Job loss. Bullying. Loss of a loved one. Mental, physical, emotional abuse. Financial uncertainty. A broken marriage. Abandonment. The responsibilities of parenthood. Traumatic accidents. Disease.
All of these things not only affect how you think, feel, and cope with daily activities..
You may be able to bounce back in a week or two, but if you’re one of the 300 million people around the world who have depression, your symptoms linger and are so significant they impair your social, educational, and occupational functioning.
You’re emotionally and mentally unstable, and you’re hurting physically. Trying to keep up with normal activities this way can feel exhausting. Run down and hopeless, some days you feel like life isn’t worth living.
You need aid. Depression isn’t a case of the blues. It’s not a weakness. It’s not something you can shake yourself out of. Without someone to give you hope and help you develop constructive thinking habits, you risk driving yourself to the point of suicide. It’s what happens to 44,000 Americans every year, making suicide the 10th leading cause of death in the U.S..
Seeking treatment for a depressive disorder is how you get back to life. It’s how you become victor over what’s been eating you up and stealing your joy. It’s how you survive.
Types of Depression and Symptoms
There are several types of depression. They may be triggered by a sudden event or be the result of a series of events that are both internal and external.
Life can throw us twists and turns. We may experience trauma or personal loss and have a period of melancholy as a result. This is reactive depression, and it typically only lasts a short time and can be corrected by the sufferer.
When you can’t move forward and display empty mood, persistent depression, and inability to function it has become a depressive disorder.
Major Depressive Disorder
If it’s been more than two weeks, you’re constantly depressed and have lost interest or fulfillment in day-to-day activities, you might be having a major depressive episode. However, a better indicator is if you experience four or more of these symptoms:
- Sleep disturbances (unable to sleep or oversleeping)
- Drastic fluctuations in weight, either up or down
- Feelings of sadness and emptiness
- Irritability, angry outbursts, overall frustration
- Fatigue or loss of energy
- Impaired mental or motor function (e.g. slowed thoughts, trouble concentrating or remembering things and reduced movements)
- Fixation on past failures or self-blame
- Feelings of excessive guilt and worthlessness
- Suicidal thoughts or suicide attempts
- Physical ailments (back pain or headaches)
An episode may occur only once, but more often episodes crop up several times over a lifetime and start in late adolescence or early adulthood. During these episodes, symptoms may last most of the day, nearly every day. You may feel miserable without even knowing why. The manifestations are serious enough to interrupt your relationships, work, and social activities.
Persistent Depressive Disorder (PDD)
Persistent depressive disorder (PDD) is classified as a chronically depressed mood that occurs for at least two years. Symptoms typically come and go during this time, lasting for more than two months at a time and varying in intensity from mild, moderate or severe.
You may experience major depressive episodes during the span of these years, or you could have had episodes leading up to this disorder. This may be referred to as double depression.
Classic signs of PDD include:
- Loss of interest in activities you once enjoyed
- Feelings of hopelessness
- Sadness, emptiness, feeling down
- Lack of productivity
- Decreased activity
- Low self-esteem
- Feelings of inadequacy
- Difficulty concentrating or indecisiveness
- Irritability or outbursts
- Avoidance of social activities
- Sleep problems
- Lack of appetite or overeating
- Unexplained physical symptoms (muscle pain and fatigue or headaches)
Though PDD is considered a less severe form of depression, these symptoms are chronic enough to make life unmanageable. It can be hard for you to be upbeat, even during happy occasions (e.g. birthday). Your personality might appear gloomy, harassing, or dull. Your inability to function or self-isolation can have critical impacts on your relationships.
Disruptive Mood Regulation Disorder
A childhood condition, disruptive mood dysregulation disorder (DMDD) is more than being moody. Kids with DMDD are extremely agitated, angry, and frequently in the throws of extreme tantrums. They may:
- Be angry or irritated most the day, just about every day
- Have intense outbursts, on average, 3 or more times per week.
- Struggle to function at home, in school, and with peers
Symptoms tend to begin before the age of 10 and remain steady for a year or more. Explosions are disproportionate given the situation at hand and inconsistent with the developmental level of a child their age. As adults they are at elevated risk for depression and anxiety disorder. .
Substance/Medication Induced Depressive Disorder
Substance-induced mood disorder is a depression caused by using drugs, alcohol, or taking certain medications. Your feelings of sadness aren’t brief and fleeting, they are worse and much longer. You might find complete lack of enjoyment in life.
Most people are unaware that their depression is even induced by substances because they tend to associate them with the positive, happy feelings. However, they always find themselves back in a lowly place, either during intoxication or withdrawal.
