What is Clinical Depression?
When we refer to depression in the following pages, we are talking about "clinical depression." Clinical depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Individuals with clinical depression are unable to function as they used to. Often they have lost interest in activities that were once enjoyable to them, and feel sad and hopeless for extended periods of time. Clinical depression is not the same as feeling sad or depressed for a few days and then feeling better. It can affect your body, mood, thoughts, and behavior. It can change your eating habits, how you feel and think, your ability to work and study, and how you interact with people. People who suffer from clinical depression often report that they "don't feel like themselves anymore."
Clinical depression is not a sign of personal weakness, or a condition that can be willed away. Clinically depressed people cannot "pull themselves together" and get better. In fact, clinical depression often interferes with a person's ability or wish to get help. Clinical depression is a serious illness that lasts for weeks, months and sometimes years. It may even influence someone to contemplate or attempt suicide.
People of all ages, genders, ethnicities, cultures, and religions can suffer from clinical depression. Each year it affects over 17 million American men and women (source: American Psychiatric Association). While clinical depression is common, it is frequently unrecognized and untreated.
There are different types and levels of clinical depression. Mental health counselors and psychiatrists are trained to diagnose and treat clinical depression. With the right treatment, most people who seek help get better within several months. Many people begin to feel better in just a few weeks.
Common Symptoms of Clinical Depression
There are different forms of clinical depression with different combinations of the following symptoms:
- Sleep disturbances-insomnia, oversleeping, waking much earlier than usual
- Changes in appetite or eating: much more or much less
- Decreased energy, fatigue
- Headaches, stomachaches, digestive problems or other physical symptoms that are not explained by other physical conditions or do not respond to treatment
- Loss of interest or pleasure in activities that were once enjoyed, such as going out with friends, hobbies, sports, sex, etc.
- Difficulty concentrating, remembering, or making decisions
- Neglecting responsibilities or personal appearance
- Persistent sad or "empty" mood, lasting two or more weeks
- Crying "for no reason"
- Feeling hopeless, helpless, guilty or worthless
- Feeling irritable, agitated or anxious
- Thoughts of death or suicide
Types of Depression
Clinical depression can come in different forms. It may start suddenly or build up over a period of weeks, months, or years. The following are descriptions of the three most prevalent forms, though for an individual, the number, severity and duration of the symptoms may vary.
Major Depression: a combination of symptoms (described above) that interfere with one's ability to work, sleep, eat and enjoy once pleasurable activities. These episodes can occur once, twice or several times in a lifetime.
Dysthymia: a less intense type of depression that involves long-term, chronic symptoms that are less severe, but keep one from functioning at full ability and from feeling good.
Bipolar Disorder (also known as manic-depressive illness): periods of depression alternate with periods of elation and increased activity, known as mania.
How Is Clinical Depression Different From Normal Stress and Sadness?
Feeling sad and depressed is often a normal reaction to a stressful life situation. For example, it is normal to feel down after a major disappointment, or to have trouble sleeping or eating after a difficult relationship break-up. Usually, within a few days, perhaps after talking to a friend, we start to feel like ourselves again. Clinical depression is very different. It involves a noticeable change in functioning that persists for two weeks or longer. Imagine that for the last three months you've slept more than 10 hours a day and still feel tired, you have stomach problems, you're unable to cope with life, and you wonder if dying would solve all your problems. Or, imagine not being able to sleep more than four hours a night, not wanting to spend time with family or friends, and constantly feeling irritable. And when friends try to reach out to you, you get even more upset and bothered. You lose perspective, and you don't realize that what you're experiencing is abnormal. You want to just "wait it out," and you don't get help because you think it's weak to ask for help or you don't want to burden your friends. These are some of the experiences that people can have when they suffer from clinical depression. Unlike normal stress and sadness, the symptoms of clinical depression persist and do not go away no matter how much the individual wants.
What Causes Depression?
You may feel you know exactly why you're depressed. Other times, however, the reasons for depression are not as clear. The causes of depression are quite complex. Very often it is a combination of genetic, psychological, and environmental factors. Regardless of the cause, depression is almost always treatable. You do not need to determine the cause of your depression to get help.
