Depression

• Reactive depression is a temporary depres sion, such as depressed feelings that arise because of a specific life situation or tran sition. Depressive reaction is called an adjustment disorder with depressed mood. The symptoms can be severe, but usually subside within two weeks to six months and do not require treatment.
• Dysthymia is known as minor chronic depression. It is similar in its symptoms to depressive reaction, but it lasts much longer, usually at least two years.
• Major depression is a serious condition that can lead to an inability to function or even to suicide. It is a cyclical illness, so although most patients recover from their first episode, the recurrence rate is high—perhaps as high as 60 percent within two years and 75 percent within ten years. Major depression often appears and disappears spontaneously and is seemingly unprovoked. It might begin as a depressive reaction following a loss or trauma, and can intensify and evolve into a full-blown depressive episode. The episode may also disappear sponta neously, usually within six to twelve months, though treatment is often needed to achieve full control of symptoms.
• Bipolar disorder (or manic-depressive disorder) involves major depressive episodes alternating with periods of wildly energetic activity. About 1 percent of the American population experiences bipolar disorder in a given year.
• Atypical depression is less constant. A person with this condition might seem deeply depressed for a few days, then fine for a while, or anxious and irritable.
• Seasonal affective disorder is often referred to as “winter blues.” A reaction to lack of sunlight in winter, mild or major depression develops in late autumn and clears up in early spring. This condition becomes more common as distance from the equator increases.
• Postpartum depression results from the enormous hormonal changes that occur when pregnant women give birth and begin the challenges of caring for an infant. Some two-thirds of new mothers experience this form of depression. However, about 10 to 15 percent become clinically depressed. And about 1 in 1,000 becomes so severely depressed that the person needs to be hospitalized.

Friends, relatives, and family doctors often miss the subtle signs that point to a need for professional help. The various types of depression don't have firm, clear boundaries. Often it takes professional judgment to decide when normal grief or an adjustment disorder has become a more serious form of depression. This is a big reason why clinical depression often goes undiagnosed and untreated. Lacking a diagnosis and help, some people attempt suicide. People often overlook depression because so many accompanying symptoms mask it. Depression often manifests itself physically in the form of physical ailments such as headaches, back pain, irritable bowel syndrome, chronic fatigue, anxiety, sleep problems, and shortness of breath.

To help doctors diagnose mental health problems, including depression, the American Psychiatric Association (http://www.apa.org) publishes a professional handbook, The Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual lists the signs and symptoms of depression in its various forms.