Depression:
Major Depression

An individual with this type of depression feels a profound and constant sense of hopelessness and despair.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Who Experiences Major Depression?

In the U.S., approximately 10% of people suffer from major depression at any one time and 20%-25% suffer an episode of major depression at some point during their lifetimes. Most people associate depression with adults, but it also occurs in children and the elderly -- two populations in which it often goes undiagnosed and untreated.

Approximately twice as many women as men suffer from major depression. This is partially because of hormonal changes throughout a woman's life: During menstruation, pregnancy, miscarriage and menopause. Other contributing factors include increased responsibilities in both professional and home lives -- balancing work while taking care of a household, raising a child alone, or even caring for an aging parent. However, depression in men may also be under-reported.

Men who suffer from major depression are less likely to seek help or even talk about their experience. Signs of depression in men are more often irritability, anger, or drug and alcohol abuse. Repressing their feelings can result in violent behavior directed both inwardly and outwardly, and an increase in illness, suicide and homicide.

What Factors Can Trigger Depression?

• Grief (loss of a loved one through death, divorce, or separation).
• Interpersonal disputes (conflict with a significant other or a superior; physical, sexual, or emotional abuse).
• Role transitions (moving, graduation, job change, retirement).
• Interpersonal deficits (leading to social isolation or feelings of being deprived).
• Not everyone has a trigger for a depressive episode.

How Is Major Depression Diagnosed?

If you are depressed and have had symptoms for more than two weeks, see your doctor or a psychiatrist. Your doctor will perform a thorough medical evaluation, paying particular attention to your personal and family psychiatric history. You may be asked to complete a depression screening test.

There is no blood, X-ray, or other laboratory test that can be used to diagnose major depression. However, your doctor may run some blood tests to help detect any other medical problems that have symptoms similar to those of depression (such as hypothyroidism).

What Treatments Are Available For Major Depression?

Major depression is a serious, but treatable, illness. Your doctor will most likely give you a prescription antidepressant medication. He or she may also suggest that you receive a specialized form of "talking" counseling called psychotherapy.

Certain medicines work better for some people. It is important to talk to your doctor about finding a treatment that fits your lifestyle. It may be necessary for your doctor to try different drugs at different doses. Aside from taking them, there is very little way to determine which medicine will work best for you.

Can Major Depression Be Prevented?

Once you have had an episode of major depression, you are at high risk of having another. The best way to prevent another episode of depression is to be aware of the triggers of depression (see above), know the symptoms of depression in you, and to seek help early if you need it.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.

Edited by Cynthia Haines, MD, WebMD, July 2005.

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Last Editorial Review: 11/28/2005