a diagnosis is made, an individual can begin treatment.

What are the treatment options for depression?

Fortunately, there are a variety of treatment options for individuals suffering from depression. Specific treatment options for depression may be found below.

• Physical activity - physical activity may not be one of the first treatment options that may come to mind when considering depression - however, physical activity and exercise can help individuals relieve the symptoms of depression. For substantial health benefits, adults should do at least 2 hours and 30 minutes to 5 hours a week of moderate-intensity, or 1 hour and 15 minutes to 2 hours and 30 minutes a week of vigorous-intensity physical activity/exercise.³
• Adequate nutrition - along with physical activity and exercise, adequate nutrition and healthy eating can help individuals relieve the symptoms of depression.² To help achieve a maximum impact, individuals should focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits - nutrient-dense foods provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium.⁴ Examples of nutrient-dense foods include the following: fruits and vegetables, whole grains, low-fat or fat-free milk products, seafood, lean meats, eggs, peas, beans, and nuts.⁴
• Psychotherapy - psychotherapy may refer to the use of talk therapy to help individuals overcome specific problems and develop healthier, positive approaches to life. It is worth noting that some of the goals of psychotherapy may include the following: improving health and overall well-being; improving quality of life; improving relationships; overcoming stress, anxiety, fears, and/or insecurities; identifying depression triggers (i.e., anything that may initiate or worsen depression); making sense of past events; and acknowledging depression as a part of life that can be effectively treated so individuals can live a rich and productive life.²
• Cognitive-behavioral therapy - cognitive-behavioral therapy may refer to a form of psychotherapy that focuses on helping individuals create positive patterns of thought, behavior, and outcomes by changing unrealistically negative patterns of thought and behavior.
• Interpersonal therapy (IPT) - IPT is a short-term type of psychotherapy that focuses on resolving relationship problems and recovery from depression. IPT typically lasts for about 12 - 16 weeks. 
• Support groups - support groups may be used as a therapeutic option for those suffering from depression. Support groups can help individuals suffering from depression avoid the social isolation often associated with depressive disorders.
• Medications - finally, medications called antidepressants may be used to treat depression. Antidepressant is a broad term that is used to include a variety of different medication classes indicated for the treatment of depression. In order for a medication to be considered an antidepressant, it must have evidence or research to show it can effectively treat depression/reduce and relieve the symptoms of depression.   

Antidepressants for depression

Antidepressants typically work, or reduce and relieve the symptoms of depression, by affecting the chemistry of the brain, which basically means that antidepressants create a stable mental environment that helps individuals handle the stress, anxiety, and rigors of the world around them. 

Common medications for depression

Some of the most commonly prescribed antidepressants include citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). The aforementioned antidepressants belong to a medication class known as selective serotonin reuptake inhibitors (SSRIs). Individuals should note that SSRIs must be prescribed by a healthcare professional, and are often well tolerated by patients - meaning their side effects have a limited impact on those taking the medications.² 

There are other types of antidepressants that may be used to treat depression, and individuals may be prescribed more than one medication to help treat their depression. Additionally, antidepressants may be used together with other forms of treatment, such as psychotherapy, to help individuals manage their depression.

Side effects of antidepressants

When taking antidepressants, individuals should note the following: it is important to follow the instructions on how much medication to take; side effects of antidepressants usually do not get in the way of daily life or daily activities; side effects of antidepressants often go away as an individual's body adjusts to the medication; some antidepressants may cause risks during pregnancy; individuals should speak to a healthcare professional if they become pregnant.

How long does it take for antidepressants to work?

Additionally, and perhaps most importantly, individuals taking antidepressants should note that it may take up to four weeks for an individual to feel the benefits of an antidepressant.² In other words, antidepressants may take up to four weeks to work. With that in mind, individuals should not stop taking antidepressants because they are not feeling better, or for any other reason, without talking to a healthcare professional first. Abruptly stopping an antidepressant can have negative consequences for an individual.      

Conclusion

After having a discussion with her husband, Elizabeth contacts a healthcare professional and schedules an appointment. Elizabeth undergoes an exam and is diagnosed with depression by a healthcare professional. Elizabeth starts Zoloft 50 mg per day and makes an effort to exercise most days of the week and eat healthier.

Six weeks later, Elizabeth is feeling much better. She no longer feels unhappy all the time, and she has more energy to engage with her family and complete her professional duties. As time progresses, Elizabeth continues her Zoloft regimen and learns how to manage her depression so it no longer negatively affects her life.

Elizabeth is happy she can talk openly about her depression and seek the help she needs. Moreover, Elizabeth is happy that depression is no longer dominating her life, and she can enjoy work and, most importantly, her family.

References 

1. National Institute of Mental Health. (2018, February). Depression.
2. Centers for Disease Control and Prevention. (2022, February 8). Mental health conditions: depression and anxiety.
3. U.S. Department of Health and Human Services. (2018). Physical activity guidelines for Americans. 2nd edition. 
4. U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020-2025. 9th Edition.