Could You Be Depressed and Not Know It?

WebMD can help you recognize depression - and find relief

From the WebMD Archives

"Could you be depressed and not know it?" This sounds like a ridiculous question. After all, wouldn't you know if you were depressed? Possibly not. Depression can take hold gradually, without a person realizing that depressive thoughts and feelings are increasingly dominating her perspective - and her life.

Many people assume that depression is easily identifiable, manifesting itself as persistent sadness that doesn't lift. In fact, symptoms of depression can take a variety of forms. Chances are that if you are reading this article, you have the feeling that something isn't quite right. You may find that you are tired all the time, and all you want to do is sleep. Depression can also trigger insomnia, forgetfulness, and an inability to take pleasure in normal activities. According to Eve Wood, MD, clinical associate professor of medicine at the University of Arizona, and author of 10 Steps to Take Charge of Your Emotional Life, "Women often say, 'I'm not depressed; I just don't care', but that indifference can signal depression." It turns out that excessive fatigue, insomnia, and joylessness can all be symptoms of depression.

As subtle and confusing as signs of depression can sometimes be, it's important to remember that depression is a serious illness that can cramp lives, cast a shadow over families, and even lead to suicide. A growing body of research has documented the serious and chronic effects of depression on the human brain - effects that can make a person susceptible to future incidents of depression.

According to the American Psychological Association, women are twice as likely as men to experience depression or dysthymia (persistent low-level depression), and misdiagnosis of depression in women is high. The good news is that depression can be effectively treated. If you suspect that you or someone you know is depressed, you've come to the right place. WebMD can help you learn more about depression and what you can do about it.

Symptoms of Depression in Women

* Changes in weight, sleep or appetite: These signs of depression can be confusing because depending on the individual, they can take very different forms. Some depressed women want to sleep all the time, for example, while others may experience insomnia.

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* Physical symptoms of depression that won't go away, like fatigue, headaches, back aches, digestive disorders, chronic pain, or menstrual problems

* Anxiety

* Agitation, irritability

* Forgetfulness or difficulty concentrating

* Low sex drive

* Pessimistic or hopeless outlook on life: While there are plenty of reasons to be pessimistic about the future, a depressed person is more apt to dwell on negative events and be unable to find anything to be happy about.

* Feelings of guilt or helplessness

* General apathy and lack of interest or pleasure in customary activities

* Thoughts of suicide

Experts say that certain behaviors can also be a sign of underlying depression. "Women often engage in behaviors that signal "masked depression," says psychologist Lara Honos-Webb, PhD, author of Listening to Depression. Compulsive shopping, working, eating, or drinking alcohol can be signs of depression -- particularly when a woman feels empty or anxious when she's not participating in these activities.

What Are the Causes of Depression?

Experts say that depression is caused by an interaction of genetic factors and real life triggers. Because depression often runs in families, experts believe that genetic factors make some people more vulnerable to than others, because of their individual brain chemistry.

Depression triggers can include:

* Situational factors: Major problems and life crises -- a romantic break-up, job loss, or the death of a loved one, for example -- are often the immediate, most obvious causes of depression. But ongoing life challenges like poverty, unemployment, and social isolation, as well as childhood trauma, also put people at higher risk for depression.

* Medical factors:Chronic pain or illness can lead to depression. Certain medical conditions -- including hypothyroidism, cancer, and hepatitis -- can cause depression. Nutritional deficiencies and some medications are culprits as well. Therefore, it's important that treatment for depression include a medical evaluation.

* Gender: Women are twice as likely as men to experience depression, a discrepancy likely due in part to the tremendous hormonal shifts that accompany menstruation, child birth, and menopause.

* Stress: A connection between chronic stress and depression has been established and could explain why stressful life situations, like poverty and unemployment, put people at far higher risk for depression.

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Treatment for Depression

According to depression experts at the American Psychological Association, you should seek treatment for depression if it persists for more than two weeks -- particularly if your depression is severe enough to interfere with normal life activities. If you suspect that you are depressed, talk to your physician, who can rule out physical causes and refer you to a mental health professional.

Experts now understand that depression has to do with shifts in brain chemistry, so a piece of the treatment puzzle involves re-balancing chemicals, Wood says. But it doesn't have to involve medication. The best treatment for your symptoms depends on your individual story, she says; whether you've been depressed before, and whether your symptoms keep you in bed all day or simply sap your energy. So try to describe your history and symptoms as precisely as possible when you speak to your physician and psychotherapist.

