Facts about Major Depression

What is Major Depression?
Major Depression (and the slightly less severe illness of Dysthymic Disorder) is a psychiatric disorder characterized by
significant periods of time in which the person experiences a sad, "blue", or low mood.  This depressed mood is often
accompanied by other unpleasant changes, such as loss of appetite or trouble sleeping.  In contrast to the normal
"blues" that many people often experience, these problems are severe enough to interfere with day-to-day functioning,
such as the ability to work, fulfill household responsibilities, and maintain interpersonal relationships.  
     The experience of depression varies considerably from one individual to the next.  Some people describe
depression as a loss of energy and interest in the world and a decreased ability to enjoy life.  For others, depression is
a unique, awful feeling of dread that is difficult to describe to someone who has not had the experience.  Living with a
person with depression can be difficult because the person may be difficult to engage and some of the depressed
feelings may "rub off" on the other person.

How Common Is Major Depression?
Major depression is one of the most common psychiatric disorders.  Between fifteen and twenty out of every one
hundred people (15-20 percent) experience an episode of major depression some time during their life.

How Is the Disorder Diagnosed?
Depression can only be diagnosed with a clinical interview.  The purpose of this interview is to determine whether the
client has experienced specific "symptoms" of the disorder for a sufficiently long period of time.  For a person to be
diagnosed with
major depression, severe symptoms must be present for at least a two-week period, although in most
cases symptoms have been present for a longer period.  If the symptoms are less severe but are present for long
periods of time, the person has the diagnosis of
dysthymic disorder.
     In addition to conducting the interview, the diagnostician must make sure that other physical problems are not
present that could produce symptoms similar to those found in depression, such as a brain tumor, a thyroid problem, or
alcohol or drug abuse.  Depression cannot be diagnosed with a blood test, an X ray, a CAT scan, or any other
laboratory test.

The Characteristic Symptoms of Depression
     The major symptoms of depression reflect both low mood and other disturbances in appetite, body weight, sleep,
and activity level.  Not all symptoms must be present for the person to be diagnosed with depression.
     
Depressed Mood.  Mood is low most of the time, according to the client or significant others.

Diminished Interest or Pleasure.  The client has few interests and gets little pleasure from anything, including
activities previously found enjoyable.

Change in Appetite and/or Weight.  Loss of appetite (and weight), when not dieting, or increased appetite (and
weight gain) are evident.

Change in Sleep Pattern.  The client may have difficulty falling asleep or staying asleep, or may wake early in the
morning and not be able to get back to sleep.  Alternatively, the client may sleep excessively (such as over twelve hours
per night), spending much of the day in bed.

Change in Activity Level.  Decreased activity level is reflected by slowness and lethargy, in terms of both the client's
behavior and his or her thought processes.  Alternatively, the client may feel agitated, "on edge", and restless.

Fatigue or Loss of Energy.  The client experiences fatigue throughout the day, or there is a chronic feeling of loss of
energy.

Feelings of Worthlessness, Hopelessness, Helplessness.  Clients may feel they are worthless as people, that
there is no hope for improving their lives, or that they are helpless to improve their unhappy situation.

Inappropriate Guilt.  Feelings of guilt may be present about events that the client did not even cause, such as
catastrophe, a crime, or an illness.

Recurrent Thoughts about Death.  The client thinks about death a great deal and may contemplate (or even
attempt) suicide.

Decreased Concentration or Ability to Make Decisions.  Significant decreases in the ability to concentrate make it
difficult for the client to pay attention to others or complete rudimentary tasks.  The client may be quite indecisive about
even minor things.

     
Other Symptoms
     Clients with depression (primarily major depression) also may have other psychiatric symptoms at the same time
that they experience depressive symptoms.  Some of the most common other symptoms include hallucinations (false
perceptions, such as hearing voices) and delusions (false beliefs, such as paranoid delusions).  These symptoms
disappear when the symptoms of depression have been controlled.

How is Major Depression Distinguished from Other Disorders?
Persons with major depression suffer episodes of depression interspersed with periods of normal mood.  If the
individual experiences both depression and the elevated, hyperenergized, expansive moods defined as mania, the
individual is then diagnosed as having bipolar disorder (manic-depression).  If the person experiences the psychotic
symptoms discussed above when not depressed, he or she is typically given a diagnosis of schizoaffective disorder.

What is the Course of Major Depression?
Major depression can develop at any time during adult life, starting during adolescence and extending up until old age.  
Some clients experience significant bouts of depression, ranging from weeks to months or even years, but fully recover
from the disorder.  For other individuals, however, depression is a lifelong disorder, with symptoms varying over time in
severity.  Many famous people have struggled with depression (such as Abraham Lincoln), but have been able to make
significant contributions to society.

What Causes Depression?
No one knows the cause of depression, although many theories have been proposed.  Many scientists believe that
there is more than one cause of depression.  Biochemical theories suggest that the disorder may be caused by an
imbalance in chemicals in the brain, particularly the chemicals norepinephrine and serotonin.  This imbalance may be
determined partly by genetic factors and partly by early effects of the environment.  There is evidence that the loss of a
significant person early in life (such as a parent) increases an individual's vulnerability to develop depression at a later
age.

Are There Factors That Might Increase the Likelihood of Relapse?
For many people, depression is recurrent.  Factors that tend to increase the likelihood of a recurrence include a life
change or a loss, a seasonal change (especially the coming of winter), and excessive alcohol use.

How is Depression Treated?
There are many effective treatments for depression.  Medication is very helpful for some clients.  Medications can
reduce or eliminate the symptoms of depression and prevent relapses from occurring.  Antidepressant medications are
the most effective medications for depression, although some clients also benefit from antipsychotic medications.  Some
individuals with severe major depression benefit from electroconvulsive therapy (ECT), also referred to as "shock
treatment".
     Individual psychotherapy is quite effective in improving the symptoms of depression.  The focus of therapy is usually
on correcting common problems with thinking (such as a tendency to think in "black and white" terms), improving social
skills and problem solving, or improving interpersonal relationships.  Family or marital therapy can reduce stress in the
family and teach the family how to monitor the disorder.
     While there are many effective treatments for depression, it must also be noted that this tends to be an episodic
disorder, and relapses often occur.  In addition, a small subset of individuals with depression continue to suffer
significant symptoms, in spite of the best pharmacologic and psychotherapeutic treatment.




Recommended Readings

Burns, D. (1980), Feeling Good: The New Mood Therapy.  New York: William Morrow
     and Company.

Copeland, M.E. (1992),
The Depression Workbook:  A Guide for Living with Depression
     and Manic Depression,
Oakland, CA: New Harbinger.

Papolos, D. & Papolos, J. (1992),
Overcoming Depression (Revised Edition).  New York:
     Harper Perennial

Yapko, M.D. (1997),
Breaking the Patterns of Depression.  New York: Doubleday.


*Note:  This handout is taken from the book
Behavioral Family Therapy for Psychiatric Disorders (1999) by Kim T.
Meuser and Shirley M. Glynn, published by New Harbinger Publications.  Used with permission.
Consult a mental health professional (such as a psychiatrist, social worker, or
psychiaric nurse) about any questions you have concerning this handout.