Depressive disorders come in different forms

By Prasanna Panditharatne (Consultant Psychologist)

“I am very glad that we live in the age that we do, because while there is still a stigma attached to mental illness, it is not as bad as it was in the past. Depression has also been referred to by many different names and particularly as ‘the Black Dog’ --- and in my terms simply as the ‘Deep Dark Hole’ with the heavy black clouds overhead” --- and I have fallen into that deep dark hole more times now than I care to remember. The deep dark hole is a horrible place to be in and because of that it can be very scary. Depression has also very nearly claimed my life, and made me just another statistic on the list of sorry individuals who could not live with the resulting problems, and pressures, and muddled up thoughts that are all by-products of depression” - Ms. A
A depressive disorder is an illness that involves the body, mood and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away.

Different forms

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. Three of the most common types of depressive disorders are described in this article. However, within these types there are variations in the number of symptoms, their severity, and persistence.
Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once, but more commonly occurs several times in a lifetime.
A less severe type of depression, Dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression).
Sometimes the mood switches are dramatic and rapid, but most often they are gradual.
Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some may experience many. Severity of symptoms varies with individuals and also varies over time. Eg:
n Persistent sad, anxious, or empty moods
n Feelings of hopelessness or pessimism
n Feelings of guilt, worthlessness or helplessness
n Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
n Decreased energy, fatigue, being “slowed down”
n Difficulty in concentrating,
remembering or making decisions
n Insomnia, early morning awakening or oversleeping
n Appetite and/or weight loss, or overeating and weight gain
n Thoughts of death or suicide, suicide attempts
n Restlessness, irritability
n Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain
n Mania
n Abnormal or excessive elation
n Unusual irritability
n Decreased need for sleep
n Grandiose notions
(High-flying)
n Increased talking
n Racing thoughts
n Increased sexual desire
n Markedly increased energy
n Poor judgment
n Inappropriate social behavior

Causes

Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder indicated that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work or school, are involved in its onset.
Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.
People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.
In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, heart attack, cancer, Parkinson’s disease and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses or none at all.

Depression in women

Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women — particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, perimenopause and menopause. Many women also face additional stresses such as responsibilities, both at work and home, single parenthood and caring for children and aging parents.
Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient “blues” are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatments by an eloquent psychologist and the family’s emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being as well as her ability to care for and enjoy the infant.

Depression in men

Although men are less likely to suffer from depression than women, 1 to 2 million men in Australia are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In fact, at age 70, the rate of men’s suicide rises, reaching a peak after age 85.
Depression can also affect the physical health in men differently from women. A new study shows that although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate.

Medications

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn’t helping at all. It is important to keep using medication until it has a chance to work, though side effects may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for at least four to nine months to prevent a recurrence of the depression. Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor.
The second most important aspect is to offer emotional support.
If you have any concerns about the depression or any other psychological issues please do contact the writer by simply visiting his website, or write to him.

www.pbpconsultancy.com
or prabu1@pbpconsultancy.com