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DEBILITATING DEPRESSION
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SchoolNutrıtıon
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troubled minds
SNAPS
By Cecily Walters
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DEPRESSION:
MORE THAN JUST
A BAD DAY
I
keep hearing references to someone being “bipolar,” but I’m not sure what that
means. Is Seasonal Affective Disorder a real condition or just something that
winter-haters claim to suffer? I don’t understand why my spouse/child/friend/parent
won’t even try to be happy. How do I know if my sister is really suffering from
postpartum depression, or if she’s just stressed out by her newborn? If someone is
working, taking care of everyday responsibilities and being social, can they be truly depressed
and in need of treatment?
If you or someone you know has been
medically diagnosed with one of several
different classes of depressive disorder, then
you likely know the answers to these
questions. But for many, depression is a
mystifying condition, one that too frequently
is dismissed and minimized.
Depression goes beyond occasionally
feeling blue or down in the dumps. It’s a
serious illness that can strike in a variety of
forms. Experts believe that depression is
most likely caused by a combination of
genetic, biological, environmental and
psychological factors. Some theorize that
certain brain chemicals (neurotransmitters)
are out of balance in depression sufferers. A
family history of depression is seen as
another factor. Different treatments are
available, but there is no single guaranteed
cure.
Because depression is so common—said
to affect some 19 million American adults
and children by one estimate—School Nutrition is leading off this month’s coverage on
mental health with an overview of this
illness. While it’s our intent to raise awareness, promote understanding and reduce
stigma about depression and other mental
and mood disorders, it’s important to note
that symptoms, causes and treatments can
vary from one person to another and the
information in this article should not be used
in place of professional medical advice from
your own practitioner.
With that cautionary in mind, let’s start
by exploring the different forms that
depression can take, recognizing that
symptoms may be quite similar from one
type to another. The value in realizing that
there is a wide spectrum of depressive
disorders may help you appreciate the scope
of possible diagnoses, as well as the importance of seeking medical assistance.
People with
a depressive
disorder can’t
just “snap out of
it” with a little
self-talk and
well-intentioned
encouragement.
Major Depression
For the past several weeks, John has felt
extremely fatigued and has had trouble
sleeping almost every night. He has
difficulty concentrating at work, and his
usual hobbies of biking and reading no
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DEBILITATING DEPRESSION
Major
depression
is usually
intense and
disabling.
It typically
prevents
the affected
person from
functioning
normally.
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troubled minds
longer hold much interest. With friends and
loved ones, he seems flat and disengaged. John
has major depression (also known as clinical
depression).
Major depression affects about 6.7% of the
U.S. population over age 18, according to the
National Institute of Mental Health. Between
20% and 25% of adults may suffer an episode of
major depression at some point in their lives.
While an individual may experience just one
incident of major depression in a lifetime, it’s
more likely for one to experience multiple
episodes.
Almost twice as many women as men are
thought to experience bouts of major depression, as hormonal changes during puberty,
menstruation, pregnancy, miscarriage and
menopause may increase incidence. The
disparity in rates of depression between
women and men may be exacerbated by the
fact that major depression in men is thought to
be underreported, with men tending to be less
likely than women to seek help or talk about
their experience. Depression in senior adults,
teens and children also often goes undiagnosed
and untreated.
Major depression is usually intense and
disabling. It typically prevents the affected
person from functioning normally. An episode
of major depression can be triggered by a wide
variety of causes and factors. These include
n grief (over the death of a loved one or the
end of a relationship);
n social isolation;
n stress at work or home;
n major life changes (moving, graduation,
job change, retirement);
n caring for an aging parent and/or raising
a child alone;
n personal conflicts in relationships;
n physical, sexual or emotional abuse; and
n serious illness or other life challenges.
It’s important to understand, however, that
a major depressive episode may occur without
an obvious trigger.
