Published May 2005

Depression: Spotting
symptoms, seeking help

By Kimberly Hilden
SCBJ Assistant Editor

Everyone experiences moments of sadness from time to time. Life events, from the death of a loved one to receiving your first high-cholesterol warning, can do that to you.

But when feelings of sadness persist and begin to interfere with daily life, it could be more than a case of the blues. It could be clinical depression, a condition that is treatable if help is sought.

“If it’s not going away after a week or so, and certainly if it is interfering with functioning ... and anytime there are thoughts of death that are concerning, (a person) should get help immediately,” said Dr. Kathryn Johnson, a licensed mental health counselor with The Everett Clinic.

Depression, an illness that can alter mood, thoughts and behavior, affects more than 19 million Americans each year, costing the U.S. economy $44 billion annually in lost workdays and decreased productivity, according to the National Mental Health Association.

Two types of depression — major depression and dysthymia — affect twice as many women as men, Johnson said.

“The most common one people talk about is major depression,” said Johnson. “And people with major depression, for women, usually have their first major depressive episode in their early 20s, though it can strike at any time.”

With major depression, there is a persistent feeling of sadness, anxiety or emptiness that lasts for at least two weeks but often can last months, according to the National Institute of Mental Health. This feeling can be accompanied by:

• A loss of interest in activities.
• Feelings of restlessness or irritability.
• Feelings of guilt, worthlessness, helplessness or hopelessness.
• Varied sleep patterns — either too much or too little.
• Appetite and weight gain or loss.
• Decreased energy.
• Thoughts of death or suicide or suicide attempts.

Those suffering from dysthymia can have the same symptoms, but milder and lasting for at least two years. They also can suffer episodes of major depression, according to NIMH.

The third type of depressive illness, bipolar disorder, is less common than the others and includes cycles of depression and mania, a state of high energy, feelings of euphoria and oftentimes irresponsibility, said mental health counselor Johnson. And while bipolar disorder affects an equal number of men as women, women with bipolar disorder tend to have more depressive episodes while men tend to have more manic episodes.

What’s behind this depression gender gap? There’s nothing conclusive, Johnson said.

“I think it’s multiple factors,” she said.

Factors such as underlying genetics coupled with reproductive events including a woman’s menstrual cycle, pregnancy and post-pregnancy that can alter mood.

Then there are social factors that may come into play, such as it being more acceptable for women to express sadness or internalize depression while men tend to act out in anger, Johnson said, adding that women also tend to be victims of abuse more often than men.

There’s also the stress factor that comes with the many roles women have in adulthood as workers, parents and caretakers of aging parents, she said.

For those who do suffer from depression, help can be had, whether it is in the form of medication, counseling or a combination of the two, said Johnson.

The two most commonly prescribed medications for depression are the selective serotonin re-uptake inhibitors and the serotonin and noradrenaline re-uptake inhibitors, she said.

It is believed that these drugs work by increasing the activity of chemicals in the brain that pass signals among brain cells, an activity that appears to be otherwise hampered by depression.

“Most primary-care doctors prescribe the (antidepressants), and people who are on any type of antidepressant should follow up with their doctor or get counseling,” Johnson said.

As for psychological treatment, cognitive behavioral therapy — changing the way a patient thinks and feels — is used most often with women suffering from depression, she said.

“The combination of treatments, both medication and therapy, has the best result,” she said, noting that treatment for depression is usually short-term, unless the person involved has a long history of recurring depression.

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