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What is Depression?
Depression is a serious mental illness. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, depression is persistent and can interfere significantly with an individualâ€™s ability to function.
What Are the Symptoms of Depression?
Symptoms of depression include persistent sad mood, loss interest or pleasure in activities that were once enjoyed, change in appetite or weight, difficulty sleeping or oversleeping, physical slowing or agitation, energy loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide. A diagnosis of unipolar major depression (or major depressive disorder) is made if a person has five or more of these symptoms and impairment in usual functioning nearly every day during the same two-week period. Major depression often begins between ages 15-30 or even earlier. Episodes typically recur. An estimated 5.3 percent of American adults ages 18 to 54 suffer from unipolar major depression in a given year.
Some people have a chronic but less severe form of depression, called dysthymia (or dysthymic disorder), that is diagnosed when depressed mood persists for at least two years and is accompanied by at least two other symptoms of depression. An estimated 1.6 percent of American adults ages 18 to 54 have dysthymia in a given year. Many people with dysthymia also have major depressive episodes. While unipolar major depression and dysthymia are the primary forms of depression, a variety of other subtypes exist.
Depression can be devastating to all areas of a personâ€™s everyday life, including family relationships, friendships, and the ability to go to work or go to school. Many people still believe that the emotional symptoms caused by depression are â€śnot real,â€ť and that a person should be able to shake off the symptoms if only he or she were trying hard enough. Because of these inaccurate beliefs, people with depression either many not recognize that they have a treatable disorder or may be discouraged from seeking or staying on treatment because of feelings of shame and stigma. Too often, untreated or inadequately treated depression leads to suicide.
Research has shown that stress in the form of loss, especially death of close family members or friends, may trigger major depression in vulnerable individuals. In addition, research supports existence of a genetic component to risk of depression.
What Treatments Are Available for Depression?
Antidepressant medications are widely used, effective treatments for depression. Antidepressant drugs are known to influence the functioning of certain neurotransmitters (chemicals used by brain cells to communicate), primarily serotonin, norepinephrine, and dopamine, known as monoamines. Older medications â€“ tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) â€“ affect the activity of all of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions. Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients to adhere to treatment. Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another. Medications that take entirely different approaches to treating depression are now in development.
Psychotherapy is also effective for treating depression. Certain types of psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80 percent of people with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination.
Recently there has been enormous interest in herbal remedies for various medical conditions including depression. One herbal supplement, hypericum, or St. Johnâ€™s wort, has been promoted as having antidepressant properties. However, no carefully designed studies have determined the antidepressant efficacy of this supplement. NIMH is currently enrolling patients in a first large-scale, multi-site, controlled study of St. Johnâ€™s wort conducted in the U.S. as a potential treatment for depression.
Fact Sheets, Major Mental Disorders; Symptoms and Treatments
Mental Health: A Report by the Surgeon General
Department of Health and Human Services
The entire 487 page report, Mental Health: A Report by the Surgeon General is available online.
For more detailed information on depression, be sure to visit our Reference Shelf. Supplemental information can be found in our First Person Experiences, Books, and Videos sections.
Return to Basic/General Information About Depression and Bipolar Disorder (Manic-Depressive Illness)
DRADA's mission is to alleviate the suffering arising from depression and bipolar illness by assisting self-help groups, providing education and information, and lending support to research programs.
Click here to go to membership and donation form. (Requires AdobeÂ® AcrobatÂ® ReaderÂ®)
The videos listed here can be purchased from DRADA. To order a video from DRADA, click here.
Videos Produced by DRADA
Day for Night: Recognizing Teenage Depression. DRADA, 1999. (26 minutes, VHS, $60.00)
In the video, teenagers relate their own experiences with depression and/or bipolar disorder (manic-depressive illness), their treatments and recovery, and encourage other teens to seek help. Also, professional explanations and tips about recognizing and treating these illnesses are provided by Paramjit Joshi, M.D., Chairman, Department of Psychiatry and Behavioral Sciences, Children's National Medical Center and formerly associate professor of Child and Adolescent Psychiatry at the Johns Hopkins University School of Medicine. Click here for more information.
