Major depression is a mental disorder, characterized by a depressed mood or a loss of interest or pleasure in usual activities, that persists for two weeks or longer. In addition, the presence of changes in some (or many) of the following areas are noted in major depression: 
 

	Mood: sad, empty, hopeless, apathetic, worried, irritable
	Thinking: poor concentration, low self-esteem, indecisiveness, preoccupation with death, thoughts of suicide, guilt, etc.
	Behavior: slowed down or restless, crying, social withdrawal, suicidal acts
	Physical: appetite decreased or increased, disturbed sleep, decreased sexual drive, digestive problems, weight gain or loss, and fatigue.

In a poll taken by the National Mental Health Association, 43 percent of those surveyed said that they believed depression was a personal or emotional weakness rather than an illness. As a result of this kind of thinking, fewer than one in three depressed people ever seek treatment. They choose to blame themselves, family members, friends, or circumstances for their depressed feelings. They are wrong. 

Depression is a highly treatable disorder. In fact, the sooner depression is diagnosed and treatment begun, the brighter the long-term outlook.  With appropriate treatment, as many as percent of those suffering with depression improve significantly within a few months. 

     TYPES OF MAJOR DEPRESSION: 

Major depression can be classified as mild, moderate, or severe. Mild depression involves a minimum number of symptoms (five are required for diagnosis), and there is little interference with work or social functioning.

Moderate depression presents more symptoms and greater impairment of daily life. 

In severe depression symptoms are increased both in number and severity and take a much greater toll on the ability to function socially and at work. In extreme cases depressives are unable to work, feed, clothe, or provide basic hygiene for themselves. 

Major depression can be further divided into three forms, melancholic, atypical, and psychotic. 

     MELANCHOLIC DEPRESSION

	feeling of sadness is profound and of a different quality than other depression.
	early morning wakening and inability to fall asleep again.
	depression most intense in morning.
	behavior either agitated or slowed down
	loss of appetite and weight loss
	persistent and complete loss of joy in life’s pleasures
	excessive and unfounded guilt.

     ATYPICAL DEPRESSION 

	ability to experience joys of life, however briefly, and can feel temporary happiness in response to something pleasurable.
	may eat or sleep much more than usual
	may report a heavy, leaden feeling in arms or legs
	chronic and extreme sensitivity to rejection, causing interference in ability to work or to socialize.

     PSYCHOTIC DEPRESSION (uncommon) 

	loss of touch with reality
	hallucinations usually reflective of their sense of doom.
	hallucinations are sensory, usually visual and/or auditory
	treatment with antipsychotic medication is essential.

SYMPTOMS - is it depression? 

     If your mood has been persistently depressed (sad, blue, hopeless, down, irritable); if you have lost interest in all or almost all usual activities and pastimes and have experienced at least four of the following symptoms for at least two weeks, major depression is a likely cause. Consultation with a professional is needed at this point.
 

	Appetite greater or less than normal. Weight gain or loss without trying.
	Sleep disturbances, more or less than usual.
	Slowed movements or agitation and restlessness.
	Fatigue, listlessness, and lack of energy.
	Hopelessness, helplessness, and worthlessness.
	Lack of concentration and inability to focus attention.
	Inability to perform as effectively or productively as in the past.
	Difficulty in thinking clearly and in decision-making.
	Forgetfulness.
	Persistent and recurring thoughts of death or suicide.
	Poor sense of self-worth and self-esteem.
	Feelings of inadequacy.
	Reflecting and brooding over the past.
	Loss of interest in sex or less sexually active than usual.
	Withdrawal from others.
	Physical symptoms such as headaches, digestive problems, aches and pains.

WHO IS AFFECTED BY MAJOR DEPRESSION? 

     At highest risk are individuals who have already experienced an episode of major depression, have close relatives with severe depression, or who abuse alcohol or drugs. 

     Depression may strike any age group, from young children to seniors, with an average onset in the mid-twenties.

     According to the National Institute of Mental Health (NIMH), 4.4 percent of Americans (or 9.4 million) will develop major depression at some point in their lives. Women are two to three times more likely to develop depression than men. 

CAUSES OF DEPRESSION 

     Some individuals may be able to point at various life events and be certain they are the reasons for their depression. For others depression comes “out of the blue,” with no apparent reason.

     Depression is an illness characterized by neurochemical abnormalities that can cause significant disability. The cause may be one or a combination of biological, genetic, chemical, psychological, social, developmental, and environmental factors.  Heredity, brain chemistry, hormonal systems, and sleep-wake controls are included in biological factors. Cognitive disorders, behavioral disorders, stress, and the traumas of life are psychological factors. 

TIME TO SEEK HELP 

     Many depressed individuals do not realize they are seriously ill. They choose to blame themselves and “tough it out.” They are not aware that depression may continue for many months or even years without proper treatment.

     If the symptoms of depression have been present every day, for most of the days, for a period of two weeks, it is time to seek help without delay. If thoughts of suicide are present, it is an emergency. Seek help immediately.

RISKS AND COMPLICATIONS

     Fifteen percent of those who are depressed kill themselves. Twice that many may attempt it. Suicide is a major and outstanding risk of major depression. Depression may also lead to or exacerbate substance abuse. Also, depression complicates and interferes with the treatment of many illnesses, from asthma and stroke to heart disease and cancer. 

TREATMENT 

     Treatment for major depression comes in many forms. For many, medication, psychotherapy, or both, are very effective. Psychotherapy alone is enough to relieve the symptoms in many cases of mild to moderate major depression. Individuals respond differently to different types of therapy. If one fails, they should not despair but go on to the next. One will work. 

     Antidepressant drugs are effective in more than half of the cases of moderate to severe depression.  It may be necessary to try several different antidepressants before finding the one that works best for you.