Depression Explained 

Do you know someone who has depression? Have you or someone in your family been diagnosed with depression? Even if we are dealing with depression in ourselves or our families, we may not know what it really is. Is it just feeling sad all the time? Why can't people just snap out of it? 

Depression is said to be the most widespread mental disorder. It affects women far more than men, and is particularly prevalent in teens. 

What Causes Depression?

There are various opinions on what causes depression, and even the role of brain chemicals is debated. Generally, though, depression can be separated into two categories: circumstantial and clinical.

Circumstantial depression refers to feelings surrounding an event, such as a death in the family or having to sell one's house and move. The circumstances that can cause depression are extremely numerous, from kids having trouble with friends at school to the elderly in a nursing home. Circumstantial depression is also highly individualized.

Clinical depression defies circumstances and the depressed person may feel more depressed because he or she can't find a reason for such dreadful feelings. Clinical depression may baffle those around the patient, too, because they can't understand how a person could be depressed when his or her life seems to be going fine. This lack of understanding may make the patient's depression worse. 

Treatment approaches differ according to the type of depression the patient is experiencing as well as the individual's personality and lifestyle. 

Myths

There are a lot of myths surrounding depression that, when explained, help people better understand the illness. For example:

* Isn't depression just self-pity? - Depressed people may seem to be "wallowing" in their sadness, but it's not willful self-pity. It's a true medical illness, sources point out, that should be treated as such. 

* Medication for depression is overkill, and just treats the symptoms - For those on the outside, so to speak, medication can seem like putting a Band-Aid on a massive wound. But often, medication is what the patient needs to feel good enough to seek help for the underlying problem.

* Depression is not a "real" illness - Actually, it is; brain imaging studies have revealed how the actual chemical imbalances occur in the brain of a depressed person. It is considered physiological, even if the cause is circumstantial - the chemical imbalance may still be present regardless of the depression's origin. 

Other Factors

Depression can be affected not only by circumstances; genetics, personality, psychology, and biology may also play a role. Women are far more likely to be diagnosed with depression, indicating possible hormonal factors. Men, on the other hand, are more likely to succeed in suicide as a result of depression than women, although more women than men attempt suicide, sources report. 

Depression - Signs and Symptoms 

How do you know when you're just having a hard time and are stressed out, or if it's something more serious? When is it clinical depression? While a doctor is the only one who can make a qualified diagnosis, there are some signs and symptoms of depression that can signal your need to see a doctor. Here are some of those signs and symptoms.

Morning Blues

According to medical sources, feeling particularly depressed in the morning is a sign that you may have depression. Feeling sad all day is also part of depression, but the morning blues - perhaps making you just want to stay in or go back to bed - are particularly likely to be connected with depression.

Anger

Many people don't realize that recent research points to a connection between anger and depression. Blowing up and yelling at people without being able to control it may signify depression.

Irritability

Slightly different from anger, irritability is more about feeling snappish or easily frustrated and/or annoyed than angry blow-ups. Irritability connected to depression may make you feel really on edge all the time.

Overwhelm

Do you find yourself wanting to give up because things seem like they're just too much? Do you say, "I just can't take anymore," often? Depression can make you feel overwhelmed and over-stressed even when your schedule is not terribly demanding. Even a simple request for you to do something may send you over the edge and make you feel super-stressed.

Feeling Inadequate

People with depression may constantly compare themselves to others. As noted above, a not-too-demanding schedule may seem overwhelming to a depressed person, thus making the depressed person feel inadequate that he/she can't handle a schedule that others seem to handle fine. This sets up a cycle of feeling inadequate. 

Insomnia or Excessive Sleepiness

Ironically, depression can cause some people to lose sleep, while it makes others want to sleep all the time (hypersomnia). 

Lack of Interest 

Are you just not interested in any outside activities? Are things you once looked forward to just burdensome things you have to trudge through and get done? This may mean you have depression. 

Changes in Weight

In another irony of depression, both weight loss and weight gain may be symptoms of depression. Generally, if you gain or lose 5% or more of your body weight in a month, it may mean depression. 

Indecision 

Depression can make you feel like you can't make a decision, even simple ones. Your schedule just seems like gibberish when you look at it; you may not show up for things you have on your calendar or get dates wrong. Everyone makes mistakes, of course, but if this is a chronic problem or you just can't seem to get a handle on your schedule even when you sit down and try to figure out what to do and what to skip, it may mean depression.

Inability to Concentrate

Depressed people often have trouble concentrating and focusing. Your mind may wander, even to thoughts of death or suicide, and you may feel like you just can't get it together. 
 

Living with Depression - Life's Not Over 

For those living with depression, every day can be a challenge. For family members of depressed people, it's sometimes hard to know what to do, and you may feel like you're walking on eggshells. Understanding depression can go a long way in helping deal with this illness, and there are some coping tips that may help. Here are some suggestions.

