Depression

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Introduction

What is depression?

Depression, also known as clinical depression, is a serious mental health disorder that often involves an imbalance of the chemicals that support brain function. Depression is more than just feeling sad or having the blues for a few days. Clinical depression is a mood disorder commonly involving feelings of sadness, loss, anger, frustration or despair that interfere with everyday life for an extended period.  

Depression is a common condition that can negatively affect a person’s ability to go to work and school, care for family, and take care of basic needs. More than 20 million people in the United States have depression, according to the National Institutes of Health (Source: NIH).

Depression is often thought of as experiencing feelings of sadness, “having the blues,” or being disheartened. However, normal feelings of sadness, such as sadness due to a death in the family, although painful, generally resolve with time. For people with depression, feelings of sadness linger and intensify to the point that they interfere with a person’s ability to function normally. This in turn can intensify the depression.

There are many types of depression including:

  • Major depression is the most intense and serious type of depression.

  • Dysthymic disorder is a less severe type of depression that is not as disabling as major depression, but is long-lasting and negatively affects your feelings of well-being and your ability to function effectively in daily living activities.

  • Bipolar disorder is also known as manic-depressive disorder. Bipolar disorder is characterized by cycling mood changes, from depression to mania, which is an extremely energetic and “up” state.

  • Postpartum depression is a type of depression that sometimes occurs in women after giving birth.

Most people with depression do not seek assistance from a mental health professional, but they continue to visit their primary care provider. Frequently, through denial or misapprehension, there is reluctance to seek help for depression. It is important to understand that depression is not a sign of weakness. People who suffer from depression can’t simply make themselves feel better and happy again. 

The good news is that there are effective treatments for depression. If you are feeling depressed for two or more weeks, contact your health care provider to discuss the many treatment options for depression, as well as self-care steps that can help in your treatment.

A serious complication of depression is suicidal thoughts or actions. Seek immediate medical care (call 911) if you, or someone you are with or know, are having or expressing feelings of wanting to hurt or kill oneself or another person.  

Symptoms

What are the symptoms of depression?

The severity and types of symptoms of depression vary from person to person. Depression is more than just feeling sad or “having the blues.”  It is normal to experience temporary feelings of sadness or “feeling down” in reaction to difficult situations in life, such as losing a job or having a death in the family. Normal feelings of sadness, although painful, generally resolve after a short time.

For people with depression, feelings of sadness linger and intensify to the point that they interfere with the person’s ability to function normally. This in turn can intensify the depression.

Typical symptoms of depression can include one or more of the following, especially if they do not go away or get better with time:

  • Aches, pains, headaches or digestive problems

  • Anger or irritability

  • Anxiety

  • Boredom

  • Difficulties with memory, concentration, or making decisions

  • Excess alcohol consumption

  • Feelings of worthlessness or guilt

  • Feelings of hopelessness and despairLoss of interest in enjoyable activities

  • Low energy levels and fatigue

  • Sadness or melancholy

  • Sleep abnormalities, such as insomnia or a desire to sleep all the time

  • Weight gain or weight loss

Symptoms that might indicate a serious or life-threatening condition

Any of the following symptoms can indicate worsening depression and a possible life-threatening situation. Seek immediate medical care (call 911) if you, or someone you are with or know, have any of these symptoms.

  • Having suicidal thoughts or thoughts of hurting oneself or others

  • Making a written plan to hurt oneself, commit suicide, or hurt another person

  • Suicidal actions including dangerous behavior, such as playing choking games or Russian roulette, or overdosing on drugs

  • Talking about or threatening to hurt oneself or another person

  • Talking about suicide, wanting to die, or not wanting to live any longer

Causes

What causes depression?

Factors associated with the development of depression including chemical imbalances in the brain, situational or environmental factors, and medical issues such as chronic pain.

An imbalance in the brain of chemicals called neurotransmitters, including serotonin, norepinephrine and dopamine, can cause depression. Neurotransmitters function within areas of the brain that regulate emotions and mood.

Situational or environmental factors also play a role in depression. These factors include traumas or stressors, such as the loss of a loved one, loss of a job, or a divorce. As life circumstances improve, the depression may or may not resolve.

Depression may also run in families. Current research is searching for specific genes that may be involved in passing a tendency toward developing depression in family lines.

Depression is also associated with chronic pain. Many patients with depression have physical symptoms, especially chronic pain. Depression and chronic pain are closely connected because mood and pain perception centers are both located in the same area of the brain. Both chronic pain and depression can deplete the body’s stores of endorphins and other neurochemicals that regulate mood and sensation. The depletion of the body’s stores of endorphins and other neurochemicals due to one condition leaves the body vulnerable to developing the other condition or a worsening of the other condition.

What are the risk factors for depression?

