Jed Magen, associate professor and chair in the Department of Psychiatry, answers common questions about depression.
1. How common is depression?
About 4% of the population has what we call major depressive disorder, the most severe kind of depression, at any one time. Less severe depressions are probably more common. It is important to note that everyone gets a low mood at times, but most pull out of this within a couple of days.
2. What are the major symptoms of depression?
Common symptoms of more severe depressions include depressed mood (of course!), appetite changes — either increased or decreased, sleep changes — either more sleep such as taking naps after sleeping all night, or decreased sleep. Decreased motivation to do things and decreased enjoyment of things that usually are enjoyable is also very common.
Anxiety and depression seem to go together so many people notice an increase in worries and feeling like they can’t stop thinking about things that are problems. Others might notice that the depressed individual is very negative about almost everything, even things that most people would see as positives.
Of course, we worry a lot about suicidal ideation. If someone has suicidal thoughts, it is vitally important that they tell someone they trust, call a suicide hotline or their physician and get assistance. Depressions will always go away with treatment eventually and it is tragic when someone ends their life when treatment may have been lifesaving.
3. How might other aspects of your health deteriorate as a result of depression? Is this common? What do people usually struggle with? Sleep? Diet? Hygiene?
Individuals who are depressed are often not so motivated to engage in healthy activities or any activities for that matter. Taking medication becomes difficult. Similarly, because of poor motivation, they can neglect diet and hygiene. Sleep difficulties are a symptom of major depressive disorder and so people can have poor motivation and be tired — not a good combination.
As important, negativity goes along with being sad; depressed individuals tend to see the worst and assume the worst about everything. Common thoughts are, "My medication won’t help," "What’s the use of doing anything?" and so on. We see people end up in a downward spiral in which everything they do that might be helpful is discounted and everything that is negative further reinforces the negativity.
4. How can therapy and medication help with depression? What has research found about these treatment methods for depression? Are they effective?
About 70% of people treated with medications will improve and some will have total resolution of symptoms. Therapy is also very effective and has the added benefit of helping you develop better coping skills when stress becomes a problem or depression reoccurs. The combination of medication and therapy is probably even better. The therapies we know most about in terms of effectiveness are cognitive behavioral therapy, insight oriented therapy and dialectical behavioral therapy. All are good.
5. If you love someone with depression, why is it important to know if these symptoms are getting worse for them? How might that indicate how you should act? What should you do if you notice that a loved one's depression symptoms are worsening?
As noted above, the biggest risk is suicide. If you notice someone else or yourself getting worse, it is important to ask them about this and ask about whether they are thinking about ending their life. The most important thing is to be sure they are safe and get them help as stated above. Over a life time 10-15% of people with major depressive disorder commit suicide so this is a disorder that can be lethal.
6. How can you tell if someone is considering suicide and how can you intervene? What should you do if you fear this?
If you are worried, you should always ask. Asking someone if they are thinking about ending their life, as hard as that may be to do, is not going to make someone more likely to do anything. In fact, it may be lifesaving. If you believe someone is highly at risk, get help. Get them to an emergency room, your local community mental health center or call their physicians office. Don’t let them be alone.
7. How should you encourage your loved one to seek help for their depression? What are some examples of things to say or do?
Empathy is always useful. Let them know you know this is difficult. It is often a good thing to point out that they are not alone in this and that other people also struggle with the same issues. Suggesting they get help is done out of concern for them and trying to support them. If you are not the best person to talk with them, find that person or people they will listen to.