Sure, everybody feels sad or blue now and then. But if you’re sad most of the time, and it’s giving you problems with:

• your grades or attendance at school
• your relationships with your family and friends
• alcohol, drugs, or sex
• controlling your behavior in other ways

the problem may be DEPRESSION.

The good news is that you can get treatment and feel better soon. Approximately 4% of adolescents get seriously depressed each year. Clinical depression is a serious illness that can affect anybody, including teenagers. It can affect your thoughts, feelings, behavior, and overall health.

Most people with depression can be helped with treatment. But a majority of depressed people never get the help they need. And, when depression isn’t treated, it can get worse, last longer, and prevent you from getting the most out of this important time in your life.

So….Listen Up:

Here’s how to tell if you or a friend might be depressed.

First, there are two kinds of depressive illness: the sad kind, called major depression, and manic-depression or bipolar disorder, when feeling down and depressed alternates with being speeded-up and sometimes reckless.

You should get evaluated by a professional if you’ve had five or more of the following symptoms for more than two weeks or if any of these symptoms cause such a big change that you can’t keep up your usual routine…..

When You’re Depressed…

• You feel sad or cry a lot and it doesn’t go away.
• You feel guilty for no reason; you feel like you’re no good; you’ve lost your confidence.
• Life seems meaningless or like nothing good is ever going to happen again. You have a negative attitude a lot of the time, or it seems like you have no feelings.
• You don’t feel like doing a lot of the things you used to like – like music, sports, being with friends, going out – and you want to be left alone most of the time.
• It’s hard to make up your mind. You forget lots of things, and it’s hard to concentrate.
• You get irritated often. Little things make you lose your temper; you over-react.
• Your sleep pattern changes; you start sleeping a lot more or you have trouble falling asleep at night. Or you wake up really early most mornings and can’t get back to sleep.
• Your eating pattern changes; you’ve lost your appetite or you eat a lot more.
• You feel restless and tired most of the time.
• You think about death, or feel like you’re dying, or have thoughts about committing suicide.

When You’re Manic…

• You feel high as a kite…like you’re “on top of the world.”
• You get unreal ideas about the great things you can do…things that you really can’t do.
• Thoughts go racing through your head, you jump from one subject to another, and you talk a lot.
• You’re a non-stop party, constantly running around.
• You do too many wild or risky things: with driving, with spending money, with sex, etc.
• You’re so “up” that you don’t need much sleep.
• You’re rebellious or irritable and can’t get along at home or school, or with your friends.

Talk to Someone

• If you are concerned about depression in yourself or a friend, TALK TO SOMEONE about it. There are people who can help you get treatment:
• a professional at a mental health center or Mental Health Association
• a trusted family member
• your family doctor
• your clergy
• a school counselor or nurse
• a social worker
• a responsible adult

Or, if you don’t know where to turn, the telephone directory or information operator should have phone numbers for a local hotline or mental health services or referrals.

Depression can affect people of any age, race, ethnic or economic group.

Let’s Get Serious Here

Having depression doesn’t mean that a person is weak, or a failure, or isn’t really trying…it means they need treatment.

Most people with depression can be helped with psychotherapy, medicine, or both together.

Short-term psychotherapy, means talking about feelings with a trained professional who can help you change the relationships, thoughts, or behaviors that contribute to depression.

Medication has been developed that effectively treats depression that is severe or disabling. Antidepressant medications are not “uppers” and are not addictive. Sometimes, several types may have to be tried before you and your doctor find the one that works best.

Treatment can help most depressed people start to feel better in just a few weeks.

So remember, when your problems seem too big and you’re feeling low for too long, YOU ARE NOT ALONE. There’s help out there and you can ask for help. And if you know someone who you think is depressed, you can help: Listen and encourage your friend to ask a parent or responsible adult about treatment. If your friend doesn’t ask for help soon, talk to an adult you trust and respect — especially if your friend mentions suicide.

What You Need to Know About Suicide…

Most people who are depressed do not commit suicide. But depression increases the risk for suicide or suicide attempts. It is not true that people who talk about suicide do not attempt it. Suicidal thoughts, remarks, or attempts are ALWAYS SERIOUS…if any of these happen to you or a friend, you must tell a responsible adult IMMEDIATELY…it’s better to be safe than sorry….

Why Do People Get Depressed?

Sometimes people get seriously depressed after something like a divorce in the family, major financial problems, someone you love dying, a messed up home life, or breaking up with a boyfriend or girlfriend.

Other times – like with other illnesses – depression just happens. Often teenagers react to the pain of depression by getting into trouble: trouble with alcohol, drugs, or sex; trouble with school or bad grades; problems with family or friends. This is another reason why it’s important to get treatment for depression before it leads to other trouble.

Depression and Alcohol and Other Drugs

A lot of depressed people, especially teenagers, also have problems with alcohol or other drugs. (Alcohol is a drug, too.) Sometimes the depression comes first and people try drugs as a way to escape it. (In the long run, drugs or alcohol just make things worse!) Other times, the alcohol or other drug use comes first, and depression is caused by:

• the drug itself, or
• withdrawal from it, or
• the problems that substance use causes.

