Depression

Depression (also called major depressive disorder, major depression, and clinical depression) is a common and serious mental health condition that affects your feelings, thoughts, and behaviors.

It is normal for you to feel sad about or grieve over difficult life events, such as losing your job, the loss of a loved one, or a divorce. However, depression is different because it basically happens every day for at least two weeks and involves symptoms other than sadness alone. Symptoms of depression can include:

• Persistent sadness, anxiety, or feeling "empty"
• Feelings of hopelessness or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Lack of energy or fatigue
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Weight gain or loss
• Thoughts of self-harm or suicide attempts

Depression will typically require long-term treatment that includes medications and psychotherapy. Most people with depression can be effectively treated and live a happy, healthy life.

The American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies them as follows:

• Major depressive disorder (MDD or clinical depression): This is one of the most common forms of depression and is also the most severe. With major depressive disorder, you have a depressed mood for at least 2 weeks as well as other symptoms such as trouble sleeping, appetite changes, and loss of interest in your day-to-day activities.
• Persistent depressive disorder (PDD): PDD, which used to be called dysthymia, occurs when you experience depression for at least 2 years. The symptoms of PDD are not as severe as major depressive disorder.
• Disruptive mood dysregulation disorder (DMDD): DMDD is a mood disorder that causes long-term, severe irritability and frequent anger outbursts in children or adolescents. Symptoms typically start before the age of 10.
• Premenstrual dysphoric disorder (PMDD): In this form, you have premenstrual syndrome (PMS) symptoms along with other symptoms, including severe depression, irritability, or anxiety. Symptoms will typically improve within a few days after your period starts.
• Seasonal affective disorder (SAD): SAD is a form of depression that is related to a certain season of the year, typically fall and winter. It is a specific type of MDD.
• Postpartum and perinatal depression: This form of MDD typically occurs during pregnancy or within 4 weeks of childbirth. It is due to hormonal changes during pregnancy and childbirth which can trigger changes in your brain that lead to mood swings.
• Depression along with health problems or medical conditions: It is common for you to have other mental illnesses or medical problems along with depression, such as obsessive-compulsive disorder (OCD), anxiety, phobias, panic disorder, substance use disorders, and eating disorders. If you or a loved one has symptoms of depression or another mental illness, talk to your doctor. Treatments can help.

Depression is a serious medical condition with a variety of possible causes, and it often results from a combination of genetic, biological, environmental, and psychological factors. Some common risk factors for depression include:

• Genetics: A family history of depression can increase your risk of developing this condition, suggesting that genetics can play a significant role.
• Brain Chemistry and Neurotransmitters: Neurotransmitters such as serotonin are naturally occurring brain chemicals that play a role in depression. Changes in the levels of these chemicals can affect your mood and are a common cause of depression.
• Hormonal Changes: Changes in your hormones may trigger or cause depression. These changes can result from thyroid problems, menopause, childbirth, and other conditions.
• Life Events: Traumatic life events such as the death of a loved one, a difficult relationship, financial problems, or any stressful situation may trigger a depressive episode.
• Early Childhood Trauma: Traumatic experiences during childhood, such as physical or emotional abuse, may influence the way the body reacts to fear and stressful situations.
• Medical Conditions: Certain conditions may worsen the risk of, or trigger, depression, including chronic illness, insomnia, chronic pain, attention-deficit hyperactivity disorder (ADHD), diabetes, cancer, heart disease, and Parkinson’s disease.
• Personality: If you have low self-esteem, are someone who is easily overwhelmed by stress, or are generally pessimistic, you may be more likely to experience depression.

Understanding the underlying causes of depression is important for effective treatment and prevention. Treatments may vary and include antidepressant medications, psychotherapy, lifestyle changes, and other treatments depending on your specific situation and the severity of the disorder.

Depression causes a variety of symptoms that affect your emotional state, cognitive functions, physical health, and behavior. Some of the common symptoms of depression include:

• Emotional Symptoms:

  • Persistent feelings of sadness, anxiety, or emptiness

  • Feelings of hopelessness, pessimism, or despair
  • Irritability or frustration, even over small matters
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities you once enjoyed

• Cognitive Symptoms:

  • Trouble concentrating, remembering details, or making decisions

  • Slowed thinking, speaking, or body movements
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts, or suicide

• Physical Symptoms:

  • Fatigue or lack of energy

  • Changes in appetite (either increased or decreased)
  • Sleep problems, including insomnia or sleeping too much
  • Unexplained physical problems, such as back pain or headaches

• Behavioral Symptoms:

  • Avoiding social interaction

  • Neglect of responsibilities and personal care
  • Decreased performance at work or school
  • Decreased performance at work or school

These symptoms must typically last for at least 2 weeks for a diagnosis of depression and must be a change from your previous behavior or mood. It is important that if you or anyone you know is experiencing these symptoms, seek professional help.

