Depression

What is depression?

Depression is a serious medical illness of the brain. It is not a feeling of sadness or feeling “blue.” Someone who has depression has symptoms nearly every day, all day, for 2 weeks or longer. It’s persistent and interferes with everyday life—from work, home, and school to relationships and daily tasks. For some, depression can lead to suicidal thoughts. If you or a loved one are having suicidal thoughts, call or text 988. This is the Suicide & Crisis Lifeline. It is staffed around the clock. Your call or text will never be turned away.

Depression can affect people of all ages and is different for every person. A person who has depression can’t control their feelings. If you or your child, teen, or older relative is depressed, it’s not their fault. Left untreated, depression can last for weeks, months, or even years.

Women are twice as likely as men to experience depression. The reason for this is unknown. Changes in a woman’s hormone levels may be related to depression.

Symptoms of depression

Symptoms are different for every person. You may have one or many of the symptoms listed below. Your symptoms may appear as emotional, physical, or a combination of both. The symptoms of depression may be different for children, teens, and seniors.

Emotional symptoms include:

• Crying easily or for no reason
• Feeling guilty or worthless
• Feeling restless, irritated, and easily annoyed
• Feeling “empty,” numb, or hopeless
• Losing interest or pleasure in things you used to enjoy (including sex)
• Thinking about death or suicide.

Physical symptoms include:

• Changes in appetite (eating more than usual or eating less and experiencing unplanned weight loss)
• Feeling extremely 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 trouble sleeping

What causes depression?

Depression is typically caused by one or more factors. This includes genetic, biological, environmental, and psychological causes.

For example, depression may be caused by an imbalance of chemicals in the brain. Sometimes there aren’t enough chemical messengers (called neurotransmitters) in the brain. Neurotransmitters that affect your mood are serotonin, norepinephrine, and dopamine. A chemical imbalance in the brain may be caused by one or more of the following:

• Your genes.Sometimes depression is hereditary. This means it runs in your family. You may be more at risk for having depression if you have a parent or sibling who has depression.
• A medical condition. Problems with your thyroid or nutrient deficiencies may be associated with an increased risk of depression. Sometimes, people experience depression after cardiac surgery. Depression also is a symptom of bipolar disorder.
• Events in your life.Situational depression can be triggered by stressful events in your life. These can include 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.
• Some people have seasonal affective disorder (SAD) in the winter, due to the reduction in sunlight and colder temperatures.
• Chronic disease. Living with a chronic disease, such as diabetes or obesity, can cause a person to be depressed. This is because the person feels they aren’t in control of their health outcomes or because their lifestyles are restricted.

Depression is not caused by personal weakness, laziness, or lack of willpower.

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 or have a hard time concentrating. They may 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.

How is depression diagnosed?

Tell your doctor about your symptoms. Don’t expect your doctor to guess that you’re depressed just by looking at you. You may feel embarrassed. It may be hard for you to imagine that treatment will help you feel better. But don’t wait to talk to your doctor. The sooner you seek treatment, the sooner the depression will lift.

Once you tell your doctor how you’re feeling, they may ask you some questions about your symptoms, your health, and 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, including substance abuse.

Reasons to get help early:

• Early diagnosis and treatment reduce the risk that depression will get worse or last a long time.
• Diagnosis and treatment can help you return to your “normal” self and enjoy life.
• Treatment can help prevent depression from returning.
• Thoughts of suicide are common in people with major depression. The risk of suicide is higher the longer you wait to treat it.

Can depression be prevented or avoided?

Generally, depression is a condition that cannot be prevented. There are lifestyle changes you can make that can boost your mood and minimize symptoms of depression (see depression treatment).

Depression treatment

Depression can be treated with prescription antidepressant medicines, counseling, or a combination of the two. Lifestyle changes can help, too. This includes a nutritious diet, regular exercise, and avoiding alcohol, drugs, and too much caffeine. Research has shown that fueling your body with healthy foods can fuel your brain.

Depression usually can be treated through visits to your doctor. You may need in-hospital treatment if you have other medical conditions that could affect your treatment. In-hospital treatment is required if you’re at high risk of suicide.

Medicine

Your doctor may prescribe medicine to treat your depression. These 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. They tend to decrease after a couple of weeks. Don’t stop taking the medicine without checking with your doctor first.

There is some new research that ketamine therapy may have a rapid effect on improving severe depression.

Counseling

Counseling (or talk therapy) may be a good treatment option for mild to moderate depression. 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.

In more serious cases, your doctor may suggest the use of electroconvulsive therapy (also called ECT or electroshock therapy). It changes your brain’s chemistry. Electric currents are passed through the brain to trigger a seizure (a short period of irregular brain activity). It lasts about 40 seconds. Medicine is given during ECT to 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 medicine. Symptoms of severe mania may include agitation, confusion, hallucinations, or delusions.
• Schizophrenia that does not respond to medicine

Living with depression

The most important part of living with depression is not giving up. Stay focused on your goal to feel better and be consistent with your doctor-recommended treatment. Do not try to “self-medicate” for depression with substance use. It only makes it worse.

Consider these dos and don’ts as you work toward recovery.

Do:

• Pace yourself
• Get involved in activities that make you feel good or feel like you’ve achieved something. This includes volunteering or joining a club.
• Avoid drugs and alcohol. Both make depression worse. Both can cause dangerous side effects with antidepressant medicines.
• Exercise regularly. It makes your body feel better. Exercise causes a chemical reaction in the body that can boost your mood. Your goal should be exercising 4 to 6 times a week for at least 30 minutes each time.
• Eat balanced meals and healthy foods. Avoid junk food and processed food.
• Get plenty of sleep. Keep your sleep routine consistent (waking up and going to bed at the same time each day).
• Take your medicine and/or go to counseling as often as your doctor recommends. Your medicine won’t work if you only take it occasionally.
• Set small goals for yourself if you have low 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 have thoughts of suicide.

Don’t:

• Don’t isolate yourself. Stay in touch with friends, family, your spiritual advisor, and your doctor.
• Don’t let negative thoughts linger in your mind. Don’t talk badly about yourself. Don’t expect to fail. This type of thinking is typical 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 while you are depressed. This includes marriage, divorce, separation, quitting your job, etc. You may not be thinking clearly while you are depressed. If you must make an important 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.

Complications

People who have depression sometimes think about suicide. This thinking is a common symptom of the depression. If you have thoughts about hurting yourself, tell someone. Tell your doctor, your friends, or your family. Or you could 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. Depression can be successfully treated.

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 support groups in my area?
• If I’m pregnant or breastfeeding, can I take antidepressants?
• Will I feel this way the rest of my life?
• Will I have to take medicine the rest of my life?
• How can I tell if a loved one is depressed?
• Does dementia increase depression?
• What should I do if I am having thoughts of suicide?

Resources

988 Suicide & Crisis Lifeline

National Institutes of Health, MedlinePlus: Depression

National Institutes of Mental Health: Depression

Substance Abuse and Mental Health Services Administration: Depression