What is depression?
There are many reasons for depression, and there can be different forms and expressions of depression. For some people, depression comes from a family and they are prone to feeling unhappy. Others fall into depression because they think bad about themselves, have a persistently pessimistic look, feel bound by concerns and problems, or are stressed by the gap between their expectations and reality. Depression can erupt after a traumatic event, a continuous stressful situation, or a perceived loss. It can come out of nowhere.
The voice of depression can be obvious, like when you tell yourself life will only get worse. However, it is not uncommon for people to project a feeling of superficial cordiality to conceal their pain.
Some feel depressed but do not show it in public. In the opera I Pagliacci by Ruggero Leoncavallo, a smiling face of sadness is presented to us. Though sad, the smiling clown of Pagliacci hid his tears. In “Tears of a Clown”, Smokey Robinson echoed this same feeling of crying when no one was near to listen. Can you be sad and depressed and still smile? Yes! But, no matter how the smile looks to an observer, it may not feel real to you. It is understandable to disguise depression. Also, it is functional when it serves the purpose ofining positive relationships. It is not adaptive when simulation gives value to troubleshooting.
Depression is rarely a simple matter linked to a single cause. When linked to a poor self-concept and a tendency to catastrophe about disappointment, injustice, and inconvenience, depression can be recurrent. Though catastrophism is not a universal sign of depression, people increase their risk of depression when they magnify and dramatize their difficulties beyond a normal response, so that they rise to cataclysmic proportions.
You may think that when you are depressed, the type of depression you experience is irrelevant. That is partially correct. All forms of depression involve a deeply sad or depressed mood and a high probability of distorted depressive thoughts.
This article provides an approach that applies to different types of depression where depressive thoughts and behaviors are present. But if you know the general type of depression you are facing, you can access the literature about that particular type of depression.
The following is a discussion of seven common varieties of depression: major depression, depression adjustment disorder, dysthymic depression; postpartum depression (POD), seasonal affective disorder (SAD), atypical depression and bipolar depression. Each form has its own literature. Depending on the type of depression, you can address it with different combinations of therapies, and sometimes in different ways. For example, you can address the form of depression known as seasonal affective disorder by intensifying your exposure to light.
Every form of depression entails a risk of depressive thinking. Each can be addressed by techniques that unlink depressive thoughts from depression and unhealthy activities of depression, such as abstinence. This disconnecting process can promote relief and reduce the risk of a relapse.
Causes of Depression
The modern version of Hippocrates’s theory is diathesis-stress theory (Sullivan, Nealee, and Kendler 2000). This is a core principle in Aaron Beck’s theory of depression. You have to have both vulnerability for depression (diathesis) and a triggering situation (stress). The diathesis can be a neurochemical event, negative early experience, or something else. Stress can come from a job loss, divorce, the death of a mate, living for years in a moribund marriage, or an accumulation of hassles. Depression may be secondary to a specific medical condition, such as diabetes, coronary heart disease, pneumonia, irritable bowel syndrome, and anemia.
In most instances, there will be a triggering event or series of events that precedes depression, including insomnia. You may have a habit of thinking negatively and magnifying events. This can trigger depression. A generalized anxiety often comes before depression.
Depression may seem to come out of the blue, without any clearly identifiable stressful event. Sylvia Plath (1972), author of The Bell Jar, tells us she had it made. She had an adoring, handsome boyfriend and a career she loved. Then, as if a bell jar had descended over her head, she felt enclosed by depression. The Bell Jar describes Plath’s feelings of hopelessness, suffering, and sense of worthlessness connected to a bipolar form of depression.
Depression has many causes. Early pubescence is linked with depression. Sedentary lifestyles, being out of work for sustained periods, rapid social changes, and a host of other psychological, social, and biological factors can presage depression. Although it is useful to understand why depression is increasing, it is crucial to take corrective actions to overcome your own depression and to learn to buffer yourself against social adversities.
The Many Faces of Depression
Depression is not a simple, uniform condition with the same causes and symptoms for everyone. Beyond a depressed mood, most people have special features in their depression that include some that are atypical. This complex condition has different causes and comes in different forms. Depression exists on a continuum from mild to very severe. Even when depression falls below the diagnostic standards, this condition is highly disruptive and burdensome.
You may have some or many of the experiences classified under depression. However, you are more than the label “depression.” You are a complex thinking, feeling, doing, pluralistic person with countless attributes who happens to feel depressed now. That means that depression is not you.
Knowing the type of depression you face does make a difference. Structuring your daily activities can make a difference, especially if you suffer from bipolar depression. Exercise seems effective for people with major depression. However, regardless of the type of depression you experience, depressive thinking, your emotional reaction to depression, and depressive behavior habits cut across categories, and you can beneficially address these three major dimensions of depression.
Once a problem is known, it is no longer mysterious. There are solutions. However, as practically everyone who has experienced depression can testify, knowing about depression, while helpful, doesn’t substitute for taking corrective actions.
Major Depression
Everyone periodically feels down in the dumps. This is not true depression. Major depression is different. A depressed mood and loss of interest or pleasure in nearly all activities are core features of major depression (Kennedy 2008). Major (unipolar or clinical) depression has a variety of unpleasant symptoms, such as several or more of the following:
- depressive thinking
- reductions in frustration tolerance
- sleep disturbances
- appetite disturbances
- difficulties paying attention and concentrating
- diminished sense of personal worth, self-doubts, and indecisiveness
- loss of ambition and enthusiasm
- loss of sexual desire
- sluggish movements
- fatigue
- suicidal thoughts
Experiencing these symptoms for two or more weeks is the current professional standard for you to qualify for a major depression (American Psychiatric Association 2000). However, this time line is arbitrary, and adjustments are currently underway to refine the definitions of the various forms of depression and to add and delete some categories. If you’ve been through depression before, you may want to start to address a recurrence of depression before two weeks have passed.
Major depressions can follow a normal bereavement, a catastrophic loss, or any condition you perceive as traumatic. Depression can start after a pattern of worry leading to general anxiety. Recurring patterns of negative self-talk that evoke negative emotions can set the stage for depression and aggravate an already depressed mood. It may just seem to come out of the blue.
Adjustment Disorder with Depression
A significant and unwanted change, such as divorce, job loss, property loss (theft, hurricane, flood, tornado, and fire), coronary bypass surgery, stock market loss, or betrayal can precipitate an adjustment disorder with depression.
Your mood is down. You feel preoccupied with and strained by negative thoughts about the troubling situation. This lingering mood is deepened by depressive thinking and by mentally magnifying stressful sensations and emotions. Nevertheless, you continue to have ample resources available that you can use in making an adjustment to the situation. There are periods when you feel fine.
What makes adjustment disorder different from major depression? It has a lesser intensity and a shorter duration. There are greater mood fluctuations during the course of a day. But this presumed minor form of depression also is not minor! It may extend into major depression.
Postpartum Depression
About 13 percent of women are at increased risk of depression following childbirth (O’Hara and Swain 1996). Sometimes called “baby blues,” this euphemism can detract from the significant importance of a condition that affects both mother and child.
Postpartum depression shares features with other forms of depression:
- depressed mood
- dating difficulties (being overweight or experiencing excessive loss of weight)
- difficulties sleeping
- loss of interest, including sexual interest
- headaches, backaches, and other unpleasant aches and pains
- difficulties paying attention, focusing, and remembering things to do
- overanxiety about the baby or fear of hurting the baby or yourself
- depressive thoughts, such as helplessness, hopelessness, worthlessness, shame, or guilt
- anger
- blame
Postpartum depression can be prevented through education and brief psychotherapy. If you suffer from postpartum depression, you can take corrective actions using methods you find in this book.
Seasonal Affective Disorder
When winter looms in northern climates, we experience shorter days, cold, snow, slush, and cloudiness. For many, this is a dreary time of the year. Life can seem oppressive compared with the balmy days of summer.
With the changes in temperature, a shorter day, and a sense of being cooped up, some feel a negative mood change. The technical term for this form of depression is seasonal affective disorder (SAD). This malaise starts around late fall in areas with distinct seasons, and lingers until spring.
