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Depression

Definition

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of time.

Alternative Names

Blues; Gloom; Sadness; Melancholy

Considerations

Symptoms of depression include:

• Consistently low or irritable mood
• A loss of pleasure in usual activities
• Trouble sleeping or excessive sleeping
• A dramatic change in appetite, often with weight gain or loss
• Fatigue and lack of energy
• Feelings of worthlessness, self-hate, and inappropriate guilt
• Extreme difficulty concentrating
• Slowed or agitated physical movements
• Inactivity and withdrawal from usual activities
• Feelings of hopelessness and helplessness
• Recurring thoughts of death or suicide

Low self-esteem is common with depression. So are sudden bursts of anger and lack of pleasure from activities that normally make you happy, including sex.

Depressed children may not have the classic symptoms of adult depression. Watch especially for changes in school performance, sleep, and behavior. If you wonder whether your child might be depressed, it's worth bringing to a doctor's attention.

The main types of depression include:

• Major depression -- five or more symptoms listed above must be present for at least 2 weeks to be diagnosed with major depression. Major depression tends to continue for at least 6 months if not treated. (Depression is classified as minor depression if you have fewer than five depression symptoms for at least 2 weeks. In other words, minor depression is similar to major depression except it only has 2 - 4 symptoms.)
• Atypical depression -- occurs in about a third of patients with depression. Symptoms include overeating and oversleeping. These patients tend to have a feeling of being weighed down and react strongly to rejection.
• Dysthymia -- a generally milder form of depression that lasts for years, if not treated.

Other common forms of depression include:

• Postpartum depression -- many women feel somewhat down after having a baby, but true postpartum depression is more severe and includes the symptoms of major depression.
• Premenstrual dysphoric disorder (PMDD) -- depressive symptoms occur 1 week prior to menstruation and disappear after you menstruate.
• Seasonal affective disorder (SAD) -- occurs most often during the fall-winter season and disappears during the spring-summer season. It is most likely related to a lack of sunlight.

Depression may also alternate with mania (known as manic depression or bipolar disorder).

Common Causes

Depression often runs in families. This may due to your genes (inherited), learned behavior, or both. Even if your genes make you more likely to develop depression, a stressful or unhappy life event usually triggers the onset of a depressive episode.

A number of factors can cause depression, including:

• Alcohol or drug abuse
• Stressful life events or situations, such as:
  • Divorce, including a parent's divorce
  • Death of a relative or friend
  • Illness in the family
  • Abuse or neglect
  • Job loss
  • Social isolation (common cause of depression in the elderly)
  • Breaking up with a boyfriend or girlfriend
  • Failing a class
• Medical conditions and treatments, such as:
  • Underactive thyroid (hypothyroidism)
  • Certain types of cancer
  • Long-term pain
  • Sleeping problems
  • Steroid medications

Home Care

If you are depressed for 2 weeks or longer, you should contact your doctor, who can offer treatment options. Regardless of the type and severity of your depression, the following self-care steps can help:

• Get enough sleep.
• Follow a healthy, nutritious diet.
• Exercise regularly.
• Avoid alcohol, marijuana, and other recreational drugs.
• Get involved in activities that make you happy, even if you don't feel like it.
• Spend time with family and friends.
• If you are a religious or spiritual person, talking to clergy or spiritual advisors may help give meaning to painful experiences.
• Consider meditation, tai chi, or related activities as ways to relax.
• Add omega-3 fatty acids to your diet, which you can get in over-the-counter supplements or from eating fish such as tuna, salmon, or mackerel.

If your depression occurs in the fall or winter months, try light therapy using a special lamp that mimics the sun.

If you have moderate to severe depression, the most effective treatment plan will likely involve a combination of talk therapy, lifestyle changes, and medication.

Call your health care provider if

Call 911, a suicide hotline, or go to a nearby emergency room if you have thoughts of harming yourself or others.

Call your doctor if:

• You hear voices that are not there
• You have frequent crying spells with little or no provocation
• You have had feelings of depression that disrupt work, school, or family life for longer than 2 weeks
• You have three or more depressive symptoms
• You think that one of your current medications may be making you feel depressed -- DO NOT change or stop any medications without consulting your doctor
• You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning

What to expect at your health care provider's office

A complete history, a psychiatric interview, and a physical examination will be performed to try to classify your depression as mild, moderate, or severe and to see if there is an underlying, treatable cause (such as alcohol abuse or an underactive thyroid). Hospitalization is usually recommended if suicide seems possible.

Expect some exploration of the issues and events associated with your feelings of depression. Your doctor will ask you about:

• Your depressive moods and other symptoms (sleep, appetite, concentration, energy)
• Possible stressors in your life, and support systems in place
• Whether thoughts about ending your life have ever crossed your mind
• Drug and alcohol use, and about the medications you are currently taking, if any

Treatment will vary according to the cause and severity of your depressive symptoms, as well as your personal preference. For mild depression, counseling and self-care measures without medication may be enough. The most effective therapy for moderate or severe depression is a combination of antidepressant medication and psychotherapy (talk therapy).

Your primary care doctor may refer you to a psychiatrist if your depression is moderate to severe, or if it does not improve with initial treatment.

For more treatment information, see: Major depression

Prevention

Healthy lifestyle habits can help prevent depression, or lessen the chances of it happening again. Talk therapy and antidepressant medication can also lower the likelihood of your becoming depressed again.

Talk therapy may help you through times of grief, stress, or low mood. Family therapy may be particularly important for teens who feel blue.

Maintaining connections to others is particularly important in preventing depression.

References

Fava M, Cassano P. Mood disorders: Major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.

American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007.