Approximately 18.8 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a depressive disorder(1). (See Types below.) Of those, almost 10 million Americans suffer from major depressive disorder each year, nearly twice as many women (6.7 million) as men (3.2 million).(2) One in twenty Americans seek professional treatment for depression annually.(3) But two-thirds of those with depression receive no treatment at all.(4)

Medical illnesses such as stroke, a heart attack, or cancer can cause depressive symptoms: the sick person becomes apathetic and unwilling to care for his or her physical needs, which can prolong the recovery period. A serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode (see Symptoms below). A combination of genetic, psychological, and environmental factors is often involved in the onset of a depressive disorder.(6)

Depression may also be understood as a spiritual problem. At least one spiritual teacher has suggested that depression can be received as a gift that will aid us in our spiritual growth. From this viewpoint, struggling with depression is part of the problem ~ don't deny the experience, study it! Don't indulge it, either, it is suggested. Instead, one can seek a middle path, developing one's awareness and self-knowledge.(7)

Regardless of which theory about depression we favor, its effects on our lives are debilitating and often crippling. Personal, family, social, occupational, and other areas of life can be seriously disrupted; some who are sufferering may require hospitalization to prevent harm to themselves or others. Clinical symptoms of a "major depressive episode" (lasting 2 weeks or more) can include(8):

• depressed or (in children and adolescents) irritable mood
• notably diminished interest or pleasure in almost all activities
• significant weight loss or gain when not dieting
• appetite for food increases or decreases
• sleep disturbance such as insomnia (sleeping too little) or hypersomnia (sleeping too much)
• fatigue or loss of energy
• feelings of worthlessness
• excessive or inappropriate guilt
• diminished ability to think or concentrate; indecisiveness
• recurrent thoughts of death; suicidal thinking and attempts

Some people experience a mix of depressed and manic feelings. A manic episode, lasting at least a week, is also seriously disabling; manic symptoms can include(9):

• abnormally and persistently elevated, expansive, or irritable mood
• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual or feels pressure to keep talking
• flights of ideas; racing thoughts
• increased distractibility
• increase in goal-oriented activity
• increase in agitation
• excessive involvement in pleasurable activities that have a high potential for painful consequences (such as unrestrained buying, sexual indiscretions, or reckless investing)

Some people can even experience periods known as a "mixed episode", during which they have both depressive and manic symptoms for at least a week..

Some therapists and others who help people fight against depression speak about different "types" of depression. This is one way to distinguish between different patterns of symptoms that people experience ~ in actuality, each person's depression is unique.

These depressive patterns or disorders include:

• Major Depressive Disorder ~ one or more major depressive episodes
• Dysthymic Disorder ~ at least 2 years of depressed mood and other depressive symptoms that together are not serious enough to be considered a major depressive episode
• Bipolar II Disorder ~ one or more major depressive episodes accompanied by at least one hypomanic (mildly manic) episode
• Cyclothymic Disorder ~ at least 2 years of periods of mild manic and mild depressive symptoms

Other disorders that can include depressive symptoms or episodes are:

• Bipolar I Disorder ~ one or more manic or mixed episodes, usually accompanied by major depressive episodes
• Mood Disorder Due to a General Medical Condition ~ a prominent and persistent disturbance in mood directly resulting from a general medical condition (for example, an organic brain disorder)
• Substance-Induced Mood Disorder ~ a prominent and persistent disturbance in mood directly resulting from a drug of abuse, medication, somatic treatment for depression, or toxin exposure (for example, depression during cocaine withdrawal)
• Seasonal Affective Disorder ~ depression that is associated with a particular seasonal weather pattern, usually winter when daily sunshine is minimal

• improve their problem solving and coping skills
• develop and use their own support systems
• address and begin healing any grief and loss issues
• improve their self-esteem
• improve their eating and sleeping patterns
• develop a proactive and preventive depression management program.(11)

• exercise ~ our immune systems may be boosted and our endorphins released through gentle exercise programs such as yoga
• meditation ~ age-old practices ranging from simple focused breathing to chanting or singing particular phrases; focused attention on images (mandalas); and dancing in trance
• St. John's Wort ~ an herbal remedy for mild cases of depression
• support groups ~ usually led by a psychiatrist or therapist, groups can provide perspective, a sense of community, and support in fighting depression(12)

Other alternative and complementary therapies for depression include:

• acupressure and acupuncture
• aromatherapy
• ayurveda (a school of medicine from India)
• biofeedback
• homeopathy
• hypnosis
• music therapy
• nutrition and diet
• visualization(13)

Depression is a serious condition and can be life-threatening in its most severe forms. Getting help is not a failure of will or a sign of weakness ~ in fact, seeking treatment for depression is a sign of hope. Contact your doctor or other helping professional for advice on overcoming depression.