In the U. S., depression is one of the most prevalent factors leading to disability, with billions of dollars spent on care and lost productivity annually. Major depression, also known as clinical depression, is a mental health mood disorder as this sample essay will discuss in detail.

Chronic depression: More than just a downer

Individuals who experience major depression often harbor feelings of sadness, anger, loss of interest, agitation, loss of sleep, frustration and irritability, although people are affected differently by the disorder. Some persons are able to function normally within their daily lives and give the impression of being happy and healthy, yet are quite disturbed within. Further, major depression can manifest itself in a variety of mental and physical pathologies, including lethargy, complication with recollection and focus, sensations of melancholy and incapacity, headaches and suicidal ideation. Major depression can be divided into two main types of disorders categorized primarily by duration – episodic depression and chronic depression. 

Major depressive disorder

Episodic depression is major depression, generally characterized by mood disorder experienced over a limited amount of time – more than two weeks. Chronic depression is major depression, characterized by symptoms lasting for two or more years. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is a comprehensive manual used by U. S. mental health care professionals to classify and diagnose mental disorder.

The manual is developed under the auspices of the American Psychiatric Association and the National Institutes of Health. Over time, as more information has been gathered, analyzed and digested, the description for some disorders have evolved. The DSM-V describes what was previously called dysthymia in its DSM-IV version, and for many years; has now been categorized as persistent depressive disorder (PDD), along with chronic major depressive disorder.

Episodic and chronic depression is not only distinguished by time. Chronic depression has the effect of more functional impairment than episodic depression. Also, in the case of chronic depression there is greater risk of suicide. Moreover, there is a parallel between chronic depression and other psychiatric disorders. Finally, chronic depression has more indications of genetic interplay and incidents of childhood trauma reported by patients. 

Symptoms of depression

Individuals who suffer from chronic depression are usually in a state of depression for the major part of the day. They also experience a loss of interest in people and relationships they valued previously, like family and friends, and lose interest in daily activities, like golf or swimming, if they liked these endeavors before. The time frame for this diagnosis requires that these symptoms persist every day for a period of 2 weeks, at minimum.

In addition to these primary symptoms, others may arise also, including, feelings of hopelessness, despair, worthlessness, self-hate; a lack of energy or fatigue on a daily basis; an ongoing sentiment of inadequacy; remorse, shame or guilt; headaches or back pain; an inability to make decisions or focus on things; an inability to sleep or a tendency to sleep too much every day; no interest or pleasure in daily activities; sensations of restlessness or feeling slow or rundown; substantial weight loss or gain within a month; or thoughts of death or suicide, or suicide attempts. If at least five or more of these manifestations are present, your doctor will likely diagnose you as having major depression disorder. 

Causes of depression

There are no perfect causes for major depression, however, some general potential triggers are abuse caused emotionally, sexually or physically; feelings of deprivation, withdrawal, loneliness and isolation; love lost by divorce, separation or death; major interpersonal conflicts at home or at work; or significant life transitions, like major moves; job or career changes; retirement or graduation; drug and alcohol abuse; some medicines.

Physical causes include changes that have transpired in the brain mass; changes in brain chemistry, such as neurotransmitters and their interaction with brain neurocircuits which help to stabilize mood; hormone imbalances; and genetic traits from relatives; underactive thyroid, cancer or long-term pain.

Prevalence of depression

Women suffer from depression twice as much as men, likely due to hormonal factors such as pregnancy, menstrual cycles, pre and post menopause, postpartum transitions, miscarriages, including additional responsibilities at home and in the workplace, and caregiving to children and aging parents. In addition, women are more likely to seek help than are men.

Despite the prevalence of depression in women, in the U. S. there are over 3 million men diagnosed with depression. The other problem, in the case of men, is the fact that men are not open to admitting the fact that they are suffering from depression, and often doctors do not suspect it. Men also hide their depression with alcohol more than women. Men commit suicide at a rate of four times more often than women and that rate even increases after men reach 70. Women are less successful at completing suicide than men. 

