What is Depression?

What is depression? 

Depression affects one in 15 adults in any given year. That is about approximately 6.7% of the population. Approximately one in six people (16.6%) will experience depression at some point in their life. On average, the first episode of depression usually appears in the late teens or mid-20s. women are twice as likely to suffer from depression than men. In fact, one-third of women will experience a major depressive episode in their lifetime. If a 1st° relative, such as parents or siblings has depression, there is approximately a 40% chance of that individual suffering from depression. 

Depression can negatively affect how you feel, the way you think, and how you act. Depression also can cause a loss of interest in activities you generally enjoyed, a loss of energy, and feelings of sadness. other issues in depression include difficulty with concentration, thoughts of death or suicide, problems with sleep, or changes in appetite. Fortunately, depression is treatable with 80% of patients having some response to treatment. 

Here is a bullet list of some of the symptoms of depression: 

  • loss of interest or pleasure in activities that the individual once enjoyed 
  • appetite changes such as excessive eating or weight loss. 
  • Loss of energy or increased fatigue 
  • feeling sad 
  • increase in purposeless physical activity such as pacing, handwringing, or inability to sit still. For others, there are slowed movements for slowed speech. 
  • Difficulty with concentration or making decisions. Difficulty with thinking. 
  • Thoughts of death or suicide 
  • feeling worthless or guilty 
  • increase sleep or insomnia 

In general, the symptoms of depression must last at least two weeks and be different than the prior level of functioning for the individual in order for them to be diagnosed with depression. Generally, medical conditions must be excluded as well such as thyroid problems, vitamin deficiencies, brain tumors, kidney failure, liver failure, drug addiction, and inherited metabolic conditions. 

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Grief or bereavement 

Grief or bereavement is different than depression. The loss of a loved one or job can result in feelings of sadness or grief. An individual may describe themselves as being depressed in such situations, however, this is actually just grief. Being sad is not the same as having depression. A grieving process is natural and individually experienced, but it does share some comparisons with depression. In grief, painful feelings frequently come in waves with intermixed memories of both positive memories of the deceased as well as sadness. Also, in grief self-esteem is usually maintained whereas in depression it is not. It is not unusual in grief situations for an individual to fantasize about joining the deceased loved one. In depression, the thoughts of death are usually due to one feeling worthless or undeserving of life or being unable to cope with the pain of depression. 

Related Conditions: 

Premenstrual dysphoric disorder (PMDD) 

women with PMDD have severe depression, irritability, and tension approximately a week before menstruation begins. symptoms include mood swings, anger, irritability, anxiety, tension, and depressed mood. Many of these individuals will display decreased interest in their usual activities, with difficulty concentrating, fatigue, low energy, appetite changes, food cravings, insomnia, or excessive sleepiness. There are physical symptoms associated with PMDD which include bloating or even weight gain. The symptoms frequently start 10 days before menstruation and stop shortly thereafter. PMDD generally occurs over a one-year period and must affect work and social functioning. It is felt that premenstrual dysphoric disorder affects between 2% to 6% of menstruating women every year. Treatments include antidepressants, birth control pills, and nutritional supplements. 

Persistent Depressive Disorder 

Persistent depressive disorder ( dysthymia) is a depressed mood for most of the day for at least two years on more days than not. Symptoms include: 

  • low energy 
  • poor appetite or overeating 
  • insomnia or hypersomnia 
  • feelings of hopelessness 
  • low self-esteem 
  • poor concentration 

This condition affects 0.5% of adults in the United States every year. Many patients do not seek help for this condition because they assume “they have always been this way.” This condition causes difficulty with work, social activities, and other areas of functioning. 

Risk factors for depression include: 

  • environmental factors which include physical abuse, sexual abuse, emotional abuse, lack of structure, lack of socialization, war, medical conditions, and famine. 
  • Genetics also influences depression. Depression tends to run in families. There is a 70% chance of depression occurring in identical twins if one has depression. 
  • Biochemistry: certain differences in the brain of depressed persons can increase the chance of depression. For example, Wilson’s disease is in excess of copper that results in neuropsychiatric conditions including depression. 
  • Personality: people with low self-esteem are easily overwhelmed by stress and have increased pessimism have a tendency to have increased depression experiences. 
  • Drugs and alcohol: drug abuse and alcoholism can lead to chronic states of depression 

How do we treat depression? 


brain chemistry in part plays a role in depression. Antidepressants, in a more simplified description, effectively modify brain chemistry, in particular serotonin, norepinephrine, and dopamine. Medications usually require up to two months of therapy for them to exert their maximum effect if they work at all. This STAR*D trial demonstrated that one third of patients have remission with their initial course of treatment. If a person fails to sequential medications, there is less than a 10% chance that the third trial of medication will produce results in their depression. It is important for the person to be compliant with their treatment as well as take the appropriate dose of their medication for the appropriate time for the effect to be maximized. It is important to maintain remission once it is achieved by the continuation of medication. Depression is a neurodegenerative process, and each subsequent bout of depression increases the likelihood of another bout. 


talk therapy is frequently utilized alone or in combination with medications for moderate to severe depression. Cognitive-behavioral therapy is effective in treating depression. It is important for the individual to recognize distorted or negative thinking with the goal of changing thoughts and behaviors in response to challenges or stresses so that they respond in a more positive manner. 

Electroconvulsive therapy (ECT) 

ECT is a treatment reserve for severe depression when the response has been minimal otherwise. Generally ECT is performed 2 to 3 times per week for a total of 6 to 12 treatments. ECT involves electrical stimulation of the brain while the patient is under anesthesia. 

Ketamine Therapy 

Ketamine therapy is a highly effective and robust method of the rapid reduction of depression. Ketamine can be administered as Spravato, an in-office nasal spray, or as an intravenous drip. 70% of patients who undergo this therapy have either a significant response or remission of their depression. 

If you are suffering from PTSD, depression, or anxiety, you may want to consider ketamine therapies as a rapid and robust treatment for your symptoms. Ketamine offers a high efficacy rate that has been reproducible across multiple trials. If you have no significant medical problems that require a prior medical evaluation such as liver failure, kidney failure, schizophrenia, heart attack, or stroke, then you are most likely a candidate for this therapy. In the Virginia, Maryland, and D.C. areas, reach out to Nova Health Recovery in Alexandria, Virginia to obtain a consultation for ketamine treatment.  

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