Understanding and healing from depression

There are many types of depression, and many treatments that can help.

Rachel is feeling hopeless, has the urge to stay in bed most days, and can’t find the bright side in much of anything. She may be experiencing the common but miserable curse of depression. Millions of people in the world struggle with the same condition.

Depression is often described as a sadness, but is much more than that. Sadness is a temporary feeling of pain that might follow a loss, breakup, or disappointment. Depression, on the other hand, continues over time, and is often combined with feelings of hopelessness and lethargy.

Fortunately, there are many ways to manage and often alleviate symptoms of depression. Understanding what depression is, what causes it, the many types, and how to treat them can help you begin the road to recovery.

Causes of Depression

While some people are more prone to depression, others seem less inclined to get it. Why is this? There are many possible causes of depression. Here’s a look at the most common causes and how they can impact this area of mental health.

  • Biology. Certain illnesses, hormonal imbalances, or genetics can relate to depression. Women are more likely to suffer from depression. The exact cause is unknown, but may at least partially relate to biological and hormonal differences in women.

A history of depression in the family also may make someone more prone to depression. Additionally, certain types of depression, such as low moods experienced with bipolar disorder, are caused by biochemical imbalances.

  • Medications. A wide variety of medications might affect mood and cause or worsen depression symptoms. Sometimes the medications cause temporary relief, but can lead to rebound effects. Common examples include benzodiazepines, opiates, hormonal medications, and antibiotics.
  • Diet and exercise. Some people are more sensitive to certain diets that might contribute to depression. Generally, lower-carb and higher vegetable diets are more helpful for mood management. Increased exercise is also shown to alleviate depression symptoms.
  • Past or current abuse. Growing up with physical or emotional abuse can make someone more prone to experience depression as an adult. Current abuse, such as an emotionally abusive partner, can also cause low self-esteem and self-doubt, which relates to depression.
  • Unresolved trauma. In addition to abuse, any type of trauma history can make one more prone to depression. Many people who experience post-traumatic stress disorder (PTSD), for example, are also diagnosed with depression.
  • Life events. Most people experience multiple stressful life events. These might include a major illness, loss of a loved one, divorce, or job loss. While some adjustment and temporary low mood is normal following this, these events might also kick off loger episodes of depression.
  • Substance or alcohol problems. Abuse or addiction to substances or alcohol can significantly affect mood, and worsen or cause depression symptoms. While substances may provide short-term relief, they are likely to cause long-term complications.
  • Relationship difficulties. Many people experience difficult relationship issues with a spouse, family member, or their children. These issues can trigger and worsen depression symptoms. Others feel isolated, or isolate with depression symptoms. This can also complicate symptoms.
  • Chronic stress. While everyone experiences stress, many have chronic issues to worry about, such as healthcare, covering basic bills, or taking care of family members. This ongoing stress can affect chemicals in the brain and can cause or worsen depression symptoms.
  • Negative thinking patterns. All humans are prone to be concerned about or prepare for bad things to happen. However, some people develop a habit of constantly looking for negative things in any situation. Or, they may constantly berate and criticize themselves. In other cases, the depression itself causes such negative thinking patterns, creating an ongoing cycle.

Types of Depression

The most common type of depression is called major depressive disorder, or MDD. However, several other conditions are similar to or overlap with MDD. Here’s a look at the types of depression people are most likely to experience.

Major Depressive Disorder (MDD)

MDD is the best-known type of depression. Almost 7% of adults in the U.S. alone suffer from major depression in a given year. Common symptoms include:

  • Feeling down, depressed, empty and/or hopeless most of the day
  • Loss of interest in things you used to enjoy or care about
  • Overeating, or not eating enough, and/or unexpected weight loss or gain
  • Low energy most days, and/or moving more slowly than usual
  • Issues with sleeping too much or having insomnia
  • Problems concentrating
  • Thoughts of suicide, or not wanting to be alive

Major depression may include one lifetime episode, or there may be repeated episodes. It affects all genders and ethnicity, but is more common in women, teens, and senior citizens.

