Depression

Condition Basics

What is depression?

Depression is a mental health condition that causes you to feel sad, lose interest in activities that you used to enjoy, withdraw from others, and have little energy. It's different from normal feelings of sadness, grief, or low energy. Depression can also cause people to feel hopeless about the future and to even think about suicide.

It is not a character flaw, and it does not mean that you are a bad or weak person.

Depression is very common. It affects people of all ages.

If you think you may be depressed, tell your doctor. Treatment can help you enjoy life again.

What causes it?

When you have depression, there may be problems with activity levels in certain parts of your brain. Or chemicals in your brain called neurotransmitters may be out of balance. Most experts believe that a combination of family history (your genes) and stressful life events may cause depression.

What are the symptoms?

One of the most common symptoms of depression is feeling sad, hopeless, or tearful. The other is losing interest in daily activities you used to enjoy. If you have had these symptoms nearly every day for at least 2 weeks, you might have depression.

How is it diagnosed?

If your doctor thinks you are depressed, he or she will ask you questions about your health and feelings. Your doctor also may do a physical exam and tests to make sure your depression isn't caused by another disease.

How is depression treated?

Doctors usually treat depression with medicines or counseling. Often a combination of the two works best. Many people don't get help because they think that they'll get over the depression on their own. But some people do not get better without treatment.

Antidepressant medicines can improve the symptoms of depression in 1 to 3 weeks. But it can take 6 to 8 weeks to see more improvement. Your doctor will likely have you keep taking these medicines for at least 6 months.

In many cases, counseling can work as well as medicines to treat mild to moderate depression. Counseling is done by licensed mental health providers, such as psychologists and social workers. This kind of treatment deals with how you think about things and how you act each day.

If depression is caused by a medical problem, treating that problem may also help relieve the depression.

Cause

When you have depression, there may be problems with activity levels in certain parts of your brain. Or chemicals in your brain may be out of balance.

Most experts believe that family history (your genes) and stressful life events may cause depression.

Certain medicines, such as steroids and opioids, can cause depression. If you stop using the medicine, the depression may go away.

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What Increases Your Risk?

You may be more likely to get depressed if:

• Someone in your family has had depression. You may have inherited a trait that makes you more likely to have depression.
• You have had depression before.
• You have another mental health problem, such as post-traumatic stress disorder (PTSD), substance abuse disorder, or anxiety.

Other things that can increase your risk of depression include getting older, having a chronic health problem, and having a history of physical or sexual abuse.

Some people become depressed after a stressful life event, like losing a job or getting a divorce. Sometimes even happy life events, like getting married or a promotion, can trigger depression. This is because of the stress that comes with change.

You also may get depressed even if there is no reason you can think of.

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Prevention

Little is known about how to prevent depression, but getting exercise and avoiding alcohol and drugs may help. You can also take steps to help prevent depression from coming back (relapse) or to help your symptoms. Steps include taking your medicine as prescribed and continuing counseling after your symptoms improve.

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Symptoms

The symptoms of depression may be hard to notice at first. They can be different from person to person.

The two most common symptoms of depression are:

• Feeling sad, hopeless, or tearful nearly every day.
• Losing interest in or not getting pleasure from most daily activities that you used to enjoy, and feeling this way nearly every day.

If you have had these symptoms for at least 2 weeks, you might have depression.

A serious symptom of depression is thinking about death and suicide. If you or someone you know talks about suicide or feeling hopeless, get help right away.

You also may:

• Lose or gain weight. You may also feel like eating more or less than usual almost every day.
• Sleep too much or not enough almost every day.
• Feel restless and not be able to sit still. Or you may sit quietly and feel that moving takes great effort. Others can easily see this behavior.
• Feel tired or as if you have no energy almost every day.
• Feel unworthy or guilty nearly every day. You may have low self-esteem and worry that people don't like you.
• Find it hard to focus, remember things, or make decisions nearly every day. You may feel anxious or worried about things.

Depression can:

• Affect your physical health. You may have headaches or other aches and pains. Or you may have digestive problems such as constipation or diarrhea. You may have trouble having sex or may lose interest in it.
• Make older adults confused or forgetful or cause them to stop seeing friends and doing things. It can be confused with problems like dementia.

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What Happens

Depression is different for everyone.

For some people, a case of depression begins with symptoms of anxiety (such as worrying a lot), sadness, or lack of energy. This may go on for days or months before the person or others think that depression could be the problem.

