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Questions About Clinical Depression

As many as 20 million Americans each year develop clinical depression, but less than half of them actually receive treatment. It's so common that one out of every five adults may experience depression at some point in their lives. Twice as many women as men suffer from it, although everyone, including children, can develop the illness.


The Saturday Early Show talked with John Markowitz,.MD, of the Weill Medical College of Cornell University about the signs and symptoms of clinical depression, the different types of depression and available treatments.


  1. What causes depression?

  2. We don't have a clear-cut cause. However, there are two theories: biological and environmental. Biologically speaking, it may be due to an imbalance of neurotransmitters, which are chemicals that enable nerve transmission or to a flaw in the expression of receptors that these chemicals plug into. When something goes wrong in these brain areas, it is reflected in a person's thoughts and feelings. Environmental factors include negative life experiences such as stress or loss.


  3. What is the difference between someone ho has clinical depression and someone who just has the blues?

  4. Feeling downhearted and sad is often a normal reaction to a life situation. All of us feel this way sometimes, but in a few days, perhaps after talking to a good friend, we start to feel ourselves again. Clinical depression is very different. It is an illness and it requires specific treatment. Unlike the blues, clinical depression persists and doesn't go away no matter how hard the individual wants it to. The most serious and tragic consequence of clinical depression is suicide. It's important to mention that depression is not a character flaw, but an illness.


  5. What are the symptoms of depression?

  6. Signs of depression include the following: persistent sad or empty mood, loss of interest or pleasure in ordinary activities, changes in appetite or weight, inability to sleep or oversleeping, restlessness or sluggishness, decreased energy or fatigue, difficulty concentrating or making decisions, feelings of guilt, hopelessness or worthlessness and thoughts of death or suicide.


  7. Are there different types of depression?

  • Major depression
  • : This is the most common type of depression and is characterized by at least five of the major symptoms of depression for at least two weeks.


  • Dysthymic disorder
  • : Someone who has this depression usually has three of the above mentioned symptoms for at two years or more. It's usually overlooked and goes undiagnosed and untreated because people have fewer symptoms, but have grown to live with them.


  • Bipolar depression
  • : This is the depressive phase of manic-depressive illness, in which there are both extreme highs and extreme lows. Bipolar depression symptoms are similar to those of majo depression, with certain variations such as excessive sleep and increase in appetite.


  • Seasonal affective disorder (SAD)
  • : This type of depression follows seasonal rhythms, with symptoms occurring in the winter months and diminishing in spring and summer. Current research indicates that the absence of sunlight triggers a biochemical reaction that may cause symptoms such as loss of energy, decreased activity, sadness, excessive eating and sleeping.


  • Why aren't people who need treatment getting it?

  • There's still a stigma that society attaches to depression. People who are depressed just squirrel up in their homes and don't seek help. Other people who have some of the symptoms of depression think they'll just get over it, but never do. It's important that these people get help because depression is very treatable.


  • How are people with depression treated?

  • More than 80% of people with depression improve wittreatment by the end of one year. There are two main treatments: medication and psychotherapy. For some, just one or the other is enough, but for others, a combination of the two is most effective.


    • Medication
    • : Antidepressant medications such as Prozac and Zoloft work by affecting brain chemistry. They affect seratonin which is a neuro-chemical in the brain. These medications are not addictive and may take several weeks to be effective.


    • Psychotherapy
    • : This is sometimes called talking therapy and comes in many forms. One common form is psycho-dynamic therapy in which people look at their childhood and past experiences. Another is cognitive behavioral therapy where you focus on the person's negative thoughts. Another is inter-personal psychotherapy where you look at how mood affects the person's life situation and how life situations affect mood.


    • Electroconvulsive therapy
    • : Electroconvulsive therapy sends a current from one side of the skull to the other, creating 35-40 second seizures.


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