Depression affects over 19 million teens and adults in the United States alone.
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It can cause severe symptoms that affect everything from how you feel to how you think. It can also impact how you handle daily activities such as sleeping, eating, or working. To be diagnosed with depression the symptoms must be present for at least two weeks.
In 2016, 16.2 million adults age 18 or older suffered at least one major depressive episode, according to recent studies. 3.1 million adolescents have experienced major depression, with the breakdown being 19.4 percent female and 6.4 percent male. The increase in depression rates among adolescents has outpaced all other age groups.
Forms Of Depression
There are several types of depression that differ slightly from one another. These include:
- Persistent depressive disorder (AKA dysthymia) is a depressed mood that lasts for a minimum of two years. A person who has been diagnosed with this disorder may have periods of major depression along with periods of less severe symptoms, but symptoms must last for at least two years to be considered a persistent depressive disorder.
- Postpartum depression is the experience of full-on major depression during pregnancy or after delivery. The sensations of extreme sadness, anxiety, and exhaustion that come with postpartum depression sometimes makes it difficult for new moms to complete daily care activities for themselves and/or for their babies. Postpartum depression far more serious than what’s called the “baby blues” that some women experience after giving birth (a relatively mild depression and anxiety that typically clears within a couple of weeks after delivery).
- Psychotic depression happens when a person is suffering from both severe depression as well as some form of psychosis, including disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive theme such as delusions of guilt, poverty, or illness.
- Seasonal affective disorder is identified by the onset of depression during the winter months when there is not as much natural sunlight. This depression generally disappears during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, generally returns every year in seasonal affective disorder.
- Bipolar disorder is quite different from depression but is included because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). A person suffering from bipolar disorder can also experience extreme high – euphoric or irritable – moods known as “mania” or a less-severe form that is called “hypomania.”
Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).
Signs and Symptoms
According to the National Institute of Mental Health, if you have been exhibiting some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
- Never-ending sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience more. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few distressing symptoms may benefit from treatment. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
According to the Mayo Clinic, depression symptoms in children and teens are similar to those of adults, but there can be some differences. In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches, and pains, refusing to go to school or being underweight.
In teens, their symptoms may include: sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.
Depression also differs in men and women:
Women encounter depression far more often than men. Biological, life cycle and hormonal factors that are unique to women may be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
Men with depression don’t necessarily display it with sadness; indeed, they are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognize their depression and fail to seek help.
Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.
What Causes Depression?
- Biological differences. People suffering from depression have undergone physical changes in the brain.
- Brain chemistry. Neurotransmitters are brain chemicals that presumably play a role in depression. Research shows that differences in both the use and effect of these neurotransmitters and how they interact with neural circuits that are involved in keeping mood stability may act as a significant role in treating depression.
- Hormones. When hormones are re-balanced, it’s assumed that it can either cause or trigger depression. Hormone changes can happen via a variety of reasons including pregnancy, thyroid problems, and menopause.
- Inherited traits. Depression can be found in people whose blood relatives also suffer from it. The gene responsible has yet to be identified.
How Is Depression Treated?
The first thing you should do in getting the right treatment is to visit a health care provider or a mental health professional – they include both psychiatrists or psychologists. Your health care provider can perform an exam, an interview, and various lab tests that rule out other health conditions that may have the same symptoms as depression. Once diagnosed accurately, depression can be treated with either medication, psychotherapy, or a combination. If these treatments do not reduce symptoms, brain stimulation therapy such as TMS may be another treatment option to explore.
Forms Of Antidepressants
Certain brain chemicals, that are known as neurotransmitters, relate in some way to depression — specifically serotonin, norepinephrine, and dopamine. Most antidepressants relieve depression by affecting these neurotransmitters. Each type of antidepressant affects these neurotransmitters in different ways.
An estimated 13% of Americans age 12 and uptake antidepressants — a 65 percent increase from 1999 to 2014.
Other Forms Of Treatment
Psychotherapy – Several types of psychotherapy (also called “talk therapy” or “counseling”) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy.
Dialectical Behavioral Therapy – DBT is a cognitive behavioral treatment that emphasizes individual psychotherapy and group skills training courses to assist people in learning new and useful skills and strategies to develop a life that they experience as worth living. DBT skills include skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Electroconvulsive Therapy – ECT is now performed as an outpatient therapy. The patient is put under a brief anesthesia and given muscle relaxant.
Transcranial Magnetic Stimulation – TMS uses a magnet to activate the brain. First developed in 1985, TMS has been studied as a treatment for depression, psychosis, anxiety, and other disorders.
Unlike ECT, in which electrical stimulation is more generalized, TMS can be targeted to a specific site in the brain. Scientists believe that focusing on a specific site reduces the chance for the types of side effects associated with ECT – but opinions differ as to what site works best.
According to the National Institute of Medical Health, TMS was approved for use by the FDA in 2008 as a treatment for major depression for patients who did not respond to at least one antidepressant medication.
Other countries use TMS as a treatment for depression in patients who have not responded to medications and who might otherwise be considered for ECT.
The evidence supporting TMS for depression was mixed until the first large clinical trial, funded by NIMH, was published in 2010. The trial found that 14% achieved remission with TMS compared to 5% with an inactive (sham) treatment. After the trial ended, patients could enter a next phase in which everyone, including those who previously received the sham treatment, was given TMS. Remission rates during the second phase rose to almost 30%. A sham treatment is like a placebo, but instead of being an inactive pill, it’s an inactive procedure that mimics real TMS.
How Does TMS Work?
The usual TMS session lasts 18 minutes and does not require any anesthesia.
During the procedure:
- An electromagnetic coil is placed against the forehead near an area of the brain that is assumed to be involved in mood regulation.
- Short electromagnetic pulses are then administered through the coil. The magnetic pulses easily pass through the skull and creates small electrical currents that stimulate nerve cells in the targeted brain region.
Because a pulse of this type generally does not reach further than just two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan – so generally, the person feels a knocking or tapping on the head as the pulses are administered.
Side effects are minimal, ranging from headaches to dizziness, but they often go away with repeated sessions or is managed with over the counter pain relievers.