Depression is when feelings of loss, anger, sadness, or frustration make it hard for you to do the things you enjoy in everyday life. Although everyone feels sad sometimes, depression lasts longer and interferes with your daily life.
Depression is one of the most common illnesses, affecting about 18 million Americans each year. It can be mild, moderate, or severe. You can have a single episode of depression, or depression that comes back or lasts a long time (more than 2 years). Many experts think that depression is a chronic illness that needs long-term treatment.
The primary types of depression include:
Other common forms of depression include:
Signs and Symptoms
While it is normal to feel down sometimes, people with major depression feel significantly depressed for a long period of time. They have trouble enjoying things they used to love. Symptoms include:
No one knows exactly what causes depression, though scientists believe a combination of physical, genetic, and environmental factors are involved. People with depression may have abnormal levels of brain chemicals called neurotransmitters, including serotonin, dopamine, and norepinephrine. These things may contribute to having depression:
Although depression can happen to anyone, no matter what age, race, or gender, the following factors may increase your risk for depression:
If you feel depressed, or have symptoms of depression, it is important to tell your doctor. Depression does not usually go away on its own. Telling your doctor is the first step toward treatment. Talk to your primary care doctor or a mental health provider.
If you have thoughts of suicide, call 911 or a local emergency hotline. It is important to talk to someone immediately. You can also call a family member or friend, your minister, or someone in your faith community.
Your doctor may run tests to rule out other conditions. Your doctor will take a medical history and ask about your symptoms. Your doctor may also order blood tests to check your thyroid function and other conditions and may refer you to a psychiatrist.
Although most people with depression are treated as outpatients, people with suicidal thoughts may need to be hospitalized.
Although there is no guarantee you can prevent depression, the following steps may help:
People with depression have several options for treatment. Most experts think a combination of psychotherapy and antidepressants is best, especially for people with major depression. Cognitive-behavioral therapy may be the type of psychotherapy that works best, particularly for teens and people with atypical or postpartum depression.
Most people with depression get better with this combination treatment. Complementary and alternative therapies (CAM) may help either reduce the side effects from antidepressants, or reduce the symptoms of mild-to-moderate depression.
Many herbs and supplements can interact with medications taken for depression and cause unwanted side effects. Be sure to talk to your doctor before trying any herb or supplement.
Studies show that regular exercise, either aerobic or strength and flexibility training, can reduce depression in people with mild-to-moderate depression. For people with major depression, exercise also improves their mood. Some studies even suggest that exercise may work as well as psychotherapy for people with mild-to-moderate depression, although more research is needed. In the meantime, it makes sense to exercise, whether or not you are taking medications or receiving therapy for depression.
Light therapy, being exposed to a bright light as soon as you wake up in the morning, may help people with SAD.
Antidepressant medications can work well in treating depression, although you may have to try a few different medications to find the one that works best for you. In general, antidepressants are taken for at least 4 to 6 months. Most medications take 2 to 4 weeks to start working, and may take up to 12 weeks for their full effects to kick in.
Antidepressants can have unwanted side effects, making it hard for some people to keep taking their medications. Often you can work with your doctor to find a medication that has fewer side effects. DO NOT stop your medication without talking to your doctor. Most antidepressants cause withdrawal symptoms if they are not stopped slowly over time or tapered down.
Note: The Food and Drug Administration (FDA) requires all antidepressants to carry a "black-box warning" saying that people under age 25 may have an increase in suicidal thoughts or behavior in the first weeks after taking an antidepressant or when the dose is changed. People under 25 should be watched closely when taking antidepressants.
There are several types of antidepressant medications, including:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs: increase the activity of a chemical in the brain called serotonin. Most doctors prescribe SSRIs first for depression, in part because their side effects are generally fewer than other antidepressants. Typical side effects caused by SSRIs include stomach upset, weight gain or loss, drowsiness, sexual dysfunction (such as impotence, loss of sex drive, and diminished orgasm), headache, jaw grinding, and apathy. Very unusual side effects from this class of prescription drugs include extreme agitation, impulsivity, tremors, and insomnia.
Drugs that are SSRIs include:
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs: are often the second kind of antidepressants prescribed. They increase the amount of the chemicals serotonin and norepinephrine available in the brain, and have fewer side effects than other antidepressants. Side effects can include nausea, insomnia, nervousness, rash, or sexual dysfunction.
Drugs that are SNRIs include:
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
This kind of drug increases the amount of the chemicals norepinephrine and dopamine available in the brain. Bupropion (Wellbutrin) is the only approved drug in this class. It does not seem to cause sexual dysfunction or weight gain, but people with a risk or history of seizure should not take it.