Biological factors: You may have heard about chemical imbalances in the brain that occur in depression, suggesting that depression is a medical illness. Depression does seem to have a biological component. Research suggests that depression may be linked to changes in the functioning of brain chemicals called neurotransmitters. Current research focuses on the serotonin, norepinephrine and dopamine systems. The usefulness of antidepressant medications suggests that brain chemistry is involved in depression. However, it is also possible that biological changes happen as a result of being depressed.
Some kinds of depression seem to run in families, suggesting a biological vulnerability. This seems to be the case with bipolar depression and, to a lesser extent, severe major depression. However, having a biological vulnerability does not mean you are destined to become depressed. Not everyone in a family develops depression, suggesting that other factors are involved. In addition, depression can occur in individuals who have no family history of depression.
Stress: Psychological and environmental stressors can contribute to a depressive episode. Common stressors among college students include:
- academic demands
- transitions-re-entry to school, being new to Berkeley
- balancing school, work, family, social life
- financial responsibilities or worries
- family concerns
- social isolation
- difficulties in relationships with friends and romantic partners being on one's own in a new environment exposure to new ideas, new people, and temptations awareness of sexual identity and orientation preparing for life after graduation, career decision-making
A major loss, chronic illness, relationship problems, work stress, family crisis, or unwelcome life changes can often trigger a depressive episode, even in individuals without a family history or genetic predisposition.
Psychological Tendencies: Psychological make-up can play a role in vulnerability to depression. People with low self-esteem, who consistently view themselves and the world with pessimism, or are readily overwhelmed by stress, may be especially prone to depression.
Alcohol or Other Drug Use: A lot of depressed people, especially young adults and men, have problems with alcohol or other drugs. Sometimes the depression comes first and people try alcohol or other drugs as a way to escape it. Other times, the alcohol/drug use comes first, and the drug itself, or withdrawal from it, or the problems caused by substance use, may lead to depression. Sometimes you can't tell which came first. The important point is that when you have both of these problems, the sooner you get treatment, the better. If you are taking medication for depression and abusing alcohol or other drugs, your medication will not work effectively. Medication should never be discontinued without talking to your doctor.
Men and Depression
Depression can strike anyone regardless of age, background, socioeconomic status or gender. However, in any given year, 12% of women (nearly 12 million women) in the United States are diagnosed with depression compared to 7% of men (over 6 million men). Important questions remain about the causes underlying this gender difference and whether depression truly is less common among men, or whether men are less likely than women to recognize, acknowledge and seek treatment for depression. Research at the National Institute of Mental Health (NIMH) on depression awareness has shown that many men are unaware that physical symptoms such as headaches, digestive disorders, and chronic pain can be associated with depression. Depression in men can present itself differently than in women. Men are more likely to acknowledge fatigue, irritability, loss of interest in hobbies, sleep disturbances, and discouragement, rather than feelings of worthlessness or guilt. Men's depression is more often masked by alcohol or other drugs, or by the socially acceptable habit of working excessively long hours. Even if a man realizes he is depressed, he may be less likely to seek help. Men express concern about seeing a mental health professional, thinking that people would find out and it might have a negative impact on their job security, promotion potential, or health insurance benefits. Men may fear that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends. On campus, male students may be more concerned about their standing in their academic department, or being labeled as weak, if they seek help. Encouragement and support from concerned family members and friends can make a difference. Significant others play an important role in helping men recognize their symptoms and getting treatment.
More About Bipolar Disorder
Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and severe lows (depression). Sometimes the mood switches are dramatic and rapid, but most often are gradual. When in the depressed cycle, an individual can have any of the symptoms of a depressive disorder. When in the manic cycle, an individual is overly "up" or irritable. Someone in a manic state may appear excessively talkative and energetic, with little need for rest or sleep. This can affect thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, an individual in a manic phase may feel elated, full of grand schemes, or engage in reckless spending sprees or increased sexual activity. Individuals who are in a manic state may feel in possession of special powers or abilities that others can't understand. Bipolar Disorder is treatable.