Depression

What is Major Depression? 
Major depression is a problem with mood in which there are severe and long lasting feelings of sadness or related symptoms that get in the way of a person's functioning. 

What are the symptoms of Major Depression? 
The symptoms of Major Depression may include:

• Sad mood
• Feeling hopeless or helpless
• Poor appetite with weight loss
• Increased appetite with weight gain
• Trouble sleep or sleeping too much
• Agitation
• General slowing down
• Loss of interest or pleasure in things that used to be fun
• Loss of energy
• Tiredness
• Feeling worthless
• Self-reproach
• Excessive guilt
• Inability to concentrate
• Indecisiveness
• Frequent thoughts of death or suicide
• Irritability
• Hallucinations
• Anxiety
• Worry about one's physical health
• Phobias
• Drug or alcohol abuse
• Problems at school or work
• Increased emotionality
• Memory loss
• Apathy
• Distractibility
• Delusions
• Tearfulness
• Brooding
• Panic attacks
• Aggressiveness
• Social withdrawal
• Poor grooming
• Memory loss

These symptoms must be severe enough to cause significant distress or loss of functioning. 

What causes Major Depression? 
Major depression has many causes. Psychological factors that increase the risk of depression include:

• Trouble expressing anger in a healthy way
• Poor self-esteem
• Strong dependency needs
• Poor people skills
• A pessimistic view of oneself and the world

Genetic inheritance is a strong risk factor for many people, as is a high level of stress. In recent years, it has become clear that depression also involves a very specific chemical imbalance in the areas of the brain that are responsible for mood and emotion. 

What happens to people who have Major Depression? 
Major depression is a one-time illness for about half the people who suffer from it. For the other half there is a lifelong risk of repeated episodes of depression. These people are said to have Recurrent Major Depression. In most people with recurrent depression, the symptoms disappear completely between episodes, but for about one- third of people with depression, there are lingering symptoms between episodes. 

What is the treatment of Major Depression? 
Treatment usually involves medicines, psychotherapy and lifestyle. Antidepressant medicines are almost always prescribed, and sometimes other kinds of medicines are needed, too: lithium, antipsychotics (when psychotic symptoms are present), mood stabilizers, or stimulants. Psychotherapies that have been proven effective in treating depression include interpersonal, cognitive-behavioral and others. ECT (shock treatments) is an effective treatment for major depression when medicines have not worked, or when medicines cannot be used because of health problems. 

What can I do to deal with my Major Depression? 
Some of the things a person can do to make the fullest possible recovery are:

• Maintain a consistent daily schedule.
• Take medicines as prescribed.
• Return to your responsibilities slowly and gradually.
• Set realistic goals.
• Ask for help when you need it.
• Meet regularly with your therapist.
• Get enough sleep. Go to sleep and get up at about the same times every day.
• Eat a healthy diet.
• Exercise regularly.
• Before taking a new prescription or over-the-counter medication, check with the person who prescribes your psychiatric medication.
• Discuss the social use of alcohol with your prescriber.
• Avoid street drugs.
• Build and keep friendships and a network of support.
• Take a course in stress management or assertiveness.
• Work hard in therapy.

What happens if the symptoms return after I get them under control? 
Since Major Depression is an illness that may return, plan what to do if signs of relapse appear. List which specific symptoms are danger signs. Make a plan to call your therapist immediately when those symptoms occur, and at the same time increase the amount of daily structure and decrease stress and responsibility for awhile. 

Where can I get more information about Depression? 
There are many good books about Major Depression: 

David D. Burns Feeling Good: The New Mood Therapy. 1999. 

Mary Ellen Copeland Living without Depression and Manic-Depression: A Workbook for Maintaining Mood Stability. 1994. 

Colette Dowling You Mean I Don't Have to Feel This Way? 1993. 

Patty Duke and Gloria Hochman A Brilliant Madness. 1998. 

Jan Fawcett, Bernard Golden and Nancy Rosenfeld New Hope for People with Bipolar Disorder 2000. 

Kay Redfield Jamison Night Falls Fast: Understanding Suicide. 1999. 

Max Fink Electroshock: Restoring the Mind. 1999. 

Frederick Goodwin, and Kay Redfield Jamison Manic-Depressive Illness. 1990. 

Jack Gorman Essential Guide to Psychiatric Drugs. 1998. 

Kay Redfield Jamison An Unquiet Mind: A Memoir of Moods and Madness. 1997. 

Kay Redfield Jamison Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. 1996. 

Donald F Klein and Paul H Wender Understanding Depression: A Complete Guide to Its Diagnosis and Treatment. 1994. 

Francis M Mondimore Bipolar Disorder: A Guide for Patients and Families. 1999. 

Francis M Mondimore Depression: the Mood Disease. 1993. 

Papolos, Dimitris. F. and Papolos, J Overcoming Depression. 1997. 

Dimitri Papolos. and Janice Papolos The Bipolar Child. 1999. 

Andrew Solomon The Noonday Demon: An Atlas of Depression. Scribner, 2001 

William Styron Darkness Visible: A Memoir of Madness. 1992. 

The following organizations can provide help, information and support: 

National Depressive and Manic-Depressive Association (NDMDA). A national support and information-giving group for people with Depression and Manic-Depressive Illness and for their family members and friends. There are local meetings throughout the New York metropolitan area and across the country. For information, call NDMDA at 1-800-82-NDMDA or you can reach them online at www.ndmda.org 

National Alliance for the Mentally Ill (NAMI). An international support and information-giving organization for people with psychiatric illness and their family members. For information about NAMI membership and availability of local meetings, call 1-800-950-NAMI, or reach them online at www.nami.org