Learn to manage depression

There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder.

 Major Depressive Disorder

Also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.

Dysthymic Disorder 

Also called dysthymia [dis-thahy-mee-uh], is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.                                                    

• Ongoing sad, anxious or empty feelings   
•  Feelings of hopelessness
•  Feelings of guilt, worthlessness, or helplessness
• Feeling irritable or restless
• Loss of interest in activities or hobbies that were once enjoyable, including sex
• Feeling tired all the time
• Difficulty concentrating, remembering details, or difficulty making decisions
• Not able to go to sleep or stay asleep (insomnia); may wake in the middle of the night, or sleep all the time
• Overeating or loss of appetite
• Thoughts of suicide or making suicide attempts
• Ongoing aches and pains, headaches, cramps or digestive problems that do not go  away.

Not everyone diagnosed with depression will have all of these symptoms. The signs and symptoms may be different in men, women, younger children and older adults.

There is no single cause of depression. Depression happens because of a combination of things including:

 Genes

Some types of depression tend to run in families. Genes are the "blueprints" for who we are, and we inherit them from our parents. Scientists are looking for the specific genes that may be involved in depression.

  Brain chemistry and structure

When chemicals in the brain are not at the right levels, depression can occur. These chemicals, called neurotransmitters, help cells in the brain communicate with each other. By looking at pictures of the brain, scientists can also see that the structure of the brain in people who have depression looks different than in people who do not have depression. Scientists are working to figure out why these differences occur.

Environmental and psychological factors

Trauma, loss of a loved one, a difficult relationship, and other stressors can trigger depression. Scientists are working to figure out why depression occurs in some people but not in others with the same or similar experiences. They are also studying why some people recover quickly from depression and others do not.

Many people need more than one form of treatment.

  Psychotherapy

Several types of psychotherapy-or "talk therapy"-can help people with depression. There are two main types of psychotherapy commonly used to treat depression: cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT teaches people to change negative styles of thinking and behaving that may contribute to their depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.

For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough.

  Medications

Medications help balance chemicals in the brain called neurotransmitters. Although scientists are not sure exactly how these chemicals work, they do know they affect a person's mood.  Different types of medications affect different chemicals in the brain.  Medications affect everyone differently. Sometimes several different types have to be tried before finding the one that works. If you start taking medication, tell your doctor about any side effects right away.

How can I help a friend or relative who is depressed?

If you know someone who is depressed, it affects you too. The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.

  To help a friend or relative:

• Offer emotional support, understanding, patience and encouragement.
• Engage your friend or relative in conversation, and listen carefully.
• Never criticize feelings your friend or relative expresses, but point out realities and offer hope.
• Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
• Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
• Remind your friend or relative that with time and treatment, the depression will lift.

How can I help myself if I am depressed?

If you have depression, you may feel exhausted, helpless and hopeless. It may be extremely difficult to take any action to help yourself. But it is important to realize that these feelings are part of the depression and do not accurately reflect actual circumstances. As you begin to recognize your depression and begin treatment, negative thinking will fade.

  To help yourself:

• Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or   activity that you once enjoyed. Participate in religious, social or other activities.
• Set realistic goals for yourself.
• Break up large tasks into small ones, set some priorities and do what you can as you can.
• Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of"your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
• Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
• Remember that positive thinking will replace negative thoughts as your depression responds to treatment.

What if I or someone I know is in crisis?

If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.

• Call your doctor.
• Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
• Call the toll-free, 24-hour hotline to talk to a trained counselor.

National Suicide Prevention Lifeline
1-800-273-TALK (1-800-273-8255)
TTY: 1-800-799-4TTY (4889)

• Make sure you or the suicidal person is not left alone.

Where can I get more information?

Life threatening Emergency: 9-1-1

National Suicide Prevention Hotline: 1-800-273-TALK (8255)
24 hours a day/ 7 days a week

Local Suicide Prevention Hotlines:

• Sacramento 916-368-3111

• Auburn   530-885-2300

• Davis   530-756-5000

• Lincoln  916-645-8866

• Roseville  916-773-3111

Websites:

• Depression and Bipolar Support Alliance (DBSA) www.dbsalliance.org 
• Mental Health Association Sacramento Chapter www.mhasc.org (916) 366-4600
• National Alliance on Mental Illness of Sacramento (NAMI) www.namisacramento.org (916) 874-9416
• National Institute of Mental Health www.nimh.nih.gov
• Excellent self-care website  www.depressiontoolkit.org 

  Books:

• The Feeling Good Handbook by David Burns, 1999
• The Cognitive Behavioral Workbook for Depression: A Step-by-Step Program by William J. Knaus, 2006
• The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland, 2002
• Thoughts and Feelings: Taking Control of Your Moods and Your Life: A Workbook of Cognitive Behavioral Techniques by Matthew McKay, Patrick Fanning, Martha Davis, 2007
• When Someone You Love is Depressed by Laura Rosen and Xavier Amador, 1997