1. UNDERSTANDING DEPRESSION
Facts and Myths

2. What is Depression?
Major depression is a mood disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by loss of interest or pleasure in normally enjoyable activities.
The DSM-IV-TR criteria for an episode of major depression specify that the patient must have at least 5 of the 9 symptoms of depression (and one of them must be depressed mood or loss of interest or pleasure)

3. DSM IV-TR
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning, at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood- incongruent delusions or hallucinations.

4. DSM IV-TR
(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day (as indicted by either subjective account or observation made by others:
(3) significant weight loss when not dieting or weight gain (e.g., change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
(4) insomnia or hyper-somnia nearly every day.
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guild about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms do not meet criteria for a Mixed Episode
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

5. Myth: Depression is not a real illness
Depression is a complex mental illness that is oftentimes misrepresented and misunderstood within our culture. Every case of depression comes with its own nuisances and complexities. We need to become more holistic in how we recognize and treat this condition, and less reliant on quick fixes.

6. Fact: Men get depressed
There is a common presumption that depression is a female affliction. This is not entirely without merit, as two times more women than men are diagnosed with depression , a striking figure that holds up across the globe. However, the disparity between the sexes does not mean that men are immune from depression. In fact, some researchers contend that men may be equally vulnerable to depression, but less likely to seek help or treatment because this goes against the rigid constructions of masculinity. Moreover, males who are experiencing depression may manifest symptoms in less emotional ways and more covert means, such as through acting out, aggression, and/or alcohol or substance abuse which may not be properly identified as manifestations of depression. In other words, there may be gendered patterns to expression of depressive symptoms that make the mental illness more likely to be identified and observed in women as compared to men.

7. Myth: Children don’t get depressed
Depression can develop in any age group, ethnic group, economic group, and gender.

8. Fact: Anyone can get depressed
Poet or linebacker, shy or outgoing, anyone can develop depression. There are many things that can trigger depression.

9. Myth: Medication is the most effective treatment
The notion that meds are the most effective intervention to date in treating depression is false. In fact, the standard FDA requires for psychiatric medications to be approved and sold to consumers is not a high one; only two independent studies that yield significant results in favor of drugs is required, regardless of how many trials may be required to render such findings.
In other words, “so long as research eventually yields evidence of efficacy, the failures would remain off the books. This is why antidepressants have been approved even though so many studies have shown them to be ineffective” (Greenberg,2010,p.216)

10. Myth: Medication is the most effective treatment (cont’d)
Moreover, research suggests that the reduction of depressive symptoms seen with antidepressant use may be more indicative of a placebo effect than the merits of the drug itself.
For instance, some sources contend that up to 80% of the effectiveness of antidepressants is due to placebo effects. (see Greenberg, 2010). This comes at a high cost, given the documented (and not so documented) side effects—chief among them that in some cases, ironically, use of antidepressants actually increase suicidal ideation (particularly among adolescents).

11. Myth: Depression is always situational
While depression often does have a situational trigger, like the loss of a loved one or divorce, the underlying condition does not need any particular event to surface. Depression is typically diagnosed when someone suffers from prolonged episodes (at least 2 weeks) of hopelessness, emptiness and lethargy that seem to have no apparent cause.

12. References
Aalai, Azadeh. “ The First Impression: What do you think of me?” Psychology Today, 10 (2013). P211.
Greenberg, G. (2010). Manufacturing Depression: The Secret History of a Modern Disease. Simon & Shuster: New York.
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author

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