Depression: What are signs and symptoms

WHAT IS DEPRESSION?

Depression is a real illness that impacts the brain. Anyone suffering from depression will tell you, it’s not imaginary or “all in your head.” Depression is more than just feeling “down.” It is a serious illness caused by changes in brain chemistry. Research tells us that other factors contribute to the onset of depression, including genetics, changes in hormone levels, certain medical conditions, stress, grief or difficult life circumstances. Any of these factors alone or in combination can precipitate changes in brain chemistry that lead to depression’s many symptoms.

Depression is a serious condition. It’s also, unfortunately, a common one. The World Health Organization characterizes depression as one of the most disabling disorders in the world, affecting roughly one in five women and one in ten men at some point in their lifetime. It is estimated that 21% of women and 12% of men in the U.S will experience an episode of depression at some point in their lifetime.

Depression does not discriminate. Men and women of every age, educational level, and social and economic background suffer from depression. There is no area of life that does not suffer when depression is present. Marriage, parenting, friendships, careers, finances – every aspect of daily living is compromised by this disease. Once an episode of depression occurs, it is also quite likely that it will recur. And the impact of depression can be even more severe when it occurs in combination with other medical illnesses such as diabetes, stroke, or cardiovascular disease, or with related disorders such as anxiety or substance abuse.

The problems caused by depression are made worse by the fact that most people suffering from the disease are never diagnosed, let alone treated. The good news is that when depression is promptly identified and treated, its symptoms are manageable and there are many effective strategies for living with the disease. Depression and bipolar disorder are both treated most effectively in their earliest stages when symptoms are less severe.

WHAT CAUSES DEPRESSION?

Although scientists agree that depression is a brain disorder, the debate continues about exact causes. Many factors may contribute to the onset of depression, including genetic characteristics, changes in hormone levels, certain medical illnesses, stress, grief, or substance abuse. Any of these factors alone or in combination can bring about the specific changes in brain chemistry that lead to the many symptoms of depression, bipolar disorder and related conditions.

WHAT ARE THE SYMPTOMS OF DEPRESSION?

Depression commonly affects your thoughts, your emotions, your behaviors and your overall physical health. Here are some of the most common symptoms that point to the presence of depression:

Feelings:

• Sadness
• Hopelessness
• Guilt
• Moodiness
• Angry outbursts
• Loss of interest in friends, family and favorite activities, including sex

Thoughts:

• Trouble concentrating
• Trouble making decisions
• Trouble remembering
• Thoughts of harming yourself
• Delusions and/or hallucinations can also occur in cases of severe depression

Behaviors:

• Withdrawing from people
• Substance abuse
• Missing work, school or other commitments
• Attempts to harm yourself

Physical problems:

• Tiredness or lack of energy
• Unexplained aches and pains
• Changes in appetite
• Weight loss
• Weight gain
• Changes in sleep – sleeping too little or too much
• Sexual problems

Of course, all of us can expect to experience one or more of these symptoms on occasion. An occurrence of any one of these symptoms on its own does not constitute depression. When healthcare professionals suspect depression, they commonly look for clusters of these symptoms occurring regularly for two weeks or longer, and impacting functional aspects of the person’s life.

COULD YOU BE SUFFERING FROM DEPRESSION?

Together with a healthcare provider, you can find out whether what you are experiencing is depression or bipolar disorder, and chart a course to feeling and functioning better. This website provides tips and tools for starting that conversation with your primary care physician or nurse practitioner, or with a community health professional. See Talking with your healthcare provider.

Prior to engaging your doctor or healthcare provider, you may find it helpful to know more about how depression and bipolar disorder are diagnosed. Experts commonly employ a series of questions called a screening tool to identify depression. To walk yourself through the same questions, click on Are you depressed?. Once you have completed the questionnaire, you can share your answers with a professional to determine the best course of action.

HOW IS DEPRESSION TREATED?

There are several strategies for treating depression. Depending upon each individual’s characteristics and symptoms, healthcare professionals may employ one or more types of psychotherapy that rely upon a sequence of interpersonal treatment sessions with a trained professional. In addition, clinicians may suggest that a patient try one of a number of different medications. Lifestyle changes, including improvements in sleeping and eating habits, physical activity and stress reduction have also proven very helpful in managing symptoms. To learn more about the many options available for treating depression, click on Know your treatment options and Take care of yourself.

Treatment for people who are at risk for suicide

There are no treatments that specifically stop suicidal thoughts. However, for each individual, identifying and treating any mental illness, and dealing with any stressors can reduce the risk of suicide. Some treatments for mental illness, including major depression and bipolar disorder, have been shown to reduce suicide risk. Certain medications have been shown to reduce the risk of suicide. 

Lithium (Eskalith, Lithobid), a mood-stabilizing medication used for bipolar disorder or major depression, has been shown to decrease suicides associated with depression.

