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What is depression?
Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. That is not depression. Those are just normal emotions, like feeling happy, stressed out, nervous or worried.
When a person has a depressive disorder, it interferes with daily life and normal functioning, and causes pain for both the one with the disorder and those who care about her. The symptoms stay for few weeks to months.
Depression is a common but serious illness, and most who have it need treatment to get better.
Depression affects both men and women, but it occurs more frequently in women. Children and adolescents are also affected.
Many men and women suffering from depression never seek treatment. But the vast majority, even those with the most severe depression, can get better with professional help.
Which are common signs and symptoms of depression?
Signs and symptoms of depression include:
- Persistent sad, anxious or "empty" feelings
- Loss of interest in activities or hobbies once pleasurable, including sex.
- Feelings of hopelessness and/or pessimism
- Irritability, restlessness, anxiety
- Feelings of guilt, worthlessness and/or helplessness
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Changes in sleep pattern (insomnia or excessive sleeping)
- Changes in appetite (increase or decreased appetite)
- Thoughts of suicide, suicide attempts
- Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
What causes depression?
We don't know exactly how depression develops. However it is likely that genetic, biological, chemical, hormonal, environmental, psychological, and social factors all intersect to contribute to depression. There are ongoing investigations to answer this question.
How is depression diagnosed and treated?
Depressive illnesses, even the most severe cases, are highly treatable disorders. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that a recurrence of the depression can be prevented.
The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. Psychiatrists are physicians who can perform a good differential diagnosis in this regard. The doctor or mental health professional will conduct a complete diagnostic evaluation.
How is depression treated?
Once diagnosed, a person with depression can be treated with a number of methods. The most common treatment methods are medication and psychotherapy.
Examples of antidepressant medications, which have shown efficacy in the treatment of depression, are:
- fluoxetine (Prozac)
- citalopram (Celexa)
- sertraline (Zoloft)
- paroxetine (Paxil)
- escitalopram (Lexapro)
- fluvoxamine (Luvox)
- venlafaxine (Effexor)
- duloxetine (Cymbalta)
- Trazodone (Desyrel; Oleptro)
- Other antidepressants like tricyclics and MAOIs
Examples of psychotherapies that have shown efficacy in the treatment of depression are:
- Cognitive behavioral therapy (CBT)
- Interpersonal psychotherapy (IPT)
Electroconvulsive therapy:
For cases in which medication and/or psychotherapy does not help alleviate a person's treatment-resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," used to have a negative reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.
Where can I go for help?
If you are unsure where to go for help, ask your family doctor. Others who can help are:
- Mental health programs at universities or medical schools (like our Depression and Anxiety Disorders Institute at the University of South Florida College of Medicine).
- Health maintenance organizations (HMOs).
- Community mental health centers.
- Hospital psychiatry departments and outpatient clinics.
- State hospital outpatient clinics.
- Family services, social agencies or clergy.
- Peer support groups.
- Private clinics and facilities.
- Employee assistance programs.
- Local medical and/or psychiatric societies.
Anxiety Disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year, causing them to be filled with fearfulness and uncertainty. Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at several months and can get worse if they are not treated. Anxiety disorders can present along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse.
Examples of anxiety disorders are:
- Panic disorder
- Generalized anxiety disorder (GAD)
- Post-traumatic stress disorder (PTSD)
- Social phobia (or social anxiety disorder)
- Obsessive-compulsive disorder (OCD)
- Specific phobias
Panic disorder
Panic disorder affects about 6 million American adults and is twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited.
Panic disorder is a real illness that can be successfully treated. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.
Some people's lives become so restricted that they avoid normal activities, such as grocery shopping or driving. About one-third become housebound or are able to confront a feared situation only when accompanied by a spouse or other trusted person. 2 When the condition progresses this far, it is called agoraphobia, or fear of open spaces.
Early treatment can often prevent agoraphobia, but people with panic disorder may sometimes go from doctor to doctor for years and visit the emergency room repeatedly before someone correctly diagnoses their condition. This is unfortunate, because panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to certain kinds of medication or certain kinds of cognitive psychotherapy, which help change thinking patterns that lead to fear and anxiety.
Generalized anxiety disorder (GAD)
GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD can't seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can't relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved physical harm or the threat of physical harm to the person or someone close to her/him, of the individual might have witnessed the traumatic situation.
Examples of traumatic experiences are: combat exposure, mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, and natural disasters.
Some symptoms of PTSD are easy startling, emotional numbness, lose interest in things previously enjoyed, irritability, outburst of anger or violence. Persons suffering from PTSD usually avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult.
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Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep.
Not every traumatized person develops full-blown or even minor PTSD. Symptoms must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer.
PTSD affects about 7.7 million American adults, but it can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families. Depression, substance abuse, and one or more of the other anxiety disorders often accompanies PTSD.
Social Phobia (Social Anxiety Disorder)
Social phobia, also called social anxiety disorder, is diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. People with social phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.
Social phobia can be limited to one situation (such as talking to people, eating or drinking, or writing on a blackboard in front of others) or may be so broad (such as in generalized social phobia) that the person experiences anxiety around almost anyone other than the family.
Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence. There is some evidence that genetic factors are involved. Social phobia is often accompanied by other anxiety disorders or depression, and substance abuse may develop if people try to self-medicate their anxiety.
Obsessive-Compulsive Disorder
People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.
For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts. Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things.
Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.
Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing.
OCD affects about 2.2 million American adults, and can be accompanied by eating disorders, other anxiety disorders, or depression. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood.
