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Depression

(Major Depressive Affective Disorder; Unipolar Disorder; Unipolar Mood Disorder)

En Español (Spanish Version)More InDepth Information on This Condition

Definition

Depression is a mental illness marked by feelings of profound sadness and lack of interest in activities. Depression is not the same as a blue mood. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment.

Causes

While the exact cause is not known, factors that may play a role in depression include:

Having a family history of depression (genetic link)

Having a certain type of brain chemistry

Experiencing stressful or traumatic life events (eg, death in the family, divorce, job loss)

Brain

Risk Factors

There are a range of factors that may increase your risk of depression. Examples include:

Gender: female

Previous episode of depression

Hormonal changes

Chronic conditions (eg, hypothyroidism , type 2 diabetes , heart disease, cancer, chronic pain, stroke , Parkinson's disease )

Other conditions related to mental health (eg, anxiety , drug abuse , insomnia , personality disorder)

Emotional or social factors, such as:

Little or no social support

Negative thought patterns and beliefs

Low self-esteem

Lack of personal control over circumstances

Feelings of helplessness

Symptoms

Depression can differ from person to person. Some people have only a few symptoms, while others have many.

Symptoms can change over time and may include:

Persistent feelings of sadness, anxiety, or emptiness

Hopelessness

Feeling guilty, worthless, or helpless

Loss of interest in hobbies and activities

Loss of interest in sex

Feeling tired

Trouble concentrating, remembering, or making decisions

Trouble sleeping, waking up too early, or oversleeping

Eating more or less than usual

Weight gain or weight loss

Thoughts of death or suicide with or without suicide attempts

Restlessness or irritability

Physical symptoms that defy standard diagnosis and do not respond well to medical treatments

Diagnosis

There is no blood test or diagnostic test for depression. The doctor will ask about your symptoms and medical history, giving special attention to:

Alcohol and drug use

Thoughts of death or suicide

Family members who have or have had depression

Sleep patterns

Previous episodes of depression

Specific mental health exams may be done. This will help the doctor get detailed information about your speech, thoughts, memory, and mood. A physical exam and other tests can help rule out other causes.

Treatment

Treatment may involve the use of medicine and/or psychotherapy.

Severe depression can require hospital care, especially if you are at risk of hurting yourself or others.

Antidepressant Medications

Antidepressant medicines may be most effective in people with severe depression. These medicines can take 2-6 weeks to reach their maximum effectiveness. There are many different types of medicines to treat depression. You will work with your doctor to find the medicine that benefits you the most and has the least side effects.

Therapy

Psychotherapy for depression consists of various types of counseling. These include cognitive-behavior therapy (CBT) , interpersonal therapy, psychodynamic therapy, or a combination of these. Therapy is designed to help you cope with difficulties in relationships, change negative thinking and behavior patterns, and resolve difficult feelings.

Diet and Exercise

Dietary Changes

Research suggests that diets high in tryptophan and certain B vitamins may be helpful. There is also mixed evidence that omega-3 fatty acids may reduce symptoms.

If you want to take supplements or change your diet, talk to your doctor first.

Dietary Supplements and Herbal Therapy

The herb St. John's wort may be an effective alternative to standard medicines with fewer side effects. However, St. John's wort may reduce the effectiveness of many drugs, such as antidepressants, birth control pills, blood thinners, and other medicines. It is important that you talk to your doctor before trying any herb.

There is also some evidence that dehydroepiandrosterone (DHEA) , a hormone that is available as a dietary supplement, may help some people.

Exercise

A regular exercise program has been shown to relieve some of the symptoms. It should play a large role in the overall management of depression.

Procedures

Electroconvulsive Therapy (ECT)

ECT is the use of an electric stimulus to produce a generalized seizure. It may be used in people with severe or life-threatening depression. ECT is also used for people who cannot take or do not respond to medicine. It is considered a safe and effective procedure.

Vagus Nerve Stimulation (VNS)

VNS is used as therapy for depression when multiple trials of medicine do not work. A pacemaker-like device stimulates the vagus nerve in the neck.

Vagus Nerve

Stimulation of the vagus nerve (yellow) at the neck is a depression therapy option.

Transcranial Magnetic Stimulation (TMS)

TMS involves the application of low-frequency magnetic pulses to the brain. The change in electrical field stimulates nerves. There are a number of studies that show the benefits of TMS for the treatment of depression. It may be used if you have not gotten better with medicines and psychotherapy.

Other Treatment Options

Bright Light Therapy

Your doctor may recommend bright light therapy. This involves being exposed to high levels of light from a special "light box" that has a screen on it.

Meditation

Meditation may help to improve the symptoms of depression.

Prevention

Strategies to reduce your chance of becoming depressed include:

Being aware of your personal risk factors

Having a psychiatric evaluation and psychotherapy if needed

Developing social supports

Learning stress management techniques

Exercising regularly

Not abusing alcohol or drugs

Getting adequate sleep, rest, and recreation

Eating healthy food, including fruits, vegetables , and whole grains

RESOURCES:

Depression and Bipolar Support Alliance

http://www.dbsalliance.org/

The National Mental Health Association

http://www.nmha.org/

CANADIAN RESOURCES:

Canadian Mental Health Association

http://www.ontario.cmha.ca/

Canadian Psychiatric Association

http://www.cpa-apc.org/

References:

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed August 23, 2012.

Clinical depression is a common, real and treatable illness. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/information/mental-health-info/depression/depression-what-you-need-to-know/depression-what-you-need-to-know . Accessed August 23, 2012.

Columbia University. Q&A on bright light therapy. Columbia University website. Available at: http://www.columbia.edu/~mt12/blt.htm . Accessed August 23, 2012.

Depression. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. . Updated July 19, 2012. Accessed August 23, 2012.

Depression. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated July 25, 2012. Accessed August 23, 2012.

Depression. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/depression . Accessed August 23, 2012.

Depression. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/topics/depression/index.shtml . Accessed August 23, 2012.

Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci Biobehav Rev . 2005;29:493-500.

St. John's wort. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated July 25, 2012. Accessed August 23, 2012.

St. John's wort for depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 26, 2012. Accessed August 23, 2012.

St. John's wort and depression. National Center for Complementary and Alternative Medicine website. Available at: http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm#issues . Updated December 2007. Accessed August 23, 2012.

12/16/2008 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance : Linde K, Berner M, Kriston L. St. John's wort for major depression. Cochrane Database Syst Rev . 2008;CD000448.

10/9/2009 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance : Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean dietary pattern with the incidence of depression. Arch Gen Psychiatry . 2009;66:1090.

7/26/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance : Lespérance F, Frasure-Smith N, St-André E, et al. The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry . 2010 Jun 15 early online.

12/13/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance : Britton WB, Haynes PL, Fridel KW, Bootzin RR. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med . 2010;72(6):539-548.

3/28/2011 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance : Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry . 2011;198:11-16, sup 1.

7/28/2011 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance : Jakobsen JC, Hansen JL, Simonsen E, Gluud C. The effect of adding psychodynamic therapy to antidepressants in patients with major depressive disorder. A systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. J Affect Disord . 2011 Apr 16. [Epub ahead of print]

Last reviewed March 2013 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.