For people suffering from a depressive illness, that advice is not only misguided, but hurtful. A person can’t simply “will” away a depressive illness, no matter how hard he or she tries.

     About 9.5 percent of the population — or about 20.9 million American adults — suffer from a depressive illness throughout any given 12-month period, according to the National Institute of Mental Health (NIMH). A depressive disorder is an illness that involves the body and mind, and it affects the way a person eats, sleeps, thinks and functions. A depressive disorder isn’t the same as a passing blue mood, nor is it a sign of personal weakness.

     Without treatment, symptoms can last for weeks, months or years. Unfortunately, many people with a depressive illness don’t seek treatment, even though there are now medications and therapies available to help with depression.

As is the case with other illnesses such as heart disease or cancer, depressive disorders come in many different forms. The following are the three most common types, according to the NIMH. (Keep in mind that within these types, there are variations in the number of symptoms, severity and persistence.)

1. Major depression is manifested by a combination of symptoms that interfere with the ability to work, concentrate, sleep, eat and enjoy activities that were once pleasurable. A disabling episode of depression may occur only once, although it more commonly occurs several times in a lifetime.
2. Dysthymia is a less severe type of depression and involves long-term, chronic symptoms that don’t disable, but do keep you from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
3. Bipolar disorder, also called manic-depressive illness, is another type of depression. Not as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). When in the depressed cycle, you can have any or all of the symptoms of a depressive disorder. When in the manic cycle, your thinking, judgment and social behavior may be affected in ways that cause serious problems. Mania, left untreated, may worsen to a psychotic state.

Not everyone who’s depressed or manic experiences every symptom on the list below, and severity of symptoms varies with individuals and also over time:

SYMPTOMS OF DEPRESSION

• Persistent sad, anxious or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Thoughts of death or suicide; suicide attempts
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Restlessness, irritability
• Persistent physical symptoms that don’t respond to treatment, such as headaches, digestive disorders and chronic pain

SYMPTOMS OF MANIA

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Overspending
• Inappropriate social behavior

So what causes a depressive disorder? Very often, a combination of genetic, psychological and environmental factors are involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses or none at all.

The following are some of the causes of a depressive disorder:

• Genetic predisposition — Some types of depressive disorder run in families, suggesting a biological predisposition that can be inherited. This seems to be the case with bipolar. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who don’t develop it. But not everybody with the genetic predisposition will develop bipolar. It appears that additional factors or triggers — stress or trauma — are involved in its onset.

In some families, major depression also occurs generation after generation. However, some people who have no family history of depression also suffer from it. Whether inherited or not, major depressive disorder is often associated with changes in brain function.

• Character attributes — People who suffer from low self-esteem, are pessimists or are overwhelmed by stress are prone to depression, but whether this represents a psychological predisposition or an early form of the illness isn’t clear.
• Medical illness — Physical changes in the body can be accompanied by mental changes. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, hormonal disorders, menopause and pregnancy can cause depressive illness.
• Life trauma — A serious loss, difficult relationship, financial problem or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode.
• Side effect of medication, especially in the elderly — Some symptoms of depressive disorder may be side effects of medication a person is taking for a physical problem or may be caused by a co-occurring illness. It’s also important to note that some people have the mistaken idea that it’s normal for the elderly to feel depressed. Or, when depression develops, it may be dismissed as a normal part of aging. It’s not.

If you think you’re suffering from a depressive disorder:

1. Confide in someone if you can (your spouse, a friend, someone in your family). Let someone know what you’re going through.
2. Get a physical exam and diagnostic evaluation by a medical doctor (who can then refer you to a mental health specialist) or visit a naturopathic doctor (if you prefer a natural approach to treatment).
3. Determine what type of treatment to pursue. You have a variety of options, such as antidepressant medications, herbal and amino acid therapies, psychotherapies such as cognitive/behavioral therapy or interpersonal therapy, and more. Expect your mood to improve gradually, not immediately. Feeling better takes time.
4. It’s advisable to postpone important decisions until the depression has lifted. If you’re suffering from a depressive disorder, your judgment and view of reality may be clouded. Before deciding to make a significant transition — such as changing jobs, getting married or divorced, etc. — discuss it with others who know you well and have a more objective view of your situation.

And remember, if you’re feeling exhausted, worthless, helpless and hopeless, it’s the depression. Negative thinking and wanting to “give up” will fade as treatment begins to take effect. People rarely "snap out of" a depression. But if they seek help, they can feel a little better, one day at a time.

written by Alex Caroline Robboy, CAS, MSW, LCSW

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