Tricyclics: increase the activity of the brain chemicals serotonin and norepinephrine. They work as well as SSRIs, but they are an older kind of antidepressant with more side effects. They are usually prescribed only when other antidepressants have not worked. Tricyclic antidepressants include:
Side effects of tricyclics may include:
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs: boost levels of norepinephrine, dopamine, and serotonin in the brain. They are an older class of antidepressants and are rarely prescribed because they can have serious side effects. People who take MAOIs have to avoid certain chemicals, called tyramines, in their diet. Tyramines are found in fish, alcohol, cheeses, processed meats, and other food. MAOIs also interact with other medications, including Ritalin and pseudoephedrine, a decongestant in many over-the-counter and prescription medications. You should not take MAOIs with other kinds of antidepressants.
Surgery and Other Procedures
Doctors may recommend:
Electroconvulsive Therapy (ECT) for depression when all other therapies have not worked. In ECT, a small electrical current is passed through the brain to cause a seizure. Scientists are not sure how ECT works, but it may boost levels of neurotransmitters in the brain. It may cause temporary confusion and memory loss, headache, muscle aches, irregular heart rhythm, or nausea. For some people, it relieves severe depression and works quickly.
Magnetic Resonance Imaging (MRI)-Guided Cingulotomy involves stimulating the brain with electrodes that are surgically implanted. It is an experimental treatment for people who have treatment-resistant depression.
Vagus Nerve Stimulation (VNS) involves surgically implanting a device that stimulates the vagus nerve. It was first developed for epilepsy, but seems to work for some people with treatment-resistant depression. The device is placed under the skin in the chest.
Nutrition and Dietary Supplements
A treatment plan for depression may include complementary and alternative therapies. Preliminary studies suggest some nutritional supplements may reduce the symptoms of depression for some people. It is important to talk to your team of health care providers about the best ways to use these therapies in your overall treatment plan.
DO NOT try to treat moderate or severe depression on your own. Always tell your provider about the herbs and supplements you are using or considering using.
The following supplements may help reduce symptoms:
Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment.
Preliminary studies suggest that electroacupuncture may reduce symptoms of depression as well as Elavil, a tricyclic antidepressant. In electroacupuncture, a small current runs through acupuncture needles. Other studies suggest that acupuncture may help people with mild depression, and those with depression related to a chronic medical illness. More research is needed.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for depression based on their knowledge and experience.
Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each person. A few homeopathic remedies that may work for depression include:
Massage and Physical Therapy
Studies of formerly depressed teen mothers, children hospitalized for depression, and women with eating disorders suggest that massage can help reduce stress, anxiety, and symptoms of depression. Giving massage may also help people who are depressed. Elderly volunteers with depression had fewer symptoms when they massaged infants.
Aromatherapy, or using essential oils in massage therapy, may also help treat depression. Aromatherapy seems to work because it helps people relax. The person's belief that it will help also has an effect. Essential oils used during massage for depression include:
Mind-body therapies and techniques that may be useful as a part of an overall treatment regimen for depression include:
Cognitive-behavioral therapy (CBT) is a kind of therapy where people learn to identify and change negative thoughts and feelings so they can better cope with the world around them. This therapy works well for people with mild-to-moderate depression, but your doctor may not recommend it if you have severe depression.
People treated with CBT had just as good, or better, results as those treated with tricyclic antidepressants. They also had lower relapse rates than those taking antidepressants.
Other types of therapy that a psychiatrist, psychologist, or social worker may offer include:
Tai Chi and Yoga
Several studies suggest that mind-body techniques, such as yoga, qi gong, and tai chi, may improve symptoms of mild depression.
Some researchers believe that mindfulness meditation may prevent depression from coming back.
Warnings and Precautions
Prognosis and Complications
Depression is a serious condition that can have a devastating effect on people's lives. It can contribute to long-lasting medical conditions, such as heart disease and stroke. Depressed people with these conditions are less likely to do healthy activities, such as exercise, and more likely to do unhealthy activities, such as smoking.
Suicide is a significant risk for people with depression. About 15% of people with a major depressive disorder commit suicide. Depression also shortens the lifespan of the elderly and is linked to memory problems and dementia.
Left untreated, depression can last up to 2 years or longer. Depression is likely to come back: 50% of people who have had one depressive episode will have a second one, 70% of those who have two episodes will have a third, and 90% of those who have three episodes will have a fourth. For women with premenstrual dysphoric disorder or SAD, symptoms usually go away after menopause.
Fortunately, there are many treatments available for depression. The prognosis is much better for people who get treatment and follow their doctor's recommendations.
Akhondzadeh Basti A, Moshiri E, Noorbala AA, et al. Comparison of petal of Crocus sativus L. and fluoxetine in the treatment of depressed outpatients: a pilot double-blind randomized trial. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:439-42.
Akhondzadeh S, Fallah-Pour H, Afkham K, et al. Comparison of Crocus sativus L. and imipramine in the treatment of mild to moderate depression: A pilot double-blind randomized trial [ISRCTN45683816]. BMC Complement Altern Med. 2004;4:12.
