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  • I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depresson, Terrence Real, Scribner, 1998.




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Depression affects all of us at one time or another. Unfortunately some people struggle with it for a lifetime. However, the average person knows very little about the different types of depression.


  • "Exogenous" depression
    This is depression that is primarily the result of upsetting and disappointing circumstances. It tends to resolve as circumstances improve or as the individual adjusts to the circumstances. Exogenous means coming from without.
  • "Endogenous" depression
    This is depression that is more related to body chemistry. It can confuse individuals because their circumstances do not seem to warrant the depression. Endogenous means coming from within.
  • Bipolar Disorder I and II
    These are additional types of depression that are also tied to body chemistry--the depressive side of Bipolar Disorder. Type I has full manic episodes and major depressive episodes. These usually alternate over time. Type II involves much less severe mood swings, never having a full manic episode. They also typically alternate over time.

    Bipolar II disorder has been diagnosed much more in recent years than in the past. It is becoming increasingly recognized as a significant factor in depression.
  • Seasonal Affective Disorder
    And finally, there is a type of depression that happens when a person's moods are unusually affected by periods of light and darkness. In the winter they are predictably depressed. In summer, their mood is much more positive. The treatment of choice for this includes phototherapy--sitting in front of a bright light for 20 minutes or so on dark days. The light apparently affects melatonin in the body and affects ones mood.

Depression can vary in intensity. A common distinction is made between a milder, more chronic depression that lasts for at least two years (called "Dysthymia") and a much more severe, shorter depression (called "Major Depression"). In very severe depression a person can have psychotic sypmtoms. This is another indicator of the chemical involvement the brain can have with depression.

Symptoms of depression

Here are the diagnostic criteria for Major Depression:


  • At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning. At least one of the symptoms is either (a) depressed mood or (b) loss of interest or pleasure in normal activities. (Do not include symptoms that are clearly due to a general medical condition or psychosis only.)
    • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). In children and adolescents this may show up as irritability.
    • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
    • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. In children, consider failure to make expected weight gains.
    • Insomnia or hypersomnia nearly every day
    • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
    • Fatigue or loss of energy nearly every day
    • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
    • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
    • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
  • In addition, all of the following must be true
    • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
    • The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
    • The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

What about treatment?

Treatment for depression usually involves several components:


  • Cognitive-behavioral intervention
    When one is overwhelmed by sad and hopeless feelings, a focus on correcting specific distorted thinking can help reduce feelings and behaviors that contribute to being depressed.
  • Medication
    If the depression is serious enough, medication may be useful. This is often a temporary measure to keep one's feelings from "bottoming out" while working therapeutically to lessen depression. It is often difficult for us to accept that our feelings are as affected to our biochemistry as they are. Of course, biochemistry is only one factor.
  • Therapy
    Talking about ones concerns in therapy and gaining hope and practical help can reduce the effects on ones life of previous negative experiences. More experiential forms of therapy like Gestalt therapy can be very helpful also.
  • Support
    It can come from support groups, therapy groups, or friends. Isolation feeds depression. So does shame.