Description

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day, and sometimes you may feel as if life is not worth living.

More than an episode of the melancholy, depression is not a weakness and you simply can't "get out" of the same. Depression may require long-term treatment. But don't be discouraged. Most people with depression feel better with medication, psychotherapy or both.

Depression care at Mayo Clinic

Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small things
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Decreased appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Difficulty thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide.
  • Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

The symptoms of depression in children and adolescents

Common signs and symptoms of depression in children and adolescents are similar to those of adults, but there may be some differences.

  • In young children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
  • In adolescents, the symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, the use of drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

The symptoms of depression in older adults

Depression is not a normal part of aging, and should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. The symptoms of depression may be different or less obvious in older adults, such as:

  • Memory difficulties or personality changes
  • Physical discomfort or pain
  • Fatigue, loss of appetite, sleep problems or loss of interest in sex is not caused by a medical condition or medication
  • Often wanting to stay at home, instead of going out to socialize or doing new things
  • Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a religious leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or the local emergency number immediately.

Also consider these options if you are having suicidal thoughts:

  • Call your doctor or mental health professional.
  • In contact with a direct line of suicide.
  • In the united states, call or text 988 to reach the 988 Suicide and Crisis Lifeline is available 24 hours a day, seven days a week. Or use the Lifeline Chat . The services are free and confidential.
  • United states veterans or service members who are in crisis you can call 988, and then press "1" to the Veterans Crisis Line . Or text 838255. Or chat online .
  • The Suicide and Crisis Lifeline in the united states has a Spanish language of the phone line in 1-888-628-9454 (toll-free).
  • Reaching out to a friend or loved one.
  • Contact a minister, spiritual leader or someone in your faith community.
  • In the united states, call or text 988 to reach the 988 Suicide and Crisis Lifeline is available 24 hours a day, seven days a week. Or use the Lifeline Chat . The services are free and confidential.
  • United states veterans or service members who are in crisis you can call 988, and then press "1" to the Veterans Crisis Line . Or text 838255. Or chat online .
  • The Suicide and Crisis Lifeline in the united states has a Spanish language of the phone line in 1-888-628-9454 (toll-free).

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or the local emergency number immediately. Or, if you think that you can do so safely, take the person to the nearest emergency room.

Causes

It is not known exactly what causes depression. As with many of the mental disorders, a variety of factors that may be involved, such as:

  • The biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help to identify the causes.
  • The chemistry of the brain. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
  • Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormonal changes can lead to pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
  • Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in the cause of the depression.

Risk factors

Depression often begins in adolescence, 20 or 30 years, but can occur at any age. More women than men are diagnosed with depression, but this may be due, in part, because women are more likely to seek treatment.

The factors that appear to increase the risk of developing or triggering depression include:

  • Certain personality traits, such as low self-esteem and being overly dependent, self-critical or pessimistic
  • Traumatic or stressful, such as physical or sexual abuse, the death or the loss of a loved one, a difficult relationship, or financial problems
  • Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide.
  • Being lesbian, gay, bisexual, or transgender, or have variations in the development of the genitals that are not clearly male or female (intersex) in an unfavorable situation
  • The history of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
  • The abuse of alcohol or recreational drugs
  • Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
  • Certain medications, such as some high blood pressure medications, or sleeping pills (talk with your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it is not treated, resulting in emotional, behavioral, and health problems that affect every area of your life.

Examples of complications associated with depression include:

  • Excess weight or obesity, which can lead to heart disease, and diabetes
  • Pain or physical illness
  • Alcohol and drug abuse
  • Anxiety disorder, panic disorder or social phobia
  • Family conflicts, relationship difficulties, and work or school problems
  • Social isolation
  • Suicidal feelings, suicide attempts or suicide.
  • The self-mutilation, such as cutting
  • The premature death of medical conditions

Prevention

There is No sure way to prevent depression. However, these strategies can help.

  • Take steps to control stress, to increase your resilience and increase their self-esteem.
  • Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
  • Get treatment at the first sign of a problem, to help prevent the depression from getting worse.
  • Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

Diagnosis

Your doctor may determine a diagnosis of depression based on:

  • Physical exam. Your doctor may perform a physical exam and ask you questions about your health. In some cases, depression may be linked to an underlying physical health problem.
  • The laboratory tests. For example, your doctor can do a blood test called a complete blood count or test your thyroid to make sure it works correctly.
  • Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to complete a questionnaire to help answer these questions.
  • The DSM-5. Your mental health professional may use the criteria of depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American psychiatric Association.

