abuse, anti depressants, anxiety, anxiety disorder, black hole, comorbidity, darkness, denial, depression, dysthymia, dysthymic disorder, empty, feeling of impending doom, Grief, health, help, hole, lonliness, loss, major depressive disorder, medicine, mental-health, negativity, overcoming depression, overwhelming sadness, panic attacks, SSRIs, support, treatment, types of depression
Sadness or downswings in mood are normal reactions to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than just sadness.
Some people describe depression as “living in a black hole” or having a feeling of impending doom. However, some depressed people don’t feel sad at all—they may feel lifeless, empty, and apathetic, or men in particular may even feel angry, aggressive, and restless.
Depression is a persistent feeling of overwhelming sadness for at least 2 weeks (and usually much longer). It’s the inability to take pleasure in almost any of life’s activities, and feeling run down or lacking the normal energy you had before depression set in. People with clinical depression also often suffer from problems with sleep and eating.
What does depression feel like?
Certainty that an acute episode [of depression] will last only a week, a month, even a year, would change everything. It would still be a ghastly ordeal, but the worst thing about it – the incessant yearning for death, the compulsion toward suicide – would drop away. But no, a limited depression, a depression with hope, is a contradiction. The experience of convulsive pain, along with the conviction that it will never end except in death – that is the definition of a severe depression.
– George Scialabba
Types of Depression
Depressive disorders come in many different types, but each type has its own unique symptoms and treatments.
The most common type of depressive disorder, major depression is characterized by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Depression is also rated by your diagnosing physician or mental health professional in terms of its severity — mild, moderate, or severe. Left untreated, major depression typically lasts for about six months. Some people experience just a single depressive episode in their lifetime, but more commonly, major depression is a recurring disorder. Some people experience a few symptoms, some many.
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being “slowed down”
- Difficulty concentrating, remembering, or making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
A person who suffers from a major depressive episode must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person’s normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. A major depressive episode is also characterized by the presence of 5 or more of these symptoms:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Irritability, short-temper, or aggressiveness much more than usual
- Consuming more alcohol than normal or engaging in other reckless behavior
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Dysthymic Disorder (also known more generally as dysthymia) is exhibited by a depressed mood for most of the days, for more days than not with feeling mildly or moderately depressed although there may be brief periods of normal mood, for at least 2 years. Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.” The person who suffers from this disorder must not have gone for more than 2 months without experiencing two or more of the following symptoms:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
These chronic symptoms make it very difficult to live life to the fullest or to remember better times. If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.” However, dysthymia can be treated, even if your symptoms have gone unrecognized or untreated for years.
manic depression (bipolar disorder)
Another type of depression is experienced as a part of bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy.
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
Causes of Depression
Depression is not just the result of a chemical imbalance in the brain, and it’s not simply cured with medication. Experts believe that depression is caused by a combination of biological, psychological, and social factors. In other words, your lifestyle choices, relationships, and coping skills matter just as much — if not more so — than genetics. However, certain risk factors make you more vulnerable to depression, such as:
- Lack of social support
- Recent stressful life experiences
- Family history of depression
- Marital or relationship problems
- Financial strain
- Early childhood trauma or abuse
- Alcohol or drug abuse
- Unemployment or underemployment
- Health problems or chronic pain
Women and Depression
Stress in general can contribute to depression in persons biologically vulnerable to the illness. Some have theorized that higher incidence of depression in women is not due to greater vulnerability, but to the particular stresses that many women face. These stresses include major responsibilities at home and work, single parenthood, and caring for children and aging parents. How these factors may uniquely affect women is not yet fully understood.
Women’s reproductive events include the menstrual cycle, pregnancy, the post-pregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood that for some women include depression. Researchers have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood; a specific biological mechanism explaining hormonal involvement is not known, however.
Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome (PMS) or premenstrual dysphoric disorder(PMDD), the changes typically begin after ovulation and become gradually worse until menstruation starts.
