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Depression: Symptoms and Treatment
In western Nigeria, an energetic Yoruba woman gradually withdraws from village life,
ceases tending her garden, and © to the dismay of her family and neighbors © spends her
days staring at the wall of her hut. In Osaka Japan, a conscientious college student
suffers weeks of anxiety and shame, convinced he will fail an upcoming examination,
and prepares to disembowel himself. In Southern California, a hard-driving sales
manager repeatedly cancels important appointments, lets his paper work pile up and
indulges in cocktails until past midnight.
These three individuals could hardly be more unlike in cultural experience, social
background and way of life. Emotionally, however, the disconsolate African mother, the
suicidal Japanese youth and the procrastinating American businessman resemble one
another more closely than they do their own family.
Almost everyone suffers periods of depression, the reaction to some shattering event ©
the loss of a job, serious bodily injury, the death of a loved one - the despair can be so
black that treatment is called for; however, in millions of people depression occurs for no
apparent reason. Mood disorders can range from mild to severe and can linger for many
months or even years. Mood disorders are divided into depressive disorders, in which the
individual has one or more periods of depression without a history of manic episodes, and
bipolar disorders, in which the individual alternates between periods of depression and
periods of elation, usually with a return to normal mood in between the two extremes;
however, manic episodes without some history of depression are very uncommon.
Negative feelings dominate aspects of living and , in some cases, can lead to
hallucinations, withdrawal from all activities, and complete breakdown, physical as well
as mental. Such depressions constitute a debilitation sickness that, according to
Depression 3
American psychiatrist Hugh Storrow, "probably causes more human suffering than any
other single disease © mental or physical" (Campbell).
It is sometimes referred to as the common cold of mental illness, but it is the prime cause
of admission to mental hospitals in Britain and ranks second only to schizophrenia in
filling mental wards in the United States. The World Health Organization estimates that
one of every five persons in the technically advanced countries experience depression,
and it is rapidly on the rise in underdeveloped countries. Depression paves the way for
drug abuse, especially of amphetamines and other drugs that induce excitement © a
"high" to counteract the low of depression. It is a precursor to alcoholism for millions of
people, and because seventy-five per cent of all suicide attempts are attributable to
depression, it is, in Storrow's words, "one of the few psychiatric illnesses with a
significant mortality rate" (Campbell). Depression is an illness, in the same way that
diabetes or heart disease are illnesses. It affects the entire body, not just the mind, and
one in five people will suffer from it in their lifetime. Untreated depression is the number
one cause of suicide and it is second only to heart disease in causing lost workdays in
America.
Depression is no respecter of persons. It affects the rich, poor, young, and old alike. It is
mentioned as far back as the Bible, when Job lamented: "Why didst thou bring me forth
from the womb? Would that I had died before any eye had seen me... Where then is my
hope?" (Bible). Abraham Lincoln endured such low periods that he suspected he might
kill himself during one of these sieges, so he would not even carry a pocketknife
(Campbell). Hippocrates (the father of medicine), Winston Churchill, Nathaniel
Hawthorne, Edgar Allen Poe, Sylvia Plath, Virginia Woolf, Colonel Edwin E. "Buzz"
Depression 4
Aldrin Jr. (the second man to walk on the moon), and even Sigmund Freud were sufferers
© along with millions more © of depression
Although depression can happen to anyone, various studies suggest that it occur more
often in women than in men and more often in married than in single people. One
estimate indicates that three times as many women as men experience depression, but no
one is sure why. Some experts speculate that hormonal differences may be to blame, but
others authorities challenge the estimate itself. Myrna Weissman, professor of psychiatry
at Yale University, noted that men are generally more reluctant to acknowledge
depression and are more likely to mask it with alcohol. Statistics seem to reinforce this
view; the alcoholism rate is four times higher among men than women.
Recognizing depression poses a challenge, not only because it takes various forms but
also because certain symptoms © crying jags, sleeplessness, or loss of appetite © can
apply with equal validity to mild, neurotic depressions that impair some of an individual's
capacities and to severe psychotic depressions. Although depression characterized as a
disorder of mood, there are actually four sets of symptoms. In addition to emotional
(mood) symptoms, there are cognitive, motivational, and physical symptoms. An
individual does not have to have all of these to be diagnosed as depressed, but the more
symptoms he has, and the more intense they are, the more certain we can be that the
individual is suffering from depression.
