What is Major Depression?

Just like a rash or heart disease, depression can take many forms. Definitions of depression and the therapies designed to ease this disease's grip continue to evolve. These shifts will continue to percolate through the field as more research flows in.

This special report addresses three main categories of depression:

• major depression
• dysthymia (a lasting, low-level depression)
• bipolar disorder, previously called manic-depressive illness.

These terms don't begin to describe the tremendous variation in people's experiences of depression. Still, while the labels sometimes seem overly simple, they do help clinicians and researchers study depression and exchange information about its various forms. The categories have many overlapping characteristics, but each has its own distinguishing features.

What is major depression?

Major depression may make you feel as though work, school, relationships, and other aspects of your life have been derailed or put on hold indefinitely. You feel constantly sad or burdened, or you lose interest in all activities, even those you previously enjoyed. This holds true nearly all day, on most days, and lasts at least two weeks. During this time, you also experience at least four of the following signs of depression:

• a change in appetite that sometimes leads to weight loss or gain
• insomnia or (less often) oversleeping
• a slowdown in talking and performing tasks or, conversely, restlessness and an inability to sit still
• loss of energy or feeling tired much of the time
• problems concentrating or making decisions
• feelings of worthlessness or excessive, inappropriate guilt
• thoughts of death or suicide, or suicide plans or attempts.

Other signs can include a loss of sexual desire, pessimistic or hopeless feelings, and physical symptoms such as headaches, unexplained aches and pains, or digestive problems. Depression and anxiety often occur simultaneously, so you may also feel worried or distressed more often than you used to.

Although these symptoms are hallmarks of depression, if you talk to any two depressed people about their experiences, you might well think they were describing entirely different illnesses. For example, one might not be able to summon the energy to leave the house, while the other might feel agitated and restless. One might feel deeply sad and break into tears easily. The other might snap irritably at the least provocation. One might pick at food, while the other might munch constantly. On a subtler level, two people might both report feeling sad, but the quality of their moods could differ substantially in depth and darkness. Also, symptoms may gather over a period of days, weeks, or months.

Despite such wide variations, depression does have certain common patterns. For example, women are almost twice as likely as men to suffer from depression. And while major depression may start at any time in life, the initial episode occurs, on average, during the mid-20s.

Depression or hopelessness may feel so paralyzing that you find it hard to seek help. Even worse, you may believe that treatment could never overcome the juggernaut bearing down.

Yet nothing could be further from the truth. The vast majority of people who receive proper treatment rebound emotionally within two to six weeks and then take pleasure in life once again. When major depression goes untreated, though, suffering can last for months.

Furthermore, episodes of depression frequently recur. About half of those who sink into an episode of major depression will have at least one more episode later in life. Some researchers think that diagnosing depression early and treating it successfully can help forestall such recurrences. They suspect that the more episodes of depression you've had, the more likely you are to have future episodes, because depression may cause enduring changes in brain circuits and chemicals that affect mood (see "The problem of recurrence"). In addition, people who suffer from recurrent major depression have a higher risk of developing bipolar disorder than people who experience a single episode.

Mild, moderate, or severe depression?

Experts judge the severity of depression by assessing the number of symptoms and the degree to which they impair your life.

Mild: You have some symptoms and find it takes more effort than usual to accomplish what you need to do.

Moderate: You have many symptoms and find they often keep you from accomplishing what you need to do.

Severe: You have nearly all the symptoms and find they almost always keep you from accomplishing daily tasks.

Source: from Harvard Health Publications, Copyright © 2008 Harvard University. All rights reserved. Harvard Medical School does not endorse products.
Used with permission of StayWell.
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