By Cecily Walters 2014-02-27 19:09:44
People with a depressive disorder can’t just “snap out of it” with a little self-talk and well-intentioned encouragement. I keep hearing references to someone being “bipolar,” but I’m not sure what that means. Is Seasonal Affective Disorder a real condition or just something that winter-haters claim to suffer? I don’t understand why my spouse/child/friend/parent won’t even try to be happy. How do I know if my sister is really suffering from postpartum depression, or if she’s just stressed out by her newborn? If someone is working, taking care of everyday responsibilities and being social, can they be truly depressed and in need of treatment? If you or someone you know has been medically diagnosed with one of several different classes of depressive disorder, then you likely know the answers to these questions. But for many, depression is a mystifying condition, one that too frequently is dismissed and minimized. Depression goes beyond occasionally feeling blue or down in the dumps. It’s a serious illness that can strike in a variety of forms. Experts believe that depression is most likely caused by a combination of genetic, biological, environmental and psychological factors. Some theorize that certain brain chemicals (neurotransmitters) are out of balance in depression sufferers. A family history of depression is seen as another factor. Different treatments are available, but there is no single guaranteed cure. Because depression is so common—said to affect some 19 million American adults and children by one estimate—School Nutrition is leading off this month’s coverage on mental health with an overview of this illness. While it’s our intent to raise awareness, promote understanding and reduce stigma about depression and other mental and mood disorders, it’s important to note that symptoms, causes and treatments can vary from one person to another and the information in this article should not be used in place of professional medical advice from your own practitioner. With that cautionary in mind, let’s start by exploring the different forms that depression can take, recognizing that symptoms may be quite similar from one type to another. The value in realizing that there is a wide spectrum of depressive disorders may help you appreciate the scope of possible diagnoses, as well as the importance of seeking medical assistance. MAJOR DEPRESSION Major depression is usually intense and disabling. It typically prevents the affected person from functioning normally. For the past several weeks, John has felt extremely fatigued and has had trouble sleeping almost every night. He has difficulty concentrating at work, and his usual hobbies of biking and reading no longer hold much interest. With friends and loved ones, he seems flat and disengaged. John has major depression (also known as clinical depression ). Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Between 20% and 25% of adults may suffer an episode of major depression at some point in their lives. While an individual may experience just one incident of major depression in a lifetime, it’s more likely for one to experience multiple episodes. Almost twice as many women as men are thought to experience bouts of major depression, as hormonal changes during puberty, menstruation, pregnancy, miscarriage and menopause may increase incidence. The disparity in rates of depression between women and men may be exacerbated by the fact that major depression in men is thought to be underreported, with men tending to be less likely than women to seek help or talk about their experience. Depression in senior adults, teens and children also often goes undiagnosed and untreated. Major depression is usually intense and disabling. It typically prevents the affected person from functioning normally. An episode of major depression can be triggered by a wide variety of causes and factors. These include • grief (over the death of a loved one or the end of a relationship); • social isolation; • stress at work or home; • major life changes (moving, graduation, job change, retirement); • caring for an aging parent and/or raising a child alone; • personal conflicts in relationships; • physical, sexual or emotional abuse; and • serious illness or other life challenges. It’s important to understand, however, that a major depressive episode may occur without an obvious trigger. Some experience minor depression, which features many of the same symptoms as major depression and lasts two weeks or more. The difference is that these tend not to be as debilitating, and the individual is more capable of participating in work, family and social activities. Still, the cumulative effects of minor depression should not be underestimated; if symptoms persist more than a few weeks, a health professional should be consulted. CHRONIC DEPRESSION To those who know her well, Kelly seems changed from the person she was only a few years ago. Sure, she’s functioning at home and work, but without much sustained enthusiasm or energy. She’s endlessly self-critical, worried and guilty. Her appetite, once healthy, has declined and she’s lost weight. Close friends and family members tell her that she seems rundown. Coworkers find her to have a “gloomy personality.” Kelly has chronic depression (also known as dysthymia ). According to the National Institute of Mental Health, chronic depression affects about 1.5% of American adults. The symptoms of chronic depression, are similar to those of major depression, but not necessarily as intense nor as disabling. But the symptoms tend to carry on for two years or much longer, and they can keep those who are affected from feeling their best and functioning optimally. People who experience chronic depression also may experience a simultaneous episode of major depression at the same time; this is called double depression. ATYPICAL DEPRESSION Like John and Kelly in the examples above, Sasha also feels sad or depressed for much of the day for days at a time, struggling to concentrate and enjoy regular activities. She also finds herself sleeping for 10 hours or more without feeling renewed or energized and notes periods where she literally feels “weighed down.” Unlike