The American Psychiatric Association's guidelines distinguish between two basic types
of depressive disorders: those that are affective, or endogenous, that is, internally caused,
not brought on by an external incident; and those that are reactive, responses to some
overt stress situation. Generally speaking, endogenous depression is more severe and
longer lasting, and it is psychotic © the patient is so deeply disturbed he
Depression 5
loses contact with reality. In reactive depression, the victim understands the reasons for
his sadness and remains rational; also, it usually has a relatively short time frame, usually
ending when there is an improvement in the stress situation that brought it on.
A common type of mood disorder is a bipolar disorder in which individuals are
excessively and inappropriately happy or unhappy. These reactions may take the form of
high elation, hopeless depression, or an alternation between the two.
In a manic-type reaction, a person experiences elation, extreme confusion, distractibility,
and racing thoughts. Often, the person has an exaggerated sense of self-esteem and
engages in irresponsible behavior such as shopping sprees or insulting remarks. In some
cases the cycle between depressive episodes and manic episodes is swift with only a brief
return to normality in between. This state is not as easy to detect as some others because
the person is optimistic, seeming to be in touch with reality, and blessed with an
unending sense of optimism. During a manic episode, a person may behave as if he or
she needs less sleep, and the activity level typically increases, as does the loudness and
frequency with which he speaks. People experiencing manic episodes behave in a way
that appears, on the surface, to be the opposite of depression. During mild manic
episodes, the individual is energetic, and full of self-confidence. He talks continually,
rushes from one activity to another with little need of sleep, and makes grandiose plans,
paying little attention to their practicality. Unlike the kind of joyful exuberance that
characterizes normal elation, manic behavior has a driven quality and often expresses
hostility more than it does elation. They are angered by attempts to interfere with their
activities and may become abusive. Impulses (including sexual ones) are immediately
expressed in actions or words. These individuals are confused and disoriented and may
experience delusions of great wealth, accomplishment, or power.
Depression 6
In the depressive-type reaction, the individual is overcome by feelings of failure,
sinfulness, worthlessness, and despair. In contrast to the optimism and high activity of a
manic-type reaction, lethargy, despair, and unresponsiveness mark a depressive-type
reaction. The behavior of someone with a major depressive disorder is essentially the
same as someone who is depressed in a bipolar disorder (Perris, 1982). In some cases, a
patient will alternate between frantic action and motionless despair. Some people
experience occasional episodes of a manic type or depressive type reaction, separated by
long intervals of relatively normal behavior. Other exhibits almost no normal behavior,
cycling instead from periods of manic-type reactions to equally intense depressive type
reactions.
Manic episodes can occur without depression, but this is very rare. Usually a depressive
episode will occur eventually, once a person has experienced a manic episode.
Bipolar disorders are relatively rare. Whereas about 6 percent of adult females and 3
percent of adult males in the United States have experienced a major depression at some
time, less than 1 percent of the adult population has had a bipolar disorder, which appears
to be equally common in men and women. Manic-depression differs from other mood
disorders in that it tends to occur at an earlier age, is more likely to run in families,
responds to different therapeutic medications, and is apt to recur unless treated. These
facts suggest that biological variables play a more important role than psychological
variables in bipolar disorders. Feeling unusually "high," euphoric, or irritable; needing
less sleep; talking a lot or feeling that you can't stop talking; being easily distracted;
having lost of ideas go through your head very quickly at one time; doing things that feel
good but have bad effects (spending too much money, excessive sexual activity, foolish
business investments); having feelings of greatness; or making lots of plans for activities
Depression 7
(at work, school, socially, or sexually) or feeling that you have to keep moving are some
of the symptoms of bipolar disorder, and if a person has four of these symptoms at one
time for at least one week, they may have had a manic episode.
However important the cause of a depression may be, it does not matter much in the first
step of treatment: recognizing that the problem exists. Though this seems obvious,
refusal to acknowledge a depressed state is common. In mild or moderate depressions,
the victim © and people around him © may pass off a serious attack as a temporary siege
of the blues. Even when the condition is chronic, one survey has shown, as long as two
to five years may elapse before the sufferer will seek professional help.
Once people become depressed and inactive, their mail source of reinforcement is the
sympathy and attention they receive form relatives and friends. The attention may
initially reinforce the very behaviors that are maladaptive. Because it is tiresome to be
around someone who refuses to cheer up, the depressed person's behavior eventually
alienates even close associates, producing a further reduction in reinforcement and
increasing the individual's social isolation and unhappiness.
