DefinitionDepression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time.For more information on the symptoms and treatment of depression, see:Adolescent depressionBipolar disorderDepression in the elderlyDysthymiaMajor depression
Alternative NamesBlues; Gloom; Sadness; Melancholy
ConsiderationsSymptoms of depression include:Low or irritable mood most of the timeA loss of pleasure in usual activitiesTrouble sleeping or sleeping too muchA big change in appetite, often with weight gain or lossTiredness and lack of energyFeelings of worthlessness, self-hate, and guiltDifficulty concentratingSlow or fast movementsLack of activity and avoiding usual activitiesFeeling hopeless or helplessRepeated thoughts of death or suicideLow self-esteem is common with depression. It is also common to have sudden bursts of anger and a lack of pleasure from activities that normally make you happy, including sex.Depressed children may not have the same symptoms as adult depression. Watch for changes in school work, sleep, and behavior. If you wonder whether your child might be depressed, it's worth talking to a health care provider.The main types of depression include:Major depression -- to be diagnosed with major depression, you must have five or more of the symptoms listed above for at least 2 weeks. Major depression tends to continue for at least 6 months if not treated. (You are said to have minor depression if you have less than five depression symptoms for at least 2 weeks. Minor depression is similar to major depression except it only has two to four symptoms.)Atypical depression -- occurs in about a third of patients with depression. Symptoms include overeating and oversleeping. You may feel like you are weighed down and get very upset by rejection.Dysthymia -- a milder form of depression that can last for years, if not treated.Other common forms of depression include:Postpartum depression -- many women feel somewhat down after having a baby, but true postpartum depression is more severe and includes the symptoms of major depression.Premenstrual dysphoric disorder (PMDD) -- symptoms of depression occur 1 week before your menstrual period and disappear after you menstruate.Seasonal affective disorder (SAD) -- occurs most often during the fall-winter season and disappears during the spring-summer season. It is most likely due to a lack of sunlight.Depression may also alternate with mania (known as manic depression or bipolar disorder).Depression may be more common in women than men. This may be because women tend to seek help for it more. Depression is also more common during the teenage years.
Common CausesDepression often runs in families. This may be due to your genes (inherited), behaviors you learn at home, or both. Even if your genes make you more likely to develop depression, a stressful or unhappy life event usually triggers the depression.Many factors can cause depression, including:Alcohol or drug abuseMedical conditions and treatments, such as:
Certain types of cancerLong-term painSleeping problems Steroid medicationsUnderactive thyroid (hypothyroidism) Stressful life events, such as:
Abuse or neglectBreaking up with a boyfriend or girlfriendCertain types of cancerDeath of a relative or friendDivorce, including a parent's divorceFailing a classIllness in the familyJob lossLong-term painSocial isolation (common cause of depression in the elderly)
Home CareIf you are depressed for 2 weeks or longer, contact your doctor or other health professional before your symptoms get worse. No matter what type of depression you have and how severe it is, the following self-care steps can help:Get enough sleep.Follow a healthy, nutritious diet.Exercise regularly.Avoid alcohol, marijuana, and other recreational drugs.Get involved in activities that make you happy.Spend time with family and friends.If you are a religious or spiritual person, talk to a clergy member or spiritual advisor.Consider meditation, tai chi, or other relaxation methods.Add omega-3 fatty acids to your diet. You can get them from over-the-counter supplements or by eating fish such as tuna, salmon, or mackerel.If your depression occurs in the fall or winter months, try light therapy using a special lamp that is like sunlight.If you have moderate to severe depression, the most effective treatment plan will likely involve a combination of talk therapy, lifestyle changes, and medication.
Call your health care provider ifCall 911, a suicide hotline, or go to a nearby emergency room if you have thoughts of harming yourself or others.Call your doctor if:You hear voices that are not thereYou cry often without causeYour depression has affected your work, school, or family life for longer than 2 weeksYou have three or more symptoms of depressionYou think one of your current medications may be making you feel depressed -- DO NOT change or stop taking any medications without talking to your doctorYou think you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning
What to expect at your health care provider's officeYour health care provider will find out how severe your depression is (mild, moderate, or severe) and look for the cause by doing a:Health historyMental health interviewPhysical examinationIf there is a risk of suicide, you may need to stay in the hospital for treatment.You will talk with the health care provider about the issues and events that may be causing your depression. Your doctor will ask you about:Your mood and other symptoms (sleep, appetite, concentration, energy)Possible stressors in your life, and support systems in placeWhether you have had thoughts about ending your lifeDrug and alcohol use, and any medications you are currently takingTreatment will depend on your symptoms. For mild depression, counseling and self-care may be enough. The most effective therapy for moderate or severe depression is a combination of antidepressant medication and talk therapy.Your primary care doctor may refer you to a psychiatrist if your depression is moderate to severe, or if it does not improve with treatment.For more treatment information, see: Major depression
PreventionHealthy lifestyle habits can help prevent depression, and reduce the chances of it coming back. Talk therapy and antidepressant medication can also make you less likely to become depressed again.Talk therapy may help you through times of grief, stress, or low mood. Family therapy may help teens who feel sad.Keeping close contact with other people is important for preventing depression.
ReferencesFava M, Cassano P. Mood disorders: Major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007.