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Understanding Depression

Estimated read time: 6-7 minutes

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This question has spawned an industry: When does normal sadness or grief turn into depression, a medical condition that needs a doctor's care?

Maybe sooner than you think.

Depression is the most prevalent form of mental malady in the United States. It's also the most treatable, with an 80 percent success rate, which is why so many people are trying to get the word out that anyone suffering can get help.

"It affects the most people," said LaDonna Haley, program director for the Mental Health Association of Greater St. Louis.

But depression gets a bad rap because mental illness gets a bad rap, Haley says. "It's not a weakness. It's a condition that needs treatment."


Professional therapists call it clinical depression. It's when emotions such as sadness, grief or unspecified bad feelings upset brain chemistry and become an impairment. Textbooks often lump the condition under "mood disorders."

"Depression is a clinical syndrome that involves a prolonged state with a group of symptoms," said Dr. Charles Conway, a psychiatrist with St. Louis University.

Sadness from a setback is one thing, says Conway. "But when it's (interfering with) areas of your life, such as work, education, relationships, then that's usually the time to see a health professional."

Clinical depression can pop up in numerous manifestations. There are two major umbrellas:


The most common set of disorders, these are categorized in three degrees:

-Mild-In this case, a person has a depressed mood for a few weeks to two years. The person still can function, but not at full speed. People in this category should see a counselor, social worker or psychologist. A therapist may suggest an mild antidepressant.

-Moderate-The impairment is more significant and involves missing work, poor concentration and decreased energy levels. Therapy is done by psychologists and social workers. A therapist most likely will suggest an antidepressant.

-Severe-Severe depression is the least common of the three levels but the most debilitating. It can include psychotic symptoms, delusions, hallucinations and thoughts of suicide. At this point, a person needs psychiatric care, medications, hospitalization and possibly shock treatments.


Known generically as manic depression, it gets a lot of attention because of the extremes of behavior it produces-mood swings from extremely agitated to extremely depressed, possibly psychotic episodes that range from risky self-destructive behavior to violence to suicide. The condition needs intense medical care.

For the purposes of this report, we'll address unipolar depression.


Primary candidates for clinical depression are people who have suffered an emotional response to a setback, Conway says. "Very rarely does it happen without a trigger."

Setbacks include losses: divorce, unemployment, death in the family, loss of your sense of self from a physical condition such as a heart attack, stroke or childbirth. Teens may get depressed after a broken romance, being bullied or getting bad grades.

Depression of every degree can run in families, Conway says. Research has revealed a genetic predisposition. However, anyone can face an event that would trigger an episode of depression, he said.

Also, if you've had one bout with depression, it's more likely you'll have another, Conway said.

The peak incidence of depression is in the 30s and 40s, Conway says, but all age groups are vulnerable.

Gender is the biggest difference: 25 percent of women will experience clinical depression at some point in their life. For men it's under 12 percent.

Women's numbers are easier to count because more women feel comfortable talking to a doctor or counselor about depression, said Lois Pierce, professor of social work at the University of Missouri at St. Louis.

"Men seem to find it more difficult to complain about being depressed," Pierce said.

Adolescent depression has been increasing, and depression among the elderly is common.


True depression can't be cured just by improving your life. It's a condition that needs medical help just like any other illness, doctors say. A person who is depressed and wins the lottery will still be clinically depressed.

"When you get to the point of a clinical depression, you're probably experiencing a biochemical involvement," Conway said. He adds that brain scans can detect biochemical disorders.

Sometimes detecting depression in a friend or loved one is easier than detecting it in yourself.

"This is where friends and loved ones can help," says Pierce of UMSL.

Many Web sites and physicians offer checklists for symptoms of clinical depression. If you spot trouble, see your doctor. A physician might suggest medication or counseling or both. Ignoring symptoms could lead to more severe episodes down the road.


In the vast majority of cases, the first person you'll meet with if you suspect you have depression will be your family physician. He may decide to refer you to a social worker or psychologist.

The therapist will diagnose the extent of your condition and may try to help you change your thinking patterns-called cognitive behavioral therapy-by showing you how to cope with the forces that set off the depression. The therapist may recommend an antidepressant medication, but a physician will have to prescribe it.

If your family doctor prescribes medication, make sure he also refers you to a counselor, therapists say. Medication may help a person feel better, but it doesn't address the underlying cause of the depression, they say.

If the front-line therapist detects a more serious problem, expect to be sent to a more specialized therapist, perhaps a psychiatrist.


While setbacks are part of life, in the case of a severe setback-death, job loss, divorce, or the like-Conway recommends seeing a counselor pre-emptively even before symptoms are blatant.

"I think it's smart to take care of your mental health as well as your physical health," he said.

Sometimes lessons in grieving or coping with a setback will prevent depression, therapists say.

Unlike other illnesses, talking is a good therapy for depression.

"For mild to the mild end of moderate (cases), psychotherapy-talking therapy-is probably equally as good as medication," Conway said.

Unfortunately, that ability to talk someone out of depression is what makes the condition a second-class citizen in the health world, therapists say.

But researchers can measure the effect that talking has on brain chemistry, says Conway. "The brain is the only organ where we've learned we can change the physiology by engaging in (talking) therapy. Essentially, you can prove biochemically that therapy works."

In addition, exercise has a place in battling milder episodes of depression, said Pierce of UMSL. Exercise can produce endorphins that help you feel good, in addition to the feelings of control and accomplishment that come from working out and dropping weight, she said.

"You don't have to run a marathon or be a medalist," Pierce said. "Just walking-if it makes you feel better, keep doing it."


(c) 2004, St. Louis Post-Dispatch. Distributed by Knight Ridder/Tribune News Service.


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