 Depression
Frequently
Asked Questions
Click here to read
the content disclaimer
Depression
(by Alvin E. Lake III, PhD)
What is Depression?
In everyday language we use the
word "depressed" to describe a wide range of feelings. At one end are brief periods
of unhappiness that we all experience at times, often in reaction to loss or unmet
expectations. At the other end lie profound feelings of hopelessness, where a person
may feel life is not worth living. In contrast to these common perspectives, clinical
depression can occur without feelings of sadness, and can be of significant concern
even when the depressed person has hope for the future.
There are three basic types of clinical
depression: major depressive disorder, dysthymic disorder, and bipolar disorder.
Major depression is marked by either
a depressed mood or loss of interest in most
things for a period of at least two weeks. These feelings represent a distinct change
from normal experience, and are accompanied by at least four of the following symptoms:
the depressed person may lose appetite and weight; eat excessively and gain weight;
sleep too much or too little; feel agitated or fatigued; experiences difficulty
with thinking, concentrating, or decision making; have a sense of enduring worthlessness
or guilt; and in some cases have recurrent thoughts of death or suicide.
Dysthymic disorder is a low-grade
depression with negative mood
and/or chronic irritability, combined with at least
two of the following: poor appetite or overeating, sleep disturbance, low energy,
low self-esteem, poor concentration or indecision, or feelings of hopelessness.
This type of depression may start early in life and persist for a long time. The
diagnosis requires that symptoms be present for at least one year in adolescents,
and two years or more in adults. The mood disturbance may come to be experienced
as if it were part of the sufferer's normal personality.
Bipolar disorders are characterized
by mood swings. Periods of elevated, energetic, or irritable mood alternate with
bouts of depression. The distinctive "highs" may last for a few hours to over a
week, and are referred to as hypomanic or manic episodes depending on their severity
and duration. The diagnosis requires at least three additional symptoms, such as
inflated self-esteem or grandiosity, decreased need for sleep (e.g. less than three
hours), talking excessively, racing thoughts, distractibility, or increased goal-directed
activity. In some cases the individual may engage in activities with a high potential
for serious adverse consequences: spending large amounts of money for unneeded items,
driving recklessly, or engaging in risky and promiscuous sexual activity.
Back to Top | Back to FAQs
How common is depression?
Based on scientific community surveys
in the United States, 7.0% of women and 2.6% of men will experience at least one
episode of major depression in their lifetime. Lifetime rates of dysthymic disorder
are similar: 4.1% of women and 2.2% of men. Bipolar disorders are less common, with
a lifetime prevalence of 1.2% for both men and women.
There is an increased risk of major
depression in migraine sufferers, between 3.1 and 3.6 times the rate for those without
migraine. For example, a recent survey of over 1000 young adults in the Detroit
area found that 34.4% of those with migraine had at least one major depressive episode,
compared to 10.4% for those without migraine. In most cases (54.5%), the migraine
headaches preceded depression by at least a year. For 30% depression came first,
and 15.5% reported the onset of both disorders in the same year.
Back to Top | Back to FAQs
What causes depression?
At its core, depression is a biological
event influenced by genetics and biochemistry. The neurotransmitters serotonin and
norepinephrine play an important role in both migraine and depression. Epidemiological
survey research suggests that the migraine-depression connection may reflect a distinct
genetically-based syndrome that differs from migraine without depression. In major
depression, early episodes are often triggered by significant life stress, although
repeated episodes later in life may occur without apparent triggers. There is some
evidence suggesting a role for early life events such as trauma, significant losses,
or hostile, negative environments, which in turn have a biological impact on the
brain of a growing child. A family history of alcoholism also increases the risk
for depression.
Depression is also affected by the
way we think. When depressed, people are more likely to focus on the negative, view
stressful events as catastrophes, see things in black or white terms, and blame
themselves for events for which they are not fully responsible. Some view depression
as a weakness, blaming themselves or others for failing to pull out of it by a sheer
force of will. This type of distorted thinking then adds further fuel to the depression
in a vicious cycle.
Back to Top | Back to FAQs
Is depression primarily a psychological reaction to the pain or disability of migraine?
There is no question that unremitting,
severe headaches can be depressing, and that depression often improves when pain
is controlled. However, not all patients with similar levels of headaches suffer
depression. Sometimes depression remains a significant concern even when headaches
are no longer a problem.
Back to Top | Back to FAQs
How is depression treated?
Most studies show a combination of antidepressant medication and psychological treatment (focused on coping skills
and enhancing interpersonal relationships) as the most effective treatment for depression.
Cognitive-behavioral psychotherapy, which addresses the relationship between thoughts
(cognitions), feelings, and behavior has been shown in controlled research studies
to be particularly helpful in both improving depression and preventing relapse.
MHNI psychologists can help clarify the diagnosis of depression, often assist in
the choice of antidepressant medication, and provide a supportive environment for
learning about depression and the necessary skills to cope with it. At MHNI, patients
have the unique opportunity to work in close collaboration with psychologists and
medical doctors to treat both headache and depression.
Back to Top | Back to FAQs
|