Some experience minor depression, which
features many of the same symptoms as major
depression and lasts two weeks or more. The
difference is that these tend not to be as
debilitating, and the individual is more capable
of participating in work, family and social
activities. Still, the cumulative effects of minor
depression should not be underestimated; if
symptoms persist more than a few weeks, a
health professional should be consulted.
Chronic Depression
To those who know her well, Kelly seems
changed from the person she was only a few
years ago. Sure, she’s functioning at home and
work, but without much sustained enthusiasm
or energy. She’s endlessly self-critical, worried
and guilty. Her appetite, once healthy, has
declined and she’s lost weight. Close friends
and family members tell her that she seems
rundown. Coworkers find her to have a
“gloomy personality.” Kelly has chronic
depression (also known as dysthymia).
According to the National Institute of
Mental Health, chronic depression affects
about 1.5% of American adults. The symptoms
of chronic depression, are similar to those of
major depression, but not necessarily as
intense nor as disabling. But the symptoms
tend to carry on for two years or much longer,
and they can keep those who are affected from
feeling their best and functioning optimally.
People who experience chronic depression also
may experience a simultaneous episode of
major depression at the same time; this is
called double depression.
DEBILITATING DEPRESSION
troubled minds
Where to Begin?
W
hile family members and friends can be invaluable in getting you
the help you need, for most people living with a depressive
disorder, you need to take the first steps yourself. The National
Institute of Mental Health offers the following guidance.
● D
o not wait too long to get evaluated or treated. Some research indicates
that the longer one waits, the greater the impairment in the future. Try to
see a mental health professional as soon as you become aware of
symptoms.
● T
ry to be active and exercise. In addition, make an effort to participate in
some of the activities and events you once enjoyed, such as a movie or
sporting event.
● S
et realistic goals for yourself. Break up large tasks into smaller ones, set
priorities and do what you can as you can.
● T
ry to avoid isolation and spend time with other people. Confide your
struggles with a trusted friend or relative. Allow others to help you.
● E
xpect your mood to improve gradually, not immediately. Do not expect
to suddenly “snap out of” your depression.
● P
ostpone important decisions (especially life-changing ones like marriage,
divorce or new job) until you feel better. Discuss decisions with others who
know you well and have a more objective view of the situation.
● R
emember that positive thinking will replace negative thoughts as your
depression responds to treatment.
● C
ontinue to educate yourself about depression.
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Atypical Depression
Like John and Kelly in the examples above,
Sasha also feels sad or depressed for much of the
day for days at a time, struggling to concentrate
and enjoy regular activities. She also finds
herself sleeping for 10 hours or more without
feeling renewed or energized and notes periods
where she literally feels “weighed down.”
Unlike John and Kelly, however, Sasha often
finds that her mood improves temporarily when
something positive happens. Sasha has atypical
depression. Mood reactivity is a significant
characteristic of atypical depression that
differentiates it from major depression, in
which an individual remains resistant to
commonplace mood elevators.
Doctors believe that, despite the name,
atypical depression is quite common and may be
underdiagnosed. Those who are affected
generally don’t have as many of the symptoms
that people with major depression may experience. Some experts make a diagnosis based on
the mood reactivity paired with at least two of
the following symptoms: excessive sleeping,
excessive appetite with weight gain, an increased
sensitivity to rejection and having a feeling of
being weighed down, paralyzed or “leaden.”
Bipolar Disorder
Eli experiences depressive periods marked by a
number of the same symptoms as John, Kelly
and Sasha. He also frequently suffers from
headaches that do not respond to treatment.
More significantly, Eli cycles between depressive episodes and manic periods.
These unpredictable and dramatic mood
swings can carry Eli from a period of restless
energy, extreme elation and unrealistic grandiose planning right into episodes of uncontrollable crying, increased sleep and thoughts of
suicide—within days, hours or even minutes.
He also tends to feel irritable at inappropriate
situations. Eli has bipolar disorder.
