Depression: A Comprehensive Overview
We all get the blues now and then, but depression is far more serious than occasional feelings of sadness. It can cause physical aches and pains, and it can interfere with daily life. Some people with depression are debilitated by the condition—unable to work, attend school or function socially.
Depression affects men and women differently.1 In men, depression often causes irritability and feelings of exhaustion. They may lose interest in work, family or hobbies, and may suffer from insomnia. And although more women with depression attempt suicide, more men with depression die by suicide.
Depression is a highly treatable illness, but unfortunately, many men don’t acknowledge their feelings or seek help for their depression. Those who do, typically find that a combination of medication and therapy effectively treats their depression and enables them to regain interest in things they once enjoyed.
Clinical Definition of Depression
Depression is a common mood disorder also known as clinical depression or major depressive disorder. Around 24 million American adults suffer from depression in any given two-week period, and 14.8 million suffer from an episode of major depression in any given year.2
Twice as many women as men are diagnosed with clinical depression every year, but men are less likely to get help and instead may withdraw socially and suffer in silence, often incorrectly considering their pain to be a sign of weakness or a character flaw.
Three Types of Depression
Major depression is diagnosed when five of the diagnosis criteria are present for at least two weeks. Major depression interferes with the ability to perform daily activities. It may onset gradually or it may occur quickly, stemming from a traumatic life event such as a death in the family or divorce. Sufferers may experience major depression just once in their life, or may experience it in recurring bouts.
Persistent depressive disorder is diagnosed when a depressive episode lasts two years or longer. While the symptoms of persistent depressive disorder are less intense than those of major depression and typically include insomnia and low energy, the condition can cause serious personal problems and dramatically reduce quality of life.
Bipolar disorder occurs in alternating cycles of severe depression, known as the depressive phase, and intense mania, known as the manic phase. The depressive phase is marked by the symptoms of major depression, while the manic phase is characterized by an increase in energy, feelings of euphoria and a reduced need for sleep.
Causes of Depression
While researchers aren’t sure what exactly causes depression or how it interferes with normal brain function, it’s clear that a number of factors have a role in developing this condition:
- Brain chemistry. According to Harvard Medical School, brain chemicals are involved in the development of depression, but it’s not a simple matter of particular chemical levels being too high or too low. Rather, it’s a highly complex chain of chemical reactions that govern mood, perceptions and experience.3
- Genetics. Researchers have identified a number of genes that make individuals more susceptible to low moods, and for these people, any stress can affect their systemic balance and leave them feeling depressed.
- Temperament. How excitable or intense one plays a role in developing depression. Harvard points out that we develop our world view early on in life, and this influences feelings when experiencing loss, rejection or disappointment.
- Stress. Stress can trigger the release of the hormone cortisol. Cortisol is responsible for the body’s fight or flight reaction to danger or stress, and when the body doesn’t properly turn off the secretion of these hormones, depression can develop. Studies have found that depressed people typically have higher levels of CRH, and as those levels return to normal, symptoms of depression are reduced.
- Trauma. A profound loss in childhood, such as the death of a loved one, can trigger depression later in life. Additionally, trauma, such as sexual abuse or exposure to violence, promotes an extreme stress response that can cause small changes in brain function and lead to symptoms of depression or anxiety.
- The seasons. Seasonal affective disorder, or SAD, is a type of depression that’s triggered by limited exposure to sunlight in the fall or winter and often subsides in spring.
- Medical problems. Harvard cites medical problems as the root of up to 15 percent of all cases of depression. Medical illness can cause or worsen symptoms of depression, and depression can worsen a medical illness. Twenty-five percent of all cancer patients and 33 percent of heart attack survivors are diagnosed with depression.4
Signs and Symptoms of Depression
Signs of depression are indicators that others may notice, and symptoms are indicators that a person with depression will feel. Not everyone who suffers from depression will experience all signs and symptoms, which can range from mild to severe:
- Feelings of helplessness, hopelessness, worthlessness or guilt
- Feelings of emptiness or sadness
- A loss of interest in hobbies and activities in which you once found enjoyment
- Withdrawal from friends and family
- A loss of energy or chronic fatigue
- Feelings of irritability
- Feelings of restlessness
- Moving or talking more slowly than normal
- A loss of motivation
- Difficulty concentrating and making decisions
- Memory problems
- Changes in appetite that leads to weight gain or weight loss
- Headaches, digestive problems and other aches and pains that have no identifiable cause and don’t get better with treatment
- Suicidal thoughts
Depression and Substance Abuse
Depression commonly co-occurs with substance abuse, which can lead to addiction. Because depression can lead to self-medication with drugs or alcohol, which almost always worsen symptoms of depression and may even cause its onset, it can be difficult to discern directionality and causality.
