The University of Pittsburgh School of Medicine

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CLINICAL DEPRESSION

Clinical depression is a medical illness which affects millions of people each year. Though people often get the "blues," clinical depression causes persistent changes in some persons mood, behavior, and feelings. The illness interferes with and disrupts a persons' education, job and family life. No amount of "cheering up" can make it go away, and neither can "keep a stiff upper lip" nor "toughing it out." No amount of exercise, vitamins, or vacation can make clinical depression disappear. People with clinical depression need to get proper treatment which usually includes medication, psychotherapy, or a combination of both.

Symptoms of Clinical Depression: Clinical depression is signaled by persistent change in a person's feelings and behavior that are often misunderstood or ignored. Typical changes include sad or empty feelings, slowed behavior, and changes in eating and sleeping patterns. People with this illness often feel down on themselves and hopeless about future. Many find it difficult to concentrate on work or studies, feel guilty or anxious, cry often or become irritable over little things. Others lose interest in friends, sex and other activities that had given them pleasure in the past. They may complain about physical aches and pains-backaches, headaches, and stomachs problems-for which no medical explanation can be found.

There are nine symptoms that doctors look for when they examine their patients for clinical depression. A diagnosis is made if a person has five or more of the following symptoms for more than two weeks or there is considerable impairment in normal functioning:

Types of Clinical Depression: Clinical depression differs greatly among people, both in its severity and how long it lasts. Some people suffer only one episode of clinical depression during their lifetime, while others experience recurring episodes. Also, people suffer from two basic types of clinical depression:

Major Depression--also called "unipolar" depression, this illness is identified by many of the symptoms cited above.

Manic Depression--also called "bipolar" depression, this illness causes alternate cycles of depression or manic elation. During a manic phase, some or all of the following symptoms often appear:

During the depressed phased of manic depression, many of the symptoms of major depression are experienced.

Two additional types of depression have also identified:

  1. Dysthymia--like a low grade infection, dysthymia is a less severe form of major depression that keeps people from feeling "good" or enjoying life. People with this illness "go through the motions" of daily life, often with little pleasure or enthusiasm, for years.
  1. Seasonal Affective Disorder (SAD)--this is a depression that relates to the season of the year and to the brightness and duration of daylight. Medical researchers link inadequate exposure to sunlight to depressed moods, which can be successfully treated with artificial light therapy and some medication.

Causes of Clinical Depression: Current theory suggests those clinical depression results from complex interactions between brain chemicals and hormones that influence a person's energy level, feelings, sleeping and eating habits. These chemical interactions are linked to many complex causes--a person's family history of illness, biochemical and psychological make-up, prolonged stress, and traumatic life crisis such as death of a loved one, job loss, or divorce. Sometimes no identifiable cause triggers an episode of clinical depression; usually one or more stresses are involved. Medical research has found that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine. New medications are available that restore these brain chemicals to their proper balance and relieve symptoms of clinical depression.

Risk Factors for Clinical Depression: Like heart disease and alcoholism, clinical depression often runs in families. More than twice as many women than men suffer from clinical depression and 25% of women and 10% of men will suffer one or more episodes of clinical depression in their lifetimes. Though clinical depression strikes people of all ages, it strikes most often among those aged 24-44.

Certain other age groups are also at risk as high school and college-age populations. Often the illness is not recognizable because its symptoms resemble normal teenage problems--changes in mood, irritability, risk-taking behavior, and troubles with friends or school work. If undiagnosed and untreated, some young people with severe clinical depression may become vulnerable to suicide--now the second leading cause of death among people between the ages of 15-24.

The elderly also frequently suffer from clinical depression. Their sad moods, fatigue and withdraw from life are often mistaken as a normal part of the aging process. For many older people, clinical depressions linked to the death of a spouse, admission to a nursing home, prolonged illness, or a major operation, such as heart surgery. The elderly depressed are much higher risks for suicide than younger depressed.

Treatment of Clinical Depression: There are a variety of antidepressant medications and psycho therapies that are effective in treating illnesses. For the clinically depressed individual, medication is usually required. In recent years, newer antidepressant medications have been developed which lack the side affects of earlier medications. These drugs are called SSRI's or Serotini-Specific Reuptake Inhibitors such as Prozac, Zoloft or Paxil. They selectively block the reuptake of one of the major neurotransmitter, serotonin. These drugs are not habit forming, though they should be carefully monitored to make certain that dosages are at a therapeutic level. In most cases, patients will be treated with medication for 6-12 months.

Psychotherapy is usually advised for individuals with clinical depression. Two of the short term therapies that have been shown to be helpful for some forms of depression are Interpersonal and Cognitive/Behavior therapies. Interpersonal therapists focus on the individual's disturbed personal relationships that both cause and exacerbate the depression. Cognitive/Behavioral therapists help the individual change the negative style of thinking and behaving often associated with depression. More long term psycho dynamic therapies, sometimes used to treat depression, focus on resolving the patient's internal psychological conflicts that are typically thought to be rooted in childhood.

Helping Yourself and Helping Others: It is important to understand that depress is a treatable illness. The negative thoughts and feelings such as worthlessness, helplessness or hopelessness that often accompanies depression will fade with proper treatment. Unfortunately, without treatment, these symptoms may sometimes lead to suicidal thoughts or behaviors. Getting help is essential!

The most important thing for friends and family to do for a depressed person is to help him or her get appropriate diagnosis and treatment. This may involve encouraging the individual to stay in treatment until the symptoms are relieved or to encourage the individual to seek different treatment if symptoms do not abate. In addition, offering emotional support such as affection, patience, encouragement and understanding is extremely important.

Sources of Treatment: Medical students who suspect that they are depressed should not put off getting help. Delay in treatment can have devastating effects on every area of a student's life. There are a number of resources for students at Pitt.

  1. Students can contact Dr. Lili Penkower at the counseling program. She can be reached at 624-1041 to set up an appointment for evaluation and treatment or referral. This is a confidential program only available to medical students.
  2. Students can contact any one of the other members of the SHARP Committee who will offer referral for evaluation and treatment.
  3. A listing of UHN participating psychiatrists is available in the UHN Directory of network providers.

Adapted from "Answers to Your Questions About Clinical Depression," National Mental Health Association and "Depression: What You Need to Know," Office of Scientific Information, National Institute of Mental Health.

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SHARP / Clinical Depression / Alcohol Abuse and Dependency /
Anorexia Nervosa and Bulimia Nervosa