I was first diagnosed with major depression at the age of 31. I was married, had two beautiful kids aged seven and three and owned a thriving business. Yet, despite having so much to live for, my mood plummeted into despair. I lost all motivation to do anything. The most simple everyday tasks suddenly required an extraordinary effort. At night, I’d lie awake ruminating over every minor thing I had ever said or done wrong – anything less than perfect. My life felt utterly worthless, despite all evidence to the contrary, and I became engulfed in sorrow and hopelessness.
As days turned into weeks, I continued to spiral downward. I became increasingly focused on death. I wasn’t suicidal, per se – though thoughts of the least painful methods of ending my suffering swirled around my mind. I wanted nothing more than to fall asleep and never wake up again.
Unable to endure the pain and emptiness any longer and terrified by my thoughts, I finally sought help. My doctor prescribed an antidepressant, and within a few weeks, the darkness lifted. I was once again my usual happy, energetic self.
But this was only the beginning of a lifelong battle with depression. Over the past couple of decades, I’ve had far too many bouts of depression to even count. Some are mild and short-lived, having minimal impact on my functioning, despite the bleak and gloomy outlook that looms over me. Other episodes are major and impact all areas of my life.
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 other medications I tried gave me any relief. Finally, I found a psychopharmacologist who knew just the right cocktail — a combination of medications — for me, and my depression went back into remission.
People with one depressive disorder often suffer from various forms. I’ve been diagnosed with major depressive disorder, dysthymia, seasonal affective disorder and either cyclothymia or bipolar II — hypomania, rather than mania — with the depression component always being the more severe problem for me.
Signs of Depression
The symptoms of depression can range from mild to severe and may include:
- Feeling depressed, sad, empty or hopeless nearly every day for at least a couple weeks.
- Unusual irritability or difficulty controlling anger.
- Ongoing trouble with 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 many classifications, or types, of depression. The following are a few of the more common.
In any given year, major depressive disorder affects nearly seven percent of the United States population, according to the National Institutes of Mental Health. During a major depressive episode, almost all aspects of a person’s life are affected. Someone suffering from major depression may lack the motivation to do anything, including such necessities as taking a shower. Because of the impairment, both work and personal life suffer. In addition to the symptoms noted above, 20% of those with major depression will also experience psychosis: hallucinations or delusions.
Dysthymia is diagnosed when someone experiences depression for most of each day and on most days for at least two years. It’s often a lower level yet enduring depression. But those with major depression who are treatment-resistant can also meet the diagnosis of dysthymia. So, impairment from dysthymia can range from mild to severe. Women, according to HealthFundingResearch.org, are three times more likely than men to suffer from dysthymia.
Those with seasonal affective disorder become depressed only or primarily during a particular season. For most with SAD, it’s during the fall and winter months, resulting from the 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 close to three percent of American adults, according to the NIMH. This treatable but lifelong disease typically develops in women in their mid to upper 20s. For men, the 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 often experience psychosis during bouts of mania and sometimes with depression too.
Postpartum depression affects 10% to 15% of women, according to the NIMH. 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 and following childbirth.
The exact cause of depression is unknown. But 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 genetic. Even hormonal changes can play a role in depression, particularly for women.
In some cases, depression results from an underlying medical condition, such as thyroid problems or low vitamin B levels. It’s important to visit your primary care physician for blood work to rule out other causes.
If medical causes are ruled out, it’s best to consult with a psychiatrist. Although primary care physicians can treat depression, psychiatrists have specialized training in diagnosing and treating the various forms of depression. For those who are treatment-resistant, psychopharmacologists have additional specialized training in how drugs affect the mind and behavior.
Many psychiatrists also recommend cognitive therapy with a behavioral therapist to help individuals cope with the effects of depression or deal with any underlying trauma or events fueling the depression. Finally, for those with SAD, sitting under a light therapy box daily for 20 to 40 minutes can help.