Individuals suffering from clinical depression symptoms experience negative and often debilitating issues that affect both physical and mental aspects of their lives. A diagnosis of clinical depression indicates that a psychologist or psychiatrist has determined that someone has exhibited depression signs over a certain period severe enough to interfere with leading a fulfilling and productive existence.
However, a professional diagnosis of clinical depression does not embrace the random feelings of unhappiness or frustration we all experience from time to time due to unforeseen events. While most people are capable of coping with minor upsets and even major ones such as divorce or a death in the family, those with clinical depression symptoms feel helpless and paralyzed in the face of such overwhelming and uncontrollable sadness. In addition, they are suffering from biological changes as well.
Included in a definition of depression is the fact that clinical depression does not “go away” on its own. This disorder, which is biological, genetic and environmental in nature, requires extensive counseling and medication prescribed by professionals who are trained to help those with clinical depression symptoms. Unfortunately, people who are incapacitated by this persistent type of depression are sometimes so caught in their own self-defeating and pessimistic thoughts that they have difficulty attempting to receive help.
Symptoms of Depression
According to the DSM-IV (Diagnostic and Statistical Manual for Mental Disorders published by the American Psychiatric Association), criteria that must be met before a diagnosis of major depressive episode can be made must include the patient experiencing at least five of these clinical depression symptoms for two weeks or more.
- Eating more or less than usual, gaining a lot of weight or losing more than five per cent body weight in a short time frame
- Insomnia or sleeping too much, sometimes 16 hours at a time
- Lack of energy, always feeling too tired to do anything
- Frequent stomachaches, digestive complaints
- Any physical symptom that has no physical basis or does not respond to usual treatments
- Extreme disinterest in things once were enjoyable
- Self-isolation
- Memory difficulties and inability to make simple decisions
- Neglecting personal hygiene, especially when a person was once particular about their appearance
- Thinking of suicide with an emphasis on how family and friends would react if the suicide was completed
- Crying when no reason for crying exists, other than the feeling of emptiness, sadness and meaninglessness
- Feeling guilty, anxious, nervous or panicky for no reason
Psychologists also investigate other aspects of the person’s life, such as medical history; existence of substance abuse patterns; chronic illnesses; family history of mental disorders; and current medications being taken. A depression screening is helpful to the professional who is attempting to accurately diagnose someone reporting clinical depression symptoms since a correct diagnosis greatly facilitates treatment and prognosis. A depression screening is a self-report given to patients suspected of being depressed which asks them to rate symptoms from “not at all” to “very much”. Sample questions would be similar to statements like “It takes great effort and time for me to do simple things” and “I feel agitated and cannot sit still most of the time”. Answers usually consist of:
- Not at all
- Very little
- Somewhat
- Moderately
- Quite often
- Very much
These self-reports are beneficial to both the client and counselor because an individual exhibiting clinical depression symptoms often has difficulty expressing what they are feeling. Depression can blunt the mind and provoke a kind of cognitive “shutdown” in which the person is out of touch with himself and capable of focusing only on the negative thoughts distorting his perception of reality.
Management of Clinical Depression Symptoms in Men and Women
Evidence culled from research studies indicates differences between men and women in regards to manifestation and management of depression symptoms. According to an article published in the March 1987 edition of Psychological Bulletin “men are more likely to engage in distracting behaviors that dampen their mood when depressed, but women are more likely to amplify their moods by ruminating about their depressed states and the possible causes of these states”.
Men, it seems, respond more dynamically to feelings of depression rather than deliberating over them. To counteract such a strong emotion as sadness or grief, men may actively seek out physical activities on which they can concentrate. Women, on the other hand, suffering from clinical depression symptoms are more prone to deliberate on powerful emotions and focus on them instead.
