Defining and Understanding Depression

Last Updated: Dec. 1, 2003

To receive a diagnosis of major depressive disorder, an individual must experience depressed mood or anhedonia (the inability to experience pleasure) for two weeks, in addition to five or more of the following symptoms: weight loss or gain, insomnia or excessive sleep, fatigue, feelings of worthlessness, difficulty concentrating, or suicidal thoughts. Most people who seek treatment have experienced symptoms for several months or longer.

How can you tell the difference between the blues and depression?
Among the factors considered by the physician are how many symptoms a person is experiencing, how long the symptoms have been present and how severe they are, and whether the individual is having trouble functioning at home and/or at work. It is particularly important that people with suicidal or self-destructive thoughts seek help.

Is gender a factor?
The major gender difference is that women are at higher risk than men to experience a first episode of depression. After that, there is no consistent gender difference in the severity or course of depression – in other words, depressed men and women don't differ in the extent to which depression interferes with their ability to function, or in the length or frequency of their depressive episodes. Women, however, are more likely than men to report a high number of depressive symptoms (i.e., seven or eight). And pure depression – in which the person has no other psychiatric illness, such as substance abuse or anxiety – is more common in women than men.

Most depressed patients, however, do not have pure depression; instead, they also suffer from other psychiatric illnesses. These other mental disorders often appear before the clinical depression. In women, depression often follows anxiety disorders, while in men it often follows substance abuse disorders or conduct disorder (i.e., antisocial behaviors).

Few men or women who have suicidal thoughts get treatment. Suicidal thinking and behavior is particularly common among adolescents and the elderly. More women attempt suicide, but more men complete suicide attempts, partly because they tend to use more lethal methods such as guns rather than medication overdoses.

Risk factors for depression
While depression is a very common illness, not everyone is equally likely to develop depression and certain risk factors increase the probability of developing this disorder.

A risk factor is a condition or behavior that precedes the onset of depression and is found at a higher rate in persons with depression than without depression. Risk factors also can provide a profile of those for whom depression is more likely and, consequently, can serve as targets for treatment and prevention strategies.

One of the most consistently determined risk factors for depression is female gender. Some of the other factors that increase risk for depression include prior episodes of depression, family history of depression in first-degree relatives (parents and siblings), and chronic medical illness.

Certain cognitive styles – ways of thinking and viewing the world – also can be risk factors for depression. For example, those who focus extensively on pleasing others to avoid disapproval and those who have an exaggerated need for control have an increased risk for depression. People with these needs establish unattainable goals that make them feel more hopeless. Another cognitive style is rumination, or replaying negative experiences and their possible meanings and consequences. With cognitive behavioral therapy, some of these styles can be modified.

Finally, a very important risk factor is life stress, or exposure to adverse experience, and the effect of this factor might be particularly helpful in explaining the gender disparity in rates of depression. Life stress greatly increases risk for depression, and women are preferentially affected by life stress and have more event-related depression than men.

Source: National Institute of Mental Health

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