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Understanding Depression

Throughout the course of our lives, we all experience periods of stress, unhappiness, sadness, or grief. Often, when we suffer a personal tragedy (e.g., death of a loved one) or difficulty such as divorce or loss of a job, we may feel depressed or have “the blues.” Most of us are able to cope with these and other types of stressful events.

Over a period of days or weeks, the majority of us are able to return to our normal activities. But when these feelings of sadness and other symptoms make it hard for us to get through the day, and when the symptoms last for more than a couple of weeks in a row, we may have what is called “clinical depression.” The term clinical depression is usually used to distinguish the illness of depression from more “typical” feelings of sadness, gloom, or the blues.

Clinical depression is not just grief or feeling sad. It is an illness that can challenge your ability to perform even routine daily activities such as bathing or working. At its very worst, depression may lead you to contemplate, attempt, or commit suicide. Depression represents a burden for both you and your family. Furthermore, at times, that burden can seem overwhelming.

Clinical depression is always abnormal and always requires attention from a medical or mental-health professional. The good news is that depression can be diagnosed and treated effectively in most people. The biggest barriers to overcoming depression are recognition of the condition and seeking appropriate treatment.

The Statistics of Depression

According to the National Institute of Mental Health, clinical depression affects about 6.7% of the U.S. population on an annual basis. About 5%-10% of women and 2%-5% of men will experience at least one major depressive episode during their adult life. Depression affects people of both genders, as well as all races, incomes, ages, and ethnic and religious backgrounds. However, it is twice as common in women compared to men and three to five times more common in the elderly than in young people.

Causes and risk factors for depression

The causes of depression are complex. The exact cause of depression is not known. Many researchers believe it is caused by chemical changes in the brain. This may be due to a problem with your genes, or triggered by certain stressful events. More likely, it’s a combination of both.

Some types of depression run in families. But depression can also occur if you have no family history of the illness. Anyone can develop depression, even children.

The following may play a role in depression:

  1. Alcohol or drug abuse

  2. Certain medical conditions, including underactive thyroid, cancer, or long-term pain

  3. Certain medications such as steroids

  4. Sleeping problems

  5. Stressful life events, such as:

  6. Breaking up with a boyfriend or girlfriend

  7. Failing a class

  8. Death or illness of someone close to you

  9. Divorce

  10. Childhood abuse or neglect

  11. Job loss

  12. Social isolation (common in the elderly)

Symptoms and Signs of Depression

Clinical depression is not something you feel for a day or two before feeling better. In true depressive illnesses, the symptoms last weeks, months, or sometimes years if you don’t seek treatment. If you are depressed, you are often unable to perform daily activities. You may not care enough to get out of bed or get dressed, much less work, do errands, or socialize.

You may be said to be suffering from a major depressive episode if you have a depressed mood for at least two weeks and have at least five of the following clinical symptoms:

  1. Feeling sad or blue

  2. Crying spells

  3. Loss of interest or pleasure in usual activities

  4. Significant increase or decrease in appetite

  5. Significant weight loss or weight gain

  6. Change in sleep pattern: inability to sleep or excessive sleeping

  7. Agitation or irritability

  8. Fatigue or loss of energy

  9. A tendency to isolate from friends and family

  10. Trouble concentrating

  11. Feelings of worthlessness or excessive guilt

  12. Thoughts of death or suicide

Men and women sometimes show depression differently. Specifically, men are more likely to experience irritability, sleep problems, fatigue, and loss of interest in activities they liked previously as a result of depression whereas women tend to have overt sadness and feelings of worthlessness and guilt when depressed

Seeking Treatment

If you feel that you are depressed, you may wish to talk about your feelings with a family member or a close friend. Communication is one of the keys to early diagnosis and treatment. People close to you may have felt you were depressed. With their encouragement, you should call your health-care provider for a referral to a mental health professional.

With mild or moderately severe symptoms of short duration (weeks), it may be reasonable to contact a health-care provider for an appointment. It is often helpful to have a trusted friend or relative accompany you to the office and offer support as needed.

After you are diagnosed with depression, your provider will usually want you to be in frequent contact. You (or your family) may need to contact your primary-care provider,psychiatrist, or psychologist if you are experiencing:

  1. Any unexpected or serious medication side effects.

  2. You start any new medication.

  3. You develop additional symptoms of depression, particularly if those symptoms are severe or develop rapidly.

  4. You feel that you are having setbacks and your present therapy is ineffective.

  5. You have trouble coping with your feelings and are starting to feel as if you are losing control.

Although health-insurance restrictions have resulted in hospitalizations occurring less frequently than in years past, hospitalization may be necessary with severe depression. You may choose to come to the hospital for evaluation, or your family or friends may need to bring you to the hospital for evaluation in these circumstances:

  1. You have thoughts of hurting yourself.

  2. You have thoughts of hurting someone else.

  3. You are no longer able to care for yourself.

Types of Treatment

Therapy frequently includes antidepressant medication and supportive care such as psychotherapy.

Therapy should be provided by a trained mental-health professional.

  1. Psychiatrists are medical doctors who have completed specialized training in mental disorders.

  2. Psychologists are non-physicians who have graduate (after college) and doctorate-level (PhD) training that includes experience in mental-health-care facilities.

  3. Psychotherapists may have a degree in psychology, social work, nursing, mental-health counseling, or couples and family therapy, as well as additional more specialized education or training.


Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.

Types of psychotherapy include:

  1. Cognitive behavioral therapy teaches you how to fight off negative thoughts. You will learn how to become more aware of your symptoms and how to spot things that make your depression worse. You’ll also be taught problem-solving skills.

  2. Psychotherapy can help you understand the issues that may be behind your thoughts and feelings.

  3. Joining a support group of people who are sharing problems like yours can also help. Ask your therapist or doctor for a recommendation.

Regardless of which treatment is used, psychotherapy, medication, or a combination, most people with depression can safely be treated in a series of office (outpatient) visits.Inpatient care (in the hospital) may be necessary for people with more serious symptoms and is required for those who are contemplating suicide or cannot care for themselves.

Self-Care at Home

Once you are being treated for depression, you can make lifestyle changes and choices that are forms of self-help through the rough times and may prevent depression from returning.

  1. Try to identify and focus on activities that make you feel better. It is important to do things for yourself.

  2. Don’t isolate yourself. Take part in activities even when you may not want to. Such activity may actually make you feel better.

  3. Talk with your friends and family and consider joining a support group. Communicating and discussing your feelings is an integral part of your treatment and will help with your recovery.

  4. Try to maintain a positive outlook. Having a good attitude can be beneficial.

  5. Regular exercise and proper diet are essential to good health. Exercise has been found to increase the levels of the body’s own natural antidepressants called endorphins.

  6. Try to get enough rest and maintain a regular sleeping pattern.

  7. Avoid drinking alcohol or using any illicit substances.


1.Fava M, Cassano P. Mood disorders: Major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusette General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.

2.American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007. Accessed January 22, 2010.

3.Little A. Treatment-resistant depression. Am Fam Physician. 2009;80:167-172. [PubMed: 19621857]

Bahareh Talei, Psy.D.

Clinical Psychologist

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