Another comprehensive study concerning the divergence of coping skills between men and women suffering from depression appeared in the April 2002 issue of the European Archives of Psychiatry and Clinical Neuroscience. Several thousand subjects participated in this study, which found that “men coped (with depression) by increasing their sports activity and consumption of alcohol and women through emotional release and religion. Women felt the effects of depression in their quality of sleep and general health, whereas men felt it more in their ability to work”.
Men and Depression
Clinical depression symptoms in men differ slightly from women as well. Men may show more anger or aggressiveness than women when depressed in an attempt to “triumph” over highly emotional feelings they cannot control. Engaging in risky behaviors is another indicator of depression, especially if such behavior is unusual for that certain individual. Some of these risky actions may include gambling, promiscuity, driving in a dangerous manner or engaging in random, physical fights with other men.
Because men are taught to repress their feelings, they may experience physical symptoms that are more intense than women when depressed. Severe migraines, unrelenting muscles aches, debilitating backaches and even heart attacks can occur when men are suffering from clinical depression symptoms.
Causes of Depression
Symptoms of depression and anxiety emerge from the interaction of complex systems constituting the entirety of an individual’s past, present and future. Depending on way in which these genetic, biological, emotional, psychological and environmental systems influence each other dictates whether someone is prone to experiencing clinical depression symptoms.
Depressive episodes commonly appear in those enduring stressful times in their lives. Examples of events frequently provoking the symptoms depression causes:
- Financial worries and responsibilities
- Demands from school, work and home
- Problems within the family
- Chronic illness
- Confusion about sexual identity
- Suffering the loss of a beloved family member, friend or pet
- Disturbing life changes
Some depression types are easier to manage than others are and will be temporary in nature. However, depending on the interplay of the various systems creating a person’s personality and core identity, an episode of depression may develop into prolonged or clinical depression symptoms.
Biological Causes of Depression
Positron emission tomography, or PET scans, provides researchers with concise pictures of the brain by injecting a patient with radioactive isotopes mixed with glucose, which reaches the brain and is absorbed by neurons. Once the glucose decays, the PET is able to detect radioactivity levels in all areas of the brain, which gives researchers the capability of studying physiological reactions to psychological processes.
Because of PET scans, as well as MRIs, scientists can examine the brain of depressed patients in order to ascertain if any common structural abnormalities are present. What they have found is a correlation between abnormalities in the hippocampus, prefrontal cortex, cerebellum, basal ganglia and thalamus with emergence of clinical depression symptoms.
However, researchers point out that due to the different types of depression, the pathology represented by certain depression types may not be evident in other individuals suffering from depression. For example, elderly people who develop depression may have abnormal brain architecture due to cerebrovascular events and other normal consequences of aging.
Reduced volume of the prefrontal cortex and amount of glial cells within this cortex has been discovered in depressed patients. This area of the brain functions as a regulator of mood states and is also extensively associated with activity in the amygdala, hypothalamus and brain stem systems controlling dopamine, serotonin and norepinephrine levels. Both the amygdala and hypothalamus govern anger, fear, hunger and sleep as well as other primal emotions and instincts. The three major neurotransmitters play a vital role in mood regulation as well.
Neurotransmitters and Clinical Depression Symptoms
Neurotransmitters such as dopamine, serotonin and norepinephrine are just three of the brain’s many chemicals utilized in transmitting messages throughout the central, peripheral and parasympathetic nervous systems. Neurons would not be able to communicate with each other without these chemicals. Absence of neurotransmitters would essentially turn the brain into a useless and inert organ.
Most of the time when someone suffers from symptoms of depression, the levels and functioning of these neurotransmitters has become unbalanced within the brain, an occurrence affecting a cascade of negative activity in which both the brain and the body are detrimentally affected. Researchers are not sure how long it takes for symptoms of depression and anxiety to develop once something goes wrong with dopamine, serotonin and norepinephrine activity. However, all clinical studies investigating the neurochemistry of depression clearly indicate that a reduction in one or all of these neurotransmitters is partially conducive to the development of clinical depression symptoms.
Chronic Stress and Depression
When people experience unrelenting stress due to work or personal relationship issues, a hormone called CRF, or corticotropin-releasing factor, is continuously released into the blood. CRF elevates enzymes that influence the production of norepinephrine, a neurotransmitter and hormone responsible for rate of heart contractions, the “fight or flight” response we instinctively assume when confronted with danger; glucose release and increased blood flow to the muscles. Vulnerability to chronic or repeated episodes of depression signs may indicate the presence of a norepinephrinergic system that is, for one reason or another, not able to manage stress as well as others.
Low levels of dopamine correlate to clinical depression symptoms as well. Dopamine is a neurotransmitter responsible for the human urge to seek out rewarding experiences, substances or other components of life that give us pleasure. Insufficient dopamine levels may demonstrate why depressed individuals feel no pleasure in activities that once gave them pleasure.
Stress plays a role in dopamine reduction by interfering with its synthesis and function in the brain. In addition, optimal dopamine utilization is associated with endorphins, which are hormones that give us feelings of happiness and satisfaction. When the brain is not using dopamine properly, this decreases endorphin activity, a chemical dysregulation that could exacerbate clinical depression symptoms.
Serotonin
Serotonin is the neurotransmitter most responsible for the manifestation of depression signs in all depression types. This is why serotonin selective reuptake inhibitors are routinely prescribed to the majority of patients suffering from depression. Antidepressants, or SSRIs, create a condition in the brain that allows defective neuronal receptors to release serotonin back into the brain rather than inhibit it. Because serotonin influences the majority of brain cells in one way or another, a deficiency or overflow of serotonin will affect various aspects of mood, sleep, attention, appetite, social behavior and memory. While no method currently exists to measure exactly how much serotonin is in the brain, researchers know that boosting the level of serotonin by prescribing SSRIs relieves many people of the incapacitating consequences of clinical depression symptoms. Another issue yet to be resolved by researchers is the question of whether the lack of serotonin causes depression or if depression causes a reduction in serotonin levels.
Using one of the following commonly prescribed antidepressants may alleviate depression symptoms:
- Abilify treats mood as well as certain mental disorders such as schizophrenia or bipolar disorder. It is frequently used in conjunction with other medications for the treatment of depression
- Effexor in addition to regulating serotonin levels, Effexor also contains an extra boost of norepinephrine to alleviate symptoms of depression. Generally prescribed to those who do not respond to SSRIs, Effexor is also frequently given to older adults suffering from depression
- Celexa and Lexapro both concentrate on returning serotonin levels to an optimal amount in the brain
- Cymbalta, in addition to treating clinical depression symptoms, Cymbalta also contains extra substances meant to relieve extreme anxiety and pain in those suffering from fibromyalgia or diabetic peripheral neuropathy
- Paxil and Zoloft are prescribed to patients experiencing depression, social anxiety, anxiety, panic and obsessive-compulsive disorders and post-traumatic stress disorder
Some antidepressants represent different classes of drugs, which also affect dopamine and norepinephrine levels in addition to serotonin. Patients who do not respond to one SSRI may respond better to another type of antidepressant.
Side Effects of Antidepressants
For those suffering from clinical depression symptoms, relief cannot come soon enough. However, antidepressants do not work overnight. Instead, it usually takes about four to six weeks before patients begin to feel better so it is important for them to take prescribed medication every day and according to directions.
Side effects are generally minimal and disappear after five to six days. However, when they are experienced, most involve:
- Dry mouth
- Nausea
- Dizziness
- Drowsiness
- Insomnia
Commonly reported side effects of extended use of antidepressant use include:
- Weight gain
- Lack of sexual desire
- Constipation
Rarely do people experience side effects from antidepressants that are severe enough to warrant discontinuation. However, depressed patients occasionally have to try several different kinds of SSRIs before finding one that effectively alleviates their clinical depression symptoms.
