A depressive disorder is an illness 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 even years. Depression can affect people at any ages of life. Appropriate treatment, however, can help most people whatever their age.
Depression in Children
Only in the past two decades has depression in children been taken very seriously. The child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary “phase” or is suffering from depression. Sometimes parents or a teacher will notice behavioral changes. If a visit to the pediatrician rules out physical problems, the doctor will probably suggest that the child be evaluated, preferably by a child psychiatrist. Treatment is usually provided by a social worker or a psychologist while the psychiatrist oversees medication if it is needed. Parents should not be afraid to ask questions: What are the therapist’s qualifications? What kind of therapy will the child have? Will the family as a whole participate in therapy? Will my child’s therapy include an antidepressant? If so, what might the side effects be?
Depression in Women
A higher frequency of depression among women has been linked with hormonal factors–particularly menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents. Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient “blues” are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic physician and the family’s emotional support for the new mother are prime considerations in aiding her to recover and enjoy her baby.
Men and Depression
Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. A new study shows that, although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate. Men’s depression is often masked by alcohol or drugs, or by workaholism. Rather than feeling hopeless and helpless, men may feel irritable, angry, and discouraged; hence, depression may be difficult to recognize. A man may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or worksite mental health programs can help men understand and accept depression as a real illness that needs treatment.
Depression in the Elderly
Some people have the mistaken idea that depression is normal for the elderly. In fact, most older people feel satisfied with their lives. Undiagnosed and untreated, depression causes needless suffering for the family and for the individual. The symptoms described are usually physical, for the older person is often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss. Many health care professionals realize this and are learning to identify and treat the underlying depression. They recognize that some symptoms may be side effects of medication prescribed for a physical problem, or they may be caused by a co-occurring illness. Treatment with medication and/or psychotherapy will help the depressed person enjoy life again.
The first step to getting treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression. If the physician rules out these possibilities, a psychological evaluation should be done, by the physician or by referral to a psychiatrist or psychologist. Based on the outcome of the evaluation, patients can choose from a variety of antidepressant medications and psychotherapies. Mild depression may be helped by psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with a combination: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life’s problems. There are now medications and psychosocial therapies such as cognitive/ behavioral, “talk,” or interpersonal that ease the pain of depression. Electroconvulsive therapy (ECT) is often useful for individuals whose depression is severe or life threatening or who cannot take antidepressant medication.
For the many undiagnosed depressed people in this country, learning about depression may be the first step toward recovery.