And sometimes you can’t tell which came first…the important point is that when you have both of these problems, the sooner you get treatment, the better. Either problem can make the other worse and lead to bigger trouble, like addiction or flunking school. You need to be honest about both problems — first with yourself and then with someone who can help you get into treatment…it’s the only way to really get better and stay better.

Depression is a real medical illness and it’s treatable.

Be Able to Tell Fact From Fiction

Myths about depression often prevent people from doing the right thing. Some common myths are:

Myth: It’s normal for teenagers to be moody; teens dont suffer from real depression.
FACT: Depression is more than just being moody, and it can affect people at any age, including teenagers.

Myth: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it.
FACT: Depression, which saps energy and self-esteem, interferes with a person’s ability or wish to get help. It is an act of true friendship to share your concerns with an adult who can help.

Myth: Talking about depression only makes it worse.
FACT: Talking through feelings with a good friend is often a helpful first step. Friendship, concern, and support can provide the encouragement to talk to a parent or other trusted adult about getting evaluated for depression.

Source: The National Institute of Mental Health

Mental illnesses affect women and men differently–some disorders are more common in women, and some express themselves with different symptoms. Scientists are only now beginning to tease apart the contribution of various biological and psychosocial factors to mental health and mental illness in both women and men. In addition, researchers are currently studying the special problems of treatment for serious mental illness during pregnancy and the postpartum period. Research on women’s health has grown substantially in the last 20 years. Today’s studies are helping to clarify the risk and protective factors for mental disorders in women and to improve women’s mental health treatment outcome.

Depressive Disorders

In the U.S., nearly twice as many women (12.0 percent) as men (6.6 percent) are affected by a depressive disorder each year. These figures translate to 12.4 million women and 6.4 million men. Depressive disorders include major depression, dysthymic disorder (a less severe but more chronic form of depression), and bipolar disorder (manic-depressive illness). Major depression is the leading cause of disease burden among females ages 5 and older worldwide.

Depressive disorders raise the risk for suicide. Although men are 4 times more likely than women to die by suicide, women report attempting suicide about 2 to 3 times as often as men. Self-inflicted injury, including suicide, ranks 9th out of the 10 leading causes of disease burden for females ages 5 and older worldwide.

Research shows that before adolescence and late in life, females and males experience depression at about the same frequency. Because the gender difference in depression is not seen until after puberty and decreases after menopause, scientists hypothesize that hormonal factors are involved in women’s greater vulnerability. Stress due to psychosocial factors, such as multiple roles in the home and at work and the increased likelihood of women to be poor, at risk for violence and abuse, and raising children alone, also plays a role in the development of depression.

While many women report some history of premenstrual mood changes and physical symptoms, an estimated 3 to 4 percent suffer severe symptoms that significantly interfere with work and social functioning. This impairing form of premenstrual syndrome, also called Premenstrual Dysphoric Disorder (PMDD), appears to be an abnormal response to normal hormone changes. Researchers are studying what makes some women susceptible to PMDD, including differences in hormone sensitivity, history of other mood disorders, and individual differences in the function of brain chemical messenger systems. Antidepressant medications known to work via serotonin circuits are effective in relieving the premenstrual symptoms. Women with susceptibility to depression may be more vulnerable to the mood-shifting effects of hormones.

Postpartum depression is a serious disorder where the hormonal changes following childbirth combined with psychosocial stresses such as sleep deprivation may disable some women with an apparent underlying vulnerability. NIMH research is evaluating the use of antidepressant medication and psychosocial interventions following delivery to prevent postpartum depression in women with a history of this disorder.

NIMH researchers recently found that women who suffer depression as they enter the early stages of menopause (perimenopause) may find estrogen to be an alternative to traditional antidepressants. The efficacy of the female hormone was comparable to that usually reported with antidepressants in the first controlled study of its direct effects on mood in perimenopausal women meeting standardized criteria for depression.

Anxiety Disorders

Anxiety disorders, which include panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), phobias, and generalized anxiety disorder, affect an estimated 13.3 percent of Americans ages 18 to 54 in a given year, or about 19.1 million adults in this age group. Women outnumber men in each illness category except for OCD and social phobia, in which both sexes have an equal likelihood of being affected.

Results from an NIMH-supported survey showed that female risk of developing PTSD following trauma is twice that of males. PTSD is characterized by persistent symptoms of fear that occur after experiencing events such as rape or other criminal assault, war, child abuse, natural disasters, or serious accidents. Nightmares, flashbacks, numbing of emotions, depression and feeling angry, irritable, or distracted and being easily startled are common. Females also are more likely to develop long-term PTSD than males and have higher rates of co-occurring medical and psychiatric problems than males with the disorder.

