DEPRESSION (di-pres/en) -- a lowering of vital energy (Webster's Dictionary)
Depression is a broad term used to refer to a range of different diseases recognized by the medical field. We also use the term to refer to temporary and minor negative feelings (i.e. I'm depressed because the Pacers lost last night or the post-holiday blues.) Depressive illnesses include major depression, the bipolar disorders, dysthymia, cyclothymia, and variations of these based on timing of the onset (i.e. seasonal or post partum), duration of symptoms, or severity of symptoms. These illnesses impact over 19 million adults in America each year. Depression is frequently seen as a complicating factor in heart attack, stroke, diabetes and cancer patients. In fact, depression increases one's risk of having a heart attack. Almost anyone who kills him or herself suffers from a mental disorder, most often a form of depression or substance abuse or both.
The key factor in diagnosing most of these illnesses is the presence of a major depressive episode. To be diagnosed with a major depressive episode your symptoms must last at least 2 weeks. The symptoms must also appear to be a change from previous functioning. There are people who resemble Winnie the Pooh's Eyre their whole life but are not depressed. The symptoms of a major depressive disorder include:
- Depressed mood.
- Diminished interest or pleasure in most activities.
- Significant weight loss or gain without effort or loss of appetite.
- Difficulty sleeping or sleeping too much.
- Psychomotor agitation or retardation.
- Feelings of worthlessness or excessive or inappropriate guilt.
- Diminished ability to think or concentrate, or indecisiveness.
- Recurrent thoughts of death, suicidal ideation, or a suicide attempt or plan.
Thankfully, most people do not experience all of the symptoms. To be diagnosed with a major depressive episode one must experience at least 5 of the above symptoms and 1 of the 5 must be either depressed mood or diminished interest or pleasure in most activities. If one meets several of these symptoms, but less than 5, there are milder depressive disorders that can still be diagnosed. It is important to remember that each person will experience a different set of symptoms with their depression and that the symptoms will look different with different people. No two people will experience depression in exactly the same manner. There are, however, some common themes that do repeat themselves, particularly in lawyers. In lawyers the most common symptoms are closely related to the work we are trying to do. Reduced ability to concentrate is one of the most bothersome symptoms for attorneys. They may have had trouble sleeping and a poor appetite for some time but attorneys often seek treatment when they realize that their ability to concentrate and get their work done is compromised. When you add together reduced ability to concentrate with fatigue and loss of interest in most all activities it is highly likely that the attorney's work is going to suffer at least in quantity if not in quality. In addition, attorneys in this condition often try to remedy the problem by working longer hours to keep up on the quantity of their work. In doing so they reduce contact with significant, supportive people in their life, reduce the amount of time they spend on exercise, hobbies, and other stress reducing activities, and cut back further on what is most likely already inadequate sleep. In their attempts to solve the problem they are doing the opposite of what they need and falling deeper into the hole of depression.
If you have a strong family history of depression you may decide that it is best to stay on medication for some time. On the other hand, if you have no family history and your depression occurred during the year that your divorce was final, your mother died, and you lost your job, you might have more of an acute and situational depression and might not be on medication very long. Regardless, the skills you learn in therapy are what will help you to avoid future episodes of depression. This is critical because it is generally accepted in the psychiatric field that if you have one episode of depression there is a 50% chance that you will have a second episode. If you have a second episode of depression there is a 70% chance that you will have a third episode and if you have a third episode there is a 90% chance that you will have yet another episode. Clearly, it is worthwhile to do all you can to treat a first episode of depression to increase the chances that it will be your only experience with depression.
Erand, marvellous post!