Once you stop taking the drugs, alcohol or medication for a few days your mood picks back up until you use again. If you’re detoxing, your depression might continue or get worse until you move through the process.
To be diagnosed, you must:
- Not have a history of depression without substance abuse
- Have symptoms that last more than a month after you’ve quit substances
- Have quality of life issues (disrupted social life and rocky employment situation, for instance)
Premenstrual Dysphoric Disorder (PMDD)
Similar to premenstrual syndrome (PMS), symptoms of premenstrual dysphoric disorder (PMDD) are more serious. You may have extreme depression, lasting irritability, fits of anger, or anxiety one to two weeks prior to your period coming. That’s when hormone levels start to fall after ovulation.
Other symptoms include:
- Feelings of despair
- Thoughts of suicide
- Tension or anxiety
- Panic attacks
- Uncontrollable crying
- Mood swings
- No interest in daily activities and relationships
- Trouble thinking or concentrating
- Fatigue or low energy
- Unable to sleeping
- Feelings out of being out of control
- Physical symptoms (cramps, headaches, bloating, breast tenderness, and muscle or joint pain)
Two to three days after your period starts, you often find relief from your symptoms.
Bipolar Disorder/Manic Depression/Borderline Personality Disorder
Depression is a classic feature of manic disorders like bipolar disorder and borderline personality disorder. These disorders are a form of major mood disorder, and are characterized by hypomanic or manic episodes.
During episodes, your mood changes from normal to being in a high energy state. You may also:
- Lose sleep, sometimes for days
- Have hallucinations or bouts of psychosis
- Undergo paranoid rage
- Have grand delusions
- Have disturbances in thinking
- Experience fits of rage
- Display a dull, empty personality
- Impairment in social functioning
The severity of the episodes can be very mild or extreme, and they can occur gradually or suddenly within a period of days to weeks. Discrete episodes happen 4 or more times annually. This is a process called rapid cycling, which is different from moment-to-moment mood changes often noted in those with manic disorder.
Treatment for Depression: There is Help
Research suggests that depression is a combination of genetic, environmental, psychological, and biological components. It often displays as a high level of anxiety as a child and balloons into a chronic depressive disorder as an adult.
This means you’ve likely had a long history with depression and though you may have periods of wellness, the cycle always returns. Each cycle builds on the last, creating a toxic environment where suicide or self-mutilation can become real options.
Treatment seeks to provide stability and balance in the midst of very complicated mental, emotional, and physical factors. Which method you receive (and how long you receive it) depends on your diagnosis. Typically, however, techniques involve a variation of psychotherapies and antidepressant medications, as these have been found to be the most effective forms of treatment for depression, according to several studies.
If you have a mild form of depression, psychotherapy, or talk therapy, may be used alone. If your depression is more severe, this therapy will be coupled with medication and other therapies.
Psychotherapy is a way to help with the mental and emotional challenges associated with depression. You can remove or control symptoms and better understand triggers so you can function better and improve your well-being. It is especially suited for helping you cope with loss, medical illness, grief, trauma—all of which can trigger depression or anxiety.
- Cognitive Behavioral Therapy to help you identify or change harmful thinking and behavioral patterns, then replace them with more accurate depictions and functional behaviors. By developing new real world skills, you learn how to focus on current problems and solve them.
- Interpersonal Therapy to understand deep interpersonal issues like unresolved grief, conflict, changes in work or social roles. As you move through these problems, you also learn how to healthily express your emotions to others and communicate effectively.
- Dialectical Behavior Therapy to regulate emotions in those with chronic suicidal thoughts and manic disorders. This involves individual and group therapy where you release your problems and are given skills to change disruptive thinking and behavior.
- Psychodynamic Therapy to improve self-awareness and to modify old patterns (repetitive thoughts or feelings) that are subconscious but stemming from childhood experiences.
Other therapies may include psychoanalysis, supportive therapy, animal-assisted therapy, creative arts therapy, and play therapy.
Each session may be 30-50 minutes long and done within an outpatient treatment center. The number of sessions will depend on your progress. Psychotherapy relies on you to open up in order for treatment to beneficial.
Doing the hard work early may mean just a few short-term sessions or, if participation is limited, may require months or years. Typically those with long-term sessions have moderate to severe depression, which necessitates involved therapies to deal with longstanding and complex issues.
Once you’re stabilized, treatments should be fewer, with most seeing their therapist for immediate issues they feel they’ve dealt with unsuccessfully on their own.
