Identifying and Treating Major Depression

by Marie Hartwell-Walker, Ed.D.
I feel like I'm floating under an endless gray sky in an endless gray sea of tepid water. There is no horizon. There is nothing to break the monotony. I feel nothing. I see nothing. I hear nothing. I can't bring myself to move. My world is nothing.

21-year-old woman suffering from major depression
No one can understand this - this sense of aloneness and pointlessness. I know I should care about my family, my job, and my friends. But it's like I'm under layers on layers of padding. They can't get to me. I don't have whatever it is to want to reach for them.

42-year-old man suffering from major depression
Why is life such a struggle? It just feels too hard to keep on living. I don't really want to die. I want this pain to end. Nothing is worth this pain.

35-year-old woman suffering from major depression

"Depression" is a term loosely tossed about in American culture. When people say, "I'm depressed," they usually mean that they are merely garden-variety sad or down about something. They know (and you know) that in a few minutes, hours, or after a good night’s sleep, they will feel better and be their usual selves.

Not so with major depression. A major depressive episode is not fleeting or insignificant. Major depression isn't about being "down in the dumps," "blue," or in a “bad mood.” Sufferers can't just "snap out of it" or distract themselves into a better mood. Rather, major depression dominates a person's life for anywhere from two weeks to many years.

It's not unusual for a person with major depression to question whether life itself is worth living. Fifteen percent of those who suffer from depression die from suicide. If you or someone you love is severely depressed, it's important that it be taken very seriously.


Symptoms of Major Depression

Five or more of the following nine symptoms must last for two weeks or more for a person to be diagnosed as suffering from major depressive disorder:

  • Depressed mood for most of the day, nearly every day (adolescents and children tend to show depression as irritability and anger rather than the sadness and withdrawal of adults);

  • Loss of interest or pleasure in most activities the person once found enjoyable;

  • Insomnia (too little sleep) or hypersomnia (too much sleep);

  • Suicidal feelings or frequent thoughts of death;

  • Feelings of either being slowed down or restless for most of the day;

  • Feelings of worthlessness or guilt;

  • Pervasive fatigue or loss of energy;

  • Significant but unintentional weight loss or weight gain or decrease or increase of appetite; and

  • Inability to concentrate or make decisions.

It Isn't Always Depression

Medical conditions can cause symptoms that look like depression. These include diabetes, hypo- or hyper-thyroidism, multiple sclerosis, Parkinson's disease, head trauma, hepatitis, AIDS, or other infectious diseases. Use of steroids or withdrawal from cocaine, alcohol, or amphetamines can also produce depressive symptoms. Finally, normal bereavement after the loss of a loved one can look very much like depression. A careful assessment includes screening for medical problems and questions regarding what else may be going on in a person's life that might produce symptoms that look like depression.

What To Do if You Are Depressed

  • Don't isolate. Get help! Fight the impulse to withdraw under the covers and shut out the world. Use whatever energy you have to find treatment. Very few people are able to handle this alone. The suicidal feelings may be only a symptom of the illness but they are powerful, none-the-less. Find the help and support you need to keep you from acting on impulses to hurt yourself (either actively by purposefully doing something self-destructive or passively by not doing something you need to do to keep yourself out of danger and in good health). Family, good friends, and helping professionals can lend you some of their optimism and energy when your own are flagging.

  • Get rid of guns and other destructive things. If you feel suicidal and there are guns, pills, or any other means for committing suicide in the house, get rid of them. It's been found that when people don't have access to a means to kill themselves, the impulse to do so usually passes. If there is a means readily available, it is difficult to resist the impulse to self-harm. Confide in friends or family members and ask them to hold your gun, medicine, or whatever else you feel you might use to hurt yourself.

  • Don't drink or use illegal drugs. The temptation to do so is often compelling. After all, people use alcohol and illegal drugs because they do make people feel better. However, this type of self-medicating often has serious "side effects" like addiction, trouble with the law, and occupational and relationship failures. If you need medication, see a doctor and get the real thing.

  • Consider medication. Consult your health care provider or, better yet, a qualified psychiatrist to see if medication might give you some relief. Often people find that depression makes it tremendously difficult to get up the energy and desire to do the things that might help. With a little relief, you may find that you have the emotional and physical energy to begin to take steps toward helping yourself.

    Yes, medications are a "crutch," but there isn't necessarily anything wrong with using a crutch when you are emotionally limping. Just as people with leg injuries gradually wean away from their crutches as they do their physical therapy and get physically stronger, chances are you can wean yourself away from a medication crutch as you do your emotional therapy and get mentally stronger.

    There are many different medications that can have a positive impact. The past decade has seen the development of medicines with fewer and less serious side effects than the older medications. Sometimes, however, the older medications are more effective for some individuals. Your psychiatrist will help you find the right medication at the right dosage for you.

    Be aware that it can take three to six weeks for most antidepressants to begin to work. It's extremely important that, at the same time, you also use other strategies to relieve the depression.

  • Do something - almost anything - active. Physical activity releases endorphins, a natural chemical reaction in your body, and that will make you feel better. Take a short walk. Make the bed. Get on that fancy “clothes rack” in your room called an exercycle and actually put in 10 minutes or so. Not only will you feel physically better, but you will also feel a little better about yourself for having accomplished something with your day.

  • Do something - almost anything - every day. Here's how the negative cycle of depression works: You feel too depressed to do anything. So you don't. At the end of the day, you feel miserable because you haven't done anything worthwhile all day. Your self-esteem drops another notch. All this makes you feel even more depressed. So the next day it's even harder to do anything worthwhile. It's depressing!

    Halting and reversing the process takes effort. Even if all you do today is get up, take a shower, and get dressed, you will feel better for it. At least you got up and got clean and dressed. This will bring your self-esteem up a notch so that, maybe tomorrow, you can take a walk or call a friend. Step by step, a more positive cycle can be put in motion to move you gradually out of depression.

  • Consider psychotherapy. There are a number of approaches to psychotherapy. Each has been proven to be helpful in combating major depression for at least some sufferers. Four major models of therapy are: (1) cognitive-behavioral therapy; (2) psychodynamic therapy; (3) interpersonal psychotherapy; and (4) systemic family therapy. Whatever model your therapist uses, the most important variable in predicting a successful treatment is whether you feel comfortable with the therapist and with what the therapist is doing. If the fit between you and the therapist feels helpful to you, it probably is.

  • Educate yourself about depression. Go to a Web site. Read a few books. Be open to the encouragement that can come with information and with the knowledge that others have come through the illness and are living successful lives.

  • Join a support group. Not only will you learn ways to take care of yourself, you will have the support of others who really do know what you are going through. Isolation is depression's friend. The mutual support and concern of people who care about each other is its enemy.

A mental health professional can work with you to help you pick and choose the interventions that you will find most helpful. It's important to remember that between 10 and 25 percent of women and between five and 12 percent of men experience major depression at some time in their lives. However lonely you may feel at this moment, you are most certainly not alone! Most people do respond to treatment. You too, can be helped.

Date published: 8/18/00
Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
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