People who have major depressive disorder have a number of symptoms nearly every
day, all day, for at least two weeks. These always include at least one of the following:
loss of interest in things; feeling sad, blue, or down in the dumps; feeling slowed down or
restless and unable to sit still; feeling worthless or guilty; increase or decrease in appetite
or weight; thoughts of death or suicide; problems concentrating, thinking, remembering,
or making decisions; trouble sleeping or sleeping too much; and loss of energy or feeling
tired all of the time. There are often other physical or psychological symptoms, including
headaches, other aches and pains, digestive problems, sexual problems, feelings of
pessimism or hopelessness, and being anxious or worried. However, sadness
Depression 8
and dejection are the most salient emotional symptoms in depression. The person feels
hopeless and unhappy, often has crying spells, and may contemplate suicide. Equally
pervasive in depression is the loss of gratification or pleasure in life. Activities that used
to bring satisfaction seem dull and joyless., and the individual gradually loses interest in
hobbies, recreation, and family activities.
Motivation is at low ebb in depression. The depressed person tends to be passive and has
difficulty initiating activities. Since the depressed person's thought are focused inward,
rather than toward external events, he may magnify aches and pains and worry about
health.
Measuring the depth of a depression has been made easier with the development of a
specific diagnostic tool © a rating scale for depression. A patients rating is based solely
upon his symptoms, either as voiced by him or as observed by a trained psychiatric
worker.
One widely used rating scale for depression is by Aaron Beck. Beck based his work on
the assumption that the "key factor in diagnosing depression is change in the
psychobiological systems" © change, in short, in the patient's physiology, behavior,
emotions, motivations and view of himself. To measure the changes the inventory poses
twenty-one sets of statements; in each set, the patient is asked to choose the statement
most applicable to him at that moment. For example, among the cognitive changes that
are looked for is a decline in the patient's estimate of his ability to make decisions. He is
presented with four statements:
I make decisions about as well as ever.
I try to put off making decisions.
I have great difficulty in making decisions.
I can't make any decisions at all anymore.
Depression 9
Other sets examine such areas as the person's ability to sleep and work, suicidal thoughts,
sexual drive and interest in other people. The more negative the response, the higher the
overall score, and the more severe the depression.
The diagnosis of a patient's depressed state © whether by rating scale, by the
psychiatrist's own observation, or by both © serves as the guideline to choice of
treatment. However, whether the case is mild, moderate or severe, and whether the cause
is known or unknown, most treatments concentrate on combining psychotherapy and
antidepressant drugs.
Three classes of antidepressant medication in widespread use today are the so-called
tricyclics, bicyclics, and the MAO © for monoamine oxidase © inhibitors. These
increase the flow of chemical substances in the brain that are reduced or blocked in
depressive states, and reduces the reabsorbation of serotonin or norepinephrine by the
presynaptic neuron.. A third medication, used increasingly in cases of manic depression,
is lithium, which affects the levels of sodium, potassium, magnesium and calcium in the
body; it appears that if these vital minerals are not present in correct amounts depression
may occur.
Once the medication has attacked the biochemical base of the depression, the therapist
can begin to explore with the patient the emotional problems that contribute to the
ailment. In severe cases, the therapy may initially consist of setting simple tasks for the
patient in an attempt to alter the behavior that has become patterned during the illness.
Most people who are treated for depression feel better and return to daily activities in
several weeks. Because it takes several weeks for treatment to work fully, it is important
to get treatment early before the depression gets worse. As with any medical condition,
one may have to try one or two treatments before finding the best one.
Depression 10
Therapy is used along with medication. In cognitive therapy, the therapist tries to replace
negative beliefs thoughts with a three-step process: identify the negative beliefs that are
influencing the patient's mood and behavior, testing to determine whether the hypotheses
are valid, and finally, replacement of the erroneous negative beliefs with more accurate
beliefs. If negative beliefs crop up again, the patient will have learned to check and
eliminate them. The success of cognitive therapy depends on the patient's monitoring of
thoughts so that he does not slip back into the habit of negative thinking. If they begin to
slip, they are taught to ask three questions (Hollon " Beck, 1979):
What is my evidence for this belief?
Is there another way of looking at this situation?
