Depression is a condition characterised by long-lasting feelings of sadness and hopelessness. People affected by depression usually suffer from the negative effects it has on their personal and social lives, as well as at work.

About one in four women and one in 10 men will suffer from depression at some point in life. Only about a third of these seek medical help.

Types of Depression

There are three main types of depression: major depression, dysthymia and bipolar depression.

Major depression is divided into four categories:

• Typical major depression is a loss of interest and pleasure in life, a loss of energy, and a tendency to see the “dark side” of everything.
• Atypical major depression is associated with overeating, oversleeping, and extreme shyness.
• Seasonal Affective Disorder (SAD) tends to develop each fall and clear up each spring.
• Psychotic major depression involves hallucinations (hearing voices in your head) and delusions (false beliefs), along with more typical symptoms of depression.

Dysthymia often begins in adolescence. This is a chronic low-grade depression, not severe enough to meet the clinical criteria for major depression. Nevertheless, sufferers may be so pessimistic, lethargic and self-critical that their lives are often completely put “on hold.”

Bipolar depression, also called manic depression, is actually the “low” phase of bipolar disorder. People with this condition have periods of emotional highs and lows that go in cycles. The lows experienced in bipolar depression are like those in typical major depression; the highs are known as the manic phase.

Men are more likely to develop bipolar disorders; women tend to suffer from typical depression. Typical depression usually appears in the 20s, 30s or 40s; whereas, bipolar depression in the teens, 20s or 30s.

Causes

Most people today are aware that depression isn’t the result of personal weakness or character flaws. Depression is caused by imbalances of the chemicals that help to send messages in the brain

Depression runs strongly in families. It’s probable that a host of unidentified genes are to blame, which combine to affect the brains of certain people slightly differently than others. While the tendency to be depressed is genetically inherited, the onset of depression can be provoked by traumatic events.

Triggers of depression include:

• negative life changes (such as losing a loved one)
• medical conditions such as Parkinson’s disease, stroke, and some cancers
• postpartum depression, which is a temporary state that often occurs after giving birth
• using certain drugs, including corticosteroids, anabolic steroids, and amphetamines
• progesterone (found in some female hormonal pills)
• alcohol has short-term and possibly long-term depressive effects

Symptoms and Complications

According to the Diagnostic and Statistical Manual of Mental Disorders, you may have major depression if suffering from depressed mood and/or loss of interest or pleasure in daily activities, plus four of the following symptoms:

• changes in appetite or weight
• slowed reactions
• insomnia (trouble sleeping) or chronic oversleeping
• noticeable changes in activity level (agitated or slowed down)
• feelings of worthlessness or guilt
• difficulty concentrating or making decisions
• recurring thoughts of death or suicide.

Depressed children may not seem “down,” but be aggressive and irritable instead.

The feeling of sadness and lack of energy of typical major depression are usually worse in the morning. Atypical depression is usually more severe in the evening. People with atypical depression tend to be moody – they cheer up on hearing good news, but slump badly in the face of adversity.

People with bipolar disorder often sleep excessively during their depressive phases. However, during the manic phase, they may be loud and overconfident. Each phase can last months. Bipolar disorder may develop in people with typical depression, especially those who first became depressed at a young age.

There is one deadly complication of depression – suicide. Suicide rates in men have rocketed in the last 20 years. Suicide is the second biggest cause of death in adolescents, yet most people who kill themselves are over 40.

Only one suicide attempt in 10 results in death. Older people succeed in suicide attempts more often than the young. Remember, it’s a myth that those who talk about it never do it. Those who threaten suicide are exactly those who do it. Talk of suicide should never be ignored.

Making the Diagnosis

If you meet the criteria in the section “Symptoms and Complications,” you may be suffering from depression. Talk things through with your doctor. Physicians today are trained to take depression and its treatment seriously. Together with your doctor, you should be able to figure out what the nature of the problem is and come up with a treatment plan. This may include referral to a psychiatrist.

Treatment and Prevention

Most types of depression respond best to a mixture of drug therapy and psychotherapy. Nobody who suffers from serious depression should make the mistake of believing that drugs are not for them. Modern antidepressants are safe and non-addictive.

There are many different drugs available today to help treat depression. You and your doctor will work together to decide what drug is best for you. All medications, including antidepressants can have side effects. Your doctor and pharmacist should explain common side effects to you and help you to manage them should they occur.

Psychotherapy can be an important part of treating depression. Psychiatrists and some family doctors are trained to help people recognize and ‘correct’ the kind of thinking that feeds depression. Support groups can also be a great help.

Light therapy can be effective in treating seasonal affective disorder. This type of therapy has recently become more common.

Electroconvulsive therapy (ECT) can be used in cases of very severe depression that are not helped by antidepressant medications. Side effects are few, but include short-term memory loss, confusion, headaches, and muscle aches after the procedure. Seventy to 90% of severely depressed patients show good response to ECT.

Exercise and sports can improve depression by helping to relieve anxiety, increase appetite, aid sleep, and above all improve mood and self-esteem. There’s good evidence that exercise boosts the body’s production of endorphins – a natural mood-elevating antidepressant.

An active lifestyle, supportive family and friends, and a positive outlook can go a long way in preventing depression. Sometimes, though, even your best efforts will not stop depression. Remember that the problem is with the chemistry in your brain and not with your personality – and that help is available.