Bipolar disorder (once called manic depression) is a complex illness. The cause is not fully
understood, though a genetic component has
been discovered and the condition can run in
families. It usually appears between ages 15 and
24 and persists for life. The scope and severity
of symptoms vary depending on the individual.
Some people may have a few symptoms, but
others may have a number of symptoms that
impair their ability to work and have a normal
life.
There are two forms of bipolar disorder.
Full-fledged mania is the primary characteristic of bipolar I disorder, while bipolar II
disorder is typified by milder periods of elation
referred to as hypomania. The difference
between mania and hypomania is “the degree
of severity,” according to the American
Psychiatric Association. If untreated, bipolar
disorder has a high rate of recurrence. In
addition, patients who experience severe mania
may require hospitalization to keep them from
risky behaviors, while those who are severely
depressed may need to be hospitalized to keep
them from acting on suicidal thoughts.
Seasonal Depression
Carmella experiences many of the symptoms of
depression mentioned throughout this article,
but they tend to occur specifically during the
fall and winter. Carmella has seasonal depression (or Seasonal Affective Disorder).
Although a spring/summer form of the
condition exists, “winter depression” is more
common.
Seasonal depression is believed to be
triggered by hormonal changes that occur at
certain times of the year. Specifically, reduced
sunlight during fall and winter months is said
to lead to a reduced production of serotonin (a
neurotransmitter that produces a soothing,
calming effect) in the brain. When the brain
does not produce enough serotonin, a person
may experience feelings of depression, along
with fatigue, weight gain and carbohydrate
cravings (because foods high in carbohydrates
increase serotonin).
Seasonal depression often starts in young
adulthood and is more common in females than
in males. While some people with this form of
depression experience mild symptoms, others
have more severe symptoms that can interfere
with relationships and productivity. As with
other types of depression, consult a medical
professional if you believe you recognize
symptoms of depression that recur at the same
time each year.
Psychotic Depression
Mike often hears “voices,” gets angry for no
apparent reason and neglects his appearance by
not bathing or changing clothes. He has
psychotic depression, a subtype of major
depression that occurs when a severe depressive
illness includes some form of psychosis. The
psychosis may take the form of hallucinations,
delusions or some other break with reality.
Psychotic depression affects about one out
of every four individuals hospitalized for
depression.
While people with other mental illnesses,
such as schizophrenia, also may experience
psychosis, someone with psychotic depression
usually experiences delusions or hallucinations
specifically associated with emotions related to
depression (such as worthlessness or failure).
Psychotic symptoms in schizophrenia, on the
other hand, tend to be less logical, more bizarre
or have no connection to a mood state. [Editors’
Note: For more on schizophrenia and other
psychiatric illnesses, see “Through the Looking
Glass,” on page 28, and this month’s Bonus
Web Content.]
Experiencing an episode of psychotic
depression increases the chance of the individual going on to exhibit symptoms of bipolar
disorder with recurring episodes of psychotic
depression, mania and attempts at suicide.
Psychotic depression can be difficult to
diagnose because the individual may go to
lengths to hide such thoughts.
Postpartum Depression
A full month after giving birth, Tanya feels
sad, hopeless and worthless. She has little
energy for caring for and bonding with her new
baby and no desire to resume any of her favorite
activities. Tanya has postpartum depression.
Many new mothers experience the “baby
blues” in the initial weeks after a newborn’s
arrival. It’s not uncommon to feel moody, teary
and overwhelmed, but these symptoms usually
are accompanied by happy feelings of welcoming new life to the world. The baby blues
typically fade within a few weeks’ time.
Postpartum depression, on the other hand,
is diagnosed when a new mother experiences a
major depressive episode within one month of
Seasonal
depression
is believed to
be triggered
by hormonal
changes
that occur
at certain
times of year.
Reduced
sunlight
during fall and
winter reduces
production
of a brain
chemical
that gives a
soothing calm.
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DEBILITATING DEPRESSION
troubled minds
Above all, try to remember that depression is NOT a character
defect or controllable weakness.
