Mood Disorders - Major Depression

Excerpted from
The Last Taboo; A Survival Guide to Mental Health Care in Canada
By Scott Simmie, Julia Nunes

As noted earlier, this mood disorder is - by one measure at least - the greatest disabler on earth. It is a very common diagnosis that directly, and indirectly, affects many millions of Canadians, young and old alike. And it can be pure hell.

When acute, depression is a crushing and overwhelming burden for any individual. It is far deeper, more paralyzing and debilitating, than merely having a case of the blues. Untreated, depression can be deadly. Up to 15% of all people with depression take their own lives (and up to 80% of people who suicide are depressed at the time of their death).

Most people suffering from depression report having at least five of the following symptoms and say they've lasted at least two weeks. To meet the criteria of a major depressive episode, the symptoms must be a departure from the way the person usually feels, must not have been triggered by the death of a loved one, and must be interfering with the person's everyday life. A clinician will also want to make sure that the symptoms have not been caused by a physical condition, medication, or substance abuse. Here are some of the typical ways you might feel if depressed.

• You feel sad or empty most of the time; a sadness or emptiness so overwhelming you feel powerless against it.

• You're sleeping too much or too little. Frequently, people in a severe depression can't even get out of bed.

• You're eating too much or too little. It's not uncommon to gain or lose a significant amount of weight during a depressive episode.

• You feel hopeless, worthless, and think the world would be better off without you.

• You feel guilty - even when there's no reason to be.

• Your body feels sluggish, you have no energy most of the time or you feel agitated and can't relax. Routine tasks like showering, shaving, or shopping can require considerable effort.

• You find it hard to think or concentrate; it's difficult to hold a thought.

• You're frequently thinking about suicide or death. Some people become fixated on dying. This is called "suicidal ideation."

• Nothing seems interesting or pleasurable any more; food can lose its taste, even the funniest movie can't bring a smile to your face. There is a total absence of joy in life.

Depression falls into a group of mood disorders also referred to as "affective disorders." Within that broad category are such variations on a theme as dysthymic disorder (low-level but chronic depression), substance-induced mood disorders, and others.

Postpartum depression is diagnosed when women develop depressive symptoms within four weeks of childbirth. Most new mothers experience the so-called "baby blues" - feelings of sadness, anxiety, and tearfulness in the week or so after a baby's birth. A smaller number - about 10% - develop the more severe and long-lasting symptoms of true depression. An even smaller number - as few as two in a thousand - suffer from a psychotic form of postpartum depression, experiencing delusions and hallucinations that may put them at risk of harming themselves or their baby. (Postpartum psychosis made front-page news in 2000 when a Toronto doctor jumped in front of a subway with her six-month-old baby in her arms; both died. Media reports emphasized her wealth and education, but her story proves the point that depression strikes people in every walk of life.)

The causes of postpartum depression are unclear, but may be related to hormonal changes. Women with a history of mood disorders, and women in an unhappy marriage, are at greater risk of developing the disorder. It's thought this type of depression is vastly underdiagnosed, in part because women fear being seen as bad mothers, even having their babies taken from them. This is unfortunate, because most women respond well to treatment, which consists of psychotherapy - especially interpersonal therapy - and/or antidepressants. If psychotic symptoms are present, hospitalization and antipsychotic medications may be required.

Depression is sometimes known as "unipolar affective disorder," meaning the person experiences just the deep and crushing lows. If, in addition to those desperate lows, they experience extraordinary highs, they may receive a diagnosis of "bipolar" affective disorder, previously known as manic depression.

The most common treatment for depression involves medication (antidepressants) and/or psychotherapy. Some studies indicate that psychotherapy is of equal benefit to drugs; other work suggests medication may be more effective. The vast majority of the literature indicates that the best results occur when both therapies are combined. There are, however, many alternatives that the evidence also supports as being useful - and which we'll cover later in the book.