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Major Depression


Depression or depressive disorder may involve one or more of the following: feelings of melancholy, loss of energy and/or appetite, insomnia or hypersomnia and/or a loss of interest in others, sex and life generally. It may be related to specific events like a death in the family or it may be chronic and continuous with little apparent relationship to daily events. Depression negatively impacts every aspect of a person’s life including the way they feel about themselves and the way they sleep, eat and interact with others. It may be experienced for hours, days, weeks, months and years.

The most commonly occurring form of depression is dysthymia. Dysthymia can range from moderate to severe. Dysthymia is characterized by a generalized lack of enjoyment or pleasure in life including a loss of energy, appetite and sexual desire that continues for at least six months. People with dysthymia often withdrawal from all social activities.

The most severe form of depression is called “major depression”. Major depression can be totally incapacitating. Individuals with major depression withdrawal socially and may not even be able to get out of bed. Major depression is episodic. It may last days or weeks. It may occur once, or in episodes throughout a person’s lifetime.

While the causes are not clear, research has shown that major depression may be caused by imbalances of brain chemicals, specifically the neurotransmitters serotonin and norepinephrine. Other medical problems, medications and even viruses may cause or contribute to major depression. Major depression may occur at any age, from childhood to late in life. While anybody may experience major depression, research clearly shows that depression runs in families. If left untreated, it may become a chronic, debilitating illness that can be life threatening.

Approximately 9.5 million people in America experience episodes of major depression each year. According to the World Health Organization, depression will be the second largest medical burden in the world by 2020. Less than 25 percent of people with depression currently receive treatment despite the fact that 80 to 90 percent of people with depression can be effectively treated with therapy and medication. Many individuals with depression simply do not have the energy or willingness to seek help. They may also fear the stigma associated with mental illness generally. This is unfortunate, because new medications and therapies make it possible for individuals with major and moderate depression to live near normal lives.


Major depression is experienced in the body as well as in the mind. Typical symptoms of major depression last for more than two weeks and include deep feelings of melancholy that are not changed by good news or the comfort of others. A person suffering from depression may express feelings of uselessness, hopelessness, profound sadness, or despair. They may experience chronic headaches, fatigue, or digestive problems that do not respond to treatment. An individual that is deep in depression may not shower, change their clothes, or get out of bed. They may be irritable, angry, or unable to concentrate. People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years.

Many complaints seem more physical than mood-related. A person with depression might say that it is stress that causes their fatigue, sleeplessness, or changes in appetite. Men often mask their symptoms of depression with anger or by pouring their energy into work. Women seem especially vulnerable to depression following changes in body chemistry, particularly after the birth of a child. Depression among the elderly is often diagnosed incorrectly, since these people tend to lose energy and slow down in their activities as a direct response to aging. Children suffering from depression may cling to a parent, or pretend to be sick, become isolated, and/or refuse to go to school. They may worry that a parent will die or abandon them. It is common for a person with major depression to have suicidal thoughts, though they may not express them.

According to the National Institute of Mental Health (NIMH), half of those who experience clinical or major depression will experience it two or more times. About a quarter of those that experience major depression will suffer from it chronically throughout their life. Episodes of depression can become more frequent and occur with increasing severity without treatment.

Causes, Genetic Factors and Cultural Influences

Major depressive disorder is often associated with changes in brain structure or brain chemistry. Research shows that children of parents with depression are at greater risk of experiencing depression themselves.

Cultural and environmental factors may also play a role in major depression. Recent Center for Disease Control statistics shows that Asian American women have the highest suicide rate in the 15 to 24 and over-65 age groups. They also found that Asian American adolescent girls have the highest symptoms of depression. Asians are also more likely to explain symptoms of depression in terms of physical problems.

There is also evidence the Hispanic Americans born in the United States experience greater depression and attempt suicide more often than Non-Hispanics. In studies conducted among adults of Asian and Mexican origin, feelings of racial discrimination were found to have a strong correlation to symptoms of depression.


Alcohol and drug abuse, eating disorders, and anxiety disorders often coexist with major depression. A person who abuses alcohol and/or drugs to treat their depression may also become addicted to them. If this occurs, they may receive a “dual diagnosis” of depression and addiction. Depressed individuals often use or abuse alcohol and drugs to cope with the illness. Such use may actually intensify the symptoms and depth of the illness.

Sometimes, people under successful treatment for depression are uncomfortable with the side effects of the medication. These can include dry mouth, nausea, reduced sexual drive, tremors, anxiety, and weight gain. If the effects are severe enough, the person may decide to stop taking their medication, increasing their risk of returning to deep depression. They also may run the risk of experiencing severe physical symptoms if they abruptly discontinue their medication without a physician’s support.