Depression is diagnosed primarily by a healthcare professional such as a psychologist, psychiatrist, or primary care provider using your symptoms. medical history, family history, and mental health history. It can include:

• Medical History and Interview: Your healthcare provider will conduct a detailed interview to gather information about your symptoms, their duration, and their impact on your daily life. They may also inquire about your personal and family medical history, as well as any history of mental health issues.
• Physical Examination: Sometimes, a physical exam and lab tests are conducted to rule out other medical conditions that might be causing the symptoms. Conditions like thyroid problems, vitamin D deficiency, and hormonal imbalances can have the same symptoms of depression.
• Psychological Evaluation: A key part of the diagnosis involves a psychological evaluation. You may be asked to complete questionnaires or self-assessment tools that help assess the presence of depressive symptoms. These tools can help in identifying patterns of depression and the severity of the symptoms.

• Diagnostic Criteria: For a diagnosis of depression, most mental health professionals use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The DSM-5 criteria include having at least five of the key symptoms of depression (such as feelings of sadness, loss of interest in usual activities, significant change in weight or appetite, insomnia or sleep problems, fatigue, feelings of worthlessness or excessive guilt, difficulty concentrating, and thoughts of death or suicide), nearly every day for at least two weeks.

• Ruling Out Other Mental Health Disorders: Your healthcare provider will rule out other mental health disorders like bipolar disorder, anxiety disorders, or schizophrenia, which can have overlapping symptoms.

Treating depression typically involves a combination of options based on your specific symptoms, medical history, and personal preferences. The main treatments for depression include medications, psychotherapy, or a combination of both. Some common treatment options include:

• Medications:

  • Antidepressants: These are commonly prescribed for depression. It may take several weeks to notice the benefits of antidepressants, and it's common to try different medications to find the most effective one with the fewest side effects. There are several classes of antidepressants, including:

    • Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram), Paxil (paroxetine), and Viibryd (vilazodone).

    • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine), Effexor XR (venlafaxine), Pristiq (desvenlafaxine), and Fetzima (levomilnacipran).
    • Tricyclic antidepressants (TCAs) such as Tofranil (imipramine), Pamelor (nortriptyline), Elavil (amitriptyline), and Norpramin (desipramine).
    • Atypical antidepressants such as Wellbutrin XL (bupropion), Remeron (mirtazapine), and Trintellix (vortioxetine).
  • Other Medicines: Other drugs may be added to your antidepressant to help treat your symptoms. This can include combining two antidepressant medications or adding a mood stabilizer, antipsychotic, or anxiety medication.

• Psychotherapy or Talk Therapy:

  • Cognitive Behavioral Therapy (CBT): This is a very effective form of psychotherapy that is used for depression. It involves identifying and changing negative thought patterns and behaviors that contribute to your depression.

  • Interpersonal Therapy (IPT): This therapy focuses on improving problems in personal relationships and other life changes that may be contributing to your symptoms of depression.

• Lifestyle Changes and Home Remedies:

  • Regular Exercise: Regular physical activity can improve your mood and overall health.

  • Nutrition: A balanced diet can affect your mood and energy levels and help relieve symptoms of depression.
  • Getting Enough Sleep: Maintaining a regular bedtime and wake-up time can help improve your mood.
  • Stress Management: Techniques such as meditation, mindfulness, or yoga can help manage stress.
  • Avoid Alcohol and Recreational Drugs: While you may think they are helping with your depression, alcohol and drugs can worsen your depression over time and make it harder to treat.

• Brain Stimulation Therapies:

  • Electroconvulsive Therapy (ECT): This is used for severe depression that has not responded to other treatments. It involves passing electrical currents through your brain to help relieve symptoms of depression.

  • Transcranial Magnetic Stimulation (TMS): TMS is a newer approach that uses magnetic pulses to stimulate nerve cells in the brain and treat depression if medications have not helped.

• Supportive Care:

  • Support Groups: Sharing with others facing similar challenges can provide emotional support and new coping techniques.

  • Education: Learning about depression can help you and your family understand your condition better.

Sources

• Depressive Disorder (Depression) Fact Sheet. World Health Organization (WHO). Accessed May 13, 2024.
• Depression. National Institute of Mental Health. Accessed May 13, 2024.
• Depression. National Alliance on Mental Illness. Accessed May 13, 2024.
• What Is Depression? American Psychiatric Association. Accessed May 13, 2024.
• Mental Health Conditions: Depression and Anxiety. Centers for Disease Control and Prevention. Accessed May 13, 2024.
• Depression. Merck Manual. Accessed May 13, 2024.