Tired,

Sad,

Angry,

Irritable,

Hopeless?

Are you feeling...

“I feel tired and achy all the time. I can’t concentrateand my body just doesn’t feel right.”

Ray B.❦

“I don’t want to get out of bed in the morning and Idon’t feel like eating. Nothing interests me anymore,not even spending time with my grandchildren.”

Mary P.

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“I feel so angry and irritable. Little things set me off.I snap at people at work and yell at my wife and kidsat home.”

Henry S.

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“My husband died over a year ago but I still feel terrible. I just can’t seem to move on with my life.”

Susan O.

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“I can’t live with this despair and emptiness anymore.I feel so helpless and hopeless. I feel like dying, just toget away from the pain.”

Christine B.

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o any of these feelings sound familiarto you? At least one out of every five people visiting a doctor complains of theseor similar feelings. Sometimes, for no reason they know of, people feel anxious,irritable, or sad.

Emotional distress and upheaval cansometimes be brought on by stressful lifeevents such as the loss of a loved one,problems on the job or at home, medicalillnesses, or a problem with a relationship.

Even positive life events, such as ajob promotion, the birth of a child, or getting married, can cause distress andmood changes. These feelings may go awayby themselves within a couple of weeks ormonths, and may not have much effect on aperson's life. But, if these feelings don't goaway, they may be a sign of an illness calledclinical depression.

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hat is Clinical Depression?

Clinical depression is a medical conditionthat affects a person's mood, thoughts, behavior,and body. It changes the way a person feels,thinks, and acts. Things that used to be easy orenjoyable, such as spending time with family orfriends, reading a good book, or going to themovies, take more effort. Even basic things likeeating, sleeping, and sexual activity can become aproblem.

Clinical depression is more than just a caseof bad nerves, the blues, or the blahs. From timeto time, and throughout our daily lives, we all feel alittle sad, blue, or edgy. Usually, we soon beginfeeling better, perhaps after hearing some goodnews or visiting with a friend. But, with clinicaldepression, unhappy or anxious feelings andthoughts don't go away. They are present almostall of the time. If not treated, depression can seriously affect your work, your personal life, andthe lives of your family and friends.

Whether you have a temporary moodchange or clinical depression, your doctor understands the connection between your physical,emotional, and mental health. Your doctor canhelp you sort out your feelings and take the nextstep towards getting better.

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hat are the Symptoms?

There are many symptoms associated withdepression. Depression affects different people indifferent ways. For example, when you’re depressedyou may sleep and eat more than usual, whilesomeone else with depression may have troublefalling asleep and not feel like eating.

Key Symptoms or Problems:

___ Feeling sad or "empty"___ Loss of interest in things that used to be

enjoyable like sex, sports, reading, or listening to music

___ Trouble concentrating, thinking, remembering,or making decisions

___ Trouble sleeping or sleeping too much___ Loss of energy or feeling tired ___ Loss of appetite or eating too much___ Losing weight or gaining weight unexpectedly___ Frequent crying___ Feeling irritable or edgy___ Feeling worthless or guilty___ Feeling hopeless or negative___ Thinking of death or suicide___ Frequent headaches, body aches, and pains ___ Digestive problems, such as bowel irregularities

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evels of Clinical Depression

Clinical depression may be mild, moderate,or severe. Some people may experience symptomsvery intensely for a few weeks or months, whileothers may have less severe symptoms that can lastmany months or years. People with severedepression may have difficulty getting out of bedand caring for themselves, and may have frequentthoughts about death, or even a wish to die.Effective treatment helps people get their energyand hopefulness back.

hat Causes Depression?

Scientists have studied depression for manyyears and have concluded that many factors areinvolved. These factors fall into several categories:biochemical, hereditary, physical, medical, and psychosocial.

Biochemical: Researchers have discovered thatwhen people are depressed, their brain chemistrychanges. During the depression, certain "brainhormones," called neurotransmitters, are not presentin the brain in the right amounts. This chemicalimbalance causes both physical and emotional changes.

Hereditary: Researchers have also discoveredthat clinical depression tends to run in families.So, if you have a relative who has suffered from depression, you may also experience depression.Remember, not everyone who has a close relative with depression gets clinically depressed. If youhave some questions about this, talk with your doctor.

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Physical: Natural changes in the body, as well asseasonal changes and lifestyle habits, can causesymptoms of depression in some people. Forexample, some women experience depression associated with their menstrual cycle, the recentbirth of a child, or menopause. Some people aresensitive to the changing seasons, and becomedepressed as winter nears. Alcohol and some drugsare “depressants,” and when used too much, cancause symptoms of clinical depression.

Medical: Certain physical illnesses such as thyroid problems, stroke, some cancers, or a braintumor can cause depression. Some prescriptionmedications such as steroids, oral contraceptives,and certain blood pressure medications can alsocause depression. If you think your symptoms ofdepression are caused by your medical condition ormedications, consult your doctor.

