What is clinical depression? Clinical depression is a serious and common disorder of mood that is pervasive, intense and attacks the mind and body at the same time. Current theories indicate that clinical depression may be associated with an imbalance of chemicals in the brain that carry communications between nerve cells that control mood and other bodily systems. Other factors may also come into play, such as negative life experiences such as stress or loss, medication, other medical illnesses, and certain personality traits and genetic factors.

What are the signs and symptoms of depression? The symptoms of depression include feeling sad and blue, not enjoying activities once found pleasurable, having difficulty doing things that used to be easy to do, restlessness, fatigue, changes in sleep, appetite or weight, inability to make decisions, feelings of worthlessness, and thoughts of death or suicide. Symptoms of depression persistent, sad, anxious or empty mood feelings of hopelessness or pessimism feelings of guilt, worthlessness or helplessness loss of interest or pleasure in ordinary activities decreased energy, a feeling of fatigue difficulty concentrating or making decisions restlessness or irritability inability to sleep or oversleeping changes in appetite or weight unexplained aches and pains thoughts of death or suicide

There are several types of depression — major depression, dysthymia, bipolar depression, and Seasonal Affective Disorder. Major depression is the most common type of depression and is characterized by at least five of the major symptoms of depression. Dysthymia is a milder form of depression that lasts two years or more. It is the second most common type of depression but because people with dysthymia may only have two or three symptoms, may be overlooked and go undiagnosed and untreated. Bipolar depression is the depressive phase of manic-depressive illness, in which there are both extreme highs and extreme lows. Bipolar depression symptoms are similar to those of major depression, with certain variations such as excessive sleep and increase in appetite. Seasonal Affective Disorder is a type of depression that follows seasonal rhythms, with symptoms occurring in the winter months and diminishing in spring and summer. Current research indicates that the absence of sunlight triggers a biochemical reaction that may cause symptoms such as loss of energy, decreased activity, sadness, excessive eating and sleeping. Recently, research produced as a result of the last several National Depression Screening Days has revealed that some people may experience depression without necessarily suffering from significant or very troublesome changes in sleep and appetite. This is an intriguing finding because changes in sleep and appetite are usually considered to be hallmarks of depression. Instead, the five most common symptoms in people being screened for depression during the past several National Depression Screening Days were: difficulty doing things done in the past, feeling hopeless about the future, difficulty in making decisions, feeling worthless and not needed, and no longer enjoying once enjoyable activities. Individuals who are experiencing these symptoms should ask their doctor about clinical depression.

What is the difference between the blues and clinical depression? Feeling downhearted and sad is often a normal reaction to a life situation. All of us feel this way sometimes, but in a few days, perhaps after talking to a good friend, we start to feel ourselves again. Clinical depression is very different. Clinical depression is an illness, and it requires specific treatment. Unlike the blues, clinical depression persists and doesn�t go away no matter how hard the individual wants it to. Clinical depression is not a weakness. It is an illness and can last for months or years if left untreated. The most serious and tragic consequence of clinical depression is suicide.

How does a health professional diagnose depression? A health professional diagnoses depression after taking a thorough medical and psychiatric history. The medical examination will determine whether or not the symptoms the individual is experiencing are caused by an illness other than depression. The psychiatric evaluation will review the individual’s symptoms, current life stressors and situation, treatment history, history of mental illness individual’s family and assess the person’s thoughts, feelings and behaviors

Who gets depression? According to the National Institute of Mental Health, more than 17 million Americans each year develop depression. Recent research indicates the number may be even higher, closer to 20 million. One thing on which researchers agree is that less than half of the people suffering from depression actually receive treatment. Yet, one out of every five adults may experience a depression at some point in their lives. Twice as many women as men suffer from depression, although everybody, including children, can develop the illness.

What are the treatments for depression? More than 80% of people with depression improve with treatment by the end of one year. There are two principal treatments for depression — medication and psychotherapy. For some, just one or the other is sufficient. For others, the most effective treatment is a combination of the two. Some people are helped by electroconvulsive therapy or self-help groups. Antidepressant medication works by affecting brain chemistry. The medications are not addictive and may take several weeks to be effective. Psychotherapy, sometimes called talking therapy, comes in many forms. Generally, the therapy is aimed at helping the person develop new ways of thinking, deal with people better, or resolve conflicts remaining from childhood. Each type of psychotherapy make take place in individual, group, or family sessions. Electroconvulsive therapy (ECT), contrary to popular mythology, is a safe and effective form of treatment. It is generally used for individuals with severe depression and for patients who cannot tolerate medication because of a medical condition or are at immediate risk for suicide. Self-help groups can provide a supportive environment for an individual with depression, his or her family, and friends. The Depression Bipolar Support Alliance, the National Alliance for the Mentally Ill, and some local hospitals offer support groups.

Why get treatment? Will it work? People with depression need treatment in order to function fully and modulate the chance of recurrence. Treatment is highly effective. With appropriate treatment, many people can experience improvement in as little as 8 weeks. In addition, the costs to not getting treatment are very high. People can lose their jobs, destroy relationships, and isolate themselves from their communities. Physical and mental health suffer as well. Depression is also costly to society. Studies indicate that the cost of clinical depression exceeds $47.3 billion annually. Fully $24 billion is comprised of lost productivity and worker absenteeism on the job.


1. Depression.American Psychiatric Press, Inc., 1988.

2. Depression: What you need to know. D/ART Program, National Institute of Mental Health. Rockville, MD.

3. Greenberg, Paul. The Economic Burden of Depression in 1990. Journal of Clinical Psych, 54, 1993.

4. Jacobs, Douglas. National Depression Screening Day Educational Lecture, 1998.

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