Depression: When sadness becomes a habit

clinical_psychotherapist_depressionTo be sad is a common human emotion. For most, sadness is often preceeded and followed by mostly happy moments at times within the same day or hour. There are, however, many whose sadness blanket their every waking moment. Tearfulness, regret, feeling tired, a sense of being alone, inescapable sense of helplessness and hopelessness, inability to feel pleasure in what once had been enjoyable activities, are some of the common presenting symptom of what we have come to know as depression.

Depression” is the common term for a family of mood disorders that fall within the category of “Depressive Disorders” or “unipolar depression.”  Further divided based upon the length of time of the affliction and extent/level of impairment caused by the depressive symptoms, “Depression” or Depressive Disorder includes Major Depressive Disorder, Dysthymic Disorder, and Depressive Disorder NOS (not otherwise specified).

Basic Criteria for Diagnosis of Depressive Disorder:

  • Lack/inability to sleep (insomnia) or oversleeping (hypersomnia)
  • Lack of interest, e.g., inability to enjoy activities the patient once enjoyed (anhedonia)
  • Guilt over past experience or sense of worthlessness
  • Lack of energy or feeling tired
  • Inability to concentrate
  • Lack of appetite or overeating
  • Observable agitation or retardation of psychomotor functioning (fidgety, inability to sit still or slowed or delayed reaction)
  • Suicidal or homicidal ideations

In children, depression may also appear as agitation, hyperactivity, opposition or defiance.  These symptoms often hide the underlying depression and result in children being misdiagnosed for other disorder, e.g., Anxiety Disorder, Attention Deficit Disorder with or without Hyperactivity, etc.

Major Depressive Disorder:

More common in women that in men, estimates for lifetime risk of developing Major Depressive Disorder for women range from 10% to 25% and 5% to 12% for men.  Approximately 6.7% of the American population, or 20.7 million in 2010 population, suffer from Major Depressive Disorder or MDD annually.

Those who suffer from Major Depressive Disorder are at higher risk of suicide.  According to the Diagnostic Statistical Manual IV-TR, up to 15% of people suffering from Major Depressive Disorder commit suicide annually with hundreds of thousands more who attempt suicide.  For those over the age of 55, the death rate for those suffering from Major Depressive Disorder is four times higher than in general population.

To be diagnosed with Major Depressive Disorder, the patient must have had two or more major depressive episodes (defined by DSM IV-TR as “a period of at least 2 weeks … depressed mood or the loss of interest or pleasure…”), plus four of the “Basic Criteria” above.  For most, the major depressive episodes hinder the patient’s ability to participate in social, occupational or relational activities, but in milder cases, the client may appear normal in his functioning.

Dysthymic Disorder:

The most important feature of Dysthymic Disorder is chronic depressed mood for most of the day lasting for at least 2 years for adults and 1 year for children.

If unresolved, Major Depressive Disorder will develop in 75% of Dysthymic Disorder sufferers within 5 years.

Depressive Disorder Not Otherwise Specified:

When a client presents some of the depressed symptoms as itemized above under “Basic Criteria for Diagnosis of Depressive Disorder,” but does not meet the criteria for Major Depressive Disorder or Dysthymic Disorder, the diagnosis is Depressive Disorder Not Otherwise Specified.

Intervention/Treatment for Depression:

For mild to moderate forms of depression, there are numerous studies that have shown pyschotherapy alone as effective in treating depression.  Depending upon the psychotherapist and the family’s willingness to participate, a psychotherapist may opt to treat the client individually or involve significant family members in therapy.

In severe cases, however, medication (e.g., antidepressants) in addition to psychotherapy may be necessary to the treatment of depression.  This is especially true when the client has exhibited, implicitly or explicitly, a potential to harm the client’s self or others — suicidal or homicidal thoughts.

Not treated, depression is associated with higher rates of substance abuse including illicit drugs, alcohol and tobacco, poor health, and suicide.  So, when sadness persists to the point that it envelopes the person’s every waking moment, help is only a phone call or an e-mail away.  Depression is a habit that can be broken.

Franco E. Santos, MA

Franco E. Santos is an adjunct professor of psychology and undergraduate advisor at Mount Saint Mary’s University in West Los Angeles.

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