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What is Clinical Depression?

Clinical depression or depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as feeling “down” or “blue.” It is not a “bad mood” or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms of clinical depression can last for weeks, months, or years. Appropriate treatment for clinical depression, however, can help most people who suffer from clinical depression. The exact cause of clinical depression is not clear. Sometimes, a stressful event can cause one to feel depressed. Sometimes it seems to happen for no reason at all.

Clinical depression strikes people of all ages, backgrounds, and ethnic groups. It is estimated that about 20 million adults in the U.S. suffer from clinical depression each year, and that up to 25% of individuals in the U.S. will experience an episode of major clinical depression some time in their lives. About 1 out of 6 American adults have clinical depression during their lifetimes.

Clinical Depression Symptoms

Not everyone who is depressed experiences every symptom. The number and severity of symptoms varies with individuals and also varies over time.

  • Persistent feelings of hopelessness, pessimism

  • Feelings of guilt, worthlessness, helplessness

  • Loss of interest in hobbies and activities that were once enjoyed, including sex

  • Decreased energy, fatigue, being "slowed down"

  • Difficulty concentrating, remembering, making decisions

  • Insomnia, early-morning awakening, or oversleeping

  • Appetite and/or weight loss or overeating and weight gain

  • Thoughts of death or suicide;

  • Restlessness, irritability

  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Types of Clinical Depression

Clinical depression, like other illnesses, comes in different forms like heart disease and diabetes. Three of the most common types of depressive disorders are major clinical depression, dysthymia, bipolar or manic depression. Within each of these types, there are variations in the number, severity, and persistence of symptoms.

Major clinical depression is characterized by a combination of symptoms, including sad mood (see symptom list), that interfere with the ability to work, sleep and enjoy once-pleasurable activities. Disabling episodes of clinical depression can occur once, twice, or several times in a lifetime.

Dysthymia is a less severe type of clinical depression. It involves long-term (chronic) symptoms that do not disable, but yet prevent the affected person from functioning at "full steam" or from feeling good. Sometimes, people with dysthymia also experience episodes of major clinical depression. This combination of the two types of clinical depression is referred to as double-depression.

Bipolar Depression (Manic Depression) shows a particular pattern of inheritance. Not nearly as common as the other types of depressive disorders, bipolar disorder involves cycles of clinical depression and mania, or elation. Bipolar disorder is often a chronic, recurring condition. Sometimes, the mood switches are dramatic and rapid, but most often they are gradual.

Diagnostic Evaluation and Treatments for Clinical Depression

The first step to getting appropriate treatments for clinical depression is a physical examination by a physician. If a physical cause for the clinical depression is ruled out, a psychological evaluation should be done by referral to a psychologist or psychiatrist.

A good diagnostic evaluation will include a complete history of symptoms and whether the symptoms were treated and what treatment was given. The psychologist should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history should include questions about a family history of clinical depression. The evaluation should include a mental status examination to determine if speech or thought patterns or memory have been affected.

Treatment choice will depend upon the outcome of the evaluation. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have proven effective for clinical depression. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Most do best with combined treatment: education to understand the nature and cause of their clinical depression, medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems.


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