John and Kelly, however, Sasha often finds that her mood improves temporarily when something positive happens. Sasha has atypical depression. Mood reactivity is a significant characteristic of atypical depression that differentiates it from major depression, in which an individual remains resistant to commonplace mood elevators. Doctors believe that, despite the name, atypical depression is quite common and may be underdiagnosed. Those who are affected generally don’t have as many of the symptoms that people with major depression may experience. Some experts make a diagnosis based on the mood reactivity paired with at least two of the following symptoms: excessive sleeping, excessive appetite with weight gain, an increased sensitivity to rejection and having a feeling of being weighed down, paralyzed or “leaden.” BIPOLAR DISORDER Eli experiences depressive periods marked by a number of the same symptoms as John, Kelly and Sasha. He also frequently suffers from headaches that do not respond to treatment. More significantly, Eli cycles between depressive episodes and manic periods. These unpredictable and dramatic mood swings can carry Eli from a period of restless energy, extreme elation and unrealistic grandiose planning right into episodes of uncontrollable crying, increased sleep and thoughts of suicide—within days, hours or even minutes. He also tends to feel irritable at inappropriate situations. Eli has bipolar disorder. Bipolar disorder (once called manic depression) is a complex illness. The cause is not fully understood, though a genetic component has been discovered and the condition can run in families. It usually appears between ages 15 and 24 and persists for life. The scope and severity of symptoms vary depending on the individual. Some people may have a few symptoms, but others may have a number of symptoms that impair their ability to work and have a normal life. There are two forms of bipolar disorder. Full-fledged mania is the primary characteristic of bipolar I disorder , while bipolar II disorder is typified by milder periods of elation referred to as hypomania. The difference between mania and hypomania is “the degree of severity,” according to the American Psychiatric Association. If untreated, bipolar disorder has a high rate of recurrence. In addition, patients who experience severe mania may require hospitalization to keep them from risky behaviors, while those who are severely depressed may need to be hospitalized to keep them from acting on suicidal thoughts. SEASONAL DEPRESSION Seasonal depression is believed to be triggered by hormonal changes that occur at certain times of year. Reduced sunlight during fall and winter reduces production of a brain chemical that gives a soothing calm. Carmella experiences many of the symptoms of depression mentioned throughout this article, but they tend to occur specifically during the fall and winter. Carmella has seasonal depression (or Seasonal Affective Disorder ). Although a spring/summer form of the condition exists, “winter depression” is more common. Seasonal depression is believed to be triggered by hormonal changes that occur at certain times of the year. Specifically, reduced sunlight during fall and winter months is said to lead to a reduced production of serotonin (a neurotransmitter that produces a soothing, calming effect) in the brain. When the brain does not produce enough serotonin, a person may experience feelings of depression, along with fatigue, weight gain and carbohydrate cravings (because foods high in carbohydrates increase serotonin). Seasonal depression often starts in young adulthood and is more common in females than in males. While some people with this form of depression experience mild symptoms, others have more severe symptoms that can interfere with relationships and productivity. As with other types of depression, consult a medical professional if you believe you recognize symptoms of depression that recur at the same time each year. PSYCHOTIC DEPRESSION Mike often hears “voices,” gets angry for no apparent reason and neglects his appearance by not bathing or changing clothes. He has psychotic depression, a subtype of major depression that occurs when a severe depressive illness includes some form of psychosis. The psychosis may take the form of hallucinations, delusions or some other break with reality. Psychotic depression affects about one out of every four individuals hospitalized for depression. While people with other mental illnesses, such as schizophrenia, also may experience psychosis, someone with psychotic depression usually experiences delusions or hallucinations specifically associated with emotions related to depression (such as worthlessness or failure). Psychotic symptoms in schizophrenia, on the other hand, tend to be less logical, more bizarre or have no connection to a mood state. [Editors’ Note: For more on schizophrenia and other psychiatric illnesses, see “Through the Looking Glass,” on page 28, and this month’s Bonus Web Content.] Experiencing an episode of psychotic depression increases the chance of the individual going on to exhibit symptoms of bipolar disorder with recurring episodes of psychotic depression, mania and attempts at suicide. Psychotic depression can be difficult to diagnose because the individual may go to lengths to hide such thoughts. POSTPARTUM DEPRESSION A full month after giving birth, Tanya feels sad, hopeless and worthless. She has little energy for caring for and bonding with her new baby and no desire to resume any of her favorite activities. Tanya has postpartum depression. Many new mothers experience the “baby blues” in the initial weeks after a newborn’s arrival. It’s not uncommon to feel moody, teary and overwhelmed, but these symptoms usually are accompanied by happy feelings of welcoming new life to the world. The baby blues typically fade within a few weeks’ time. Postpartum depression, on the other hand, is diagnosed when a new mother experiences a major depressive episode within one month of delivery. One in eight new mothers develops this condition, and experts believe that it appears to be brought on by the changes in hormone levels that occur after pregnancy. Any woman can