Depression: Symptoms and Treatment

Depression shows up far more often than most people realize, and it can carry heavy consequences. Plenty of us would struggle to explain what it actually is, who tends to get it, or how to respond when someone close to us is caught in it. The condition takes many shapes. It gets treated in several different ways, produces a wide range of symptoms, and does not look the same across age groups, between men and women, or in people whose general health varies. Knowing even the basics gives you something to work with if it turns up in your own life or in the life of someone you care about.

Symptoms range from mild to severe, and a person may have any mix of them. Common ones include feeling hopeless or losing any sense of optimism; sleeping too little or too much; losing interest in things that used to bring pleasure; running low on energy and feeling worn out; becoming irritable, unfocused, or forgetful; eating far more or far less than usual; aches, headaches, cramps, stomach trouble, or pain with no clear cause; and thoughts of suicide or suicide attempts.

The National Institute of Health describes six major types of depression, each with its own presentation and its own effect on a person. Major depression is diagnosed when symptoms interfere with ordinary daily life: work, hobbies, sleep, eating, spending time with others. In this form the symptoms run for a limited stretch, under two years.

Once depressive symptoms persist past the two-year mark, the condition tends to be classified as persistent depressive disorder. There are no extra symptoms that define it. Duration alone is the deciding factor.

Psychotic depression is uncommon. Here the usual depressive symptoms come paired with psychosis, meaning delusions, hallucinations, or a break from reality. Postpartum depression is another form, and it affects mothers after they give birth. It goes well beyond the ordinary exhaustion and sadness of adjusting to a newborn; the symptoms are considerably more severe, and roughly 10 to 15 percent of mothers experience it after delivery.

Some people only feel depressed during the winter. That pattern is called seasonal affective disorder, or SAD, and its symptoms resemble major depression except that the person tends to recover once summer arrives. Finally there is the depression that comes with bipolar disorder. In that case a person swings between crushing lows and elated highs, the highs being what we call mania, cycling between the two extremes with little time spent anywhere near an even emotional middle.

Treatment is a deeply individual matter. One person responds to a given approach in a way another never will. A combination of treatments is often necessary, and finding the right mix can take a while. Across all types of depression, the two main tools are prescription medication and counseling (psychotherapy).

Antidepressants are frequently prescribed once a diagnosis is made, and several categories exist: selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclics, and monoamine oxidase inhibitors (MAOIs). Working closely with a doctor to settle on the right one matters a great deal. Many of these drugs interact with other medications, carry serious side effects, or can even deepen the depression. In rare instances, children and young adults have faced a higher suicide risk while on antidepressants. That means close monitoring of whoever is taking the medication, along with a willingness to switch if the current drug isn't helping.

Counseling generally comes in two main forms. Cognitive behavioral therapy helps a person retrain negative thought patterns into positive ones; over time the habit of automatic positive thinking can lift mood. Interpersonal therapy helps a person make sense of relationship troubles and find ways to cope with or resolve the things that may be feeding the depression. For many, pursuing both is the better route. Medication on its own or counseling on its own may fall short, yet together the two can be quite effective.

The condition plays out differently from person to person. In men it tends to come through as frustration, irritability, fatigue, loss of interest, and trouble sleeping. Men are more likely than women to lean on drugs and alcohol while depressed, and they more often turn reckless or abusive.

Women are diagnosed with depression more often than men. For them it frequently takes the form of overwhelming sadness, a sense of being worthless, and heavy guilt. The higher rate among women may stem from the hormonal shifts they move through over a lifetime, along with the strain of holding down work while raising a family.

Children with depression may not show the obvious signs. They are more apt to fake being sick, dodge school, cling to a parent, or develop irrational fears that someone they love will die. Some act out instead, landing in trouble at school, carrying a sour attitude, and insisting that nobody understands them or what their life is like.

Diagnosing older adults is especially tricky, because the symptoms of depression overlap so closely with those of grief. Several medical conditions also imitate depressive symptoms. Keeping a close eye on elderly loved ones and raising any worries with a medical professional is the way to figure out whether treatment is actually needed.

If someone you care about is depressed, the most useful things you can do are stay supportive, listen, and try to grasp what they're living through. Offer hope and a fresh angle, but never tell them they shouldn't feel the way they do. Invite them out to do things with you without pushing, and nudge them to talk with their doctor. Help them get to appointments when that's needed. And never brush off any mention of suicide: those remarks are serious and belong in front of their doctor or counselor.

If you suspect you may be depressed yourself, don't put off getting help. It's out there, and recovery is genuinely possible. Try to exercise and take part in the activities you normally like even when you have no appetite for them; simply doing the activity can keep symptoms from sliding further. Hold onto whatever positivity you can, and guard against pulling away from the people in your life. Open up to someone you trust, and give recovery room. It does arrive, though it can take time to land on the combination of treatments that fits your situation.

Depression is a serious condition touching millions of people worldwide, and it reaches them regardless of age, sex, or general health. There are many ways to treat it, often several at once. A working understanding of it leaves you better able to grasp what a depressed person is facing and how to walk alongside them toward recovery, or, if you are the one struggling, how to look after yourself. - Tina Fuster