According to an article published in the journal Science and Practice Perspectives, 67 percent of people in treatment for alcohol addiction have suffered at least one episode of depression in their lifetime.5Additionally, 32 percent of people who have depression have a co-occurring substance use disorder. People who have a substance use disorder are twice as likely as those without one to suffer from depression.
When a substance use disorder co-occurs with depression, it’s known as a dual diagnosis, and successful treatment depends on addressing both disorders at the same time, each in the context of the other. Dual diagnosis treatment has been shown to improve engagement in treatment and produce better treatment outcomes than treating just the substance use disorder or just the depression.
Treating Depression with Medication
A wide range of medications are used to successfully treat depression. Because not every medication works effectively for every individual, it can take some time to find the right medication or combination of medications.6
Medications for depression work to restore the balance of brain chemicals, including those related to mood. The most common and successful medications for depression are reuptake inhibitors. When neurotransmitters are released to send a chemical message, they’re reabsorbed into nerve cells once the message is sent. Reuptake inhibitors prevent the chemical from being reabsorbed, therefore keeping it the brain longer and improving nerve cell communication.
The most commonly prescribed reuptake inhibitors include:
- Norepinephrine-dopamine reuptake inhibitors, or NDRIs, which prevent the reuptake of the brain chemicals norepinephrine and dopamine. Wellbutrin is the only FDA-approved NDRI on the market today.
- Serotonin and norepinephrine reuptake inhibitors, or SNRIs, which prevent the reuptake of serotonin and norepinephrine. These medications include Cymbalta, Effexor and Pristiq.
- Serotonin antagonist and reuptake inhibitors, or SARIs, which prevent the reuptake of serotonin and also send this brain chemical to specific receptors for improved function of nerve cells involved in mood regulation. SARIs include trazodone and nefazodone.
- Selective serotonin reuptake inhibitors, or SSRIs, prevent the reuptake of serotonin. These include Zoloft, Lexapro and Prozac, which are effective, safe and have fewer side effects than other reuptake inhibitor antidepressants.
- Tetracyclics are another type of medication that doesn’t prevent the reuptake of brain chemicals, but instead prevent serotonin and norepinephrine from binding with specific nerve receptors. These chemicals then build up between nerve cells, increasing their levels for better brain function.
Treating Depression with Psychotherapy
The National Institute on Mental Health recommends a combination of medication and psychotherapy, or talk therapy, for treating depression.7 Medication alone can treat the symptoms of depression, but psychotherapy—particularly cognitive-behavioral therapy and interpersonal therapy—helps individuals overcome depression for the long haul.
Cognitive-behavioral therapy helps individuals:
- Identify and address underlying issues that contribute to the depression.
- Identify and address distorted and negative attitudes, behaviors and patterns of thinking to relieve depression.
- Identify and address feelings of helplessness and hopelessness and work to enhance their emotional well-being by setting realistic goals and working through issues and thought patterns that contribute to these feelings.
- Develop skills and strategies to combat stress and other triggers of depression, as well as improve the symptoms of depression.
Interpersonal therapy is a 12- to 16-week program that helps individuals:
- Identify the specific interpersonal issues that contribute to the depression, such as role transitions, social isolation or bereavement.
- Address these issues and learn healthy ways of expression to gain a higher level of independence and learn how to feel more capable.
- Address personality issues that make it difficult to resolve conflicts.
- Improve personal relationships and social functioning.
Treating Depression with Brain Stimulation
In cases where medication doesn’t help depression, certain brain stimulation therapies may be an effective treatment option.
- Repetitive transcranial magnetic stimulation, or rTMS, sends electrical currents through specific areas of the brain to stimulate and improve the function of particular nerve cells. During rTMS, an electromagnetic coil is held against the head and small electrical currents are sent into the brain.
- Electroconvulsive therapy, or ECT, also involves passing electric currents through the brain to change brain chemistry and improve functioning. ECT is administered under general anesthesia.
- Vagus nerve stimulation, or VNS, involves implanting a device under the skin that sends electrical pulses through the left vagus nerve every five minutes to alter the function of brain chemical associated with mood.
Complementary, Alternative and Lifestyle Remedies for Depression
In many cases, medication and psychotherapy are essential for treating depression. In some cases, individuals can improve their symptoms through other means, including making important lifestyle changes.