Eating Disorders

Females comprise the vast majority of people with an eating disorder–anorexia nervosa, bulimia nervosa, or binge-eating disorder. In their lifetime, an estimated 0.5 to 3.7 percent of females suffer from anorexia and an estimated 1.1 to 4.2 percent suffer from bulimia. An estimated 2 to 5 percent experience binge-eating disorder in a 6-month period. Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable illnesses. In addition, eating disorders often co-occur with depression, substance abuse, and anxiety disorders, and also cause serious physical health problems. Eating disorders call for a comprehensive treatment plan involving medical care and monitoring, psychotherapy, nutritional counseling, and medication management. Studies are investigating the causes of eating disorders and effectiveness of treatments.

Schizophrenia

Schizophrenia is the most chronic and disabling of the mental disorders, affecting about 1 percent of women and men worldwide.In the U.S., an estimated 2.2 million adults ages 18 and older, about half of them women, have schizophrenia. The illness typically appears earlier in men, usually in their late teens or early 20s, than in women, who are generally affected in their 20s or early 30s. In addition, women may have more depressive symptoms, paranoia, and auditory hallucinations than men and tend to respond better to typical antipsychotic medications. A significant proportion of women with schizophrenia experience increased symptoms during pregnancy and postpartum.

Alzheimer’s Disease

The main risk factor for developing Alzheimer’s disease (AD), a dementing brain disorder that leads to the loss of mental and physical functioning and eventually to death, is increased age. Studies have shown that while the number of new cases of AD is similar in older adult women and men, the total number of existing cases is somewhat higher among women. Possible explanations include that AD may progress more slowly in women than in men; that women with AD may survive longer than men with AD; and that men, in general, do not live as long as women and die of other causes before AD has a chance to develop. Research is being conducted to find ways to prevent the onset of AD and to slow its progression.

Caregivers of a person with AD are usually family membersoften wives and daughters. The chronic stress often associated with the caregiving role can contribute to mental health problems; indeed, caregivers are much more likely to suffer from depression than the average person. Since women in general are at greater risk for depression than men, female caregivers of people with AD may be particularly vulnerable to depression.

Source: The National Institute of Mental Health

Depression is a pervasive and impairing illness that affects both women and men, but women experience depression at roughly twice the rate of men. Researchers continue to explore how special issues unique to women-biological, life cycle, and psycho-social-may be associated with women’s higher rate of depression.

No two people become depressed in exactly the same way. Many people have only some of the symptoms, varying in severity and duration. For some, symptoms occur in time-limited episodes; for others, symptoms can be present for long periods if no treatment is sought. Having some depressive symptoms does not mean a person is clinically depressed. For example, it is not unusual for those who have lost a loved one to feel sad, helpless, and disinterested in regular activities. Only when these symptoms persist for an unusually long time is there reason to suspect that grief has become depressive illness. Similarly, living with the stress of potential layoffs, heavy workloads, or financial or family problems may cause irritability and “the blues.” Up to a point, such feelings are simply a part of human experience. But when these feelings increase in duration and intensity and an individual is unable to function as usual, what seemed a temporary mood may have become a clinical illness.

The Types of Depressive Illnesses

1. In major depression, sometimes referred to as unipolar or clinical depression, people have some or all of the symptoms listed below for at least 2 weeks but frequently for several months or longer. Episodes of the illness can occur once, twice, or several times in a lifetime.
2. In dysthymia, the same symptoms are present though milder and last at least 2 years. People with dysthymia are frequently lacking in zest and enthusiasm for life, living a joyless and fatigued existence that seems almost a natural outgrowth of their personalities. They also can experience major depressive episodes.
3. Manic-depression, or bipolar disorder, is not nearly as common as other forms of depressive illness and involves disruptive cycles of depressive symptoms that alternate with mania. During manic episodes, people may become overly active, talkative, euphoric, irritable, spend money irresponsibly, and get involved in sexual misadventures. In some people, a milder form of mania, called hypomania, alternates with depressive episodes. Unlike other mood disorders, women and men are equally vulnerable to bipolar disorder; however, women with bipolar disorder tend to have more episodes of depression and fewer episodes of mania or hypomania.

Symptoms of Depression and Mania

A thorough diagnostic evaluation is needed if three to five or more of the following symptoms persist for more than 2 weeks (1 week in the case of mania), or if they interfere with work or family life. An evaluation involves a complete physical checkup and information gathering on family health history. Not everyone with depression experiences each of these symptoms. The severity of the symptoms also varies from person to person.

Depression

• Persistent sad, anxious, or “empty” mood
• Loss of interest or pleasure in activities, including sex
• Restlessness, irritability, or excessive crying
• Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
• Sleeping too much or too little, early-morning awakening
• Appetite and/or weight loss or overeating and weight gain
• Decreased energy, fatigue, feeling “slowed down”
• Thoughts of death or suicide, or suicide attempts
• Difficulty concentrating, remembering, or making decisions
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania

• Abnormally elevated mood
• Irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased activity, including sexual activity
• Markedly increased energy
• Poor judgment that leads to risk-taking behavior
• Inappropriate social behavior

Causes of Depression

Genetic Factors

There is a risk for developing depression when there is a family history of the illness, indicating that a biological vulnerability may be inherited. The risk is somewhat higher for those with bipolar disorder. However, not everybody with a family history develops the illness. In addition, major depression can occur in people who have had no family members with the illness. This suggests that additional factors, possibly biochemistry, environmental stressors, and other psychosocial factors, are involved in the onset of depression.

