What is depression?
When doctors talk about depression, they mean the medical illness called major depression. Someone who has major depression has symptoms like those listed in the Symptoms section nearly every day, all day, for 2 weeks or longer. There is also a minor form of depression that causes less severe symptoms. Both kinds of depression have the same causes and treatment.
Depression can affect people of all ages and is different for every person. A person who has depression can’t control his or her feelings. If you or your child, teen, or older relative is depressed, it’s not his or her fault.
Is depression more common in women than in men?
Yes. Women are twice as likely as men to experience depression. The reason for this is unknown, but changes in a woman’s hormone levels may be related to depression.
What are the symptoms of depression?
The symptoms of depression are different for every person. You may have one or many of the symptoms listed below. Your symptoms may include only emotional or only physical symptoms, or both.
- Crying easily or for no reason
- Feeling guilty or worthless
- Feeling restless, irritated, and easily annoyed
- Feeling sad, numb, or hopeless
- Losing interest or pleasure in things you used to enjoy (including sex)
- Thinking about death or suicide
- Changes in appetite (eating more than usual, or eating less than usual)
- Feeling very tired all the time
- Having other aches and pains that don’t get better with treatment
- Having trouble paying attention, recalling things, concentrating, and making decisions
- Headaches, backaches, or digestive problems
- Sleeping too much, or having problems sleeping
- Unintended weight loss or gain
The symptoms of depression may be different for children, teens, and seniors.
Causes & Risk Factors
What causes depression?
Depression may be caused by an imbalance of chemicals in the brain. Sometimes there aren’t enough chemical messengers (called neurotransmitters) in the brain. Examples of neurotransmitters that affect your mood are serotonin (say: “sair-a-tone-in”), norepinephrine (say: “nor-ep-in-ef-rin”), and dopamine (say: “dope-a-mean”). A chemical imbalance in the brain may be caused by one or more of the following:
Depression is not caused by personal weakness, laziness, or lack of willpower.
- Your genes. Sometimes depression is hereditary, meaning it runs in your family. If you have a parent or sibling who has depression, you may be more at risk for having depression yourself.
- A medical condition. Problems with your thyroid, nutrient deficiencies, or chronic diseases such as heart disease, diabetes, or cancer may cause depression.
- Events in your life. Depression can be triggered by stressful events in your life, such as the death of someone you love, a divorce, chronic illness, or loss of a job.
- Medicines, drugs, or alcohol. Taking certain medicines, abusing drugs or alcohol, or having other illnesses can also lead to depression.
Can giving birth cause depression?
In the days following the birth of a baby, it is common for some mothers to have mood swings. They may feel a little depressed, have a hard time concentrating, lose their appetite, or find that they can’t sleep well even when the baby is asleep. This is called the baby blues and goes away within 10 days after delivery. However, some women have worse symptoms or symptoms that last longer. This is called postpartum depression.
Diagnosis & Tests
How does my doctor know if I’m feeling depressed?
You need to tell your doctor about your symptoms. Don’t expect your doctor to be able to guess that you’re depressed just by looking at you. You may feel embarrassed, or it may be hard for you to imagine treatment will actually help you feel better. But don’t wait to talk to your doctor. The sooner you seek treatment, the sooner the depression will lift.
How is depression diagnosed?
Once you tell your doctor how you’re feeling, he or she may ask you some questions about your symptoms, about your health, and about your family history. Your doctor may also give you a physical exam and do some tests. It is important to tell your doctor about any medicines that you are taking.
Reasons to get help for depression
- Early diagnosis and treatment helps keep depression from getting worse or lasting a long time.
- Diagnosis and treatment can help you return to your “normal” self and enjoy life.
- After you’re diagnosed, treatment can help prevent depression from coming back.
- Thoughts of suicide are common in people with depression. The risk of suicide is higher if you don’t get help for your depression. When depression is successfully treated, the thoughts of suicide will go away.
How is depression treated?
Depression can be treated with medicines, with counseling, or with both. A nutritious diet, exercising on a regular basis, and avoiding alcohol, drugs, and too much caffeine can also help.
Will I need to go to the hospital?
Depression can usually be treated through visits to your doctor. Treatment in the hospital may be needed if you have other medical conditions that could affect your treatment or if you’re at high risk of suicide.
How long will the depression last?