SAD seems regional. You rarely hear of SAD cases in Southern California and Florida. SAD is primarily concentrated in northern latitudes. This winter doldrums syndrome is serious for about 10 percent of people living in northern winter climates and affects many more in lesser ways (Westrin and Lam 2007).
In a SAD state of mind and body, you might plant yourself with glazed eyes fixed on the TV. You might get testy with mates and friends. You might worry excessively about the future.
With longer days and exposure to light, SAD wanes. If you suffer from SAD, chapter 18 describes how to get a lift during the winter months.
Atypical Depression
Atypical depression is actually one of the more typical forms of depression. Depression is labeled “atypical” when its symptoms vary from those typically associated with major depression. Whereas with major depression, you probably will have insomnia, with atypical depression you are likely to sleep excessively. You are likely to lose weight with major depression and gain weight with atypical depression. While in both major and atypical depression, you may be sensitive to rejection, with atypical depression you are more likely to be oversensitive to real or imagined rejection.
Where even a surprise visit from a good friend has no mood-changing effect for someone suffering from major depression, any positive change can temporarily lift the mood of someone who is atypically depressed. The founder of American psychology, William James, may have suffered from atypical depression. He described instances when he was unable to move because of the heaviness of his depression. Then a bird might fly by his window and his mood would lift.
Some forms of depression are misdiagnosed, and those afflicted get the wrong medications from their primary care physicians (Kessler et al. 2006).
As with other forms of depression, you can effectively address atypical depression with cognitive and behavioral forms of intervention.
Bipolar Depression
The second-century Greek physician Aretaeus was the first to see that the radical mood swings between depression and elation were part of the same condition, which is now called bipolar disorder. He also saw this condition as existing on a continuum.
Types I and II
Bipolar disorders fall into two general groupings. Bipolar I is characterized by major mood swings between high levels of elation, or mania, and depression. It’s critical to control the manic phase, and drugs, such as lithium carbonate, are effective for this purpose.
Bipolar II is similar to bipolar I except that the highs don’t reach a manic level. These less intense “ups” are called hypomanic episodes.
In milder forms of manic euphoria, you may have thoughts racing through your head, talk faster than usual, have a greater interest in sex than usual, and spend much more money than usual. These elevated times are relatively brief compared to depressive cycles that tend to include lingering melancholic feelings, anxiety, guilt, anger, and hopelessness.
People with bipolar depression often spend up to 33 percent of their adult lives in depression. They may languish in depression for months or even years without seeking help (Kupfer et al. 2002). Antidepressants, such as the SSRIs, can worsen bipolar depression. A cognitive-behavioral bibliotherapy program, such as the one in this book, promotes improved functioning (Veltro et al. 2008).
Bipolar disorder is often associated with noteworthy accomplishments. Composer Ludwig van Beethoven, the humorist Mark Twain, and Clifford Beers, the founder of the mental health movement in the United States, all suffered from bipolar disorder. So does the actor Catherine Zeta-Jones.
If you’ve been diagnosed with bipolar disorder, you’ll want to start by educating yourself about it and accepting that bipolar disorder is a lifetime condition that needs to be managed. There are many positive stories of people who’ve accepted that they had bipolar depression. They accept it as they would accept a diabetic condition. They do what is necessary to contain and rise above it.
Signs
Your depression merits attention if you’ve had a depressed mood and any two or more of these conditions that linger:
- You’ve lost interest and pleasure in life.
- You have no desire for sex when you previously had desire.
- Your depressed mood seems out of proportion with your life situation.
- Depression significantly interferes with your day-to-day functioning.
- You have persistent sleep and appetite problems.
- You feel apathetic, lethargic, and dull.
- You have thoughts of hopelessness, helplessness, and worthlessness.
- You have trouble paying attention and concentrating.
- You have a low tolerance for discomfort.
- You’ve thought about suicide.
Managing a bipolar condition takes a special effort—much like sustaining a desired weight loss takes effort. Defusing depressive thinking and following a predictable schedule helps you lead a more normal life.