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Depression

Depression is an emotionally crippling disorder that can be a gateway for a host of medical problems. Each year, more than 25 million people in the United States are diagnosed with depression, and almost 10 percent of those diagnosed commit suicide. Moreover, people experience depression across ethnic groups, socioeconomic levels, marital status, and education levels. Nonetheless, two to three times as many women and girls compared with men and boys experience depression. Not to be confused with being in a sad mood or having a few blue days, depression can be long-lasting, severely impairing a person's day-to-day functioning and resulting in unrelenting mental and emotional anguish. This entry describes types, variations, causes, prevention, and treatment of depression.

Types of Depression

Major depressive disorder and bipolar disorder are two types of clinically recognized depression.

Major Depressive Disorder

Persons with major depressive disorder (MDD) present at least five of the following symptoms for 2 weeks or more: dysphoria (feeling unwell or unhappy), anhedonia (inability to experience pleasure), sleep disturbances, appetite changes, excessive or unreasonable guilt, irritability, concentration difficulties, low energy, and suicidal ideation. These symptoms must not be attributable to substance dependence or abuse, other concurrent diseases or disorders, or normal grief.

Bipolar Disorder

Bipolar disorder is characterized by severe depression and by periods of elevated or irritable moods. Approximately 2.6 percent of U.S. adults have bipolar disorder. Previously known as manic-depressive illness, bipolar I is characterized by recurrent manic and depressive episodes.

Manic episodes in bipolar I are characterized by elevated or irritable moods with three or more of the following symptoms most of the day, nearly every day for at least one week: increased energy, racing thoughts, concentration difficulties, decreased need for sleep, irritability, increased sex drive, unrealistic beliefs in one's abilities, poor judgment, aggression, spending sprees, substance abuse, and denial of the illness. Alternating with mania, bipolar I depression is characterized by five or more of the same symptoms as MDD for nearly every day for 2 or more weeks.

Characterized by fewer severe manic symptoms, bipolar II involves recurrent hypomania (mild to moderate mania) alternating with depression. Although bipolar I occurs equally in men and women, women are more likely to suffer from bipolar II. Additionally, women report more depressive lifetime episodes, but men report more manic lifetime episodes. Moreover, women report more mixed episodes (simultaneous mania and depression) and more rapid cycling.

Variability of Depression

Across numerous cultures and ethnic groups, women are twice as likely to develop major depression as males are. One explanation for this difference may be that women are more likely to report their symptoms and seek treatment, artificially inflating their depression rates. Conversely, men tend to mask their symptoms with alcohol or drug abuse rather than seeking help. However, community-based epidemiological and clinical studies using self-reports and informant reports consistently reveal a greater prevalence of major depression among women, indicating the gender gap is not an artifact of self-reporting symptoms.

The experience of depression is also different for women and men. Women report higher levels of anxiety, sleep troubles, and physical problems; additionally, they develop the disorder earlier, experience more chronic and recurrent depression, and suffer greater severity and increased functional impairment than men do. Contrastingly, men are more likely to ignore depressive symptoms, engage in more enjoyable activities, suppress depressive moods and thoughts, or abuse substances to escape depression. Although women attempt suicide three times more frequently, men are more likely to complete the act.

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