Just Blue or Seriously Depressed?

Did you know that women are twice as likely as men to develop depression? And it only gets worse over time. So how do you know if you’re truly depressed or just suffering from a case of the blues? We asked experts what causes the disease, symptoms to watch, who’s at risk and how to seek help... Have you ever felt depressed? It’s OK if you answer yes. Being sad is natural. “It’s part of the human condition,” says Nada L. Stotland, M.D., professor of psychiatry and obstetrics/gynecology at Rush University in Chicago and former president of the American Psychiatric Association. Most people bounce back from a blue mood within a few days or weeks. They’re the lucky ones. Each year, about 19 million Americans develop depression, meaning the negative feelings don’t go away. Depression can affect your ability to maintain relationships with friends and family, and to function at home and work. In fact, depression costs the U.S. economy an estimated $44 billion per year in job absences and lowered productivity. It also takes a toll on your health. “The detrimental effects of depression on quality of life match those of heart disease and exceed those of diabetes, arthritis and peptic ulcer,” says Alan Manevitz, M.D., associate professor of clinical psychiatry at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. The effects get worse over time. Among people 65 and older, those who are severely depressed are nearly twice as likely to die sooner than those without depression, regardless of their health, according to a 2002 UCLA Neuropsychiatric Institute study. What Is Depression? Although many of us are confused about whether we’re blue or actually depressed, “this is one disease where there are very clear symptoms,” Stotland says. To be diagnosed, you must have one or more of the following debilitating symptoms for at least two weeks, according to the National Alliance for Mental Illness and the American Psychiatric Association guidelines: Feeling sad, anxious or empty A loss of interest or pleasure in things you once enjoyed Feeling restless, irritable or crying a lot Feelings of hopelessness, helplessness or low self-esteem Trouble concentrating, remembering things and making decisions A loss of energy or feeling tired Difficulty sleeping, or sleeping too much A change in appetite that leads to sudden weight loss or gain Thoughts of death or suicide Symptoms can run from mild to major (or severe). Major depression can leave you curled up in a ball, weepy and unable to function. Mild depression is still serious, “since it can get gradually worse,” Stotland says. One chronic, mild form of depression, called dysthymic disorder, is subtle but no less worrisome. Although it occurs for most of the day, more days than not, you can suffer from it for years without knowing you have it. “A person [with dysthymia] always walks around feeling sad or down in the dumps. It becomes the way [that] person is,” Manevitz explains. In fact, about 3% of people develop dysthymia (Greek for “bad state of mind” or “ill humor”) at some point, according to Mental Health America, a nonprofit organization dedicated to improving mental health. Who’s at Risk? Experts don’t know why certain people get depressed and others take setbacks and down days in stride. “There are probably biological factors that make some more resilient than others,” says psychologist Susan Nolen-Hoeksema, Ph.D., director of the Yale University Depression and Cognition Program. “And some people may have a greater emotional reaction to situations than others do.” Experts do know that depression can run in families, so genes may be a culprit. Brain chemistry is another factor. If you’re prone to depression, mood-regulating brain chemicals known as neurotransmitters may be out of balance. Simply being female is also a risk factor. Women develop depression at twice the rate of men, according to the National Institutes of Mental Health. There are three stages in life when a woman is most vulnerable to depression, probably because of changes in hormones: Each month before her period (PMS) After she has a baby (postpartum depression) During perimenopause - the years leading up to menopause - when estrogen levels fluctuate. Life events can also trigger depression: divorce, death of a loved one, illness, losing a job, sexual or physical abuse, even poverty. Even your personality can put you in danger. It’s more likely if you tend to ruminate – that is, go over things that have happened in the past or worry about what could happen in the future, says Nolen-Hoeksema, author of Women Who Think Too Much: How to Break Free of Overthinking and Reclaim Your Life (Holt Paperbacks). “When you ruminate, you passively worry about your problems without taking action,” she says. As a result, you can get stuck in a negative, depressed rut. Why You Need Help Whatever the cause, depression is debilitating. And many people don’t get the help they need. “People who are depressed feel helpless, hopeless and guilty,” Stotland says. “If you get a pain in your tummy, you have someone look at it. If you have depression, you think it’s your fault.” Friends, family and bosses may respond to your blue mood by telling you to buck up or snap out of it. But typically, depression doesn’t go away by itself. If left untreated, the symptoms get worse. “You’re suffering and unable to get out of the fix that precipitated depression in the first place,” Stotland says. If you think you have depression – or you suspect a friend or loved one does – it’s crucial to seek help. How to Seek Treatment It’s one thing to be familiar with depression symptoms, but another to admit to yourself or a doctor you have them. “If you have depression, you think I’m a bad person. Nobody can help me. Nothing can be done,” Stotland says. “It’s extra-important for you to fight that feeling and for people who care about you to help you.” Likewise, if you notice that someone you care about seems down, take action. “You need to nudge them and say, ‘I’m concerned you’ve come down with a disease, and it’s important for you to get help,’ ” Stotland adds. Start with your personal physician. He or she should be prepared to discuss depression with you. The U.S. Preventive Services Task Force, an independent panel of health experts, has advised that all primary-care providers screen adults for depression and put systems in place to properly diagnose and treat the condition. In fact, more than half of all depression is treated in primary-care medical practices, according to a 2002 report in the journal Psychosomatics. About 35% of patients seen in primary care meet criteria for some form of depression and 10% suffer from major depression, according to the American College of Preventive Medicine (ACPM). “When you see a primary-care provider, you should have some level of screening for depression, just as you would for other chronic health conditions like diabetes and hypertension,” says Michael T. Compton, M.D., M.P.H., associate professor of psychiatry and behavioral sciences at Emory University in Atlanta, who’s on the ACPM’s prevention practice committee. “Depression can be as valid a reason for going to your doctor as anything else,” he adds. If you’d prefer to talk to a mental-health professional - either to be evaluated for depression or to receive talk therapy - there are several ways to go about it. You can ask your primary-care physician for a recommendation, or get one from friends or family members in therapy. Or find one using the free psychologist locator on the American Psychological Association website. To find a free screening site in your area (there are 3,000 nationwide), go to www.mentalhealthscreening.org. (The screening, which is done anonymously, determines if you have depression symptoms and, if you do, refers you to an expert for further evaluation.) Check with your health insurer too. The company may have a directory of therapists in your area who accept your insurance plan. If cost is a concern, many affordable options are available. There may be low-cost or free clinics in your area, and some therapists offer sliding-scale fees. Whatever your situation, if you think you’re depressed, it’s extremely important to get professional help, Stotland says. “You can and deserve to get better,” she adds. For more information, visit our Depression Health Center. Could You Be Depressed? Like Picasso, everyone goes through a "blue period" from time to time. But if you're depressed, you are experiencing more than just the occasional bad mood or terrible day. Depression affects 20 million people in any given year and is a serious enough disorder to compromise one's ability to function normally day to day. Find out if you're just blue or if you might be clinically depressed.