 Similarly, clozapine (Clozaril, FazaClo), an antipsychotic medication, can reduce the risk of suicide in people with schizophrenia. It is not clear if these medications reduce suicide risk when used to treat people with other diagnoses.

In contrast, there have been concerns that antidepressants actually increase the risk of suicidal thoughts. In fact, the U.S. Food and Drug Administration (FDA) has required a warning stating that antidepressants may increase the risk of suicidal thoughts in children, teens, and adults in their 20s. There was no evidence that these medicines increased suicidal behavior in older people. This warning was based on a review of studies that suggested this increase. Some researchers and clinicians disagree with this warning and feel that not prescribing antidepressants has actually increased suicidal thoughts and attempts, since fewer people are treated for depression. Ongoing studies will hopefully answer these questions more clearly. In the meantime, it is important that people taking antidepressants know about this risk and are given information about how to get help if they have suicidal thoughts.

People who frequently have suicidal thoughts may benefit from specific types of psychotherapy ("talk therapy" or counseling). Cognitive behavioral therapy (CBT) addresses negative thoughts and cognitive distortions. Cognitive distortions are ways that the mind reads things around us in an overly negative way (for example, if someone receives a critical comment from one person, they believe everyone thinks badly about them). By repeated practice, people can learn to overcome these thought patterns and reduce depression and suicide risk. CBT has been shown in many research studies to help improve symptoms of depression and anxiety disorders. Similarly, dialectical behavioral therapy (DBT), a type of therapy developed to help people with borderline personality disorder, also can reduce suicidality. DBT uses mindfulness and other coping skills to decrease impulsive and destructive urges that can lead to suicide attempts.

Nonemergency situations

If you have suicidal thoughts, but aren't in a crisis situation, you may need outpatient treatment. This treatment may include:

• Psychotherapy. In psychotherapy, also called psychological counseling or talk therapy, you explore the issues that make you feel suicidal and learn skills to help manage emotions more effectively. You and your therapist can work together to develop a treatment plan and goals.
• Medications. Antidepressants, antipsychotic medications, anti-anxiety medications and other medications for mental illness can help reduce symptoms, which can help you feel less suicidal.
• Addiction treatment. Treatment for drug or alcohol addiction can include detoxification, addiction treatment programs and self-help group meetings.
• Family support and education. Your loved ones can be both a source of support and conflict. Involving them in treatment can help them understand what you're going through, give them better coping skills, and improve family communication and relationships.

The reasons people attempt suicide

Suicide is the act of taking one’s own life. According to the American Foundation for Suicide Prevention, suicide is one of the leading causes of death in the United States, taking the lives of approximately 43,000 Americans each year.

There’s no single reason why someone may try to take their own life, but certain factors can increase the risk. Someone may be more likely to attempt suicide if they have a mental health disorder. About 90 percent of people who commit suicide have a mental illness at the time of their death. Depression is the top risk factor, but there are various other mental health disorders that can contribute to suicide, including bipolar disorder and schizophrenia.

Aside from mental illnesses, there are several risk factors that may contribute to thoughts of suicide, attempted suicide, and actual suicide. They include:

• previous suicide attempts
• substance abuse
• incarceration
• family history of suicide
• poor job security or low levels of job satisfaction
• history of being abused or witnessing continuous abuse
• being diagnosed with a serious medical condition, such as cancer or HIV
• being socially isolated or a victim of bullying
• being exposed to suicidal behavior

Those who have been shown to be at a higher risk for suicide are:

• men
• people over age 45
• Caucasians, American Indians, or Alaskan Natives

People who have suicidal thoughts are often so overwhelmed by feelings of sadness and hopelessness that they think they have no other option. While it can be hard to know how someone is feeling on the inside, there are various behaviors that can indicate suicidal tendencies. It’s important to recognize these warning signs so you can help a family member or a friend who may be experiencing suicidal thoughts. Taking action and getting someone the help they need may help prevent a tragic suicide attempt or death.

SIGNS & SYMPTOMS

You have a suicidal behavior if you:

• feel hopeless
• feel trapped
• feel alone
• feel anxious or agitated
• feel as if there is no reason to go on living
• think of suicide as a way out
• experience mood swings
• are abusing alcohol or drugs

Signs That you May Attempt Suicide

You can’t see what a person is feeling on the inside, so it isn’t always easy to identify someone who is having suicidal thoughts. However, some outward warning signs that a person may be contemplating suicide include:

• talking about feeling hopeless
• talking about having no reason to go on living
• making a will or giving away personal possessions
• searching for a means of doing personal harm, such as buying a gun
• sleeping too much or too little
• eating too little or eating too much, resulting in significant weight gain or weight loss
• engaging in reckless behaviors, including excessive alcohol or drug consumption
• avoiding social interactions with others
• expressing rage or intentions to seek revenge
• showing signs of anxiousness or agitation

In the next article we will talk about treatment for people who are at risk to attempt suicide.