How common is depression?

Depression is called the "common cold" of mental illness, not because its symptoms are mild but because the disease is so widespread across cultures. It is the most diagnosed mental health disorder in the United States, among the most debilitating, and the most lethal (15 percent of all untreated clinical depressions result in suicide). At any given moment, somewhere between 15 and 20 million Americans are suffering from depressive disorders, and about one in five will develop the illness at some point during their lifetimes.

Who gets depressed?

Depression does not discriminate among its victims-it affects all age groups, all economic groups, and all gender and ethnic categories. While the average age of onset was once a person's mid-thirties, it is now moving towards adolescence and even early childhood. Although depression has become the malaise of our times, it has plagued humankind since antiquity. King Saul of the Bible (who needed David's music to soothe his despondency) was a classic depressive. The Greeks were the first to understand the biological nature of depression and gave it the name "melancholia" (from the roots "melaina chole", meaning "black bile").

What causes depression?

Depression is a complex, multi-faceted, multi-dimensional disorder. Just as there is no single cause of cancer, neither is there a single cause of depression. Depression, like the trunk of a tree, has many roots. Some of these include:

* Genetics and biology. Depression, like heart disease and cancer, tends to run in families. People can be born with a certain brain chemistry or temperament that predisposes them to being melancholic.

* Childhood trauma and other psychological factors. Changes in our psychology (reactions to trauma, personal loss, rejection) can also alter the biochemistry of the brain and nervous system - sometimes permanently. Hence, the greatest predictor of depression in adulthood is a person's loss of a parent at an early age.

* Environmental factors. Poor nutrition, hormonal imbalances, toxins in the environment, brain injuries, stress, substance abuse, and can lead to depressive states. People become depressed when losing a job, a partner, or after contracting a serious illness.

* Adverse reactions to medication. Many people do not realize that a number of common prescription drugs have side effects that can induce depression. These include cardiac drugs and hypertensives, sedatives, steroids, stimulants, antibiotics, antifungal drugs and analgesics.

* Sociological factors. Many changes in modern society, such as the breakdown of traditional communities, the dissolution of extended families, the widening gap between rich and poor, and our disconnection from the natural world, may play a part in the rising rates of depression worldwide.

* Spiritual crises. People can suffer from an existential depression when life loses its meaning and purpose. Any significant transition, especially a change of roles in family or work, can trigger this crisis in meaning.

What are the symptoms of depression?

Depression is a complex disorder and its symptoms express themselves on many levels. Depression creates physical problems, behavioral problems, distorted thinking, changes in emotional well being, troubled relationships and spiritual emptiness. The symptoms of major depression can be divided into three categories:

Disturbances of emotion and mood.
Changes in the "housekeeping" functions of the brain - those that regulate sleep, appetite, energy and sexual function.
Disturbances of thinking and concentration.

The most common symptoms of clinical depression include:

* chronically sad or empty mood.
* loss of interest or pleasure in ordinary pleasurable activities, including sex.
* decreased energy, fatigue, feeling slowed down, slowed movement, slurred speech.
* sleep disturbances (insomnia, early morning waking, or oversleeping).
* eating disturbances (loss of appetite, significant weight loss or weight gain).
* difficulty concentrating, impaired memory, difficulty in making decisions.
* agitated actions (pacing, hand-wringing, etc.)
* feelings of guilt, worthlessness or helplessness.
* feelings of hopelessness and despair.
* thoughts and/or talk of death and suicide.
* irritability or excessive crying.
* social withdrawal or isolation.
* chronic aches and pains that don't respond to treatment.
* suicide attempts.
* increase in addictive behavior.

In order to best apply this cluster of symptoms to your own situation, think of your symptoms in terms of three words - number, duration and intensity.

1) Number. The symptoms of depression are "additive" - that is, the greater the number of symptoms you have, the more likely you are to be clinically depressed. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), five or more of these symptoms should be present for a person or someone close to that person to consider him or herself "clinically depressed."

2) Duration. The longer you have been down in the dumps, the more likely it is that you are clinically depressed. According to the DSM IV, the five or more symptoms must exist for at least two weeks for a diagnosis of major depression to be made. (In the case of dysthymia or chronic low-grade depression, symptoms must be present for two years or more.)

3) Intensity. Many of us can feel emotional pain and still cope with our daily existence. Some experiences of depression are within the normal course of living. The pain of major depression can be so great, however, that its intensity (along with the number and duration of symptoms) can significantly impair one's ability to cope.

Can one heal from depression?

Though depression is a serious illness, it is highly treatable, as it normally responds to a combination of antidepressants, psychotherapy, and a variety of holistic treatments. Unfortunately, the majority of people with depression do not seek treatment because the symptoms are unrecognized, misdiagnosed, or so disabling that the person cannot reach out for help. In many instances, the individual is deterred from seeking help by the stigma surrounding mental illness. The promise of highly effective treatment for sufferers makes it essential for family members or friends to strongly encourage the depressed individual to seek appropriate treatment.