Depression is the leading cause of disability in the United States for individuals 15-44 years of age and more than 15 million adults in the United States are diagnosed with depression each year. Depressive disorders are characterized under mood disorders and cause severe symptoms that affect how one thinks, feels, and interacts with others. This can result in extreme unhappiness in every aspect of an individual’s life resulting in potential turmoil in the workplace, in the home and in personal relationships with others. Depression is a multifactorial mood disorder meaning that many causes contribute to this disorder such as genetic factors and major life stressors. Individuals with depression may not even report depressive signs and symptoms and instead present to their physician for somatic or physical symptoms such as headaches, abdominal pain, muscle pain, and fatigue. Individuals may also complain of irritability or problems concentrating. This disorder may be difficult to initially diagnose, as many individuals may not show the clear-cut signs and symptoms of depression.
Living with untreated depression can potentially lead to self-harm, eating disorders and even suicide and therefore recognizing the signs and symptoms and seeking the appropriate treatment is imperative to overcoming the battle with depression and living a health and fulfilling life.
Persistent depressive disorder, formerly referred to as dysthymic disorder. Persistent depressive disorder differs from major depressive disorder in that the symptoms usually wax and wane over a period of years. In order to diagnosis persistent depressive disorder, adults must exhibit a depressed mood for the majority of the day for at least two years where as children must exhibit these symptoms for at least one year.
Adjustment disorder is characterized by the presence of emotional or behavioral symptoms that occur as a response to an identifiable stressor within three months of the onset of the stressors. Stressors could include a loss/change in job, a divorce, a new marriage, a newborn child, a move or other events that could result in a distress that is out of proportion with the expected reaction to the stressor. Symptoms associated with this disorder must be clinically significant and cause marked distress and impairment in functioning. Depressed mood is a subtype of adjustment disorder and symptoms include sadness, loss of pleasure, feelings of loneliness or isolation, decreased self-esteem, sense of hopelessness, and lack of motivation.
The grey skies and cold winter months can bring a somber mood to those who are diagnosed with the “winter blues”, formally known as seasonal affective disorder (SAD). This disorder starts to become apparent in the fall, pique in the winter and resolve in the springtime and is more apparent for individual living in the Pacific Northwest and the Northeast where grey skies are prominent 4-6 months out of the year. Seasonal affective disorder is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a separate condition. Instead it is listed as a specifier "with seasonal pattern" under Major Depressive Disorder, recurrent and the Bipolar Disorders. SAD is usually more common in the fall and winter (Winter SAD), though it may occur during the spring and summer (Spring SAD). Winter-onset SAD is more common and is often characterized by atypical depressive symptoms including; hypersomnia, increased appetite, and craving for carbohydrates. On the other hand, spring/summer also seen and is more frequently associated with typical depressive symptoms including insomnia and loss of appetite.
Postpartum depression is more persistent and severe than postpartum blues and often interferes with the mother’s ability to care for herself and her newborn child. Postpartum depression occurs in approximately 10-15% of the female general population and develops most commonly in the first four months following delivery however it can occur anytime in the first year after delivery and therefore this disorder often goes unrecognized by many individuals including mental healthcare professionals. The risk of recurrence for postpartum depression is 25% and the signs and symptoms are indistinguishable from major depressive disorder. These symptoms include depressed mood, tearfulness, recurrent thoughts of death, insomnia, fatigue, feelings of guilt, poor concentration, appetite disturbance, suicidal thoughts, and lack of interest.
Treatment for depression consists of a combination of medications and psychotherapy. Although studies have shown that these medications and psychotherapy approaches can be used alone for mild depression, when used in combination, individuals receive the best outcomes in terms of symptoms relief for moderate depression. The most common pharmacological treatments include antidepressant classes such as selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), atypical antipsychotics, and tricyclic antidepressants (TCAs).
Medication generally takes approximately 6-8 weeks for results to take effect. Psychotherapy includes cognitive behavioral therapy, interpersonal therapy, problem-solving therapy and mindfulness-based cognitive therapy.
Cognitive behavioral therapy and interpersonal psychotherapy are the two most common therapy approaches to treating depression. Cognitive behavioral therapy focuses on reducing depressive symptoms by recognizing the thought the irrational thought patterns, emotions, beliefs and distorted attitudes toward oneself and their environment that results in symptoms of depression. Once the recognition of maladaptive thoughts occurs, an individual can then work on their behavioral patterns to turn these negative symptoms around into positive outlooks, and gain insight and self-appreciation in order to develop behavioral techniques such as self-control therapy, problem solving, and social skill training. Interpersonal psychotherapy focuses on acknowledging the triggers associated depression such as the loss of a loved one, a stressful social situation, the loss of a job, financial burdens, social isolations, or the loss of a romantic relationship. In this form of therapy, depression is viewed as a medical illness and the illness is the cause of the depression. Techniques that involve building relationships, learning coping mechanisms, and developing conflict resolution skills can help diminish these triggers and form positive insight in future conflicts. Other forms of psychotherapy that have been implanted to treat depression include the following:
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An antidepressant medication is usually the first-step in the treatment plan for an individual with mild to moderate depression. There is a vast array of medications available and the initial selection often depends on the known medication side effects, safety and tolerability of these side effects, duration of timing it takes for the drug to work, an individual’s response to prior antidepressant medications, cost of the medication, interactions with other medication and the individual’s preference. Antidepressants take two-six weeks, at the correct dosage, for a clinical response to occur and therefore it is imperative individuals stay motivated and compliant during this time period. Additionally, psychotherapy can be initiated at the start while these medications take their time to produce clinical effects. The following are classes of antidepressants widely used in the general population to treat depression: