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The many faces of depression

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Understanding Depression
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Depression is more than a passing bout of sadness or dejection, or feeling down in the dumps. It can leave you feeling continuously burdened and can sap the joy out of once-pleasurable activities. Effective treatment can lighten your mood, strengthen your connections with loved ones, allow you to find satisfaction in interests and hobbies, and make you feel more like yourself again.

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Depression isn't a one-size-fits-all illness. Just like a rash or heart disease, depression can take many forms. As you'll see, there's a cluster of symptoms that are typically present, but one person's experience of depression often differs from another's. Definitions of depression — and the therapies designed to ease this disease's grip — also continue to evolve.

What is major depression?

Major depression may make you feel as though work, school, relationships, and other aspects of your life have been derailed or put on hold indefinitely. You feel constantly sad or burdened, or you lose interest in all activities, even those you previously enjoyed. This holds true nearly all day, on most days, and lasts at least two weeks. During this time, you also experience at least four of the following signs of depression:

  • a change in appetite that sometimes leads to weight loss or gain
  • insomnia or (less often) oversleeping
  • a slowdown in talking and performing tasks or, conversely, restlessness and an inability to sit still
  • loss of energy or feeling tired much of the time
  • problems concentrating or making decisions
  • feelings of worthlessness or excessive, inappropriate guilt
  • thoughts of death or suicide, or suicide plans or attempts.

Other signs can include a loss of sexual desire, pessimistic or hopeless feelings, anxiety, and physical symptoms such as headaches, unexplained aches and pains, or digestive problems.

What is dysthymia?

Mental health professionals use the term dysthymia (dis-THIGH-me-ah) to refer to a low-level drone of depression that lasts for at least two years in adults or one year in children and teens. While not as crippling as major depression, its persistent hold can keep you from feeling good and can intrude upon your work, school, and social life. Unlike major depression, in which relatively short episodes may be separated by considerable spans of time, dysthymia lasts for an average of at least five years.

If you suffer from dysthymia, more often than not you feel depressed during most of the day. You may carry out daily responsibilities, but much of the zest is gone from your life. Your depressed mood doesn't lift for more than two months at a time, and you also have at least two of the following symptoms:

  • overeating or loss of appetite
  • insomnia or sleeping too much
  • tiredness or lack of energy
  • low self-esteem
  • trouble concentrating or making decisions
  • hopelessness.

Sometimes an episode of major depression occurs on top of dysthymia; this is known as double depression.

What is bipolar disorder?

Bipolar disorder always includes one or more episodes of mania, characterized by high mood, grandiose thoughts, and erratic behavior. It also often includes episodes of depression. During a typical manic episode, you would feel terrifically elated, expansive, or irritated over the course of a week or longer. You would also experience at least three of the following symptoms:

  • grandiose ideas or pumped-up self-esteem
  • far less need for sleep than normal
  • an urgent desire to talk
  • racing thoughts and distractibility
  • increased activity that may be directed to accomplishing a goal or expressed as agitation
  • a pleasure-seeking urge that might get funneled into sexual sprees, overspending, or a variety of schemes, often with disastrous consequences.

How to cope when a loved one is depressed, suicidal, or manic

Like a pebble thrown into a pond, depression, dysthymia, and bipolar disorder create ripples that spread far from their immediate point of impact. Those closest to people who have these illnesses often suffer alongside them. It's upsetting and often frustrating to deal with the inevitable fallout. But you can do a lot to help a loved one and yourself handle this difficult period.

Encourage him or her to get treatment and stick with it. Remind the person about taking medication or keeping therapy appointments. Don't ignore comments about suicide. If you believe your loved one is suicidal, call his or her doctor or therapist. If neither is available, call a local crisis center or emergency room.

Care for yourself. Being a caretaker is a difficult job. You may want to seek individual therapy or join a support group. Numerous mental health organizations sponsor such groups and can also provide you with information on the illness and the latest treatments.

Offer emotional support. Your patience and love can make a huge difference. Ask questions and listen carefully to the answers. Try not to brush off or judge the other person's feelings, but do offer hope. Suggest activities that you can do together, and keep in mind that it takes time to get better. Remind yourself that a disease is causing your loved one to act differently or perhaps be difficult. Do not blame him or her, just like you wouldn't if it were chronic physical pain that caused the person to change in certain ways.

Try to prevent reckless acts during manic episodes. It's all too common for a person to make poor decisions when manic, so it's a good idea to try to prevent this problem by limiting access to cars, credit cards, and bank accounts. Watch for signs that a manic episode is emerging. Disruption of sleep patterns can trigger an episode, so support your loved one in keeping a regular sleep schedule. Consistent patterns for other activities such as eating, exercising, and socializing may also help.


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Healthy Eating: A guide to the new nutrition
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Eat real food. That’s the essence of today’s nutrition message. Our knowledge of nutrition has come full circle, back to eating food that is as close as possible to the way nature made it. Based on a solid foundation of current nutrition science, Harvard’s Special Health Report Healthy Eating: A guide to the new nutrition describes how to eat for optimum health.

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Olive oil and health

Q. I've read that olive oil is good for health, but is extra virgin olive oil worth the extra cost, or is it just another trendy gimmick?

A. You probably should be asking a chef, not a doctor. Extra virgin olive oil is trendy — so popular, in fact, that menus in many high-style restaurants boast of serving "EVOO," the in-crowd's acronym for extra virgin olive oil.

People in the know say that extra virgin olive oil has a characteristic zesty, almost pungent flavor that is missing from ordinary olive oil, which is bland, if less expensive. There is a chemical explanation for the difference between the two types of olive oil, and it may have implications for health as well as flavor.

Like other edible seed oils, olive oil is composed of a mixture of fatty acids. In the case of olive oil, about 75% of the fat is oleic acid, a mono-unsaturated fatty acid in the omega-9 group. Oleic acid is also a major constituent of canola oil, and it's equally present in extra virgin and regular olive oil. But there is a difference in the minor components of the olive oils. Unlike the others, extra virgin olive oil is obtained from the first pressing of olives; the other oils are extracted by solvents, heating, or both. As a result, extra virgin olive oil retains phenols. Various phenols, such as oleuropein, are antioxidants, and they may explain why olive oil helps protect LDL ("bad") cholesterol from the oxidative damage that enables it to trigger inflammatory damage in artery walls. And because of the way it's made, extra virgin olive oil has other vascular, anti-clotting, and anti-inflammatory properties that may be helpful.

A European trial tested this theory. Two hundred healthy male volunteers were randomly assigned to drink just under an ounce of low-, medium-, or high-phenol olive oil a day. In just three weeks, the high-phenol oil increased levels of HDL ("good") cholesterol and reduced evidence of oxidative stress.

Do these chemical changes translate into clinical benefit and better health? It's too early to say. For that matter, although scientists are confident that olive oil is better for the heart (and prostate) than saturated fat or trans fat, they are not completely sure that olive oil promotes health because of its own properties or just because it displaces harmful fats from the diet.

Until scientists can tell us more, we won't know if the phenols and other minor constituents of extra virgin olive oil actually make a difference for health. If they make a difference in taste for you, join the trendy EVOO crowd, but as with all high-calorie foods, use in moderation.

— Harvey B. Simon, M.D.
Editor, Harvard Men's Health Watch