Depression: More Than a Mood Swing

by Food and Drug Administration (FDA)

Thirty-three-year-old Saritza Velilla of Frisco, Tex., was just 7 years old when she first started feeling worthless. As the years went by, these feelings intensified and she became more withdrawn from social activities. But it wasn't until 1996 that Velilla was diagnosed with clinical depression, and only recently that she found relief from her ongoing symptoms.

"I always felt outside the mainstream," she remembers. "I could feel alone in a roomful of people." Velilla grew up for the most part with a great void in what she calls "that important emotional need" for parental care, affection, or attention. "Without those bonds in place," she says, "I did not develop emotionally and had trouble relating to others."

Velilla is not alone in grappling with the consequences of mental illness. An estimated 22 percent of Americans 18 and older — about 1 in 5 adults — have a diagnosable mental disorder in any given year, according to the National Institute of Mental Health (NIMH). To complicate matters, many people struggle with more than one mental disorder at a time. The pain and suffering that goes along with these illnesses is felt not only by those who have a disorder, but also by the people who care about them.

Family members often watch their loved ones cycle in and out of treatment, on and off medications, and, in some cases, in and out of jail. Pete Earley of Fairfax, Va., says that if medical experts had responded to his son's mental condition as quickly as law enforcement reacted to his criminal behavior, his son would be receiving therapy instead of facing a possible prison term.

Earley's son has bipolar disorder — also called manic-depressive illness — a form of mental illness different from Velilla's that can cause extreme shifts in mood, energy and functioning. Earley says his son is frequently delusional, paranoid, and psychotic. If he discontinues his medications, he exhibits bizarre, irrational behavior.

According to the NIMH, most people with a depressive illness do not get the help they need, although the great majority — even those whose depression is severe — can be helped. Without treatment, the symptoms of depression can last for weeks, months, or even years. With treatment, many people can find relief from their symptoms and lead a normal, healthy life.

More Than a Mood Swing

Clinical depression, one of the more common categories of mental illnesses, is a serious brain disorder that affects the way nearly 19 million American adults feel, think, and interact. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, clinical depression is extreme and persistent and can interfere significantly with a person's ability to function. People with depression cannot merely "pull themselves together" and get better. Depression cannot be willed or wished away.

There are three main types of clinical depression: major depressive disorder; dysthymic disorder; and bipolar depression, the depressed phase of bipolar disorder. Within these types are variations in the number of associated mental symptoms, and their severity and persistence.

A person experiencing major depressive disorder suffers from, among other symptoms, a depressed mood or loss of interest in normal activities that lasts most of the day, nearly every day, for at least two weeks. Such episodes may occur only once, but more commonly occur several times in a lifetime.

Unlike major depressive disorder, dysthymic disorder — a chronic but less severe type — doesn't strike in episodes, but is instead characterized by milder, persistent symptoms that may last for years. Although it usually doesn't interfere with everyday tasks, people with this milder form of depression rarely feel like they are functioning at their full capacities.

Bipolar disorder cycles between episodes of major depression, similar to those seen in major depressive disorder, and highs known as mania. In a manic phase, a person might act on delusional grand schemes that could range from unwise business decisions to romantic sprees. Mania left untreated may deteriorate into a psychotic state.

For Earley, one of his son's recent psychotic episodes played out in a burglary charge. The pair was headed home from a local hospital where doctors had refused to treat him involuntarily. Earley's son suddenly leapt from their moving car, ran away, and broke into a stranger's house. After throwing a potted plant through a glass door and smashing some furniture, he then ran upstairs and drew himself a bubble bath. Earley says his son has never been in trouble with the law before and that he did not take anything from the house.

It's Not 'All In The Head'

Because the symptoms, course of illness, and response to treatment vary so much among people with depression, doctors believe that depression may have a number of complex and interacting causes.

Some factors include another medical illness, losing a loved one, stressful life events, and drug or alcohol abuse. Any of these factors also may contribute to recurrent major depressive episodes.

Modern brain imaging technologies are revealing that neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly in people with depression. Imaging studies also indicate that critical neurotransmitters — chemicals used by nerve cells to communicate — are out of balance.

Moreover, genetics research suggests that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. The hormonal system that regulates the body's response to stress also is overactive in many depressed people.

Research conducted in the fields of psychiatry, behavioral science, neuroscience, biology, and genetics, including studies of twins, lead scientists to believe that the risk of developing mental illness increases if another family member is similarly affected, suggesting a hereditary component.

This was the case for 34-year-old Susan Poage of Thornton, Colo. She recently was diagnosed with clinical depression, like her mother before her. Poage recalls a dismal childhood.

"There was a lot of silent crying, promiscuity, alcohol and drugs," she says, "and I don't remember having any good times." With the help of her doctor and a five-year struggle with drug therapy, Poage today is managing her symptoms of depression, including thoughts of suicide.

Despite strong evidence for genetic susceptibility, scientists still don't know the number of genes that might be involved in making someone more likely to develop a mental disorder. Identification of these genes has proved to be extremely difficult.

Similarly, the role of environmental effects in the development of mental illness remains largely unknown.

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