What Is Depression?

Depression (major depressive disorder) is a common and serious medical illness that
negatively affects how you feel, the way you think and how you act. Fortunately, it is
also treatable. 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 symptoms can vary from mild to severe and can include:

o Feeling sad or having a depressed mood

o Loss of interest or pleasure in activities once enjoyed
o Changes in appetite — weight loss or gain unrelated to dieting
o Trouble sleeping or sleeping too much
o Loss of energy or increased fatigue
o Increase in purposeless physical activity (e.g., hand-wringing or pacing) or
slowed movements and speech (actions observable by others)
o Feeling worthless or guilty
o Difficulty thinking, concentrating or making decisions
o Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of 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 general medical causes.

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, 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.

Depression Is Different From Sadness or Grief/Bereavement

The death of a loved one, loss of a job or the ending of a relationship are difficult
experiences for a person to endure. It is normal for feelings of sadness or grief to
develop in response to such situations. Those experiencing loss often might describe
themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural
and unique to each individual and shares some of the same features of depression.
Both grief and depression may involve intense sadness and withdrawal from usual
activities. They are also different in important ways:
 o 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 most of two weeks.
o In grief, self-esteem is usually maintained. In major depression, feelings of
worthlessness and self-loathing are common.
o For some people, the death of a loved one can bring on major depression.
Losing a job or being a victim of a physical assault or a major disaster can lead to
depression for some people. When grief and depression co-exist, the grief is
more severe and lasts longer than grief without depression. Despite some
overlap between grief and depression, they are different. Distinguishing between
them can help people get the help, support or treatment they need.

Risk Factors for Depression

Depression can affect anyone—even a person who appears to live in relatively ideal
circumstances.

Several factors can play a role in depression:

o Biochemistry: Differences in certain chemicals in the brain may contribute to

symptoms of depression.
o Genetics: Depression can run in families. For example, if one identical twin has
depression, the other has a 70 percent chance of having the illness sometime in
life.
o Personality: People with low self-esteem, who are easily overwhelmed by stress,
or who are generally pessimistic appear to be more likely to experience
depression.
o Environmental factors: Continuous exposure to violence, neglect, abuse or
poverty may make some people more vulnerable to depression.

How Is Depression Treated?

Depression is among the most treatable of mental disorders. Between 80 percent and
90 percent of people with depression eventually respond well to treatment. Almost all
patients gain some relief from their symptoms.

Before a diagnosis or treatment, a health professional should conduct a thorough

diagnostic evaluation, including an interview and possibly a physical examination. In
some cases, a blood test might be done to make sure the depression is not due to a
medical condition like a thyroid problem. The evaluation is to identify specific symptoms,
medical and family history, cultural factors and environmental factors to arrive at a
diagnosis and plan a course of action.

Medication: Brain chemistry may contribute to an individual’s depression and may factor

into their treatment. For this reason, antidepressants might be prescribed to help modify
one’s brain chemistry. These medications are not sedatives, “uppers” or tranquilizers.
They are not habit-forming. Generally antidepressant medications have no stimulating
effect on people not experiencing depression.

Antidepressants may produce some improvement within the first week or two of use.
Full benefits may not be seen for two to three months. If a patient feels little or no
improvement after several weeks, his or her psychiatrist can alter the dose of the
medication or add or substitute another antidepressant. In some situations other
psychotropic medications may be helpful. It is important to let your doctor know if a
medication does not work or if you experience side effects.

Psychiatrists usually recommend that patients continue to take medication for six or
more months after symptoms have improved. Longer-term maintenance treatment may
be suggested to decrease the risk of future episodes for certain people at high risk.

Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment

of mild depression; for moderate to severe depression, psychotherapy is often used in
along with antidepressant medications. Cognitive behavioral therapy (CBT) has been
found to be effective in treating depression. CBT is a form of therapy focused on the
present and problem solving. CBT helps a person to recognize distorted thinking and
then change behaviors and thinking.

