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DIAGNOSIS
Researchers are unclear about the specific causes of depression. An imbalance of certain chemicals in the brain called neurotransmitters, including serotonin, dopamine and norepinephrine, may be partly responsible. Researchers at Tufts University in Boston have implicated low levels of folate as another possible link. Also, some people may have a genetic predisposition (your family history puts you at risk) to depression: scientists find that adults who carry a short form of a particular gene are more susceptible to depression after experiencing serious life events than adults who carry a long form of the same gene.
If you have a history of substance abuse, or physical or sexual abuse, you are particularly at risk for depression. Also, women who are separated or divorced, as well as married women with young children at home, are more vulnerable to depression than other women.
Because depression is so common, your primary health care professional should ask you about any symptoms of depression you may be experiencing during any comprehensive physical examination. Unfortunately, only about 50 percent of primary care physicians accurately diagnose and treat depression. And women themselves may be unable to sense or admit to their own depression.
If your primary health care professional suspects a depressive disorder, he or she may request a consultation with a mental health specialist such as a psychiatrist, clinical social worker or psychologist. To assess your mental health, a health care professional may ask you questions like:
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Have you been sad a lot lately?
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Have you had crying spells?
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Is there a change in your productivity or your ability to concentrate?
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How does your future look?
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Do you have difficulty making decisions?
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Have you lost interest in aspects of life that used to be important to you?
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Are you tired?
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Do you feel guilty or like a failure?
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Do you wish you were dead?
Untreated episodes of major or acute depression last an average of about six months. At least five of the symptoms below must occur for a period of at least two weeks, and they must represent a change from previous behavior or mood, to receive a diagnosis of major or acute depression.
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depressed mood on most days for most of each day
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total or very noticeable loss of pleasure most of the time
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significant increase or decrease in appetite, weight, or both
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sleep disorders, either insomnia or excessive sleepiness, nearly every day
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sexual dysfunction including (loss of interest)
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feelings of agitation or a sense of intense slowness
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loss of energy and a daily sense of tiredness
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sense of guilt and worthlessness nearly all the time
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excessive crying
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inability to concentrate occurring nearly every day
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recurrent thoughts of death or suicide
How to Tell the Difference Between Depression and Other Mood-Related Conditions
The symptoms of grief or bereavement mimic those of depression in many ways, but if you are grieving, you experience a succession of emotions over a period of three to six months that lead to a recovery period. Severe grief lasting longer than six months affects your health and increases your risk for ongoing depression, however. Some experts suggest that this severe persistent grieving state be categorized as a separate psychological diagnosis termed complicated grief disorder, which would be related to post-traumatic stress syndrome and require special treatment.
Dysthymia (chronic, low-grade depression) is marked by the same symptoms as major depression but is not usually accompanied by changes in appetite or sexual drive, and severe agitation, sedentary behavior and suicidal thoughts are not usually present. Possibly because of the duration of the symptoms, you may not exhibit marked changes in mood or daily functioning.
As the days get shorter, people with seasonal affective disorder (SAD) get increasingly tired and lethargic and have difficulty concentrating. You may also experience a craving for carbohydrates and sweets. Your appetite increases, often resulting in weight gain, and as the winter darkens you may become socially withdrawn and despondent. The exact causes of SAD are unclear. One theory is that serotonin, a chemical in the brain widely believed to play a major role in depression, is triggered by sunlight and falls to its lowest level during the winter months. If you are affected by SAD, you may have less serotonin available or be less able to handle the decrease than those unaffected by the disorder.
Like other forms of depression, the causes of postpartum depression (PPD) have not been pinpointed, but both psychologic and neurochemical influences are suspected. Women who experience PPD very often have had problems with depression prior to pregnancy. Also, if you experience premenstrual syndrome (PMS), you may be more susceptible to varying degrees of PPD. Another significant risk factor is lack of social support for the mother and baby. The stress involved with adjustment to a new baby; being unprepared and subsequently overwhelmed by the baby's birth; a difficult birthing experience; a sick or colicky infant; and exhaustion may also contribute. Symptoms of PPD include:
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uncontrollable crying
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feelings of inadequacy or negative feelings toward the baby
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irritability
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anxiety or panic
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feeling numb
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excessive sleep or inability to sleep
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over- or under-eating
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other symptoms common to depression
The most severe form of PPD can include intense, suicidal and homicidal thoughts, and/or postpartum psychosis. Only one or two women in 1,000 experience this serious form of PPD following childbirth.
The symptoms of premenstrual dysphoric disorder (PMDD) are similar to those of major depressive disorder but subside with the onset of menstruation. They include: a markedly depressed mood, decreased interest in usual activities, lethargy, fatigue, or lack of energy, insomnia, and hypersomnia (sleeping too much). A diagnosis of premenstrual dysphoric disorder PMDD requires that these symptoms occur during most menstrual cycles, get worse seven to 14 days before the menstrual period begins, and improve once it starts or soon afterwards.
