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major depressive disorder
What is Depression?
According to the American Psychiatric Foundation
Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.
General Statistics
National Institute of Mental Health
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Major depressive disorder affects approximately 17.3 million American adults, or about 7.1% of the U.S. population age 18 and older, in a given year. (National Institute of Mental Health “Major Depression”, 2017)
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Major depressive disorder is more prevalent in women than in men. (Journal of the American Medical Association, 2003; Jun 18; 289(23): 3095-105)
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1.9 million children, 3 – 17, have diagnosed depression. (Centers for Disease Control “Data and Statistics on Children’s Mental Health”, 2018)
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Adults with a depressive disorder or symptoms have a 64 percent greater risk of developing coronary artery disease. (National Institute of Health, Heart disease and depression: A two-way relationship, 2017)
What is depression? - Helen M. Farrell | Ted-Ed
Depression is the leading cause of disability in the world; in the United States, close to ten percent of adults struggle with the disease. But because it’s a mental illness, it can be a lot harder to understand than, say, high cholesterol. Helen M. Farrell examines the symptoms and treatments of depression, and gives some tips for how you might help a friend who is suffering.
ARTICLES ABOUT DEPRESSION
Talking About Depression Is Uncomfortable, but Necessary
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"We need to break through the uncomfortable barrier in order to really help someone. Being uncomfortable for a few seconds, minutes or hours is worth it if it saves a life. Seems a bit dramatic but it’s true. I was once contemplating my suicide and if it would hurt. However depressed and suicidal I was, I got a message on Facebook from my partner, just asking how I was. That saved my life. She saved my life without even knowing it. The littlest things can keep a person living. Remember that."
The Unexpected Symptoms I Didn't Realize 'Screamed' Depression
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"One thing that makes depression so complex to understand is the fact that it varies so much from person to person. There are multiple lists you can find online with lots of symptoms of depression. When you get the flu, you might have a fever, sore throat and upset stomach and you will know something is wrong and will probably go into the doctor.
With depression, you could feel more tired than usual, irritable, and feel more down on yourself and may have no idea you’re experiencing depression because the “common” symptoms most people use to recognize depression are suicidal thoughts, loss of appetite, hopelessness, anxiety, emptiness and depressed mood. Therefore, because there’s a wide variety of symptoms and you may not match up with all of them, you could easily dismiss it as a rough patch in your life. Or you may not notice the change at all because it’s not uncommon to forget to pay attention to your mental health."
When I Heard Someone Say Some Depressed People 'Don't Want to Get Better'When I Heard Someone Say Some Depressed People 'Don't Want to Get Better'
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"The comment was about how some depressed people don’t want to get better because they get used to feeling that way, so they just don’t try. Wow. But for those of us with clinical depression (or anxiety, bipolar disorder, etc.), more often than not we do want to get better. That is why we take our medications and go to therapy. Just like patients get treatment and have follow-up visits with their doctors. The list could go on of conditions that are medical and are, therefore, medically treated.
The general population doesn’t seem to get that it’s one and the same with depression. This to me is just ignorance and misinformation. There is a gap between what people think they know about depression and what depression is really like. I think that gap exists for two reasons: One is, like I mentioned before, ignorance and misinformation. It’s when people believe we’re just having a bad day and need to snap out of it. The second reason is you probably can’t understand depression if you have never experienced true clinical depression."
THE CHEMISTRY
BEHIND
DEPRESSION
"Increasingly sophisticated forms of brain imaging — such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) — permit a much closer look at the working brain than was possible in the past. An fMRI scan, for example, can track changes that take place when a region of the brain responds during various tasks. A PET or SPECT scan can map the brain by measuring the distribution and density of neurotransmitter receptors in certain areas.
Use of this technology has led to a better understanding of which brain regions regulate mood and how other functions, such as memory, may be affected by depression. Areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus (see Figure 1).
Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI study published in The Journal of Neuroscience, investigators studied 24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed. The more bouts of depression a woman had, the smaller the hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe stress can suppress the production of new neurons (nerve cells) in the hippocampus.
Researchers are exploring possible links between sluggish production of new neurons in the hippocampus and low moods. An interesting fact about antidepressants supports this theory. These medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters). Yet people typically don't begin to feel better for several weeks or longer. Experts have long wondered why, if depression were primarily the result of low levels of neurotransmitters, people don't feel better as soon as levels of neurotransmitters increase.
