The 'Blues' - Major Depressive Disorder

Excerpted from

Am I Okay? A Layman's Guide to the Psychiatrist's Bible

By ,

There is nothing uniquely human about being depressed-it happens all the time to mammals, both in the wild and in the laboratory. The four major triggers of human depression are the loss of a loved one, a stress that can't be handled, a loss of status, or a feeling of guilt. Animals are definitely able to experience depression in response to the first three of these situations-whether they can also feel guilty depression in the way we do is unknown but at least possible.

The essence of being a mammal is love and attachment. We are born too helpless to survive without the nurturance derived from mutual mother/child delight. But love offers a hostage to fate. Losing someone precious brings at least temporary heartbreak and sometimes a long-standing depression. Animals in the wild sometimes withdraw from life and die of grief after losing a cherished loved one. In a like way, humans have a much elevated rate of depression and mortality after losing a spouse. What starts out as normal grieving sometimes turns into a depressive illness.

Depressions related to stress have been neatly (if not always kindly) duplicated in laboratory experiments. A mouse or monkey who is unable to succeed in performing a difficult or stressful task will eventually give it up, withdraw, and get demoralized. This is particularly likely to happen if the animal's best efforts have no impact whatever on the outcome. In one particularly telling experiment, we animals are yoked together so that they will receive exactly the same mildly unpleasant shock, but one of the two can take steps that will improve or worsen the outcome for both. Even though both animals receive exactly the same total amount of discomfort, the active animal who can exert some influence experiences much less depression than the totally passive victim. Having some say in our fate, even if it is a difficult fare, helps to prevent demoralization and depression.

The loss of status after losing a dominance struggle can also provoke depression and slinking away-throughout the animal kingdom and in the corporate boardroom. Very often the defeated animal has trouble adjusting to a more submissive role, leaves the group, and quickly perishes. This can also happen to the victim of office politics, country club high jinks, or disgruntled retirement.

If all mammals can experience depression, it is no surprise that it is the most frequently encountered of all the psychiatric disorders in humans. As many as 20 percent of women and 10 percent of men will suffer an episode of depression at some point in their lives. At any given time, 5 to 10 percent of women and 3 percent of men are depressed. The economic consequences are staggering: the cost in lost productivity and increased use of medical services is over thirty billion dollars annually. Having depression on top of another medical condition (like heart disease) can also be dangerous to your health-causing more complications and a much higher risk of death. Unfortunately, however, four out of five cases of depression go undiagnosed and untreated. Most people suffer in silence, and without help. This chapter will help you to determine whether your sad feelings fall within normal mood variation or whether they constitute a clinical condition that deserves diagnosis and treatment. Early identification and treatment helps to tame depression before it can cause serious damage and become a way of life.

There are two forms of Mood Disorder-one called unipolar depression because the person has only downs, and no ups. The other-Bipolar Disorder-describes mood oscillations in both directions. The person with Bipolar Disorder has depressions that are quite similar or even identical to those described here, but also has manic highs. Approximately 15 percent of people with clinical depression will at some point develop a period of elevated mood, resulting in a change in diagnosis from Major Depressive Disorder to Bipolar Disorder. This distinction between unipolar mood disorder and bipolar mood disorder has crucial treatment and prognostic significance that will be a major focus of attention in the next chapter.

In the remainder of this chapter, we discuss the two types of unipolar depression recognized in the DSM-IV: Major Depressive Disorder and Dysthymic Disorder. Most people have the episodic form of depression - called Major Depressive Disorder. In contrast, Dysthymic Disorder is a long-standing, but milder, depression that starts early in life and persists more or less continuously.

Major Depressive Disorder

The severity of an episode of Major Depressive Disorder can range from the equivalent of no more than a bad case of flu to something that more resembles terminal cancer (but fortunately is much more treatable). Even at its mildest, major depression takes the wind out of your sails. You may, or may not, be able to slug through your daily routine of work, family, and social obligations, but everything is burdened by the weight of the illness. At its most severe extreme, you seem to disappear into the illness. The symptoms are so intense, pervasive, and crippling that you can't do much of anything, including thinking straight about getting treatment. You may become virtually unrecognizable to other people and feel as if you have lost yourself.

Perhaps the most dangerous aspect of depression is that most people have little or no insight concerning the enormous influence it has on their self-evaluation and perception of the past and the future. It is as if a sunny summer day has turned into a terrible storm without your noticing the change. Everything becomes gray or black, turbulent, and dreary. Even worse, all your previous sunny days are totally forgotten and the weather forecast promises nothing but an eternity of storms. Depression robs hope and makes everything look much more worse than it really is.

The key step to recovery and gaining control over the illness is being intimately familiar with its particulars. If you can spot the early signs of depression, you can start the process of turning them around before they snowball into something more serious. If you are aware that you are depressed, you will be able to extricate yourself from the distortions in thinking it causes. You can stop blaming yourself for the illness and start doing something about curing it. Know the following symptoms so well that you can spot emerging episodes before they get out of hand. You can't control the weather, but you can control depression.

Handicapping the odds about the future course of your illness can help you in planning how best to deal with it. Major Depressive Disorder is usually, but not always, a recurrent condition. The frequency and severity of episodes can vary greatly. If you have one episode of Major Depressive Disorder, there is about a 50 percent chance that you will never have another. If you are part of the unlucky 50 percent who will go on to have a second episode, it is likely that you will have additional further episodes unless you take certain precautions to prevent them. For instance, if you have already had two episodes, the chances of going on to have a third rise to about 70 percent. If you have had three depressions, the odds of your having a fourth go up to about 90 percent. We, therefore, recommend that you consult a mental health professional and plan a long term, and perhaps lifelong, treatment strategy intended to keep the number of your lifetime episodes of depression to an absolute minimum.

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Tags: Mental Health


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