Types of depression

The symptoms caused by the great depression can vary from person to person. To clarify the type of depression, your doctor may add one or more specifiers. A specifier means that you have depression with specific characteristics, such as:

  • Anxiety, anguish, depression with unusual concern about possible events or the loss of control
  • Mixed features simultaneous depression and mania, which includes the elevation of self-esteem, talking too much and increased energy
  • Melancholic features — severe depression with lack of response to something that used to bring pleasure, and is associated with waking up early in the morning, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or slowness
  • Atypical features of depression, which includes the ability temporarily to be cheered by the happy events, increased appetite, excessive need for sleep, rejection sensitivity, and a feeling of heaviness in the arms or legs
  • Psychotic features , depression accompanied by delusions or hallucinations, which may involve the staff of the failure or the refusal of the topics
  • Catatonia in depression, including the engine of the activity that involves either uncontrollable and involuntary movement, or fixed and inflexible posture
  • Peripartum onset of the depression that occurs during pregnancy or in the weeks or months after delivery (postpartum)
  • Seasonal pattern — depression related to changes in seasons and the reduction of exposure to sunlight

Other disorders that cause symptoms of depression

Several other disorders, such as those below, which include depression as a symptom. It is important to obtain an accurate diagnosis, so that you can receive the appropriate treatment.

  • Bipolar I and II disorders. These mood disorders include mood swings that range from high (mania) to lows (depression). Sometimes it is difficult to distinguish between bipolar disorder and depression.
  • Cyclothymic disorder. Cyclothymic (sy-kloe-THIE-mik) disorder consists of highs and lows that are milder than those of bipolar disorder.
  • Disruptive mood disorder of dysregulation. This mood disorder in children includes chronic and severe irritability and anger with frequent extreme outbursts of temper. This disorder usually develops in major depressive disorder or an anxiety disorder during adolescence or adulthood.
  • Persistent depressive disorder. Sometimes called dysthymia (dis-THIE-me-uh), this is a less severe but more chronic form of depression. While that is usually not disabling, persistent depressive disorder may impede the normal operation of your daily routine and live life to the fullest.
  • Premenstrual dysphoric disorder. This involves symptoms of depression associated with the hormonal changes that begin a week before, and to improve within a couple of days after the start of your period, and are minimal or have disappeared after the end of your period.
  • Other disorders of depression. This includes the depression caused by the use of recreational drugs, some prescription medications or another medical condition.

Treatment

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve the symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

If you have severe depression, you may need a stay in the hospital, or you may have to participate in an outpatient treatment program until your symptoms improve.

Here's a closer look at depression treatment options.

Drugs

Many types of antidepressants are available, including the ones below. Be sure to discuss potential side effects with your doctor or pharmacist.

  • Selective serotonin reuptake inhibitors (Ssris). Doctors often start by prescribing an SSRI. These medicines are considered safer and generally cause fewer bothersome side effects than other types of antidepressants. Ssris include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), and vilazodone (Viibryd).
  • The serotonin reuptake inhibitors norepinephrine (Snris). Examples of Snris include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
  • Antidepressants atypical. These drugs do not fit neatly into any of the other antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone, and vortioxetine (Trintellix).
  • The tricyclic antidepressants. These drugs, such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin), and protriptyline (Vivactil), can be very effective, but tends to cause more serious side effects than the newer antidepressants. So the tricyclic antidepressants, in general, are not prescribed unless you have tried an SSRI first without improvement.
  • Monoamine oxidase inhibitors (Maois). Mao inhibitors such as tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) — may be prescribed, usually when other medications have not worked, because it can have serious side effects. The use of mao inhibitors requires a strict diet because of dangerous or even fatal) interactions with foods such as certain cheeses, preserves and wines — and some medications and herbal supplements. Selegiline (Emsam), a new inhibitor of MAO that sticks to the skin as a patch, may cause fewer side effects than other maois do. These medicines may not be combined with Ssris.
  • Other medications. Other medications may be added to an antidepressant to improve the antidepressant effects. Your doctor may recommend a combination of two antidepressants or adding medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications can also be added for short-term use.

Finding the right medication

If a family member has responded well to an antidepressant, may be one that could help you. Or you may need to try several medications or combination of medications before finding one that works. This requires patience, as some medications need several weeks or longer to take full effect and side-effects to ease as your body adapts.

Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of genetic testing (a blood test or cheek swab) can provide clues about how your body may respond to a particular antidepressant. However, other variables, in addition to genetics can affect your response to the medication.