Postpartum mood changes can range from transient “blues” immediately following childbirth to an episode of major depression to severe, incapacitating, psychotic depression. Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed and treated.
Pregnancy (if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. In addition, motherhood may be a time of heightened risk for depression because of the stress and demands it imposes.
Menopause, in general, is not associated with an increased risk of depression. In fact, while once considered a unique disorder, research has shown that depressive illness at menopause is no different than at other ages. The women more vulnerable to change-of-life depression are those with a history of past depressive episodes.
Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who have been raped as adolescents or adults. Since far more women than men were sexually abused as children, these findings are relevant. Women who experience other commonly occurring forms of abuse, such as physical abuse and sexual harassment on the job, also may experience higher rates of depression.
Abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. There may be biological and environmental risk factors for depression resulting from growing up in a dysfunctional family. At present, more research is needed to understand whether victimization is connected specifically to depression.
|If you scored…||You may have…|
54 & up
36 – 53
22 – 35
|Mild to moderate depression|
18 – 21
10 – 17
|Possible mild depression|
0 – 9
|No depression likely|
Treatment for Depression
Treatment for depression, like for most mental disorders, usually relies on psychotherapy and medication for the quickest, strongest effects. There are a wide number of different types of effective therapeutic approaches utilized for the treatment of depression today. These range from cognitive behavioral therapy, to behavioral therapy, to interpersonal therapy, to rational emotive therapy, to family and psychodynamic approaches. The most commonly prescribed medications for depression are referred to as antidepressants. A class of antidepressants called selective serotonin re-uptake inhibitors (SSRIs) are the most commonly prescribed medication for depression today. Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) and Luvox (fluvoxamine) are the most commonly prescribed brand names. SSRIs work on increasing the amount of serotonin in the brain. (Serotonin released uplifts the mood hence relieving depression.)
Additionally, omega-3 fatty acids such as eicosapentaeoic acid (EPA) and docosahexaenoic acid (DHA) might have an impact on depression because these compounds are widespread in the brain. The evidence is not fully conclusive, but omega-3 supplements are an option. One to two grams of omega-3 fatty acids daily is the generally accepted dose for healthy individuals, but for patients with mental disorders, up to three grams has been shown to be safe and effective.
Deficiencies of magnesium and vitamins B and D have been linked to depression. Hoang and colleagues (2011) found that low vitamin D levels are associated with greater depressive symptoms — especially in people with a prior history of depression. Taking between 1,000 and 2,000 IU of vitamin D each day may help with keeping depression at bay.
Another way of helping to improve depressive symptoms is exercise. Although it’s mentioned all the time, people still seem often reluctant to try it. This is not surprising since some of the symptoms of depression that many people experience include lethargy and a lack of motivation and energy. Find exercises that are continuous and rhythmic (rather than intermittent): Walking, swimming, dancing, stationery biking, and yoga are good choices.
An antidepressant of the selective serotonin re-uptake inhibitor (SSRI) class. Zoloft is primarily prescribed for major depressive disorder in adult outpatients as well as obsessive–compulsive, panic, and social anxiety disorders in both adults and children. Treatment of panic disorder with Zoloft results in a significant decrease of the number of panic attacks and an improved quality of life. Zoloft is effective for both severe depression and dysthymia, a milder and more chronic variety of depression.
The common adverse effects associated with Zoloft and listed in the prescribing information: Somnolence (drowsiness), dizziness, nausea, dry mouth, insomnia, diarrhea, tremor; and decreased libido.
Medication can help relieve the symptoms of depression in some people, but they aren’t a cure and they come with drawbacks of their own. Learning the facts about antidepressants and weighing the benefits against the risks can help you make an informed and personal decision about whether medication is right for you.
