By Lynn Hagan, PsyD, CTRL, LCSW

Depression is much more than simple unhappiness. Clinical depression, sometimes called major depression, is a “mood disorder” that is a significant mental health problem.

Symptoms

The main symptom of depression is a sad, despairing mood that:

• Is present most days and lasts most of the day
• Lasts for more than two weeks
• Impairs the person’s performance at work, at school or in social relationships.

Other symptoms may include:

• Changes in appetite and weight
• Sleep problems
• Loss of interest in work, hobbies, people or sex
• Withdrawal from family members and friends
• Feeling useless, hopeless, excessively guilty, pessimistic or low self-esteem
• Agitation or feeling slowed down
• Irritability
• Fatigue
• Trouble concentrating, remembering and making decisions
• Crying easily, or feeling like crying but being not able to
• Thoughts of suicide (which should always be taken seriously)
• Loss of touch with reality, hearing voices (hallucinations) or having strange ideas (delusions).

Depression Through the Lifespan

Major depression can occur in 10 to 25 per cent of women — almost twice as many as men. Many hormonal factors may contribute to the increased rate of depression in women — particularly during times such as menstrual cycle changes, pregnancy and postpartum, miscarriage, pre-menopause, and menopause.

Men with depression typically have a higher rate of feeling irritable, angry, and discouraged. This can make it harder to recognize depression in men. The rate of completed suicide in men is four times that of women, though more women attempt it.

Some people have the mistaken idea that it is normal for older adults to feel depressed. Older adults often don’t want to discuss feeling hopeless, sad, a loss of interest in normally pleasurable activities, or prolonged grief after a loss.

A child who is depressed 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 or 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 has depression.

Types of Depression

Different types of depression have different symptoms. These include:

• Seasonal Affective Disorder:  Usually affected by the weather and time of the year.
• Postpartum Depression: About 13% of women will experience this type of depression following the birth of a child.
• Depression with Psychosis: Depression so severe that a person loses touch with reality and experiences hallucinations (hearing voices or seeing people or objects that are not really there) or delusions (beliefs that have no basis in reality).
• Dysthymia:  Low mood with moderate symptoms of depression.

Causes of Depression

• Genetic or family history of depression, psychological or emotional vulnerability to depression.
• Biological factors such as imbalances in brain chemistry and in the endocrine/immune systems, or a major stress in the person’s life.
• Result of another illness that shares the same symptoms, such as lupus or hypothyroidism.
• A reaction to another illness, such as cancer or a heart attack.
• May be caused by an illness itself, such as a stroke, where neurological changes have occurred.

Misconceptions

• People should just get on with their lives.
• Clinical depression is not just unhappiness — it is a complex mood disorder caused by a variety of factors. Depression is not something that people can “get over” by their own effort.
• My life will never be normal again.Most people can and do return to function at the level they did before they became depressed.

Treatments for Depression

The most commonly used treatments, used individually or in combination, are:

• Pharmacotherapy (medication)
• Psychoeducation
• Psychotherapy
• Group therapy
• Self-help organizations, run by clients of the mental health system and their families

Recovery

Clinical depression needs to be managed over a person’s lifetime. Depression, like disorders such as diabetes, can be effectively managed and controlled by combining a healthy lifestyle and treatments.

One should always seek out a mental health professional, such as a clinical social worker, to assist in the diagnosis and treatment of depression. A clinical social worker is one who is licensed by the state to diagnose and treat various types of mental illness. Social workers not only provide support, but also psychotherapy, group therapy, and will interface with psychiatrists to ensure a quality continuum of care. A social worker treats not only the client, but often provides support for the entire family. Such support is vital when working with a family member with depression or some other form of mental illness. Only with continued support from professionals, can depression be truly managed.