Even if it is true, is it as bad as it seems?
Only about ten percent do not recover and remain chronically depressed (Lewinsohn,
Fenn, " Franklin, 1982). Unfortunately, depressive episodes tend to recur. About half the
individuals who have a depressive episode will experience another one.
Even for people who experience depression there is hope. Despite the profound suffering
it causes, it is unlike many physical illnesses in that recovery is total. Depression does
not leave the individual with a weakened heart, for example, or the partial loss of
mobility. In fact, depression can help an individual to find a more satisfying and
meaningful life. Frederic Flach, in a book entitled The Secret Strength of Depression,
noted that many people rebound from depression better able to cope, often reaching new
levels of creativity. The illness, he wrote, enables a person to examine, the relinquish,
old assumptions that block a fresh appraisal of the possibilities in life. "to experience
acute depression," Flach concluded, "is an opportunity for a person not just to learn more
about himself, but to become more whole than he was" (Campbell 87).
Keywords:
depression symptoms treatment western nigeria energetic yoruba woman gradually
withdraws from village life ceases tending garden dismay family neighbors spends days
staring wall osaka japan conscientious college student suffers weeks anxiety shame
convinced will fail upcoming examination prepares disembowel himself southern
california hard driving sales manager repeatedly cancels important appointments lets
paper work pile indulges cocktails until past midnight these three individuals could
hardly more unlike cultural experience social background life emotionally however
disconsolate african mother suicidal japanese youth procrastinating american
businessman resemble another more closely than they their family almost everyone
suffers periods depression reaction some shattering event loss serious bodily injury death
loved despair black that treatment called however millions people depression occurs
apparent reason mood disorders range from mild severe linger many months even years
mood disorders divided into depressive disorders which individual more periods without
history manic episodes bipolar which individual alternates between periods elation
usually with return normal mood between extremes however manic episodes without
some history very uncommon negative feelings dominate aspects living some cases lead
hallucinations withdrawal from activities complete breakdown physical well mental such
depressions constitute debilitation sickness that according american psychiatrist hugh
storrow probably causes human suffering than other single disease mental physical
campbell sometimes referred common cold mental illness prime cause admission
hospitals britain ranks second only schizophrenia filling wards united states world health
organization estimates that every five persons technically advanced countries experience
rapidly rise underdeveloped countries paves drug abuse especially amphetamines other
drugs induce excitement high counteract precursor alcoholism millions people because
seventy five cent suicide attempts attributable storrow words psychiatric illnesses with
significant mortality rate campbell illness same diabetes heart disease illnesses affects
entire body just mind five people will suffer their lifetime untreated number cause suicide
second only heart disease causing lost workdays america respecter persons affects rich
poor young alike mentioned back bible when lamented didst thou bring forth womb
would died before seen where then hope bible abraham lincoln endured such suspected
might kill himself during these sieges would even carry pocketknife campbell hippocrates
father medicine winston churchill nathaniel hawthorne edgar allen sylvia plath virginia
woolf colonel edwin buzz aldrin second walk moon even sigmund freud were sufferers
along with millions although happen anyone various studies suggest occur often women
than often married single estimate indicates three times many women experience sure
experts speculate hormonal differences blame others authorities challenge estimate itself
myrna weissman professor psychiatry yale university noted generally reluctant
acknowledge likely mask alcohol statistics seem reinforce this view alcoholism rate four
times higher among women recognizing poses challenge only because takes various
forms also because certain symptoms crying jags sleeplessness loss appetite apply equal
validity mild neurotic depressions impair individual capacities severe psychotic
depressions although characterized disorder there actually four sets symptoms addition
emotional there cognitive motivational physical does have have these diagnosed
depressed intense they certain suffering american psychiatric association guidelines
distinguish between basic types depressive those affective endogenous internally caused
brought external incident those reactive responses overt stress situation generally
speaking endogenous severe longer lasting psychotic patient deeply disturbed loses
contact reality reactive victim understands reasons sadness remains rational also usually
relatively short time frame usually ending when there improvement stress situation
brought common type disorder bipolar disorder which individuals excessively
inappropriately happy unhappy reactions take form high elation hopeless alternation
manic type reaction person experiences elation extreme confusion distractibility racing
thoughts often person exaggerated sense self esteem engages irresponsible behavior such
shopping sprees insulting remarks cases cycle depressive episodes swift brief return
normality this state easy detect others person optimistic seeming touch reality blessed
