Major depression affects almost 16 million adults in the U.S. – about 6.7 percent, but also occurring in over 4-5 percent of adolescents and two percent of young children. It occurs highest in young adults and Caucasians. Women are twice as likely as men to suffer depression; however, women are also more likely to seek help. After heart disease, depression is the most debilitating illness for women, while it’s tenth for men. Ten to 25% of women will experience major depression in their lifetime. (Read more on depression in women.) Each depressive episode makes another more likely. Rather than building resilience, we become more vulnerable and sensitive. A major depressive episode lasts two or more weeks. There are other forms of depression, such as post-partum depression, bi-polar depression, seasonal depressive disorder (“SAD”), and dysthymia, or “persistent depressive disorder.”
Dysthymia is a milder with less symptoms, but more chronic, lasting two or more years. It affects 5.4 percent of the population and is common among codependents. Because people with dysthymia can still function and work, it’s likely that it’s under-reported and affects many more people than official statistics would suggest. People with dysthymia can also have a major depression – called “double depression.” Some people experience depression mixed with anxiety, or flip between the two.
Depression is characterized by depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. To meet the diagnosis for major depression, you must have five of the following nine symptoms nearly every day:
- Depressed mood or irritability
- Feeling shame, worthlessness, or guilt
- Change in activity level – either
- Loss of interest in activities that you once enjoyed most of each day
- Fatigue or decreased energy
- Difficulty thinking, concentrating, making decisions
- Difficulty falling or staying asleep, early waking, or oversleeping and not wanting to get up
- Weight gain or loss of at least 5 percent
- Thoughts death, or suicide
Depressed mood may include feeling sad, hopeless, or numb or empty, and crying or be tearful almost daily. You also may feel anxious or irritable and get annoyed, or angry easily. You may want to isolate and find it hard to motivate yourself to do much of anything.
For a diagnosis of dysthymia, you must have two of the following symptoms:
- Low energy or fatigue
- Sleep disturbances
- Increased or decreased appetite
- Irritable or angered easily (for children and teens)
- Low self-esteem
- Difficulty concentrating or making decisions
- Feeling hopeless or pessimistic
If you experience physical symptoms that do not get better with treatment, such as headaches, upset stomach, or chronic pain, they may be a sign of depression.
There are a number of causes or risk factors for depression.
- A family history of depression
- Chemical imbalance
- Hormonal factors may all cause a woman to develop depression.
- Environmental factors, such as trauma, loss of a loved one, a bad relationship, work responsibilities, caring for children and aging parents, abuse, and poverty
- Medical illness
- Substance Abuse
A dysfunctional childhood home environment is a risk factor for depression and other health problems according to the ACE (“Adverse Childhood Experiences”) report. The study found a direct correlation between adult symptoms of negative health and childhood ACE occurrences. They measured incidents of emotional, physical, and sexual abuse, domestic violence, substance abuse, mental illness, parental separation or divorce, incarceration, and physical or emotional neglect. These are also risk factors for codependency.
Many people blame their depressed mood on their relationship or work, not realizing that these conditions are really magnifying internal problem. They may be uplifted when they achieve a success professionally or their partner expresses love for them, not realizing that the real cause is disconnection from their real self making their happiness dependent on outside circumstances. Inside, they may feel inadequate, lonely or empty or that or unworthy of love. They don’t realize that their depression and emptiness stem from emotional abandonment in childhood and codependency. They try to control things they can’t, lack of assertiveness, and often repress feelings, which contribute to intimacy issues and chronic depression. Internalized shame from childhood trauma causes low self-esteem, insecurity, and guilt that can lead to depression. Untreated, codependency worsens over time, and feelings of hopelessness and despair deepen.
Often the loss of a relationship triggers depression in codependents that can last from months to years. Relationships help them feel secure, loved, and provide purpose to their lives. Read more on “Recovery from Breakups and Rejection.”
Psychotherapy is the treatment of choice, and when indicated, antidepressant medication can be very helpful. Cognitive behavioral therapy can reduce negative thinking patterns. Sometimes past trauma and PTSD from prior abuse must also be addressed.
Patients need to develop better coping skills and to change shame-based beliefs that lead to feelings of inadequacy and unworthiness. They need support in taking steps to increase self-esteem, confidence and assertiveness, achieve their goals, and to restructure their thinking and relationship patterns.
If you are or have been depressed in the past, develop a strong support system, which can help prevent depression as well as recover from it. It’s important to develop good coping strategies and beliefs to deal with stress and negative life events. Becoming more autonomous and assertive leads to greater happiness and empowerment, while protecting against depression. Therapy can assist in all of these areas; with treatment, 80% of people improve. Depression is an illness so don’t let shame and thinking you must change on your own to stop you from getting help needed to recover, as you would for any physical illness.
Darlene Lancer, MFT – Depression Counseling, Depression Management, and Depression Treatment in Santa Monica, Los Angeles, and Culver City, CA, California
©Darlene Lancer 2016