Depression

What is depression?

Depression is a whole-body illness. It involves the body, mood, and thoughts. Depression affects the way you eat and sleep. It also can affect the way you feel about yourself, the people around you, and other things. It's not the same as being unhappy or in a “blue” mood. It is not a sign of personal weakness or a condition that can be willed or wished away. When you have depression, you can’t “pull yourself together” and get better. Treatment is often needed and many times crucial to recovery.

Depression has different forms, just like many other illnesses. Here are the types of depressive disorders:

• Major depression. This includes symptoms of depression most of the time for at least 2 weeks and that affect your ability to work, sleep, eat, and enjoy life. It can put you out of action for a while. These episodes of depression can happen once, twice, or several times in a lifetime.

• Dysthymia. Also known as persistent depressive disorder, this condition is a long-term (chronic) depressed mood and other symptoms that are not as severe or extensive as those in major depression. These symptoms can still keep you from functioning at "full steam" or from feeling good. People with dysthymia sometimes also have major depressive episodes.

• Bipolar disorder. This long-term (chronic) condition includes cycles of extreme lows (depression) and extreme highs (hypomania or mania).

• Perinatal depression. This happens when a pregnant person experiences major depression during pregnancy or after delivery (called postpartum depression).

• Seasonal affective disorder. This comes and goes with the seasons. It usually starts in late fall and early winter and goes away during spring and summer.

• Depression with psychosis. This is not as common as other types of depression. It is a severe form of depression where a person may experience delusions or hallucinations.

What causes depression?

There is no clear cause of depression. Experts think it happens because of chemical problems in the brain. Many factors can play a role in depression. These include environmental, mental health, physical, and inherited factors.

Some types of depression seem to run in families. But no genes have yet been linked to depression. People of all ages can suffer from depression that is serious and that greatly affects their life.

Women have depression about twice as often as men. Many hormonal factors may add to the increased rate of depression in women. This includes menstrual cycle changes, premenstrual syndrome, pregnancy, miscarriage, postpartum period, perimenopause, and menopause. Many women also deal with additional stresses, such as responsibilities both at work and home, single parenthood, and caring for both children and aging parents.

Many women are especially at risk after giving birth. Women have hormonal and physical changes on top of the added responsibility of caring for a baby. These factors can lead to postpartum depression in some women. The “baby blues" are common in new mothers and last a week or two. A full-blown depressive episode is not normal and needs treatment.

What are the symptoms of depression?

These are the most common symptoms of depression. But each person may have slightly different symptoms. Symptoms may include:

• Lasting sad, anxious, or empty mood

• Weight or appetite changes because of eating too much or too little

• Changes in sleeping patterns. These include fitful sleep, inability to sleep, early morning awakening, or sleeping too much.

• Loss of interest and pleasure in activities formerly enjoyed, including sex

• Increased restlessness and irritability

• Decreased energy, fatigue, and being "slowed down"

• Physical symptoms, such as headaches, digestive problems, or chronic pain that doesn’t get better with treatment

• Feeling of worthlessness or helplessness

• Lasting feelings of hopelessness

• Feelings of inappropriate guilt

• Problems concentrating, thinking, or making decisions

• Frequent thoughts of death or suicide, or wishing to die

• Suicide. People who are actively talking about suicide should get emergency medical care right away. Do not leave them alone. Call or text 988 or 800-273-TALK (8255). You will be connected to trained mental health crisis services at the 988 Suicide & Crisis Lifeline. An online chat choice is also available. Help is available 24 hours a day, 7 days a week. The call is free and confidential.

Without treatment, symptoms can last for weeks, months, or even years. The correct treatment can help most people who suffer from depression.

How is depression diagnosed?

Depression can occur alone or with other health problems, such as disabling injuries, heart disease, cancer, or diabetes. Middle-age and older adults with these conditions are at particular risk for depression. It can also happen with other mental health disorders, such as substance abuse or anxiety disorders. Getting an early diagnosis and treatment is important to recovery.

