Answers to Your Questions About Clinical Depression

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Answers to Your Questions About Clinical Depression

Information about The National Mental Health Association and the source of this booklet.

The NMHA Clinical Depression Self-Screening Test.

The National Mental Health Association Order Form for some of the NMHA's publications, groups, and membership.

This booklet provides important information about clinical depression, but does not contain complete information. If you have additional questions about clinical depression, please discuss them with a doctor or mental health specialist.


Clinical depression is a serious medical illness affecting millions of Americans. Each year more than 11 million people suffer from this illness, which is as common as it is misunderstood. Many people go through life suffering from clinical depression, never understanding that it is a medical illness or that effective treatments are available. Too often, the illness has carried with it fear and shame that prevented people from asking basic questions about its causes and treatments.

If you think you or someone you know may have clinical depression, reading this booklet is an important first step to answering your questions and getting proper medical care for this painful illness.

Most people who suffer from clinical depression feel a sense of relief when they learn the facts about this medical illness. They realize that depression is not a personal weakness and that they are not alone - men and women from every walk of life, young and old, suffer from clinical depression. They are also relieved to know medical research has produced a variety of effective new medications to treat the illness. The National Institute of Mental Health estimates that eighty percent of people with clinical depression can now be successfully treated, usually with medication, psychotherapy, or a combination of both.

Clinical depression is a treatable illness, and doctors know more about it today than ever before. This booklet will explain the symptoms, causes, and treatments of clinical depression and where people can recieve treatment for the illness.

What is clinical depression?

Clinical depression is much more than just sad feelings or "the blues" - it is a serious medical illness that causes persistent changes in a person's mood, behavior, and feelings. If not treated, the episode can last nine months to a year and will probably happen again during a person's lifetime.

This illness interferes with and disrupts a person's job and family life. No amount of "cheering up" can make it go away, and neither can "keeping a stiff upper lip" or "toughing it out." No amount of exercise, vitamins, or vacation can make clinical depression dissapear. People with clinical depression need to get proper treatment, which usually includes medication, psychotherapy, or both.

What are the symptoms of clinical depression?

Clinical depression is sighaled by persistent changes in a person's feelings and behaviors that are often misunderstood or ignored. Typical changes include sad or empty feelings, slowed behavior, and changes in eating and sleeping patterns. People with this illness often feel down on themselves and hopeless about their future. Many think their brain is "broken," feel guilty or anxious, cry a lot, or become irritable over little things. Others lose interest in friends, sex, and other activities that used to give them pleasure. They often complain about physical aches and pains - backaches, headaches, and stomach problems - for which no medical explanation can be found.

There are nine symptoms that doctors look for when they examine their patients for clinical depression. A doctor makes the diagnosis of clinical depression if a person has had five or more of the following symptoms for more than two weeks or there is a considerable impairment in normal functioning:

Is clinical depression the same for everyone?

No. Clinical depression differs greatly among people, both in its severity and how long it lasts. Some people suffer only one episode of clinical depression during their lifetime, while others experience recurring episodes. Also, people suffer from two basic types of clinical depression:

Major depression
Also called "unipolar" depression, this illness is identified by sad and hopeless feelings; slowed behavior; changes in weight or appetite and sleeping patternns; loss of interest in friends and activities; and thoughts of death and suicide.

Manic depression
Also called "bipolar depression", this illness causes alternate cycles of depression or manic elation. During a manic phase, some or all of the following symptoms often appear:

During a depressed phase, many of the symptoms of major depression are experienced.

Doctors have identified two additional types of clinical depression:

Like a low-grade infection, dysthymia is a less severe form of major depression that keeps people from "feeling good" or enjoying life. People with this illness "go through the motions" of daily life, often with little pleasure or enthusiasm, for years.

Seasonal Affective Disorder (SAD)
This is depression that relates to the season of the year and the brightness and duration of daylight. Medical researchers link inadequete exposure to sunlight to depressed moods, which can be successfully treated with artificial light therapy and sometimes medication.

What causes clinical depression?

Clinical depression results from complex interactions among brain chemicals and hormones that influence a person's energy level, feelings, and sleeping and eating habits. These chemical interactions are linked to many complex causes - a person's family history with the illness, biochemical and psychological make-up, prolonged stress, and traumatic life crises such as death of a loved one, job loss, or divorce. Sometimes no identifiable cause triggers an episode of clinical depression, usually one or more stresses are involved. Medical research has found that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine. New medications are available that restore these brain chemicals to their proper balance and relieve the symptoms of clinical depression.

Who suffers from clinical depression?

Americans of all religions, races, and income levels suffer from clinical depression. But some are more likely to suffer the illness than others. Like heart disease and alcoholism, clinical depression often runs in families. The interactions in brain chemicals that are linked to the illness are often inherited from one generation to the next.