Biochemical Factors

Evidence indicates that brain biochemistry is a significant factor in depressive disorders. It is known, for example, that individuals with major depressive illness typically have dysregulation of certain brain chemicals, called neurotransmitters. Additionally, sleep patterns, which are biochemically influenced, are typically different in people with depressive disorders. Depression can be induced or alleviated with certain medications, and some hormones have mood-altering properties. What is not yet known is whether the “biochemical disturbances” of depression are of genetic origin, or are secondary to stress, trauma, physical illness, or some other environmental condition.

Environmental and Other Stressors

Significant loss, a difficult relationship, financial problems, or a major change in life pattern have all been cited as contributors to depressive illness. Sometimes the onset of depression is associated with acute or chronic physical illness. In addition, some form of substance abuse disorder occurs in about one-third of people with any type of depressive disorder.

Other Psychological and Social Factors

Persons with certain characteristics-pessimistic thinking, low self-esteem, a sense of having little control over life events, and a tendency to worry excessively-are more likely to develop depression. These attributes may heighten the effect of stressful events or interfere with taking action to cope with them or with getting well. Upbringing or sex role expectations may contribute to the development of these traits. It appears that negative thinking patterns typically develop in childhood or adolescence. Some experts have suggested that the traditional upbringing of girls might foster these traits and may be a factor in women’s higher rate of depression.

Women are at Greater Risk for Depression than Men

Major depression and dysthymia affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. The same ratio has been reported in ten other countries all over the world. Men and women have about the same rate of bipolar disorder (manic-depression), though its course in women typically has more depressive and fewer manic episodes. Also, a greater number of women have the rapid cycling form of bipolar disorder, which may be more resistant to standard treatments.

A variety of factors unique to women’s lives are suspected to play a role in developing depression. Research is focused on understanding these, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. And yet, the specific causes of depression in women remain unclear; many women exposed to these factors do not develop depression. What is clear is that regardless of the contributing factors, depression is a highly treatable illness.

The Many Dimensions of Depression in Women

Investigators are focusing on the following areas in their study of depression in women:

The Issues of Adolescence

Before adolescence, there is little difference in the rate of depression in boys and girls. But between the ages of 11 and 13 there is a precipitous rise in depression rates for girls. By the age of 15, females are twice as likely to have experienced a major depressive episode as males. This comes at a time in adolescence when roles and expectations change dramatically. The stresses of adolescence include forming an identity, emerging sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females. Studies show that female high school students have significantly higher rates of depression, anxiety disorders, eating disorders, and adjustment disorders than male students, who have higher rates of disruptive behavior disorders.

Adulthood: Relationships and Work Roles

Stress in general can contribute to depression in persons biologically vulnerable to the illness. Some have theorized that higher incidence of depression in women is not due to greater vulnerability, but to the particular stresses that many women face. These stresses include major responsibilities at home and work, single parenthood, and caring for children and aging parents. How these factors may uniquely affect women is not yet fully understood.

For both women and men, rates of major depression are highest among the separated and divorced, and lowest among the married, while remaining always higher for women than for men. The quality of a marriage, however, may contribute significantly to depression. Lack of an intimate, confiding relationship, as well as overt marital disputes, have been shown to be related to depression in women. In fact, rates of depression were shown to be highest among unhappily married women.

Reproductive Events

Women’s reproductive events include the menstrual cycle, pregnancy, the postpregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood that for some women include depression. Researchers have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood; a specific biological mechanism explaining hormonal involvement is not known, however.

Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), the changes typically begin after ovulation and become gradually worse until menstruation starts. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

Postpartum mood changes can range from transient “blues” immediately following childbirth to an episode of major depression to severe, incapacitating, psychotic depression. Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed and treated.

Pregnancy (if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. Women with infertility problems may be subject to extreme anxiety or sadness, though it is unclear if this contributes to a higher rate of depressive illness. In addition, motherhood may be a time of heightened risk for depression because of the stress and demands it imposes.

Menopause, in general, is not asssociated with an increased risk of depression. In fact, while once considered a unique disorder, research has shown that depressive illness at menopause is no different than at other ages. The women more vulnerable to change-of-life depression are those with a history of past depressive episodes.

Specific Cultural Considerations

As for depression in general, the prevalence rate of depression in African American and Hispanic women remains about twice that of men. There is some indication, however, that major depression and dysthymia may be diagnosed less frequently in African American and slightly more frequently in Hispanic than in Caucasian women. Prevalence information for other racial and ethnic groups is not definitive.

Possible differences in symptom presentation may affect the way depression is recognized and diagnosed among minorities. For example, African Americans are more likely to report somatic symptoms, such as appetite change and body aches and pains. In addition, people from various cultural backgrounds may view depressive symptoms in different ways. Such factors should be considered when working with women from special populations.

