It was really hard to get out of bed in the morning. I just wanted to hide under the covers and not talk to anyone. I didn't feel much like eating and I lost a lot of weight. Nothing seemed fun anymore. I was tired all the time, yet I wasn't sleeping well at night. But I knew that I had to keep going because I've got kids and a job. It just felt so impossible, like nothing was going to change or get better. I started missing days from work, and a friend noticed that something wasn't right. She talked to me about the time that she had been really depressed and had gotten help from her doctor. Everything didn't get better overnight, but I find myself more able to enjoy life and my children.

 

Depression and anxiety often occur together.  Struggling with chronic fear and anxiety can leave you exhausted and depressed.  A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things.

A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

In any given year, 9.5% of American adults (20.9 million) suffer from a depressive illness. Like anxiety, depression often interferes with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them.

There are different types of depressive disorders, just as is the case with other illnesses such as heart disease.

Major Depression.  Major Depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Dysthymia.  Dysthymia is a less severe type of depression that involves long-term (2 years or more), chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Major Depression and Dysthymia are the two types of depressive disorders that occur most frequently with anxiety disorders and are the two types of depression treated most frequently by the Florida Anxiety Clinic.

Bipolar.  The third type of depression is bipolar disorder, which is also commonly known as manic-depressive illness. Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression).  Sometimes the mood switches are dramatic and rapid, but most often they are gradual.

When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, over talkative, and have a great deal of energy.

Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Symptoms of Depression

* Persistent sad, anxious, or "empty" mood

* Feelings of hopelessness, pessimism

* Feelings of guilt, worthlessness, helplessness

* Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

* Decreased energy, fatigue, being "slowed down"

* Difficulty concentrating, remembering, and making decisions

* Insomnia, early-morning awakening, or oversleeping

* Appetite and/or weight loss or overeating and weight gain

* Thoughts of death or suicide; suicide attempts

* Restlessness, irritability

* Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Symptoms of Mania

* Abnormal or excessive elation

* Unusual irritability

* Decreased need for sleep

* Grandiose notions

* Increased talking

* Racing thoughts

* Increased sexual desire

* Markedly increased energy

* Poor judgment

* Inappropriate social behavior

The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests.

If a physical cause for the depression is ruled out, the Florida Anxiety Clinic can conduct a psychological evaluation to thoroughly assess the history and nature of the depression, as well as contributing causes. 

Treatment choice will depend largely on the outcome of the evaluation. Patients may need antidepressant medications in addition to psychotherapy.  Patients with milder forms of depression may do well with psychotherapy alone. Patients with moderate to severe depression most often benefit from antidepressants. Most patients, however, do best with combined treatment. 

Two of the short-term (10-12 sessions) psychotherapies that research has shown helpful for unipolar (without mania) depression are interpersonal and cognitive-behavioral therapies.

In interpersonal psychotherapy, the focus is on the patient's disturbed personal relationships that both cause and exacerbate depression. Cognitive-behavioral therapy help patients change the negative styles of thinking and behaving often associated with depression. 

At the Florida Anxiety Clinic, our treatment protocol for depression combines both interpersonal and cognitive-behavioral therapies.

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Source: NIMH (edited version)