Treatment is usually effective for major depression

July 11, 2005

Depression is a term that is widely used and widely misunderstood.

Everyone has periods of down moods. However, more serious episodes of feeling sad or depressed can be quite painful and disabling. Between 2 percent and 4 percent of Americans experience this kind of problem, called major depression by mental health workers.

Major depression causes weeks or months of persistent sadness, loss of interest in activities, and trouble experiencing pleasure in life. Sleep and appetite are disturbed.

Persons with this kind of depression lack energy and motivation, and they have trouble concentrating. They might become anxious or withdrawn. In more severe episodes, persons might feel excessively guilty or worthless.


The most dangerous complication is hopelessness, leading to suicidal thinking. Rarely, persons with severe depression might develop false beliefs. They might believe that they have an incurable bodily disease or that they are guilty of terrible crimes. This might require hospitalization to ensure safety and to provide intensive treatment.

Because severe depression affects thinking, behavior, and emotions, it is often referred to as an illness. This illness can have many causes. People might develop depression in response to painful life events such as loss, health or financial problems or relationship difficulties. For others, the depression can start "out of the blue" with no obvious trigger. Often in these cases, there is a family history of mood disorders, suggesting a genetic cause.

Whatever the underlying factors might be, major depression often is like a snowball rolling downhill, gathering force and rolling over the unfortunate person in the way.

It is important to understand that persons with major depression are not able to reverse the process on their own. Depression is not caused by willfulness, weakness or lack of religious faith. This is often puzzling and difficult for family and friends to accept.

Without treatment, major depression can persist for months or years, although sometimes persons might go through cycles of improvement.

The good news about major depression is that treatment is usually effective. There are a range of helpful treatments and the choice of intervention depends on how severe the problem is and what kind of help the person prefers.

Education about what depression is and what to expect from treatment is often helpful. Persons with depression need to be offered hope and support as they often feel discouraged and alone. It is often helpful to include family in visits to the doctor or therapist.

Talking therapy, also known as counseling or psychotherapy, is an important part of recovery for most people. Therapists might focus on solving relationship problems, increasing self-esteem, and improving coping abilities.

Since depression leads to overly negative patterns of thinking, therapists might help the person with depression to identify and change thoughts and beliefs that cause sadness and a feeling of worthlessness. This is called cognitive therapy. In therapy, a person may also be encouraged to change behaviors that are not helpful, to avoid alcohol and to exercise.

Some people with depression can get better with counseling alone. Commonly, however, antidepressant medications are recommended. These medicines are most helpful when there are problems with sleep, appetite, energy and motivation. They are necessary to treat more severe kinds of depression.

Dr. Matthew Wagner is a staff psychiatrist at Behavioral Health Services of Washington County Health System.

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