Victimization

Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who have been raped as adolescents or adults. Since far more women than men were sexually abused as children, these findings are relevant. Women who experience other commonly occurring forms of abuse, such as physical abuse and sexual harassment on the job, also may experience higher rates of depression. Abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. There may be biological and environmental risk factors for depression resulting from growing up in a dysfunctional family. At present, more research is needed to understand whether victimization is connected specifically to depression.

Poverty

Women and children represent seventy-five percent of the U.S. population considered poor. Low economic status brings with it many stresses, including isolation, uncertainty, frequent negative events, and poor access to helpful resources. Sadness and low morale are more common among persons with low incomes and those lacking social supports. But research has not yet established whether depressive illnesses are more prevalent among those facing environmental stressors such as these.

Depression in Later Adulthood

At one time, it was commonly thought that women were particularly vulnerable to depression when their children left home and they were confronted with “empty nest syndrome” and experienced a profound loss of purpose and identity. However, studies show no increase in depressive illness among women at this stage of life.

As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Most important, depression should not be dismissed as a normal consequence of the physical, social, and economic problems of later life. In fact, studies show that most older people feel satisfied with their lives.

About 800,000 persons are widowed each year. Most of them are older, female, and experience varying degrees of depressive symptomatology. Most do not need formal treatment, but those who are moderately or severely sad appear to benefit from self-help groups or various psychosocial treatments. However, a third of widows/widowers do meet criteria for major depressive episode in the first month after the death, and half of these remain clinically depressed 1 year later. These depressions respond to standard antidepressant treatments, although research on when to start treatment or how medications should be combined with psychosocial treatments is still in its early stages.

Depression is a Treatable Illness

Even severe depression can be highly responsive to treatment. Indeed, believing one’s condition is “incurable” is often part of the hopelessness that accompanies serious depression. Such individuals should be provided with the information about the effectiveness of modern treatments for depression in a way that acknowledges their likely skepticism about whether treatment will work for them. As with many illnesses, the earlier treatment begins, the more effective and the greater the likelihood of preventing serious recurrences. Of course, treatment will not eliminate life’s inevitable stresses and ups and downs. But it can greatly enhance the ability to manage such challenges and lead to greater enjoyment of life.

The first step in treatment for depression should be a thorough examination to rule out any physical illnesses that may cause depressive symptoms. Since certain medications can cause the same symptoms as depression, the examining physician should be made aware of any medications being used. If a physical cause for the depression is not found, a psychological evaluation should be conducted by the physician or a referral made to a mental health professional.

Types of Treatment for Depression

The most commonly used treatments for depression are antidepressant medication, psychotherapy, or a combination of the two. Which of these is the right treatment for any one individual depends on the nature and severity of the depression and, to some extent, on individual preference. In mild or moderate depression, one or both of these treatments may be useful, while in severe or incapacitating depression, medication is generally recommended as a first step in the treatment. In combined treatment, medication can relieve physical symptoms quickly, while psychotherapy allows the opportunity to learn more effective ways of handling problems.

Medications

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications-chiefly the selective serotonin reuptake inhibitors (SSRIs)-and the tricyclics and monoamine oxidase inhibitors (MAOIs). The SSRIs-and other newer medications that affect neurotransmitters such as dopamine or norepinephrine-generally have fewer side effects than tricyclics. Each acts on different chemical pathways of the human brain related to moods. Antidepressant medications are not habit-forming. Although some individuals notice improvement in the first couple of weeks, usually antidepressant medications must be taken regularly for at least 4 weeks and, in some cases, as many as 8 weeks, before the full therapeutic effect occurs. To be effective and to prevent a relapse of the depression, medications must be taken for about 6 to 12 months, carefully following the doctor’s instructions. Medications must be monitored to ensure the most effective dosage and to minimize side effects. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing recurring episodes.

The prescribing doctor will provide information about possible side effects and, in the case of MAOIs, dietary and medication restrictions. In addition, other prescribed and over-the-counter medications or dietary supplements being used should be reviewed because some can interact negatively with antidepressant medication. There may be restrictions during pregnancy.

For bipolar disorder, the treatment of choice for many years has been lithium, as it can be effective in smoothing out the mood swings common to this disorder. Its use must be carefully monitored, as the range between an effective dose and a toxic one can be relatively small. However, lithium may not be recommended if a person has pre-existing thyroid, kidney, or heart disorders or epilepsy. Fortunately, other medications have been found helpful in controlling mood swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol) and valproate (Depakote). Both of these medications have gained wide acceptance in clinical practice, and valproate has been approved by the Food and Drug Administration for first-line treatment of acute mania. Studies conducted in Finland in patients with epilepsy indicate that valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Therefore, young female patients should be monitored carefully by a physician. Other anticonvulsants that are being used now include lamotrigine (Lamictal) and gabapentin (Neurontin); their role in the treatment hierarchy of bipolar disorder remains under study.

