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What is the clinical definition of depression?
The American Psychiatric Association defines depression this way:
"Depression...is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. ... Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home."
Depression can happen at any age, but we are told that it is not the same as grief after the loss of a loved one. The American Psychiatric Association makes this distinction between depression and grief:
"In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for ... two weeks. In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common."
[Author's Note: These descriptions are, probably on purpose, somewhat brief in detail. To suggest, for instance, that grief will only last two weeks seems somewhat ludicrous. Many of us have lost loved ones and we know that the grieving period goes on for many weeks and even years — and doesn't always end. Instead, we simply learn to live with the reality as we have no other choice.]
What are the symptoms of depression?
The American Psychiatric Association lists the following symptoms of depression:
- Feeling sad;
- Having a depressed mood;
- Loss of interest or pleasure in activities once enjoyed;
- Changes in appetite — weight loss or gain unrelated to dieting;
- Trouble sleeping or sleeping too much;
- Loss of energy or increased fatigue;
- Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others);
- Feeling worthless or guilty;
- Difficulty thinking, concentrating or making decisions; and,
- Thoughts of death or suicide.
"Symptoms must last at least two weeks for a diagnosis of depression. All of us have some of these emotions occasionally, but depression occurs when they are long-lasting and ever-pervading." 2
What are the causes of depression?
There are four things which might play a role in depression which are listed by the American Psychiatric Association on their website. They are:
- Biochemistry: Certain chemicals in the brain may contribute to depression. Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out other causes.
- Genetics: Unfortunately, depression can run in families. If a person has a relative (parent or sibling) who had depression, their chances increase of also having it.
- Personality: People who have low self-esteem or are generally pessimistic are more likely to feel overwhelmed and depressed.
- Environmental Factors: Exposure to violence, neglect, abuse or poverty (whether current or long-ago) may make a person more vulnerable to depression.
"Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, [it] first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime." 3
What are the treatments for depression?
Most people are aware of medications known as anti-depressants which might be prescribed to help modify brain chemistry. Improvement may happen within a few weeks, but usually it takes several months for the person to truly feel better. Medication may have to be adjusted throughout the process.
Cognitive Behaviour Therapy (CBT) can be effective for some people, and it is often used without medication. This work can be done with a therapist, and it might involve another person (such as the person's spouse). For those with "mild" depression, psychotherapy may help within weeks.
Finally, Electroconvulsive Therapy (ECT) is most often used for patients with severe major depression who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia and is used two to three times a week for a total of 6 to 12 treatments. Says the American Psychiatric Association: "This treatment has been used since the 1940s, and many years of research have led to major improvements. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant." [Author's Note: As mentioned in the sidebar, my mother had this treatment in the 1960's. Most everyone has seen films of this procedure and are somewhat repelled by it. While psychiatrists say that "research has led to major improvements," I am not so sure that this is, as they say, safe and effective. It is mentioned here because the American Psychiatric Association mentions it, so it is clearly being used. For me, more research is needed to "prove" that this treatment will heal and not harm. It is still a controversial issue.]
The following comments about ECT can be found on the Mayo Clinic page:
" ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. [It] often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone....ECT is much safer today. Although ECT may still cause some side effects, it now uses electric currents given in a controlled setting to achieve the most benefit with the fewest possible risks."
"Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects."
To read the full article, go here: Electric Convulsive Therapy.
The Canadian Psychiatric Association puts a little more reservation on the use of ECT, but it is still being used. A 2008 article from the CBC says this:
"Despite protests calling for a ban on the treatment, electroshock therapy is frequently used by Canadian psychiatrists to treat severe depression. The Canadian Institute for Health Information (CIHI) estimates that last year, the procedure, which dates back to 1938 and involves passing electrical currents though the brain to trigger seizures, was used more than 15,000 times in the country. The figure has remained virtually unchanged since 2002, CIHI says, showing that the popularity of the procedure remains strong."
"A report in the Canadian Medical Association Journal last week shows the procedure is commonly used to treat drug-resistant depression in seniors."
The full version of this article is still on the CBC website, but not available to you unless you have a subscription. If you do, you can find it under this title: "Despite criticism, ECT commonly used in depression."
What about exercise and depression? Can it help?
First, remember that there are many levels of depression and anxiety. Those who suffer from severe depression may not find that exercise helps them as much as those who suffer from mild depression.
A very small study completed in Germany in 2001 concluded that "aerobic exercise can produce substantial improvement in mood in patients with major depressive disorders in a short time." But the writers of the study said that much more investigative study was needed.
Another study completed by three Ph.D.'s in psychology came to similar conclusions. With little effort, one can find many studies that conclude that exercise will improve mood, but many of them are small, somewhat inconclusive, and insist that "more study" is needed.
Whether or not we have strong studies to support the assumption that exercise will improve mood, we know that exercise:
- Reduces immune system chemicals that can make depression worse;
- Increases levels of endorphins and seratonin which are natural mood enhancers;
- May help to improve sleep patterns; and,
- Limits the effect of stress on your brain.
We know that exercise must happen regularly in order to improve mood. Evidence has suggested that exercise may be an often-neglected intervention in improving mental health care. Aerobic exercises — including jogging, swimming, cycling, walking, gardening, and dancing — have been proved to reduce anxiety and depression.
For more on this topic, see Exercise and Mood.
Is there light at the end of the tunnel?
As a fitness instructor, it's not uncommon for me to talk to participants who are suffering from depression. Symptoms will range from mild — "I found it hard to get out of bed this morning but I'm here!" — to quite severe — "I don't want to go anywhere!" It has been most difficult for me to find a way to encourage those with severe depression to break free from their anxieties and attend class. This seems to be their greatest challenge: Just getting there.
If you can manage to take care of yourself through exercise, meditation, yoga, or whatever you have found to help you cope, then I congratulate you for your efforts. It's not easy. If you are unable to deal with it alone, I encourage you to get medical assistance and advice.
This article is part of a series about various health conditions and the benefits of exercise. The other articles are:
- Exercise and Allergies
- Exercise and Arthritis
- Exercise and Asthma
- Exercise and Balance
- Exercise and Cancer
- Exercise and Chronic Pain
- Exercise and Circulation
- Exercise and COPD
- Exercise and Dementia
- Exercise and Diabetes
- Exercise and Heart Disease
- Exercise and Hypertension
- Exercise and Lifestyle and Older Adults: Recent Research
- Exercise and Mood
- Exercise and Osteoporosis
- Exercise and Our Brain
- Exercise and Pain vs. Burn: Will it ever stop hurting?
- Exercise and Parkinson's
- Exercise and Sleep
- Exercise and Stroke
- Exercise and Viruses: Exercise Immunology
I am a BCRPA-certified fitness instructor in Vancouver, BC. I teach four classes at the West End Community Centre in Vancouver, BC, mostly designed for the older adult. The Inevitable Disclaimer: Everything published here expresses only my opinion, based on my training and research. What you do with the information is entirely your own responsibility. I am not liable for any injury you suffer that seems to be related to anything you read here. Always consult your doctor before beginning an exercise program. For other articles, return to the table of contents.