Psychosocial: Stressful experiences and losses areamong the reasons that some people becomedepressed. These can include the loss of a lovedone, a separation or divorce, job stress or loss,financial difficulties, loneliness or isolation, movingto another place, or having a child leave home.Losses due to accident or illness (such as becomingunable to see, walk, or drive) or undergoing achange in how you look, sometimes lead people tobecome depressed. Feeling like you are not livingup to expectations set by yourself, your family, or asocial group can also cause stress that may lead toclinical depression. A history of physical, verbal, orsexual abuse or any severe trauma may make aperson more likely to develop clinical depression.

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on't Blame Yourself!

Depression is not a personal weakness, apersonality flaw, or laziness. Don't blame your-self for becoming depressed or experiencing anyof the symptoms of depression. Your symptomsare part of a medical illness. While you can'tcontrol whether you become depressed, you canseek treatment for it.

ow Long Does It Last?

Although some people recover naturallyfrom clinical depression, many suffer with depression for weeks, months, or even years.Clinical depression can be acute, lasting for several weeks or months, or chronic, lasting forseveral years. How long depression lasts dependson the severity of symptoms, whether and whensomeone seeks treatment, and personal factors.Research shows that appropriate treatment candramatically speed recovery from depression.People who are treated are also less likely tobecome depressed again in the future.

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etting Help

Sometimes, the idea of needing to get helpfor depression is hard to think about, especially ifyou are feeling hopeless. The idea of gettingprofessional help for depression may seem embarrassing to you. Some people think that taking alcohol, street drugs, or tranquilizers willmake them feel better. In fact, these substancesmake depression worse.

There can be other barriers to getting thehelp you need. For example, your family andfriends may believe that you should be able to "getyourself together" and "snap out of it." Clinicaldepression is a medical illness, and like othermedical illnesses, it is not fully within your control.Getting the right treatment is the key to recovery.

The first step in getting the right help fordepression is talking to your doctor. Make sure totalk about any symptoms you are experiencing(especially the ones described in this booklet).Your doctor will help determine if you suffer fromclinical depression, and help you choose the kind oftreatment that is best for you. Taking this important first step will guide you onto the roadto recovery.

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hat Can Be Done?

Clinical depression can be treated severalways: with psychotherapy, antidepressant medications, or a combination of the two. Bothpsychotherapy and antidepressant medication helpreturn physical and emotional functioning to normal.The type of treatment recommended depends onthe type of symptoms, the severity of symptoms,and your personal preferences. Together, you andyour doctor can choose the treatment best suited toyour symptoms and lifestyle. The process of feelingbetter usually begins after only a few weeks oftreatment. Although full recovery from symptomsof clinical depression may take a few months oftreatment, you can take heart from the fact that fullrecovery is the usual outcome of treatment.

PsychotherapyPsychotherapy is one method used to treat

clinical depression. Used by itself, withoutmedications, psychotherapy is most helpful withmild or moderate depression. In combination withmedications, psychotherapy can also be used tohelp recovery from severe depression. If you andyour doctor choose psychotherapy, you will bereferred to a trained psychotherapist who will workwith you to find ways to understand your problemsand develop techniques to work through them. Inpsychotherapy, you learn how to change behaviorsthat make your depression worse, learn how to

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change negative thoughts and beliefs, and learnhow to develop a more positive outlook. You alsolearn how to improve your relationships andincorporate more positive activities into your dailylife.

Psychotherapy may begin working rightaway, or it may take a few weeks to show beneficialeffects. There are no physical side effects associatedwith psychotherapy.

Antidepressant Medications

Antidepressant medications are also used totreat clinical depression. These medications areespecially necessary for treating severe depression,but can be helpful in treating mild and moderatedepression as well. These medications help to balance the chemicals in your brain. They improvesleep, raise your energy level, and return yourappetite to normal. It may take you a few weeks tofeel better on these medications. Your symptoms,medical history, and family history provide importantclues about which specific antidepressant medicineis the most appropriate for you. Your doctor willwork with you on selecting the medication that ismost beneficial and makes you the most comfortable.Antidepressant medications are not addictive.These medications may, however, have some physical side effects. Your body will usually adjustto antidepressant medication within a week or two.If not, your doctor will change your medication toreduce any side effects you experience.

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hy Get Help?

Treatment can help free you from the sadness, despair, and isolation caused byclinical depression. No matter how bad thefeelings and thoughts associated withdepression are, there is hope. Clinicaldepression is a treatable medical illness.Treatment can help you to feel better, andhelp return you to a happier, more fulfillinglife.

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NOTES

NOTES

RAND1700 Main Street, P. O. Box 2138

Santa Monica, CA 90407-2138© Copyright 1996 RAND

“Overcoming my depression has been the greatest challenge of my life. I’m still recovering, but I continue to get stronger, and it is this strength that hasbeen my reward.”

David L.❦

“My treatment has helped me to think out a lot ofthings before reacting, especially when it comes toanger, and to understand that depression is a realproblem and that I’m not making it up.”

Liz R.

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“Before, I was just barely clinging to life. Themedication and the therapy have kept me alive.”

Laura B.

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“Some days, I couldn’t get out of bed. I didn’t knowwhy I felt that way. Now, thanks to my doctor, I getup and walk every day, I’m active in my church andneighborhood, and plan to stay that way.”

Anita P.

❦

“In the depth of winter, I finally learned that within me there lay an invincible summer.”

Albert Camus

© Copyright 1996 RANDMR-1198/11-AHRQ