The answer may be that mood only improves as nerves grow and form new connections, a process that takes weeks. In fact, animal studies have shown that antidepressants do spur the growth and enhanced branching of nerve cells in the hippocampus. So, the theory holds, the real value of these medications may be in generating new neurons (a process called neurogenesis), strengthening nerve cell connections, and improving the exchange of information between nerve circuits. If that's the case, depression medications could be developed that specifically promote neurogenesis, with the hope that patients would see quicker results than with current treatments."
Hippocampus: The hippocampus is part of the limbic system and has a central role in processing long-term memory and recollection. Interplay between the hippocampus and the amygdala might account for the adage "once bitten, twice shy." It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormone impairs the growth of nerve cells in this part of the brain.
HOW DOES TREATMENT HELP?
Amygdala: "The amygdala is part of the limbic system, a group of structures deep in the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. The amygdala is activated when a person recalls emotionally charged memories, such as a frightening situation. Activity in the amygdala is higher when a person is sad or clinically depressed. This increased activity continues even after recovery from depression."
Thalamus: "The thalamus receives most sensory information and relays it to the appropriate part of the cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning. Some research suggests that bipolar disorder may result from problems in the thalamus, which helps link sensory input to pleasant and unpleasant feelings."
"Living with depression can be difficult, but treatment can help improve your quality of life. Talk to your doctor about possible options.
You may successfully manage symptoms with one form of treatment, or you may find that a combination of treatments works best. It’s common to combine medical treatments and lifestyle therapies, including the following:
Medications
Your doctor may prescribe antidepressants, antianxiety, or antipsychotic medications.
Each type of medication that’s used to treat depression has benefits and potential risks.
Psychotherapy
Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.
Light Therapy
Exposure to doses of white light can help regulate mood and improve symptoms of depression. This therapy is commonly used in seasonal affective disorder (which is now called major depressive disorder with seasonal pattern).
Alternative Therapies
Ask your doctor about acupuncture or meditation. Some herbal supplements are also used to treat depression, like St. John’s wort, SAMe, and fish oil.
Talk with your doctor before taking a supplement or combining a supplement with prescription medication because some supplements can react with certain medications. Some supplements may also worsen depression or reduce the effectiveness of medication.
Exercise
Aim for 30 minutes of physical activity three to five days a week. Exercise can increase your body’s production of endorphins, which are hormones that improve your mood.
Avoid Alcohol and Drugs
Drinking or using drugs may make you feel better for a little bit. But in the long run, these substances can make depression and anxiety symptoms worse.
Learn How To Say No
Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.
Take Care of Yourself
You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.
Sometimes depression doesn’t respond to medication. Your doctor may recommend other treatment options if your symptoms don’t improve.
These include electroconvulsive therapy, or transcranial magnetic stimulation to treat depression and improve your mood."
MY EXPERIENCE
WITH DEPRESSION
TRIGGER WARNING: Self-harm, depression, suicidal idealization
Two years ago, in 2017, I almost gave up. I had panic attacks everyday in school and wound up in the big all gender bathroom stall every lunch, crying mascara down my cheeks until all that was left was trails of black. Some people would hear me crying but I felt so alone that I tried hard to muster my crying because I knew that people called me dramatic an someone who craved attention. I'm sick and tired of that stigma. People could come and ask me to come out even though they didn't often didn't know who I was. They saw me run to the bathroom crying and they would tell me to come out and hug me. Those hugs meant a lot even though sometimes they were uncomfortable.
Sometimes you would cry so hard your lungs started shuddering uncontrollably and it's difficult to get enough oxygen to your brain and the rest of your body and it escalates your panic attack that much more. I think this is the way that it goes for a lot of people, so that you can't remember exactly how fast the days went and how strong your feelings were but all your remember was numbness. That's what it felt like for me. Time felt slow. Everything took so much effort. I stopped enjoying the thing that I loved and felt out of place in the places I used to call home.
Depression is something that fucks with every aspect of your life. It's not just a figment of the imagination. It's not just a tactic people use to get attention. It's an illness which is caused by chemical changes in the brain. You've heard in biology that our brain chemistry can be altered by our surroundings, and it's very real.