Psychotherapy may involve only the individual, but it can include others. For example,
family or couples therapy can help address issues within these close relationships.
Group therapy involves people with similar illnesses.

Depending on the severity of the depression, treatment can take a few weeks or much
longer. In many cases, significant improvement can be made in 10 to 15 sessions.

Electroconvulsive Therapy (ECT) is a medical treatment most commonly used for

patients with severe major depression or bipolar disorder who have not responded to
other treatments. It involves a brief electrical stimulation of the brain while the patient is
under anesthesia. A patient typically receives ECT two to three times a week for a total
of six to 12 treatments. ECT 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.

Self-help and Coping

There are a number of things people can do to help reduce the symptoms of
depression. For many people, regular exercise helps create positive feeling and
improve mood. Getting enough quality sleep on a regular basis, eating a healthy diet
and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

Depression is a real illness and help is available. With proper diagnosis and treatment,
the vast majority of people with depression will overcome it. If you are experiencing
 symptoms of depression, a first step is to see your family physician or psychiatrist. Talk
about your concerns and request a thorough evaluation. This is a start to addressing
mental health needs.

Related Conditions

o Peripartum depression (previously postpartum depression)

o Seasonal depression (Also called seasonal affective disorder)
o Persistent depressive disorder (previously dysthymia)
o Premenstrual dysphoric disorder
o Disruptive mood dysregulation disorder
o Bipolar disorders

References

 American Psychiatric Association. Diagnostic and Statistical Manual of Mental

Disorders (DSM-5), Fifth edition. 2013.
 National Institute of Mental Health. (Data from 2013 National Survey on Drug
Use and Health.) www.nimh.nih.gov/health/statistics/prevalence/major-depression-
among-adults.shtml
 Kessler, RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV
Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry.
2005;62(6):593602. http://archpsyc.jamanetwork.com/article.aspx?articleid=208678

Physician Review By:

Ranna Parekh, M.D., M.P.H.

January 2017

Depression (mood)
From Wikipedia, the free encyclopedia

"Despair" redirects here. For other uses of despair, see Despair (disambiguation). For the mood
disorder, see Major depressive disorder.

"Hopelessness" redirects here. For the album by ANOHNI, see Hopelessness (album).

Depression
 Lithograph of a man diagnosed as suffering from melancholia with

strong suicidal tendency (1892)

Classification and external resources

Specialty Psychiatry, psychology

[edit on Wikidata]

Depression is a state of low mood and aversion to activity that can affect a person's thoughts,

behavior, feelings, and sense of well-being. A depressed mood is a normal temporary reaction to life
events such as loss of a loved one. It is also a symptom of some physical diseases and a side effect
of some drugs and medical treatments. Depressed mood is also a symptom of some mood
disorders such as major depressive disorder or dysthymia.[1]
People with a depressed mood may be notably sad, anxious, or empty; they may also feel notably
hopeless, helpless, dejected, or worthless. Other symptoms expressed may include senses of guilt,
irritability, or anger.[2][3] Further feelings expressed by these individuals may include feeling ashamed
or an expressed restlessness. These individuals may notably lose interest in activities that they once
considered pleasurable to family and friends or otherwise experience either a loss of appetite or
overeating. Experiencing problems concentrating, remembering general facts or details, otherwise
making decisions or experiencing relationship difficulties may also be notable factors in these
individuals' depression and may also lead to their attempting or actually dying by suicide.
Depression is one of the major causes or risk factors of suicide among adolescents, and more than
half suicide victims in this age group are diagnosed with depressive orders before their demise.
[4]
 Depression among teenagers is also a leading cause of educational and social impairments,
substance abuse, obesity, and increased risk of smoking. [4] Expressed insomnia, excessive
 sleeping, fatigue, and vocalizing general aches, pains, and digestive problems and a reduced energy
may also be present in individuals experiencing depression. [5]