Different Types of Depression
Because depression is such a comprehensive mental disorder, it is frequently co-morbid with other psychological issues, such as bipolar, schizoaffective and psychotic disorders. A diagnosis of unipolar depression means the depression exists by itself, or it is not co-morbid with another mental issue.
Major depression is perhaps the most serious kind of diagnosed depression due to the grouping and tenacity of its symptoms. According to the National Alliance on Mental Health, “major depression is a serious medical illness affecting 15 million American adults, or approximately 5 to 8 percent of the adult population in a given year”. Individuals suffering from major depression are sometimes hospitalized when medications and counseling does not help them regain their lives. Although an individual can be depressed but not suicidal, most people who are hospitalized due to severe clinical depression symptoms have threatened or tried to commit suicide.
Dysthymic Disorder
Dysthymic disorder is a depression type that represents a low to moderate chronic depression level affecting a patient for at least two years. Although clinical depression symptoms are generally not severe enough to detrimentally impact a patient’s life, it does reduce the quality of life and tends to isolate someone from friends and family. Sometimes a person with dysthymic disorder has suffered from moderate depression signs for so long they simply think it is part of their personality rather than a treatable disorder.
According to the Diagnostic and Statistics Manual of Mental Disorders, symptoms of dysthymic disorder are:
- · Feeling depressed most days for at least two years
- · Low self-esteem
- · Extremes of appetite
- · Moodiness
- · Fatigue, feeling weak and without energy
- · Decision-making is slow and problematic
- · Frequently feeling pessimistic or hopeless
- · During the two years of experiencing dysthymia, these symptoms were never absent longer than two months in a row
- · Patient was never diagnosed with schizophrenia, delusional disorder or psychosis
- · Clinical depression symptoms are not related to causes induced by drugs, alcohol or medical condition
Depression precipitated by dysthymic disorder is one of the more difficult depression types to treat. Psychotherapy and cognitive behavioral therapy is often employed to teach dysthymic individuals how to effectively cope with stress. Talk therapy may eventually reveal the root cause of their clinical depression symptoms as well, which can then be addressed with appropriate treatment plans.
Bipolar Depression
Bipolar depression refers to the “down” sides of mood swings experienced by individuals with bipolar disorder.
Someone who suffers from bipolar disorder periodically undergoes extreme manic periods where they exhibit reckless and dangerous behavior that often causes a plethora of problems in their lives. Gambling, maxing out credit cards, acting on grandiose ideas that are clearly irrational and engaging in promiscuity are behaviors frequently seen in people with bipolar disorder.
Manic phases may last two weeks or two months but eventually bottom out into a severe depressive state, totally unlike the previous state of mind. It is during this phase that clinical depression symptoms affect bipolar individuals who feel even guiltier and despondent over the problems they may have caused during their manic phase.
Rapid cyclers, or those with bipolar disorder who experience four or more manic/depressed phases in one year, require long-term treatment plans involving psychotherapy and medications other than just antidepressants. Lithium is the most frequently prescribed drug for people with bipolar disorder, a mood-stabilizing medication that works to decrease manic and clinical depression symptoms within two to three weeks of administration. Some antipsychotic as well as anticonvulsant drugs such as Depakote are also given to reduce bipolar cycling.
Major Depression with Psychotic Features
In some cases, when depression is left untreated, an individual suffering from depression signs will start to exhibit behavior that is bizarre or delusional. This is the most serious form of the depression types, with affected individuals needing immediate hospitalization and treatment. Clinical depression symptoms with psychotic features include:
- Audio or visual hallucinations
- Suicide attempts
- Delusions, believing that the president is sending them messages through the computer, for example
- Extreme neglect of hygiene such as leaving the house in inappropriate clothing
- Extreme agitation or aggression over something imaginary
- Inability to understand what is being said to them
Causes of psychotic depression potentially involve:
- Genetics, having family members who have suffered from major depression with psychotic features
- Abnormally functioning thyroid
- Prescription drugs producing an aberrant reaction
- Organic brain disorders
The difference between someone experiencing psychotic depression and someone who is schizophrenic has to do with the fact that a psychotically depressed person is somewhat aware that what they may be hearing or seeing is, in fact, not real. A person with schizophrenia, on the other hand, believes what he sees or hears is very real and cannot differentiate between reality and psychotic unreality.
