130715 DepressionEverybody gets the blues.  When the dog dies, you lose a job or a boyfriend, a check bounces, the roof leaks, you get sick, your team loses – you feel down, sad and empty.   In a relatively short time though, you bounce back.  You get better because the circumstance changes, you take some action or your feelings just go away.

For some of us, though, things don’t get better.  Our mood is persistently sad.  We lose interest or pleasure in activities that we once enjoyed. We experience a significant change in appetite or body weight.  We can’t sleep or sleep too much.  We don’t have any energy.  Feelings of worthlessness or inappropriate guilt are complicated by difficulty thinking or concentrating.  We have recurrent thoughts of death or suicide.

If you have five or more of these symptoms during the same two-week period, you meet the diagnostic criteria for Major Depression.  How bad do the symptoms have to be?  Most of us tend to minimize how bad we are feeling, but the defining question is do the symptoms interfere with your ability to function: to get things done around the house, to go to work, to interact with those you love.

130715 depression1The problem is more pervasive and serious than we think.  6.7% of us will contract Major Depression during the next year, and there’s a one in five chance that sometime during your life you’ll suffer from this condition.  A recent study sponsored by the World Health Organization and the World Bank found Major Depression to be the leading cause of disability in the United States and worldwide.

And Major Depression can kill you.  Over 80% of people who die by suicide have Major Depression.   We tend to think that this extreme outcome is pretty rare, but suicide is the tenth leading cause of death in the U.S.  In 2009, it accounted for 34,598 deaths.  Suicide is a major, preventable public health problem.

How do we prevent suicide? By treating the underlying depression.   Women tend to suffer from depression more than men, and this has biological and cultural sequelae.  The primary reason may be that while men tend to “act out” – fighting, drinking or other acts of aggression, women who are depressed tend to turn inward, feeding that sense of hopelessness associated with depression.

130715 Depression2Depression can appear two other diagnoses.  First, depression is associated with Bipolar Disorder, which was previously known as Manic-Depression.  Persons with Bipolar Disorder swing between the “poles” of major depression and mania, which is abnormally and persistently elevated mood, accompanied by grandiosity, decreased need for sleep, racing thoughts and impulsive behaviors.

A less severe form of depression that lasts at least two years is known as Dysthymic Disorder, or dysthymia.  Many people with dysthymic disorder also experience major depressive episodes.

To see the criteria doctors and therapists use to diagnose depression, click here.

Next time, I’ll talk about how treatment of depression has changed over the last few decades.