Depression is a complex and confusing term
that can refer to a state of mind, a mood, an emotional adjustment problem or a serious
Almost everyone knows what it is like to feel depressed but not
everyone knows what it feels like to experience a major
depressive illness that seriously impairs their ability to function
and cope with life. Conditions that are called clinical depression,
major depression, depressive illness, endogenous depression or 'biochemical
imbalance' usually manifest physical symptoms such as persistent
tiredness, fatigue, loss of interest and pleasure, sleep problems(too
little or too much sleep) and appetite changes(eating more or less
than usual). There is usually a sad, negative, pessimistic or even
hopeless mood but in some cases only unusual impatience and irritability
may be present. Disturbances of concentration and attention as well
and memory and decision making may be present. The depressed person
often worries about his health and fears coming down with a serious
illness - including insanity, the fear of which is common in depression.
Along with the decreased ability to enjoy and look forward to things
the depressed person often loses interest in sex and other activities
they formerly enjoyed.
Although depression may and sometimes does arise seemingly from nowhere in the midst of a
life without unusual stresses or strains, in many cases there are precipitating causes or
triggers for serious depression, such as the loss of an important relationship or a major
and stressful life change or illness. Events that might be expected to cause a relatively
mild and self-limited depression in normal individuals may initiate a progressive and
ongoing depression in those predisposed to depression by genetics or family history.
Medical illnesses and medications may sometimes cause depressions that are
indistinguishable from clinical depression. Substance use and abuse, e.g. alcohol, cocaine
and other mind and mood altering chemicals may result in chronic and sometimes treatment
resistant depressions as long as the substances continue to be consumed.
Depression may consist of a single episode with full remission or of recurrent episodes
with full or partial remission between episodes. In general, major depression tends to be
a recurrent illness. Individuals who have had one episode have about a 50 per cent chance
of having another episode at some time in their lives. In a minority of cases depression
is preceded or followed by euphoric or elated mood states with hyperactivity of thought
and behavior, including impulsive or irrational decisions which may later be regretted
when the bipolar or manic state has worn off.
Proper treatment of depression requires correct diagnosis of the
type and severity of the depression along with an evaluation of
all personal, medical and social factors that may be contributing
to it or making recovery difficult. By no means must all depressions
be treated with anti-depressant medications, although there are
some, usually the more severe depressions, that respond best to
treatment combined with individual or group psychotherapy.
Psychological theories and treatments of
depression focus upon loss, grieving and irrational or unrealistic thoughts. Many
depression prone individuals are perfectionistic and hold such high standards for
themselves that they are constantly failing to live up to their own demands on themselves,
becoming discouraged, demoralized and depressed as a result. Sometimes individuals find
their own feelings and thoughts unacceptable and difficult to deal with, as in the case of
anger at others which is then denied, repressed or internalized, sometimes turning into
depression. Depression may be a natural and valuable warning sign of an unhealthy
lifestyle or relationship and thus likely to remit spontaneously when the afflicted person
gives proper heed to the symptom of trouble and begins to take better care of themselves.
In other cases depression may signal existential or spiritual difficulties which require
attention before the individual can begin to feel better and find more satisfaction in
Regardless of cause, most depressions are characterized by a pervasive impairment of the
ability to enjoy and take satisfaction in matters great and small. The capacity to look
forward to and positively anticipate the future is lost or impaired and is often replaced
by a gloomy sense of foreboding and dread of feared or unknown complications and
catastrophes. The depressed individual tends to feel weary and heavy laden and to soldier
on as though upon a perpetual forced uphill march. His gratifications are few but his
worries and tribulations many. Life goes from an interesting three dimensional color
production to a flat, stale, two dimensional black and white endless re-run.
Like a bad weather system
that so completely obscures the sun and sky that it becomes difficult for
those trapped beneath it even to remember what brighter and warmer days
were like, depression casts a pall over past, present and future alike.
The depressed individual may become convinced, contrary to all evidence,
that he has never really been happy, that his entire life has been a tale
of misery and suffering, and that the future promises no better but only
worse for him. One of the most painful and sometimes lethal features of
depressive thinking is its tendency to deprive the sufferer of hope itself.
Even individuals who have successfully recovered from previous episodes
of severe depression may be convinced that the latest episode is different
and that they will never feel well again. But whatever the cause and no
matter how severe, depression
is always treatable.