I was admitted to McLean Hospital on May 25th, 2017; one year ago today, and stayed there for a month. It wasn't anything like the horror movies. No shapes in white cloth. No one witnessing suicides. People were depressed and struggled with other mental illnesses, including addiction. Depression isn't always an urge to kill yourself, sometimes it's losing interest in the everything you loved, and sometimes it's giving up on a part of yourself because you feel as though you have a 400 pound monster that is sitting on your chest, crushing your lungs and taking away your ability to move. You're motionless. You're trapped. That's how I felt. The hospital was kind of like a camp in a way. You got to take nice private showers and you were never isolated unless you wanted to be. You had a roommate and a closet with lots of space. When someone moved out, there were always happy feelings for the person, but often times sadness because we would miss our friends, or even jealousy because we were looking forward to leaving.
I met amazing people there. Inspiring people with incredible ideas. I was surrounded by sappy posters that said things like "hang in there" and "you are worth more than you believe", but those posters honestly gave me strength on the darkest days. There was a gym facility and I vividly remember having such an awful day that I ran for three miles, despite being very out of breath, but I got my anger out as well and urges of self-harm out and I was so proud. It was one of the first days I felt like I had truly made an improvement.
While there are and always will be up's and down's to my recovery journey, I know that I have the strength to recover and get through anything, as do others who face depression.
BOOKS THAT EFFECTIVELY PORTRAY DEPRESSION
TRIGGER WARNING: Suicidal Ideation, Depression
veronika decides to die
by Paulo Caelho
Overview
"In Veronika Decides to Die, Paulo Coelho takes the reader on a distinctly modern quest to find meaning in a culture overshadowed by angst, soulless routine, and pervasive conformity. Based on events in Coelho's own life, Veronika Decides to Die questions the meaning of madness and celebrates individuals who do not fit into patterns society considers to be normal. Poignant and illuminating, it is a dazzling portrait of a young woman at the crossroads of despair and liberation, and a poetic, exuberant appreciation of each day as a renewed opportunity."
by the time you read this i'll be dead
by Julie Anne Peters
Overview
"Sylvia Plath's shocking, realistic, and intensely emotional novel about a woman falling into the grip of insanity.
Esther Greenwood is brilliant, beautiful, enormously talented, and successful, but slowly going under—maybe for the last time. In her acclaimed and enduring masterwork, Sylvia Plath brilliantly draws the reader into Esther's breakdown with such intensity that her insanity becomes palpably real, even rational—as accessible an experience as going to the movies.A deep penetration into the darkest and most harrowing corners of the human psyche, The Bell Jar is an extraordinary accomplishment and a haunting American classic."
it's a funny kind of story
by Ned Vizzini
Overview
"Ambitious New York City teenager Craig Gilner is determined to succeed at life - which means getting into the right high school to get into the right job. But once Craig aces his way into Manhattan's Executive Pre-Professional High School, the pressure becomes unbearable. He stops eating and sleeping until, one night, he nearly kills himself.
Craig's suicidal episode gets him checked into a mental hospital, where his new neighbors include a transsexual sex addict, a girl who has scarred her own face with scissors, and the self-elected President Armelio. There, Craig is finally able to confront the sources of his anxiety.
Ned Vizzini, who himself spent time in a psychiatric hospital, has created a remarkably moving tale about the sometimes unexpected road to happiness."
CELEBRITIES WHO ADVOCATE
"'As I grew older, I found a way to release myself from those darker thoughts through music. Music was my way of overcoming a lot of pain and anxiety. If you give yourself to your creativity and imagination, it can help you overcome almost anything and really enable you to feel free and powerful.'... 'I’ve suffered through depression and anxiety my entire life, I still suffer with it every single day,' she explained."
"James Franco, who covered OUT's September issue, told the magazine that he struggled with depression early in his career. "I have a very addictive personality," he said. 'When I was a teenager I got over certain addictions, and that's when I started acting, at age 17. I really threw myself into it, and that became everything, to the point where I didn't even socialize. And then after, like, 10 years of that, at age 27, I realized, man, I'm so depressed. On the surface my life seems pretty good -- I have a career and everything -- but I feel isolated and lonely.'"