by Kimberly Blaker
I was about 31 when I was first diagnosed with major depression. I was married, had two beautiful kids ages 7 and 3, and owned a thriving business. Despite having plenty to live for, my usual happy mood had plummeted into despair. I’d lie awake at night ruminating about every minor thing I had ever said or done wrong – or imperfectly. During the day, I had no motivation to do anything. The simplest everyday tasks suddenly required extraordinary effort. My life felt utterly worthless, despite all evidence to the contrary, and I was engulfed in sorrow and hopelessness.
As days turned into weeks, I continued to spiral on a downward path. I became increasingly focused on death. I wasn’t suicidal, per se – though thoughts of the least painful methods of ending my suffering certainly swirled around in my mind. I wanted nothing more than to fall asleep and never wake again.
Finally, unable to endure the emptiness any longer and terrified by my thoughts, I sought help. I was immediately started on an antidepressant, and within a few short weeks, the darkness lifted. I was my usual happy, energetic self once again.
But this was only the beginning of what would become a lifelong battle with depression. Over the past couple decades, I’ve gone through far too many bouts of depression to count. Some have been mild and short-lived having little impact on my functioning despite the bleak and gloomy outlook looming over me. Other episodes have been major and affected all aspects of my life.
Most recently, I experienced my first dysthymic episode – a depression that lasted two years, cycling between mild and severe. I had become resistant to my long-trusted friend, Wellbutrin, and none of the many other medications I tried gave me any relief. It was when I finally found a psychopharmacologist who knew just the right cocktail (combination of medications) for me that my depression finally went back into remission.
People with depression often suffer from various forms. In addition to being diagnosed with major depressive disorder and dysthymia, I’ve also been diagnosed with seasonal affective disorder (SAD) and bipolar II (hypomania, rather than mania) with the depression component being the more severe problem for me.
Women are particularly at risk for depression
Depression does affect both men and women, but women are twice as likely to experience major depression according to Harvard Medical School. Women also experience higher rates of dysthymia, seasonal affective disorder (SAD), and the depressive side of bipolar disorder.
Depression, unlike the normal sadness everyone experiences from time to time, is a soul-sucking darkness that for many is debilitating. It causes feelings of hopelessness, helplessness, and worthlessness, and can affect every aspect of life from work and school to parenting, friendships, and the very basics of living.
For most women who’ve been diagnosed with depression in the past, when it begins to set in, the feeling is unmistakable. But for those who suffer from milder forms of depression and sometimes even those suffering from a first major depressive episode, they don’t immediately connect all the dots. So, some people can experience depression not realizing they’re suffering from a treatable illness.
Signs of depression
The symptoms of depression can range from mild to severe. Not everyone experiences every symptom, but several symptoms must be present for at least two weeks to receive a diagnosis of depression. The exact criteria for specific types of depression vary slightly.
The following are all indicators:
- Feeling depressed (sad, empty, or hopeless) nearly every day for at least a couple weeks
- Unusual irritability or difficulty controlling anger
- Ongoing trouble sleeping or sleeping more than usual
- An increase or decrease in appetite or significant unexplained weight loss or gain
- Loss of interest or pleasure in all or most activities
- Difficulty concentrating or making decisions
- Feelings of fatigue or loss of energy
- Excessive or inappropriate feelings of guilt or worthlessness
- Visible psychomotor slowing down or agitation
- Recurrent thoughts of death or suicide, with or without a plan, or attempted suicide
Types of depression
There are quite a few classifications, or types, of depression. The following are a few of the more common.
In a given year, major depressive disorder affects nearly 7% of U.S. population, according to the National Institutes of Mental Health (NIMH). During a major depression, almost all aspects of a person’s life are affected. It can be difficult for someone with major depression to find the motivation to do anything including such necessities as taking a shower. As a result of the impairment, both work and personal life suffer. In addition to the symptoms in the section above, 20% of people with major depression will also experience psychosis. This means they’ll experience hallucinations and delusions.
Dysthymia is diagnosed when a person has experienced depression for most of each day and on most days for at least two years. For many, it’s a lower level but enduring depression. However, people with major depression who are treatment resistant can meet the diagnosis of dysthymia as well. So those with dysthymia can range from mild to severe impairment. Women, according to HealthFundingResearch.org, are three times more likely than men to suffer from dysthymia.
Those with seasonal affective disorder (SAD) become depressed only or primarily during a particular season. For most with SAD, it’s the fall and winter months with their shorter days and reduced sunshine. But some people experience SAD during the summer months instead. The onset of SAD is typically around the age of 20 and affects 10 million Americans each year.
Bipolar disorder affects 2.6% of American adults according to the NIMH. This treatable, but lifelong disease typically develops in women in their mid to upper 20s. For men, onset is usually in the teens to the early 20s. Bipolar is signified by its bouts of both mania (or hypomania) and its opposite extreme, depression. Though an individual with bipolar will experience both sides of the spectrum, in women, depression is often the most problematic, while for men it’s the mania. Those with bipolar disorder often experience psychosis during bouts of mania and sometimes with depression.
Postpartum depression is one of the forms of depression exclusive to women. According to the NIMH, 10 to 15% of women will develop it. Postpartum depression shouldn’t be confused with the “baby blues,” which is milder, short-lived, and related to the worry and fatigue of parenting a new baby. Instead, postpartum depression results from hormonal changes. During pregnancy, a woman’s hormone levels increase; then immediately following childbirth, the hormone levels rapidly drop to normal levels. This ultimately results in depression in some women. Like other forms of depression, it can be mildly to severely debilitating.
The exact cause of depression is unknown, although several factors likely contribute to the condition. According to the Mayo Clinic, those with depression have physical changes in their brains. These changes in the brain may eventually help researchers determine the exact cause of depression.
Depression is also known to be genetic because of the higher incidence of depression in those with blood relatives who suffer from the condition.
Brain chemicals called neurotransmitters play a role in depression. The Mayo Clinic explains that the way the neurotransmitters function and how they affect the neurocircuits involved in mood stability plays a significant role both in depression and its treatment.
Hormonal changes can also play a role in depression, particularly for women. During pregnancy and for several months following pregnancy women are especially vulnerable. Menstruation cycles and menopause can also trigger depression.
In some cases, depression results from an underlying medical condition such as thyroid problems or low vitamin B levels. For this reason, it’s essential to visit your primary care physician for blood work to rule out other causes. If the cause of depression is the result of an underlying medical condition, treatment for that condition is likely all that’s needed to cure the depression.
If medical causes have been ruled out, then it’s best to consult with a psychiatrist. Although primary care physicians can treat depression, psychiatrists have specialized training in diagnosing the various forms of depression and experience in treating them. Psychiatrists often know which medications will work best for a particular patient based on a variety of factors. In fact, depending on the type of depression and the specific set of symptoms, some people with depression require a combination of anti-depressants, anti-anxiety medications, and mood stabilizers. Psychiatrists know how to tailor treatment to each individual for best results.
For those who are treatment resistant, look for a psychiatrist with the special ‘psychopharmacologist’ designation. Psychopharmacologists have gone through additional specialized training in how drugs affect the mind and behavior.
In addition to medication, many psychiatrists recommend cognitive therapy with a psychologist or behavioral therapist in conjunction. This can be helpful both in coping with the effects of depression as well as dealing with any underlying trauma or events fueling the depression.
Finally, for those with SAD, sitting under a light therapy box is often recommended and has been found to be helpful. You can order one online, and depending on your doctor’s recommendations, you can sit under it for 20 to 40 minutes each day.