Causes of Depression and a Closer Look at What Depression Is
What Is Depression?
Virginia J. Duffy PhD, Psychiatric Nurse Practitioner
People use the word depression loosely to mean a number of
different moods. I prefer to use the term “clinical depression” to
distinguish the type of depression that may improve with medication.
Clinical depression is more than the "blues” or sadness. It is not something
a person can "just get over" or talk themselves out of. Clinical depression
is at least partially based on brain biochemical imbalance (we are still in
early stages of understanding this) and often runs in families. Stress and
psychological factors also play an important role, although we do not fully
understand the causes and factors that result in clinical depression
Common symptoms of depression include sad or irritable mood, loss of
interest / energy, poor or excessive sleep and appetite, difficulty with
concentration and memory, and physical complaints. Medication is often
necessary in serious depression and MAY be helpful with less severe types.
Types Of Depression
There are four types of depression listed in the current Diagnostic and
Statistical Manual (DSM 4 TR). The intent of this manual is to help those in
the mental health field make accurate diagnoses. One of its goals is to make
the diagnosis more consistent between providers. Unfortunately it is often
used haphazardly.
1. Adjustment Disorder With Depressed Mood
A reaction to a stressor. (Loss of a loved one, job, physical illness, move
etc.) This type of disturbed mood is usually mild and self-limiting. When
symptoms last longer than 6 months another type of depression should be
considered. Counseling, therapy and support may be sufficient treatment.
Medication is not usually necessary.
2. Dysthymia
A chronic low-level depression. It can be very debilitating and may be a
part of the personality. It also can be difficult to treat with medication;
therapy is recommended.
3. Major depression
A severe form of depression with multiple symptoms as described above.
Medication is necessary and usually very effective. Therapy may be helpful
after acute symptoms have abated. Suicide potential must be monitored. This
can be severe enough to cause psychotic (loss of reality) symptoms, such as
delusions and hallucinations.
4. Bi-Polar 1 Disorder
A cycle of depression and elevation of mood (hypomania or mania). This can
be very severe, with psychotic symptoms. Antidepressants may be avoided due
to risk of switching the mood to mania. This condition needs expert
psychiatric treatment usually with mood stabilizing medication. (By the way
there is a significant amount of confusion and disagreement about this
diagnosis especially between Bipolar 1 and Bipolar 2 disorders. Bipolar 2
disorder is less severe and medication is often not necessary.)
Differential Diagnosis (problems that may be confused with
depression)
• Hypothyroidism (low thyroid)
• Grief
• Substance abuse
• Chronic pain
• Anxiety
• Side effects of medication
Target Symptoms Of Depression
Identifying and describing specific target symptoms is crucial if treatment
is to be monitored and its’ effectiveness evaluated. It is easy to forget
how severe symptoms were when depression is resolved. The more specific the
target symptoms are, the better to keep track of changes. Some examples of
target symptoms are listed below.
• Sleep Disturbance (difficulty falling or staying asleep, awakening often
during the night, early morning awakening, oversleeping)
• Concentration / Memory Problems
• Low Energy Level
• Irritability
• Physical complaints
• Change in Appetite (decreased or increased)
• Lack Of Motivation / Interest
• Mood Changes (sadness, anger hopelessness)
Is Depression
a Chemical Imbalance?
Seasonal Affective Disorder Beware the Winter Blahs!
This site is
entirely funded by Dr. Duffy Please send any email correspondence
to:
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