Depression is a serious medical condition that affects the body, mood, and thoughts. It affects the way one eats and sleeps. It affects how one thinks about things, and one's self perception. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition one can will or wish away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. However, appropriate treatment, often involving medication and/or short term psychotherapy, can help most people who suffer from depression.
"I can remember it started with a loss of interest in basically everything that I like doing. I just didn't feel like doing anything. I just felt like giving up. Sometimes I didn't even want to get out of bed." -Rene Ruballo, Police Officer
Depression can strike anyone regardless of age, ethnic background, socioeconomic status, or gender; however, large scale research studies have found that depression is about twice as common in women as in men.1,2 In the United States, researchers estimate that in any given one year period, depressive illnesses affect 12 percent of women (more than 12 million women) and nearly 7 percent of men (more than six million men).3 But important questions remain to be answered about the causes underlying this gender difference. We still do not know if depression is truly less common among men, or if men are just less likely than women to recognize, acknowledge, and seek help for depression.
In focus groups conducted by the National Institute of Mental Health (NIMH) to assess depression awareness, men described their own symptoms of depression without realizing that they were depressed. Notably, many were unaware that "physical" symptoms, such as headaches, digestive disorders, and chronic pain, can be associated with depression. In addition, men were concerned that seeing a mental health professional or going to a mental health clinic would have a negative impact at work if their employer or colleagues found out. They feared that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends, or their standing in the community.
Over the past 20 years, biomedical research, including genetics and neuroimaging, has helped to shed light on depression and other mental disorders - increasing our understanding of the brain, how its biochemistry can go awry, and how to alleviate the suffering caused by mental illness. Brain imaging technologies are now allowing scientists to see how effective treatment with medication or psychotherapy is reflected in changes in brain activity.4 As research continues to reveal that depressive disorders are real and treatable, and no greater a sign of weakness than cancer or any other serious illness, more and more men with depression may feel empowered to seek treatment and find improved quality of life.
Types of Depression
Just like other illnesses, such as heart disease, depression comes in different forms. This booklet briefly describes three of the most common types of depressive disorders. However, within these types, there are variations in the number of symptoms, their severity, and persistence.
Major depression(or major depressive disorder) is manifested by a combination of symptoms (see symptoms list below) that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.
A less severe type of depression, dysthymia(or dysthymic disorder), involves long lasting, chronic symptoms that do not seriously disable, but keep one from functioning well or feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Another type of depressive illness is bipolar disorder(or manic depressive illness). Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between. Sometimes the mood switches are dramatic and rapid, but usually they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, over talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees and unsafe sex. Mania, left untreated, may worsen to a psychotic state.
Symptoms of Depression and Mania
Not everyone who is depressed or manic experiences every symptom. Some people experience only a few; some people suffer many. The severity of symptoms varies among individuals and also over time.
- Persistent sad, anxious, or "empty" mood.
- Feelings of hopelessness or pessimism.
- Feelings of guilt, worthlessness, or helplessness.
- Loss of interest or pleasure in hobbies and activities that were once enjoyable, including sex.
- Decreased energy, fatigue; feeling "slowed down."
- Difficulty concentrating, remembering, or making decisions.
- Trouble sleeping, early morning awakening, or oversleeping.
- Changes in appetite and/or weight.
- Thoughts of death or suicide, or suicide attempts.
- Restlessness or irritability.
- Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.
"You don't have any interest in thinking about the future, because you don't feel that there is going to be any future." -Shawn Colten, National Diving Champion
"I wouldn't feel rested at all. I'd always feel tired. I could get from an hour's sleep to eight hours sleep, and I would always feel tired." -Rene Ruballo, Police Officer
- Abnormal or excessive elation.
- Unusual irritability.
- Decreased need for sleep.
- Grandiose notions.
- Increased talking.
- Racing thoughts.
- Increased sexual desire.
- Markedly increased energy.
- Poor judgment.
- Inappropriate social behavior.
Co-Occurrence of Depression with Other Illnesses
Depression can coexist with other illnesses. In such cases, it is important that the depression and each co-occurring illness be appropriately diagnosed and treated.
Research has shown that anxiety disorders - which include post traumatic stress disorder (PTSD), obsessive compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder - commonly accompany depression.5,6 Depression is especially prevalent among people with PTSD, a debilitating condition that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural disasters, accidents, terrorism, and military combat. PTSD symptoms include: re experiencing the traumatic event in the form of flashback episodes, memories, or nightmares; emotional numbness; sleep disturbances; irritability; outbursts of anger; intense guilt; and avoidance of any reminders or thoughts of the ordeal. In one NIMH supported study, more than 40 percent of people with PTSD also had depression when evaluated at one month and four months following the traumatic event.7
Substance use disorders (abuse or dependence) also frequently co occur with depressive disorders.5,6 Research has revealed that people with alcoholism are almost twice as likely as those without alcoholism to also suffer from major depression.6 In addition, more than half of people with bipolar disorder type I (with severe mania) have a co occurring substance use disorder.8
Depression has been found to occur at a higher rate among people who have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson's.6,9 Symptoms of depression are sometimes mistaken for inevitable accompaniments to these other illnesses. However, research has shown that the co occurring depression can and should be treated, and that in many cases treating the depression can also improve the outcome of the other illness.