Contents
  [hide] 

 1Factors
o 1.1Life events
o 1.2Personality
o 1.3Gender identity and sexuality
o 1.4Medical treatments
o 1.5Substance-induced
o 1.6Non-psychiatric illnesses
o 1.7Psychiatric syndromes
o 1.8Historical legacy
 2Assessment
 3Management
 4See also
 5References
 6External links

Factors[edit]
Life events[edit]
Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse,
and unequal parental treatment of siblings can contribute to depression in adulthood. [6][7] Childhood
physical or sexual abuse in particular significantly correlates with the likelihood of experiencing
depression over the life course.[8]
Life events and changes that may precipitate depressed mood include (but are not limited to):
childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education,
family, living conditions etc.), a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved
one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation,
and catastrophic injury.[9][10][11] Adolescents may be especially prone to experiencing
depressed mood following social rejection, peer pressure and bullying.[12]
Personality[edit]
High scores on the personality domain neuroticism make the development of depressive symptoms
as well as all kinds of depression diagnoses more likely, [13] and depression is associated with
low extraversion.[14]
Gender identity and sexuality[edit]
Studies have shown that those who fall into minorities due to either their gender identity or sexual
orientation (such as those that identify as LGBT), are more prone to depression.[15]
Medical treatments[edit]
Depression may also be iatrogenic (the result of healthcare), such as drug induced depression.
Therapies associated with depression include interferon therapy, beta-
blockers, Isotretinoin, contraceptives,[16] cardiac agents, anticonvulsants, antimigraine
drugs, antipsychotics, and hormonal agents such as gonadotropin-releasing hormone agonist.[17]
Substance-induced[edit]
Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal,
and from chronic use. These include alcohol, sedatives (including
prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs such as
heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants.[18]
Non-psychiatric illnesses[edit]
Main article: Depression (differential diagnoses)

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies,

neurological conditions[19] and physiological problems, including hypoandrogenism (in
men), Addison's disease, Cushing's syndrome, hypothyroidism, Lyme disease, multiple
sclerosis, Parkinson's disease, chronic pain, stroke,[20] diabetes,[21] and cancer.[22]
Psychiatric syndromes[edit]
Main article: Depressive mood disorders

A number of psychiatric syndromes feature depressed mood as a main symptom. The mood

disorders are a group of disorders considered to be primary disturbances of mood. These
include major depressive disorder (MDD; commonly called major depression or clinical depression)
where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly
all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet
the severity of a major depressive episode. Another mood disorder, bipolar disorder, features one or
more episodes of abnormally elevated mood, cognition and energy levels, but may also involve one
or more episodes of depression. [23] When the course of depressive episodes follows a seasonal
pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as
a seasonal affective disorder. Outside the mood disorders: borderline personality disorder often
features an extremely intense depressive mood; adjustment disorder with depressed mood is a
mood disturbance appearing as a psychological response to an identifiable event or stressor, in
which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for
a major depressive episode;[24]:355 and posttraumatic stress disorder, an anxiety disorder that
sometimes follows trauma, is commonly accompanied by depressed mood. [25] Depression is
sometimes associated with substance use disorder. Both legal and illegal drugs can cause
substance use disorder.[26][unreliable medical source?]
Historical legacy[edit]
Main article: Dispossession, oppression and depression

Researchers have begun to conceptualize ways in which the historical legacies of racism and
colonialism may create depressive conditions.[27][28]

