A serious and common mental illness, depression is the number one cause of disability in the world, affecting about 350 million people, the World Health Organization (WHO) reports. Within the United States, the Centers for Disease Control and Prevention (CDC) estimates that one out of every five Americans suffers from a mood disorder like anxiety or depression. According to the National Alliance on Mental Illness (NAMI), women suffer from depression more often than men, as they have a 70 percent greater risk of developing the disorder. Young adults between the ages of 18 and 25 also have a higher risk (60 percent higher) than those over the age of 50, per NAMI.
There are many levels of depression, from mild bouts of sadness to overwhelming negative and disturbing emotions that may lead to suicidal thoughts and actions. Depression can affect the way a person thinks and feels, and it can interfere with the performance of regular everyday tasks like sleeping, eating, social activities, and work or school functions. General signs of depression include:
- Feeling of pessimism or lack of hope
- Constant feelings of “emptiness” or sadness
- Low levels of energy
- Difficulties falling or staying asleep and potentially trouble waking up
- Change in appetite levels
- Feelings of shame and guilt
- Trouble concentrating
- Memory lapses
- Difficulty making decisions
- Lack of interest in activities or things that were enjoyed before
- Slow or labored movements and speech patterns
- Restlessness and trouble sitting still
- Feelings of worthlessness and low self-esteem
- Physical discomfort without a medical cause (e.g., headaches, stomach or gastrointestinal upset, muscle aches, pains, or cramps)
- Suicidal thoughts and musings about death
Not every symptom from the above list will be present in everyone who battles depression. Individuals may suffer from only a handful of these symptoms. Most people likely feel “blue” at some point in their lives, but it is when these feelings start to impact daily life and persist for two weeks or longer that it may be diagnosable as a major depressive episode. Someone suffering from a major depressive episode likely gets little to no relief from the feelings of sadness, malaise, and depressed mood, as these feelings may pervade their thoughts consistently. The National Institute of Mental Health (NIMH) publishes that in 2014, over 15.5 million American adults (aged 18 and older) suffered from one or more major depressive episodes in the previous year.
The Depression and Bipolar Support Alliance (DBSA) publishes that close to 80 percent of those who receive treatment for depression show improved symptoms within a month or so. Early diagnosis and professional treatment can help to alleviate even mild symptoms of depression. Cognitive Behavioral Therapy (CBT) and the use of antidepressant medications can help to break patterns of negative thoughts and decrease depressive episodes. As a result, depression is a highly treatable disorder, Psychology Today reports. Anytime depressive symptoms persist for at least a two-week period, it may be a sign that it is time to seek professional help.
What Causes Depression?
Depression is not caused by one specific factor or incident, but rather, it is most often due to a number of contributing factors. Genetics and biology may certainly play a role in the onset of depression, as brain chemistry and regions of the brain responsible for feeling pleasure, processing reward, and garnering motivation may not function as they should. Environmental factors, like experiencing a trauma, chronic exposure to high levels of stress, and childhood neglect and/or abuse, may predispose someone to suffer from depression. Stress causes levels of the hormone corticotropin-releasing factor (CRF) to increase, for instance. The Brain & Behavior Research Foundation reports that studies show heightened levels of CRF in individuals diagnosed with depression. Other parts of the brain, such as the hippocampus and frontal lobe, may also be impacted by both stress and depression.
Abusing substances like drugs or alcohol, which also interact with the brain’s circuitry and chemical messengers, can also increase the risks for developing depression. NAMI publishes that of those who struggle with issues related to substance abuse, about 30 percent also suffer from depression. Substance abuse and depression, when combined, form a complicated picture, as each may predispose a person to the other disorder. It may also be difficult to discern which may have come first, the depression or the substance abuse. Regardless of which came first, however, substance abuse can complicate treatment and exacerbate depressive symptoms, just as depression may increase the risk factors and side effects of drug and alcohol abuse, and interfere with treatment measures. When depression and substance abuse co-occur and a dual diagnosis is made, an integrated treatment model that manages both disorders at once is generally thought to be the most beneficial.