Other people may feel depressed suddenly. This may happen after a big change in life, such as the loss of a loved one or a serious accident.

If you don't get treated, depression may last from months to a year or longer. A small number of people feel depressed for most of their lives and always need treatment.

Depression can return after treatment. At least half of the people who have depression once get it again. But it's less likely to come back if you follow your treatment plan.

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When to Call a Doctor

Call 911 or other emergency services immediately if:

• You or someone you know is thinking seriously about or has attempted suicide. Serious signs include these thoughts:
  • You have decided on how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.
• You feel you can't stop from hurting yourself or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Call 1-800-273-TALK (1-800-273-8255).
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Call a doctor now if:

• You hear voices.
• You have been thinking about death or suicide a lot, but you don't have a plan to harm yourself.
• You are worried that your feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

• You have symptoms of depression, such as:
  • Feeling sad or hopeless.
  • Not enjoying anything.
  • Having trouble with sleep.
  • Feeling guilty or worthless.
  • Feeling anxious or worried.
• You have been treated for depression for more than 3 weeks, but you are not getting better.

Check your symptoms

Exams and Tests

If your doctor thinks you are depressed, you may be asked questions about your health and feelings. Your doctor may have you fill out a form. Your doctor also may:

• Do a physical exam.
• Do tests to make sure your depression isn't caused by a disease such as an underactive thyroid (hypothyroidism) or anemia. Depending on your history and risk factors, your doctor may order other tests.
• Ask if you've had any thoughts of self-harm or suicide.
• Ask if you have symptoms of bipolar disorder.
• Ask you about symptoms of seasonal affective disorder.
• Ask you if you have recently lost a loved one.
• Ask about your drug and alcohol use.

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Treatment Overview

Treatment for depression includes counseling, medicines, and lifestyle changes. Your treatment will depend on you and your symptoms. Counseling and medicine usually work well to treat depression. Sometimes counseling alone is enough.

You and your health care team will work together to find the best treatment for you.

Medicines

Antidepressant medicines may improve or completely relieve the symptoms of depression. Whether you need to take medicine depends on your symptoms. You and your doctor can decide if you need medicine and which medicine is right for you.

You may start to feel better within 1 to 3 weeks after you start taking antidepressant medicine. It can take as many as 6 to 8 weeks to see more improvement.

Counseling

Counseling and psychotherapy are important parts of treatment for depression. You will work with a mental health professional such as a psychologist, licensed professional counselor, clinical social worker, or psychiatrist. Together you will develop an action plan to treat your depression.

Lifestyle changes

You can do many things to help yourself when you feel depressed or are waiting for your medicine to work. These things include being active, getting enough sleep, and eating a balanced diet.

Other treatment

Other treatments for depression include:

• Brain stimulation. This includes:
  • Electroconvulsive therapy (ECT). Electrodes that produce a brief electrical stimulation to the brain are placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.
  • Deep brain stimulation. A device that uses electricity to stimulate the brain is put in your head. It is used for Parkinson's disease. But it has not been well studied for depression.
  • Vagus nerve stimulation. A generator the size of a pocket watch is placed in your chest. Wires go up from the generator to the vagus nerve in your neck. The generator sends tiny electric shocks through the vagus nerve to the brain.
  • Transcranial magnetic stimulation. An electromagnet is placed on your head. It sends magnetic pulses that stimulate your brain.
• Complementary therapies. Always tell your doctor if you are using any of these types of therapies. They include:
  • Massage therapy, yoga, and other relaxation exercises.
  • Fish oil containing omega-3 fatty acids.
  • SAM-e (S-adenosylmethionine).

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Self-Care

You can try many things to help yourself when you feel depressed. These things may also help lower the chance of depression coming back.

Things to think about

Be realistic.

Set goals you can meet. If you have a big task to do, break it up into smaller steps you can handle. Don't take on more than you can handle. Be realistic in what you expect and what you can do.

Don't blame yourself or others for your depression.

Build your self-esteem, and try to keep a positive attitude.

Think about putting off big decisions until your depression has lifted.

Wait a bit on making decisions about marriage, divorce, or jobs. Talk it over with friends and loved ones who can help you look at the whole picture.

Think positively.

How you think can affect how you feel. Challenge negative thoughts with statements such as "I am hopeful," "Things will get better," and "I can ask for the help I need." Write down these statements and read them often, even if you don't believe them yet.

Things to do

Get regular exercise.

Even something as easy as walking can help you feel better.

