Have Depression? You are in Good Company

Many people suffering from depression have gone on to make significant achievements despite their illness. Charles Darwin had many lifelong and serious illnesses, including depression and agoraphobia and there have been at least three books and numerous articles written on his life. The intensity of his sad feelings left him embarrassed and in his own words “not able to do anything one day out of three.” He wrote, “the race is for the strong.” And “I shall probably do little more but be content to admire the strides others made in science.”

Clearly, he was depressed and suffering from low self esteem. But to many, including himself, the cause of his illness was a mystery. It was clear to Darwin, and those that knew him, that his depression made him withdraw from the world and may have enabled him to dedicate himself to his work in order to escape his depressed moods.

But for many, depression is a burden that can severely impact their lives and prevent them from achieving their dreams and professional aspirations. Every year, approximately 80 percent of those diagnosed with depression have it severe enough to affect their functioning at work or home, while close to 30 percent of those diagnosed have depression so severe that it warrants professional help. Unfortunately, fewer than 50% of those diagnosed with major depression actually seek help, according to the Centers for Disease Control (CDC).

Estimates for those diagnosed with the disease in the United States range from 17 to 21 million people a year or roughly 10 percent of the country, though World Health Organization (WHO) reports that rates can vary dramatically by region and demographics.

It must be noted that there are many different types of depression, and all depression types are not the same. The three of the most common are:

1. Major depression, also known as clinical depression
2. Dysthymia, also known as chronic depression
3. Bipolar disorder, also known as manic depression.

For most patients, episodes of major depression last a limited amount of time. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) specifies that symptoms last at least two weeks, and treatment studies report a median duration of about 20 weeks. But for some patients, the condition becomes chronic, with symptoms lasting at least two years.

The differences between episodic and chronic depression encompass more than just duration. Studies have shown that, compared with episodic major depression, chronic depression causes more functional impairment, increases risk of suicide, and is more likely to occur in conjunction with other psychiatric disorders. Patients with chronic depression are also more likely than patients with episodic depression to report childhood trauma and a family history of mood disorders.

Because chronic depression lasts longer and tends to be more severe than episodic depression, treatment is more intensive, and relapse is also a challenge. About half of patients with chronic depression who respond to treatment (whether with antidepressants, psychotherapy, or a combination of the two) will suffer a relapse within one to two years if they stop treatment. For that reason, some type of maintenance therapy may be necessary.

But there are also other types of depression with unique signs, symptoms, and treatment strategies.

Other types of depression include:

• Atypical Depression with symptoms that may include weight gain, sleeping too much, and feeling anxious.
• Postpartum depression is increasingly common affecting 1 in 8 women during the first months after childbirth and symptoms include sadness, anxiety, tearfulness, and trouble sleeping. These symptoms usually appear within several days of delivery and go away by 10 to 12 days after the birth. About 20% of women who have postpartum depression symptoms will develop more lasting depression.
• Seasonal Depression (SAD) occurs when individuals become depressed during certain times of the year.
• Psychotic Depression involves psychosis, hallucinations, and other signs.

Treatment for depression:

If you are suffering from depression, there are a number of treatments available. Medications and psychotherapy, either alone or in combination, are the most common forms of depression treatment. Electroconvulsive Therapy (ECT) and Vagus Nerve Stimulation (VNS) are generally only used when other treatments have failed or when medication could seriously affect the patient's health. Your doctor can help you choose the best depression treatment for you.

Depression treatments are largely determined by the cause of the disease. Depression can be caused by many reasons. Stresses or problems with family relationships, at work, grief or loss issues and exposure to trauma can lead to the disease. Depression can also develop with no apparent cause.

By definition, in an episode of major depression, symptoms occur for at least two weeks. In chronic depression, they must last at least two years.

Because chronic depression tends to be more pronounced than episodic depression, treatment is more intensive.

Some studies showed promising evidence of a type of therapy designed specifically for chronic depression, known as Cognitive Behavioral Analysis System of Psychotherapy (CBASP), a variation of CBT developed by Dr. James P. McCullough at Virginia Commonwealth University. The premise of CBASP is that patients with chronic depression think, behave, and communicate in ways that make traditional therapy difficult. They may be uncooperative, they tend to focus on themselves, and often have difficulty controlling their emotions. In addition, they tend to view current situations either as a replay of a negative event in the past or a precursor to a similar situation in the future.

Therapy with CBASP entails exposing and challenging these perceptions and behaviors. For example, using a technique known as situational analysis, the therapist helps a patient break down a distressing event into a sequence of events, and then find junctures where the outcome might have been different had the patient changed his or her behavior or reactions.

Cognitive Behavioral Therapy (CBT) involves learning new skills to manage your symptoms. It teaches you new ways of thinking and behaving by reframe situations in more positive ways. Because patients with chronic depression may have entrenched feelings of hopelessness, however, CBT techniques tend to be more intensive than usual. It is often suggested that therapy take place twice a week instead of once a week, and often must target behaviors or thought processes most amenable to change, increasing the chance that patients will see progress. Patients often are assigned homework to practice new skills learned in the therapy session and then learn how to apply them to their life everyday.

References:

National Institute of Mental Health -- Depression Facts
http://www.nimh.nih.gov/health/topics/depression/index.shtml

CDC Data & Statisticshttp://www.cdc.gov/Features/dsBRFSSDepressionAnxiety/

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.

McCullough JP, Jr. "Treatment for Chronic Depression Using Cognitive Behavioral Analysis System of Psychotherapy (CBASP)," Journal of Clinical Psychology (Aug. 2003): Vol. 59, No. 8, pp. 833–46.