Myths and realities of depression

Millions of Americans suffer from forms of depression, but help is available . . .

Dr. Susan Locke

An estimated 19 million American adults are living with “major depression.” Depression can be caused by life events, biochemical components or a combination of both. Whatever the trigger, it’s never easy for the person struggling.

Most people suffering from depression want to feel better, but the nature of the disease makes it difficult for them to find the motivation to take the necessary steps.

How can you know if you or a loved one is depressed or just feeling down? To help, here are some symptoms of different depressive disorders.

Major depression: The diagnosis of major depression requires five of the following symptoms, at least one of which is depressed mood or loss of interest. The symptoms must be present for at least two weeks and must cause clinically significant impairment in social, work or other important areas of functioning almost every day.

• Depressed mood most of the day
• Diminished interest or pleasure in most activities
• Significant unintentional weight loss/gain or significant increase/decrease in appetite
• Insomnia or hypersomnia
• Agitation or psychomotor retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Diminished ability to think or concentrate, indecisiveness
• Recurrent thoughts of death

Dysthymic Disorder: This disorder is distinguished from major depression. The diagnostic criteria require a depressed mood most of the day for more days than not, for at least two years and the presence of two or more of the following symptoms which cause clinically significant impairment in social, work or other important areas of functioning.

• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

Bipolar disorder: Recurrent major depressive episodes commonly occur in bipolar disorder. To make a diagnosis of a major depressive episode as part of bipolar disorder, the individual must have had at least one manic or hypomanic episode.

Manic episodes are characterized by a distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least one week. During the period of mood disturbance, three or more of the following symptoms have persisted (four symptoms if mood is irritable).

• Increased self-esteem or grandiosity
• Decreased need for sleep
• More talkative/pressured speech
• Flight of ideas/racing thoughts
• Distractibility
• Increase in goal-directed activity/psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences.

Adjustment disorder with depressed mood: This is a psychological reaction to overwhelming emotional or psychological stress resulting in depression or other symptoms. These symptoms do not reach the level of severity of major depression and do not last as long as dysthymic disorder.

Substance-induced mood disorder: Disturbance in mood is the direct physiological effects of a substance such as prescriptions and over-the-counter medications. Depression may also result from use of an illegal substance. Alcohol does not tend to cause depression, but can significantly worsen existing symptoms.

Mood disorder due to a general medical condition: Some underlying medical conditions cause mood disorders like Parkinson’s disease or hypothyroidism.

Depression is a treatable disorder and you should call your primary care physician if you concerned about your symptoms. Healthnetwork may also be able to assist with treatment centers for more severe cases of depression.

Susan Locke, MD, is Healthnetwork Foundation’s medical director. An abridged version of this article appeared in the December 2012 issue of Legatus magazine.

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