Overview

Throughout the history of humankind, depression has been the source of much human suffering. It wreaks havoc with what makes us most human… our emotions, our relationships, our attitudes, and our ability to trust our judgments about those closest to us. Repeated plunges into depression can lay waste to marriages, friendships and careers.

Clinically, speaking, it’s a mood disturbance, typically experienced as significantly lower than normal mood for an extended period of time. Mild, short-lived mood fluctuations are normal. We all experience some degree of mood swings throughout our lives. We have our “up” days and “down” days. And for most of us, these extreme feelings are transient, and typically pass within a day or two. It’s when these feelings linger for weeks, months or even years, consuming your thoughts day in and day out, that the condition becomes clinically significant.

For the person suffering from depression, mood disturbances can become so disabling that they interfere with daily life, preventing the person from functioning normally. Depression begins to invade every corner of their lives and the impact can be devastating, both for the person with depression and for the people around him or her. Some depressed people don’t even realize they’re depressed. They may only sense that something’s wrong, that normal daily activities that used to be a breeze have become a struggle. Or they may suspect that they’re depressed but continue to live in denial, oblivious to the impact that depression is having on their lives and the lives of others who must compensate for their impairment.

If you or someone you love struggles with depression, you may feel alone. But in truth, depression has become such a common psychological disorder that it has been referred to as the “common cold of mental illness.” Depression plagues every population across the globe and is often said to be the largest non-fatal health burden worldwide. In other words, because depression is, for many, a chronic disorder, more people are living with depression than any other non-fatal illness. But they are not living with it unharmed. True clinical depression is far more devastating than the common cold. Left untreated, depression can spiral into a cycle of debilitating episodes that recur again and again throughout a person’s lifetime.

• Roughly 20% of the population will experience some degree of depression during their lifetime.
• An estimated 5.8% of men and 9.5% of women worldwide will experience a depressive episode in any given year (World Health Organization).
• Nearly one in ten Americans is experiencing symptoms of major depression at any given moment.
• 10 to 25 percent in women and 5 percent to 12 percent of men will become clinically depressed and experience a Major Depressive Episode or develop Major Depressive Disorder at some point in their lives (DSM-IV-TR, 2000).
• Depression is associated with a high mortality rate. Up to 15 percent of those with Major Depressive Disorder will die by suicide (DSM-IV-TR, 2000).

Depression can occur in people of any age, gender, ethnicity or socioeconomic status. But, in general, people who experience any of the following are at higher risk for depression:

• A previous depressive episode
• A family history of depression (Major Depressive Disorder is 1.5 to 3 times more common among first-degree biological relatives)
• Difficult childhood, especially physical, sexual or emotional abuse
• Substance abuse problem
• Single, with no significant other
• Recent bereavement
• Women who have recently given birth
• Recent serious medical conditions, such as stroke, heart attacks, diabetes
• Recent trauma, such as assault, military service or witnessing a fatal accident
• Recent severe stressors, such as divorce or loss of employment
• Women are at significantly greater risk than men; Major Depression occurs twice as frequently in woman
• People who have not developed good coping skills

No two people experience depression exactly the same way. While all depressions are assessed by the same essential criteria, each is shaped by the unique histories, biochemistries and stressors of the individual’s life.

We think of depression as a mental health condition, but depression takes a toll on our physical health, as well. In fact, depression usually manifests as an intricately entangled cluster of mental and physical symptoms that can take a monumental toll on both mind and body. Many people with depression, for example, suffer back problems, headaches, and compromised immune systems, which makes them vulnerable to a host of physical illnesses. Some depressed people actually feel changes churning within their bodies. Some experience anxiety and agitation. Others experience a sensation of “heaviness” or lethargy and even physical pain.

Psychological (mental/emotional) symptoms of depression may include:

• Persistent low mood
• Low self-esteem and low self-confidence
• Pessimism and a negative outlook
• A sense of despair
• Irrational feelings of guilt
• Hopelessness and helplessness; feelings of worthlessness
• Thoughts of death

People with depression also typically suffer anhedonia or loss of pleasure in activities they once enjoyed. Somatic (biological and physiological) symptoms, may include:

• Fatigue and lack of energy
  • An inability to concentrate or make decisions
  • Sleep problems; either insomnia or hypersomnia
  • Change in appetite, weight gain or loss
  • Sexual dysfunction, loss of sex drive
    • Psychomotor activity changes, such as slower movements or speeded up, agitated movements

Loss of pleasure is nearly universal among people with depression. More than three-fourths report trouble with sleep — either hypersomnia or insomnia. Many lose appetite and weight. For many, mood is significantly worse in the morning, then improves somewhat as the day wears on (known as diurnal variation).

Most people with depression complain of fatigue — which they may report as tiredness or loss of energy — and a general lack of motivation, which, in a particularly cruel twist of irony, may prevent them from seeking treatment.

Speech and movements may be slower than normal (known as psychomotor retardation); for example, there may be a marked pause before they answer questions or initiate action. Speech may be quiet, even inaudible. Some people with depression even stop speaking completely, other than to respond to a direct question. At the extreme, a depressed person may even become totally mute. At the other extreme are people with depression who are so anxious that they become agitated, which may be expressed as hand-wringing, pacing or an inability to sit still.

Other symptoms might include crying spells, phobias, obsessions, compulsions and symptoms of anxiety, such as panic attacks. Many people with depression drink more or abuse other substances and substance abuse sets up a vicious cycle by worsening the mood disorder.

People suffering from depression often lose the ability to objectively evaluate themselves, a symptom which often manifests as low self-esteem, feelings of worthlessness, or guilt. Guilt may include unrealistic negative evaluations of one’s worth, or guilty preoccupations with and ruminations over minor past failings. They may slip into a persistent negative feedback loop, constantly circling their personal mistakes and misfortunes. They may misinterpret neutral or trivial events as further evidence of their personal defects, further fueling a cycle of guilt, shame and a sense of hopelessness and worthlessness… further fueling a vicious, recurrent cycle of depression. They may assume an exaggerated or inappropriate sense of responsibility for negative events. The sense of worthlessness or guilt may even be of delusional proportions.

Many people suffer cognitive impairments. In fact, people suffering from severe clinical depression may exhibit symptoms of thought disorder, such as, disorganized thinking, indecisiveness, impaired perception, memory and judgment, an inability to focus and complete tasks.

People tend to think of depression as extreme sadness or melancholy, but the deepest, darkest clinical depression may not be experienced as sadness or melancholy. The most severe and most dangerous depression is emotional numbness, a complete absence of feeling and a loss of concern about oneself and others. When something good happens, severely depressed people are often unable to recognize it, or may be too numb to enjoy or appreciate it. The chronically depressed tend to expect only bad things to happen and eventually stop expecting positive outcomes.

(For detailed diagnostic criteria for each disorder, see Assessing Depressive Disorders)