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Major depression

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

Last reviewed: March 10, 2014.

Major depression is a mental health condition. It is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with daily life for weeks or longer.

Causes

Doctors 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, even children and teens.

Depression and men

Depression may be brought on by:

  • Certain medical conditions, including underactive thyroid, cancer, or long-term pain
  • Certain 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 the elderly), 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, anger
  • Becoming withdrawn or isolated
  • Fatigue and lack of energy
  • Feeling hopeless and helpless, worthless, guilty, 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.

Only medicine can treat depression.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.How do antidepressants work to treat depression?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.How soon will antidepressants help?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.Once you feel better, you should stop taking antidepressants after: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.What are common side effects of antidepressants?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.If you don't feel better after taking antidepressants for a month or two, you should: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.Cognitive-behavioral therapy (CBT) can help you deal with negative thoughts.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.A typical course of CBT lasts: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.Electroconvulsive therapy (ECT) is painful and risky.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.St. John's wort can treat major depression.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.If you're depressed, regular exercise could help you feel better.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 health care provider will ask about your medical history and symptoms. Your answers can help your doctor 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 includes medicines, talk therapy, or both.

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 doctor. 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 health care 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 doctor 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 health care 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 doctor 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 doctor for help in managing these health problems.

Alcohol or drug use can make depression worse. Talk to your doctor 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 doctor 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 doctor instructed. Learn to recognize the early signs that your depression is getting worse.

Keep going to your talk therapy sessions. Counseling is just as effective as taking medicine.

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

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.
  2. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd edition. October 2010. Available at: http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1667485. Accessed: March 10, 2014.

Review Date: 3/10/2014.

Reviewed by: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Second‐generation antipsychotic drugs for major depressive disorder Second‐generation antipsychotic drugs for major depressive disorder 
    This review found 28 studies on five second‐generation antipsychotic drugs (amisulpride, aripiprazole, olanzapine, quetiapine and risperidone) comparing the effects of the drugs alone or adding them or placebo to antidepressants for major depressive disorder and dysthymia. There is evidence that amisulpride might lead to symptom reduction in dysthymia, while no important differences were seen for major depression. There is limited evidence that aripiprazole leads to symptom reduction when added to antidepressants. Olanzapine had no beneficial effects for treatment of depression when compared to antidepressants or compared to placebo but there was limited evidence for the benefits of olanzapine as additional treatment. Data on quetiapine indicated beneficial effects for quetiapine alone or as additional treatment when compared to placebo; data on quetiapine versus duloxetine did not show beneficial effects in terms of symptom reduction for either group, but quetiapine treatment was less well tolerated. The data, however, are very limited. Slight benefits of risperidone as additional treatment, in terms of symptom reduction, are also based on a rather small number of randomised participants. Generally, treatment with second‐generation antipsychotic drugs was associated with worse tolerability, mainly due to sedation, weight gain or laboratory values such as prolactin increase.
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Figures

  • Depression and men.
    Forms of depression.
    St. John's Wort.
    Walking for health.

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