Depression (Major Depressive Disorder)( updated Oct 2006)

Depression can be a temporary state or a long-term emotional disorder marked by feelings of intense sadness, loss of interest or pleasure in almost all activities of the day, nearly every day. Feelings of loneliness, despair, low self-esteem, and self-reproach are also described. These feelings can occur at any point in life. These symptoms are not clinically described as depression, unless the symptoms last most of the day, nearly daily, for at least two weeks or longer. Depressive disorders take many different forms. While the symptoms are often similar, the causes and treatment may be different. The classic symptoms of depression are:

  • performing fewer daily activities
  • withdrawing from friends and social contact
  • having no appetite
  • eating less than usual, or eating more than usual
  • gaining or losing more than five pounds in a month
  • sleeping too little or too much
  • having trouble falling or staying asleep
  • having trouble concentrating
  • having memory problems
  • feeling low or irritable
  • losing interest in previously enjoyed activities
  • feeling tired often
  • having low self-esteem
  • feeling guilty, worthless, or constantly sad
  • acting irresponsibly
  • being preoccupied with thoughts about death
  • having suicidal thoughts or plans or attempting suicide


Depression can be a response to life events. While people normally have ups and downs, a depressed mood that persists without lifting is more serious. In many cases, the exact causes of depression are not known. But a person is more likely to become depressed if he or she:

  • loses a loved one or friend
  • experiences big or unwanted changes in life, such as a change in jobs, becoming a parent, or starting menopause
  • experiences a serious disappointment at home or work
  • takes certain medications, such as corticosteroids, tranquilisers, pain relievers, and some types of hormonal birth control
  • suffers major emotional or physical trauma or abuse
  • was abused as a child
  • has serious health problems, such as anaemia, a thyroid disorder, cancer, cardiac problems and dementia
  • has a family history of depression
  • abuses alcohol or other drugs such as marijuana.
  • experiences stress or anxiety for long periods of time.

Some women suffer from postpartum depression after the birth of a baby.  Depression is not entirely preventable but a person can avoid certain risks for it. It is important to seek help before depression gets too strong a grip if a person. Striking a balance in relationships, work, diet, exercise, and leisure is key.

 
To help diagnose depression, a doctor will ask about symptoms. The questions will delve into any issues and events tied to the depression, such as:

  • alcohol or drug use
  • stress
  • recent life changes
  • illnesses
  • relationships
  • past emotional problems and treatments
  • issues that might have triggered the depression or made it worse
  • whether or not the timing of the depression has any meaning

To rule out a health condition or problem with medication, a medical history and physical examination will be done. Laboratory tests may be done, too, if needed.
 
If depression is not effectively treated, a person can experience serious difficulties in every area of life. Depression often hurts relationships. It also impairs work or academic performance. In some cases, it leads to suicide. With good treatment, many people recover from depression. Some people experience it only once in their lives. Others, who are thought to be at risk due to a family history, have periodic bouts of depression. Usually, if a treatment worked in the past, subsequent episodes will respond to similar treatment.
 
If the cause is physical, the right medical care often resolves the problem. A person with a thyroid disorder, for example, might cast off depressive symptoms once thyroid hormones are at the right level. When there is no physical cause, depression is often treated successfully with therapy, antidepressants, or a combination of the two.

Research has shown that cognitive - behavioural therapy (CBT) is effective in many cases of mild to moderate depression. Interpersonal psychotherapy is also effective in treating milder forms of depression. More severe depression requires the use of antidepressants in addition to psychotherapeutic interventions. There are many types of antidepressants and the doctor will advise you as to what to start based on the symptoms being experienced and past response to treatment. It is recommended that a coarse of antidepressants is at least one year. Stopping antidepressants early or irregular compliance leads to an early relapse or symptoms or prolonged periods of unwellness. It is important that one tells the doctor what other prescription and over the counter medications they are on so the doctor can check for possible interactions. Once starting the medications, it is important to return to the doctor for regular review. Another big reason why people may not improve, is that they did not have their dosage of medications reviewed regularly. It is also important to tell the doctor about side effects you might be experiencing so this can be addressed (usually by adjusting the dose or changing medication)

 

In circumstances where the depression is so severe that normal life sustaining activities are compromised, electro-convulsive therapy (ECT) may be the treatment of choice. When administered selectively, ECT has up to 80% success rate (that is far greater then other treatments). Patients who have recurrent or severe first episode depression may require life long maintenance treatment with antidepressants.

Occasionally, people with severe depression must be hospitalised in a psychiatric unit. This is considered when a person is suicidal or intends to harm himself or herself in some other way. It is also done when a depressed person is acting very irresponsibly.

  
A person recovering from depression should consider:  

  • attending ongoing therapy
  • taking any antidepressant drug prescribed
  • resuming once pleasurable activities even if the person does not feel like doing so
  • spending time with friends and family, rather than withdrawing
  • joining a support group
  • creating or restoring a balanced lifestyle
  • eating regular, nutritious meals
  • exercising regularly
  • avoiding alcohol and drugs
  • establishing a regular sleep pattern
  • finding ways to reduce stress


People who have been clinically depressed often experience further episodes of depression. A person should try to be alert to subtle symptoms. If those symptoms arise, he or she should call their doctor and promptly try treatments or methods that helped with the previous depression.

Finally Depression is an illness that can strike anyone. You should not feel ashamed about becoming depressed. Do not hesitate to seek help as early intervention leads to better outcomes.