Depression

Depression

Depression takes the joy out of life and makes it hard to carry out daily activities. Yet too many people struggle silently with depression.

Treatment can lighten your mood, strengthen your connections with loved ones, let you enjoy your interests and hobbies again, and make you feel more like yourself.

What is depression?

Most people feel “down” or “blue” from time to time. That’s normal. But depression is more than passing sadness, grief, or disappointment. Depression is a major illness that takes the pleasure out of life, saps energy, and makes it hard to get through the day.

It can also increase the risk of developing heart disease and other health problems. Anyone can become depressed, and many people do.

Causes of depression include

  • genes
  • chemical changes in the brain
  • hormones
  • life experiences
  • medications

Symptoms of depression

Depression comes in many forms. People with major depression disorder have five or more of the symptoms below for two weeks or longer. A depressed mood or loss of interest are key symptoms required for a diagnosis of clinical depression.

Depression symptoms:

  • depressed mood most of the day, nearly every day
  • trouble sleeping or sleeping too much
  • loss of interest or pleasure in most or all activities
  • inability to focus
  • restlessness and agitation
  • change in appetite or weight
  • low energy
  • thoughts of worthlessness or guilt
  • sluggish thinking and movement
  • thinking often about death or suicide

Other signs include a loss of interest in sex, pessimistic or hopeless feelings, headaches, unexplained aches and pains, or digestive problems.

If you are having suicidal thoughts, seek help immediately.

The National Suicide Prevention Lifeline has a hotline that is free and available 24 hours a day.

Call 800-273-TALK (8255). You can also call 911 or go to your local emergency room.

How can my doctor tell if I have depression?

Your doctor will want to know about your mood, experiences, and overall health.

If your symptoms suggest depression, your doctor will want to know if you’ve been feeling sad or hopeless and whether you’ve noticed any changes in your appetite, sex drive, or sleep patterns.

Your doctor should also evaluate your general health. Certain medical problems are linked to significant and lasting depression. Examples include:

  • too little thyroid hormone
  • some nutritional deficiencies
  • multiple sclerosis
  • some infections, such as mononucleosis

A physical exam and blood tests can often identify certain medical problems that may cause your depression.

    Treating depression

    There is no single “best” treatment for depression.

    A combination of medication and talk therapy helps many people feel better.

    Talk therapy, or psychotherapy, can ease depression and prevent future episodes by teaching you more productive ways of thinking and acting. Common and effective forms of talk therapy include:

    Cognitive behavioral therapy. Cognitive therapy helps you change negative patterns of thinking. Behavioral therapy helps you get back to doing the things you used to enjoy.

    Interpersonal psychotherapy. This method helps you improve how you cope with conflicts in relationships and better deal with social roles.

    Psychodynamic psychotherapy. This technique focuses on how life events, along with past and current relationships, affect your choices and how you feel.

    More important than the method is finding someone you’re comfortable talking to.

    Medications for depression

    Medications called antidepressants can greatly relieve symptoms of depression.

    Some people start to feel better within a week or two, but it often takes three to six weeks to get full relief.

    Antidepressants can have side effects including:

    • loss of sexual function and feeling
    • nausea
    • trouble sleeping
    • headache
    • dizziness
    • dry mouth
    • constipation
    • loss of appetite
    • drowsiness

    There are many different types of antidepressants. It’s usually possible to work with your doctor to try a different drug to reduce or eliminate side effects.

    Depression is a serious illness requiring treatment. Don’t let side effects get in the way of feeling better.

    Other ways to manage depression

    Taking good care of yourself can help improve your health and depression.

    If you have mild depression, the following steps may greatly improve your mood and sense of well-being. If your depression is moderate or severe, these are still likely to improve your quality of life.

    Exercise

    Being physically active every day can improve anyone’s mood. There’s no set rule for how often or how hard you need to exercise. Aim for at least 30 minutes of moderate exercise most days of the week. Even walking at a good pace can help.

    Diet

    A diet rich in fruits and vegetables; chicken, fish, and other kinds of lean protein; nuts; legumes (peas and beans); and olive oil may help improve your mood.

    Mindfulness meditation

    Mindfulness is the practice of centering attention on what is happening right now and accepting it without judgment. Meditation—focusing your attention by concentrating on your breathing, a phrase, or an image—is one way to learn mindfulness. A meditation class or CD can help you learn this technique.

    Other treatments for depression

    Therapies that activate the brain with electricity, magnets, or implants may help when other treatments don’t.

    The oldest, quickest, and most effective treatment for the most severe forms of depression is electro- convulsive therapy, or shock therapy.

