Does this sound familiar? To some, it sounds like the week after a close relative passed away, or maybe the week you found out you didn't get that job you wanted. For others, it may sound like every week. So how do you know if that empty, sad feeling is just the temporary blues or a serious depression?

"I think the difference between just having the blues and depression lies in the symptoms," said Raymond Crowe, M.D., UI professor of psychiatry. "If 'the blues' persist for more than a couple of weeks and are accompanied by trouble eating, difficulty sleeping, or suicidal thoughts, you should see someone."

Crowe said there are three main types of clinical depression, each with a number of symptoms.

Major depression, or unipolar disorder, is one type of depression that is a serious medical condition today, affecting more than 17 million adults in America. The onset of this disorder usually occurs earlier in life, and women are almost twice as likely as men to develop the condition. Major depression is characterized by a number of symptoms including:

• A persistently sad, anxious or empty mood
• Loss of interest in activities previously enjoyed
• Excessive crying
• Decreased ability to concentrate and make decisions
• Decreased energy
• Thoughts of suicide or suicide attempts
• Weight gain or loss
• Social withdrawal
• Changes in sleep patterns
• Increased restlessness and irritability
• Feelings of helplessness, guilt and/or hopelessness
• Physical ailments that don't respond to standard treatment (i.e., chronic headaches).

The American Psychiatric Association says a patient must exhibit at least five of these symptoms to be diagnosed as having depression.

A second type of depression is called dysthymia, or dysthymic disorder. Dysthymia has the same symptoms as clinical depression, but usually in a less severe form. Dysthymia is classified as a separate disorder because it is more chronic, or longer lasting, than major depression. An adult must exhibit a depressed mood for at least two years, accompanied by at least two of the symptoms, to be diagnosed with dysthymia. This condition also affects women twice as often as men.

The third classification of depression, affecting over 2.3 million adults, is manic depression, or bipolar disorder. Manic depression is a cyclical illness, moving through symptoms of severe major depression to periods of extremely elevated moods, euphoria and manic behavior. People experiencing a manic period may show such behavior as extreme overspending, starting large and involved projects, and staying up all night all the time. Other manic symptoms include:

• Overly inflated self-esteem
• Decreased need for rest and sleep
• Increased distractibility
• Increased physical discomfort
• Excessive involvement in pleasurable activities that may result in painful consequence
• Increased talkativeness
• Excessive "high" feelings
• Increased sex drive
• Increased energy level
• Increased denial
• Uncharacteristically poor judgment

Manic depression affects both men and women in equal numbers, although women are more likely to experience more depressive symptoms and less manic episodes. This disorder often begins in adolescence or early adulthood. If symptoms are present before a child has reached puberty, they often are misdiagnosed as attention-deficit/hyperactivity disorder (ADHD). For a diagnosis of manic depression to be made, an individual must show both manic and depressive symptoms over a period of time.

One explanation for symptoms of depression is an imbalance of serotonin, a neurotransmitter, in the brain. "The first line of treatment for depression is usually a drug in the Prozac 'family,'" Crowe said. Prozac is a popular antidepressant that increases the level of serotonin in the brain to correct this imbalance. There are a number of the drugs in the Prozac family that work in a similar way, but differ in some of their other effects.

Crowe said there are two other classes of drugs for individuals who don't respond to Prozac, both with more side effects than drugs in the Prozac family. Medications in the third and oldest class of drugs, many from the 1960s, cause the most severe side effects, but may work best for patients who have been failed by newer drugs.

Another much less popular form of treatment for depression is electroconvulsive therapy (ECT) in which patients receive a brief application of an electric stimulus to produce a generalized seizure. Crowe said this early form of treatment is now reserved for extreme cases of depression, where the disorder is affecting an individual's physical health, causing dehydration, malnutrition or self-inflicted injuries, for example, or if the patient is suicidal. ECT also is used for psychotic depression, which involves delusions such as seeing and hearing things. ECT is used for these extreme cases because the benefits of the treatment are visible immediately.

"One of the problems with medications is that it can take from two to six weeks for them to act," Crowe said. "If you have someone who is very suicidal, they can certainly carry out a suicide in that length of time."

Depression is related to a number of factors including daily stress, predispositions in personality and major life events. Genetics also play a role in the development of the disorder.

"There is no question that genes are involved in causing depression," Crowe said. "There also is no question that they are not the end of the story."

Crowe noted that many studies are being conducted today that may allow researchers to identify genes related to depression and learn more about what causes the disease. A large cooperative study supported by the National Institutes of Health currently is underway in six locations around the country, including Iowa. The purpose of the study is to collect 800 families from across the nation in which two or more members have a form of depression. The families will then be studied to identify genes related to depression and other causes. For more information about participating in the study, call (877) 578-8845.

For more information about mental health issues, listen to University of Iowa Health Care Today to hear to hear Russel Noyes, M.D., professor in the Department of Psychiatry, speak on anxiety disorders Wednesday, May 16, at 7:40 a.m. on KXIC-AM (800), and Thursday, May 24, at 5:40 p.m. on WMT-AM (600).

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