Assessment[edit]
Questionnaires and checklists such as the Beck Depression Inventory or the Children's Depression
Inventory can be used by a mental health provider to help detect, and assess the severity of
depression.[29] The Seasonal Pattern Assessment Questionnaire can be used to screen for seasonal
affective disorder. Semi structured interviews such as the Kiddie Schedule for Affective Disorders
and Schizophrenia (KSADS) and the Structured Clinical Interview for DSM-IV (SCID) are used for
diagnostic confirmation of depression.
Management[edit]
Depressed mood may not require professional treatment, and may be a normal temporary reaction
to life events, a symptom of some medical condition, or a side effect of some drugs or medical
treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead
to a diagnosis of a psychiatric or medical condition which may benefit from treatment. [30][unreliable medical
source?]
 Different sub-divisions of depression have different treatment approaches. [31] In the United
States, it has been estimated that two thirds of people with depression do not actively seek
treatment.[32] The World Health Organisation (WHO) has predicted that by 2030, depression will
account for the highest level of disability accorded any physical or mental disorder in the world
(WHO, 2008).[33]
The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate
that antidepressants should not be routinely used for the initial treatment of mild depression,
because the risk-benefit ratio is poor.[34] A recent meta-analysis also indicated that most
antidepressants, besides fluoxetine, do not seem to offer a clear advantage for children and
adolescents in the acute treatment of major depressive disorder. [35]

See also[edit]
 Cognitive theory of depression
 Behavioral theories of depression
 Biology of depression
 Evolutionary approaches to depression
 Existential crisis
 Feeling
 Melancholia
 Tripartite Model of Anxiety and Depression

References[edit]
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American Psychiatric Association. 2013.
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3. Jump up^ "Depression (major depressive disorder)". Angry outbursts, irritability or frustration,
even over small matters
4. ^ Jump up to:a b Thapar, Anita; Collishaw, Stephan; Pine, Daniel S; Thapar, Ajay K
(2012).  "Depression in adolescence".  The Lancet. 379(9820): 1056–1067.
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6. Jump up^ Christine Heim; D. Jeffrey Newport; Tanja Mletzko; Andrew H. Miller; Charles B.
Nemeroff (July 2008). "The link between childhood trauma and depression: Insights from HPA axis
studies in humans".  Psychoneuroendocrinology.  33  (6): 693–
710.  doi:10.1016/j.psyneuen.2008.03.008. PMID 18602762. Retrieved  20 April 2014.
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Differentiation and Depressive Symptoms Among Adult Children". Journal of Marriage and
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2014). "Sexual and physical abuse in childhood is associated with depression and anxiety over the life
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72.  doi:10.1007/s00038-013-0519-5. PMID 24122075.
9. Jump up^ Schmidt, Peter (2005). "Mood, Depression, and Reproductive Hormones in the
Menopausal Transition". The American Journal of Medicine. 118 Suppl 12B (12): 54–
8. doi:10.1016/j.amjmed.2005.09.033.  PMID  16414327.
10. Jump up^ Rashid, T.; Heider, I. (2008).  "Life Events and Depression"  (PDF). Annals of
Punjab Medical College. 2  (1). Retrieved  15 October 2012.
11. Jump up^ Mata, D. A.; Ramos, M. A.; Bansal, N; Khan, R; Guille, C; Di Angelantonio, E; Sen,
S (2015).  "Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A
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2383.  doi:10.1001/jama.2015.15845. PMC  4866499  . PMID 26647259.
12. Jump up^ Davey, C. G.; Yücel, M; Allen, N. B. (2008). "The emergence of depression in
adolescence: Development of the prefrontal cortex and the representation of reward".  Neuroscience
& Biobehavioral Reviews.  32  (1): 1–19. doi:10.1016/j.neubiorev.2007.04.016. PMID 17570526.
13. Jump up^ Jeronimus; et al. (2016). "Neuroticism's prospective association with mental
disorders: A meta-analysis on 59 longitudinal/prospective studies with 443 313
participants".  Psychological Medicine. 46 (14): 2883–
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14. Jump up^ Kotov; et al. (2010). "Linking "big" personality traits to anxiety, depressive, and
substance use disorders: a meta-analysis".  Psychological Bulletin. 136 (5): 768–
821.  doi:10.1037/a0020327.  PMID  20804236.
15. Jump up^ Plöderl, M; Tremblay, P (2015). "Mental health of sexual minorities. A systematic
review". International review of psychiatry (Abingdon, England). 27 (5): 367–
85.  doi:10.3109/09540261.2015.1083949.  PMID  26552495.
16. Jump up^ Rogers, Donald; Pies, Ronald (9 January 2017). "General Medical Drugs
Associated with Depression".  Psychiatry (Edgmont).  5 (12): 28–41. ISSN 1550-5952.  PMC 2729620 
.  PMID  19724774.
17. Jump up^ Botts, S; Ryan, M. Drug-Induced Diseases Section IV: Drug-Induced Psychiatric
Diseases Chapter 18: Depression. pp. 1–23.
18. Jump up^ American Psychiatric Association (2013). Diagnostic and statistical manual of
mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
19. Jump up^ Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological
Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM,
Jankovic J (eds.) Butterworth Heinemann. 12 April 2012. ISBN 978-1437704341
20. Jump up^ Saravane, D; Feve, B; Frances, Y; Corruble, E; Lancon, C; Chanson, P; Maison,
P; Terra, JL; et al. (2009). "Drawing up guidelines for the attendance of physical health of patients
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9. doi:10.1016/j.encep.2008.10.014.  PMID  19748369.
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1276–86. doi:10.1016/j.psyneuen.2011.03.005.  PMID  21474250.
22. Jump up^ Li, M; Fitzgerald, P; Rodin, G (2012). "Evidence-based treatment of depression in
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96.  doi:10.1200/JCO.2011.39.7372.  PMID  22412144.
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DC: American Psychiatric Publishing. p. 1296.
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Publishing, Inc. ISBN 0-89042-025-4.
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90.  doi:10.1016/j.amjmed.2005.09.027. PMID 16651048.
 Depression
Overview

