Depression is far more sinister than sadness — but with treatment, there is hope
By Kimberly Blaker, July 2020 Issue.
I was first diagnosed with major depression at the age of 31. I was married, had two beautiful kids ages seven and three, and owned a thriving business. Yet, despite having so much to live for, my mood plummeted into despair. I lost all motivation to do anything. The simplest everyday tasks suddenly required an extraordinary effort. At night, I’d lie awake ruminating over every minor thing I had ever said or done wrong — or less than perfect. My life felt utterly worthless, despite all evidence to the contrary, and I became engulfed in sorrow and hopelessness.
As days turned into weeks, I continued to spiral downward. I became increasingly focused on death. I wasn’t suicidal, per se — though thoughts of the least painful methods of ending my suffering swirled around in my mind. I wanted nothing more than to fall asleep and never wake up again.
Unable to endure the pain and emptiness any longer and terrified by my thoughts, I finally sought help. My doctor prescribed an antidepressant, and within a few weeks, the darkness lifted. I was once again, my usual happy, energetic self.
But this was only the beginning of a lifelong battle with depression. Over the past couple of decades, I’ve had far too many bouts of depression to even count. Some are mild and short-lived, having minimal impact on my functioning, despite the bleak and gloomy outlook that looms over me. Other episodes are major and impact all areas of my life.
Recently, I experienced my first dysthymic episode — a depression that lasted two years, cycling between mild and severe. I had become resistant to my long-trusted friend, Wellbutrin, and none of the other medications I tried gave me any relief. Finally, I found a psychopharmacologist who knew just the right cocktail (a combination of medications) for me, and my depression went back into remission.
People with one depressive disorder often suffer from various forms. I’ve been diagnosed with major depressive disorder, dysthymia, seasonal affective disorder (SAD), and either cyclothymia or bipolar II (hypomania, rather than mania), with the depression component being the more severe problem for me.
Women are particularly at risk for depression
Depression does affect both women and men. But, women are twice as likely to experience major depression, according to Harvard Medical School. Women also experience higher rates of dysthymia, seasonal affective disorder (SAD), and the depressive side of bipolar disorder.
Depression, unlike the normal sadness everyone experiences from time to time, is a soul-sucking darkness that’s debilitating. It causes feelings of hopelessness, helplessness, and worthlessness. Depression can affect every aspect of life, from work and school to parenting, friendships, and the very basics of living.
For most women who’ve been diagnosed with depression in the past, the feeling is unmistakable when it begins to set in. But those who suffer from milder forms of depression and sometimes, even those suffering from a first major depressive episode, don’t immediately connect all the dots. So, some people can experience depression and not realize they’re suffering from a treatable illness.
Signs of depression
Symptoms of depression can range from mild to severe. Not everyone experiences every symptom. But several symptoms must be present for at least two weeks to receive a diagnosis of depression. The exact criteria for specific types of depression vary slightly. But the following are all indicators.
• Feeling depressed (sad, empty, or hopeless) nearly every day for at least a couple weeks
• Unusual irritability or difficulty controlling anger
• Ongoing trouble sleeping or sleeping more than usual
• An increase or decrease in appetite or significant unexplained weight loss or gain
• Loss of interest or pleasure in all or most activities
• Difficulty concentrating or making decisions
• Feelings of fatigue or loss of energy
• Excessive or inappropriate feelings of guilt or worthlessness
• Visible psychomotor slowing down or agitation
• Recurrent thoughts of death or suicide, with or without a plan, or attempted suicide
Types of depression
There are quite a few classifications, or types, of depression. The following are a few of the more common.
In any given year, major depressive disorder affects nearly 7% of the U.S. population, according to the National Institutes of Mental Health (NIMH). During a major depressive episode, almost all aspects of a person’s life are affected. Someone suffering from major depression may lack the motivation to do anything, including such necessities as taking a shower. Because of the impairment, both work and personal life suffer. In addition to the symptoms noted above, 20% of those with major depression will also experience psychosis (hallucinations or delusions).
Dysthymia is diagnosed when someone experiences depression for most of each day and on most days for at least two years. It’s often a lower level yet enduring depression. But those with major depression who are treatment-resistant can also meet the diagnosis of dysthymia. So, impairment from dysthymia can range from mild to severe. Women, according to HealthFundingResearch.org, are three times more likely than men to suffer from dysthymia.
Those with seasonal affective disorder (SAD) become depressed only or primarily during a particular season. For most with SAD, it›s during the fall and winter months resulting from the shorter days and reduced sunshine. But some people experience SAD during the summer months instead. The onset of SAD is typically around the age of 20 and affects 10 million Americans each year.
Bipolar disorder affects 2.6% of American adults, according to the NIMH. This treatable, but lifelong disease typically develops in women in their mid to upper 20s. For men, the onset is usually in the teens to the early 20s. Bipolar is signified by its bouts of both mania (or hypomania) and its opposite extreme, depression. Though an individual with bipolar will experience both sides of the spectrum, in women, depression is often the most problematic. For men, it›s the mania. Those with bipolar often experience psychosis during bouts of mania and sometimes with depression.
Postpartum depression will affect 10 to 15% of women, according to the NIMH. Postpartum depression shouldn’t be confused with the ‘baby blues,’ which is milder, short-lived, and related to the worry and fatigue of parenting a new baby. Instead, postpartum depression results from hormonal changes. During pregnancy, a woman’s hormone levels increase. Then immediately following childbirth, hormone levels rapidly drop to normal levels. This ultimately results in depression in some women. Like other forms of depression, it can be mildly to severely debilitating.
The exact cause of depression is unknown. But several factors likely contribute to the condition. According to the Mayo Clinic, those with depression have physical changes in their brains. These changes in the brain may eventually help researchers determine the exact cause of depression.
Depression is also genetic. A higher incidence of depression has been found in those with blood relatives who suffer from the condition.
Brain chemicals called neurotransmitters play a role in depression. The Mayo Clinic explains that the way neurotransmitters function and their effect on the neurocircuits involved in mood stability plays a significant role both in depression and its treatment.
Hormonal changes can also play a role in depression, particularly for women. During pregnancy and for several months following pregnancy, women are especially vulnerable. Menstruation cycles and menopause can also trigger depression.
In some cases, depression results from an underlying medical condition such as thyroid problems or low vitamin B levels. For this reason, it’s essential to visit your primary care physician for blood work to rule out other causes. If the cause of depression is an underlying medical condition, treatment for that condition is likely all that’s needed to cure the depression.
If medical causes have been ruled out, then it’s best to consult with a psychiatrist. Although primary care physicians can treat depression, psychiatrists have specialized training in diagnosing the various forms of depression and experience in treating them. Psychiatrists often know which medications will work best for a particular patient based on a variety of factors. In fact, depending on the type of depression and the specific set of symptoms, some people with depression require a combination of antidepressants, anti-anxiety medications, and mood stabilizers. Psychiatrists know how to tailor treatment to each individual for optimal results.
For those who are treatment-resistant, look for a psychiatrist with the special ‘psychopharmacologist’ designation. Psychopharmacologists have gone through additional specialized training in how drugs affect the mind and behavior.
In addition to medication, many psychiatrists recommend cognitive therapy with a psychologist or behavioral therapist in conjunction. This can help people cope with the effects of depression as well as dealing with any underlying trauma or events fueling the depression.
Finally, for those with SAD, sitting under a light therapy box is often recommended and can be helpful. You can order one online, and depending on your doctor’s recommendations, you can sit under it for 20 to 40 minutes each day.