Get the Best Treatment

The first step for a depressed person is to get treatment - but it's equally important to get the best treatment, say experts. This means taking the time to get the help you need, or helping your depressed family member get optimal help. 

Include Family in Therapy

While the depressed individual may not want family members present in every counseling or therapy session, it may be a good idea to include family members at least some of the time. The therapist can then see a slice of the family dynamic, and the family members can gain a better understanding of the issue. Some family members are more likely to believe a therapist's "take" on things than take the depressed person's word for it.  

Including family may also help other family members to better understand how to treat the depressed individual, and what things they can say or do to support the depressed person.

Parents of Teens

Because teenagers are a high-risk group for developing depression, sources say, the parents of teens may benefit from some tips on living with a depressed teen. Here are some suggestions.

* Develop a tough skin. Teens who are depressed may yell at you to leave them alone, to go away, or to stop talking to them. For teens, this may be a sort of test of your parenting - the teen may be testing to see if you care enough to press through the anger and continue trying to reach them. Parents who truly do care may miss this aspect and just give up after being yelled at. Instead, remember it's not personal and your teen still needs you. 

* Listen. Busy parents often forget to listen, and how important it is. Parents sometimes need to stop running and take a break to listen and talk. A parent-teen "date" or retreat can help - maybe a mother-daughter shopping trip or father-son fishing excursion. 

* Encourage your depressed teen to problem solve. As parents, we just want their struggles to go away; but giving them the tools to cope is a gift that will last a lifetime. It's okay to help, encourage, and prompt your teen; but experts say your goal as a parent is to get their brains working on solving their own problems. 

Nurture Relationships

As a depressed person, it may be hard to maintain friendships. But supportive friends are important for your depression management and coping. Try to make a point of nurturing these relationships; it will help you break out of yourself and focus on someone else.
 

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Treatment Options for Depression

Depression is different for different people. It's important to work with your healthcare provider to work out a suitable treatment that fits your needs. Here are some of the treatment options your doctor may discuss with you.

Pharmaceuticals

There are various drugs available that are used to treat depression. It's a good idea to be as detailed as you can in sharing your symptoms with your doctor, because he or she will base your medication on these symptoms. All depression medications are not the same; they are specifically designed to treat certain symptoms. In cases of severe depression, medication is often needed to enable the patient to seek other forms of treatment. 

One thing to keep in mind is that it may not be a good idea to rely on medication alone. Most sources agree that you should seek other forms of treatment in addition to your medication. One final point on medicines for depression - if you don't like the side effects or think you're "all better now" and don't need them, don't just stop taking them on your own. 

Psychotherapy

For depression that is mild or moderate, psychotherapy can help a great deal. Professional psychotherapists work with depressed people to help them talk things out and focus on the thought processes and habits that contribute to the patient's depression. Psychotherapists sort of "explain" the depression to the patient so it seems less frightening and overwhelming; they help the patient gain control. Therapy sessions may include family members or be done on an individual basis.

Exercise

Research has shown the effectiveness of exercise in treating depression. Exercise helps boost "feel good" brain chemicals and helps improve overall health and fitness, which may boost self-esteem. Most sources suggest 30 to 60 minutes of exercise daily to get the full benefits. 

Supplements

Studies suggest that supplements may help depression. Vitamins, minerals, and certain herbs may relieve the symptoms of mild or moderate depression. St. John's Wort has been shown to help decrease depression symptoms. Other supplements that may help include:

* Fish oil
* Evening primrose oil (said to be particularly helpful for depression in women)
* B-complex vitamins 
* Magnesium
* Flax oil
* Valerian (a mild herbal sedative)

Diet

A healthy diet may help boost mood in depressed individuals. Nutrient-dense foods can provide your body with the necessary substances that it needs to fight depression and get your brain in optimal working order. Here are some dietary tips for helping treat your depression.

* Whole grains and complex carbs may help boost serotonin levels in the brain. Some depressed people crave sugar; this may be your body's way of telling you it needs carbs. Give it what it needs, but not in unhealthy forms like sugar or white flour baked goods.

* Fresh fruits and vegetables provide antioxidants and nutrients. Make sure to include lots of these in your diet.

* Healthy fats can be helpful in treating depression. Go for fish and nuts to give your body the healthy fats it needs.
 

Depression  (Information from NIMH.NIH.GOV)

Overview

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

• Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two 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 two years to be considered persistent depressive disorder.

• Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

• Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

• Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

• Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two 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

Not everyone who is depressed experiences every symptom. Some people 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 benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Risk Factors

Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

• Personal or family history of depression

• Major life changes, trauma, or stress

• Certain physical illnesses and medications

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.

You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH Psychotherapies webpage.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

• ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.

• Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.

• Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.

• ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.

• ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

• Try to be active and exercise.

• Set realistic goals for yourself.

• Try to spend time with other people and confide in a trusted friend or relative.

• Try not to isolate yourself, and let others help you.

• Expect your mood to improve gradually, not immediately.

• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

• Continue to educate yourself about depression.