    Three newer treatments are sometimes used:

    • repetitive transcranial magnetic stimulation
    • vagus nerve stimulation
    • deep brain stimulation

    They also ease depression by generating impulses that help specific brain circuits work better.

    However, these treatments don’t have the proven track record of shock therapy.

    How to stick with your treatment plan

    Depression can make it hard to take the necessary steps to feel better.

    Here are some tips to help you stay on track.

    • Take your medications as directed. Don’t skip pills or change doses without checking with your doctor.
    • Report any side effects. Your doctor may be able to adjust your dose or try a different drug.
    • Try to stay connected. Joining a club, taking a class, having a meal with an understanding friend, attending religious services, or going to a movie, ball game, or concert can help lift mood.
    • Don’t make big decisions—about moving, changing jobs, or personal relationships—until your depression has eased or is under control.
    • If you decide to try a “natural” remedy, ask your doctor or pharmacist whether it might interact with any other medication you’re taking.

    Friends and family often want to help. Let them.

    Postpartum depression

    Depression in a new mother is a serious problem that needs attention. Most women experience mood swings (“baby blues”) after giving birth. These usually last only a week or two. However, about 15% of women develop a more serious form of depression. It’s called postpartum depression and can begin any time within 2-3 months after delivery.

    Signs of postpartum depression are similar to those of major depression, but can also include:

    • feeling like you can’t care for your baby or yourself
    • not wanting to be alone with your baby
    • worrying a lot about your baby
    • having negative feelings or thoughts about harming your baby
    • not being interested in caring for your baby

    It can be hard to admit you're struggling emotionally at a time when the world expects you to be happy. But postpartum depression can and should be treated. Ask your doctor or midwife about medications that are generally safe when breastfeeding, as well as other ways to help improve your mood.

        Getting help

        Don’t let fear keep you from getting the treatment you need.

        People suffering from depression may be embarrassed by their depression and reluctant to seek help. This can lead to more pain, poorer quality of life, and, in some cases, suicide.

        Depression isn’t something to be ashamed of or embarrassed by. Acknowledging the pain and talking with a health professional can help you feel better.

        Other resources for help with depression include:

        • National Institute of Mental Health, 866-615-6464 (toll-free) www.nimh.nih.gov
        • Depression and Bipolar Support Alliance, 800-826-3632 (toll-free) www.dbsalliance.org
        • National Alliance on Mental Illness, 800-950-6264) (toll-free) www.nami.org
        • American Foundation for Suicide Prevention 888-333-2377 (toll-free) www.afsp.org

        Many people fight depression. Depression can make it difficult to work, connect with your loved ones, and enjoy life. There’s no reason to struggle with depression on your own. Treatment can make you feel more like you again, able to connect with family and friends and participate in your interests and hobbies again.

        Depression in men

        Anger or aches and pains can be signs of depression in men.

        For men, depression doesn’t always come in the form of persistent sadness or feeling “down.” It might show up in other ways:

        Anger. Irritability, loss of sense of humor, anger, verbal abuse of loved ones. A man who seems to need “anger management” counseling may actually be suffering from depression.

        Physical symptoms. Low back pain, headaches, insomnia, sexual problems, stomach and digestive problems. If these problems are caused by depression, their standard treatments may not improve them—but depression treatment might.

        Compulsive behaviors. Increasing intake of alcohol, abuse of drugs, compulsive gambling.

        Recklessness. Impulsive, risky behaviors, such as reckless driving or unsafe sex.

        Seasonal affective disorder

        In some people, the onset of winter can trigger a type of depression caused seasonal affective disorder.

        Seasonal affective disorder seems to be triggered by reduced exposure to daylight. It usually comes on during the fall or winter months and goes away in the spring. Symptoms are similar to those of major depression.

        Light Therapy

        The treatment for seasonal affective disorder is light therapy, also known as phototherapy. This involves sitting close to a special light source every day. This light is far more intense than normal indoor light. In order to work, the light must enter through your eyes, not shine on your skin.

        It's best to talk with your doctor before trying light therapy. Certain drugs and health conditions can make it more likely that light therapy could damage your eyes.

          Talk with your doctor

          Whether this is your first visit or a follow-up, ask your doctor:

          • How can I tell the difference between normal sadness and depression?
          • What kind of depression might I have?
          • Could an underlying health problem be causing my symptoms?
          • Should I try medication to relieve my depression?
          • Should I see a mental health professional? If so, what kind?
          • What should I do if I feel like harming myself?

          Your doctor may want to know:

          • Have you noticed changes in your appetite, energy, or sleep habits?
          • Have you experienced a recent loss or stressful event in your life?
          • How often have you felt down, depressed, or hopeless over the last month?
          • Have you taken less interest in doing things, or gotten less pleasure from activities?