Risk Factors

Surveys indicate that almost 15 million Americans are affected by major depressive disorder in a year's time. The onset of depression clusters around the teen years and in patients in their twenties or thirties, though the average age is 32. People who abuse alcohol or illegal drugs are particularly susceptible to depression. There is a dual susceptibility in the case of alcohol, in that drinking leads to depression and conversely, depression leads to alcoholism.

Other drug risk factors include use of sleeping pills and high blood pressure medicine. In the case of genetics, relatives who have committed suicide, are alcoholics, bipolar or who have a history of depression have higher risk of onset. Those who have other disorders, like eating or anxiety disorders, are at risk of depression. Transgender, gay, bisexual and lesbian individuals are at greater risk for depression.

Research indicates that lesbians, gay and bisexuals have a higher rate of mental disorders, likely inspired by discrimination, with a higher recurrence rate of major depression among gay men, and a higher use of mental health facilities by individuals with same sex partners. Other groups with high risk factors include women, African-American and those who live in poverty. Smoking has a substantial risk factor for depression. People who are inclined towards depression have a 25% chance of becoming depressed when they quit smoking and the potential risk lasts for up to six months. 

Diagnosis of depression

Individuals who seek help for feelings of depression often go to their family doctor first. The initial conversations between a doctor and patient usually focus on screening questions like,

“over the past month, have you felt down, depressed or hopeless? Over the past month, have you felt little interest or pleasure in doing things?.

If referred to a mental health clinician, a patient might receive a screening test, for example the Hamilton Rating Scale or the Beck Depression Inventory screen. These screens generally consist of a set of 20 questions posed to the patient, though the doctor may just check symptoms and other criteria.

Treatment of depression

The excellent news is that depression can be treated. The most popular treatment options involve psychotherapy, medicines, such as antidepressants, or a combination of both options. The method selected is dependent upon a variety of factors including the extent of the disorder, the specific category of depression, other possible medical issues, a woman’s pregnancy condition and possibly the person’s age.

Individuals with chronic depression often receive cognitive behavioral therapy (CBT) in combination with antidepressants which usually need to be taken for four to nine months to reduce the likelihood of recurrence. Studies indicate that the combination of antidepressants with CBT are the most effective treatment. Another option for those who are resistant and hard to treat is a brain stimulation method called electroconvulsive therapy (ECT). In fact, there are a number of newer experimental treatments that are being researched. 

Sadly, people with depression often do not get the care they truly need, receiving less than adequate care or none at all. There are many possible reasons for this including lack of health insurance, limited access to health care facilities, failure to complete doctor’s orders, or healthcare professionals who simply lack training or ability to recognize symptoms. 

Exercise 

Antidepressants, although beneficial for many, are often used in combination with CBT, including exercise. Research indicates that exercise has a major significant impact on patients with depression as an adjunct treatment method. In one of the studies, the study group walked for twenty to forty minutes, three times per week compared to a placebo group, and the results were quite impressive.

In addition, it was discovered that exercise often led to a longer lasting period of success, and in the case of many involved in the study group, the participant continued to exercise from the beginning of the program through their one year follow-up and indicated that the exercise had a positive impact on their depression.

Prevention of depression

Depression can generally be treated successfully when the regimen prescribed by the doctor is followed completely. If that regimen is just antidepressants, just CBT or a combination of both, the best solution is completing the recommendations made by the mental health professional. In some instances, depression is not preventable because it might be the result of a hormone imbalance, or altered brain chemistry. If depression can be prevented, however, it would be though the development of healthy eating habits, exercise, finding time for relaxation and fun, and avoiding stressful situations. 

Conclusion

Chronic depression is a serious disorder that requires proactive intervention on the part of the patient. Although most experience major depressive disorder in their teens, twenties or thirties, thirty two is the average age of onset. The disorder can be caused by genetics, other diseases, imbalances in hormones or brain chemistry, or abuse of drugs and alcohol, and more. Depression is not something that a person who falls victim to it, can simply “snap out ” of. When someone indicates that they are feeling depressed, they should be taken seriously and encouraged to see a doctor to be screened. If the person does not recognize the symptoms but displays them, they should be encouraged to see a mental healthcare professional for safe keeping. If they are male, they will likely have to be pushed a little more. We are our brothers’ keepers. 

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