Depression

Depression is one of the most common medical disorders in the world. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished or banished away. People with a depressive illness cannot merely "pull themselves together" and get better.

Depression is a serious medical condition that involves the body, mood, thoughts and behaviors. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who have depression.

Depression comes in different forms, just as is the case with other illnesses such as diabetes or hypertension. The three main depressive disorders are: major depressive disorder, dysthymic disorder, and bipolar disorder.

Major depression (or major depressive disorder) is manifested by a combination of symptoms (see symptom list below) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once, but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.

Dysthymic disorder, also called dysthymia, is characterized by long-term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

Bipolar disorder (or manic-depressive illness) is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the person may be overactive, over-talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behaviour in ways that cause serious problems and embarrassment. For example, an individual in a manic phase may feel elated and full of grand schemes that might range from unwise business decisions to romantic sprees.

It is very important to differentiate between bipolar disorder and major depressive disorder given that medical treatment is not the same for both disorders.

Not everyone with a depressive disorder experiences every symptom. The number and severity of symptoms may vary among individuals and also over time. Symptoms of depression include:

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• 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
• Trouble sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Restlessness, irritability
• Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain, which do not respond to routine treatment

More than 80 percent of people with depressive disorders improve when they receive appropriate treatment. Treatment choice will depend on the patient's diagnosis, severity of symptoms, and preference. In general, severe depressive illnesses, particularly those that are recurrent, will require a combination of treatments for the best outcome. It usually takes a few weeks of treatment before the full therapeutic effect occurs. Once the person is feeling better, treatment may need to be continued for several months-and in some cases, indefinitely-to prevent a relapse into depression.