Research shows that most who receive psychotherapy find relief and living with function. Approximately 75 percent who enter psychotherapy show improvement of emotions and behaviors, and studies suggest even changes in their brain and body.
Not only do they have fewer sick days, fewer medical issues, more work satisfaction and less disability, brain imaging techniques show positive changes at the cellular level.
If you’re living with moderate to severe depression, you will likely be given both antidepressants and psychotherapy. The medication will help to relieve symptoms, while therapies like talk therapy help you gather effective ways to deal with depression and life’s problems.
There are many types of antidepressant medications. Your doctor may try one or more to find which are most effective. Sometimes it’s not the medication itself but the dosage that needs to be tweaked.
Some see improvements within a few short weeks; most others require a month or two before therapeutic effects have been fully realized.
A 2018 study of more than 100,000 patients with major depressive disorder found all antidepressants to be more effective than placebo, which amounts to no treatment. What’s interesting is that researchers found some antidepressants to be better than others.
“In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants,” said the study, “whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84).”
“For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants,” the study added, “whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates.”
In those with manic disorders, antidepressants alone are not effective. Mood stabilizers such as lithium are much more helpful when used with antidepressants. Some antipsychotics, anticonvulsants, and benzodiazepines may also give a mood boost.
As a whole, these medications help control the extreme highs and lows of bipolar disorder and borderline personality disorder by reducing the risk of mania.
A 2014 study using Swedish national registries, identified more than 3,000 patients with bipolar disorder. They started with antidepressants but had no treatment the previous years. Those who received antidepressant treatment alone were at increased risk for mania. Those who received antidepressant therapy plus a mood stabilizer showed no risk of mania during the 3 months after starting treatment. Their risk decreased further over 3 to 9 months.
Like antidepressants, mood stabilizers and antipsychotic medication are likely to take a month or two kick in. During this time, you’ll be undergoing therapy, engaging in physical activity (exercise), developing a sleep schedule, improving your social networks, and maintaining a healthy diet.
Addiction and Depression
If you’re battling a depressive disorder, you are more likely to abuse substances—this has been shown in 1 in 4 adults. Drugs and alcohol become a way to lift your mood or dull out painful thoughts. But because substances contain chemicals that affect the central nervous system, the uplift in spirit is temporary.
As you come down, you end up having a different effect than what you intended. You become sad, hopeless, lethargic until your next use. This dependency causes depression and substance abuse to feed into one another, making both conditions worse.
When addiction and depression occur together, it’s referred to as dual diagnosis. The layering of two complex conditions drastically increases your risk of injury, self-harm, chronic illness, psychosis and suicide.
It is imperative that if you have a dual diagnosis you seek treatment as neither condition stand to resolve on their own. Withdrawing from drug and alcohol addiction is dangerous and rarely effective.
Upon giving up substances, depression can be made worse, tossing you back into use. In many cases, use increases as a result of the heightened depression and the chances of overdosing spike.
This is why specialists use integrated treatment for substance abuse and depression at the same time. Not treating the depression will still drive the addiction, and not treating the addiction will drive the depression.
Addressing both can better ensure your success after rehabilitation.
Types of Treatment Centers
Treatments for depression, mental illness, and substance abuse can take place in several environments:
- Clinical Residential Treatment. This requires you to stay in a controlled, residential-like environment where your medications are actively monitored, detox is implemented if necessary, and therapy sessions occur in-house.
- Group Home, Farm-or-Work-Based Facility, Apartment-Style Facility. These offer more flexibility and comfort, and are designed to help you implement skills you learn in therapy in real-world environments.
- Specialized Care. These facility types involve natural depression treatment like animal-assisted therapy. The idea is to bring in softer, natural elements of our world such as pets to ease depression.
- Manic Disorder-Targeted Facilities. These facilities often start off as inpatient to get stability and require a combination of medication and psychotherapies to manage depressive symptoms as well as mania. Treatment is ongoing even after stabilization occurs. Doctors will monitor medication and continue therapy sessions as needed.
- Outpatient Facilities. If your depression is mild, outpatient may be the best option. You will have scheduled sessions with your therapist and groups weekly, but can return to your day-to-day life once it is over.
When to Consider a Treatment Center
Treatment for depression should be considered anytime your symptoms lasts more than two weeks and don’t improve. Even if relief is found but it returns, these are signs that what is triggering your depression has not been dealt with and it’s only a matter of time before another episode comes on.
Since episodes can be mild to extreme and you have no control over which you level you go to, the dangers of leaving depression untreated include health problems and suicidal ideation.
If you or a loved one are dealing with depression, it’s time to get help and hope.