What Are the Signs of Depression?
Not everyone who is depressed experiences every symptom. Some people experience a few symptoms, some many. The severity of symptoms varies among individuals and over time.
Depression often involves persistent sad, anxious, or empty mood; feelings of hopelessness or pessimism; and feelings of guilt, worthlessness, or helplessness. It can also involve loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex. Decreased energy, fatigue, or a sense of being "slowed down" are also common, as are restlessness, irritability, and difficulty concentrating, remembering, or making decisions. Many with depression have thoughts of death or suicide.
People with depression may experience disruptions in sleep (insomnia, early morning awakening or oversleeping) and in eating behavior (appetite changes, weight loss or gain). Persistent physical symptoms may include headaches, digestive disorders, and chronic pain.
What Causes Depression?
There is no single known cause of depression. Rather, it likely results from a combination of genetic, biologic, environmental, and psychological factors. Major negative experiences—trauma, loss of a loved one, a difficult relationship, or any stressful situation that overwhelms the ability to cope—may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger.
Depression is not an inevitable consequence of negative life events, however. Research increasingly suggests that it is only when such events set in motion excessive rumination and negative thought patterns, especially about oneself, that mood enters a downward spiral.
Research utilizing brain-imaging technologies such as magnetic resonance imaging (MRI) shows that the brains of people who have depression look different than those of people who do not. Specifically, the parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behavior appear to function abnormally. It is not clear which changes seen in the brain may be the cause of depression and which may be the effect.
Some types of depression tend to run in families, suggesting there may be some genetic vulnerability to the disorder.
How Is Depression Treated?
Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier treatment begins, the more effective it can be and the greater the likelihood that recurrence can be prevented.
Appropriate treatment for depression starts with a thorough psychological evaluation and consultation conducted by a licensed psychologist. Once a diagnosis of major depressive disorder is provided, a person with depression can be treated a number of ways. The most common treatments are medication and psychotherapy. Many studies show that cognitive behavioral psychotherapy is highly effective, alone or in combination with drug therapy.
Cognitive Behavioral Therapy, among other evidenced-based treatments for depression, addresses the unhealthy thoughts, emotions and behavioral patterns that are often associated with depression, and studies show that it prevents recurrence. Drug therapy is often helpful in relieving symptoms, such as severe anxiety, so that people can engage in meaningful psychotherapy.
What Is Anxiety?
Anxiety encompasses feelings of worry, nervousness, or dread. Although unpleasant, occasional bouts of anxiety are natural and sometimes even productive: By signaling that something isn’t quite right, anxiety can help people both avoid danger and make important and meaningful changes.
But persistent, pervasive anxiety that disrupts one’s daily life, whether at school, work, or with friends, can be the mark of an anxiety disorder. Nearly one-third of adults in the U.S. will grapple with one at some point in their lives, according to the National Institutes of Health, and the condition strikes more women than men.
Anxiety disorders manifest in different ways, and are often diagnostically distinct. Generalized anxiety disorder is a chronic state of severe worry and tension, often without provocation. Panic disorder refers to sudden and repeated panic attacks—episodes of intense fear and discomfort that peak within a few minutes. Obsessive-compulsive disorder is marked by intrusive thoughts or compulsions to carry out specific behaviors, such as hand-washing. Post-traumatic stress disorder may develop after experiencing or witnessing a traumatic event.
Anxiety is often accompanied by depression, and the two share an underlying genetic architecture.
Beyond genetics, childhood experiences such as early trauma or parental over-protection can play a role in forming an anxious disposition. In people with anxiety disorders, the brain circuitry that controls the threat response seems to go awry: The amygdala, a structure that detects danger, can become overactive, triggering a threat where none really exists.
How to Treat Anxiety
Anxiety is often treated successfully using therapy, medication or both. Cognitive behavioral therapy is one of the most effective options, in which patients learn to identify problematic thought patterns and change how they respond. Mindfulness meditation is another effective technique for some.
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