Most people who have bipolar disorder take more than one medication. Along with lithium and/or an anticonvulsant, they often take a medication for accompanying agitation, anxiety, insomnia, or depression. Some research indicates that an antidepressant, when taken without a mood stabilizing medication, can increase the risk of switching into mania or hypomania, or of developing rapid cycling, in people with bipolar disorder. Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring by the physician.

Herbal Therapy

In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John’s wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John’s wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.

Because of the widespread interest in St. John’s wort, the National Institutes of Health (NIH) is conducting a 3-year study, sponsored by three NIH components-the National Institute of Mental Health, the National Institute for Complementary and Alternative Medicine, and the Office of Dietary Supplements. The study is designed to include 336 patients with major depression, randomly assigned to an 8-week trial with one-third of patients receiving a uniform dose of St. John’s Wort, another third an SSRI commonly prescribed for depression, and the final third a placebo (a pill that looks exactly like the SSRI and the St. John’s Wort, but has no active ingredients). The study participants who respond positively will be followed for an additional 18 weeks. After the 3-year study has been completed, results will be analyzed and published.

The Food and Drug Administration issued a Public Health Advisory on February 10, 2000. It stated that St. John’s Wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as heart disease, depression, seizures, certain cancers, and rejection of transplants. Therefore, health care providers should alert their patients about these potential drug interactions. Any herbal supplement should be taken only after consultation with the doctor or other health care provider.

Psychotherapy

In mild to moderate cases of depression, psychotherapy is also a treatment option. Some short-term (10 to 20 week) therapies have been very effective in several types of depression. “Talking” therapies help patients gain insight into and resolve their problems through verbal give-and-take with the therapist. “Behavioral” therapies help patients learn new behaviors that lead to more satisfaction in life and “unlearn” counter-productive behaviors. Research has shown that two short-term psychotherapies, interpersonal and cognitive-behavioral, are helpful for some forms of depression. Interpersonal therapy works to change interpersonal relationships that cause or exacerbate depression. Cognitive-behavioral therapy helps change negative styles of thinking and behaving that may contribute to the depression.

Electroconvulsive Therapy

For individuals whose depression is severe or life threatening or for those who cannot take antidepressant medication, electroconvulsive therapy (ECT) is useful. This is particularly true for those with extreme suicide risk, severe agitation, psychotic thinking, severe weight loss or physical debilitation as a result of physical illness. Over the years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. At least several sessions of ECT, usually given at the rate of three per week, are required for full therapeutic benefit.

Treating Recurrent Depression

Even when treatment is successful, depression may recur. Studies indicate that certain treatment strategies are very useful in this instance. Continuation of antidepressant medication at the same dose that successfully treated the acute episode can often prevent recurrence. Monthly interpersonal psychotherapy can lengthen the time between episodes in patients not taking medication.

The Path to Healing

Reaping the benefits of treatment begins by recognizing the signs of depression. The next step is to be evaluated by a qualified professional. Although depression can be diagnosed and treated by primary care physicians, often the physician will refer the patient to a psychiatrist, psychologist, clinical social worker, or other mental health professional. Treatment is a partnership between the patient and the health care provider. An informed consumer knows her treatment options and discusses concerns with her provider as they arise.

If there are no positive results after 2 to 3 months of treatment, or if symptoms worsen, discuss another treatment approach with the provider. Getting a second opinion from another health or mental health professional may also be in order.

Here, again, are the steps to healing:

• Check your symptoms
• Talk to a health or mental health professional.
• Choose a treatment professional and a treatment approach with which you feel comfortable.
• Consider yourself a partner in treatment and be an informed consumer.
• If you are not comfortable or satisfied after 2 to 3 months, discuss this with your provider. Different or additional treatment may be recommended.
• If you experience a recurrence, remember what you know about coping with depression and don’t shy away from seeking help again. In fact, the sooner a recurrence is treated, the shorter its duration will be.

Depressive illnesses make you feel exhausted, worthless, helpless, and hopeless. Such feelings make some people want to give up. It is important to realize that these negative feelings are part of the depression and will fade as treatment begins to take effect.

Along with professional treatment, there are other things you can do to help yourself get better. Some people find participating in support groups very helpful. It may also help to spend some time with other people and to participate in activities that make you feel better, such as mild exercise or yoga. Just don’t expect too much from yourself right away. Feeling better takes time.

Where to Get Help

If unsure where to go for help, ask your family doctor, OB/GYN physician, or health clinic for assistance. You can also check the Yellow Pages under “mental health,” “health,” “social services,” “suicide prevention,” “crisis intervention services,” “hotlines,” “hospitals,” or “physicians” for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for an emotional problem and will be able to tell you where and how to get further help.

Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.

• Family doctors
• Mental health specialists such as psychiatrists, psychologists, social workers, or mental health counselors
• Health maintenance organizations
• Community mental health centers
• Hospital psychiatry departments and outpatient clinics
• University- or medical school-affiliated programs
• State hospital outpatient clinics
• Family service/social agencies
• Private clinics and facilities
• Employee assistance programs
• Local medical and/or psychiatric societies

Source: The National Institute of Mental Health

What is Clinical Depression?