A Patient's Perspective—Dick Cavett. DRADA, 1993. (43 minutes, VHS, $14.28)
In a conversational interview format talk-show host Dick Cavett describes in clear detail his debilitating experiences with depression. Despite the seriousness of the topic, he slipped in many lively, quick-witted comments which are his trademark. The interview took place at DRADA's 1992 Mood Disorders Research/Education Symposium, and includes questions from the audience.
A Patient's Perspective—Mike Wallace. DRADA, 1992. (40 minutes, VHS, $14.28)
In this 1992 video, the CBS correspondent describes his experiences with depression. In this breakthrough appearance Mike Wallace was one of the first media stars to discuss the illness in this type of format. The interview took place at DRADA's 1991 Mood Disorders Research/Education Symposium.
Depressive Illness: What You Need to Know. Education/Information Committee. DRADA, 1991. (63 minutes, VHS, $19.04)
This video combines discussion of key information about the illness illustrated by relevant excerpts of DRADA members discussing their personal experiences with the illness. Features J. Raymond DePaulo, Jr., M.D.
Downtime: A Worksite Guide to Understanding Clinical Depression. DRADA in cooperation with the Wellness Councils of America (WELCOA), 1993. (16 minutes, VHS [comes with a 34-page meeting guide]. Was $65.00, now $19.04.
Portrays the on-the-job story of employees with depression, and gives additional information. Outlines, in printed guide for presenters, a worksite training session. An award-winner, with commentary by Dick Cavett.
Videos Produced by Kay Redfield Jamison
To Paint the Stars. Kay Redfield Jamison, Ph.D., 1990 (56 minutes, VHS, $33.33)
A moving 1990 video about Vincent van Gogh, and the effect of mental illness on his life and work.
Moods and Music. Kay Redfield Jamison, Ph.D., 1988, distributed only by DRADA. (60 minutes, VHS, $33.33)
An evening at the Kennedy Center in Washington, D.C., organized by Key Jamison and colleagues to honor four composers who had mood disorders: George Frideric Handel, Robert Schumann, Hugo Wolf, and Hector Berlioz. Music demonstrates their highs and lows.
Stronger than Death: When Suicide Touches Your Life, Chance, Sue, M.D. New York: Norton & Company, 1992. ($19.95)
Stronger than Death is Sue Chance's personal account of the aftermath of her son's suicide, with excerpts from the journal she kept for nearly a year. The author, a psychiatrist, is able to convey the intensity of her grief, while always keeping an avenue open to allow for hope, and somehow, recovery. She reviews not only her own relationship with her son, but also those of her parents, brother, and other family and friends. Her trained, analytical mind looks everywhere for answers but does not place any blame.
This is a small, very well written book, intimate and intense, with no wordiness or technical jargon that would tend to hide Dr. Chance's devastation and how she dealt with it. The author thoughtfully provided a section on resources, symptoms of major depression and posttraumatic stress disorder, as well as a bibliography and index.
by Louise Riemer
DRADA Book Committee
A PATIENT'S PERSPECTIVE — ROBERT BOORSTIN, a report on an interview 1 of Robert Boorstin, Smooth Sailing, Spring 1994
Mr. Robert Boorstin, special assistant to President Clinton, presented a lively, candid, and often very humorous account of his experiences living with and learning to cope with his bipolar disorder.
He was first diagnosed with the illness in July 1987 after having been seriously depressed for over four years. During that time he made a number of attempts to learn what was wrong with him, but he continued to be tearful and often unable to get out of bed; and he called his parents frequently for sympathy and support.
