People who are depressed often experience physical symptoms, such as headaches, sleep disturbance or fatigue, and do not recognize these could be signs of depression. Depression and anxiety are often experienced together.

Depression may be experienced as:

• Feelings of sadness, emptiness, flat mood, loneliness, or depression.
• Loss of interest in or pleasure in activities, withdrawal from activities and people.
• Significant weight loss or gain.
• Significant change in sleep pattern (excessive sleep or difficulty sleeping).
• Agitation, nervousness, anxiety.
• Considerable fatigue or loss of energy.
• Feelings of guilt or worthlessness.
• Difficulty with concentration and focus.
• Thoughts of death or suicide.

There are different types of depressive disorders, including bipolar illnesses, major depressive disorders, and chronic, low-level depressive conditions.

According to the National Institute of Mental Health, an estimated 18.8 million adult Americans suffer from depression during any one-year period. Many do not even recognize that they have a condition that can be treated very effectively.

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How does depression differ from occasional sadness?

Everyone feels sad or “blue” on occasion. Most people grieve over upsetting life experiences such as a major illness, loss of a job, a death in the family, or a divorce. These feelings of grief tend to become less intense on their own as time goes on.

Depression occurs when feelings of extreme sadness or despair last for at least two weeks or longer and when they interfere with activities of daily living such as working or even eating and sleeping. Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. Some may have thoughts of death or suicide.

People who are depressed may become overwhelmed and exhausted and stop participating in certain everyday activities altogether. They may withdraw from family and friends.

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What causes depression?

For many individuals, depression signals first and foremost that certain mental and emotional aspects of life are out of balance. Changes in the body’s chemistry also influence mood and thought processes, and biological factors contribute to some cases of depression. In addition, chronic and serious illnesses such as heart disease or cancer may be accompanied by depression.

Significant transitions and major life stressors such as the death of a loved one or the loss of a job can help bring about depression. Other more subtle factors that lead to a loss of identity or self-esteem may also contribute. The causes of depression are not always immediately apparent, so the disorder requires careful evaluation and diagnosis by a trained mental health care professional.

Sometimes the circumstances involved in depression are ones over which an individual has little or no control. At other times, however, depression occurs when people are unable to see that they actually have choices and can bring about change in their lives.

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Can depression be treated successfully?

Absolutely. Depression is highly treatable when an individual receives competent care. Psychologists are primary providers of treatment for depression and have contributed much research to understanding it.

There is still some stigma, or reluctance, associated with seeking help for emotional and mental problems, including depression. Unfortunately, feelings of depression often are viewed as a sign of weakness rather than as a signal that something is out of balance. The fact is that people with depression cannot simply “snap out of it” and feel better spontaneously.

Persons with depression who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen a depression. The importance of obtaining quality professional health care cannot be overemphasized.

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How does psychotherapy help people recover from depression?

There are several approaches to psychotherapy – including cognitive-behavioural, interpersonal, psycho-dynamic and other kinds of “talk therapy” – that help depressed individuals recover. Psychotherapy offers people the opportunity to identify the factors that contribute to their depression and to deal effectively with the psychological, behavioural, interpersonal and situational causes.

Psychologists can work with depressed individuals to:

Pinpoint the life problems that contribute to their depression, and help them understand which aspects of those problems they may be able to solve or improve. A trained therapist can help depressed patients identify options for the future and set realistic goals that enable these individuals to enhance their mental and emotional well-being. Therapists also help individuals identify how they have successfully dealt with similar feelings, if they have been depressed in the past.

Identify negative or distorted thinking patterns that contribute to feelings of hopelessness and helplessness that accompany depression. For example, depressed individuals may tend to over generalize, that is, to think of circumstances in terms of “always” or “never.” They may also take events personally. A trained and competent therapist can help nurture a more positive outlook on life.

Explore other learned thoughts and behaviours that create problems and contribute to depression. For example, therapists can help depressed individuals understand and improve patterns of interacting with other people that contribute to their depression.

Help people regain a sense of control and pleasure in life. Psychotherapy helps people see choices as well as gradually incorporate enjoyable, fulfilling activities back into their lives.

Having one episode of depression greatly increases the risk of having another episode. There is some evidence that ongoing psychotherapy may lessen the chance of future episodes or reduce their intensity. Through therapy, people can learn skills to avoid unnecessary suffering from later bouts of depression.

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In what other ways do therapists help depressed individuals and their loved ones?

The support and involvement of family and friends can play a crucial role in helping someone who is depressed. Individuals in the “support system” can help by encouraging a depressed loved one to stick with treatment and to practice the coping techniques and problem-solving skills he or she is learning through psychotherapy.

Living with a depressed person can be very difficult and stressful for family members and friends. The pain of watching a loved one suffer from depression can bring about feelings of helplessness and loss. Family or marital therapy may be beneficial in bringing together all the individuals affected by depression and helping them learn effective ways to cope together. This type of psychotherapy can also provide a good opportunity for individuals who have never experienced depression themselves to learn more about it and to identify constructive ways of supporting a loved one who is suffering from depression.

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Are medications useful for treating depression?

Medications can be helpful for reducing the symptoms of depression in some people, particularly for cases of severe depression. Some health care providers treating depression may favour using a combination of psychotherapy and medications. Given the side effects, any use of medication requires close monitoring by the physician who prescribes the drugs.

Some depressed individuals may prefer psychotherapy to the use of medications. By conducting a thorough assessment, a psychologist can help make recommendations about an effective course of treatment for an individual’s depression.

Depression can seriously impair a person’s ability to function in everyday situations. But the prospects for recovery for depressed individuals who seek appropriate professional care are very good. By working with qualified and experienced therapists, those suffering from depression can help regain control of their lives.

(Information includes excerpts from The American Psychological Association Practice Directorate, which gratefully acknowledges the assistance of Daniel J. Abrahamson, Ph.D., Lynne M. Hornyak, Ph.D., and Lynn P. Rehm, Ph.D., in developing its fact sheet on depression.)