Clinical depression can affect your body, mood, thoughts, and behavior. It can change your eating habits, how you feel and think about things, your ability to work and study, and how you interact with people.

Clinical depression is not a passing mood, a sign of personal weakness or a condition that can be willed away. Clinically depressed people cannot “pull themselves together” and get better.

Depression can be successfully treated by a mental health professional or certain health care providers. With the right treatment, 80 percent of those who seek help get better. And many people begin to feel better in just a few weeks.

Types of Depressive Illness

Depressive illnesses come in different forms. The following are general descriptions of the three most prevalent, though for an individual, the number, severity, and duration of symptoms will vary.

Major depression is manifested by a combination of symptoms that interfere with your ability to work, sleep, eat, and enjoy once pleasurable activities. These impairing episodes of depression can occur once, twice, or several times in a lifetime.

Symptoms of Major Depression

• Sadness, anxiety, or “empty” feelings
• Decreased energy, fatigue, being “slowed down”
• Loss of interest or pleasure in usual activities
• Sleep disturbances (insomnia, oversleeping, or waking much earlier than usual)
• Appetite and weight changes (either loss or gain)
• Feelings of hopelessness, guilt, and worthlessness
• Thoughts of death or suicide, or suicide attempts
• Difficulty concentrating, making decisions, or remembering
• Irritability or excessive crying
• Chronic aches and pains not explained by another physical condition

A less intense type of depression, dysthymia, involves long-term, chronic symptoms that are less severe, but keep you from functioning at your full ability and from feeling well.

In bipolar illness (also known as manic-depressive illness), cycles of depression alternate with cycles of elation and increased activity, known as mania.

How to Recognize Depression

The first step in defeating depression is recognizing it. It’s normal to have some signs of depression some of the time. But five or more symptoms for two weeks or longer, or noticeable changes in usual functioning, are all factors that should be evaluated by a health or mental health professional. And remember, people who are depressed may not be thinking clearly and may need help to get help.

I kept asking myself, “How could I be depressed? I’d had a normal family life, had been getting good grades, and hadn’t experienced any big trauma – where did my depression come from?” – John

What Causes Depression?

The causes of depression are complex. Very often a combination of genetic, psychological and environmental factors is involved in the onset of clinical depression. At times, however, depression occurs for no apparent reason. Regardless of the cause, depression is almost always treatable.

Family History - Depression often runs in families, which usually means that some, but not all, family members have a tendency to develop the illness. On the other hand, sometimes people who have no family history also develop depression.

Stress - Psychological and environmental stressors can contribute to a depressive episode, though individuals react differently to life events and experiences.

In coping with stress, some people find writing in a journal, exercising, or talking with friends helpful. But in clinical depression you need some form of treatment (usually medication and short-term psychotherapy) to start feeling better soon.

I had a period of nearly constant turmoil when I wanted to “come out” to my friends about being gay but didn’t want to be treated like an outsider. A good friend made jokes about homosexuals and I was afraid of what he’d say about me. That stress played a big part in my becoming depressed. - Josh

My family wanted me home every other weekend and I didn’t fit in there anymore. I’d argue constantly with my father, who still treated me like a child. My sister thought I was ‘uppity.’ Everyone was miserable and I felt guilty. – Kim

College and Stress

Common stressors in college life include:

• Greater academic demands
• Being on your own in a new environment
• Changes in family relations
• Financial responsibilities
• Changes in your social life
• Exposure to new people, ideas, and temptations
• Awareness of your sexual identity and orientation
• Preparing for life after graduation

Psychological make-up can also play a role in vulnerability to depression. People who have low self-esteem, who consistently view themselves and the world with pessimism, or are readily overwhelmed by stress may be especially prone to depression.

For Marta, her feelings of being “not good enough” were worsened by the stress of the academic demands of college and the emotional conflict caused by her parents’ divorce, which combined to trigger her episode of major depression.

Bipolar Disorder (Manic Depression)

As mentioned earlier, bipolar disorder is a type of depressive illness that involves mood swings that go from periods of depression to periods of being overly “up” and irritable. Sometimes the mood swings are dramatic or rapid, but most often they occur gradually, over several weeks. The “up” or manic phase can include increased energy and activity, insomnia, grandiose notions and impulsive or reckless behavior, including sexual promiscuity.

Medication usually is effective in controlling manic symptoms and preventing the recurrence of both manic and depressive episodes.

During a manic episode, I stayed awake for five days straight, but had a lot of energy. I spent my tuition on a major shopping spree and long distance phone calls. I also had sex with several guys that I hardly knew. At the time, I felt so great that I couldn’t see that there were serious problems with what I was doing. – Teresa

Suicide

Thoughts of death or suicide are usually signs of severe depression. “If you’re feeling like you can’t cope anymore, or that life isn’t worth living, get help,” advised Darrel, a student who tried to kill himself during his freshman year. “Talking to a professional can get you past those intense feelings and save your life.”

