Depression
Depression, also called major depressive disorder or clinical depression, is a common mood disorder that causes persistent sadness, hopelessness and loss of interest. Depression adversely affects your normal activities like sleeping, eating and working, and in serious cases, can even make you feel that life isn’t worth living.
Causes of depression
We don’t know the exact causes of depression, but as with many mental disorders, we believe a variety of risk factors may be involved:
- Biological differences in brain chemistry. People with depression appear to have physical changes in their neurotransmitters, naturally occurring brain chemicals that likely play a role in depression.
- Hormones. Changes in your balance of hormones may cause or trigger depression.
- Inherited traits. Depression is more common in people who have a blood relative who has depression.
Signs and symptoms of depression
According to the National Institute of Mental Health, if you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least 2 weeks, you may be suffering from depression:
- Persistent sad, anxious or “empty” mood.
- Feelings of hopelessness or pessimism.
- Irritability.
- Feelings of guilt, worthlessness or helplessness.
- Loss of interest or pleasure in hobbies and activities.
- Decreased energy or fatigue.
- Moving or talking more slowly.
- Feeling restless or having trouble sitting still.
- Difficulty concentrating, remembering or making decisions.
- Difficulty sleeping, early-morning awakening or oversleeping.
- Appetite and/or weight changes.
- Thoughts of death or suicide, or suicide attempts.
- Aches or pains, headaches, cramps or digestive problems without a clear physical cause and/or that do not ease even with treatment.
People experience depression differently
Some people with depression experience only a few symptoms, while others may experience many.
Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few but distressing symptoms may also benefit from treatment. The severity and frequency of symptoms, and how long they last, will vary depending on each person's particular illness. Symptoms may also vary depending on the stage of the illness.
Types of depression
In order to develop the best treatment plan for you, your primary care provider will diagnose the type of depression you have by evaluating your symptoms while also looking for specific features, such as:
- Anxious distress. Unusual restlessness or anxiety over possible events or loss of control.
- Atypical features. Includes the ability to temporarily be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection and a heavy feeling in the arms or legs.
- Bipolar depression, or bipolar disorder. Different from depression, but someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for a major depressive disorder. A person with bipolar disorder also experiences extreme high moods, called mania, or a less severe form called hypomania.
- Catatonia. Includes motor activity that involves either uncontrollable and purposeless movement, or fixed and inflexible posture.
- Dysthmia, or persistent depressive disorder. Lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years to be considered persistent depressive disorder.
- Melancholic features. Major depressive disorder with lack of response to something that used to bring pleasure.
- Mixed features. Similar to bipolar depression, in that a person feels simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy.
- Peripartum onset. Occurs during pregnancy.
- Postpartum onset. Occurs in the weeks or months after childbirth.
- Psychotic features. Accompanied by delusions or hallucinations.
- Seasonal affective disorder, or seasonal pattern. Related to cold seasons and reduced exposure to sunlight.
Treatment options for depression
Even if your depression is severe, we can treat it and help you enjoy your extraordinary life again.
The earlier you see your primary care provider for a personalized treatment plan, the more effective it will be. It will involve medications, psychotherapy or a combination of the two. If these treatments do not reduce your symptoms, we will explore other options.
Antidepressant medications
Antidepressant medications treat depression by improving the way your brain uses certain chemicals that control mood or stress. You may need to try different antidepressants before finding the one that works best for you with manageable side effects. Medications for treating depression include:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs). Includes duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
- Selective serotonin reuptake inhibitors (SSRIs). Considered safer and cause fewer side effects than other types of antidepressants. Includes citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).
- Monoamine oxidase inhibitors (MAOIs). Can have serious side effects, particularly with foods like cheese, pickles and wine, and can’t be combined with SSRIs. Includes tranylcypromine (Parnate), phenelzine (Nardil), selegiline (Emsam), and isocarboxazid (Marplan).
- Tricyclic antidepressants. Can be very effective, but tend to cause more severe side effects. Includes imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and protriptyline (Vivactil).
- Atypical antidepressants. Includes bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).
Antidepressants usually take 2 to 4 weeks to work. If you begin taking an antidepressant, do not stop taking it without consulting your primary care provider.
Your doctor may recommend combining 2 antidepressants or adding medications such as mood stabilizers, anti-anxiety medications or antipsychotics.
Psychotherapy
Your treatment plan will likely include psychotherapy, also called talk therapy, with a professional therapist. Your therapist will work with you to determine the right kind of therapy for you, which may be cognitive behavioral therapy (CBT), interpersonal therapy (IPT) or problem-solving therapy.
Psychotherapy can help you:
- Cope and solve problems in difficult situations and crises.
- Develop tolerance and skills for having positive interactions with others.
- Explore relationships and experiences.
- Identify negative beliefs and behaviors and replace them with healthy, positive ones.
- Regain a sense of satisfaction and control in your life.
- Set realistic goals.
If medications and psychotherapy do not reduce your symptoms, your provider may recommend electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS) or vagus nerve stimulation (VNS). These brain stimulation treatments have proven effective in severe cases of medication-resistant depression. Your provider will discuss your options with you.
How to help someone you know who has depression
If you think someone you know is suffering from clinical depression, encourage them to see their primary care provider for help. Let them know you care. You can also encourage them to:
- Avoid alcohol, as it is a depressant.
- Be active and exercise.
- Let others help them.
- See a counselor.
- Set realistic goals for getting better.
- Spend time with other people.
- Postpone important decisions, and discuss any decisions with others who have a more objective view of the situation.
- Talk about their feelings and symptoms with you or someone else in their life.
If this person is expressing suicidal thoughts or gestures, get emergency help.
References
National Institute of Mental Health (NIMH). Depression (https://www.nimh.nih.gov/health/topics/depression)
The Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA’s National Helpline (https://www.samhsa.gov/find-help/national-helpline)
American Psychological Association. Depression (https://www.apa.org/topics/depression)