His depression became worse as he pushed himself harder in his graduate studies at Cambridge, England. He was trying to learn Chinese and Russian, teach classes, and write his graduate thesis at the same time. Under this pressure he began to drink excessively, napped a great deal, failed to exercise, and was generally miserable. He had "suicidal flashes" but was never actively suicidal because he knew what his death would do to his mother.
After returning to the United States, he worked as a writer for the New York Times. In New York he had his first manic episode, which resulted in his first admission to the hospital. His symptoms of mania were sleeping only three to four hours a night, getting speeding tickets for driving at 120 mph, frantic socializing, and hypersexuality.
He describes his first hospitalization as "ego shattering. One day you are a writer for the New York Times and the next you are in a mental hospital." He developed a pattern of castigating himself for being mentally ill; then he said, "I would get mad at myself for getting mad at myself!" He humorously described the antipsychotic medication given early in his hospitalization as "steel wool to the brain." He does well on lithium, which he says keeps him from going too far up or too far down. He has a few side effects from lithium, such as a slight tremor, some slowing of his thinking, and some daytime sleepiness. He handles the sleepiness with daily half-hour naps, which he is entitled to as a "reasonable accommodation" under the Americans with Disabilities Act.
Mr. Boorstin is more concerned about the mania than the depression; the latter is well controlled with medication. A particularly poignant dilemma is his inability to trust his own emotions and, therefore, to completely enjoy being happy; he always wonders whether he is just happy or if he is headed for trouble in the form of a manic episode. He finds it helpful to direct his assistant to monitor his behavior, let him know if he gets too irritable or too "off the wall."
Mr. Boorstin was quite candid in his discussion of what he found helpful and unhelpful during episodes of his illness. He found participation in a support group enormously helpful. There he learned "how lucky (he) was" in that his illness was responsive to medication. His mother was helped greatly early in the course of his first hospitalization by the reassurance of a hospital nurse, who said that she should "relax; he will be out of here in a few weeks and he'll be good as new."
Despite some difficult experiences, Mr. Boorstin believes wholeheartedly in the value of psychotherapy. "Drugs alone are not enough," he says. Psychotherapy is especially useful to help the patient accept the reality of his or her illness and the need for continued and probably lifelong treatment. Mr. Boorstin is most pleased with his current therapist, who has helped him through various stages of understanding and accommodation to his illness. He describes these stages as self-pity (why me?), helplessness (I'm manic-depressive and I can't do anything about it), and objectivity (I'm a person who happens to have manic-depressive illness). Mr. Boorstin especially values the steadfastness of his current therapist—his never giving up on him.
The audience question-and-answer period was lively. In response to a question about obtaining a government security clearance, Mr. Boorstin explained that he was so open about his illness when the FBI agent questioned him that the agent revealed that his own sister had the illness as well! Mr. Boorstin has been equally open with his colleagues. When he became ill the first time, his colleague George Stephanopoulos visited him in the hospital.
He is very active in advising government officials on mental health issues, particularly with regard to national health insurance. To overcome stigma it is vital for patients and family members to be open about the illness. Mr. Boorstin urged that primary-care physicians be educated more thoroughly about mental disorders since they provide much of the diagnosis and treatment. And, finally, Mr. Boorstin encourages the use of a great deal of what was in frequent evidence throughout his talk—a sense of humor. Mr. Boorstin's presentation was candid, informative, and thought provoking, and his lively use of humor made it most enjoyable.
1 An interview at a DRADA/Johns Hopkins symposium, Baltimore, Maryland, April,1994
Young People's Outreach Program
DRADA's most notable educational program is the Young People's Outreach Program, which seeks to:
Mental health professionals from DRADA or involved with DRADA visit high schools to talk about depression to students, parents, and teachers. This program continues to expand and already is well recognized for its effectiveness in teaching teens about the signs and symptoms of depression as well as where to seek help. These visits include presentations of "Day for Night-Recognizing Teenage Depression", DRADA's award winning video.
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