Depression

Also known as: Blues, Gloom, Sadness or Melancholy

Definition

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time.

For more information on the symptoms and treatment of depression, see:

Which of these may be a symptom of depression?The correct answer is all of the above. Depression may be described as feeling sad, blue, unhappy, or miserable. Most of us feel this way sometimes for short periods. But depression as a medical condition affects your daily life in a persistent way. Talk with your doctor if you have any of these symptoms, or if you think you may be depressed.Depression is a state of mind – if you try hard enough, you can snap out of it.The correct answer is myth. Depression is a real medical disorder that causes real suffering. Brain scans have shown that certain areas of the brain look different in people with depression. It's unclear what causes the disorder, but an imbalance of brain chemicals or genetics may play a role.If a friend or loved one talks about suicide, what should you do?The correct answer is to seek professional help immediately. Suicide can be prevented with prompt intervention. If you or a loved one feels suicidal, call your doctor right away or call the 24-hour National Suicide Prevention Lifeline at 1-800-273-8255. Never try to manage the problem on your own.Depression is more common in women.The correct answer is fact. Hormonal fluctuations throughout a woman’s life may play a role. At puberty, girls have twice the risk for depression than boys. Many women experience mood changes and even depression around their period, after childbirth, and around the time of menopause.People who are depressed tend to:The correct answer is either A or B. While some people lose interest in food when they are depressed, others turn to food for comfort and overeat.Children don't get depressed.The correct answer is myth. A depressed child may complain of aches and pains, refuse to go to school, or worry all the time. About one out of every five teenagers has depression at some point in their teens. Note any changes in your teen’s daily routines or behaviors. This can be a sign of depression.Men may spend more time at work when they are depressed.The correct answer is fact. Men often react to depression in different ways than women. They are more likely to work long hours, abuse alcohol or drugs, lose their temper, or behave recklessly.Which types of talk therapy are effective in treating depression?The correct answer is all of the above. Cognitive-behavioral therapy teaches you how to fight negative thoughts and develop self-awareness and problem-solving skills. Psychotherapy can help you understand the issues behind your thoughts and feelings. Ask your doctor for a recommendation.Depression can make the symptoms of other illnesses seem worse.The correct answer is fact. If you have a health condition like diabetes, depression can make the symptoms more severe. Feeling sad or down also makes it harder for you to do the work needed to manage your illness. Getting help for depression usually makes it easier to successfully treat your condition.Which of the following is true of antidepressant medicines?The correct answer is if one type of antidepressant doesn't help, chances are another one will. It can take 4 to 12 weeks for it to work fully, so try to be patient. Some benefits start earlier than that. If your medicine isn’t helping, talk to your doctor. Changing to a different antidepressant or adding a second medicine may help.Depression is very difficult to treat.The correct answer is myth. Most patients get better when treated with medicine, talk therapy, or a combination of the two. The first step is to talk to your doctor, who can refer you to a mental health professional. Make that first call, and you will be on the path to your recovery.

Considerations

Symptoms of depression include:

  • Low or irritable mood most of the time
  • A loss of pleasure in usual activities
  • Trouble sleeping or sleeping too much
  • A big change in appetite, often with weight gain or loss
  • Tiredness and lack of energy
  • Feelings of worthlessness, self-hate, and guilt
  • Difficulty concentrating
  • Slow or fast movements
  • Lack of activity and avoiding usual activities
  • Feeling hopeless or helpless
  • Repeated thoughts of death or suicide

Low self-esteem is common with depression. It is also common to have sudden bursts of anger and a lack of pleasure from activities that normally make you happy, including sex.

Depressed children may not have the same symptoms as depressed adults. Watch for changes in school work, sleep, and behavior. If you wonder whether your child might be depressed, it's worth talking to a health care provider.

The main types of depression include:

  • Major depression -- to be diagnosed with major depression, you must have five or more of the symptoms listed above for at least 2 weeks. Major depression tends to continue for at least 6 months if not treated. (You are said to have minor depression if you have less than five depression symptoms for at least 2 weeks. Minor depression is similar to major depression except it only has two to four symptoms.)
  • Atypical depression -- occurs in about a third of patients with depression. Symptoms include overeating and oversleeping. You may feel like you are weighed down and get very upset by rejection.
  • Dysthymia -- a milder form of depression that can last for years, if not treated.

