Depression is a medical illness that involves the mind and body. Also called major depression, major depressive disorder and clinical depression, it affects how you feel, think and behave. Depression can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and depression may make you feel as if life isn't worth living. More than just a bout of the blues, depression isn't a weakness, nor is it something that you can simply "snap out" of. Depression is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure. But don't get discouraged. Most people with depression feel better with medication, psychological counseling or other treatment.
Complications of Depression
Depression is a serious illness that can take a terrible toll on individuals and families. Untreated depression can result in emotional, behavioral and health problems that affect every area of your life. Complications associated with depression can include:
Heart disease and other medical conditions
Work or school problems
Causes of Depression
It's not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:
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 pinpoint causes.
Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.
Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result from thyroid problems, menopause and a number of other conditions.
Inherited traits. Depression is more common in people whose biological family members also have the condition. Researchers are trying to find genes that may be involved in causing depression.
Life events. Events such as the death or loss of a loved one, financial problems and high stress can trigger depression in some people.
Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause permanent changes in the brain that make you more susceptible to depression.
Signs & Symptoms of Depression
Depression symptoms include:
Feelings of sadness or unhappiness
Irritability or frustration, even over small matters
Loss of interest or pleasure in normal activities
Reduced sex drive
Insomnia or excessive sleeping
Changes in appetite — depression often causes decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain
Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
Slowed thinking, speaking or body movements
Indecisiveness, distractibility and decreased concentration
Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren't going right
Trouble thinking, concentrating, making decisions and remembering things
Frequent thoughts of death, dying or suicide
Crying spells for no apparent reason
Unexplained physical problems, such as back pain or headaches
For some people, depression symptoms are so severe that it's obvious something isn't right. Others people feel generally miserable or unhappy without really knowing why.
Depression affects each person in different ways, so depression symptoms vary from person to person. Inherited traits, age, gender and cultural background all play a role in how depression may affect you.
Depression symptoms in children and teens
Common symptoms of depression can be a little different in children and teens than they are in adults.
In younger children, symptoms of depression may include sadness, irritability, hopelessness and worry.
Symptoms in adolescents and teens may include anxiety, anger and avoidance of social interaction.
Changes in thinking and sleep are common signs of depression in adolescents and adults, but are not as common in younger children.
In children and teens, depression often occurs along with behavior problems and other mental health conditions, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).
Depression symptoms in older adults
Depression is not a normal part of growing older, and most seniors feel satisfied with their lives. However, depression can and does occur in older adults. Unfortunately it often goes undiagnosed and untreated. Many adults with depression feel reluctant to seek help when they're feeling down.
In older adults, depression may go undiagnosed because symptoms — for example, fatigue, loss of appetite, sleep problems or loss of interest in sex — may seem to be caused by other illnesses
Older adults with depression may say they feel dissatisfied with life in general, bored, helpless or worthless. They may always want to stay at home, rather than going out to socialize or doing new things.
Suicidal thinking or feelings in older adults is a sign of serious depression that should never be taken lightly, especially in men. Of all people with depression, older adult men are at the highest risk of suicide.
Diagnosis of Depression
Because depression is common and often goes undiagnosed, some doctors and health care providers may ask questions about your mood and thoughts during routine medical visits. They may even ask you to fill out a brief questionnaire to help check for depression symptoms. When doctors suspect someone has depression, they generally ask a number of questions and may do medical and psychological tests. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:
Physical exam. This may include measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
Laboratory tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly.
Psychological evaluation. To check for signs of depression, your doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide or self-harm. Your doctor may have you fill out a written questionnaire to help answer these questions.
Treatments of Depression
Numerous depression treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most people. In some cases, a primary care doctor can prescribe medications to relieve depression symptoms. However, many people need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist). Many people with depression also benefit from seeing a psychologist or other mental health counselor. Usually the most effective treatment for depression is a combination of medication and psychotherapy.
If you have severe depression, a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve. Here's a closer look at your depression treatment options.
A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood.
Types of antidepressants include:
Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may go away as your body adjusts to the medication. They can include digestive problems, jitteriness, restlessness, headache and insomnia.
Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. In high doses these medications can cause increased sweating and dizziness. People with liver disease shouldn't take duloxetine.
Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It's one of the few antidepressants that don’t cause sexual side effects. At high doses, bupropion may increase your risk of having seizures.
Atypical antidepressants. These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone (Desyrel) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep.
Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more severe side effects, a tricyclic antidepressant generally isn't prescribed unless you've tried an SSRI first without an improvement in your depression. Side effects can include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Older adults taking these medications are susceptible to memory problems, confusion and hallucinations. Tricyclic antidepressants are also known to cause weight gain.
Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods such as certain cheeses, pickles and wines and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs.
Other medication strategies. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation.
Prevention of Depression
There's no sure way to prevent depression. However, taking steps to control stress, to increase your resilience and to boost low self-esteem may help. Friendship and social support, especially in times of crisis, can help you weather rough spells. In addition, treatment at the earliest sign of a problem can help prevent depression from worsening. Long-term maintenance treatment also may help prevent a relapse of depression symptoms.
When to seek Medical Advice
If you feel depressed, make an appointment to see your doctor as soon as you can. Depression symptoms may not get better on their own — and depression may get worse if it isn't treated. Untreated depression can lead to other mental and physical health problems or problems in other areas of your life. Feelings of depression can also lead to suicide. If you're reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.
If you have suicidal thoughts
If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
Contact a family member or friend.
Seek help from your doctor, a mental health provider or other health care professional.
Contact a minister, spiritual leader or someone in your faith community.
When to get emergency help
If you think you may hurt yourself or attempt suicide, call your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.