Depression is categorized by the mental health profession as a mood disorder, but its symptoms can vary widely from one person to another. It is also accurate to think of depression as a complex problem that can affect many different aspects of the sufferer's life. It can affect the body, and generate such physical symptoms as insomnia, fatigue, appetite disturbances, diminished sex drive, and anxiety. It can affect the mind, interfering with the ability to think clearly, notice and remember details, and make good decisions. It can affect emotions, causing feelings of sadness, despair, guilt, worthlessness, and apathy. It can affect behavior, leading to alcohol or drug abuse, suicide attempts, and other socially or self-destructive behaviors. It can affect interpersonal (social and family) relationships, leading to aggression, withdrawal, or marital and family distress.

The main forms of depression are: major depressive disorder, also called "unipolar" for its affecting only one end of the mood continuum -- depression; and bipolar disorder, formerly called manic-depressive illness, ("bipolar" for its affecting both ends of the mood continuum -- depression and euphoria, or mania.) Depression can also present itself as dysthymia, a less intense and more chronic form of depression. Major depression is far more common than bipolar disorder, and has a much wider range of contributing factors.

Throughout the course of our lives, we all experience episodes of unhappiness, sadness, or grief. Often, when a loved one dies or we suffer a personal tragedy or difficulty such as divorce or loss of a job, we may feel depressed (some people call this "the blues"). Most of us are able to cope with these and other types of stressful events.

Over a period of days or weeks, the majority of us are able to return to our normal activities. But when these feelings of sadness and other symptoms make it hard for us to get through the day, and when the symptoms last for more than a couple of weeks, we may have what is called clinical depression. The term "clinical depression" is usually used to distinguish "true" depression from the blues.

Clinical depression is not just grief or sadness. It is an illness that can challenge your ability to perform even routine daily activities. At its worst, depression may lead you to contemplate or commit suicide. Depression represents a burden for both you and your family. Sometimes that burden can seem overwhelming.

Clinical depression always requires attention from a medical or mental-health professional. The good news is that depression can be diagnosed and treated effectively in most people. The biggest barrier to overcoming depression is recognizing that someone is depressed and seeking appropriate treatment.

Depressed people will likely experience unpleasant moods, thoughts and self-perception. A depressed person may have difficulty making decisions - day-to-day tasks of paying bills, caring for children, meeting people and making telephone calls may seem overwhelming.

If the following symptoms are present each day for a few weeks; and interfere with daily activities such as work, self-care, child-care, sleep or social life; please consider getting professional help:

• Preoccupied with death or suicide
• Insomnia and/or major sleep changes
• Appetite and/or major weight changes
• Decreased energy, fatigue - always tired
• Feeling hopeless, helpless or pessimistic
• Feeling guilt, worthlessness, helplessness
• Loss of interest or pleasure in work or profession
• Little pleasure in activities that were once enjoyed
• Sadness, anxiety, emptiness, restless and irritable
• Little interest or pleasure in romance or sexual activity
• Difficulty concentrating, remembering, making decisions

The symptoms of depression described above make it clear: To be depressed is to suffer. The hopelessness and helplessness that people experience when they are depressed is more than just a frame of mind at such times -- it is an entire way of being. People stop trying, they stop caring, they withdraw from life, and of course, this makes them feel even worse. Their lives deteriorate, and it affects others as well. Family members are not immune to the depressive's negativity -- the never-ending complaints, the steady stream of criticisms, the lack of emotional closeness, and the loss of the ability to have fun together. Spouses can feel hurt and alienated, and children may feel guilty, resentful, and as if they are to blame. In turn, family relationships can also exacerbate depressive symptoms.

As a general answer, you should seek help when depression is starting to affect your life (your family, your job, your outlook) in negative ways, and you are not very clear about what you need to do to prevent things from getting worse. You should seek help -- for yourself, loved ones, or both -- long before things get really bad.

To be more specific, take into account the following factors when deciding to seek professional treatment.

• Suicidal thoughts or feelings: Suicide is a terrible and irreversible solution to specific problems. The depressed person and his or her family need to think preventively, and get help immediately if someone is suicidal.
• Acute depression turning chronic: Before settling into "life as a depressed person," the depressed person, and family if possible, should do all they can to resolve it early on. Every day spent suffering is too costly.
• Lifestyle disruption: The depressed person, and his or her family, can prevent bad circumstances from getting worse by acting quickly. The depressed person does not have to ignore his or her health, lose a job, or hurt or alienate family and friends.
• Reality testing: If a family and their depressed member do not have someone good to talk to, someone with whom they can share their private thoughts, then how will they know whether what they are thinking makes sense? A good therapist is a valuable partner for "reality testing."

Depression has no single cause; often, it results from a combination of things. You may have no idea why depression has struck you.

Whatever its cause, depression is not just a state of mind. It is related to physical changes in the brain, and connected to an imbalance of a type of chemical that carries signals in your brain and nerves. These chemicals are called neurotransmitters.