Other common forms of depression include:

  • Postpartum depression -- many women feel somewhat down after having a baby, but true postpartum depression is more severe and includes the symptoms of major depression.
  • Premenstrual dysphoric disorder (PMDD) -- symptoms of depression occur 1 week before your menstrual period and disappear after you menstruate.
  • Seasonal affective disorder (SAD) -- occurs most often during the fall-winter season and disappears during the spring-summer season. It is most likely due to a lack of sunlight.

Depression may also alternate with mania (known as manic depression or bipolar disorder).

Depression may be more common in women than men. This may be because women tend to seek help for it more. Depression is also more common during the teenage years.

Common Causes

Depression often runs in families. This may be due to your genes (inherited), behaviors you learn at home, or both. Even if your genes make you more likely to develop depression, a stressful or unhappy life event usually triggers the depression.

Many factors can cause depression, including:

  • Alcohol or drug abuse
  • Medical conditions and treatments, such as:
    • Certain types of cancer
    • Long-term pain
    • Sleeping problems
    • Steroid medications
    • Underactive thyroid (hypothyroidism)
  • Stressful life events, such as:
    • Abuse or neglect
    • Breaking up with a boyfriend or girlfriend
    • Certain types of cancer
    • Death of a relative or friend
    • Divorce, including a parent's divorce
    • Failing a class
    • Illness in the family
    • Job loss
    • Long-term pain
    • Social isolation (common cause of depression in the elderly)

Home Care

If you are depressed for 2 weeks or longer, contact your doctor or other health professional before your symptoms get worse.

No matter what type of depression you have and how severe it is, the following self-care steps can help:

  • Get enough sleep.
  • Follow a healthy, nutritious diet.
  • Exercise regularly.
  • Avoid alcohol, marijuana, and other recreational drugs.
  • Get involved in activities that make you happy.
  • Spend time with family and friends.
  • If you are a religious or spiritual person, talk to a clergy member or spiritual advisor.
  • Consider meditation, tai chi, or other relaxation methods.
  • Add omega-3 fatty acids to your diet. You can get them from over-the-counter supplements or by eating fish such as tuna, salmon, or mackerel.

If your depression occurs in the fall or winter months, try light therapy using a special lamp that is like sunlight.

If you have moderate to severe depression, the most effective treatment plan will likely involve a combination of talk therapy, lifestyle changes, and medication.

Call your health care provider if

Call 911, a suicide hotline, or go to a nearby emergency room if you have thoughts of harming yourself or others.

Call your doctor if:

  • You hear voices that are not there.
  • You cry often without cause.
  • Your depression has affected your work, school, or family life for longer than 2 weeks.
  • You have three or more symptoms of depression.
  • You think one of your current medications may be making you feel depressed -- DO NOT change or stop taking any medications without talking to your doctor.
  • You think you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.

What to expect at your health care provider's office

Your health care provider will find out how severe your depression is (mild, moderate, or severe) and look for the cause by doing a:

  • Health history
  • Mental health interview
  • Physical examination

If there is a risk of suicide, you may need to stay in the hospital for treatment.

You will talk with the health care provider about the issues and events that may be causing your depression. Your doctor will ask you about:

  • Your mood and other symptoms (sleep, appetite, concentration, energy)
  • Possible stressors in your life and support systems in place
  • Whether you have had thoughts about ending your life
  • Drug and alcohol use, and any medications you are currently taking

Treatment will depend on your symptoms. For mild depression, counseling and self-care may be enough. The most effective therapy for moderate or severe depression is a combination of antidepressant medication and talk therapy.

Your primary care doctor may refer you to a psychiatrist if your depression is moderate to severe, or if it does not improve with treatment.

For more treatment information, see: Major depression

Prevention

Healthy lifestyle habits can help prevent depression, and reduce the chances of it coming back. Talk therapy and antidepressant medication can also make you less likely to become depressed again.

Talk therapy may help you through times of grief, stress, or low mood. Family therapy may help teens who feel sad.

Keeping close contact with other people is important for preventing depression.

References

Fava M, Cassano P. Mood disorders: Major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.

American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007.

Review date:
September 11, 2013
Reviewed by:
Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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