The risks of abruptly stopping the medication

Do not stop taking an antidepressant without first talking to your doctor. Antidepressants are not addictive, but sometimes physical dependence (which is different from the addiction) can occur.

Discontinue treatment abruptly or missing several doses may cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression. Work with your doctor to slowly and safely decrease your dose.

Antidepressants and pregnancy

If you are pregnant or breast-feeding, some antidepressants may represent a greater risk to the health of your unborn child or nursing infant. Talk with your doctor if you become pregnant or are planning to become pregnant.

Antidepressants and increased risk of suicide

Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the strictest warnings for prescriptions. In some cases, children, teenagers, and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior, especially when you start using a new medication or a change in the dose. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact a doctor or seek emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Psychotherapy

Psychotherapy is a general term for the treatment of depression, talking about your condition and related issues with a mental health professional. Psychotherapy is also known as talk therapy or psychological therapy.

The different types of psychotherapy can be effective for depression, such as cognitive-behavioral therapy or interpersonal therapy. Your mental health professional may also recommend other types of therapies. Psychotherapy can help:

  • Adjust to a crisis or other current difficulty
  • Identify the negative beliefs and behaviors and replace them with healthy, positive
  • Explore the relationships and experiences, and to develop positive interactions with others
  • Find better ways to cope and solve problems
  • Identify the problems that contribute to depression and to change the behaviors that make it worse
  • To recover a sense of satisfaction and control in your life and help relieve the symptoms of depression, such as hopelessness and anger
  • Learn how to set realistic goals for your life
  • Develop the ability to tolerate and accept distress by healthier behaviors

Alternative formats for therapy

Formats for depression therapy as an alternative to face-to-face, in the office of the sessions are available and may be an effective option for some people. The therapy can be, for example, as a computer program, for the online sessions, or through videos and books. The programs can be guided by a therapist or be partially or completely independent.

Before you choose one of these options, discuss these formats with your therapist to determine if they can be of use to you. Also, ask your therapist if he or she can recommend a trusted source or program. Some may not be covered by your insurance, and not all the developers and online therapists have the proper credentials or training.

Smartphones and tablets offer mobile health apps, such as general support and education about depression, they are not a substitute for seeing your doctor or therapist.

The Hospital and residential treatment

In some people, depression is so severe that the hospital stay is necessary. This may be necessary if you can't take care of himself properly or when it is in danger of harming yourself or someone else. Psychiatric treatment at a hospital can help keep them calm and safe until your mood improves.

Partial hospitalization or day treatment programs can also help some people. These programs provide outpatient support and advice needed to get your symptoms under control.

Other treatment options

For some people, other procedures, sometimes called brain stimulation therapies may be suggested:

  • Electroconvulsive therapy (ECT). In ECT, the electrical currents that pass through the brain to the impact of the role and the effect of neurotransmitters in the brain to alleviate depression. ECT is generally used for people who do not improve with medication, can't take antidepressants for health reasons or who are at high risk of suicide.
  • Transcranial magnetic stimulation (TMS). TMS may be an option for those who have not responded to antidepressants. During TMS, a coil is placed against your scalp sends brief magnetic pulses to stimulate nerve cells in the brain that are involved in the regulation of mood and depression.

Lifestyle and home remedies

The depression usually is not a disorder that can be treated by your account. But in addition to professional treatment, these self-care measures can help:

  • Stick to your treatment plan. Do not skip the psychotherapy sessions or appointments. Even if you feel well, do not stop taking your medication. If it stops, the symptoms of depression may come back, and you may also experience symptoms of withdrawal. Recognize that it will take time to feel better.
  • Learn about the depression. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about depression to help them understand and support.
  • Pay attention to the warning signs. Work with your doctor or therapist to learn what might trigger your symptoms of depression. Make a plan so you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask family members or friends to help you see the warning signs.
  • Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or substance use.
  • Take care of yourself. Healthy eating, physical activity and getting enough sleep. Consider walking, jogging, swimming, gardening, or other activities that you enjoy. Good sleep is important for your physical and mental well-being. If you are having trouble sleeping, talk with your doctor about what you can do.

Alternative medicine

Alternative medicine is the use of a non-traditional approach in place of conventional medicine. Complementary medicine is a non-traditional approach is used together with conventional medicine — sometimes called integrative medicine.

