Depressive Illnesses are Serious but Treatable Disorders

• Depressive illnesses are more than temporary "blue" moods or periods of grief after a loss.
• Symptoms of depression affect thoughts, feelings, body,and behaviors.
• Without treatment, the symptoms can last for months, years, or a lifetime.

• Some depressive episodes occur suddenly for no apparent reason.
• Some are triggered by a stressful experience.
• Some people have one episode in a lifetime; others, recurrent episodes.
• Some people's symptoms are so severe they are unable to function as usual.
• Others have ongoing, chronic symptoms that do not interfere with functioning, but keep them from feeling really well.
• Some people have bipolar disorder (also called manic-depressive illness). They experience cycles of terrible "lows" and inappropriate "highs."

Depressive illnesses take a staggering toll:

• They cause great pain to millions of people.
• The lives of families and friends are affected, often seriously disrupted.
• They hurt the economy, costing an estimated $30.4 billion in 1990.

Nearly two-thirds of depressed people do not get appropriate treatment because their symptoms:

• Are not recognized.
• Are blamed on personal weakness.
• Are so disabling that people cannot reach out for help.
• Are misdiagnosed and wrongly treated.

• Persistent sad or "empty" mood
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, being "slowed down"
• Sleep disturbances (insomnia, early-morning waking, or oversleeping)
• Eating disturbances (loss of appetite and weight, or weight gain)
• Difficulty concentrating, remembering, making decisions
• Feelings of guilt, worthlessness, helplessness
• Thoughts of death or suicide; suicide attempts
• Irritability
• Excessive crying
• Chronic aches and pains that don't respond to treatment

• Excessively "high" mood
• Irritability
• Decreased need for sleep
• Increased energy and activity
• Increased talking, moving, and sexual activity
• Racing thoughts
• Disturbed ability to make decisions
• Grandiose notions
• Being easily distracted

• Decreased productivity
• Morale problems
• Lack of cooperation
• Safety problems, accidents
• Absenteeism
• Frequent complaints of being tired all the time
• Complaints of unexplained aches and pains
• Alcohol and drug abuse

A thorough diagnosis is needed if five or more of the symptoms of depression or mania persist for more than two weeks, or are interfering with work or family life. A good diagnosis involves a complete physical checkup and a review of family history of health problems.

Most People can be Helped Quickly

Depression with Other Illnesses: Depression often co-occurs with medical, psychiatric, and substance abuse disorders, though it is fequently unrecognized and untreated. This can lead to unnecessary suffering since depression is usually treatable, even when it co-occurs with other disorders.

Individuals or family members with concerns about the co-occurence of depression with another illness should discuss these issues with the physician.

With available treatment, 80 percent of the people with serious depression--even those with the most severe forms--can improve significantly. Symptoms can be relieved, usually in a matter of weeks.

• There are effective medications and psychotherapies(talk therapies) treatments that often are used in combination. In severe depression, medication is usually required.
• A number of short-term talk therapies to treat clinical depression have been developed in recent years.
• Several types of medications are available, none of them habit-forming. People with severe depression respond more rapidly and more consistently to medication. Those with recurring depression, including bipolar disorder, may need to stay on medication to prevent or lessen further episodes.
• Many patients need psychotherapy to deal with the psychological or interpersonal problems often associated with their illness.
• Other biological treatments can be helpful. For example, electroconvulsive treatment (ECT) is a safe and often effective treatment for the most severe depressions. Research is also being done on the use of light for the treatment of depression.
• Early intervention may lessen severity of symptoms and shorten the episode. Individuals respond differently to treatment. if after several weeks symptoms have not improved, the treatment plan should be re-evaluated.
• Individuals respond differently to treatments. If after several weeks symptoms have not improved, the treatment plan should be discussed with the doctor.

When diagnosed early in the course of the illness, depressed people usually can be treated on an outpatient basis and improve productivity, avoid lost work time, and reduce high costs for:

• Prolonged treatment,
• Hospitalization,
• Treatment of other physical and mental disorders resulting from untreated depression.

• Physicians
• Mental health specialists
• Employee assistance programs (EAPs)
• Health maintenance organizations
• Community mental health centers
• Hospital departments of psychiatry or outpatient psychiatric clinics
• University- or medical school-affiliated programs
• State hospital outpatient clinics
• Family service/social agencies
• Private clinics and facilities
• In addition to teatment, joining a support group may be helpful

The very nature of depressive illnesses can interfere with a person's ability or wish to get help. Depression saps energy and self-esteem and makes a person feel tired, worthless, helpless, and hopeless.

Therefore,

• Seriously depressed people need encouragement from family and friends to seek treatment to ease their pain.
• Some people need even more help, becoming so depressed, they must be taken for treatment.
• Don't ignore suicidal thoughts, words or acts. Seek professional help immediately.

NIMH Publication No. 95-3590, printed 1995