This depends on how soon you get help. Left untreated, depression can last for weeks, months, or even years. The main risk in not getting treatment is suicide. Treatment can help depression lift in 8 to 12 weeks or less.
What medicines are used to treat depression?
Medicines that treat depression are called antidepressants. They help increase the number of chemical messengers (serotonin, norepinephrine, dopamine) in your brain.
Antidepressants work differently for different people. They also have different side effects. So, even if one medicine bothers you or doesn’t work for you, another may help. You may notice improvement as soon as 1 week after you start taking the medicine. But you probably won’t see the full effects for about 8 to 12 weeks. You may have side effects at first, but they tend to decrease after a couple of weeks. Don’t stop taking the medicine without checking with your doctor first.
How does counseling help?
For mild to moderate depression, counseling may be a good treatment option. For major depression and for some people with minor depression, counseling may not be enough. A combination of medicine and talk therapy is usually the most effective way of treating more severe depression. If you continue the combination treatment for at least a year, you are less likely to have depression come back.
In psychotherapy, you talk with a trained therapist or counselor about things that are going on in your life. The focus may be on your thoughts and beliefs, on things that happened in your past, or on your relationships. Or the focus may be on your behavior, how it’s affecting you, and what you can do differently. Psychotherapy usually lasts for a limited time, such as 8 to 20 visits.
What is electroconvulsive therapy?
Electroconvulsive therapy (also called ECT or electroshock therapy) is a procedure used to help treat certain mental illnesses. Electric currents are passed through the brain in order to trigger a seizure (a short period of irregular brain activity), lasting about 40 seconds. Medicine is given during ECT to help prevent damage to muscles and bones.
Electroconvulsive therapy may help people who have the following conditions:
- Severe depression that does not respond to antidepressants (medicines used to treat depression) or counseling.
- Severe depression in patients who can’t take antidepressants.
- Severe mania that does not respond to medication. Symptoms of severe mania may include agitation, confusion, hallucinations, or delusions.
- Schizophrenia that does not respond to medication.
Tips on getting through depression
- Pace yourself.
- Get involved in activities that make you feel good or feel like you’ve achieved something.
- Avoid drugs and alcohol. Both make depression worse. Both can cause dangerous side effects with antidepressant medicines.
- Exercise often to make yourself feel better. Physical activity seems to cause a chemical reaction in the body that can improve your mood. Exercising 4 to 6 times a week for at least 30 minutes each time is a good goal. But even less activity can be helpful.
- Eat balanced meals and healthful foods.
- Get enough sleep.
- Take your medicine and/or go to counseling as often as your doctor recommends. Your medicine won’t work if you only take it once in a while.
- Set small goals for yourself, because you may have less energy.
- Encourage yourself.
- Get as much information as you can about depression and how to treat it.
- Call your doctor or the local suicide crisis center right away if you start thinking about suicide.
- Don’t isolate yourself. Stay in touch with your loved ones and friends, your religious advisor, and your family doctor.
- Don’t believe negative thoughts you may have, such as blaming yourself or expecting to fail. This thinking is part of depression. These thoughts will go away as your depression lifts.
- Don’t blame yourself for your depression. You didn’t cause it.
- Don’t make major life decisions (for example, about separation or divorce). You may not be thinking clearly while you are depressed, so the decisions you make at this time may not be the best ones for you. If you must make a big decision, ask someone you trust to help you.
- Don’t expect to do everything you normally can. Set a realistic schedule.
- Don’t get discouraged. It will take time for your depression to lift fully. Be patient with yourself.
- Don’t give up.
People who have depression sometimes think about suicide. This thinking is a common part of the depression. If you have thoughts about hurting yourself, tell someone. You could tell your doctor, your friends, your family, or call your local suicide hotline, such as the National Suicide Prevention Lifeline at 1-800-273-8255.
Get help right away. There are people who can help you, and depression can be successfully treated.
- Depression and Bipolar Support Alliance
- National Institute of Mental Health
- Mental Health America
- National Alliance for the Mentally Ill
- American Psychiatric Association
- National Federation of Families for Children’s Mental Health
- American Psychological Association
- National Institute on Aging
Questions to Ask Your Doctor
- I’ve been feeling ______. Could I be depressed?
- Do I need treatment? What are my treatment options?
- Should I see a therapist?
- Is there anything I can do at home to help myself?