experience postpartum depression in the months after childbirth, miscarriage or stillbirth, but some studies show that first-time mothers may be at a higher risk. Women who previously have had depression or postpartum depression, have poor support from their partner and/or other loved ones, have a sick or colicky baby and/or experience a great deal of other stress also are believed to have a greater chance of experiencing postpartum depression. Symptoms may intensify over time, peaking three to four months after pregnancy. Men can experience a variation of postpartum depression, too, according to research published in the Journal of the American Medical Association in 2010. Symptoms of postpartum depression in men include sadness, loss of interest, sleep problems and low energy. A man also may find himself irritable, wanting to withdraw and disengage from the family. Postpartum depression occurs in men at a rate that is two times higher than other forms of depression in men. The cause is not understood, but research shows that it tends to run in families, and fathers are more likely to become depressed before or after a baby’s birth if their spouse or partner also experiences postpartum depression. Above all, try to remember that depression is NOT a character defect or controllable weakness. GETTING HELP To treat most types of depression, a doctor may suggest an antidepressant medication and/or psychotherapy (also called “talk therapy”) with a medical professional who specializes in mental health. In addition, many experts also encourage patients with depression to make lifestyle adjustments associated with chasing away the more conventional “blues.” These include regular exercise, a balanced diet, stress-reducing activities like yoga and meditation, consistent bed-times, etc. Certain forms of depression require other tactics. For a seasonal depression diagnosis, for example, a doctor may recommend (in addition to medication) that the individual try to get outside early in the morning to increase exposure to natural light, spending some time outside every day (even when it is cloudy) and daily use of a light box (shining light 20 times brighter than normal room lighting). A woman with postpartum depression will need to work with her doctor to determine the effect of medications on breastfeeding. Treatment for psychotic depression generally requires in-patient care at a hospital. Untreated depression of any type can have debilitating and devastating consequences. If you are experiencing symptoms of depression, recognize that these likely will leave you feeling depleted of energy, unwilling or unsure of what to do to help yourself feel better—right when you need help the most! Awareness is your best tool in this situation. Try to identify and collect resources at a time when you are not in the middle of a depressive period, so these are easily accessible when you are at your lowest. School Nutrition has compiled a list that may prove helpful; you can find it at www.schoolnutrition.org/snmagazine bonuscontent. Empower loved ones to provide assistance. [Editors’ Note: “Love and ‘Madness,’” on page 36, addresses the role of friends and family in addressing depression.] Other tips and advice appear in the box on page 24. Above all, try to remember that depression is not a character defect or controllable weakness. It’s not your fault, and it makes you no less worthy of love or the good things in life than someone who is not depressed. Be gentle with yourself and approach your management of this medical condition on a day-by-day basis. Finally, if you experience symptoms of depression that last for more than two weeks, don’t delay in making an appointment with a doctor or other mental health professional. Where to Begin? While family members and friends can be invaluable in getting you the help you need, for most people living with a depressive disorder, you need to take the first steps yourself. The National Institute of Mental Health offers the following guidance. • Do not wait too long to get evaluated or treated. Some research indicates that the longer one waits, the greater the impairment in the future. Try to see a mental health professional as soon as you become aware of symptoms. • Try to be active and exercise. In addition, make an effort to participate in some of the activities and events you once enjoyed, such as a movie or sporting event. • Set realistic goals for yourself. Break up large tasks into smaller ones, set priorities and do what you can as you can. • Try to avoid isolation and spend time with other people. Confide your struggles with a trusted friend or relative. Allow others to help you. • Expect your mood to improve gradually, not immediately. Do not expect to suddenly “snap out of” your depression. • Postpone important decisions (especially life-changing ones like marriage, divorce or new job) until you feel better. Discuss decisions with others who know you well and have a more objective view of the situation. • Remember that positive thinking will replace negative thoughts as your depression responds to treatment. • Continue to educate yourself about depression. Cecily Walters is School Nutrition’s managing editor. Photography by VMJones, BeholdingEye and V2images/istockphoto.com. TO YOUR CREDIT: For CEUs toward SNA certification, complete the “To Your Credit” test on page 58. SNAPSHOT • Depression is a serious condition that is more disabling and sustained than periodically feeling blue. • It can interfere with multiple aspects of a person’s daily life and relationships. • There are many different forms of diagnosed depression. BONUS WEB CONTENT Some people with a depressive disorder may find themselves preoccupied with suicidal thoughts, feeling that the world would be better off without them. Learn the important facts about suicide and how to reach out for help if you are feeling suicidal as part of this month’s online-exclusive content at www.schoolnutrition.org/snmagazinebonuscontent. In addition, we’ll explore how depression manifests itself with older adults, as well as children and teens. Plus, we’ve compiled a list of resources for more information and support.
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