In addition, particularily when there is some genetic vulnerability, people who are under a great deal of prolonged stress, have suffered abuse or experienced a life crisis - death of a loved one, divorce, or job loss - may be more likely to suffer from clinical depression than others.

If a person thinks he or she may have clinical depression, family members should be asked if any relatives have had the illness. This information should be shared with a doctor to help the doctor make the correct diagnosis of the illness.

Do more women than men suffer from clinical depression?

National Institute of Mental Health studies have found that more than twice as many women than men suffer from clinical depression - 25% of women and 10% of men will suffer one or more episodes of clinical depression during their lifetimes.

But these numbers may not tell the whole story. Some researchers believe that women are more likely than men to admit their symptoms and seek treatment for clinical depression. Furthermore, even if men recognize their symptoms of clinical depression, many view the illness as personal weakness to be handled alond and with a "stiff upper lip." Others ignore their symptoms or cope with their suffering by abusing alcohol or other drugs or both.

Do people of all ages suffer from clinical depression?

Clinical depression strikes Americans of all ages but most often when they are in the prime of their lives - ages 24 to 44. Yet, certain other age groups are also at risk. For example, the high school and college-age population suffers high rates of clinical depression. Many parents and teachers do not recognize the illness because its symptoms may resemble normal teenage problems - changes in mood, irritability, risk-taking behavior, and trouble with friends or school work. However, if undiagnosed and untreated, some young people with severe clinical depression may become vulnerable to suicide - now the second leading cause of death between the ages of 15 to 24.

Senior citizens also frequently suffer from clinical depression. Their sad moods, fatigue, and withdrawl from life are often mistaken for a normal part of the aging process. For many senior citizens, clinical depression is linked to death of a spouse, admission to a nursing home, prolonged illness, or a major operation, such a heart surgery. The elderly depressed are at a much higher risk for suicide that younger depressed people.

How is clinical depression treated?

Effective treatment for clinical depression includes medication and psychotherapy, used singly or in combination. However, for more severly depressed individuals, medication is generally required. A complete examination by a doctor or mental health specialist is necessary to make a correct diagnosis. A medical examination is recommended to eliminate the possibility of other medical conditions.

How is clinical depression treated by medication?

Antidepressant medications were discovered in the 1950s and have been used successfully ever since to treat clinical depression. Medical researchers are continually learning more about the brain chemicals linked to the illness and developing new, improved medication with fewer side effects.

There are three principal categories off these medications: each working slightly differently: tricyclics, monoamine oxidase inhibitors, and serotonin reuptake inhibitors. In addition, lithium and some anticonvulsants are used to treat manic depression. Doctors closely monitor their patients who begin taking antidepressant medication to make sure it is working properly, taken as directed, and prescribed in the correct dosage. During the course of treatment, doctors may change or combine medications to make sure their patients are getting the most effective treatment.

When medication is prescribed for clinical depression, it is helpful to discuss with the doctor how the medication works, how long it takes to begin working, and what its side effects are so that these can be reported to the doctor. There is a wide range of possible side effects, from dry mouth to problems with digestion and sexual function.

It is important that people with clinical depression keep all their appointments with their doctor and take their medication as often and for as long as the doctor prescribes - usually six to twelve months or more. Too often patients stop taking their medication soon after they start feeling better and/or before the medication has been given enough time to take full therapeutic effect - usually two to six weeks. When they stop taking the medication too soon, symptoms of clinical depression may reappear.

How does psychotherapy help people with clinical depression?

Research studies show that 80% of people with clinical depression can be successfully treated with medication, psychotherapy, or a combination of both. Therapy is conducted by psychiatrists, psychologists, clinical social workers, marriage and family therapists, mental health counselors, or pastoral counselors. Both Cognitive Therapy, which addresses negative thinking patterns, and interpersonal therapy, which addresses problems in personal relationships, are effective in treating people with clinical depression.

In therapy, the person with clinical depression can work to understand the illness, solve problems, and manage stressful situations that could otherwise trigger another episode of the illness. Cognitive and interpersonal therapies are often sufficient. Some people with clinical depression will need long-term individual psychotherapy.

Can clinical depression lead to suicide?

Unfortunately, research studies show that 15% of people with severe clinical depression will die of suicide. The hopelessness, helplessness, and acute physical pain experienced by these people often lead them to dispair and thoughts of suicide.

If you are concerned that someone you know is contemplating suicide, look for specific warning signs such as: the person is winding up his or her affairs, giving away belongings, discussing details of suicide methods, expressing hopeless feelings (that "life isn't worth living"), or appearing suddenly serene and content - he or she may have found a "solution" to their suffering. Listen carefully - those who discuss their suicide plans are moste likely to carry them out.