A number of factors are thought to increase your chances of having depression or are associated with depression. These include:

  • Alcohol or drug abuse

  • Being a woman, due to the hormonal changes of such events as puberty, menstruation, pregnancy, childbirth, perimenopause and menopause

  • Being an adolescent

  • Being elderly, especially an older person with chronic illnesses and disabilities

  • Chronic pain

  • Family history of depression

  • Having certain medical conditions, such as hypothyroidism, stroke, insomnia, type 2 diabetes, and vitamin D deficiency

  • Posttraumatic stress disorder (PTSD)

  • Smoking

  • The winter months, in those with seasonal affective disorder

  • Traumatic events or life stressors, such as the loss of a loved one, severe illness, loss of a job, or a divorce

Reducing your risk of depression

Not all people who are at risk will develop depression, but you may be able to reduce your risk for depression by:

  • Eating a healthy diet that is low in saturated fats and high in fiber, whole grains, and fruits and vegetables

  • Getting enough sleep, rest and relaxation

  • Getting outside and enjoying some sunshine

  • If you drink alcohol, limiting intake to one drink per day for women and two drinks per day for men

  • Participating in a regular exercise program

  • Quitting smoking

  • Reducing excessive stress

  • Regularly participating in leisure activities or activities you enjoy

  • Seeking regular medical care and following your treatment plan for such conditions as hypothyroidism, stroke, insomnia, type 2 diabetes, and vitamin D deficiency

Treatments

How is depression treated?

Depression is treatable. In general, the sooner that the symptoms of depression are recognized and treated, the more effective treatment will be. The overall treatment goal for people living with depression is to feel better and live normal, functional and productive lives. Treatment can include:

  • Complementary or alternative treatments, such as acupuncture, massage therapy, and yoga may help to reduce stress, elevate mood, and improve overall well-being. Complementary treatments are not meant to substitute for full medical care.

  • Electroconvulsive therapy (ECT) may be recommended in certain rare and serious situations in which medications and psychotherapy have not been effective.

  • Regular exercise can help reduce feelings of depression by increasing the body’s supply of endorphins, chemicals in the body that increase the feeling of well-being.

  • Psychotherapy (talk therapy) is a type of therapy in which a psychotherapist builds a relationship with a client, establishes trust, and helps the client address depression through such techniques as communication and behavior therapy. These techniques can help you recognize and work through issues that are encouraging depression and can teach you more effective ways of thinking and behaving in order to help change negative thoughts and behaviors.

  • Regular follow-up care is very important to help monitor your treatment and progress and to promptly address any problems, medication side effects, or complications.

  • Treating chronic pain effectively can help minimize the symptoms of depression, and treating depression can help reduce chronic pain.

Medications used to treat depression

Antidepressant medications treat depression by helping to correct an imbalance of brain chemicals called neurotransmitters, including serotonin, norepinephrine and dopamine. Neurotransmitters function within the areas of the brain that regulate emotions and mood. Commonly prescribed types of antidepressants include:

  • SSRIs, selective serotonin reuptake inhibitors, such as Prozac, Paxil and Zoloft

  • SNRIs, serotonin and norepinephrine reuptake inhibitors, such as Effexor

  • Tricyclic antidepressants such as Tofranil

  • MAOIs, monoamine oxidase inhibitors

Antidepressants have side effects, but are generally considered safe when taken as directed under medical supervision. However, some people, especially children, teenagers, and young adults may experience increased thoughts of suicide while taking certain antidepressants. Seek immediate medical (call 911) if you, or someone you are with or know, are having or expressing feelings of wanting to hurt or kill oneself.

A popular herbal supplement that has been touted to treat depression is St. John’s wort. This herbal supplement is available without a prescription in the United States. St. John’s wort has been researched by the National Institutes of Health and was not found to be any more effective in treating major depression than a sugar pill. In addition, taking St. John’s wort can also seriously interfere with the effectiveness of other medications; therefore, it is important to consult with your health care provider before taking this supplement or any other supplement.

What are the possible complications of depression?

Complications of depression can be serious and even life threatening in some cases. You can minimize the risk for serious complications of depression by following the treatment plan you and your health care professional design specifically for you.

Complications of depression include:

  • Decreased ability to function in work, school or daily life

  • Decreased sexual desire

  • Disability

  • Impaired social interactions

  • Migraine headaches, backaches and other chronic pain

  • Sleep disturbances

  • Social isolation

  • Suicidal thoughts or actions

Seek immediate medical care (call 911) if you, or someone you are with or know, are having or expressing feelings of wanting to hurt or kill oneself or another person.  

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 14
  1. 1. Depression. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml
  2. 2. Depression. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/depression.html
  3. 3. Major Depression. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/
  4. Kravitz RL, Ford DE. Introduction: chronic medical conditions and depression--the view from primary care. Am J Med 2008; 121:S1.
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