Depression (major depressive disorder or clinical depression) is a common but serious mood
disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities,
such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be
present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique
circumstances, such as:

 Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least
two years. A person diagnosed with persistent depressive disorder may have episodes of major
depression along with periods of less severe symptoms, but symptoms must last for two years to be
considered persistent depressive disorder.
 Postpartum depression is much more serious than the “baby blues” (relatively mild depressive
and anxiety symptoms that typically clear within two weeks after delivery) that many women experience
after giving birth. Women with postpartum depression experience full-blown major depression during
pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and
exhaustion that accompany postpartum depression may make it difficult for these new mothers to
complete daily care activities for themselves and/or for their babies.
 Psychotic depression occurs when a person has severe depression plus some form of psychosis,
such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others
cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such
as delusions of guilt, poverty, or illness.
 Seasonal affective disorder is characterized by the onset of depression during the winter
months, when there is less natural sunlight. This depression generally lifts during spring and summer.
Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain,
predictably returns every year in seasonal affective disorder.
 Bipolar disorder is different from depression, but it is included in this list is because someone
with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major
depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme
high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Examples of other types of depressive disorders newly added to the diagnostic classification
of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and
adolescents) and premenstrual dysphoric disorder (PMDD).

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly
every day, for at least two weeks, you may be suffering from depression:

 Persistent sad, anxious, or “empty” mood

 Feelings of hopelessness, or pessimism
 Irritability
 Feelings of guilt, worthlessness, or helplessness
 Loss of interest or pleasure in hobbies and activities
 Decreased energy or fatigue
 Moving or talking more slowly
 Feeling restless or having trouble sitting still
 Difficulty concentrating, remembering, or making decisions
 Difficulty sleeping, early-morning awakening, or oversleeping
 Appetite and/or weight changes
 Thoughts of death or suicide, or suicide attempts
 Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or
that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few
symptoms while others may experience many. Several persistent symptoms in addition to low
mood are required for a diagnosis of major depression, but people with only a few – but
distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The
severity and frequency of symptoms and how long they last will vary depending on the
individual and his or her particular illness. Symptoms may also vary depending on the stage of
the illness.