A diagnosis is made after a careful mental health exam and health history done by a psychiatrist or other licensed mental health provider.

How is depression treated?

Generally, depressive disorders may be treated with one or a combination of the following:

• Medicine. Many different medicines are available. But it often takes 4 to 6 weeks to feel the full effects of antidepressants. It’s important to keep taking the medicine, even if it doesn’t seem to be working at first. It’s also important to talk with your healthcare provider before stopping. Most medicines need to be decreased over a period of time, rather than stopped all at once. This prevents uncomfortable withdrawal symptoms. Some people have to switch medicines or add medicines to get results.

• Psychotherapy. This treatment is most often cognitive-behavioral or interpersonal therapy. It focuses on changing the distorted views you have of yourself and your environment. It helps you work to improve your interpersonal relationship skills, and to identify and manage stress in your life.

• Electroconvulsive therapy. This treatment may be used in people with severe, life-threatening depression that has not responded to medicines. An electrical current is passed through the brain, setting off a seizure. For unknown reasons, the seizures help to restore the normal balance of chemicals in the brain and ease symptoms.

You can also do things to help yourself. Depressive disorders can make you feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings may make you feel like giving up. It's important to realize that these negative views are part of the depression. They often don't accurately reflect true circumstances. Negative thinking fades as treatment starts to take effect, often in a matter of weeks. In the meantime, if you think you have depression, consider the following:

• Get help. If you think you may be depressed, see a healthcare provider as soon as possible.

• If you have thoughts of harming yourself, seek help right away. Ask your provider, family, or friends for help. Call or text 988 or 800-273-TALK (8255). You will be connected to trained mental health crisis services at the 988 Suicide & Crisis Lifeline. An online chat choice is also available. Help is available 24 hours a day, 7 days a week. The call is free and confidential.

• Set realistic goals in light of the depression. Take on only what you reasonably think you handle.

• Break large tasks into small ones and set priorities. Do what you can as you can.

• Try to be with other people and confide in someone. It is usually better than being alone and secretive.

• Do things that make you feel better. Going to a movie, gardening, or taking part in religious, social, or other activities may help. Doing something nice for someone else can also help you feel better.

• Get regular exercise. Try for 30 minutes a day. But if that is too much, 5 to 10 minutes of walking is a great place to start. Walking outside, preferably in a natural setting or a park, may bring added benefits.

• Expect your mood to get better slowly, not right away. Feeling better takes time.

• Eat healthy, well-balanced meals.

• Stay away from alcohol and illegal drugs. These can make depression worse.

• It is best to put off important decisions until the depression has lifted. Before deciding to make a major life change—change jobs, move, get married, or divorced—discuss it with others who know you well. They will have a more objective view of your situation.

• Remember, people rarely “snap out of” a depression. But with treatment they can feel a little better day by day.

• Try to be patient and focus on the positives. It may help replace the negative thinking that is part of the depression. The negative thoughts will disappear as your depression responds to treatment.

• Let your family and friends help you.

Key points about depression

• Depression is a whole-body illness. This means that it involves the body, mood, and thoughts. It is not the same as being unhappy or in a “blue” mood. Treatment is often needed.

• There is no clear cause of depression, but healthcare providers think it’s a result of chemical problems in the brain. Some types of depression seem to run in families, but no genes have yet been linked to depression.

• Women have depression about twice as often as men. Many hormonal factors may play a role in the increased rate of depression in women.

• Depression may be diagnosed after a careful mental health exam by a a psychiatrist or other mental health provider.

• Depression is most often treated with medicine, psychotherapy, or cognitive behavioral therapy. It can also be a combination of medicine and therapy.

• If you are with a person who has suicidal thoughts or a suicide plan, take their comments seriously and seek help right away. DO NOT leave them alone, even for a moment. Call or text 988 or 800-273-TALK (8255). You will be connected to trained mental health crisis services at the 988 Suicide & Crisis Lifeline. An online chat choice is also available. Help is available 24 hours a day, 7 days a week. The call is free and confidential.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.