In a very positive book about depression, Dr. Michael Yapko persuasively argues in Depression is Contagious that the cornerstone of the majority of people’s depression today is about relationships — or the lack of healthy, good, close relationships in our life. Relationships just don’t fall into our laps, but when we’re depressed, we may specifically isolate ourselves from our existing and new relationships. This is a symptom of the depression. Our thoughts shape our behaviors, not the other way around. How and what we think directly impact how we behave, and many would argue, how we feel. If we feel depressed, it may be because we are often thinking depressing thoughts. You can’t just stop thinking such thoughts, but you can learn to identify the thoughts as they occur. As you track your thoughts throughout the day, you can also learn ways of evaluating them, and answering them back when they are unhealthy or irrational. This exercise forms the basis of cognitive-behavioral therapy, but the joy of this therapeutic technique in treating depression is that you can learn it all on your own, outside of a therapy relationship.
There’s a reason that most therapists suggest taking it slow when trying to treat depression. If you feel good one day, and decide to try and start a new business or make a new friend and you fail, it could be a forceful setback in overcoming depression. Instead, try things out slowly, and experiment with change one step at a time. As you do take steps into the future, trying out new behaviour strategies or relationship skills, reward yourself for your successes.
All journeys are not a straight line forward. There will be setbacks in your journey recovering from depression. Take the setbacks in stride, though, and keep them in perspective — it wouldn’t be work if it was simple to recover from depression. Depression recovery is a process that will take time, but as long as you stick with the goal of change, you can overcome depression in due time. Remember, hope is one of the things that leaves when a person is depressed. But hope can be reignited through small successes along the way, reinvigorating the memory of better times — times that can be just around the corner as you begin to win the battle over depression.
Anxiety and Depression
Inside, a depressed person often experiences a lot of anxiety – even leading to panic attacks. Of course, having panic attacks can itself be a depressing thing. Any lack of control within our lives can contribute to depression.
Depression generates emotions such as hopelessness, despair and anger. Energy levels are usually very low, and depressed people often feel overwhelmed by the day-to-day tasks and personal relationships so essential to life. A person with anxiety disorder, however, experiences fear, panic or anxiety in situations where most people would not feel anxious or threatened. The sufferer may experience sudden panic or anxiety attacks without any recognized trigger, and often lives with a constant nagging worry or anxiousness.
Depression can make people feel profoundly discouraged, helpless, and hopeless. Anxiety can make them agitated and overwhelmed by physical symptoms – a pounding heart, tightness in the chest, and difficulty breathing. People diagnosed with both depression and anxiety tend to have:
- More severe symptoms
- More impairment in their day-to-day lives
- More trouble finding the right treatment
- A higher risk of suicide
The reason there is often comorbidity (more than one disorder present at a time in a person) between the two conditions i.e. anxiety and depression is because not everyone suffers from the condition every day; and because not all depression and anxiety exhibits itself in the same way. Some show symptoms of both, but not all.
For example, some may feel life is not worth living (depression) because nothing good is happening. They have hope or wish good things will happen though, which is less indicative of depression and more common with anxiety. But then when those things don’t happen, they continue to have their suicidal ideations.
What does an anxiety/ panic attack feel like?
Like epileptic seizures, a series of frenzied anxiety attacks would descend upon me without warning. My body was possessed by a chaotic, demonic force which led to my shaking, pacing and violently hitting myself across the chest or in the head. This self-flagellation seemed to provide a physical outlet for my invisible torment, as if I were letting steam out of a pressure cooker.
– Douglas Bloch, M.A., author of Healing From Depression
A panic attack is an experience of sudden and intense anxiety. Panic attacks can have physical symptoms including shaking, feeling confused or disorientated, rapid heartbeats, dry mouth, sweating, dizziness and chest pain. The symptoms of a panic attack normally peak within 10 minutes. Most episodes (attacks) will last for between five minutes and half an hour.
“Many people have a sense of impending disaster, and think they’re going to faint, lose control or even die,” says Professor Paul Salkovskis, a psychologist at King’s College London.
