"Watson, Stephanie. "Depression." Gale Health and Wellness Online Collection, Gale, 2018.
Depression is a mood disorder that causes persistent feelings of sadness, hopelessness, and decreased energy. To be diagnosed with major depression, you must have had symptoms consistently for a period of at least two weeks. However, depression is more than just unhappiness. It can be severe enough to interfere with work, school, and other daily activities. Doctors also refer to this condition as major depressive disorder or clinical depression.
An estimated 1 in 6 people, or nearly 17 percent of Americans, will experience depression at some point in their lifetime, according to the American Psychiatric Association. About 7 percent of Americans had at least one major depressive episode in the past year. Although the symptoms can start at any age, depression is most likely to begin during a person's teens or 20s.
Along with major depression, there are several other types of depression, which are characterized by their symptoms or causes:
Dysthymia, or persistent depressive disorder, is a milder form of depression in which symptoms last for at least two years.
Postpartum depression involves feelings of extreme sadness, fatigue, and anxiety that start after a woman gives birth.
Premenstrual dysphoric disorder (PMDD) is severe depression, irritability, and anxiety that occurs in the week or two before a woman's period.
Seasonal affective disorder (SAD) is depression that occurs during the winter months and is relieved by the change of season.
Bipolar disorder, formerly called manic depression, is characterized by alternating episodes of extremely low mood (depression) and exuberant highs (mania).
Psychotic depression includes features of both depression and psychosis, such as having false beliefs (delusions) or seeing and hearing things that are not there (hallucinations).
Depression stems from a combination of biological, environmental, and psychological factors. People with depression often have family members with the condition, which suggests that genetics are involved. If one biological twin has depression, the other twin has a 70 percent chance of also having the condition.
Researchers have discovered differences in the brains of people with depression, as well as in the function of chemical messengers called neurotransmitters. Hormonal changes may also set off depressive symptoms; for example, during a woman's menstrual cycle or after she gives birth.
The following factors increase the risk for depression:
a personal or family history of depression or other mental health disorder
trauma or stress, such as physical or sexual abuse, relationship issues, or financial worries
drug or alcohol abuse
medical conditions such as diabetes, cancer, heart disease, stroke, and Parkinson's disease
certain medications, including those used to treat high blood pressure and insomnia
People who have depression will experience some or all of the following symptoms almost every day for at least two weeks:
Persistent sad or empty mood
Feelings of hopelessness, helplessness, emptiness, worthlessness, or guilt
Low energy, fatigue
Irritability, restlessness, anxiety
Slowed thinking, speaking, or movement
Loss of interest in activities they once enjoyed
Trouble concentrating, remembering, or making decisions
Loss of appetite, or eating too much
Weight gain or loss
Trouble sleeping, or sleeping too much
Headache, stomachache, and other aches and pains that do not have a clear physical cause
Thoughts of death or suicide
Some people with depression will experience many of these symptoms. Others will have just a few. The severity of depression symptoms can range from mild to severe enough to impact the person's day-to-day life.
Doctors start the diagnostic process with a physical exam and lab work to rule out possible physical causes of depression, such as a thyroid disorder or vitamin deficiency. A psychologist or physician can do a psychological evaluation, asking questions and assessing symptoms according to established criteria for identifying depression and arriving at a diagnosis.
The typical treatment for depression includes antidepressants or other medications, psychotherapy (talk therapy), or a combination of the two interventions. Personalizing treatment to the individual can increase the chances that it will be successful.
Antidepressants are a class of drugs used to treat depression. They include the following types:
Selective serotonin reuptake inhibitors (SSRIs) are often the first drugs doctors prescribe for depression. These drugs affect the chemical messenger, serotonin, which helps to regulate mood. Low serotonin levels have been linked to depression.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) work on two brain chemicals—serotonin and norepinephrine.
Atypical antidepressants act on the brain in a different way from other antidepressants. These drugs may be an option for people who have not found relief from SSRIs or SNRIs.
Tricyclic antidepressants are an older class of antidepressant. They work on three brain chemicals: serotonin, norepinephrine, and dopamine. Tricyclics are not used as often as they once were because they have a higher risk for side effects than newer antidepressants.
Monoamine Oxidase Inhibitors (MAOIs)
Sometimes doctors will prescribe another type of medication—such as an anti-anxiety drug, antipsychotic medicine, or stimulant—along with the antidepressant. Antidepressants can take up to four weeks to start working. It can take a few tries to find the best drug and dosage combination that will relieve your depression.
Talk therapy programs like cognitive-behavioral therapy (CBT) help people with depression identify the negative thoughts and behaviors that result from depression, and replace them with more positive strategies for building coping skills and psychological resilience. Therapy can be done one-on-one with a therapist, as part of a group, or together with a partner or other family members.
If these treatments do not work, electroconvulsive therapy (ECT) may be an option. ECT is done while you are under general anesthesia. Small electrical currents are passed through your brain to induce a seizure. Research finds ECT is often effective in cases where antidepressants and talk therapy fail.
A few alternative remedies and supplements are used to treat depression, including acupuncture, meditation, guided imagery, and tai chi. Evidence that herbal supplements like St. John's wort and SAMe help with depression symptoms is inconclusive, and they are not FDA-approved treatments. Because these supplements can often cause side effects or interact with other medications you take, alert your doctor first if you would like to try them.
Depression is highly treatable. Up to 90 percent of people will eventually improve with medication, therapy, a combination of the two, or another treatment. However, it can take some trial and error to find the therapy that works best for you. Help is available for people are struggling with depression through the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-HELP (4357).
Suicidal thoughts and actions can occur in people who are severely depressed. If you are thinking about hurting yourself, call a trusted health care provider right away, reach out to supportive friends or family members, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). If you are at immediate risk for self harm, dial 911 or local emergency services.
"Depression." National Institute of Mental Health. February 2018. https://www.nimh.nih.gov/health/topics/depression/index.shtml (accessed February 13, 2020).
"Depression (major depressive disorder)." Mayo Clinic. February 3, 2018. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007 (accessed February 13, 2020).
"What Is Depression?" American Psychiatric Association. January 2017. https://www.psychiatry.org/patients-families/depression/what-is-depression (accessed February 13, 2020).
American Psychiatric Association Street 800 Maine Avenue, S.W., Suite 900 Washington D.C. 20024 Phone (888) 357-7924 https://www.psychiatry.org
National Alliance on Mental Illness (NAMI) Street 3803 N. Fairfax Drive, Suite 100 Arlington VA 22203 Phone (800) 950-6264 https://www.nami.org
National Institute of Mental Health Street 6001 Executive Boulevard, Room 6200 Bethesda MD 20892-9663 Phone (866) 615-6464 https://www.nimh.nih.gov
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Source: "Academy of American Family Physicians, http://www.aafp.org. Disclaimer: This information is not a tool for self-diagnosis or a substitute for professional care. This image may be used for personal, non-commercial purposes only.
"Depressive Disorders." The Gale Encyclopedia of Children's Health: Infancy through Adolescence, edited by Deirdre S. Blanchfield, 3rd ed., vol. 2, Gale Health and Wellness, Gale, 2016, www.gale.com.