Wednesday, January 6, 2010

Could You Be Depressed and Not Know It?

By Jenny Stamos Kovacs

"Could you be depressed and not know it?" This sounds like a ridiculous question. After all, wouldn't you know if you were depressed? Possibly not. Depression can take hold gradually, without a person realizing that depressive thoughts and feelings are increasingly dominating their perspective - and their life.

Many people assume that depression is easily identifiable, manifesting itself as persistent sadness that doesn't lift. In fact, symptoms of depression can take a variety of forms. Chances are that if you are reading this article, you have the feeling that something isn't quite right. You may find that you are tired all the time, and all you want to do is sleep. Depression can also trigger insomnia, forgetfulness, and an inability to take pleasure in normal activities. According to Eve Wood, MD, "People often say, 'I'm not depressed; I just don't care', but that indifference can signal depression." It turns out that excessive fatigue, insomnia, and joylessness can all be symptoms of depression.

As subtle and confusing as signs of depression can sometimes be, it's important to remember that depression is a serious illness that can cramp lives, cast a shadow over families, and even lead to suicide. A growing body of research has documented the serious and chronic effects of depression on the human brain - effects that can make a person susceptible to future incidents of depression and misdiagnosis of depression is high. The good news is that depression can be effectively treated.

Symptoms of Depression:
* Changes in weight, sleep or appetite: These signs of depression can be confusing because depending on the individual, they can take very different forms. Some depressed individuals want to sleep all the time, for example, while others may experience insomnia.
* Physical symptoms of depression that won't go away, like fatigue, headaches, back aches, digestive disorders, chronic pain, or menstrual problems
* Anxiety
* Agitation, irritability
* Forgetfulness or difficulty concentrating
* Low sex drive
* Pessimistic or hopeless outlook on life: While there are plenty of reasons to be pessimistic about the future, a depressed person is more apt to dwell on negative events and be unable to find anything to be happy about.
* Feelings of guilt or helplessness
* General apathy and lack of interest or pleasure in customary activities
* Thoughts of suicide

Experts say that certain behaviors can also be a sign of underlying depression. "People often engage in behaviors that signal "masked depression," says psychologist Lara Honos-Webb, PhD, author of Listening to Depression. Compulsive shopping, working, eating, or drinking alcohol can be signs of depression -- particularly when one feels empty or anxious when they're not participating in these activities.

What Are the Causes of Depression?
Experts say that depression is caused by an interaction of genetic factors and real life triggers. Because depression often runs in families, experts believe that genetic factors make some people more vulnerable to than others, because of their individual brain chemistry.

Depression triggers can include:
* Situational factors: Major problems and life crises -- a romantic break-up, job loss, or the death of a loved one, for example -- are often the immediate, most obvious causes of depression. But ongoing life challenges like poverty, unemployment, and social isolation, as well as childhood trauma, also put people at higher risk for depression.
* Medical factors: Chronic pain or illness can lead to depression. Certain medical conditions -- including hypothyroidism, cancer, and hepatitis -- can cause depression. Nutritional deficiencies and some medications are culprits as well. Therefore, it's important that treatment for depression include a medical evaluation.
* Stress: A connection between chronic stress and depression has been established and could explain why stressful life situations, like poverty and unemployment, put people at far higher risk for depression.

Treatment for Depression:
According to depression experts at the American Psychological Association, you should seek treatment for depression if it persists for more than two weeks -- particularly if your depression is severe enough to interfere with normal life activities. If you suspect that you are depressed, talk to your physician, who can rule out physical causes and refer you to a mental health professional.

Experts now understand that depression has to do with shifts in brain chemistry, so a piece of the treatment puzzle involves re-balancing chemicals, Wood says. But it doesn't have to involve medication. The best treatment for your symptoms depends on your individual story, she says; whether you've been depressed before, and whether your symptoms keep you in bed all day or simply sap your energy. So try to describe your history and symptoms as precisely as possible when you speak to your physician and psychotherapist.

Treatment for depression usually involves psychotherapy, antidepressants, or both, according to Susan G. Kornstein, MD, a professor in Virginia Commonwealth University's School of Medicine. Experts now believe that a combination of both is most effective. There is evidence that in many cases, psychotherapy works as well as antidepressants do, and there are no side effects, according to Whiffen. Interpersonal Therapy (IPT) for example, focuses on improving the patient's relationships to help reduce depressive symptoms.

For many people, antidepressants are very effective in treating depression, particularly when depression is severe or persistent. We don't completely understand how antidepressants work, but we do know that they readjust the balance in brain chemicals known as neurotransmitters. There are currently many different types of antidepressants on the market, so be sure to work with a psychiatrist who can help you find the medication that is most effective for you.

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Brian will share some of his story tomorrow regarding his dealing face to face with depression.