CAMP Health

Many of us have experienced depression or know and love someone who does. Yet, this serious illness is often misunderstood or misjudged. Depression is an illness which affects millions of Americans. In fact, it is estimated that 18.8 million Americans suffer from depression in any given one year period. Studies suggest that the GLBT community is at an increased risk of serious depressive disorders.

The causes of depression are multifaceted. Some depression seems to run in families, suggesting that a biological vulnerability can be inherited. However, it can occur in people who have no family history of depression as well. Depression and related mood disorders are commonly associated with changes in brain functioning or structure causing chemical imbalances. Loss, personal failures at work or in relationships, or unwelcome changes in life can trigger a depressive episode. Medical problems such as cancer, HIV/AIDS, heart attack, stroke, Parkinson’s disease and hormonal changes can cause depressive disease as well.

Major depression manifests as a combination of symptoms that include persistent sad, anxious feelings of emptiness, decreased energy and fatigue, difficulty with concentration, memory and decision-making, insomnia, early morning wakening or oversleeping, loss of appetite, or increased appetite, pervasive thoughts of death or suicide, suicide attempts, restlessness and irritability, hopelessness, pessimism and withdrawal. Major depression is disabling and extremely painful. For some people, depression occurs in a single episode; but more often multiple episodes occur.

Dysthymia involves long-term chronic symptoms which are less acute than those listed above; but are equally challenging to the depressed individual because of the persistent inability to "feel good." Most people who suffer from dysthymia also experience a major depressive episode at some point in their lives. A person who has had one major depression is at an increased risk for recurring episodes.

Another type of depression is bipolar disorder, also called manic-depressive illness. This disorder is characterized by cycling mood changes. A person with bipolar disorder experiences dramatic highs (mania) and severe lows (depression). The cycling of mood can be rapid or slow. When manic, a person may be hyperactive, over-talkative, or seem to have a great deal of energy. It is important to realize that episodes of mania do not have a "feel good" quality to them. These episodes are frightening and can be painful because the individual with bipolar disorder knows that each period of mania is to be followed by a depression.

A common type of depression is Seasonal Affective Disorder (SAD). It is believed that the cause of SAD is related to changes in brain chemistry due to changes in the sun’s light. The most common symptoms of SAD are low energy, poor sleep, overeating (or a craving for carbohydrates). The central feature of SAD is that the onset and remission occur at characteristic times of the year. In most cases episodes begin in fall or winter and remit in the spring. SAD is not linked to seasonal psychosocial stressors such as holidays, seasonal unemployment or school schedules.

Major depression and bipolar disorder, if untreated, can lead to psychosis. As with all serious illness, the sooner one is treated the better the outcome. Unfortunately, people who suffer from depressive disorders can be incapacitated and too depressed to seek treatment.

If you have depression, it is essential to get appropriate treatment. First and foremost, medical assessment and diagnosis is necessary. If you experience dysthymia or SAD, your primary care physician may be well equipped to treat. For acute depression or bipolar disorder, a psychiatrist is the best choice of physician. There are several different types of antidepressant medicines used to treat depressive disorders. One of these may be effective; but often they are used in combination. It is important to take an antidepressant medicine regularly for a minimum of three or four weeks to achieve the full therapeutic benefit.

In conjunction with antidepressant medicines, psychotherapy is an important part of treatment. Psychotherapy should address the triggers of depressive episodes, the impact of the disease on overall functioning, and reassurance that the patient is neither "crazy" nor "weak." As the patient fully recovers from depression, psychotherapy can help the person safely "come off" the medicine. Recurrence does not represent failure on the part of the patient, physician or therapist. It is often a recurring illness. Acupuncture is also a powerful intervention which supports the body, mind and spirit.

Complementary treatments such as yoga therapy, massage and energy therapy, nutrition, exercise, herbal remedies, relaxation techniques, meditation and breathing techniques as well as participation in support groups are powerful tools to support recovery from depression.

Unfortunately, depression is widely misunderstood, often perceived as weakness, character flaw or laziness. We live in a culture that values "pulling yourself up by your bootstraps," and unwittingly, we often blame the people who are victims of this devastating illness.

Well meaning friends and family who do not understand depression as disease often become impatient with a depressed love one. "Get out and get some fresh air and exercise," "chin up," "buck up," move on," "you’re too negative, look at the bright side," are refrains offered by concerned friends and family, creating feelings of alienation, shame, and guilt for the depressed person and exacerbate symptoms.

Depressive disorders comprise a body of disabling conditions that can rob a person and their family of quality of life. At the same time, most depressive disorders are usually manageable with skilled care. People living with depression are as creative, thoughtful, and productive as their non-depressed counterparts. The key to the disease is realizing that professional attention is required to treat the condition. Like any other illness, effective intervention promotes the most positive outcome.