Some of the more common factors involved in depression are:

• Family history. Genetics play an important part in depression. It can run in families for generations.
• Trauma and stress. Things like financial problems, the breakup of a relationship, or the death of a loved one can bring on depression. You can become depressed after changes in your life, like starting a new job, graduating from school, or getting married.
• Pessimistic personality. People who have low self-esteem and a negative outlook are at higher risk of becoming depressed. These traits may actually be caused by low-level depression (called dysthymia).
• Physical conditions. Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.
• Other psychological disorders. Anxiety disorders, eating disorders, schizophrenia, and (especially) substance abuse often appear along with depression.

If your symptoms indicate that you have clinical depression, it is strongly recommended to seek treatment. Treatment may include supportive therapy, such as changes in lifestyle and behavior, psychotherapy, complementary therapies, and may often include medication. Without treatment, your symptoms will last much longer and may never get better. In fact, they may get worse. With treatment, your chances of recovery are quite good.

Psychotherapy and antidepressant medications are the two most commonly used treatments for managing depression. Many people use a combination of the two. People's responses vary, of course, but these approaches hold good promise for providing relief.

Most people have already heard of the popular antidepressant medication, Prozac. It is only one of the many "newer generation" medications that do, in fact, help the majority of people who take them. Medication is a valuable tool for reducing symptoms and "raising the floor" on depression. Speaking to a psychiatrist about the use of medications in your particular case is the best way to explore whether medications are viable for you. A psychotherapist can also help you with this decision.

Psychotherapy is an non-drug alternative that is generally as effective as medication, and in some ways is even superior (though not quite as fast-acting). For example, people who receive therapy tend to have a lower relapse (recurrence) rate, and tend to feel better as an active participant in the recovery process. Psychotherapy can help individuals and families who are dealing with depression. The most effective psychotherapies are called cognitive therapy (which teaches how to identify and correct distorted thinking), behavior therapy (which teaches how to behave more effectively), and interpersonal therapy (which teaches relationship skills). All of these are short-term therapies, and all focus on changing things in the present.

The fact that long-term research shows the effectiveness of medication and psychotherapy for treating depression can be wonderfully reassuring for depression sufferers and their families. Depression is highly responsive to good treatment, and good treatment is available from a variety of sources.

Psychotherapy - Psychotherapy involves working with a trained therapist to figure out ways to solve problems and cope with depression. Three major approaches are commonly used to treat clinical depression. In general, these therapies take weeks to months to complete. Each has a goal of alleviating your symptoms. More intense psychotherapy may be needed for very severe depression or for depression with other psychiatric symptoms.

Cognitive behavioral therapy (CBT): This helps to alleviate depression and reduce the likelihood it will come back by helping you change your way of thinking. CBT uses three techniques to accomplish these goals.

• Didactic component: This phase helps to set up positive expectations for therapy and promote your cooperation.
• Cognitive component: Helps to identify the thoughts and assumptions that influence your behaviors, particularly those that may predispose you to being depressed.
• Behavioral component: Employs behavior-modifying techniques to teach you more effective strategies for dealing with problems.

Once you are being treated for depression, you can make lifestyle changes and choices that will help you through the rough times and may prevent depression from returning:

• Try to identify and focus on activities that make you feel better. It is important to do things for yourself. Don't isolate yourself. Take part in activities even when you may not want to. Such activity may actually make you feel better.
• Talk with your friends and family and consider joining a support group. Communicating and discussing your feelings is an integral part of your treatment and will help with your recovery.
• Try to maintain a positive outlook. Having a good attitude can be beneficial.
• Regular exercise and proper diet are essential to good health. Exercise has been found to increase the levels of the body's own natural antidepressants called endorphins.
• Try to get enough rest and maintain a regular sleeping pattern.
• Avoid drinking alcohol or using any illicit substances.

Books
Feeling Good Handbook, by David D. Burns. NAL/Dutton (1990). This book includes techniques that enable readers to cope with a range of everyday problems such as depression. Presents ideas of cognitive therapy through exercises, self-tests, and forms.

Mind Over Mood. By Dennis Greenberger and Christine Padesky. Guilford (1995). This treatment manual draws on the authors' extensive experience as clinicians and teachers of cognitive therapy to help readers successfully understand and improve their moods, alter their behavior, and enhance their relationships.

The Shelter of Each Other. By Mary Pipher. Ballantine (1996). Offers thoughtful, practical strategies to reach families and help them call upon their reserves of mutual nurture and support in the face of societal, cultural, and economic pressures. Challenges readers to find the courage to nurture and revive the families they cherish.

Hand-Me-Down Blues: How to Stop Depression from Spreading in Families. By Michael Yapko. St.Martins (1999). Describes the role of the family system in developing depression for both biological and developmental reasons, and teaches specific strategies for helping families reduce and even prevent depression in their members.

Breaking the Patterns of Depression. By Michael Yapko. Random House/Doubleday (1997). A comprehensive, "user-friendly" book that recommends an active, skill-building approach to self-help. Includes nearly 100 structured activities to engage the reader in learning the skills to overcome depression.

Organizations:
National Depressive and Manic-Depressive Association
(800) 826-3632, www.ndmda.org

National Foundation for Depressive Illness
(800) 239-1265 or (212) 268-4260

National Institute of Mental Health
(866) 615-6464 (toll-free), nimhinfo@nih.gov

National Mental Health Association
(800) 969-NMHA (6642) (toll-free)