Diseases and Conditions » Depression

·         Definition

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.

·         Symptoms

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.

o    In younger children, symptoms of depression may include sadness, irritability, hopelessness and worry.

o    Symptoms in adolescents and teens may include anxiety, anger and avoidance of social interaction.

o    Changes in thinking and sleep are common signs of depression in adolescents and adults, but are not as common in younger children.

o    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.

o    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

o    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.

o    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.

§  When to see a doctor

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:

o    Contact a family member or friend.

o    Seek help from your doctor, a mental health provider or other health care professional.

o    Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.

·         Causes

It's not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:

o    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.

o    Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.

o    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.

o    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.

o    Life events. Events such as the death or loss of a loved one, financial problems and high stress can trigger depression in some people.

o    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.

§  Risk factors

Depression typically begins in the late 20s, but it can happen at any age. Twice as many women are diagnosed with depression as men, but this may be due in part because women are more likely to seek treatment for depression.

Although the precise cause of depression isn't known, researchers have identified certain factors that seem to increase the risk of developing or triggering depression, including:

• Having biological relatives with depression
• Being a woman
• Having traumatic experiences as a child
• Having biological relatives with a history of alcoholism
• Having family members who have committed suicide
• Experiencing stressful life events, such as the death of a loved one
• Having few friends or other personal relationships
• Recently haven given birth (postpartum depression)
• Having a depressed mood as a child
• Having a serious illness, such as cancer, heart disease, Alzheimer's or HIV/AIDS
• Having personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic
• Abusing alcohol, nicotine or illicit drugs
• Being poor
• Taking certain high blood pressure medications, sleeping pills or certain other medications (talk to your doctor before stopping any medication you think could be affecting your mood)

·         Complications

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:

• Alcohol abuse
• Substance abuse
• Anxiety
• Heart disease and other medical conditions
• Work or school problems
• Family conflicts
• Relationship difficulties
• Social isolation
• Suicide

·         Preparing for your appointment

You're likely to start by seeing your primary care doctor. However, in some cases when you call to set up an appointment, you may be referred directly to a psychiatrist — a medical doctor who specializes in diagnosing and treating mental health conditions.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

§  What you can do

o    Write down any symptoms you've had, including any that may seem unrelated to the reason for which you scheduled the appointment.

o    Write down key personal information, including any major stresses or recent life changes.

o    Make a list of all medications, as well as any vitamins or supplements, that you're taking.

o    Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

o    Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For problems related to depression, some basic questions to ask your doctor include:

o    Is depression the most likely cause of my symptoms?

o    Other than the most likely cause, what are other possible causes for my symptoms or condition?

o    What kinds of tests will I need?

o    What treatment is likely to work best for me?

o    What are the alternatives to the primary approach that you're suggesting?

o    I have these other health conditions. How can I best manage them together?

o    Are there any restrictions that I need to follow?

o    Should I see a psychiatrist or other mental health provider?

o    Are there any possible side effects or other issues I should be aware of with the medications you're recommending?

o    Is there a generic alternative to the medicine you're prescribing?

o    Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

§  What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

o    When did you or your loved ones first notice your symptoms of depression?

o    How long have you felt depressed? Do you generally always feel down, or does your mood fluctuate?

o    Does your mood ever swing from feeling down to feeling euphoric and full of energy?

o    Do you ever have suicidal thoughts when you're feeling down?

o    How severe are your symptoms? Do they interfere with your daily life or relationships?

o    Do you have any biological relatives with depression or another mood disorder?

o    What other mental or physical health conditions do you have?

o    Do you drink alcohol or use illicit drugs?

o    How much do you sleep at night? Does it change over time?

o    What, if anything, seems to improve your symptoms?

o    What, if anything, appears to worsen your symptoms?

·   Tests and diagnosis

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.

§  Diagnostic criteria for depression

To be diagnosed with major depression, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

To be diagnosed with major depression, you must have five or more of the following symptoms over a two-week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Symptoms can be based on your own feelings or may be based on the observations of someone else. They include:

o    Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful (in children and adolescents, depressed mood can appear as constant irritability)

o    Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day

o    Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in children, failure to gain weight as expected can be a sign of depression)

o    Insomnia or increased desire to sleep nearly every day

o    Either restlessness or slowed behavior that can be observed by others

o    Fatigue or loss of energy nearly every day

o    Feelings of worthlessness, or excessive or inappropriate guilt nearly every day

o    Trouble making decisions, or trouble thinking or concentrating nearly every day

o    Recurrent thoughts of death or suicide, or a suicide attempt

To be considered major depression:

o    Your symptoms aren't due to a mixed episode — simultaneous mania and depression that can occur in bipolar disorder

o    Symptoms must be severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others

o    Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or having a medical condition such as hypothyroidism

o    Symptoms are not caused by grieving, such as temporary sadness after the loss of a loved one

§  Other conditions that cause depression symptoms

There are several other conditions with symptoms that can include depression. It's important to get an accurate diagnosis so you can get the appropriate treatment for your particular condition. Your doctor or mental health provider's evaluation will help determine if your symptoms of depression are caused by one of the following conditions:

o    Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect your feelings, thoughts and behavior.

o    Bipolar disorder. This type of depression is characterized by mood swings that range from highs to lows. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's important to get an accurate diagnosis so that you can get the proper treatment and medications.

o    Cyclothymia. Cyclothymia (si-klo-THI-me-uh), or cyclothymic disorder, is a milder form of bipolar disorder.

o    Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. While it's usually not disabling, dysthymia can prevent you from functioning normally in your daily routine and from living life to its fullest.

o    Postpartum depression. This is a common type of depression that occurs in new mothers. It often begins four to eight weeks after delivery and may last for months.

o    Psychotic depression. This is severe depression accompanied by psychotic symptoms such as delusions or hallucinations.

o    Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder.

o    Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.

Make sure you understand what type of depression you have so that you can learn more about your specific situation and its treatments.

·   Treatments and drugs

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.

§  Medications

Lifestyle and home remedies

Depression generally isn't an illness that you can treat on your own. But you can do some things for yourself that will help. In addition to professional treatment, follow these self-care steps:

• Stick to your treatment plan. Don't skip psychotherapy sessions or appointments, even if you don't feel like going. Even if you're feeling well, resist any temptation to skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms.
• Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so that 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 watch for warning signs.
• Get exercise. Physical activity reduces depression symptoms. Consider walking, jogging, swimming, gardening or taking up another activity you enjoy.
• Avoid alcohol and illicit 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.
• Get plenty of sleep. Sleeping well is especially important when you're depressed. If you're having trouble sleeping, talk to your doctor about what you can do.

·   Coping and support

Coping with depression can be challenging. Talk to your doctor or therapist about improving your coping skills, and try these tips:

o    Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.

o    Consider writing in a journal. Journaling can improve mood by allowing you to express pain, anger, fear or other emotions.

o    Read reputable self-help books. Your doctor or therapist may be able to recommend books to read.

o    Join a support group. Connecting with others facing similar challenges can help you cope. Local support groups for depression are available in many communities, and support groups for depression are also offered online.

o    Don't become isolated. Try to participate in social activities, and get together with family or friends regularly.

o    Take care of yourself. Eat a healthy diet, exercise regularly and get plenty of sleep.

o    Learn ways to relax and manage your stress. Examples include meditation, yoga and tai chi.

o    Structure your time. Plan your day and activities. You may find it helpful to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.

o    Don't make important decisions when you're down. Avoid decision making when you're feeling very depressed, since you may not be thinking clearly.