If the person exhibits warning signs of suicide, talk with a doctor immediately for advice or referral. Also, get the person to a doctor or therapist as soon as possible for treatment and remove all guns or other easily available means of suicide (eg. pills) from the person's home. In the meantime, encourage the person to call a local suicide hotline or talk toyou about his or her feelings and suicide plans. Reassure him or her of your concern and willingness to help. Do not leave the person alone.

How does a person with clinical depression get well?

Recovery from clinical depression involves proper treatment, support, and education. The most important steps to a person's recovery from clinical depression are to see a doctor and stick to a treatment plan of medication and therapy. That means taking the medication as prescribed and keeping all appointments with a doctor and therapist. Participating in a patient support group is also very helpful during the recovery process, as is educating oneself about clinical depression and its treatments.

How does a person with clinical depression find the right doctor?

While a family doctor can diagnose and treat clinical depression, psychiatrists are the physician specialtists most skilled at helping people with this illness. Clinical depression is one of the most common illnesses psychiatrists treat; almost all of them utilize medication and psychotherapy. Psychologists, clinical social workers, and other mental health specialists may also provide psychotherapy, either by itself or in combination with medication prescribed by a doctor.

Psychiatrists specializing in mood disorders who have expertise in psychopharmacology and neuropsychiatry may be needed to treat those who have not responded to standard treatments. These specialized psychiatrists often practice at university medical schools but can also be located by calling the local psychiatric association, Mental Health Association, medical society, or hospital referral service. Other places to receive medical treatment for clinical depression are community mental health centers and "mood disorder" clinics at local hospitals.

Be sure to ask the doctors if they have treated people with clinical depression and what treatments they use. If not satisfied with their answers, get a second opinion from a different doctor or find another doctor altogether.

How does a person with clinical depression find the right psychotherapist or counselor?

While some people with clinical depression receive treatment from a psychiatrist who both prescribes medication and conducts therapy, others receive care from two professionals - a doctor who prescribes medication and a therapist who helps change negative thinking and behavior patterns. While a family doctor often maken referrals to therapists who treat people with clinical depression, therapists can also be located by calling the local mental health center, psychologists association, psychiatric association, marriage and family therapists association, mental health counselors association, pastoral counseling center, Mental Health Association, or social workers association.

Be sure to ask the therapists if they have treated people with clinical depression and what treatments they use. If not satisfied with their answers, get a second opinion from a different therapist or find another therapist altogether.

How can support groups help people with clinical depression?

Many people with clinical depression have found a wellspring of emotional support, acceptance, encouragement, and friendship by joining patient support groups. Support group members share their experiences with the illness, learn coping skills, distribute information about new treatments, and refer people to doctors and therapists in their community. To locate a patient support group, call the National Depressive and Manic-Depressive Association (NDMDA) at 1.800.82.NDMDA or the local Mental Health Association, community mental health center, or hospital.

Support groups for family members with a relative suffering from clinical depression are also available in many communities. These support groups provide up-to-date information about new treatments and help families find the best medical care in their community. To locate a family support group, call the National Depressive and Manic-Depressive Association (NDMDA) at 1.800.82.NDMDA, the National Alliance for the Mentally Ill (NAMI) at 1.800.950.NAMI or the local Mental Health Association, community mental health center, or hospital.

How can people with clinical depression learn more about the illness?

People with clinical depression, as well as their family members, find it very helpful to learn as much as they can about the illness and its treatments, especially since medical research is always improving the medications used to treat the illness.

A free resource card describing where to find information and resources about clinical depression is available from the National Mental Health Association. To order a resource card, check this item on the mail-in order form.

The National Institute of Mental Health provides a full range of free educational materials about clinical depression, some of which are printed in Spanish. To order, call 1.800.421.4211.

The National Depressive and Manic-Depressive Association (NDMDA) has a mail order bookstore offering educational brochures, books, and videotapes about clinical depression. To request a free NDMDA bookstore catalogue or to purchase one of the publications listed below, write to the NDMDA, 730 N. Franklin Street, Suite 501, Chicago, IL, 60610.

Do You Have a Depressive Illness, How to Tell, What to Do, D. E. Klein, MD, and P. H. Wender, MD. Question-and-answer format; answers by medical authorities. 128 p, paper, 1988. Price: $8.00

How to Cope With Depression - A Complete Guide for You and Your Family, J. Raymond DePaulo Jr, MD and Keith R. Ablow, MD. Views depression from four perspectives: disease, personality, behavior, and life stories. 216 p. Price: $4.45

Manic Depressive Illness, A Guide for Patients and Families, Ruth Thompson, et al. Excellent introduction for new patients and their families. 24 p. booklet, rev. 1987. Price: $3.00

Overcoming Depression, Dimitri F. Papolos, MD and Janice Papolos. Summary of current knowledge about causes and treatments of depression. 319 p, c. 1992, paper. Price: $11.70

[Provided as a public service through an educational grant from Eli Lilly and Company]

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