Major Depression

What is major depression?

Depression is a condition in which you feel sad, hopeless, and uninterested in daily life. Major depression is severe depression that lasts for at least 2 full weeks.

How does it occur?

Major depression may start after some event or it may not be caused by anything specific. You may have major depression after a period of having dysthymia. Dysthymia is being mildly depressed almost every day for 2 or more years. If major depression develops from dysthymia, you are more likely to have major depression in the future.

People are more likely to develop this condition if they:

• have family members who have had depression, bipolar disorder, or anxiety problems
• are female. Women are twice as likely as men to have major depression
• have a major medical problem such as heart disease or cancer.

The chemicals in your nervous system and the way that brain cells communicate changes with major depression. Exactly how this works and what it means are not fully understood.

Major depression may start at any age. Teenagers and young adults, as well as older adults, are more likely to have this condition than middle-aged adults.

What are the symptoms?

Besides feeling very 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.
• Feel more anxiety or panic.
• Notice changes in your appetite and weight, either up or down.
• Notice changes in your energy level, usually down but sometimes feeling overexcited.
• Lose sexual desire and function.
• Feel worthless and guilty.
• Have trouble concentrating or remembering things.
• Feel hopeless or just not care about anything.
• Have unexplained physical symptoms.
• Think often about death or suicide.

Other symptoms may vary with age. If you are a teenager, you may be irritable, get angry, abuse substances, and cause trouble with parents and at school. If you are a young or middle-aged adult, you may abuse substances such as drugs or alcohol, have physical problems (like pain or stomach upsets), or feel nervous. For seniors, being confused and having problems concentrating are frequent symptoms.

How is it diagnosed?

Your healthcare provider or a mental health professional will ask about your symptoms and any drug or alcohol use. You may have lab tests to rule out medical problems such as hormone imbalances. There are no lab tests that directly diagnose depression.

How is it treated?

Do not try to overcome clinical depression by yourself. It can usually be successfully treated with psychotherapy, antidepressant medicine, or both. Discuss this with your healthcare provider or therapist.

Medicine

Several types of prescription medicines can help treat major depression. Your healthcare provider will work with you to carefully select the right medicine for you.

You must take these medicines daily for 3 to 6 weeks to get full benefit from them. Most people benefit from taking these medicines for at least 6 months.

No nonprescription medicines are available to treat major depression.

Psychotherapy

Seeing a mental health therapist can help with all forms of depression. You may need therapy for a short time or for many months. One very helpful form of psychotherapy is cognitive behavioral therapy (CBT). CBT helps you identify and change thought processes that can lead to depression. Replacing negative thoughts with more positive ones reduces depression. Interpersonal therapy has also been shown to work very well.

Complementary Treatments

Diets rich in fruits and vegetables are recommended for people with depression. A multivitamin and mineral supplement may also be recommended.

Studies suggest that eating fatty fish 2 to 3 times per week may reduce feelings of depression and anxiety. These fish contain omega-3 polyunsaturated fatty acids. Fatty fish include salmon, tuna, mackerel, herring, and sardines. For people who dislike fish, flaxseed, pumpkin seed, walnuts, and olive oil are also sources of omega-3 fatty acids. Fish oil supplements are available.

Taken in appropriate doses, St. John's wort may help with some forms of mild depression. It does not help with severe depression, and may cause side effects, such as sun sensitivity, anxiety, or sleeplessness.

Other supplements that may be helpful in treating depression include SAMe, DHEA, and 5-hydroxytryptophan.

Be careful which products you use. "Natural" products are not standardized. They may have different strengths and effects. Some may be contaminated. Herbs and supplements affect your body and may interact with prescription medicines. Talk to your healthcare provider or pharmacist about any supplements that you are using or considering.

Other treatments to help treat depression are:

• Biofeedback. In biofeedback you learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration, but it is not a treatment for major depression.
• Massage Therapy. Massage therapy may help lower stress, but it does not directly treat depression.
• Relaxation Therapies. Learning ways to relax can help with depression, along with medicines and psychotherapy. Yoga and meditation may also be helpful.
• Art and Music Therapies. Some people find art and music therapy are helpful in treating depression.

How long will the effects last?

Major depression usually improves within a few weeks. Some people have it only once, while others have many episodes. Major depression can be shortened, and possibly prevented, with treatment.

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

Seeking treatment quickly is the best thing to do. Watch closely for the signs of depression. Get treatment before the symptoms become bad.

Certain medicines can add to the symptoms of depression. If you have had depression, tell all healthcare providers who treat you about all medicines you are taking, including nonprescription products and natural remedies.

Maintaining a healthy lifestyle and social activities are most important. To help prevent depression:

• Exercise for at least 20 minutes every day, for example a brisk walk.
• Learn which activities make you feel better and do them often.
• Talk to your family and friends.
• Eat a healthy diet.
• Avoid alcohol, caffeine, and nicotine.
• Do not use drugs.
• Learn ways to lower stress, such as breathing and muscle relaxation exercises.

When should I seek help?

If you are showing the signs of major depression, seek professional help quickly. Do not try to treat your depression by yourself. Professional treatment is necessary.

Most of the time, you will feel much better after a few weeks of treatment. Some people with untreated major depression commit suicide. Many more attempt suicide or try to hurt themselves. After treatment and feeling better, these same people usually cannot believe that once they felt so bad and wanted to die.

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

For more information, see:
Depression: Its Symptoms and Treatment
Adjustment Disorders with Depressed Mood
Cognitive Therapy