What is a depressive disorder?

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
In the 1950s and '60s, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job. In the 1970s and '80s, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree on the following:

1. A depressive disorder is a syndrome (group of symptoms) that reflects a sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.
2. Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished participation and a decreased or increased activity level.
3. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.
4. Depressive disorders are a huge public health problem, due to its affecting millions of people. Facts about depression include that approximately 10% of adults, up to 8% of teens, and 2% of preteen children experience some kind of depressive disorder. Postpartum depression is the most common mental health disorder to afflict women after childbirth.

• The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism from work or school.
• Adolescents who suffer from depression are at risk for developing and maintaining obesity.
• In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in some ways as often as coronary artery disease.
• Depression can increase the risks for developing coronary artery disease, HIV, asthma, and many other medical illnesses. Other complications of depression include its tendency to increase the morbidity (illness/negative health effects) and mortality (death) from these and many other medical conditions.
• Depression can coexist with virtually every other mental health illness, aggravating the status of those who suffer the combination of both depression and the other mental illness.
• Depression in the elderly tends to be chronic, has a low rate of recovery, and is often undertreated. This is of particular concern given that elderly men, particularly elderly white men have the highest suicide rate.

5. Depression is usually first identified in a primary-care setting, not in a mental health professional's office. Moreover, it often assumes various disguises, which causes depression to be frequently underdiagnosed.
6. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often undertreated. Hopefully, this situation can change for the better.
7. For full recovery from a mood disorder, regardless of whether there is a precipitating factor or it seems to come out of the blue, treatment with medication and/or electroconvulsive therapy (ECT)

What is the prognosis for depression?

Even though clinical depression tends to occur in episodes, most people who experience one such episode will eventually have another one. Also, it seems that any subsequent episodes of depression are more easily triggered than the first one. However, most depression sufferers recover from the episode. In fact, individuals who have mild depression and are treated with medication tend to respond equally as well to sugar pill (placebo). Those with more severe depression seem to be less likely to get better when taking placebo versus taking antidepressant medication. Other encouraging information is that research shows that even people from teenage through adulthood who do not improve when treated with a first medication trial can improve when switched to another medication or given another medication in addition to psychotherapy.

How can depression be prevented?

Programs that use mental health professionals to teach thinking skills (cognitive techniques) that assist in coping with stress seem to be effective in preventing depression. Key aspects in the prevention of postpartum depression include helping new mothers decrease those specific aspects of their lives that may contribute to depression, like having little social support and poor adjustment to their marriage or other domestic union.

What about self-help and home remedies for depression?

Depressive disorders can make those afflicted feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual situation. It should be remembered that negative thinking fades as treatment begins to take effect. In the meantime, the following are helpful tips for coping with depression:

• Eat healthy foods. The frequent lack of adequate nutrients and presence of excessive fats, sugars and sodium in fast foods can further sap the energy of depression sufferers.
• Many may find that folate and vitamin D food supplements help improve their mood.
• Make time to get enough rest to physically promote improvement in your mood.
• Express your feelings, either to friends, in a journal, or using art to help release some negative feelings.
• Do not set difficult goals for yourself or take on a great deal of responsibility.
• Break large tasks into small ones, set some priorities, and do what you can when you can.
• Do not expect too much from yourself too soon as this will only increase feelings of failure.
• Try to be with other people, which is usually better than being alone.
• Participate in activities that may make you feel better.
• You might try exercising, going to a movie or a ball game, or participating in religious or social activities.
• Don't rush or overdo it. Don't get upset if your mood is not greatly improved right away. Feeling better takes time.
• Do not make major life decisions, such as changing jobs or getting married or divorced without consulting others who know you well. These people often can have a more objective view of your situation. In any case, it is advisable to postpone important decisions until your depression has lifted.
• Do not expect to "snap out" of your depression. People rarely do. Help yourself as much as you can, and do not blame yourself for not being up to par.
• Remember, do not accept your negative thinking. It is part of the depression and will disappear as your depression responds to treatment.
• Plan how you would get help for yourself in an emergency, like calling friends, family, your physical or mental health professional or a local emergency room if you were to develop thoughts of harming yourself or someone else.
• Limit your access to things that could be used to hurt yourself or others (for example, do not keep excess medication of any kind, firearms, or other weapons in the home).

  How can someone help a person who is depressed?

  Family and friends can help! Since depression can make the affected person feel exhausted and helpless, he or she will want and probably need help from others. However, people who have never had a depressive disorder may not fully understand its effects. Although unintentional, friends and loved ones may unknowingly say and do things that may be hurtful to the depressed person. It may help to share the information in this article with those you most care about so they can better understand and help you.
  The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This help may involve encouraging the individual to stay with treatment until symptoms begin to go away (usually several weeks) or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication for several months after symptoms have improved. Always report a worsening depression to the patient's physician or therapist.
  The second most important way to help is to offer emotional support. This support involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the depressed person's therapist.
  Invite the depressed person for walks, outings, and to the movies and other activities. Be gently insistent if your invitation is refused. Encourage participation in activities that once gave pleasure, such as hobbies, sports, or religious or cultural activities. However, do not push the depressed person to undertake too much too soon. The depressed person needs company and diversion, but too many demands can increase feelings of failure.
  Do not accuse the depressed person of faking illness or of laziness. Do not expect him or her "to snap out of it." Eventually, with treatment, most depressed people do get better. Keep that in mind. Moreover, keep reassuring the depressed person that, with time and help, he or she will feel better.

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