Types of Depression

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. Three of the most common types of depressive disorders are discussed here. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Adult Depression Linked To TV Time As A Teen

A recent study revealed that teens who spend most of their time watching tv have a higher risk of having depression when they grow up.

The more than 4,100 adolescents in the study were first asked in 1995 about the number of hours they had spent the previous week watching television or videocassettes, playing computer games, or listening to the radio. They reported an average daily exposure of about 5.7 hours, including 2.3 hours of television viewing.

Seven years later, at an average age of almost 22, 308 (7.4 percent) of the young people had developed symptoms consistent with depression. The incidence of those symptoms was directly related with the number of hours of exposure to television and other electronic media reported at the start of the study, the researchers noted.

However, "while we were able to control for a lot of variables such as socioeconomic status and education, in the final analysis we cannot be sure it was cause-and-effect," researchers said.

It's possible to speculate about why watching television might lead to depression, they said. "One theory is that you see a lot of depressing events on television and are likely to internalize them," researchers said. "Television emphasizes bad news, and repeated exposure to it might be internalized."

Depression and Anxiety Hinders the Quality of Life After Stroke

Many people who survive a subarachnoid hemorrhage stroke have a poor quality of life due to anxiety, depression and fatigue, Dutch researchers report.

A subarachnoid hemorrhage (SAH) stroke occurs when a blood vessel on the brain surface ruptures and bleeds into the space between the skull and the brain, but not into the brain. This study included 141 women and men, average age 51, living in the community two to four years after an SAH stroke.

Using the Stroke Specific Quality of Life scale, the researchers found that 32 percent of the survivors reported anxiety, 23 percent reported depression, and 67 percent reported fatigue. Overall, the best scores were in physical function, while the lowest scores were in emotional and social areas.

"The major point is to look beyond physical symptoms and look at psychological symptoms and personality characteristics to evaluate quality of life. These characteristics are important to planning rehabilitation and targeting an intervention to help improve quality of life," study author Dr. Anne Visser-Meily, a rehabilitation specialist at the University Medical Center in Utrecht, said in an American Heart Association news release.

"When you analyze depression, anxiety and fatigue [in SAH survivors], you find there is a strong correlation with a passive coping style and neuroticism. Those with a passive coping style need psychological support to encourage them to be more independent," Visser-Meily said.

She and her colleagues also found that cognitive function is another important determinant of quality of life associated with coping style. Survivors were more likely to have neuropsychological problems if they had a passive coping style and were depressed.

"This emphasizes the need to take personality into account as a potential vulnerability factor for decreased QOL [quality of life]," Visser-Meily said.

A separate study also led by Visser-Meily found that coping is the most important predictor of psychological well-being of spouses of stroke survivors. The study, which included 211 stroke survivors and their spouses (average age 54), found that active coping strategies were associated with less stress and higher levels of participation, while a passive coping style was associated with negative outcomes.

While caregiver burden decreased significantly over time, 43 percent of spouses still scored above the cut-off point for burden three years after their partner's stroke. The study also found that the number of spouses with depressive symptoms decreased from 68 percent at the start of rehab to 53 percent at two months after rehab. But there was no further decrease in depressive symptoms, and there was a steady decline in relationship harmony and social relations.

"These findings highlight the need to monitor the long-term psychosocial functioning of the spouses of stroke patients as part of a family-centered approach," Visser-Meily said. "It is a very difficult job to be a caregiver. You not only have to manage the care of the stroke patient, you also have to take care of yourself. Not only burden, but also depressive mood, harmony in the relationship, and social relations need more attention in clinical practice."

Persistent Insomnia in Teens may Lead to Depression

Persistent bouts of insomnia in young adults can increase their risk of developing depression, says a new report.

A long-term study of almost 600 young adults found that those with annual one-month periods of insomnia found the incidents of sleeplessness gradually increased over two decades, especially among women. In 40 percent of subjects, insomnia developed into more chronic forms over time,.

Insomnia lasting two weeks or longer predicted major depressive episodes and disorders, according to the report. Seventeen percent to 50 percent of subjects with insomnia lasting two weeks or longer later developed a major depressive episode.

"The results show that insomnia seems to be followed by depression more consistently than the other way around. In addition, we found that insomnia tended to be a chronic problem that gets more persistent over time, whereas depression was a more intermittent problem," study author Dr. Daniel J. Buysse, of the University of Pittsburgh, said in a prepared statement.

"We used to think that insomnia was most often just a symptom of depression. However, a growing body of evidence suggests that insomnia is not just a symptom of depression, but that it may actually precede depression. In other words, people who have insomnia but no depression are at increased risk for later developing depression," Buysee said.

Insomnia, the most common of all sleep disorders, is when a person has trouble falling asleep, staying asleep or waking up too early. About 30 percent of adults have symptoms of insomnia.

Insomnia is more common among elderly people. According to a separate Sleep study from University of Rochester researchers in New York, elderly patients being treated for depression were almost two to four times more likely to remain depressed if they had persistent insomnia, compared with patients with no insomnia. Elderly patients receiving standard care for their depression fared worse than those receiving more enhanced care.

Herbal Solutions To Counter Depression

In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John's wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.

The Food and Drug Administration issued a Public Health Advisory on February 10, 2000. It stated that St. John's wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as AIDS, heart disease, depression, seizures, certain cancers, and rejection of transplants. Therefore, health care providers should alert their patients about these potential drug interactions.

Some other herbal supplements frequently used that have not been evaluated in large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng. Any herbal supplement should be taken only after consultation with the doctor or other health care provider.

Depression May Be A Big Factor In Poor Health

Depression has a greater impact on overall health than arthritis, diabetes, angina, and asthma, but it all too often goes unrecognized and untreated, a report from the World Health Organization (WHO) suggests.

Based on interviews with almost 250,000 people living in 60 countries, WHO researchers found depression to be a greater predictor of poor health in patients with these chronic conditions than having one or more chronic medical conditions without depression.

People who had arthritis, diabetes, angina, or asthma were more likely to suffer from depression than people without these conditions.

And consistent across different countries and cultures, people with depression plus one or more of the chronic diseases included in the study had the worst overall health scores.

The findings, which appear in the Sept. 8 issue of The Lancet, illustrate the urgency of identifying and treating depression in patients with other chronic health problems and in the population as a whole, the WHO researchers conclude.

"We have to recognize that mental health is not a luxury. It is a necessity for good overall health," researcher Somnath Chatterji, MD, tells WebMD.

"Health care providers are so focused on the physical health of their patients that they often miss the signs of depression. But treating depression can have a big impact on overall health."