Types of Depression
According to Psych Central, major depressive disorder (MDD) is the most common form of depression. In some instances, an individual may suffer from a major depressive episode only one time in their lifetime; however, it is likely more common that MDD is a reoccurring and chronic mood disorder that interferes with a person’s ability to function within society on a daily basis. The Anxiety and Depression Association of America (ADAA) reports that for a diagnosis of MDD, an individual will suffer from at least five of the typical symptoms of depression for a time period of 14 days or more in each instance. In addition to major depressive disorder, other types of depression, or depressive disorders, as published by NIMH, are:
- Persistent depressive disorder or dysthymia: These symptoms may be the same as general depressive symptoms or those of MDD, although depression and depressive symptoms last for at least two years. Symptoms may not be severe for the whole time; however, they do exist and are persistent for two years or more.
- Bipolar disorder: Sometimes referred to as manic-depressive disorder, bipolar disorder is considered separate from depression, although depressive symptoms are part of the disorder as well. The difference with bipolar disorder is that mood swings from high to low are common, and episodes of extreme mania are also present.
- Seasonal affective disorder (SAD): With SAD, individuals may become depressed when there is less natural sunlight, like in the winter months, and symptoms may improve during the summer months. Weight gain, social withdrawal, and sleeping more often during the winter each year are symptoms of SAD.
- Psychotic depression: When major depressive symptoms are combined with psychosis, including delusions or hallucinations, psychotic depression may be diagnosed. Delusions are beliefs that are both disturbing and false, and hallucinations are seeing and/or hearing things that aren’t really there. Individuals suffering from psychotic depression may have delusions or hallucinations that focus on specific things such as poverty, illness, or guilt.
- Perinatal and postpartum depression: A form of depression that either occurs during pregnancy (perinatal) or after delivery of the baby (postpartum), it includes major depressive symptoms, anxiety, and exhaustion that may make it difficult for a woman to care for herself or her newborn.
- Disruptive mood dysregulation disorder (DMDD): Diagnosed in children and adolescents between the ages of 6 and 18, per Psych Central, DMDD is characterized by chronic irritable mood, temper tantrums, and outbursts that are out of proportion to the situation at hand. This diagnosis replaces childhood bipolar disorder in the most current Diagnostic and Statistical Manual of Mental Disorders, the DSM-5.
- Premenstrual dysphoric disorder (PMDD): About 5-11 days before the start of a woman’s menstrual cycle, irritable mood, tension, and significant depressive symptoms may be signs of PMDD, which is more severe than PMS (premenstrual syndrome) and stops when the menstrual cycle begins or shortly thereafter, the National Library of Medicine (NLM) reports.
Getting Help for Depression
Suicide is a potential risk factor for depression, and self-destructive thoughts or behaviors may be heightened when drugs or alcohol are added to the picture as well. The CDC reports that in 2013, close to 4 percent of American adults reported suicidal thoughts in the previous year, and suicide was 10th on the list for leading causes of death in the United States.
Any suicidal ideations or chronic thoughts of death should be addressed immediately with the aid of a trained professional. Numerous hotlines and crisis centers exist to help families and individuals in the throes of an emotional emergency situation. The Suicide Prevention Lifeline is available 24 hours a day, seven days a week.
Depressive symptoms can be treated with a variety of methods in many different settings. For example, clinics, hospitals, physicians’ offices, counseling centers, community outreach facilities, outpatient programs, residential facilities, and substance abuse treatment centers may all be places where someone battling depression can get help. Mental health professionals, such as psychiatrists, counselors, therapists, and psychologists, can all provide services for those suffering from depression. When someone also struggles with issues surrounding drug or alcohol abuse or addiction, a substance abuse treatment facility may be the optimal choice for care. Behavioral therapies, including CBT, are often coupled with medications, like antidepressants, and holistic measures, such as mindfulness meditation, during treatment for depression. In the case of substance dependence and/or addiction, medical detox in a safe and secure facility may be beneficial initially as well.
No two people will react to treatment in exactly the same way, so it can be very useful to undergo a complete and comprehensive evaluation and assessment before entering into a specially and individually designed treatment program. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a Behavioral Health Treatment Services Locator tool that families and individuals can use to find local services.
Insurance may cover services related to both depression and substance abuse, and insurance providers and professionals at substance abuse treatment facilities can be wonderful resources in determining how to go about using insurance coverage for these services. Many insurance plans may require individuals to remain in-network, and choose a provider from a specified list, as well as first obtaining a referral from a primary care physician. Making an appointment with the primary care provider can be a great place to start discussing potential depressive symptoms and determining what the next steps may be. These professionals can also provide referrals to specialty services when needed or as required for insurance purposes.