- Are there any support groups in my area?
- What are the risks and benefits of taking antidepressants?
- I’m pregnant. Should I take antidepressants?
- I’m breastfeeding. Should I take antidepressants?
- Will I have to take medicine the rest of my life?
- I care for an older adult. How do I tell if he or she is depressed?
- What kinds of treatment are safe for older adults who have other health problems, such as dementia?
- What should I do if I am having or start having thoughts of suicide?
Depression in Older Adults
Is depression a normal part of growing older?
Depression is not a normal part of growing older, but it is common in adults who are 65 years of age or older. Retirement, health problems, and the loss of loved ones are things that happen to older adults. Feeling sad at these times is normal. But if these feelings persist and keep you from your usual activities, you should talk to your doctor.
Why does depression often go undiagnosed in older adults?
In older adults, it can be hard to tell the difference between depression and illnesses such as dementia. Also, older adults may not talk to their doctors or caregivers about their sad or anxious feelings because they are embarrassed. But depression is nothing to be embarrassed about. It is not a personal weakness. It’s a medical illness that can be treated.
How are the symptoms of depression different for older adults?
In addition to the standard emotional and physical symptoms of depression, older adults who are depressed may also experience:
- Delusions or hallucinations
- Feelings of boredom or worthlessness
- Memory problems or confusion
- Withdrawal from social activities
I’m caring for an older adult. When should I talk to my loved one’s doctor?
If you are caring for an older adult, tell your loved one’s doctor about any new symptoms or changes in behavior that concern you or may be due to depression. The doctor may:
- Ask you and other family members questions.
- Do some tests to rule out other medical problems.
- Talk with your relative.
- Want to know what medicines your loved one takes.
What can be done to help depression in older adults?
Treatment of depression in older adults is often exactly the same as treatment for all other individuals.
Many older adults take prescription medicines to treat other health conditions. If one of these medicines might be causing the depression, the doctor will probably switch that medicine.
If you are caring for an older adult who is depressed, the doctor may also have some advice for you and other family members and caregivers on how to cope. He or she may recommend support groups that can help you.
Depression in Children and Teens
How are the symptoms of depression different for children and teens?
Children and teens might not show all of the usual symptoms of depression seen in adults, but they will often have some of them. Younger children who are depressed may:
Older children who are depressed may:
If you notice these signs every day for several weeks, it might mean your child is depressed.
- Have a poor appetite and/or weight loss
- Feel sad or hopeless
- Not enjoy playing as much as usual
- Worry more
- Be angry (lose their temper) or anxious
- Have changes in appetite (eating more than usual, or eating less)
- Not want to go to school or other social activities
- Seem less confident or feel like they can’t do anything right
Why do young people get depressed?
Many things can cause depression, including genetics, medical conditions, and life events. The following are some of the reasons children and teens might get depressed:
- The family moves to a new place to live
- The child has to change to a new school
- A pet, friend, or family member dies
- Someone in the family is very sick
- The child experiences the hormonal changes of puberty
- Behavior problems or conditions such as attention deficit hyperactivity disorder (ADHD)
What should I do if I think my child is depressed?
Ask your child about his or her thoughts and feelings. It may also be a good idea to talk to your doctor about your child’s behavior and your concerns about his or her depression. In most cases, taking your child to your family doctor is a good idea. A medical problem may be causing the depression. Your doctor may want to give your child a general medical check-up.
What can be done to help depressed children and teens?
Most depressed children and teens should talk to a counselor, therapist, psychologist, or psychiatrist about what is making them feel the way they are feeling. Family counseling can help everyone in the family. Your family doctor can refer you and your child to someone for counseling. Most depressed children and teens do best when they get both counseling and medicine.
This content has been supported by Forest Laboratories Inc.
- Depression in Women: Diagnostic and Treatment Considerations by SC Bhatia, M.D. and SK Bhatia, M.D. (American Family Physician July 01, 1999, http://www.aafp.org/afp/990700ap/225.html)
- Antidepressant Discontinuation Syndrome by CH Warner, MAJ, MC, USA; W Bobo, LCDR, MC, USN; C Warner, MAJ, MC, USA; S Reid, CPT, USAF, MC; and J Rachal, MAJ, USAF, MC (American Family Physician August 01, 2006, http://www.aafp.org/afp/20060801/449.html)
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.