Understanding Depression

by Archibald D. Hart, Ph.D.

Depression has been called the "common cold" of the emotions: It comes in many forms and affects all of us at some time in our lives. It can be as natural as feeling sad when a friend moves away or so devastating as to cause a person to commit suicide. We should all, therefore, know about depression how to recognize it and what treatments are available for the more serious forms.

Depression is the most commonly encountered emotional disorder. Sooner or later, we can all expect to experience some form of depression. The more you know about it, the better you will be able to cope with it when it comes!

There was a time when serious depression was a feared illness. There was no effective treatment for it. Chances were that you would be hospitalized and have to "ride out the storm." Now there are effective treatments available even for the most serious depression. But it takes the full cooperation of the depressed person, as well as those near to him or her, to achieve this healing.

The problem with major depression today is not that it cannot be treated because it can. The problem is that many fail to seek treatment, and a high percentage of those who do get help don't follow through with their treatment. Only about one in three severely depressed people seek help. Of those who do go for help, barely 25 percent continue with the treatment until it takes effect.

Why would those needing treatment for depression not seek it? Mainly because they misunderstand the nature of depression. Many believe that they are somehow personally to blame if they are depressed. If only they tried harder or had more faith, they wouldn't be depressed. Some even believe that their depression is some form of punishment from God.

Types of depression

There are many forms of depression. In some people it comes on suddenly and doesn't seem to be related to anything happening in their lives. In others it follows a period of intense stress or life change. A few seem to be depressed all their lives. As far back as they can remember, they have never really felt happy. At times the depression seemed to get worse and then go away again, but never has it left them entirely.

Depression comes in all intensities, from a feeling of sadness when a loved one dies to the most frightening emotional darkness you can imagine. Occasional mild depression is natural and usually takes care of itself in time. But a more intense depression is called "clinical depression," meaning that the sadness persists and doesn't go away. It might become even more intense, preventing you from carrying out your normal duties.

At the other end of the spectrum we encounter the severest forms of depression. They are called major, because they can seriously disrupt normal functioning. They can even be a risk to life due to the potential of suicide.

We now know that while the feelings connected with depression are common across the whole spectrum, not all depressions are the same. Some are purely psychological a reaction to something going on in your life. Other depressions are biological, caused by medical conditions such as an underactive thyroid gland or a deficiency of neurotransmitter in the brain. And some spiritual factors can also cause or contribute to psychological depressions.

So right at the outset it is important to know what type of depression you suffer from. Why? Because the treatment is different. You may not even need any treatment. Perhaps all you need is time to do some grieving.

Biological depressions are generally referred to as "endogenous," meaning "from within." But not all biological depressions are as simple as a problematic thyroid gland. Almost any physical disease can also produce some depression.

The most common and debilitating form of depression involves a disturbance in the complex chemical messengers in the brain, called neurotransmitters. Sometimes these disturbances are transmitted genetically hence the tendency for depression to run in families. Fortunately, there is effective treatment now available for such disturbances.

Another form of depression is a feature of bipolar disorder, also called manic depression. A bipolar patient may experience a period of depression and then swing into a period of mania, including extreme excitability, grandiose thinking, the inability to sleep, and so on. These mood swings are what make bipolar disorders different from other types of depression. During a depressive phase, however, the treatment is the same.

Frequently, different types of depression appear together. For example, a person could be biologically depressed because of, say, an insufficient neurotransmitter and then lose his job. He now has a reactive depression on top of a biological one. This is called a "double depression." It needs both medication and good counseling.

Probably as many as one out of every five adults will experience a serious clinical depression at least once, and often several times, in a normal lifetime. The sooner treatment is started, the sooner the depression will be relieved. Also, the sooner treatment starts, the higher the success rate. Serious depressions, left untreated for long periods of time, can sometimes become resistant to treatment. Depression becomes a way of life that is difficult to reverse.