At least 19 million Americans over the age of 18 suffer one depressive illness each year. There are even more who experience the various forms of this debilitating and distressing illness. It is often confused for bad attitude, laziness, hostility, or some other behavior which people assume is voluntary.

Normal Depressed Mood and Natural Grief
These conditions are natural reactions to losses in life. They typically involve sadness, lethargy, and in serious cases -- for example, grief after the death of a loved one -- often despair, anger, insomnia, poor appetite, or weight gain, obsessive thoughts about the lost person, and terrible guilt about any problems in the depressed person's relationship with the deceased individual. What makes these reactions normal is that people eventually recover. After losing a ball game, it may take a day or two to bounce back. After a lay-off, it may take a few months. After the death of a loved one, it may take up to a year. If symptoms persist, they have a clinical depression and should call a doctor.

Normal depressed mood and grief presume a triggering life event. If you or anyone you know displays these symptoms without a loss, or if the depression seems out of proportion to the loss -- such as not getting a raise and sobbing inconsolably for days -- call a doctor.

Adjustment Disorder and Depressed Mood
Life is full of changes and coping with them can be difficult. Many people feel overwhelmed and "crazy" for a while. Then they get things under control. If they don't, and they become persistently gloomy, angry, and unable to cope, it's most likely adjustment disorder with depressed mood.

Adjustment disorder with depressed mood presumes a triggering life event -- the change you have to adjust to. If you or anyone you know displays these symptoms without a life change, or if the depression seems out of proportion to the change -- such as moving to a new city and not being able to get out of bed -- professional help should be contacted.

Mild Depression (Dysthymia)
Dysthymia (pronounced dis-THIM-ee-uh) involves chronic depressed mood, low self-esteem, and low-level symptoms of major depression . People with this condition can still function, but not at a very high level. Further, they consider themselves to be losers.

There may or not be a triggering event. Frequently, there is no trigger- no loss of life, job, or life change. The symptoms can be difficult to understand for the person affected, and their loved ones and associates. Dysthymia can occur at any time and without reason.

Major Depression
When people are seriously depressed, the symptoms are extremely serious. Major depression causes despair and hopelessness so profound that the person simply cannot cope. It is almost impossible to get out of bed, show up at work, achieve pleasure or sexual arousal. The illness can cause other problems not typically associated with depression, such as weight loss or gain, anxiety, irritability, indecisiveness, sleep disturbance (insomnia or sleeping all the time). In other words, you can have the condition and not experience typical symptoms.

Often, major depression strikes without any specific cause. This can be confusing and frustrating for both the person affected, and their loved ones. We want our illnesses to have clear causes and clear solutions. But many serious diseases do not: diabetes, cancer, arthritis. That is the same for major depression.

To be characterized as major depression, the episode must involve at least two weeks of deep despair and at least four of the following:

• Sleep problems. Insomnia or sleeping all the time.
• Appetite problems. Loss of appetite or major weight gain.
• Lack of energy. Apathy, lethargy, no interest in anything.
• Feelings of worthlessness, hopelessness, and/or terrible guilt.
• Difficulty concentrating, or unusual indecisiveness.
• Suicidal thoughts, or suicide attempts.

Bipolar Disorder (Manic-Depression)
About 1% of the American population experiences bipolar disorder annually. This illness involves major depressive episodes alternating with high-energy periods of wildly unrealistic activity. A manic friend might, for example, call at 3 a.m. to announce in all seriousness that she's flying to Hollywood immediately to marry Robert Redford, and star in his next movie.

Typically, bipolar disorder develops without any clear cause.

Atypical Depression
"Atypical" means unusual. Instead of feeling unrelenting gloominess and lethargy, a person with this condition might seem deeply depressed for a few days, then fine for a while, or anxious and irritable.

Like many other forms of depression, the atypical variety often develops without a triggering event.

Seasonal Affective Disorder (SAD)
This condition is often called "winter blues." A reaction to lack of sunlight in winter, mild or major depression develops in late fall and clears up in early spring. As distance from the equator increases, this condition becomes more common. In the northern hemisphere, December, January, and February are the worst months.

Post-partum Depression
New mothers typically anticipate great joy after giving birth. However, the birthing process causes enormous hormonal changes during delivery and anticipating the challenges of dealing with an infant. Approximately, two-thirds of women feel transient sadness. About 10% to 15% become clinically depressed. And about one in 1000 become so severely depressed that they must be hospitalized for their own safety and the safety of their baby.