Suicide is an extremely serious possibility in major depression. Surprisingly, the risk escalates when the depressed person begins to feel a little better and gains enough energy to commit suicide. Do not hesitate to contact 911 emergency services in a crisis.


The treatment for major depression typically involves a combination of medications and therapy. While not 100 percent effective, such treatment can help individuals with depression lead effective and functional lives. The first step in treatment is getting a physical evaluation to rule out a medication reaction or other illnesses as a cause of the symptoms. The evaluation should include a comprehensive family history along with an assessment of alcohol and drug use. Some people with mild depression are helped with therapy alone. Individuals with major and moderate levels of depression may be prescribed combined treatments of medication and therapy for the most-effective relief.

There are four main types of medications commonly used to treat major depression. One group of drugs is called heterocyclics or tricyclics imipramine (Tofranil®), protriptyline (Vivactil®), clomipramine (Anafranil®), amoxapine (Asendin®), nortriptyline (Aventyl®), and desipramine (Norpramin®). More recent medications belong to the family of selective serotonin reuptake inhibitors fluoxetine (Prozac®), sertraline (Zoloft®), nefazodone (Serzone®), and paroxetine (Paxil®). Physicians may also prescribe MAO inhibitors phenelzine (Nardil®), tranylcypromine (Parnate®). The final medication is lithium (Lithonate®, Eskalith®, Lithobid®, or Lithotabs®), more typically used for bipolar disorder.

The interaction of these medications with individual body chemistry is not totally predictable. As a result, it may take several prescriptions over a period of weeks or months to identify the most appropriate drug treatment for an individual. The type and intensity of side effects may also vary by individual. Typical side effects including dizziness, insomnia, dry mouth, constipation, reduced sexual drive and performance, and weight gain may occur. Be sure to report unanticipated side effects to your doctor

In some cases electroconvulsive therapy (ECT) is used with individuals with life-threatening depression or who cannot take antidepressant medication. There may be more than one ECT procedure, conducted under mild anesthesia. It has proven to be an effective and safe procedure in these difficult situations.

There are short and long-term modes of therapy that are effective in treating depression. For some people, a short-term (10 to 20 week) course of therapy works best. Doctors can help a person identify problems and solutions and create new behaviors. This process can help the person change negative perceptions that contribute to depression. Other people with depression may undertake long-term talk therapy to resolve deep, historical issues. Physicians may also recommend changes in lifestyle, diet and exercise.

How You Can Help

If you think a friend or family member needs help, the National Institute of Mental Health (NIMH) recommends that you encourage the individual to get an evaluation from a mental health professional. Family members and friends can help an individual recognize that they have an illness that can be treated if they are willing. It is important to understand that diagnosing serious mental illness is not simple or straightforward. Your doctor may need to revise the initial diagnosis, treatment and drug therapies one or more times over a period of weeks or months to find the best treatment regimen.

Sometimes, family members and friends need to intervene if a loved one with serious mental illness refuses to obtain treatment. This can be a very difficult situation for both the individual with the illness and the family members and friends. It is important to obtain assistance from a mental health professional to guide you through the medical and legal issues involved in an intervention.

Family members and friends of a person with serious mental illness can help by offering their support and affection to the extent possible. It is important to understand that people with serious mental illness cannot simply “pull themselves together” and get better. The support of family members and friends over the long term can be invaluable to an individual with a serious mental illness. Support groups can also be invaluable. Consumer groups offer individuals with mental illness an opportunity to share their needs, concerns and struggles with others in the same situation. Consumer support groups are available in many communities.

Family members and friends need to become educated about serious mental illness. They also need to take care of their own emotional needs. Support groups can also help family members and friends cope with their loved one’s illness. Family support groups provide a place for family members to share their experiences and obtain current information and education about their loved one’s mental illness.

NAMI California maintains a list of NAMI affiliates in your community that offer resources and support to individuals and families needing help with serious mental illness. The list includes information, contact persons, crisis numbers, telephone listings, and email contacts.

Family physicians, mental health professionals, religious counselors, community mental health centers, social service agencies, state and private hospitals are also available to provide help and support as needed. NAMI California maintains a current list mental health professionals (psychiatrists, psychologists, care homes, etc.) that provide support for serious mental illness in your community.

NAMI California also offers the “Family-to-Family” program to educate and support families who have members afflicted with a serious mental illness.

Finally, and most importantly, do not hesitate to get help from your local 911 emergency service or suicide hotline in a crisis.

For additional information, visit these web sites:

National Alliance for Research on Schizophrenia and Depression

Depression and Bipolar Support Alliance



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