Persistent Depressive Disorder (PDD)

Persistent depressive disorder is also referred to as dysthymic disorder. This condition is much like MDD, however it persists for at least two years. Symptoms are not quite as severe as with major depression, but last longer.

Symptoms, like MDD, may include the following:

  • Feelings of hopelessness
  • Low energy
  • Negative thought patterns
  • Little interest in activities
  • Avoiding social settings
  • Problems sleeping, or sleeping too much

While MDD and PDD are the most similar presentations of depression, they are not alone in this category.

Bipolar I and Bipolar II

Bipolar disorder, sometimes still referred to as manic depressive disorder, affects roughly 3% of the population. It includes episodes of depression, as well as episodes of extremely high energy called mania, or a less severe form of this called hypomania.

Symptoms of bipolar disorder include a combination of the following:

  • Episodes of depression that are present between episodes of mania, or may follow periods of no symptoms
  • Manic episodes of increased energy, and feelings of high irritability or euphoria (present in Bipolar I, but not Bipolar II)
  • Less severe energetic episodes called hypomania (present Bipolar II and sometimes Bipolar I)
  • Changes in personality often noticed by friends and family members which might include increased shopping, reckless behavior, sudden travel, gambling, excessive cleaning, etc.
  • Possible episodes of psychosis during mania episodes (hearing voices, having delusions, paranoia, disorganized thinking and speech)

Unlike major depression, which can often alleviate entirely, bipolar disorder is a chronic medical condition. However, many people are able to manage it effectively with medication.

Seasonal Affective Disorder (SAD)

Many people are familiar with seasonal affective disorder (SAD), now referred to as MDD with a seasonal pattern. Most people experience this condition in winter months. Common symptoms of seasonal depression include:

  • Onset of symptoms during certain seasons, such as winter (but it can also occur in other seasons)
  • Lack of interest in activities
  • Feeling down or sad
  • Trouble experiencing positive feelings
  • Concentration issues
  • Feelings of hopelessness
  • Isolating or avoiding activities

The specific cause of seasonal depression is unknown, but most people believe it relates to less access to sunlight. It’s also possible that the social changes in winter months, such as spending more time inside or alone, may be a factor in this condition.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder, or PMDD, is a more severe form of premenstrual syndrome (PMS). However, with PMDD symptoms can become more extreme. It may lead to severe mood swings, anxiety and even suicidal thoughts. Common symptoms include:

  • Sadness
  • Hopelessness
  • Suicidal thoughts
  • Sudden mood swings
  • High anxiety and/or panic attacks
  • Alleviation of symptoms after period starts

Some researchers hypothesize, and have found some evidence, that an imbalance of estrogen and progesterone may relate to PMDD.

Postpartum Depression

Another type of depression can occur after a woman gives birth. Women often experience hormonal adjustments in the first couple of weeks after the birth, often called baby blues. It’s common for women to cry, to feel sad, irritable and overwhelmed, and have mood swings.

However, postpartum depression is more severe than this, and lasts longer. It has symptoms consistent with MDD, such as hopelessness, feeling down, and loss of interest in usual activities. However, there are also other symptoms specific to postpartum depression. These include:

  • Bonding difficulties with the baby
  • Withdraw and isolation
  • Feeling inadequacy and self-doubt
  • Extreme anxiety
  • Thoughts of harming the baby
  • Thoughts of suicide

Some women also experience what’s called postpartum psychosis. This includes more dangerous symptoms such as paranoia, hallucinations, plans or acts to harm the baby, confusion, and obsessive thoughts.

Depression Caused by Post-Traumatic Stress

One category of symptoms that occur with post-traumatic stress disorder (PTSD) involves depression symptoms. Unlike with major depression, negative feelings and thoughts are more specific to complications from the trauma. Common symptoms of this type of depression includes:

  • Shame and guilt about the trauma
  • Believing the world is a horrible place
  • Difficulty trusting people
  • Self-blame for what happened

This is not its own condition, but rather occurs as part of PTSD. However, many people with PTSD are also diagnosed with MDD, so symptoms of each condition can overlap or complicate each other.

