Depression is a serious medical condition that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who have depression.

Types of Depression

Depression comes in different forms, just as is the case with other illnesses such as heart disease. The three main depressive disorders are: major depressive disorder, dysthymic disorder, and bipolar disorder.

Major depression (or major depressive disorder) is manifested by a combination of symptoms (see symptom list below) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once, but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.

A less severe type of depression, dysthymia (or dysthymic disorder), involves long-lasting symptoms that do not seriously disable, but keep one from functioning well or feeling good. Many people with dysthymia also experience major depressive episodes during their lives.

Another type of depressive illness is bipolar disorder (or manic-depressive illness). Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between.

When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the person may be overactive, over-talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, an individual in a manic phase may feel elated and full of grand schemes that might range from unwise business decisions to romantic sprees.

Symptoms of Depression

Not everyone with a depressive disorder experiences every symptom. The number and severity of symptoms may vary among individuals and also over time. In addition, men and women may experience depression differently. Symptoms of depression include:

- Persistent sad, anxious, or "empty" mood

- Feelings of hopelessness, pessimism

- Feelings of guilt, worthlessness, helplessness

- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex - Decreased energy, fatigue, being "slowed down"

- Difficulty concentrating, remembering, making decisions

- Trouble sleeping, early-morning awakening, or oversleeping

- Appetite and/or weight changes

- Thoughts of death or suicide, or suicide attempts

- Restlessness, irritability

- Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain, which do not respond to routine treatment

Some Facts About Depression

Depressive disorders are common: they affect an estimated 9.5 percent of adult Americans in a given year, or about 19 million people. Depressive disorders often begin between ages 15 and 30 but also can appear in children.

The World Health Organization's World Health Report, 2001 states that in the year 2000, depression (not including bipolar disorder) was the leading cause of years lived with a disability among men and women of all ages in the U.S. and worldwide.

Treatments

More than 80 percent of people with depressive disorders improve when they receive appropriate treatment. The first step to getting treatment is a physical examination by a physician to rule out other possible causes for the symptoms. Next, the physician should conduct a diagnostic evaluation for depression or refer the patient to a mental health professional for this evaluation.

Treatment choice will depend on the patient's diagnosis, severity of symptoms, and preference. A variety of treatments, including medications and short-term psychotherapies (i.e., "talking" therapies), have proven effective for depression. In general, severe depressive illnesses, particularly those that are recurrent, will require a combination of treatments for the best outcome.

It usually takes a few weeks of treatment before the full therapeutic effect occurs. Once the person is feeling better, treatment may need to be continued for several months-and in some cases, indefinitely-to prevent a relapse into depression.

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