Jon Draud, MD: psychiatrist
TOPIC: Depression and the Holidays
Monday, November 22, 2010
News notes via www.webmd.com
What is Depression?
According to the DSM-IV, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following nine symptoms at the same time:
- a depressed mood during most of the day, particularly in the morning
- 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
- recurring thoughts of death or suicide (not just fearing death)
- a sense of restlessness -- known as psychomotor agitation -- or being slowed down -- retardation
- significant weight loss or gain (a change of more than 5% of body weight in a month)
How long do these signs have to be present before they are diagnosed as depression?
With major or clinical depression, one of the key signs is either depressed mood or loss of interest. For a diagnosis of depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. In addition, the depressive symptoms need to cause clinically significant distress or impairment. They cannot be due to the direct effects of a substance, for example, a drug or medication. Nor can they be the result of a medical condition such as hypothyroidism. Finally, if the symptoms occur within two months of the loss of a loved one, they will not be diagnosed as depression.
What are some common feelings associated with depression?
According to the National Institute of Mental Health, people with depressive illnesses do not all experience the same symptoms. How severe they are, how frequent, and how long they last will vary. It depends on the individual and his or her particular illness. Here are common symptoms people with depression experience:
- difficulty concentrating, remembering details, and making decisions
- fatigue and decreased energy
- feelings of guilt, worthlessness, and/or helplessness
- feelings of hopelessness and/or pessimism
- insomnia, early morning wakefulness, or excessive sleeping
- irritability, restlessness
- loss of interest in activities or hobbies once pleasurable, including sex
- no pleasure left in life any more
- overeating or appetite loss
- persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
- persistent sad, anxious, or "empty" feelings
- thoughts of suicide, suicide attempts
While these are common symptoms of depression, they may also occur in patterns. For example, a person may experience depression with mania or hypomania -- a condition sometimes called manic depression. Or the symptoms may be seasonal as in the case of seasonal affective disorder.
There are several types of manic depression. People with bipolar II disorder have at least one episode of major depression and at least one hypomanic -- mild elation or high -- episode. People with bipolar I disorder have a history of at least one manic -- extreme elation or high -- episode, with or without past major depressive episodes. A patient with unipolar depression has major depression only but does not have hypomania or mania.
Is depression difficult to diagnose?
It is estimated that, by the year 2020, major depression will be second only to ischemic heart disease in terms of the leading causes of illness in the world. But patients with depression sometimes fail to realize (or accept) that there is a physical cause to their depressed moods. As a result, they may search endlessly for external causes.
In the U.S., about 14.8 million adults suffer from major depression, according to the National Institute of Mental Health. The suicide risk in people with this type of depression is the highest rate for any psychiatric state. For people between the ages of 10 and 24, suicide is the third leading cause of death. Unfortunately, most people with clinical depression never seek treatment. Left undiagnosed and untreated, depression can worsen, lasting for years and causing untold suffering, and possibly suicide.
Are there different types of depression?
There are a number of different types of depression including:
- major depression
- chronic depression (dysthymia)
- bipolar depression
- seasonal depression (SAD or seasonal affective disorder)
- psychotic depression
- postpartum depression
- substance-induced mood disorder (SIMD)
Are You at Risk for Depression?
Are you at risk for clinical depression? Knowing what factors increase your risk of having major depression may help you get the best medical help when you need it. Depression treatment is most effective early on.
What Are the Risk Factors for Depression?
There are a number of significant risk factors for depression that you should be aware of:
- Genetics. A family history of depression may increase your risk. It's thought that depression is passed genetically from generation to generation. The exact way this happens, however, is not clear.
- Death or loss. Sadness or grief from the death or loss of a loved one can trigger symptoms of major depression.
- Conflict. Personal conflicts or disputes with family members or friends may lead to depression.
- Abuse. Past physical, sexual, or emotional abuse is a major risk factor for depression.
- Major events. Even good events, such as moving or graduating, can put you at risk for becoming clinically depressed. Other events that increase your risk include changing jobs, losing a job or income, getting married or divorced, retiring.
- Serious illnesses. Sometimes depression co-exists with a major illness or is a reaction to the illness.
- Certain medications. Depression can be a side effect of a medication you take for another condition.
- Substance abuse. Nearly 30% of people with substance abuse problems also have major depression.
- Other personal problems. Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can lead to depression.
Quick Tips: Reducing Holiday Stress
The holidays can be a joyful time, offering a chance to reconnect with friends and family. But they can also be stressful. You may feel pressure to buy and give gifts. Maybe you are worried about money. The holidays can also be hectic. There never seems to be enough time to get things done.
Think about the kinds of events that trigger stress for you during the holidays. Then you can focus on one or two things you can do that will help the most to reduce stress. Here are some ideas:
Preparing for the holidays
- Know your spending limit. Lack of money is one of the biggest causes of stress during the holiday season. This year, set a budget, and don't spend more than you've planned. It's okay to tell your child that a certain toy costs too much. Don't buy gifts that you'll spend the rest of the year trying to pay off.
- Give something personal. You can show love and caring with any gift that is meaningful and personal. It doesn't have to cost a lot. Or use words instead of an expensive gift to let people know how important they are to you. Make a phone call or write a note and share your feelings.
- Get organized. Make lists or use an appointment book to keep track of tasks to do and events to attend.
- Share the tasks. You don't have to do everything yourself. Share your "to do" list with others. Spend time with friends and family while you share tasks like decorating, wrapping gifts, and preparing the holiday meal.
- Learn to say no. It's okay to say "no" to events that aren't important to you. This will give you more time to say "yes" to events that you do want to attend.
- Be realistic. Try not to put pressure on yourself to create the perfect holiday for your family. Focus instead on the traditions that make holidays special for you. And remember that just because it's a holiday, family problems don't go away. If you have a hard time being around your relatives, it's okay to set limits on your time at events and visits.
During the holidays
You may not be able to avoid stressful situations during the holidays. But you can plan to respond to them in a healthy way.
- Take breaks from group activities. Pay attention to your own needs and feelings. Spend a little time by yourself if you can. Meditate, or do some relaxation breathing. Go for a short walk.
- Keep a regular sleep, meal, and exercise schedule. Limit your alcohol. Taking care of yourself will help you deal with stressful situations during the holidays.
- Get support if you need it. Holidays can sometimes trigger depression. They can be especially hard if you are already dealing with the death of a loved one or the breakup of a relationship. You may feel embarrassed to ask for help, or you may think that you'll get over "the blues" on your own. But most people need treatment to get better. Talk with your doctor about counseling and medicine for depression.