Eat a balanced diet.

Include plenty of fresh fruits and vegetables, whole grains, and lean protein. If you have lost your appetite, eat small snacks rather than large meals.

Get enough sleep.

A good night's sleep can help mood and stress levels. Avoid sleeping pills unless your doctor prescribes them.

Find ways to cope with stress.

Too much stress may trigger depression. Using positive coping skills, such as listening to music or talking things over with a friend, can help you with your stress level.

Avoid drinking alcohol or using illegal drugs.

Also avoid taking medicines that have not been prescribed to you. Having a substance use problem makes treating depression harder.

Be thankful.

• Thank people for the small and big things they do for you.
• Be thankful for big things like having a home, family, and friends.
• Be thankful for little things like making people laugh, enjoying a piece of music, or finding warm gloves for the winter.

Do things with others.

Try to be part of spiritual, social, holiday, or other activities. Help others who are not as well off as you are.

Get support from others.

Let your family and friends help you. Find someone you can trust and confide in, and talk to that person. This includes telling people you trust about depression. It is usually better than being alone and keeping it a secret.

Taking good care of yourself is important as you recover from depression. If your doctor prescribed medicines, take them exactly as they are prescribed. Be sure to make and go to all appointments, including counseling. And call your doctor if you are having problems.

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Counseling

Counseling is an important part of treatment for depression. You will work with a mental health professional such as a psychologist, licensed professional counselor, clinical social worker, or psychiatrist. Together you will develop an action plan to treat depression.

When you hear "counseling" or "therapy," you may think of lying on a couch and talking about your childhood. But these treatments focus on how you think about things and how you act each day.

Therapies that are helpful for people with depression include:

Cognitive behavioral therapy (CBT).

CBT teaches you how to change the ways you think and behave. This can help you stop thinking bad thoughts about yourself and your life. You can take part in CBT with a therapist or in a group setting.

Interpersonal therapy.

This therapy looks at your social and personal relationships and related problems.

Acceptance and commitment therapy (ACT).

In ACT, you work with a therapist to learn to accept your negative feelings but not let them run your life. You learn to make choices and to act based on your personal values, not negative feelings.

Mindfulness-based therapies.

Examples include mindfulness-based stress reduction and mindfulness-based cognitive therapy. These treatments help you to focus your attention on what is happening at the moment without trying to change it. They teach you to let go of past regrets and not worry about the future. For people who have had more than one episode of depression, mindfulness-based cognitive therapy may help reduce the risk of relapse.

Other treatments that may be helpful include:

How long will you need counseling?

How long your treatment lasts depends on how severe your depression is and how well your treatment goes. Short-term counseling usually lasts from 10 to 20 weeks. You usually see a counselor once a week but may need to meet with him or her more often or for a longer time.

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Medicines

Whether you need to take medicine depends on your symptoms. You and your doctor can decide if you need medicine and which medicine is right for you.

Antidepressant medicines may improve the symptoms of depression. But they work in different ways. No antidepressant works better than another. But different ones work better or worse for different people.

The side effects of these medicines are different and may lead you to choose one instead of another.

You may have to try different medicines or take more than one to help your symptoms. Many people find a medicine that works within a few tries. Other people take longer to find the right one. They may need to take the antidepressant and another type of medicine, such as an antiseizure, mood stabilizer, antipsychotic, or antianxiety medicine.

How long will you need to take antidepressants?

You may start to feel better within a few weeks after you start taking antidepressant medicine. But it can take up to 2 to 3 months. And even then, they don't work for everyone. If you have questions or concerns about your medicines, or if you aren't feeling better as expected, talk to your doctor.

If antidepressants work well for you, your doctor may suggest taking them for at least 6 months after you feel better. This can help prevent you from feeling depressed again (relapse). If this isn't the first time you have been depressed, your doctor may want you to take these medicines even longer.

Some people need to take medicine for several months to years. Others will need medicine long-term. Long-term use is more likely if you have had several bouts of depression that seriously affected your home life, work life, or both.

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Giving Support

If someone you care about is depressed, you may feel helpless. But there are some things you can do.

• Help the person get treatment or stay with it. This is the best thing you can do.
• Support and encourage the person.
• Help the person have good health habits. Urge the person to get regular exercise, eat a balanced diet, and get enough sleep.
• Take care of yourself. Ask others to give you emotional and practical support while you are helping a friend or loved one who has depression.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Call 1-800-273-TALK (1-800-273-8255).
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

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