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Major depression

  • Definition

    • Depression is feeling sad, blue, unhappy, or down in the dumps. Most people feel this way once in a while.

      Major depression is a mood disorder. It occurs when feelings of sadness, loss, anger, or frustration get in the way of your life over a long period of time. It also changes how your body works.
  • Alternative Names

    • Depression - major; Depression - clinical; Clinical depression; Unipolar depression; Major depressive disorder
  • Causes

    • Health care providers do not know the exact causes of depression. It is believed that chemical changes in the brain are responsible. This may be due to a problem with your genes. Or it may be triggered by certain stressful events. More likely, it is a combination of both.

      Some types of depression run in families. Other types occur even if you have no family history of the illness. Anyone can develop depression, including children and teens.

      Depression and men

      Depression may be brought on by:

      • Alcohol or drug use
      • Certain medical problems, such as underactive thyroid, cancer, or long-term pain
      • Some kinds of medicines, such as steroids
      • Sleeping problems
      • Stressful life events, such as death or illness of someone close to you, divorce, childhood abuse or neglect, loneliness (common in older people), relationship breakup
  • Symptoms

    • Depression can change or distort the way you see yourself, your life, and those around you.

      With depression, you often see everything in a negative way. It is hard for you to imagine that a problem or situation can be solved in a positive way.

      Forms of depression

      Symptoms of depression can include:

      • Agitation, restlessness, and irritability, and anger
      • Becoming withdrawn or isolated
      • Fatigue and lack of energy
      • Feeling hopeless, helpless, worthless, guilty and self-hate
      • Loss of interest or pleasure in activities that were once enjoyed
      • Sudden change in appetite, often with weight gain or loss
      • Thoughts of death or suicide
      • Trouble concentrating
      • Trouble sleeping or sleeping too much

      Depression in teens may be harder to recognize. Problems with school, behavior, or alcohol or drug use can all be signs.

      If depression is very severe, you may have hallucinations and delusions (false beliefs). This condition is called depression with psychotic features.

      Test Your Depression Treatment IQ

      1. Only medicine can treat depression.

        1. A. True
        2. B. False

        The correct answer is false. People with mild depression often get better with talk therapy alone. People with severe depression may need a combination of both medicine and counseling. Your doctor can recommend a treatment plan that will work best for you.

      2. How do antidepressants work to treat depression?

        1. A. They make you forget your problems
        2. B. They control how you think
        3. C. They increase certain chemicals in your brain that affect mood

        The correct answer is they increase certain chemicals in your brain that affect mood. These medicines won't make you forget your problems or affect your ability to think. But they will help you feel better, which makes it easier to deal with the stress in your life.

      3. How soon will antidepressants help?

        1. A. Right away
        2. B. A few days
        3. C. A few weeks
        4. D. 3 months

        The correct answer is a few weeks. It can take several weeks before you start to feel better. So try to be patient. Keep taking your medicine, and discuss any concerns with your doctor.

      4. Once you feel better, you should stop taking antidepressants after:

        1. A. 3 months
        2. B. 6 months
        3. C. 1 year
        4. D. None of the above

        The correct answer is none of the above. You should not stop taking antidepressants without talking with your doctor. Even if you feel better, if you stop taking medicine too soon, your depression may return. Stopping too quickly can also cause withdrawal symptoms. Most people treated with antidepressants are eventually able to stop their medicine.

      5. What are common side effects of antidepressants?

        1. A. Headache
        2. B. Trouble sleeping
        3. C. Nausea
        4. D. Fatigue
        5. E. Sexual problems
        6. F. All of the above

        The correct answer is all of the above. These are all common side effects, but most go away after a few days. Many people who take antidepressants have no side effects. Tell your doctor if you have any bothersome side effects or side effects that don't go away.

      6. If you don't feel better after taking antidepressants for a month or two, you should:

        1. A. Stick with it a little longer
        2. B. Give up on medicine and try something else
        3. C. Tell your doctor

        The correct answer is tell your doctor. Your doctor may change your antidepressant, prescribe a higher dose, or add a second medicine. Adding talk therapy is another good option.

      7. Cognitive-behavioral therapy (CBT) can help you deal with negative thoughts.

        1. A. True
        2. B. False

        The correct answer is true. CBT is a type of talk therapy that teaches you to recognize and change negative thoughts. You'll also learn to spot things that might make your depression worse and develop problem-solving skills.

      8. A typical course of CBT lasts:

        1. A. 6 weeks
        2. B. 12 weeks
        3. C. 6 months
        4. D. 1 year

        The correct answer is 12 weeks. Most CBT takes place once a week over the course of 3 to 4 months. Ask your doctor to recommend a therapist who specializes in CBT.

      9. Electroconvulsive therapy (ECT) is painful and risky.

        1. A. True
        2. B. False

        The correct answer is false. ECT is a safe and effective treatment for severe depression. During ECT, a small electric current causes seizure activity in the brain. You will be asleep until the procedure is over. ECT is a good option for people who can't take antidepressants or who don't respond to them.

