What is depression? How is it treated?
Updated: Jan 5, 2019
The National Institute of Mental Health defines depression (major depressive disorder or clinical depression) as a common but potentially serious mood disorder. Clinical depression causes severe symptoms that affect feelings, thoughts, one's ability to 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 can be much more serious than the “baby blues” or a mild mood disorder that generally clears within two weeks after delivery. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery. 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 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 a person with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). A person with bipolar disorder also experiences extreme high moods or “mania” or a less severe form called “hypomania.”
Disruptive mood dysregulation disorder (diagnosed in children and adolescents)
PMDD or premenstrual dysphoric disorder (PMDD).
Signs and Symptoms
To be diagnosed with depression one may 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 sadness, 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. 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.
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 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 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 with a psychiatrist.
Antidepressants are medicines that treat depression. They may help improve the way the brain uses certain chemicals that control mood or stress. One may need to try several different antidepressant medicines before finding the one that improves the symptoms and has manageable side effects, or that after a few weeks period causes no 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.
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.
Brain Stimulation Therapies
If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. The National Mental Health Institute indicates that ECT, based on recent research, can provide relief for people with severe depression who have not been able to feel better with other treatments.
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. Seek counseling if the symptoms are not improving with self help techniques. Never hesitate to call the suicide crisis hotline if thoughts of ending life are present (see resource list).