Each type of depression does not necessarily fit into a neat box. Normal grief or an adjustment disorder is relatively minor compared to the grief and complete inability to function of major depression. Often, with some of the milder forms of depression, subtle signs of trouble are not read, or they are passed off as a bad day, or the individual can disguise to the true feelings. Because clinical depression goes undiagnosed and untreated, many cases end up not attended by a professional. Often, this can result in suicide attempts.

What To Do
While it may be difficult for the affected person to admit there is a problem, because they do not want to feel "flawed" or "crazy", and associates and family may look the other way, it is critical to act

Antidepressant medications are successful in mood elevation in approximately 60% to 80% where use is consistent and as directed for several months. There are different responses to the medications and it takes some trial and error to bracket on the best results with the least side effects.

While drugs have been effective for many people stricken with depression, a number of other non-drug therapies can create the best outcomes in conjunction with counseling or psychotherapy.

Drug Therapy
Depression has been associated with abnormal serotonin levels in the brain. The first selective serotonin reuptake inhibitor, Prozac, was approved by the FDA in 1987. Zoloft followed in 1991 and Paxil in 1992. Celexa was approved in 1998. Luvox is also an SSRI, but is only FDA-approved for use in obsessive-compulsive disorder (OCD).

SSRIs are as effective as the other antidepressants, but no more so. They help 60% to 80% of those who use them as directed. In addition to treating depression, SSRIs may also help treat anxiety, panic, obsessive-compulsive disorder, and bulimia. Typically, it takes several weeks of regular use to obtain the full antidepressant effect. These drugs are not addicting. However, abrupt cessation of use of antidepressants, can cause withdrawal effects. Users should be slowly weaned from the drug

Side effects can cause mild sleep disorders, loss of sexual appetite, inability to achieve orgasm, lack of lubrication in women, excessive sweating, or nausea.

Other Therapies
A multi-pronged approach is highly recommended. Other activities which have contributed to successful management of the condition include the following:

• Cognitive therapy. You can't talk yourself out of depression, but you can stop talking yourself deeper into it. Cognitive therapy -- also called cognitive restructuring -- instructs patients to identify and correct depressive thinking. It attempt to make people more forgiving and understanding of their shortcomings without falling into the depressive trips of ascribing incompetence and failure.
• Exercise. A tremendous amount of research shows that exercise -- particularly strenuous aerobic exercise -- elevates mood, relieves anxiety, improves appetite, sleep, sexual interest and functioning, and self-esteem. Also, it has been demonstrated that aerobic exercise normalizes chemical imbalances.
• Psychotherapy. Freudian psychoanalysis has been supplanted by talk therapies, which have demonstrated significant improvement in those with mild to moderate depression. Studies reveal that those having therapy for 16 weeks or more, there was significant improvement.
• Support groups. Depression is terribly isolating. Embarrassment, a sense of being different, the stigma of being crazy can leave the afflicted individual alone with his/her condition. Support groups show you that you're not alone. They are particularly helpful for depressions associated with drug or alcohol abuse, which is why Alcoholics Anonymous and the other Anonymous organizations are so popular.
• Herbal medicines. Several medicinal herbs have antidepressant effects. The most powerful is St. John's wort, a natural SSRI and weak MAO inhibitor. In addition, kava-kava, ginkgo, and caffeine can also help.
• Dietary supplements. Certain vitamin deficiencies -- notably B-6, B-12, C, folic acid, thiamine, niacin, riboflavin, biotin, and pantothenic acid -- can cause depression. Examining diet to determine balance and taking good chelated multivitamins can help address this issue.
• Phototherapy. Seasonal affective disorder is caused by lack of sunlight in winter. Supplemental artificial light successfully treats it by exposing the patient to a half-hour a day in front of a special bright-light appliance. This is successful in lifting spirits in 60% to 80% of those with winter depression.
• Acupuncture, aromatherapy, and other alternative treatments. The United Nations World Health Organization recognizes acupuncture as effective for mild-to-moderate depression. Other helpful treatments include aromatherapy, massage therapy, music therapy, and meditation.
• Electro-convulsive therapy (ECT). In cases of severe depression where antidepressants prove ineffective, ECT is an option. Pejoratively described as "shock therapy", it is, nevertheless, successful in severe depression in 80% to 90% of cases. Because of its stigma, however, it is difficult to get people to undergo this type of treatment.

References
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