Treatment for depression usually involves psychotherapy, antidepressants, or both, according to Susan G. Kornstein, MD, a professor in Virginia Commonwealth University's School of Medicine. Experts now believe that a combination of both is most effective. In a study from Vanderbilt University in Nashville, TN, researchers concluded that psychotherapy and medication together were effective for 70% of women, says Valerie E. Whiffen, PhD, professor of psychology at the University of Ottawa, Ontario, and author of A Secret Sadness.

There is evidence that in many cases, psychotherapy works as well as antidepressants do, and there are no side effects, according to Whiffen. Interpersonal Therapy (IPT) for example, focuses on improving the patient's relationships to help reduce depressive symptoms. Half of the women in the Vanderbilt study who received IPT were no longer depressed at the end of treatment -- the same result seen with antidepressants alone.

For many people, antidepressants are very effective in treating depression, particularly when depression is severe or persistent. We don't completely understand how antidepressants work, but we do know that they readjust the balance in brain chemicals known as neurotransmitters. There are currently many different types of antidepressants on the market, so be sure to work with a psychiatrist who can help you find the medication that is most effective for you.

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While you are seeking help for your depression, remember to take care of yourself. Avoid alcohol and drugs, and be sure to get enough sleep. Exercise can be surprisingly helpful in boosting your mood. If your depression is mild to moderate, it can cut symptoms nearly in half, research from the University of Texas Southwestern Medical Center notes, making it just as effective as medication.

Whatever you do, don't sit back and wait for depression to abate on its own. If you are depressed, it is nothing to be ashamed of -- and you don't have to continue to suffer. Depression is one of the most treatable conditions in all of medicine, according to Kornstein. Unfortunately, it continues to be under diagnosed and under treated.

It is also important to get help because depression affects more just than your mood, says Harvard assistant professor Alice D. Domar, PhD, co-author of Self-Nurture. While you procrastinate, hoping to get better on your own, depression can wreak havoc on your health, raise your risk of heart disease and infertility, and suppress your immune system. Perhaps even more important, experts now know that, left untreated, depression is likely to recur and to be more severe and difficult to treat with each recurrence.

WebMD Feature Reviewed by Amal Chakraburtty, MD on July 01, 2007

Sources

SOURCES: Alice D. Domar, PhD, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School; executive director of the Domar Center for Complementary Health Care; co-author of Self-Nurture.Lara Honos-Webb, PhD, a California-based clinical psychologist; author of Listening to Depression. Jane Sadler, MD, a Texas-based physician with Baylor Health Care System. Eve Wood, MD, clinical associate professor of medicine at the University of Arizona; psychiatrist in private practice; author of 10 Steps to Take Charge of Your Emotional Life. Susan G. Kornstein, MD, professor of psychiatry and obstetrics and gynecology in Virginia Commonwealth University's School of Medicine. Valerie E. Whiffen, PhD, professor of psychology at the University of Ottawa, Ontario, Canada; author of A Secret Sadness. American Psychiatric Association (APA): "Many Americans Know Little about Mental Illnesses." Survey released Apr 25, 2006. 10 Steps To Take Charge of Your Emotional Life by Eve A. Wood, MD. Hollon, S. D. Journal of Clinical Psychiatry, April 2005: vol 66; pp455-468. Dunn, A.L., American Journal of Preventive Medicine, January 2005; vol 28: pp 1-8. Lindwall, M. J Aging Phys Act., Jan 2007; vol 15: pp 41-55. American Psychological Association, "Women and Depression," http://www.apa.org/ppo/issues/pwomenanddepress.html. National Institute of Mental Health,"Depression,"http://www.nimh.nih.gov/publicat/depression.cfm#ptdep3, 20. American Psychological Association, "Hard-hitting Hormones: the Stress-Depression Link," http://www.apa.org/monitor/jan05/hormones.html, National Institute of Medicine, "Depression," http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm, 22. American Psychological Association, "Depression and How Psychotherapy and Other Treatments Can Help People Recover,"http://www.apa.org/topics/recover.html, Interview with John Greden, MD, University of Michigan Depression Center, http://www.medicineatmichigan.org/magazine/2002/summer/depress/default.asp.

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