Treatment for someone diagnosed with clinical depression symptoms with psychotic features disorder consists of atypical antipsychotics such as Risperidone, Aripiprazole or Olanzapine usually in combination with an antidepressant. Known as a “second generation” psychotic medication, AAPs or atypical antipsychotics block dopamine pathway receptors in the brain, just as older antipsychotics do. However, AAPs do not cause tremors or muscle rigidity which older psychotic medication produce, especially in long-term use.
Post Partum/Post Natal Depression
Post partum depression only affects women who have recently given birth and may last for months after the birth if no treatment is implemented. According to the Womenshealth.gov website, postpartum depression is the result of many factors aggravating and amplifying each other. Some of these factors include:
- Genetics as women who have family members diagnosed with depression are more likely to suffer from postpartum depression
- Imbalance of neurotransmitters and hormone fluctuation, especially estrogen and progesterone levels
- Stressful events occurring during and shortly after childbirth
- Thyroid hormone levels decrease after giving birth and may contribute to clinical depression symptoms manifesting in postnatal women
- Feelings of being overwhelmed, unattractive and incompetent
- Lack of support from friends, family or significant other
- Money and marriage issues
- Drug or alcohol abuse
Women experiencing one or more of these symptoms may be suffering from postpartum depression:
- Moodiness or extreme mood swings
- Feeling anxious, irritable or sad for the greater part of the day
- Appetite loss or eating without being hungry
- Insomnia, even when sleep-deprived
- Crying suddenly for no reason
- Feeling guilty about not wanting to take care of the baby
- Inability to focus or get anything done around the house
- Experiencing vague physical symptoms such as nausea, headaches, dizziness or muscle aches
In contrast to postpartum, clinical depression symptoms, postpartum psychosis is rare and only occurs in about two out of every 1000 births. Women with postpartum psychosis won’t experience symptoms for several weeks after having a baby but these symptoms resembling psychotic depression symptoms are much more serious and need immediate intervention. Womenshealth.gov also states, “that women who have bipolar disorder or another mental health problem called schizoaffective disorder have a higher risk for postpartum psychosis”.
Am I Depressed?
Several types of depression screening tests exist such as the Beck Depression Inventory or the Standard Geriatric Depression Scale. However, all contain questions that ask the same fundamental queries regarding the severity, length and details of someone’s clinical depression symptoms.
Typical questions may include interrogative statements such as:
- In the past two weeks, how many times have you felt like things were hopeless or meaningless?
- Have you recently thought about suicide, or how your family and friends would react if you were to commit suicide?
- Do you find yourself sleeping more or less than usual in the past two weeks?
- Have you missed work or school due to feeling extremely depressed?
- Have you spent whole days in bed doing nothing but watching television or sleeping?
- Have you stopped participating in activities that were once enjoyable? If so, for how long?
- Do you find yourself crying for no reason at any time of the day?
According to the article, “Screening Tools for Depression in Primary Care” published in the November 2001 edition of West Journal of Medicine, “physicians sometimes miss diagnosing depression when somatic (physical) symptoms are the patient’s major complaints”. Similar to the Beck Depression Screening Inventory, any given depression screening concentrates on emotional symptoms and only generalizes physical symptoms.
The authors suggest that accurate diagnoses of major depressive disorder may be better addressed by comprehensively testing for all depression types rather than just unipolar depression. Such a screening would increase the identification of clinical depression symptoms in patients that are not typical of commonly observed depression signs.
Recent Observations Concerning Depression
Research into the mechanisms of depression is consistently discovering new information regarding etiology of this debilitating mental disorder. In the past decade, a correlation between levels of folate and depression has been suggested by observation and knowledge concerning the role of folate, or folic acid in the brain’s complex chemical processes.