Akhondzadeh S, Tahmacebi-Pour N, Noorbala AA, et al. Crocus sativus L. in the treatment of mild to moderate depression: a double-blind, randomized and placebo-controlled trial. Phytother Res. 2005;19:148-51.
Alpert JE, Mischoulon D, Nierenberg AA, Fava M. Nutrition and depression: focus on folate. Nutrition. 2000;16:544-581.
Babyak M, Blumenthal JA, Herman S, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000;62(5):633-638.
Bottiglieri T, Laundy M, Crellin R, Toone BK, Carney MW, Reynolds EH. Homocysteine, folate, methylation, and monoamine metabolism in depression. J Neurol Neurosurg Psychiatry. 2000;69(2):228-232.
Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clin Ther. 2000;22(4):411-419.
Bruinsma KA, Taren DL. Dieting, essential fatty acid intake, and depression. Nutrition Rev. 2000;58(4):98-108.
Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis. Psychiatry Res. 2010 Sep 14. (Epub ahead of print)
Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study. Fortschr Neurol Psychiatr. 2000;68(3):137-144.
Gaster B, Holroyd J. St. John's wort for depression. Arch Intern Med. 2000;160:152-156.
Johnson MA. Nutrition and aging--practical advice for healthy eating. J Am Med Womens Assoc. 2004;59(4):262-9.
Kasper S, Caraci F, Forti B, Drago F, Aguglia E. Efficacy and tolerability of Hypericum extract for the treatment of mild to moderate depression. Eur Neuropsychopharmacol. 2010 Nov;20(11):747-65. (Epub 2010 Aug 14.)
Kim JM, Stewart R, Kang HJ, et al. A prospective study of statin use and poststroke depression. J Clin Psychopharmacol. 2014;34(1):72-9.
Lazarou C, Kapsou M. The role of folic acid in prevention and treatment of depression: an overview of existing evidence and implications for practice. Complement Ther Clin Pract. 2010 Aug;16(3):161-6.
Linde K, Mulrow CD. St. John's wort for depression (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
Margaretten ME, Katz P, Schmajuk G, Yelin E. Missed opportunities for depression screening in patients with arthritis in the United States. J Gen Intern Med. 2013;28(12):1637-42.
Markus R, Panhuysen G, Tuiten A, Koppeschaar H. Effects of food on cortisol and mood in vulnerable subjects under controllable and uncontrollable stress. Physiol Behav. 2000;70(3-4):333-342.
McGinn LK. Cognitive behavioral therapy of depression: theory, treatment, and empirical status. Am J Psychother. 2000;54(2):257-262.
Meyers S. Use of neurotransmitter precursors for treatment of depression. Altern Med Rev. 2000;5(1):64-71.
Morelli V, Zoorob RJ. Alternative therapies: Part 1. Depression, diabetes, obesity. Am Fam Phys. 2000;62(5):1051-1060.
Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry. 2002;159:477-9.
Obach RS. Inhibition of human cytochrome P450 enzymes by constituents of St. John's wort, and herbal preparation used in the treatment of depression. J Pharmacol Exp Ther. 2000;294(1):88-95.
Paluska SA, Schwenk TL. Physical activity and mental health. Sports Med. 2000;29(3):167-180.
Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002;59:913-9.
Rondanelli M, Giacosa A, Opizzi A, Pelucchi C, La Vecchia C, Montorfano G, Negroni M, Berra B, Politi P, Rizzo AM. Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr. 2010 Feb;29(1):55-64.
Roschke J, Wolf CH, Muller MJ, et al. The benefit from whole body acupuncture in major depression. J Affect Disord. 2000;57:73-81.
Rush AJ, George MS, Sackeim HA, et al. Vagus nerve stimulation (VNS) for treatment of resistant depressions: a multicenter study. Biol Psychiatry. 2000;47:276-286.
Rutledge T, Kenkre TS, Thompson DV, et al. Depression, dietary habits, and cardiovascular events among women with suspected myocardial ischemia. Am J Med. 2014;127(9):840-7.
Scherrer JF, Svrakic DM, Freedland KE, et al. Prescription opioid analgesics increase the risk of depression. J Gen Intern Med. 2014;29(3):491-9.
Shaw, K., Turner, J., and Del Mar, C. Tryptophan and 5-hydroxytryptophan for depression. Cochrane Database Syst Rev. 2002;(1):CD003198.
Shen CC, Tsai SJ, Perng CL, Kuo BI, Yang AC. Risk of Parkinson disease after depression: a nationwide population-based study. Neurology. 2013;81(17):1538-44.
Su KP, Huang SY, Chiu CC, Shen WW. Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol. 2003;13:267-71.
Yeung AS, Ameral VE, Chuzi SE, Fava M, Mischoulon D. A pilot study of acupuncture augmentation therapy in antidepressant partial and non-responders with major depressive disorder. J Affect Disord. 2010 Aug 5. (Epub ahead of print)
Review Date: 3/25/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.