What is depression and how is it different from just feeling sad?

Sadness and loneliness are normal, healthy emotional experiences. Loneliness helps us know when we have been alone too long. Sadness is a normal response to losing someone or something that really matters to us… a friend, a lover, a job, a home. Grief is a more intense form of sadness that we experience after a particularly painful loss such as the death of a loved one. During a period of grief, it can also be normal to experience problems sleeping, not wanting to eat, feeling fatigued, have trouble concentrating or reduced interest in your usual activities. These symptoms are usually temporary and will resolve within a few days or weeks. All of these experiences are normal and healthy emotional responses to stressful and difficult life experiences.

Depression is not a normal or healthy experience. Depression is a physical illness. It can be helpful to think of it as something like having pneumonia of the brain. As with lung pneumonia, it may begin when you are under stress and your resistance is down. It may start out with minor symptoms which don’t get better as they normally would. With time the symptoms worsen and it becomes harder and harder to feel good or handle your usual responsibilities.

Your brain is an organ just like your lungs and your heart. The brain can become ill just like any other organ. When your brain is ill with depression, it cannot perform its usual functions normally. Your emotions become more erratic. Your normal eating and sleeping patterns change. Your ability to concentrate deteriorates. It becomes harder to think clearly or rationally.

What causes depression?

Although researchers haven’t identified the specific genes that cause depression, we know that the vulnerability to depression is inherited. Having the genes for depression, however, doesn’t mean you will develop the illness. Typically, depressive illness occurs due to a combination of genetic vulnerability and environmental or physical stressors (e.g. losing your job, developing another medical illness). Genes play a greater role in depression that occurs at a young age while environmental or physical factors are more significant when depression develops later in life.
Overly stressful childhood experiences can make us more susceptible to developing depression as an adult. Abuse (sexual, physical, emotional), death of a family member, serious illnesses and injuries, and exposure to excessive family fighting are some of the most common experiences that can increase the risk of developing depression both during childhood and later in life.
Depression is more likely to occur when your body’s defenses are weakened by physical illness, dietary deficiencies or toxic substances. Some of the most common of these physical factors include drug and alcohol abuse, hormone imbalances (e.g. pregnancy, menopause, and thyroid disease), some medications (e.g. steroids and opiates), sleep disorders (e.g. sleep apnea, restless legs syndrome, and sleep deprivation), chronic pain conditions (e.g. fibromyalgia) and nutritional deficiencies (e.g. essential fatty acids, B vitamins, Vitamin D).

What are the symptoms of depression?

  • Frequently sad, blue or down
  • Getting less pleasure from usual activities; feeling apathetic and unmotivated
  • Increased irritability
  • Increased anxiety
  • Reduced or increased appetite
  • Feeling easily hurt or rejected; overly sensitive to criticism
  • Unusually tired or fatigued
  • Weight loss or weight gain
  • Difficulty falling and/or staying asleep or wanting to sleep too much
  • Increased body pain or headaches
  • More difficulty concentrating and remembering
  • Difficulty making decisions
  • Your thoughts feeling slowed down or having difficulty shutting your mind off
  • Thoughts becoming overly negative, pessimistic or self critical
  • Worrying excessively about minor problems
  • Thinking that you would be better off dead or wanting to harm yourself

What is the best medication to treat depression?

There is no one best antidepressant medication. A medication that works great for one person may not help someone else. The wrong medication can sometimes even make your symptoms worse. Every antidepressant has a different way of working and there are no tests that can tell us which one will work best for you. If you have had a good experience in the past with a particular medication, it is often a good idea to try that first. If you have never been on an antidepressant medication before, we choose a medication that is best suited to your type of depression and any other psychiatric conditions you may also have (e.g. anxiety disorder, attention deficit disorder). Ultimately, you may need to try several different medications before finding the one that works best for you.

What about psychotherapy for depression?

While depression is a biological illness, improvement and recovery does not always require an antidepressant medication. Psychotherapy can treat depression by helping you identify primary sources of stress, improve coping strategies, resolve stressful situations, make healthy changes in your lifestyle, change unhealthy thinking and behavior patterns and improve the quality of your relationships. The more effort you put into psychotherapy, the better the results. As depression becomes more severe, however, it becomes more difficult to make progress without the addition of medication therapy. For moderate to severe depression, the best treatment is to combine psychotherapy with medication therapy. Once you have recovered from depression, the changes you have make as a result of psychotherapy improve your chances of staying well and reduce your need to continue on antidepressant medications long term.

Do children get depression?

Although it is more common in adults, depression can develop at a very young age. Depression in children and teens can be hard to recognize as their symptoms are often different from those an adult will experience. For example, depressed children and teens have more anger and irritability than sadness. They are more likely to start sleeping too much than to have problems falling or staying asleep. Some other signs of depression in children and teens include:

  • Increased behavior problems or behavior changes such as getting in trouble at school, falling grades, getting into fights, tempter tantrums, disobedience.
  • Increased physical complaints such as headaches and stomach aches
  • Wanting to drop out of activities they used to enjoy
  • Saying more negative and critical things about themselves
  • Suicidal statements (Always take these seriously and consult a physician)

Depression is more likely to occur during childhood if one or more family members also suffer from depression. This is partly because the vulnerability to depression is inherited. But it is also related to the negative effect of depression on the emotional health of other family members. Children are particularly at risk when a parent suffers from chronic, untreated depression. In this situation, treatment for the parent is a priority.

Are antidepressant medications safe for children?

The Food and Drug Administration (FDA) recently released warnings about the potential dangers of antidepressants when given to children. Specifically, the FDA warned that some children can develop or experience a worsening of suicidal thoughts after starting antidepressant medications. Psychiatrists have long known about and watched for the potential “behavioral” side effects of antidepressants. These new warnings from the FDA have been helpful in alerting other physicians and parents to this rare but serious risk. Unfortunately, the new warnings have also led to confusion and uncertainty among both parents and physicians who are struggling with decisions about how to help children suffering from depression. Physicians and parents need to be aware that the risks of a negative reaction to an antidepressant are far less than the risks from failing to treat this devastating and potentially fatal illness.

The safest approach to treatment of depression in children is a process of thoughtfully weighing the risks and benefits of various treatment options, deciding on and implementing a plan of treatment, careful monitoring of the child’s response to treatment and timely modification of the treatment if the child’s depression worsens or fails to improve. When a child experiences a negative response to a medication, this is easily remedied by stopping the medication and then implementing an alternative treatment. Careful monitoring by both parents and physicians is the key to safe and effective medication therapy for depressed children.

How do I find out if I have depression?

  • As a first step, you could take one of the screening questionnaires available online.
  • Most primary care doctors are comfortable treating depression.
    Consider making an appointment to discuss this with your physician.
  • Contact a mental health professional.
    • Psychiatrists specialize in medication therapy for treatment of depression
    • Psychologists and other types of mental health therapists specialize in treating depression with psychotherapy.