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Specific Phobias
A specific phobia is an intense, irrational fear of something that poses little or no actual danger. Some of the more common specific phobias are centered on closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood. Such phobias aren't just extreme fear; they are irrational fear of a particular thing. Specific phobias affect an estimated 19.2 million adult Americans and are twice as common in women as men. They usually appear in childhood or adolescence and tend to persist into adulthood. The causes of specific phobias are not well understood, but there is some evidence that the tendency to develop them may run in families.
If the feared situation or feared object is easy to avoid, people with specific phobias may not seek help; but if avoidance interferes with their careers or their personal lives, it can become disabling and treatment is usually pursued.
Specific phobias respond very well to carefully targeted psychotherapy.
How is anxiety treated?
In general, anxiety disorders respond to medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person's preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation to determine whether a person's symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse.
Medication
The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.
Psychotherapy
Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.
Cognitive-Behavioral Therapy has demonstrated efficacy in treating anxiety disorders.
Combination treatment
Medication can be combined with psychotherapy for specific anxiety disorders, and this is the might be the best approach for some patients.
Where can I go for help?
If you are unsure where to go for help, ask your family doctor. Others who can help are:
- Mental health programs at universities or medical schools (like our Depression and Anxiety Disorders Institute at the University of South Florida College of Medicine).
- Health maintenance organizations (HMOs).
- Community mental health centers.
- Hospital psychiatry departments and outpatient clinics.
- State hospital outpatient clinics.
- Family services, social agencies or clergy.
- Peer support groups.
- Private clinics and facilities.
- Employee assistance programs.
- Local medical and/or psychiatric societies.
What is bipolar disorder?
Bipolar disorder is a serious brain illness. It is also called manic-depressive illness. People with bipolar disorder go through unusual mood changes. Sometimes they feel very happy and "up," and are much more active than usual. In some patient a predominant symptom might be severe irritability even outside of the home. This is called mania or hypomania. Sometimes people with bipolar disorder feel very sad and "down", and are much less active. This is called depression. Bipolar disorder can also cause changes in energy and behavior.
Bipolar disorder is not the same as the normal ups and downs everyone goes through. Bipolar symptoms are more powerful than that. They can damage relationships and make it hard to go to school or keep a job. They can also be dangerous. Some people with bipolar disorder try to hurt themselves or attempt suicide.
People with bipolar disorder can get treatment. With help, they can get better and lead successful lives.
Who develops bipolar disorder?
Anyone can develop bipolar disorder. It often starts in a person's late teen or early adult years. But children and older adults can have bipolar disorder too. The illness usually lasts a lifetime.
What causes bipolar disorder?
Several factors may contribute to bipolar disorder, including:
- Genes, because the illness runs in families
- Abnormal brain structure and brain function.
The causes of bipolar disorder aren't always clear. Scientists are finding out more about the disorder by studying it. Research may help doctors predict whether a person will get bipolar disorder and find better treatments for it.
What are the symptoms of bipolar disorder?
People having a manic episode may:
- Feel very "up" or "high"
- Feel "jumpy" or "wired"
- Talk really fast about a lot of different things
- Be agitated, irritable, or "touchy"
- Have trouble relaxing or sleeping
- Think they can do a lot of things at once and are more active than usual
- Do risky things, like spend a lot of money or have reckless sex.
People having a depressive episode may:
- Feel very "down" or sad
- Feel worried and empty
- Have trouble concentrating
- Forget things a lot
- Lose interest in fun activities and become less active
- Feel tired or "slowed down"
- Have trouble sleeping
- Think about death or suicide.
Is bipolar disorder easy to diagnose?
No. Some people have bipolar disorder for years before anyone knows. This is because bipolar symptoms may seem like several different problems. Family and friends may not see that a person's symptoms are part of a bigger problem.
However a well-trained mental health professional (like a psychiatrist or psychologist) will be able to conduct a thorough diagnostic interview and arrive to a clear diagnosis.
Sometimes additional test are required to rule out other conditions that may mimic or worsen bipolar disorder symptoms (i.e. blood work, urine drug screens, brain imaging, etc.).
How is bipolar disorder treated?
Right now, there is no cure for bipolar disorder. But treatment can help control symptoms. Most people can get help for mood changes and behavior problems. Treatment works best when it is ongoing, instead of on and off.
Medication
Different types of medication can help. Mood stabilizers like Lithium and Depakote are first line treatments for bipolar disorder. People respond to medications in different ways, so the type of medication depends on the patient. Sometimes a person needs to try different medications to see which are best.
Therapy
Different kinds of psychotherapy, or "talk" therapy, can help people with bipolar disorder. Therapy can help them change their behavior and manage their lives. It can also help patients get along better with family and friends. Sometimes therapy includes family members. Psychotherapy without medication/s has not demonstrated to be efficacious for bipolar disorder.
Other treatments
Some people do not get better with medication and therapy. These people may respond to electroconvulsive therapy (ECT). ECT, formerly known as "shock therapy," used to have a negative reputation. But in recent years, it has greatly improved and can provide relief for patients with bipolar disorder who have not been able to feel better with other treatments.
Where can I go for help?
If you are unsure where to go for help, ask your family doctor. Others who can help are:
- Mental health programs at universities or medical schools (like our Depression and Anxiety Disorders Institute at the University of South Florida College of Medicine).
- Health maintenance organizations (HMOs).
- Community mental health centers.
- Hospital psychiatry departments and outpatient clinics.
- State hospital outpatient clinics.
- Family services, social agencies or clergy.
- Peer support groups.
- Private clinics and facilities.
- Employee assistance programs.
- Local medical and/or psychiatric societies.