Introduction | Symptoms and diagnosis | Causes of depression | Treatment | Role of family and friends

Introduction

The term 'depression' is often used to describe an emotion experienced by many people. Everyone feels, sad or 'down' occasionally, but such feelings can pass fairly quickly. In contrast, people who are diagnosed by their doctors as suffering from 'major depression' are experiencing a serious medical illness, which affects not only their mood, but also a range of other normal bodily functions. Depression may affect the way a person eats and sleeps, but not least the way they feel about themselves. This is not a passing mood, and people with depression cannot be 'blamed' for their feelings.

People with major depression often feel sad, helpless, hopeless, and irritable. While it is normal for everyone to experience these feelings occasionally, people suffering from clinical depression cannot simply 'snap out of it'. It is the persistence and severity of the emotions that distinguishes the mental illness of depression from normal mood changes. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, clinical depression is persistent and can interfere significantly with an individual's ability to function. Depression can be devastating to all areas of a person's everyday life, including family relationships, friendships, and the ability to work or go to school.

If someone is diagnosed with depression (the doctor may also refer to 'clinical depression') this means that the symptoms with which the person is suffering are severe enough to require treatment. Doctors recognize several types of clinical depression, which differ in important ways. Among these are major depression, dysthymia, double depression, bipolar disorder, and seasonal affective disorder (SAD).

Depression is a major world-wide health problem, and places great demands on health and social services. In any year, nearly one in ten adults may be suffering from depressive symptoms; depression is the single greatest cause of problem disability across the world. The highest rates of depressive illness are found among people in their early twenties to mid forties, and the rate of clinical depression in women (about 12%) is almost double that in men (about 7%). One in four women, is likely to experience severe depression, yet only about one fifth of women with depression receive the correct treatment. Women are also more likely to suffer from other symptoms, such as anxiety, sleep disorders, panic attacks, and eating disorders, at the same time as depression.

Depressive illnesses usually begin in adolescence or early adulthood, but for many people, their depression goes undetected for several years. This may be partly due to the public perception that depression is not a real illness. Because of this, people with depression either may not realize that they have a treatable illness, or may be discouraged from asking for treatment because of feelings of shame (at the thought that they are to blame for their symptoms). As a result, many people suffer for years without a proper diagnosis or treatment. This is very unfortunate, because depression is one of the most treatable of the mental illnesses. Between 80 and 90% of depressed people respond to treatment, and nearly all depressed people who receive treatment experience at least some relief from their symptoms. Psychiatrists agree that severely depressed patients benefit most from a combination of medication and psychotherapy. However, without treatment, the symptoms of depression can last for weeks, months, or years. Having one episode of depression greatly increases the risk of having another episode.

Depression is an illness, which affects people over many years, and needs long periods of treatment. Some people may seem to recover but then relapse, but it is important to recognize that treatment can prevent this. However, this means that some people may feel well, but will still need to take medication to prevent their symptoms reappearing.

Depression in older people is often not detected or not treated correctly. As a person ages, the signs of depression are much more likely to be dismissed as eccentricity or bad-temper. Depression can also be difficult to recognize in older people, because confusion or problems with attention, which are caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Mood changes and signs of depression can also be caused by medicines, which older people may take for high blood pressure or heart disease.