Folic acid, or vitamin B9, is necessary for synthesis and repair of DNA, cell growth and production of red blood cells. According to an article in the May 1997 edition of Nutrition Reviews, “clinical depression symptoms are the most common neuropsychiatric manifestation of folate deficiency”. Additionally, low levels of folic acid have been associated with weaker responses by depressed individuals to SSRIs. Although folate deficiency is rare due to the amount we consume in the foods we eat, some individuals may suffer from the inability to properly absorb and use folic acid due to genetic disorders that have been previously undiagnosed.
A deficiency of zinc has also been shown to have a causal relationship with clinical depression symptoms as well. An article in a 2005 issue of Pharmacological Reports states that zinc reacts to brain chemistry the way antidepressants react to brain chemistry by “inducing brain derived neurotrophic factor gene expression and increasing levels of zinc in the hippocampus”. Additionally, research has found that depressed patients who have low serum zinc levels respond minimally or not at all to antidepressants.
Reducing the Risk of Developing Clinical Depression Symptoms
Although depression may not be preventable in certain cases, individuals who possess predisposing traits for the development of depression can engage in specific behaviors that may help reduce the severity or emergence of a major depressive disorder. Self-help tips for those recovering from depression or for people who feel they may be at risk include:
- Cultivate relationships with friends and family as loneliness and isolation exacerbate depression
- Don’t be afraid to reach out and talk to loved ones about your feelings
- Although you may not feel like it, maintain a steady pace of social activities, do not spend days by yourself in your apartment or house, even if it means going to the local coffee shop for coffee, get out and socialize!
- Seek out depression support groups for encouragement, advice and friendship
- Volunteer your services with a non-profit organization
- Exercise regularly with a workout buddy
- If you don’t have a pet, think about getting one as caring for an animal reduces clinical depression symptoms, blood pressure and relieves loneliness
- Don’t expect perfection from yourself
- Train yourself to stop negative thinking as soon as you recognize it
- De-stress and simplify your life as much as possible
Managing clinical depression symptoms can be accomplished by learning how to successfully cope with stress, taking prescribed medication as directed and understanding how your thoughts directly impact your perceptions of yourself and of the world.
http://psycnet.apa.org/journals/bul/101/2/259/
http://www.uhs.berkeley.edu/lookforthesigns/clinicaldepression.shtml
http://www.sci.sdsu.edu/classes/psychology/psy760/handouts/depression.htm
www.adoc.us/Providers/ADOC_Depression.pdf
http://psychcentral.com/depquiz.htm
http://www.thorne.com/media/alternative_medicine_review/2000/Volume_5/Number_1/Neurotransmitter_Precursors.pdf
http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=12999&cn=5
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553257/
http://www.webmd.com/depression/recognizing-depression-symptoms/serotonin
http://www.psychologyinfo.com/depression/depression_types.html
http://www.nami.org/Template.cfm?Section=depression
http://www.cchs.net/health/health-info/docs/2200/2266.asp?index=9294
http://www.depression-information.org/depression-types/psychotic-depression.htm
http://74.6.238.254/search/srpcache?ei=UTF-8&p=medication+for+psychotic+depression+treatment&xa=3g_fBBSZFd.GDxVzgFTDdA–%2C1320782141&fr=yfp-t-464-s&u=http://cc.bingj.com/cache.aspx?q=medication+for+psychotic+depression+treatment&d=4585857185547946&mkt=en-US&setlang=en-US&w=c642ee62,1b88b871&icp=1&.intl=us&sig=.1CdS38IFA19bMN63bTieg–
http://www.everydayhealth.com/depression/5-questions-doctors-ask-when-screening-for-depression.aspx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071624/http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.cfm#d
http://www.spectracell.com/media/027fullpaper2005pharmcolrepzincanddepressionpdf-.pdf
http://www.helpguide.org/mental/depression_tips.htm