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Depression is a common psychological problem, experienced by many people at some time during their lives. One member of most families has experienced an episode of depression severe enough to require formal treatment. Depressed mood is costly to individuals and society as a whole, both economically as well as in terms of quality of life.
The primary feature of depression is a sad mood state, which, in its most severe form, is experienced as a feeling of helplessness, hopelessness, and despair. When people experience depressed mood, it is common for them also to experience a decrease in social activities, problems with relationships, and an increase in crying or “a desire to cry even if you cannot get the tears out” (called dry tears depression).
There are also several cognitive features of depression that may include a loss of concentration and memory; a belief that you are becoming worthless; a belief that things cannot be made better, have gotten bad, and will get worse; and a focus on negative things about yourself without enough attention on positive things about yourself.
The biological characteristics of depression include disrupted sleep (especially trouble falling sleep and a pattern of waking up very early in the morning), loss of appetite, loss of sexual desire or lack of interest in sexual activity, and fatigue or tiredness during the day. It is also important to know that depression may happen along with increased anxiety and feelings of anger or hostility. In about 10% of cases, depression will be followed by problems with alcohol or drugs.
Depression severe enough to require formal treatment occurs in about 6% of the women and 3% of the men in this country. Depression can occur, although at lower rates, among children. During adolescence, the rates gradually increase, so that by age 14 or 15 they equal those of adults. Among the elderly, the rates decrease slightly, but depression remains a frequent and serious problem among this age group.
Although no definitive and final answer exists to the question of what causes depression, much is known. Depression may be caused by major negative life events – for example, the death of a loved one, a divorce, a severe financial setback, or even a move to a different neighborhood or part of the country. Other factors that may cause depression include trouble having and keeping social relationships and trouble keeping your everyday life in line with your values in life.
Depression also may be related to faulty thinking patterns. These might include magnifying how badly things are going for you, drawing negative conclusions from life events even when it doesn’t make good sense to do so, and generally having a negative view of oneself, the world, and the future.
There are several types of biochemical imbalances that may occur in depression. Depression may develop when a biological predisposition to depression is activated by an event. This predisposition is activated when one experiences a major life event (or a sequence of more minor negative life events) and/or develops a negative cognitive pattern of evaluating oneself and one’s life events. It is believed that the biological characteristics of depression (sleep disturbance, appetite loss, loss of sexual interest , and tiredness) are related to this biochemical imbalance.
During the past few years, very effective treatments have been developed for depression. The majority of people experiencing depression can expect to experience considerable relief from depression within 3 or 4 weeks of effective treatment, and long-lasting relief within 3 to 6 months of treatment.
Behavioral and Cognitive Behavioral Therapies
Behavior therapy and cognitive behavior therapy are among the treatments that have been most extensively evaluated and that have been shown through research to be effective. Behavioral treatments help a person to engage in healthy life activities, particularly activities that are consistent with one’s life values. Behavior therapy also helps people to develop skills and abilities to cope with major life events and to learn social relationship skills when these are missing. Cognitive behavior therapy includes the development of behavioral skills, but focuses more on correcting the faulty thinking patterns of depression. Most people experiencing depression will profit from participating in cognitive behavioral therapy that is widely available from mental health professionals.
Some severe depressions, especially those involving severe biological symptoms, may require antidepressant medications. Such medications are available, and many produce quick and effective relief of depression. When antidepressant medication is necessary, it may be combined with behavior therapy or cognitive behavior therapy to produce effective and long-lasting treatment results. Some people believe that depression will gradually go away, or that if you “just get yourself in gear” you can get over it yourself. Indeed, in some small percentage of cases that may be true. Unfortunately, depression usually does not go away without treatment. Therefore, if you are experiencing a severe, acute depression or a chronic lower level depression, it is best and wise to seek and participate in therapy. Fortunately, there are treatments available to lessen depression and the life difficulties that come along with it.