Self Help For Depression

If you believe you’re experiencing a type of depression, it’s important to get professional help. If you’re having current suicidal or self-harm thoughts, you should contact your doctor immediately, call emergency services, or contact the Suicide Prevention Lifeline.

If you’re not in immediate danger, you can begin with self-help strategies while you wait to get in with a health provider. Here are some methods that may help you alleviate or manage symptoms.

  • Try exercise. Multiple studies show that adding or increasing aerobic exercise can help alleviate depression symptoms, and can work as well as an antidepressant. If you are struggling with being active, start with small steps each day, such as going for a five-minute walk and building up.
  • Make yourself socialize. In many cases, someone who is feeling depressed cringes at the thought of socializing. However, the isolation that often comes with depression tends to make it worse. If you can contact old friends, plan a visit, or attend an activity (even online) it can make a difference.
  • Add mindfulness activities. Activities such as yoga, meditation, or Tai chi can help manage stress and provide your brain an opportunity to work through difficult thoughts.
  • Journal. In some cases, journaling has been shown to be comparable to therapy for depression. Writing about positive things from the day and good experiences can be particularly helpful.
  • Pick up a hobby. Because a common symptom of depression is lack of interest in activities, it can be very difficult to start a new activity. However, if you can simply go through the steps and do it anyway, a new (or old) activity can help. Hobbies such as playing music, creating art, or playing games can all help you begin to crawl out of the claws of depression.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is the most common type of therapy recommended for nearly all types of depression. Even for types of depression with a primarily biological cause, like PMDD or bipolar disorder, therapy can be helpful. In CBT, you learn to notice your patterns of thinking and begin to reframe your thoughts.

Since negative thoughts can both cause and be caused by depression, this is often a helpful step. Depression often includes self-criticism and feelings of doubt and shame. CBT can help you heal and challenge these patterns of thinking.

Acceptance and Commitment Therapy (ACT)

A lesser-known therapy used with depression is acceptance and commitment therapy (ACT). In ACT, rather than challenging thoughts, you begin to notice and release them. In this way you “go with the flow.” This therapy also helps you identify your values and make choices that align with the things that are important to you.

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) is most commonly used with borderline personality disorder. It has expanded to be used with many conditions, for adolescents and adults, and can be helpful for depression. In DBT, you practice mindfulness, and learn specific skills to deal with mood issues, self-harm urges, social challenges, and more. The therapy generally includes both individual therapy and group education and therapy.

Trauma-Focused Therapies

If your depression is caused by trauma and/or PTSD, then addressing the past trauma can help alleviate symptoms. Examples of trauma-focused therapies include the following:

  • Eye movement and desensitization and reprocessing (EMDR)
  • Cognitive processing therapy (CPT)
  • Prolonged exposure therapy (PE)

These therapies help you process past trauma and heal negative thoughts about yourself. As other symptoms of PTSD get better, depression often does as well.

Medication Assessment and Therapy

Many people participate in therapy while also taking an antidepressant medication. The use of each treatment can help make the other more effective. For certain types of depression, like bipolar disorder or PMDD, medications may be the key to feeling better. You can discuss options with both your therapist and doctor to determine if medication is appropriate for your needs.

If your depression is a side effect of therapy or another health condition, a doctor can help you sort out the problem. You and your doctor might discuss changing medications, trying alternative treatment options, or taking another medication to counter side effects.

Moving Forward The many types of depression remind us that millions of people are affected by this difficult condition. It’s helpful to understand the different types of depression, so you can accurately address the cause and begin to feel better. Self-help and therapy can make a big difference. While no one feels great all of the time, everyone deserves to be happy and live life to the fullest.

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