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Acute/Major Depression

What is Depression? 

Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general. When these feelings last for a short period of time, it may be a case of "the blues."

Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions. At any point in time, 3 to 5 percent of people suffer from major depression:

  •  Persistent sad, anxious or "empty" mood

  •  Feelings of hopelessness, pessimism

  •  Feelings of guilt, worthlessness, helplessness

  •  Loss of interest or pleasure in hobbies and activities, including sex

  •  Decreased energy, fatigue, feeling "slowed down"

  • ​Thoughts of death or suicide, suicide attempts

  • ​Restlessness, irritability

  • Difficulty concentrating, remembering, making decisions

  • Insomnia, early-morning awakening, or oversleeping

  • Low appetite and weight loss or overeating and weight gain

  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and pain for which no other cause can be diagnosed

A major depressive episode may include these symptoms:
Major Depression involves at least five of these symptoms for a two-week period. Such an episode is disabling and will interfere with the ability to work, study, eat, and sleep. Major depressive episodes may occur once or twice in a lifetime, or they may re-occur frequently. They may also take place spontaneously, during or after the death of a loved one, a romantic breakup, a medical illness, or other life event. 
Three main types of depressive disorders - major depression, dysthymia, and bipolar disorder - can occur with any of the anxiety disorders.

Dysthymia

Dysthymia is a less sever, long-term, and chronic form of depression. It involves the same symptoms as major depression, mainly low energy, poor appetite or overeating, and insomnia or oversleeping. It can manifest as stress, irritability, and mild anhedonia, which is the inability to derive pleasure from most activities.

People with dysthymia might be thought of as always seeing the glass as half empty.

Treatment for Depression

Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.

Appropriate treatment for depression starts with a physical examination by a physician. Certain medications, as well as some medical conditions such as viral infections or a thyroid disorder, can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation that includes a mental status exam should be done either by the physician or by referral to a mental health professional.

For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for recurrence.

How to Help Yourself If You Are Depressed

Depressive disorders can make a person feel exhausted, worthless, helpless and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not reflect actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.

  • Break large tasks into small ones, set some priorities and do what you can, as you can.

  • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.

  • Participate in activities that may make you feel better.

  • Mild exercise, going to a movie or a ball game, or participating in religious, social or other activities may also help.

  • Expect your mood to improve gradually, not immediately; feeling better takes time.

  It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorce—discuss it with others who know you well and have a more objective view of your situation.

  People rarely "snap out of" a depression. But they can feel a little better day by day.

Remember, positive thinking will replace the negative thinking that is part of the depression, and this negative thinking will disappear as your depression responds to treatment.

Let your family and friends help you.

How Family and Friends Can Help the Depressed Person

If you know someone who is depressed, it affects you too. The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with her to see the doctor. Encourage him to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.

The second most important thing is to offer emotional support. This involves understanding, patience, affection and encouragement. Engage the depressed person in conversation and listen carefully. Do not dispel feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies and other activities. Keep trying if he declines, but don't push her/him to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure. Remind your friend or relative that with time and treatment, the depression will lift