These complementary and alternative treatments can have a major impact on the intensity of symptoms associated with depression when used alone or with medication and/or psychotherapy:
Exercise. A Duke University study found that an hour and a half of moderate exercise each week can be as effective as antidepressants for treating depression, and it can also help prevent depression from returning in the future.8 Exercise is extremely effective for easing stress, increasing the production of natural feel-good brain chemicals and reducing the amount of the stress hormone cortisol in the blood.
Eating a healthy diet. A number of studies have found that highly processed foods and those full of unhealthy sugars and fats can lead to depression, while a healthy diet of mostly plant-based foods and fish is effective for preventing the onset of depression or helping to combat it.9
Acupuncture. The practice of inserting thin needles into the skin at various pressure points around the body, acupuncture promotes the release of the body’s natural painkillers known as endorphins and improves blood circulation and lymphatic function. A University of Arizona study found that acupuncture specifically designed for depression reduced the intensity of symptoms in 43 percent of study participants.10
Yoga. A powerful stress reliever, yoga involves certain breathing patterns combined with poses that promote balance, flexibility and strength of body, mind and spirit. Sudarshan Kriya yoga, known as SKY, is a type of yoga that utilizes cyclical breathing. According Harvard Medical School, SKY has been shown to reduce feelings of depression by 75 percent.
Meditation. Meditation is the practice of quieting the mind and focusing attention inward to become closer to your subconscious and communicate with other aspects of yourself. Meditation is quickly becoming a mainstream treatment for a wide range of illnesses and conditions. A recent study by Johns Hopkins University showed that a half hour of meditation each day delivered as much relief as antidepressant medications for symptoms of depression.11
Why Men Don’t Seek Help for Depression
Men of all ages and ethnicities are far less likely than women to get help for depression.12 Some of the reasons for this include:
- Being so out of touch with emotions that they don’t even realize they’re depressed.
- Having been conditioned by family and society to avoid expressing vulnerability and suppress emotional responses.
- Difficulty admitting needing help.
- Adherence to social norms that say men who can’t “tough it out” are weak.
- A belief that being depressed isn’t “normal” and fear of admitting being abnormal or dysfunctional.
Does Insurance Cover Depression Treatment?
In 2008, the Mental Health Parity and Addiction Equity Act was passed to require group health plans and insurance providers to ensure that treatment limitations for mental health conditions and substance use disorders are no more restrictive than coverage for medical problems.13 This ensures that people seeking treatment for depression and other mental illnesses are able to be adequately treated without unfair limitations on the number of therapy visits or caps on the cost of treatment.
There is Hope
Depression is very common and highly treatable. You don’t have to continue living under the weight of your depression. Help is available, and treatment can dramatically improve your sense of well-being and vastly increase your quality of life as well as prevent recurrences of depressive episodes in the future.
- Men and Depression. (2013). Retrieved from http://www.nimh.nih.gov/health/publications/men-and-depression/index.shtml
- Depression. (2016, July 6). Retrieved from http://www.cdc.gov/nchs/fastats/depression.htm
- What Causes Depression? (2009, June). Retrieved from http://www.health.harvard.edu/mind-and-mood/what-causes-depression
- Depression Statistics. (n.d.). Retrieved from http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression
- Quello, S. B., Brady, K. T., & Sonne, S. C. (2005, December). Mood Disorders and Substance Abuse Disorder: A Complex Comorbidity. Science and Practice Perspectives, 3(1), 13-21. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/
- Depression: Treatments and Drugs. (2016, July 7). Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/basics/treatment/con-20032977
- Depression. (2016, May). Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml
- Study: Exercise Has Long-Lasting Effect on Depression. (2000, September 22). Retrieved from https://today.duke.edu/2000/09/exercise922.html
- Zeratsky, K. (2015, March 11). Depression: Can a Junk Food Diet Increase Your Risk of Depression? Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/depression-and-diet/faq-20058241
- Acupuncture Effective in Treatment of Mental Illness. (n.d.). Retrieved from https://www.actcm.edu/news/acupuncture-effective-in-treatment-of-mental-illness/
- Meditation for Anxiety and Depression? (2014, January 6). Retrieved from http://www.hopkinsmedicine.org/news/media/releases/meditation_for_anxiety_and_depression
- Winerman, L. (2005, June). Helping Men to Help Themselves. Retrieved from http://www.apa.org/monitor/jun05/helping.aspx
- The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). (2010, January 29). Retrieved from http://www.dol.gov/ebsa/newsroom/fsmhpaea.html