BONUS
WEB CONTENT
S
ome people with a
depressive disorder
may find themselves
preoccupied with suicidal
thoughts, feeling that the
world would be better off
without them. Learn the
important facts about suicide
and how to reach out for
help if you are feeling suicidal
as part of this month’s
online-exclusive content at
www.schoolnutrition.org/
snmagazinebonuscontent.
In addition, we’ll explore
how depression manifests
itself with older adults, as
well as children and teens.
Plus, we’ve compiled a list
of resources for more
information and support.
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SchoolNutrıtıon
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delivery. One in eight new mothers develops
this condition, and experts believe that it
appears to be brought on by the changes in
hormone levels that occur after pregnancy.
Any woman can experience postpartum
depression in the months after childbirth,
miscarriage or stillbirth, but some studies show
that first-time mothers may be at a higher risk.
Women who previously have had depression or
postpartum depression, have poor support from
their partner and/or other loved ones, have a
sick or colicky baby and/or experience a great
deal of other stress also are believed to have a
greater chance of experiencing postpartum
depression. Symptoms may intensify over time,
peaking three to four months after pregnancy.
Men can experience a variation of postpartum depression, too, according to research
published in the Journal of the American
Medical Association in 2010. Symptoms of
postpartum depression in men include sadness,
loss of interest, sleep problems and low energy.
A man also may find himself irritable, wanting
to withdraw and disengage from the family.
Postpartum depression occurs in men at a rate
that is two times higher than other forms of
depression in men. The cause is not understood, but research shows that it tends to run in
families, and fathers are more likely to become
depressed before or after a baby’s birth if their
spouse or partner also experiences postpartum
depression.
Getting Help
To treat most types of depression, a doctor may
suggest an antidepressant medication and/or
psychotherapy (also called “talk therapy”) with
a medical professional who specializes in mental
health. In addition, many experts also encourage patients with depression to make lifestyle
adjustments associated with chasing away the
more conventional “blues.” These include
regular exercise, a balanced diet, stress-reducing activities like yoga and meditation, consistent bed-times, etc.
Certain forms of depression require other
tactics. For a seasonal depression diagnosis, for
example, a doctor may recommend (in addition
to medication) that the individual try to get
outside early in the morning to increase
exposure to natural light, spending some time
outside every day (even when it is cloudy) and
daily use of a light box (shining light 20 times
brighter than normal room lighting).
A woman with postpartum depression will
need to work with her doctor to determine the
effect of medications on breastfeeding. Treatment for psychotic depression generally
requires in-patient care at a hospital.
Untreated depression of any type can have
debilitating and devastating consequences. If
you are experiencing symptoms of depression,
recognize that these likely will leave you feeling
depleted of energy, unwilling or unsure of what
to do to help yourself feel better—right when
you need help the most!
Awareness is your best tool in this situation.
Try to identify and collect resources at a time
when you are not in the middle of a depressive
period, so these are easily accessible when you
are at your lowest. School Nutrition has
compiled a list that may prove helpful; you can
find it at www.schoolnutrition.org/snmagazine
bonuscontent. Empower loved ones to provide
assistance. [Editors’ Note: “Love and Madness,”
on page 36, addresses the role of friends and
family in addressing depression.] Other tips and
advice appear in the box on page 24.
Above all, try to remember that depression is
not a character defect or controllable weakness.
It’s not your fault, and it makes you no less
worthy of love or the good things in life than
someone who is not depressed. Be gentle with
yourself and approach your management of this
medical condition on a day-by-day basis.
Finally, if you experience symptoms of depression that last for more than two weeks, don’t
delay in making an appointment with a doctor
or other mental health professional. SN
Cecily Walters is School Nutrition’s managing editor.
Photography by VMJones, BeholdingEye and V2images/
istockphoto.com.
To Your Credit: For CEUs toward SNA
certification, complete the “To Your Credit” test on
page 58.