unending sense optimism during episode behave needs less sleep activity level typically
increases does loudness frequency speaks experiencing behave appears surface opposite
during mild energetic full self confidence talks continually rushes activity another little
need sleep makes grandiose plans paying little attention their practicality unlike kind
joyful exuberance characterizes normal behavior driven quality expresses hostility does
they angered attempts interfere activities become abusive impulses including sexual ones
immediately expressed actions words individuals confused disoriented delusions great
wealth accomplishment power type reaction overcome feelings failure sinfulness
worthlessness despair contrast optimism high activity lethargy despair unresponsiveness
mark behavior someone major essentially same someone depressed bipolar perris cases
patient will alternate frantic action motionless occasional separated long intervals
relatively normal other exhibits almost cycling instead reactions equally intense reactions
occur without this very rare episode occur eventually once experienced episode relatively
rare whereas about percent adult females percent adult males united states have
experienced major time less percent adult population appears equally common differs
tends earlier likely families responds different therapeutic medications recur unless
treated facts suggest biological variables play important role psychological variables
feeling unusually euphoric irritable needing less sleep talking feeling stop talking being
easily distracted having lost ideas through your head very quickly time doing things feel
good effects spending much money excessive sexual foolish business investments having
feelings greatness making lots plans activities work school socially sexually feeling keep
moving four least week important cause matter much first step treatment recognizing
problem exists though seems obvious refusal acknowledge depressed state moderate
victim around pass serious attack temporary siege blues when condition chronic survey
shown long years elapse before sufferer seek professional help once become inactive mail
source reinforcement sympathy attention receive form relatives friends attention initially
reinforce behaviors maladaptive tiresome around someone refuses cheer eventually
alienates close associates producing further reduction reinforcement increasing social
isolation unhappiness major number nearly every least weeks always include least
following loss interest things blue down dumps slowed down restless unable still
worthless guilty increase decrease appetite weight thoughts death suicide problems
concentrating thinking remembering making decisions trouble sleeping sleeping much
energy tired psychological including headaches aches pains digestive problems sexual
problems pessimism hopelessness being anxious worried sadness dejection most salient
emotional feels hopeless unhappy crying spells contemplate equally pervasive
gratification pleasure life used bring satisfaction seem dull joyless gradually loses interest
hobbies recreation family motivation tends passive difficulty initiating since thought
focused inward rather toward external events magnify aches pains worry about health
measuring depth been made easier development specific diagnostic tool rating scale
patients rating based solely upon either voiced observed trained psychiatric worker
widely used rating scale aaron beck beck based work assumption factor diagnosing
change psychobiological systems change short patient physiology emotions motivations
view himself measure changes inventory poses twenty sets statements each asked choose
statement most applicable moment example among cognitive changes looked decline
estimate ability make decisions presented statements make decisions about well ever
making great difficulty make anymore sets examine areas ability suicidal thoughts drive
interest negative response higher overall score diagnosis state whether scale psychiatrist
observation both serves guideline choice whether case moderate whether known
unknown most treatments concentrate combining psychotherapy antidepressant drugs
three classes antidepressant medication widespread today called tricyclics bicyclics
monoamine oxidase inhibitors increase flow chemical substances brain reduced blocked
states reduces reabsorbation serotonin norepinephrine presynaptic neuron third
medication used increasingly lithium affects levels sodium potassium magnesium
calcium body appears vital minerals present correct amounts once medication attacked
biochemical base therapist begin explore emotional contribute ailment therapy initially
consist setting simple tasks attempt alter become patterned illness treated feel better
return daily several weeks takes several fully early before gets worse medical condition
treatments finding best therapy along cognitive therapy therapist tries replace negative
beliefs step process identify beliefs influencing testing determine hypotheses valid finally
replacement erroneous beliefs accurate crop again learned check eliminate them success
depends monitoring slip back into habit thinking begin slip taught questions hollon beck
what evidence belief another looking situation true seems recover remain chronically
lewinsohn fenn franklin unfortunately tend recur half hope despite profound suffering
causes unlike many illnesses recovery total leave weakened heart example partial
mobility fact help find satisfying meaningful frederic flach book entitled secret strength
noted rebound better able cope reaching levels creativity wrote enables examine
relinquish assumptions block fresh appraisal possibilities acute flach concluded
opportunity just learn whole
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