Make sure you understand the risks and possible benefits if you are looking for an alternative or complementary therapy. Do not replace conventional medical treatment, or psychotherapy with alternative medicine. When it comes to depression, alternative treatments are not a substitute for medical care.

Supplements

Examples of supplements that are sometimes used for depression include:

  • St. John's wort. In spite of this herbal supplement is not approved by the Food and Drug Administration (FDA) for the treatment of depression in the united states, it can be helpful for mild or moderate depression. But if you choose to use it, be careful — the St. John's wort can interfere with some medicines, such as drugs for the heart, blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and medications to prevent the rejection of organs after a transplant. Also, avoid taking St. John's wort while you are taking antidepressants, since the combination can cause serious side effects.
  • Same. It is pronounced "same," this dietary supplement is a synthetic form of a chemical substance that occurs naturally in the body. The name is the abbreviation of S-adenosylmethionine (is-uh-den-o-sul-muh-THIE-o-neen). The same is not approved by the FDA to treat depression in the united states can be helpful, but more research is needed. Same can trigger mania in people with bipolar disorder.
  • Omega-3 fatty acids. These healthy fats are found in cold-water fish, flaxseed, flax oil, nuts, and other foods. Omega-3 supplements are being studied as a possible treatment for depression. While it is considered safe, at high doses, omega-3 supplements may interact with other medications. More research is needed to determine if the consumption of foods with omega-3 fatty acids can help to alleviate depression.

Nutritional and dietary products are not monitored by the FDA the same way that medications are. You can't always be sure what you're doing and if it is safe. Also, because some herbs and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplement.

Mind-body connections

Integrative medicine doctors believe that the mind and the body should be in harmony for you to stay healthy. Examples of mind-body techniques that can be useful for depression include:

  • Acupuncture
  • Relaxation techniques such as yoga or tai chi
  • Meditation
  • Guided imagery
  • Massage therapy
  • The music or the art of therapy
  • Spirituality
  • Aerobic exercise

Relying solely on these therapies is generally not sufficient to treat depression. They can be useful when used in addition to medication and psychotherapy.

Coping and support

Talk with your doctor or therapist about improving their coping skills, and try these tips:

  • Simplify your life. Trim obligations when possible, and to set goals for yourself. Give yourself permission to do less when you are feeling down.
  • Write in a journal. The journal, as part of your treatment, you can improve the state of mind that allows you to express pain, anger, fear or other emotions.
  • Read reputable self-help books and websites. Your doctor or therapist may be able to recommend books or websites.
  • Find useful groups. Many organizations, such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance, the supply of education, support groups, counseling and other resources to help with the depression. Employee assistance programs and religious groups can also offer help for mental health problems.
  • Don't isolate yourself. Try to participate in social activities, and to meet with family or friends on a regular basis. Support groups for people with depression can help you connect to others facing similar challenges and share experiences.
  • Learn ways to relax and manage stress. Examples include meditation, progressive muscle relaxation, yoga, and tai chi.
  • The structure of its time. The Plan for the day. You may find it helps to make a list of daily tasks, the use of sticky notes as reminders or the use of a planner to keep organized.
  • Do not make important decisions when you are down. Avoid making decisions when you are depressed, because you can't think clearly.

Preparing for your appointment

You can see your primary care doctor, or your doctor may refer you to a mental health professional. Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

  • The symptoms that I had, including those that may seem unrelated to the reason for your appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins or supplements that you are taking, including the dosage
  • Questions to ask your doctor or mental health professional

Have a friend or family member, if possible, to help you remember all the information provided during the appointment.

Some basic questions to ask your doctor include:

  • Depression is the most likely cause of my symptoms?
  • What are other possible causes of the symptoms?
  • What kind of proof do you need?
  • What treatment is likely to work best for me?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • You should see a psychiatrist or other mental health professional?
  • What are the main side effects of the medications that you are recommending?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a series of questions. Be prepared to answer to reserve a time to go over any points you want to focus on. Your doctor may ask:

  • When you or your loved ones first notice the symptoms of depression?
  • How much time have you felt depressed? In general, how do you always feel down, or your mood fluctuate?
  • Does your mood every time you swing from feeling down to feeling intensely happy (euphoric) and full of energy?
  • Have you had thoughts of suicide when you're feeling down?
  • Do your symptoms interfere with your daily life or relationships?
  • Do you have any blood relatives with depression or another mood disorder?
  • What other mental or physical health conditions do you have?
  • Do you drink alcohol or use recreational drugs?
  • How much can you sleep at night? Does it change with time?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Depression (major depressive disorder)