Depression

Depression is a common illness that can affect anyone — children, adolescents and adults. About 1 in 20 Americans — more than 17 million people — suffer from depression every year. Women are twice as likely as men to become depressed. Depression is a medical problem that can be treated, but it is important that you share your feelings and concerns with your doctor so appropriate steps can be taken to treat the condition.

What Is Depression?

Depression is a medical disorder that can last for years if untreated. Depression disrupts your daily life. It affects your thoughts, feelings, behavior and physical health, and how you relate to your family, friends and coworkers.

Depression has many causes. A family history of depression or a history of physical, emotional or sexual trauma early in life increases your risk of depression. It often occurs alongside other emotional problems, such as anxiety and panic attacks. About 10 to 15 percent of all cases of depression are triggered by other medical conditions, such as thyroid disease, cancer or neurologic problems. In some cases, medications can increase the risk of depression or cause symptoms to worsen. In some people, depression may occur when the chemicals in the brain are not balanced. The use of drugs or alcohol or a history of abuse also can be linked to depression.

Depression is not a weakness or a fault, and can occur even when life is good. Extreme stress or grief may trigger the disorder. Sources of stress may include:

• Trying to balance tasks at work and at home
• Relationship problems
• A stressful job
• Being a single parent
• Money problems
• Divorce or death of a partner
• Being the victim of a crime or trauma

Depression can worsen around the time of certain reproductive events, such as menstruation, pregnancy, loss of a baby, birth of a baby (postpartum depression), infertility and menopause.

When feelings of sadness are linked to a certain situation, you may feel better when the situation improves. However, symptoms linked to a situation can trigger more long-lasting depression. If the feelings do not go away, they may need to be treated. Talk to your doctor about what options may be right for you.

Symptoms

People who are depressed have several symptoms of the illness nearly all day, every day, for at least two weeks. They may:

• Lack interest in things they used to enjoy
• Feel sad, blue or “down in the dumps”
• Slow down or act restless and unable to sit still
• Feel worthless or guilty
• Have a change in appetite, or lose or gain weight
• Have thoughts of death or suicide, or try to commit suicide
• Have problems concentrating, thinking, remembering or making decisions
• Sleep too much or be unable to fall or stay asleep
• Lack energy and feel tired all the time

If you or someone you know has had at least five of these symptoms (including at least one of the first two), you may be depressed. If you have any of these symptoms, talk to your doctor.

You may also have other physical or mental symptoms of depression, including:

• Headaches or other aches and pains
• Digestive problems
• Sexual problems
• Hopeless and negative feelings
• Worry or fear

The time when the symptoms of depression occur is called an episode. It can last at least two weeks or longer. People often have more than one episode.

Depression may be mild, moderate or severe (major). If you have mild depression, it may take extra effort to do what you have to do, but often you can still do those things. With moderate depression, you may not be able to do some of the things you need to do. If you have major depression, you may not be able to do any of the daily tasks you need to do. No matter what type of depression you have, if you ever feel that life is not worth living or think about suicide, get help right away.

Some kinds of depression are mild but chronic (long-lasting or recurring episodes). These symptoms should be treated.

Diagnosis

The diagnosis of depression is based on the types, frequency and severity of the symptoms. In looking for the cause of your depression, the doctor will ask questions about other medical problems, and use of certain medications, drugs or alcohol. If one of these things may be causing your depression, treating that problem may relieve the depression. If you’ve ever thought about suicide, your doctor may refer you to a specialist.

Coping With Depression

If you are depressed, there are things you can do to make your daily life easier:

• Do not demand too much of yourself.
• Set a routine that is realistic. Do not expect to be able to do all the things you are used to doing.
• Avoid making any major life decisions. If you must make such a decision, ask someone you trust to help you.
• Avoid drinking alcohol or using drugs that your doctor has not prescribed.
• Seek out people you trust and support groups for help. Emotional support is key to helping you get better.
• Follow your doctor’s advice. Take medication correctly and keep all your appointments.
• Follow a regular schedule for going to bed and waking up.
• Eat healthy foods and drink plenty of water.

Treatment

You and your doctor should work as a team to find the best treatment options for you. Treatment may include antidepressant medication, psychotherapy, or both. Some types of treatment work better for some types of depression than for others. When thinking about treatment options, make sure to get the answers to these questions:

• How long will it take for me to get better?
• What are the risks and side effects?
• How long will I require treatment?

Antidepressants

Antidepressants are often used to treat severe depression, but may also be useful in treating moderate depression. Antidepressants, which change the balance of chemicals in the brain, relieve symptoms in more than half of the people who take them. Most people who take them start to feel better after a few weeks.

