Researchers estimate that as many as 20 million people in the United States suffer from some form of depression—yet, many people remain undiagnosed and untreated. Could you have depression?
Winston Churchill called his continual bouts of depression "the black dog." President Abraham Lincoln, who suffered with depression throughout his adult life, once said, "I am now the most miserable man living." Until very recently, the understanding and treatment of various forms of depression were usually poor; and people were reluctant to admit to depression even when they understood that they had it.
Thanks to recent research, a new generation of medications, and a deeper understanding of how depression works, those days are gone. In the past few years, many celebrities and public figures have gone public with their own depressive experiences. (Read actor Kirk Douglas's comments about depression related to his stroke, starting on page 8.) Among them are newsman Mike Wallace and humorist Art Buchwald, actresses Brooke Shields and Lorraine Bracco (who played psychiatrist Dr. Jennifer Melfi on The Sopranos television series), Tipper Gore and Alanis Morrisette, and many others. Their testimony has also helped Americans to understand the different kinds of depression.
In her book Down Came the Rain: My Journey Through Postpartum Depression, Shields candidly discussed her depression, and the sense that it would never go away. "I just felt as though I would never be happy again, and as if I had fallen into a big black hole." But Shields and many others have gotten help, and they know that depression can be successfully treated.
"There's nothing, repeat, nothing to be ashamed of when you're going through a depression," says 60 Minutes' newsman Mike Wallace, who has taped public service announcements about depression for the CBS Cares ads. "If you get help, the chances of your licking it are really good. But, you have to get yourself onto a safe path."
"There's help. It's treatable," writes Lorraine Bracco in her book, On the Couch. "Getting treatment for depression was the best decision I ever made; going public about it was the second best."
But many people today continue to suffer from the baffling condition that can leave them feeling sad, worthless, and uninterested in any activities. Other symptoms can include sleeplessness or oversleeping, energy loss, weight gain or loss, and even thoughts of death or suicide.
The National Institute of Mental Health (NIMH) is at the forefront of research on the different types of depression, their treatments, and on ways to help the American public understand that help is available. The first step, say NIMH researchers, is to understand the types of depression and what treatments are available from your physician.
Types of Depression
Just like other illnesses, such as heart disease, depression comes in different forms. And within these, there are variations in the number of symptoms, their severity, and persistence.
- Major depression can have a combination of symptoms (see accompanying symptoms list) that interferes with the ability to work, study, sleep, eat, and enjoy previously pleasurable activities. A major depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime.
- Dysthymia, a less severe type of depression, involves longlasting, chronic symptoms that do not seriously disable, but keep you from functioning well or feeling good.
- 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.
- Postpartum depression can make new mothers feel restless, anxious, fatigued, and worthless. Some new moms worry they will hurt themselves or their babies. Unlike the "baby blues," postpartum depression does not go away quickly. Researchers think that changes in a woman's hormone levels during and after pregnancy may lead to postpartum depression.
- Seasonal affective disorder (SAD) has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and a lack of sunlight in winter. Some people may sleep too much, have little energy, and crave sweets and starchy foods. They may also feel depressed.
Symptoms of Depression
Not everyone who is depressed or manic experiences every symptom. The severity of symptoms varies among individuals and also over time.
- Persistent sad, anxious, or "empty" mood.
- Feelings of hopelessness or pessimism.
- Feelings of guilt, worthlessness, or helplessness.
- Loss of interest or pleasure in hobbies and activities that were once enjoyable, including sex.
- Decreased energy, fatigue; feeling "slowed down."
- Difficulty concentrating, remembering, or making decisions.
- Trouble sleeping, early morning awakening, or oversleeping.
- Changes in appetite and/or weight.
- Thoughts of death or suicide, or suicide attempts.
- Restlessness or irritability.
- Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.
Types of Medications
There are several types of medications used to treat depression. These include newer antidepressant medications—chiefly what are called selective serotonin reuptake inhibitors (SSRIs)—and older ones, called tricyclics and monoamine oxidase inhibitors (MAOIs). In addition to medications, a type of psychotherapy called cognitive behavioral therapy (CBT) can help relieve depression. (See accompanying article, "Working It Out.")
Sometimes, a doctor will try a variety of antidepressants before finding the most effective medication or combination of medications for the patient.
Selective serotonin reuptake inhibitors (SSRIs):
- citalopram (brand name: Celexa)
- escitalopram (brand name: Lexapro)
- fluoxetine (brand name: Prozac)
- paroxetine (brand names: Paxil, Pexeva)
- sertraline (brand name: Zoloft)
- amitriptyline (brand name: Elavil)
- desipramine (brand name: Norpramin)
- imipramine (brand name: Tofranil)
- nortriptyline (brand name: Aventyl, Pamelor)