Symptoms, Risks, and Diagnosis of Depression

Introduction

Depression is one of the most common health conditions in the world. Depression isn’t a weakness, nor is it something that you can simply “snap out of.” Depression, formally called major depression, major depressive disorder or clinical depression, is a medical illness that involves the mind and body. It affects how you think and behave and can cause a variety of emotional and physical problems. You may not be able to go about your usual daily activities, and depression may make you feel as if life just isn’t worth living anymore.

Most health professionals today consider depression a chronic illness that requires long-term treatment, much like diabetes or high blood pressure. Although some people experience only one episode of depression, most have repeated episodes of depression symptoms throughout their life.

Effective diagnosis and treatment can help reduce even severe depression symptoms. And with effective treatment, most people with depression feel better, often within weeks, and can return to the daily activities they previously enjoyed.

Signs and symptoms

Symptoms of depression include:

• Loss of interest in normal daily activities
• Feeling sad or down
• Feeling hopeless
• Crying spells for no apparent reason
• Problems sleeping
• Trouble focusing or concentrating
• Difficulty making decisions
• Unintentional weight gain or loss
• Irritability
• Restlessness
• Being easily annoyed
• Feeling fatigued or weak
• Feeling worthless
• Loss of interest in sex
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems, such as back pain or headaches

Depression symptoms can vary greatly because different people experience depression in different ways. A 25-year-old man with depression may not have the same symptoms as a 70-year-old man, for instance. For some people, depression symptoms are so severe that it’s obvious something isn’t right. Others may feel generally miserable or unhappy without really knowing why.

Causes

It’s not known specifically what causes depression. As with many mental illnesses, it’s thought that a variety of biochemical, genetic and environmental factors may cause depression:

• Biochemical. Some evidence from high-tech imaging studies indicates that people with depression have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. The naturally occurring brain chemicals called neurotransmitters, which are linked to mood, also may play a role in depression. Hormonal imbalances also could be a culprit.
• Genes. Some studies show that depression is more common in people whose biological family members also have the condition. Researchers are trying to find genes that may be involved in causing depression.
• Environment. Environment is also thought to play a causal role in some way. Environmental causes are situations in your life that are difficult to cope with, such as the loss of a loved one, financial problems and high stress.

Risk factors

Although precise statistics aren’t known, depression is considered relatively common. In any given year, about 12 million adults in the United States have depression. Depression cuts across all racial, ethnic and economic divides — no one is immune from the risk of getting depression.

Depression typically begins in the late 20s, but it can arise at any age, affecting everyone from young children to older adults. Twice as many women are diagnosed with depression as men, but this may be due in part because women are more likely to seek treatment for depression.

Although the precise cause of depression isn’t known, researchers have identified certain factors that seem to increase the risk of developing or triggering depression, including:

• Having other biological relatives with depression
• Having family members who have taken their own life
• Stressful life events, such as the death of a loved one
• Having a depressed mood as a youngster
• Illness, such as cancer, heart disease, Alzheimer’s or HIV/AIDS
• Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills or, occasionally, birth control pills
• Certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic
• Alcohol, nicotine and drug abuse
• Having recently given birth
• Being in a lower socioeconomic group

When to seek medical advice

It’s perfectly normal to occasionally feel sad or upset, or to be unhappy with situations in your life. But with depression, these feelings linger for weeks, months or even years. And these feelings also are much more intense than “just the blues” and can interfere with relationships, work and daily activities, and even your ability to eat and bathe.

Feelings of depression can also lead to suicide. If you have any symptoms of depression, seek medical help as soon as possible. Depression usually doesn’t get better on its own, and it may even get worse if left untreated.

If you have a primary care doctor, talk to him or her about your depression symptoms. Or seek help from a mental health provider. If you’re reluctant to seek treatment, try to work up the courage to confide in someone about your feelings, whether it’s a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment of depression.

When you have suicidal thoughts
Suicidal thoughts and behavior are common among people with depression. If you’re considering suicide right now and have the means available, talk to someone now. The best choice is to call 911 or your local emergency services number. If you simply don’t want to do that, for whatever reason, you have other choices for reaching out to someone:

• Contact a family member or friend
• Contact a doctor, mental health provider or other health care professional
• Contact a minister, spiritual leader or someone in your faith community
• Go to your local hospital emergency room
• Call a crisis center or hot line

Helping a loved one with depression symptoms
If you have a loved one who you think may have symptoms of depression, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support.

You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help.

Screening and diagnosis

Some doctors and health care providers may ask you questions about your mood and thoughts during routine medical visits. They may even ask you to fill out a brief questionnaire to help screen, or check, for depression symptoms.

When doctors suspect someone has depression, they typically run a battery of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

• Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
• Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you’ve had similar episodes in the past. You’ll also discuss any thoughts you may have of suicide or self-harm.

Diagnostic criteria for depression
There are several other conditions whose symptoms may include depression. It’s important to get an accurate diagnosis so you can get the appropriate treatment. Your doctor or mental health provider’s evaluation will help determine if you have major depression or one of these other conditions that can sometimes resemble major depression:

• Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It’s a type of stress-related mental illness that may affect your feelings, thoughts and behavior.
• Bipolar disorder. This type of depression is characterized by mood swings that range from highs to lows. It’s sometimes difficult to distinguish between bipolar disorder and depression, but it’s very important to get the right diagnosis so that you can get the proper treatment and medications.
• Cyclothymia. Cyclothymia, or cyclothymic disorder, is a milder form of bipolar disorder.
• Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. While it’s usually not disabling, dysthymia can prevent you from functioning normally in your daily routine and from living life to its fullest.
• Postpartum depression. This is depression that occurs in a new mother usually within a month of having a baby.
• Psychotic depression. This is severe depression accompanied by psychosis, such as delusions or hallucinations.
• Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder.
• Seasonal affective disorder. This type of depression is related to changes in seasons and a lack of exposure to sunlight.

Major depression is distinguished from these other conditions by its symptoms and their severity. To be diagnosed with major depression, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for depression include:

• Symptoms that occur nearly every day for two or more weeks
• A depressed mood
• Loss of interest or pleasure in most activities
• Significant unintentional weight loss or weight gain
• Sleeping difficulties, whether sleeping too much, too little or frequent waking episodes while trying to sleep
• Feelings of restlessness and agitation
• Feelings of sluggishness
• Fatigue or lack of energy
• Feelings of worthlessness or guilt
• Problems thinking, concentrating or making decisions
• Thoughts of death or suicide
• Your symptoms cause you distress or impair your ability to function in your daily life

Make sure you understand what type of depression you have so that you can learn more about your specific situation and its treatments.

Complications

Depression is a serious illness that can take a terrible toll on individuals and families. Untreated, depression can lead to a downward spiral of disability, dependency and suicide. Depression can result in severe emotional, behavioral, health and even legal and financial problems that affect every area of your life. Complications that depression may cause or be associated with include:

• Suicide
• Alcohol abuse
• Substance abuse
• Anxiety
• Heart disease and other medical conditions
• Work or school problems
• Family conflicts
• Relationship difficulties
• Social isolation

Article found at Mayo Clinic

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