Suicidal feelings, thoughts, impulses, or behaviors always should be taken seriously. If you are thinking about hurting or killing yourself, SEEK HELP IMMEDIATELY. Contact someone you trust to help you: a good friend, academic or resident advisor, or:

• Staff at the student health or counseling center
• A professor, coach, or advisor
• A local suicide or emergency hotline (get the phone number from the information operator or directory)
• A hospital emergency room
• Call 911

If someone you know has thoughts about suicide, the best thing to do is help him or her get professional help.

“I’m back from the edge,” Darrel continued. “Now that I’ve gotten some treatment, I know how to keep from being out there again.”

Depression and Alcohol and Other Drugs

A lot of depressed people, especially teenagers, also have problems with alcohol or other drugs. (Alcohol is a drug, too.) Sometimes the depression comes first and people try drugs as a way to escape it. (In the long run, drugs or alcohol just make things worse!) Other times, the alcohol or other drug use comes first, and depression is caused by:

• the drug itself, or
• withdrawal from it, or
• the problems that substance use causes.

And sometimes you can’t tell which came first… the important point is that when you have both of these problems, the sooner you get treatment, the better.

Getting Help – Treatment Works

If you think you might be depressed, discuss this with a qualified health care or mental health professional who can evaluate your concerns. Bring along an understanding friend for support if you are hesitant or anxious about the appointment.

Several effective treatments for depression are available and can provide relief from symptoms in just a few weeks. The most commonly used treatments are psychotherapy, antidepressant medication, or a combination of the two. Which is the best treatment for an individual depends on the nature and severity of the depression.

Sharing your preferences and concerns with your treatment provider helps determine the course of treatment. Certain types of psychotherapy, particularly cognitive behavioral therapy, can help resolve the psychological or interpersonal problems that contribute to, or result from, the illness. Antidepressant medications relieve the physical and mood symptoms of depression and are not habit-forming. In severe depression, medication is usually required.

Individuals respond differently to treatment. If you don’t start feeling better after several weeks, talk to the professional you are seeing about trying other treatments or getting a second opinion.

Making a Decision

Don’t let fear of what others might say or think stop you from doing what’s best for you. Parents and friends may understand more than you think they might, and they certainly want you to feel better.

Taking the First Step

I knew I was depressed but thought I could pull out of it by myself. Unfortunately, friends reinforced this attitude by telling me to just toughen up. When that didn’t work, I felt even worse because I had ‘failed’ again. When a friend suggested I talk to his counselor, I resisted at first. In my mind, professional help was for weak, messed up people. But then, I hit a bottom so low that I was willing to try anything. – John

I decided to try treatment when my friends got fed up with me. They didn’t want to talk about my problems any more, but my problems were the major focus of my life. I needed someone who could help me understand what was happening to me. I’d seen ads for the counseling center and decided to give it a try. - Kim

When I began considering suicide, I knew I needed serious help. My resident advisor helped me call a local hotline where I got some good referrals. It was just a phone call, but it was the starting point that got me to the professional help I needed. – Leah

Help Yourself: Be an Informed Consumer

Don’t give in to negative thinking. Depression can make you feel exhausted, worthless, helpless and hopeless, making some people want to give up. Remember, these negative views are part of the depression, and will fade as treatment takes effect.

Take an active role in getting better. Make the most of the help available by being actively involved in your treatment and by working with a qualified therapist or doctor. Once in treatment, don’t hesitate to ask questions in order to understand your illness and the way treatment works. And, if you don’t start feeling better in a few weeks, speak with the professional you are seeing about new approaches.

Be good to yourself while you‘re getting well. Along with professional help, there are some other simple things you can do to help yourself get better, for example: participating in a support group, spending time with other people, or taking part in activities, exercise, or hobbies. Just don’t overdo it and don’t set big goals for yourself. The health care professional you are seeing may suggest useful books to read and other self-help strategies.

Helping a Depressed Friend

The best thing you can do for a depressed friend is to help him or her get treatment. This may involve encouraging the person to seek professional help or to stay in treatment once it is begun. The next best thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation or activities and be gently insistent if you meet with resistance. Remind that person that with time and help, he or she will feel better.

Helpful Resources

The professionals at a student health center or counseling service, the Resident Advisor in your dorm, your family health care provider, and your clergy can be helpful resources for getting treatment. You also might contact any of the following organizations in your area for mental health services or referrals:

• A community mental health agency
• A hospital psychiatric outpatient department or clinic
• A private or nonprofit counseling center
• Your local Mental Health Association

The telephone directory or information operator at your school or in your community, or a local hotline, should have telephone numbers for these and other mental health services.

Finding Affordable Treatment

People are sometimes reluctant to seek help because they are concerned about the cost of treatment. Services at college counseling centers are often low-cost or free. Also city or county mental health services are often offered on a “sliding scale” (the fee is based on your financial resources). Check out any health insurance you may have and see if it pays for private mental health services.

Source: The National Institute of Mental Health