      10. St. John's wort can treat major depression.

        1. A. True
        2. B. False

        The correct answer is false. One study found that this herbal remedy worked no better than a sugar pill for treating major depression. However, it may help some people with mild depression. St. John's wort may interact with other medicines, so talk with your doctor before trying it.

      11. If you're depressed, regular exercise could help you feel better.

        1. A. True
        2. B. False

        The correct answer is true. Getting regular exercise and following other healthy habits can give you an edge in fighting depression and often improves symptoms of depression. Also do your best to get enough sleep, avoid alcohol, spend time with caring friends, and do activities that you enjoy.
  • Exams and Tests

    • Your provider will ask about your medical history and symptoms. Your answers can help your provider diagnose depression and determine how severe it may be.

      Blood and urine tests may be done to rule out other medical conditions that have symptoms similar to depression.
  • Treatment

    • Depression can be treated. Treatment typically includes medicines, with or without talk therapy.

      If you are thinking about suicide or are very depressed and cannot function, you may need to be treated in a hospital.

      After you have been on treatment, if you feel your symptoms are getting worse, talk with your provider. Your treatment plan may need to be changed.

      MEDICINES

      Antidepressants are medicines used to treat depression. They work by bringing back the chemicals in your brain to the right levels. This helps relieve your symptoms.

      If you have delusions or hallucinations, your provider may prescribe additional medicines.

      Tell your provider about any other medicines you take. Some medicines can change the way antidepressants work in your body.

      Allow your medicine time to work. It may take a few weeks before you feel better. Keep taking your medicine as instructed. DO NOT stop taking it or change the amount (dosage) you are taking without talking to your provider. Ask your provider about possible side effects, and what to do if you have any.

      If you feel your medicine is not working, tell your provider. The medicine or its dosage may need to be changed. DO NOT stop taking medicines on your own.

      WARNING

      Children, teens, and young adults should be watched closely for suicidal behavior. This is especially true during the first few months after starting medicines for depression.

      Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their provider.

      St. John's Wort

      Beware of natural remedies such as St. John's wort. This is an herb sold without a prescription. It may help some people with mild depression. But it can change the way other medicines work in your body, including antidepressants. Talk to your provider before trying this herb.

      TALK THERAPY

      Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.

      Types of talk therapy include:

      • Cognitive behavioral therapy teaches you how to fight off negative thoughts. You learn how to become more aware of your symptoms and how to spot things that make your depression worse. You are also taught problem-solving skills.
      • Psychotherapy can help you understand the issues that may be behind your thoughts and feelings.
      • At group therapy, you share with others who have problems like yours. Your therapist or provider can tell you more about group therapy.

      OTHER TREATMENTS FOR DEPRESSION

      • Electroconvulsive therapy (ECT) may improve mood in people with severe depression or suicidal thoughts who do not get better with other treatments. ECT is generally safe.
      • Light therapy may relieve depression symptoms in the winter time. This type of depression is called seasonal affective disorder.
  • Outlook (Prognosis)

    • You may start feeling better a few weeks after starting treatment. If you take medicine, you will need to stay on the medicine for several months to feel good and prevent depression from returning. If your depression keeps coming back, you may need to stay on your medicine for a long period.

      Chronic depression may make it harder for you to manage other illnesses such as diabetes or heart disease. Ask your provider for help in managing these health problems.

      Alcohol or drug use can make depression worse. Talk to your provider about getting help.
  • When to Contact a Medical Professional

    • If you have thoughts of suicide or harming yourself or others, call your local emergency number (such as 911) right away. Or go to the hospital emergency room.

      You can also call a suicide hotline 24 hours a day: 1-800-SUICIDE or 1-800-999-9999.

      Call your provider right away if:

      • You hear voices not coming from people around you.
      • You have frequent crying spells with little or no reason.
      • Your depression is disrupting work, school, or family life.
      • You think that your current medicine is not working or is causing side effects. DO NOT stop or change your medicine without talking to your doctor.
  • Prevention

    • DO NOT drink alcohol or use illegal drugs. These substances make depression worse and may lead to thoughts of suicide.

      Take your medicine exactly as your provider instructed. Learn to recognize the early signs that your depression is getting worse.

      Keep going to your talk therapy sessions.

      Walking for health

      The following tips may help you feel better:

      • Get more exercise.
      • Maintain good sleep habits.
      • Do activities that bring you pleasure.
      • Volunteer or get involved in group activities.
      • Talk to someone you trust about how you are feeling.
      • Try to be around people who are caring and positive.

      Learn more about depression by contacting a local mental health clinic. Your workplace employee assistance program (EAP) is also a good resource. Online resources can also provide good information.
  • References

    • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.

      American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. 2010. psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf. Accessed March 3, 2016.

      Fava M, Ostergaard SD, Cassano P. Mood disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 29.