Major Depression (Clinical Depression)

Feeling sad and helpless? It's possible you have major depression, also known as clinical depression. People with major depression feel a profound and constant sense of hopelessness and despair.

With major depression, you may have symptoms that make it difficult to work, study, sleep, eat, and enjoy friends and activities. Some people have clinical depression only once in their life. Others may have it several times in a lifetime.

What is major or clinical depression?

Most people feel sad or low at some point in life. But clinical depression is marked by a depressed mood most of the day, particularly in the morning. In addition, according to the DSM-IV -- a manual used to diagnose mental health conditions -- you may have other symptoms with major depression. Those symptoms might include:

* Fatigue or loss of energy almost every day

* Feelings of worthlessness or guilt almost every day

* Impaired concentration, indecisiveness

* Insomnia or hypersomnia (excessive sleeping) almost every day

* Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others.)

* Psychomotor agitation or retardation (restlessness or being slowed down)

* Recurring thoughts of death or suicide (not just fearing death)

* Significant weight loss or gain (a change of more than 5% of body weight in a month)

To distinguish your condition as major depression, one of your symptoms must be either depressed mood or loss of interest. Also, the symptoms must be present for most of the day every day or nearly every day for at least two weeks.

Who is at risk for major depression?

Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Overall, between 20% and 25% may suffer an episode of major depression at some point during their lifetime.

Major depression affects adults, teens, children, and the elderly alike. Major depression frequently goes undiagnosed and untreated in children and the elderly.

Are women at higher risk for depression?

About twice as many women as men have major depression. It's thought that hormonal changes in women during puberty, menstruation, pregnancy, miscarriage, and menopause may increase the risk of major depression.

Among other factors that increase the risk of major or clinical depression are increased responsibilities at home or at work. Juggling kids, careers, commitments, and caring for an aging parent may increase the risk of major depression. Raising a child alone will also increase the risk.

What are signs of major depression in men?

Depression in men is significantly underreported. Men who suffer from clinical depression are less likely to seek help or even talk about their experience.

Signs of depression in men may include irritability, anger, or drug and alcohol abuse. Repressing their feelings can result in violent behavior directed both inwardly and outwardly. It can also result in an increase in illness, suicide, and homicide.

What triggers major depression?

Not everyone has a trigger for clinical depression. Some common triggers or causes, however, include:

* Grief from losing a loved one through death, divorce, or separation

* Interpersonal deficits that lead to social isolation or feelings of being deprived

* Major life changes -- moving, graduation, job change, retirement

* Personal conflicts in relationships either with a significant other or a superior

* Physical, sexual, or emotional abuse

Major depression also seems to occur from one generation to the next in some families. However, major depression can also occur in people who have no family history of depression.

How is major depression diagnosed?

A health professional -- such as your primary care doctor or a psychiatrist -- will perform a thorough medical evaluation. The professional will ask about your personal and family psychiatric history. You may also have to complete a depression screening test.

There is no blood test, X-ray, or other laboratory test that can be used to diagnose major depression. However, your doctor may run some blood tests to help detect any other medical problems that have symptoms similar to those of depression. For example, hypothyroidism can cause some of the same symptoms as depression. Alcohol use or abuse, some medications, stroke or the use of illegal drugs can also cause symptoms of depression.

How is major depression treated?

Major or clinical depression is a serious but treatable illness. Your doctor will most likely give you a prescription antidepressant medication. He or she may also suggest that you receive a specialized form of talk therapy called psychotherapy. Sometimes, other medications are added to the antidepressant to boost its effectiveness.

Certain medicines work better for some people. It is important to talk to your doctor about finding a treatment that fits your lifestyle. It may be necessary for your doctor to try different drugs at different doses. Aside from your taking them, there is almost no way to determine which medicine will work best for you.

There are other treatment options for depression -- such as electroconvulsive therapy, also called ECT or shock therapy -- that can be used if drugs prove ineffective.

Can major depression be prevented?

Once you have had one episode of major depression, you are at high risk of having another. The best way to prevent another episode of depression is to be aware of the triggers or causes of major depression (see above). It is also important to know what the symptoms of major depression are and to talk with your doctor early if you have any of these symptoms.