Risk Factors

Depression is one of the most common mental disorders in the U.S. Current research suggests
that depression is caused by a combination of genetic, biological, environmental, and
psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized
as occurring in children and adolescents, although it sometimes presents with more prominent
irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high
levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical
illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are
often worse when depression is present. Sometimes medications taken for these physical
illnesses may cause side effects that contribute to depression. A doctor experienced in treating
these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

 Personal or family history of depression

 Major life changes, trauma, or stress
 Certain physical illnesses and medications
Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the
more effective it is. Depression is usually treated with medications, psychotherapy, or a
combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy
(ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no "one-size-
fits-all" for treatment. It may take some trial and error to find the treatment that works best for
you.

Medications
Antidepressants are medicines that treat depression. They may help improve the way your brain
uses certain chemicals that control mood or stress. You may need to try several different
antidepressant medicines before finding the one that improves your symptoms and has
manageable side effects. A medication that has helped you or a close family member in the past
will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep,
appetite, and concentration problems improve before mood lifts, so it is important to give
medication a chance before reaching a conclusion about its effectiveness. If you begin taking
antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking
antidepressants feel better and then stop taking the medication on their own, and the depression
returns. When you and your doctor have decided it is time to stop the medication, usually after a
course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose.
Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an
increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few
weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug
Administration (FDA) also says that patients of all ages taking antidepressants should be
watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become
pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your
unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.

You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling
botanical product, the FDA has not approved its use as an over-the-counter or prescription
medicine for depression, and there are serious concerns about its safety (it should never be
combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort
before talking to your health care provider. Other natural products sold as dietary supplements,
including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have
not yet been proven safe and effective for routine use. For more information on herbal and other
 complementary approaches and current research, please visit the National Center for
Complementary and Integrative Health website.

Psychotherapies
Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling)
can help people with depression. Examples of evidence-based approaches specific to the
treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT),
and problem-solving therapy. More information on psychotherapy is available on the NIMH
website and in the NIMH publication Depression: What You Need to Know.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may
be an option to explore. Based on the latest research:

 ECT can provide relief for people with severe depression who have not been able to feel better
with other treatments.
 Electroconvulsive therapy can be an effective treatment for depression. In some severe cases
where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line
intervention.
 Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The
treatment consists of a series of sessions, typically three times a week, for two to four weeks.
 ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually
these side effects are short-term, but sometimes memory problems can linger, especially for the months
around the time of the treatment course. Advances in ECT devices and methods have made modern ECT
safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand
the potential benefits and risks of the treatment before giving your informed consent to undergoing
ECT.
 ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put
under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which
takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-
resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve
stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn
more about these therapies on the NIMH Brain Stimulation Therapies webpage.

If you think you may have depression, start by making an appointment to see your doctor or
health care provider. This could be your primary care practitioner or a health provider who
specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for
Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:
 Try to be active and exercise.
 Set realistic goals for yourself.
 Try to spend time with other people and confide in a trusted friend or relative.
 Try not to isolate yourself, and let others help you.
 Expect your mood to improve gradually, not immediately.
 Postpone important decisions, such as getting married or divorced, or changing jobs until you
feel better. Discuss decisions with others who know you well and have a more objective view of your
situation.
 Continue to educate yourself about depression.

Join a Study

What are Clinical Trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and
conditions, including depression. During clinical trials, some participants receive treatments
under study that might be new drugs or new combinations of drugs, new surgical procedures or
devices, or new ways to use existing treatments. Other participants (in the “control group”)
receive a standard treatment, such as a medication already on the market, an inactive placebo
medication, or no treatment. The goal of clinical trials is to determine if a new test or treatment
works and is safe. Although individual participants may benefit from being part of a clinical trial,
participants should be aware that the primary purpose of a clinical trial is to gain new scientific
knowledge so that others may be better helped in the future.

