Depression: Its Symptoms and Treatment

What is depression?

Depression is a condition in which you feel sad, hopeless, and uninterested in daily life. You may have other symptoms as well.

We all have times when we feel sad and blue. However, when you feel this way for more than 2 weeks in a row, it is called clinical depression. Clinical depression is a medical problem.

There are several kinds of clinical depression. For more information see: Depression: Its Many Forms

How does it occur?

Depression can begin at any age. It usually begins in the late teenage through young adult years unless it is caused by medical or substance abuse problems. It may come on slowly over weeks or months, but it can also come on suddenly.

The exact cause of depression is not known. It may result from chemical imbalances in the brain and nervous system. You may have abnormal levels of the chemicals that your nervous system uses to send signals to and from the brain. Depression tends to run in families. Things like job stress, poverty, major illness, negative thinking patterns, or a history of abuse also play a part.

What are the symptoms?

Depression can be mild, moderate, or severe. Besides feeling sad and uninterested in things you usually enjoy, you may also:

• Be irritable.
• Have trouble falling asleep, wake up very early, or sleep too much.
• Notice changes in your appetite and weight, either up or down.
• Notice changes in your energy level, usually down but sometimes feeling overexcited.
• Lose interest in sex.
• Feel worthless and guilty.
• Have trouble concentrating or remembering things.
• Feel hopeless or just not care about anything.
• Have unexplained pain or get headaches.
• Think often about death or suicide.

How is it diagnosed?

Your healthcare provider or a mental health therapist can tell you if your symptoms are caused by clinical depression. He or she will ask about your symptoms and any drug or alcohol use. You may have some lab tests to rule out medical problems such as hormone imbalances.

How is it treated?

Depression is a physical illness as well as a psychological one. Do not expect yourself to "snap out of it." It will take time to treat depression. You should not try to overcome clinical depression by yourself. Depression can be successfully treated with psychotherapy, antidepressant medicine, or both. Discuss this with your healthcare provider or therapist.

Medicine

Several types of medicines can help treat clinical depression. Your healthcare provider will carefully select one for you. Some medicines are:

• selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro)
• tricyclic antidepressants such as imipramine (Tofranil), nortriptyline (Aventyl HCl, Pamelor), and desipramine (Norpramin)
• monoamine oxidase inhibitors (MAOs) such as tranylcypromine (Parnate), and phenelzine (Nardil)
• other antidepressants such as mirtazapine (Remeron), venlafaxine (Effexor), duloxetine (Cymbalta) and bupropion (Wellbutrin)
• mood stabilizers (primarily for bipolar and cyclothymic disorders) such as lithium (Eskalith, Lithobid, Lithonate, Lithotabs), carbamazepine (Tegretol), oxcarbazepine (Trileptal), and valproic acid (Depakene, Depakote), and lamotrigine (Lamictal).

You must usually take antidepressant medicines daily for 3 to 6 weeks for them to begin to work.

Certain medicines such as isotretinoin (Accutane), levofloxacin (Levaquin), mefloquine (Lariam), benzodiazepines, and some beta blockers can add to the symptoms of depression. If you have been or are being treated for depression, it is important to check with your healthcare provider before taking any new medicines, either nonprescription drugs or drugs prescribed by other healthcare providers.

Psychotherapy

Seeing a mental health therapist can help with all forms of depression. Therapy may last a short time or may need to go on for many months. Cognitive behavioral therapy (CBT) is a way to help you identify and change thought processes that can lead to depression. Replacing negative thoughts with more positive ones can help you with depression.

Natural and Alternative Treatments

Claims have been made that many herbal and dietary products help depression. St. John's wort is the only one that research shows can help mild symptoms of depression. At 300 to 400 mg per day, hypericum (St. John's wort) may help mild depression. It will not help severe cases of depression or bipolar disorder.

Many types of alternative treatments are said to help depression. Some of them are:

• Biofeedback. You learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration.
• Acupuncture. Acupuncture may be helpful in treating some types of depression.
• Massage Therapy. Massage therapy may help lower stress.
• Relaxation Therapies. Learning ways to relax can help with depression. Yoga and meditation may also be helpful.
• Art and Music Therapies. Some people find art and music therapy, along with medicines and psychotherapy, are helpful in treating depression.

How long will the effects last?

Different kinds of clinical depression last for different amounts of time. Experts do not fully understand why. Often depression lasts a few weeks and never comes again. It can also last months or years. Some people experience depression over and over all their lives.

What can I do to help myself or my loved one?

Maintaining a healthy lifestyle is important. To help prevent depression:

• Exercise for at least 20 minutes every day, for example, take a brisk walk.
• Learn which activities make you feel better and do them often.
• Talk to your family and friends.
• Eat a healthy diet and drink less caffeine.
• Get 7 to 9 hours sleep per night.
• Do not abuse alcohol or drugs.
• Learn ways to lower stress, such as breathing exercises or relaxation techniques.

When should I seek help?

Do not try to overcome depression all by yourself. Seek professional help if you believe that you or a loved one have the symptoms of clinical depression.

Get emergency care if you or a loved one have serious thoughts of suicide or harming others.

For additional information, see Depression: Resource List.