Major Depressive Disorder (also called unipolar or clinical depression, or just depression) is more than feeling sad or going through a difficult time in life. It’s a debilitating clinical condition that requires medical care. If not treated, depression can cause significant problems in the sufferer’s life.
What exactly is depression? Depression can present differently depending on the person, but most people describe a sense of generalized sadness or inability to enjoy life. This is often accompanied by hopelessness, poor self-esteem, guilt, indecisiveness, poor concentration, low energy and motivation, problems with sleep and appetite (too little or too much), and thoughts of death. These symptoms last for at least two weeks but, for some, can last years. Depression causes problem with life functioning and can lead to suicide. Depression is one of the leading causes of disability in the world.
What’s the difference between sadness and depression? Being sad from time to time is normal. We all have sad moments, but “normal” sadness doesn’t usually last long, a few hours or days at the most, and it usually doesn’t cause major dysfunction in the sufferer’s life. Sadness becomes depression when it lasts for more than two weeks and is accompanied by problems with life functioning.
What are the causes of depression? Depression often runs in families, though it isn’t always genetic. It can be caused by physical ailments (like hypothyroidism, menopause, stroke, sleep apnea, or chronic pain), chronic insomnia, medications (like birth control pills or certain blood pressure medications), problematic diet (causing low vitamins), or drug or alcohol abuse/withdrawal. It can also be triggered by victimization or trauma, difficult life circumstances, distorted belief systems, and ongoing problem behaviors that feed the depression (life self-defeating behaviors). Regardless of the cause, depression is linked to physiological brain changes, especially in the emotion/memory centers and frontal lobes of the brain
How do you treat depression? Once you’ve been diagnosed with depression, you might be referred to your primary care doctor to rule out medical causes of your mood. For mild depression, psychotherapy is the treatment of choice. For moderate depression, psychotherapy or medications can be helpful, but medications are always used in severe depression. Talk to your provider about the different types of psychotherapy and medications for depression. Treatment can be enhanced with vitamin supplements, light therapy, exercise, diet changes, stress-management techniques, self-help books, drug use cessation, healthy change of environment, support groups, family/couple therapy, and by stabilizing other psychiatric disorders and symptoms (like anxiety). For people with profound depression that don’t respond to medications, consider electroconvulsive therapy, transcranial magnetic stimulation, ketamine treatment, vagal nerve stimulation, and deep brain stimulation. Your doctor will talk to you about hospitalization if there are safety issues.
Once I’m better, how can I keep from getting depressed again? Although it can’t prevent it, adopting a healthy lifestyle can decrease the risk of depressive relapse. This might include getting regular sleep, staying away from drugs and alcohol, choosing your environment carefully, not isolating, learning both stress tolerance and stress management skills, doing goofy and fun things, as well as pursuing activities that make you feel proud. In addition to lifestyle changes, a provider might recommend you stay in psychotherapy and/or take medications long-term to help avoid getting depressed again.