What is depression and what

can I do about it?
Last updated Thu 30 November 2017

By Markus MacGill

Reviewed by Timothy J. Legg, PhD, CRNP

1. Diagnosis
 

2. Signs and symptoms

 
 3. Causes
 

4. Treatment
 

5. Types
Sadness, feeling down, having a loss of interest or pleasure in daily activities -
these are symptoms familiar to all of us. But, if they persist and affect our life
substantially, it may be depression.

According to the Centers for Disease Control and Prevention (CDC), 7.6

percent of people over the age of 12 have depression in any 2-week period.
This is substantial and shows the scale of the issue.

According to the World Health Organization (WHO), depression is the most

common illness worldwide and the leading cause of disability. They estimate
that 350 million people are affected by depression, globally.

Fast facts on depression:

 Depression seems to be more common among women than men.

 Symptoms include lack of joy and reduced interest in things that used
to bring a person happiness.

 Life events, such as bereavement, produce mood changes that can

usually be distinguished from the features of depression.

 The causes of depression are not fully understood but are likely to be
a complex combination of genetic, biological, environmental, and
psychosocial factors.
Tests
Depression is a mood disorder characterized by persistently low mood and a
feeling of sadness and loss of interest. It is a persistent problem, not a
passing one, lasting on average 6 to 8 months.
Diagnosis starts with a consultation from a mental health expert.
Diagnosis of depression starts with a consultation with a doctor or mental
health specialist. It is important to seek the help of a health professional to
rule out different causes of depression, ensure an accurate differential
diagnosis, and secure safe and effective treatment.

As for most visits to the doctor, there may be a physical examination to check
for physical causes and coexisting conditions. Questions will also be asked -
"taking a history" - to establish the symptoms, their time course, and so on.

Some questionnaires help doctors to assess the severity of depression.

The Hamilton depression rating scale, for example, has 21 questions, with
resulting scores describing the severity of the condition. The Hamilton scale is
one of the most widely used assessment instruments in the world for clinicians
rating depression.

What does not class as depression?

Depression is different from the fluctuations in mood that people experience
as a part of normal life. Temporary emotional responses to the challenges of
everyday life do not constitute depression.

Likewise, even the feeling of grief resulting from the death of someone close
is not itself depression if it does not persist. Depression can, however, be
related to bereavement - when depression follows a loss, psychologists call it
a "complicated bereavement."
Signs and symptoms
 Symptoms include reduced interest in pleasurable activities and lower mood.

Symptoms of depression can include:

 depressed mood

 reduced interest or pleasure in activities previously enjoyed, loss of

sexual desire

 unintentional weight loss (without dieting) or low appetite

 insomnia (difficulty sleeping) or hypersomnia (excessive sleeping)

 psychomotor agitation, for example, restlessness, pacing up and down

 delayed psychomotor skills, for example, slowed movement and speech

 fatigue or loss of energy

 feelings of worthlessness or guilt

 impaired ability to think, concentrate, or make decisions

 recurrent thoughts of death or suicide, or attempt at suicide

LIFE HACKS: DEALING WITH POSTPARTUM DEPRESSION

IF YOU HAVE RECENTLY HAD A BABY AND YOU ARE FEELING LOW, IT COULD BE
POSTPARTUM DEPRESSION. FIND OUT MORE

READ NOW

Causes
The causes of depression are not fully understood and may not be down to a
single source. Depression is likely to be due to a complex combination of
factors that include:
Depression has a wide range of causes and potential treatments.
 genetics

 biological - changes in neurotransmitter levels

 environmental

 psychological and social (psychosocial)

Some people are at higher risk of depression than others; risk factors include:

 Life events: These include bereavement, divorce, work issues,

relationships with friends and family, financial problems, medical concerns, or
acute stress.

 Personality: Those with less successful coping strategies, or previous

life trauma are more suceptible.

 Genetic factors: Having a first-degree relatives with depression

increases the risk.

 Childhood trauma.