Treatment for Anxiety and Depression
Antidepressant medication is often used for anxiety and depression, and behavioral therapy frequently helps people overcome both conditions. Learning to relax, which isn’t as easy as it sounds, can help to relieve some of this stress and tension, and may also help you to deal more effectively with your panic attacks when they occur. Regular exercise, especially aerobic exercise, will help you to manage stress levels, release tension, improve your mood and boost confidence. Antidepressants and cognitive behavioural therapy (CBT) are the two recommended treatments for panic disorder.
The Road to Recovery
Just as the symptoms and causes of depression are different in different people, so are the ways to feel better. What works for one person might not work for another, and no one treatment is appropriate in all cases. If you recognize the signs of depression in yourself or a loved one, take some time to explore the many treatment options. In most cases, the best approach involves a combination of social support, lifestyle changes, emotional skills building, and professional help.
Lifestyle changes are not always easy to make, but they can have a big impact on depression. Lifestyle changes that can be very effective include:
- Cultivating supportive relationships
- Getting regular exercise and sleep
- Eating healthfully to naturally boost mood
- Managing stress
- Practicing relaxation techniques
- Challenging negative thought patterns
Getting the support you need plays a big role in lifting the fog of depression and keeping it away. On your own, it can be difficult to maintain perspective and sustain the effort required to beat depression, but the very nature of depression makes it difficult to reach out for help. However, isolation and loneliness make depression even worse, so maintaining your close relationships and social activities are important. The thought of reaching out to even close family members and friends can seem overwhelming. You may feel ashamed, too exhausted to talk, or guilty for neglecting the relationship. Remind yourself that this is the depression talking. You loved ones care about you and want to help.
Depression puts a negative spin on everything, including the way you see yourself, the situations you encounter, and your expectations for the future. But you can’t break out of this pessimistic mind frame by “just thinking positive.” Happy thoughts or wishful thinking won’t cut it. Rather, the trick is to replace negative thoughts with more balanced thoughts.
Types of negative thinking that add to depression
|All-or-nothing thinking – Looking at things in black-or-white categories, with no middle ground (“If I fall short of perfection, I’m a total failure.”)|
|Overgeneralization – Generalizing from a single negative experience, expecting it to hold true forever (“I can’t do anything right.”)|
|The mental filter – Ignoring positive events and focusing on the negative. Noticing the one thing that went wrong, rather than all the things that went right.|
|Diminishing the positive – Coming up with reasons why positive events don’t count (“She said she had a good time on our date, but I think she was just being nice.”)|
|Jumping to conclusions – Making negative interpretations without actual evidence. You act like a mind reader (“He must think I’m pathetic”) or a fortune teller (“I’ll be stuck in this dead end job forever”)|
|Emotional reasoning – Believing that the way you feel reflects reality (“I feel like such a loser. I really am no good!”)|
|‘Shoulds’ and ‘should-nots’ – Holding yourself to a strict list of what you should and shouldn’t do, and beating yourself up if you don’t live up to your rules.|
|Labeling – Labeling yourself based on mistakes and perceived shortcomings (“I’m a failure; an idiot; a loser.”)|
In order to overcome depression, you have to take care of yourself. While you can’t force yourself to have fun or experience pleasure, you can choose to do things that you used to enjoy. Push yourself to do things, even when you don’t feel like it. Even if your depression doesn’t lift immediately, you’ll gradually feel more upbeat and energetic as you make time for fun activities.
If support from family and friends, positive lifestyle changes, and emotional skills building aren’t enough, seek help from a mental health professional. Needing additional help doesn’t mean you’re weak. There are many effective treatments for depression, including therapy, medication, and alternative treatments.
I often shed a tear when I contemplate that I came very close to taking my life, only a year before I met the love of my life, who is now my wife.
– Michael Ellsberg, How I Overcame Bipolar II (and Saved My Own Life), Forbes