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Depression: Major Depression & Unipolar Varieties
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The Far Reaches of Depression

Rashmi Nemade, Ph.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

The seemingly contradictory list of depression symptoms (e.g. sleeping too much or too little), suggests that different people experience depression in different ways. What does not differ across individuals is the fact that this disorder can seriously impact people's health, relationships, and social functioning. Days, months, and even years can be wasted when people remain stuck in a depressive disorder.

When you are depressed, you typically do not feel like doing things for yourself. You may not feel like getting out of bed, brushing your teeth, taking a shower, or eating nutritious meals. These neglectful behaviors can lead to the development of secondary health problems such as cavities, acne, and weight loss or weight gain. If the behaviors continue for long enough, they can have serious, and even life-threatening consequences. For example, not brushing your teeth can lead to serious tooth infections, which may eventually affect your brain if left untreated. Weight gain and obesity can lead to a host of health complications such as diabetes, heart disease, and so on.

Your relationships at home and work or school can also be affected during a depressive episode. Often, people who are depressed don't have the energy to interact with others in social settings and end up withdrawing from regular social interactions. As a result, they become quite socially isolated. Social isolation is not a good thing when it comes to depression. Isolation can lead to increased negative feelings and thoughts about oneself and others, which can then contribute to more frequent or intense depressive episodes. In addition, people who are depressed are typically not fun to be around. Your negative mood and behavior can cause friends and loved ones to start avoiding you, which only serves to increase social isolation.

Depression often influences a person's ability to meet their social and occupational responsibilities. If waking up and getting out of bed is a challenge for you, then going to work may seem a nearly impossible task to accomplish. It will not come as a surprise then, that depression is the second leading cause of missed work in the United States, accounting for approximately 16 days of lost productivity annually per worker, on average. Numerous studies have tried to estimate the total economic burden of depression on society. One such study found that depression costs employers about $33 billion a year in absenteeism and inefficiencies. Depression can also affect people's ability to maintain their daily routines and activities such as answering mail and paying bills. When bills go unpaid and messages go unanswered for long periods of time, bad things can happen, such as termination of heat, electricity and other utilities, and sometimes even repossession of a home.

Seemingly inconsequential behaviors such as not paying attention to hygiene, avoiding social gatherings, and taking a few days off work for mental health purposes are not necessarily serious warning signs of a mood disorder when they occur infrequently and in isolation. However, when such behaviors become frequent, their combined impact can quickly become cumulative and destructive.

Suicide is the most tragic consequence of Major Depression. Completed suicides, and suicide attempts are shockingly common among depressed people. It is estimated that approximately 15% of people with severe Major Depression die by suicide. This statistic does not capture the enormity of the problem. For every completed suicide, there are many people who unsuccessfully attempt suicide. Even more depressed people contemplate suicide or entertain thoughts that the world would be better off without them. Because the problem of suicide is so large, and because the devastation that suicide causes families and friends of suicide victims is so overwhelming, no discussion of depression would be complete without an extended discussion of suicide and how to help prevent it from occurring. We discuss suicide in more detail at the end of this document.