 Some prescription drugs: These include corticosteroids, some beta-

blockers, interferon, and other prescription drugs.

 Abuse of recreational drugs: Abuse of alcohol, amphetamines, and

other drugs are strongly linked to depression.

 A past head injury.

 Having had one episode of major depression: This increases the risk of
a subsequent one.

 Chronic pain syndromes: These and other chronic conditions, such

as diabetes, chronic obstructive pulmonary disease, and cardiovascular
disease make depression more likely.
 Treatment
Depression is a treatable mental illness. There are three components to the
management of depression:

 Support, ranging from discussing practical solutions and contributing

stresses, to educating family members.

 Psychotherapy, also known as talking therapies, such as cognitive

behavioral therapy (CBT).

 Drug treatment, specifically antidepressants.

Psychotherapy
Psychological or talking therapies for depression include cognitive-behavioral
therapy (CBT), interpersonal psychotherapy, and problem-solving treatment.
In mild cases of depression, psychotherapies are the first option for treatment;
in moderate and severe cases, they may be used alongside other treatment.

CBT and interpersonal therapy are the two main types of psychotherapy used
in depression. CBT may be delivered in individual sessions with a therapist,
face-to-face, in groups, or over the telephone. Some recent studies suggest
that CBT may be delivered effectively through a computer

Interpersonal therapy helps patients to identify emotional problems that affect

relationships and communication, and how these, in turn, affect mood and can
be changed.

Antidepressant medications
Antidepressants are drugs available on prescription from a doctor. Drugs
come into use for moderate to severe depression, but are not recommended
for children, and will be prescribed only with caution for adolescents.
 A number of classes of medication are available in the treatment of
depression:

 selective serotonin reuptake inhibitors (SSRIs)

 monoamine oxidase inhibitors (MAOIs)

 tricyclic antidepressants

 atypical antidepressants

 selective serotonin and norepinephrine reuptake inhibitors (SNRI)

Each class of antidepressant acts on a different neurotransmitter. The drugs
should be continued as prescribed by the doctor, even after symptoms have
improved, to prevent relapse.

A warning from the Food and Drug Administration (FDA) says that

"antidepressant medications may increase suicidal thoughts or actions in
some children, teenagers, and young adults within the first few months of
treatment."

Any concerns should always be raised with a doctor - including any intention
to stop taking antidepressants.

Exercise and other therapies

Aerobic exercise may help against mild depression since it raises endorphin
levels and stimulates the neurotransmitter norepinephrine, which is related to
mood.

Brain stimulation therapies - including electroconvulsive therapy - are also

used in depression. Repetitive transcranial magnetic stimulation sends
magnetic pulses to the brain and may be effective in major depressive
disorder.
Electroconvulsive therapy
Severe cases of depression that have not responded to drug treatment may
benefit from electroconvulsive therapy (ECT); this is particularly effective for
psychotic depression.

Types
Unipolar and bipolar depression
If the predominant feature is a depressed mood, it is called unipolar
depression. However, if it is characterized by both manic and depressive
episodes separated by periods of normal mood, it is referred to as bipolar
disorder (previously called manic depression).

Unipolar depression can involve anxiety and other symptoms - but no manic

episodes. However, research shows that for around 40 percent of the time,
individuals with bipolar disorder are depressed, making the two conditions
difficult to distinguish.

Major depressive disorder with psychotic features

This condition is characterized by depression accompanied by psychosis.
Psychosis can involve delusions - false beliefs and detachment from reality, or
hallucinations - sensing things that do not exist.

Postpartum depression
Women often experience "baby blues" with a newborn, but postpartum
depression - also known as postnatal depression - is more severe.

Major depressive disorder with seasonal pattern

Previously called seasonal affective disorder (SAD), this condition is related to
the reduced daylight of winter - the depression occurs during this season but
lifts for the rest of the year and in response to light therapy.

Countries with long or severe winters seem to be affected more by this

condition.