There are many types of antidepressants. Your doctor will prescribe one based on your symptoms and your medical and family history. It may take some time to find the type that works best for you and has the fewest side effects. Like all medications, antidepressants work best if you:

• Take them as your doctor prescribes
• Report side effects that bother you
• Follow all parts of your treatment plan

All antidepressant medications have some side effects. About half of the people who take them get some side effects in the first 2 to 3 weeks of treatment. Most side effects go away after this time. Common ones include:

• Nausea
• Dizziness
• Constipation
• A skin rash
• Feeling sleepy or having trouble sleeping
• Gaining or losing weight
• Feeling restless
• Sexual problems, including loss of libido

More serious side effects are rare, but may include trouble urinating, heart problems, seizures or fainting. Tell your doctor if you have any side effects.

Do not drink alcohol or use any drugs your doctor has not prescribed while taking antidepressants. Drugs and alcohol can affect how well the medication works and may cause unsafe side effects.

Your doctor will want to see you more often when you begin treatment to see how it is working, check the dosage and watch for side effects. Once you begin to feel better, you may visit your doctor less often. You may need to take the medication for at least a few months after you feel better to prevent the depression from coming back. If you’ve had three or more episodes of depression, you may need long-term treatment to stay well.

Psychotherapy

In psychotherapy, a therapist works with you to help you overcome your depression by identifying problems and changes in behavior that can help relieve symptoms. Psychotherapy alone helps about half of those with mild to moderate depression. You can work with your doctor to find a therapist.

You may have one-on-one therapy (with just the therapist and you) or group therapy (with a therapist and other people with problems like yours). If you have family or marriage therapy, you and your spouse or family members may work with a therapist.

If psychotherapy does not work, another kind of treatment may be needed. Psychotherapy often is coupled with antidepressant medication to treat severe depression.

Psychotherapy Plus Antidepressants

Psychotherapy plus medication relieves the symptoms of depression in most patients. It may take a couple of months for the treatment to work. This combined treatment may work best for long-term depression, for people with more severe episodes, or for people who do not respond fully to medicine or psychotherapy alone.

Light Therapy

Some people have mild or moderate seasonal depression that occurs during seasons with shorter days. This is known as seasonal affective disorder or SAD. Light therapy, treatment in which people are exposed to light for about 20 minutes every morning, may help some people who have this disorder.

Hospital Treatment

Most people who suffer from depression are treated on an outpatient basis. People who do not get better or who are at risk of suicide may need to stay in the hospital for a few days or longer. Hospitalization removes the patient from stressful conditions and offers more intense treatment.

Depression During Pregnancy

Pregnancy is often thought to be a very happy time in a woman’s life. But for some women it can be a time of sadness, stress and, in some cases, depression. About 15 to 20 percent of women will have some symptoms of depression during pregnancy. Some women are depressed before pregnancy and some develop the symptoms during pregnancy. Although being pregnant does not increase a woman’s risk of depression, pregnancy also does not protect against it.

Women with any of the following risk factors may be at increased risk for depression during pregnancy:

• Family or personal history of depression
• Previous pregnancy loss
• Stressful life events, such as financial or relationship problems
• Complications during pregnancy

If you are depressed, planning for pregnancy can improve your health and that of your future child. You should see your doctor before getting pregnant to discuss your care. If you are taking antidepressants to treat depression, your doctor may recommend that you continue to take them or suggest that you decrease the dose or stop the medication altogether until you have the baby. Some medications are more harmful to the fetus than others, so you may need to switch to a different medication during pregnancy. In some cases, it may be better to keep taking medication than to risk having depression during pregnancy. Untreated depression can pose risks to the mother and the baby. It can lead to poor nutrition, increased alcohol and drug use, mother–child bonding problems and family relationship problems.

Some women may feel fine during pregnancy, but feel sadness, anger or anxiety after having a baby. This is sometimes called the “baby blues” and it is normal. In fact, about 70–80 percent of women have baby blues after childbirth. It does not mean that you are a failure as a woman or as a mother or that you have a mental illness. Having these feelings means that you are adjusting to the many changes that follow the birth of a child. The baby blues often go away in a few hours or a week without treatment.

If the baby blues do not go away after a week or two, you may have postpartum depression. Women with postpartum depression have such strong feelings of sadness, anxiety or despair that they have trouble coping with their daily tasks. Without treatment, postpartum depression may become worse or last longer.

If you think you may be depressed, get help. Talk with your doctor about your symptoms and treatment options.