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This topic covers depression in adults. For information on
depression in young people, see the topic
Depression in Childhood and Adolescence. For
information on depression following childbirth, see the topic
Postpartum Depression. What is depression?Depression is a mood disorder that causes you to feel
sad or hopeless for an extended period of time. More than just a bout of "the
blues" or temporary feelings of grief or low energy, depression can have a
significant impact on your enjoyment of life, your work, your health, and the
people you care about. Depression affects people differently. Some feel down for
extended periods of time; for others the feelings of depression come and go. If
you have short episodes of mild depression, you may be able to continue to work
and take care of daily activities. However, if you do not seek some form of
treatment for your depression, you are at risk for getting more depressed or
becoming physically ill. In severe cases, depression can cause people to become
incapable of communicating, unable to do routine activities, or suicidal. In
these cases, it is essential to seek medical attention. People with depression may be reluctant to seek help because they
feel that it is a sign of personal weakness or a character flaw or that they
should be able to "pull out of it" on their own. We now know that depression,
like other medical conditions, has a chemical and biological basis. Treatment
for depression is safe and usually effective even for severely depressed
people. If you think you may have depression, take a short quiz to
evaluate your symptoms: - Interactive Tool: Are you
depressed?
What causes depression? Depression may be triggered by stressful life events, other
illnesses, certain drugs or medications, or inherited traits. Although causes
of depression are not entirely understood, we know it is linked to an imbalance
in brain chemistry. Once the imbalance is corrected, symptoms of depression
generally improve. What are the symptoms?Depression is more than just the normal, temporary feelings of
sadness and hopelessness associated with difficult life events. The symptoms of
depression are often subtle at first. It can be hard to recognize that symptoms
may be connected and that you might have depression. Common symptoms
include: - Depressed mood.
- Inability to
enjoy activities.
- Problems concentrating.
- Changes in
eating habits or appetite.
- Weight gain or weight
loss.
- Changes in sleeping habits.
- Difficulty going to
work or taking care of your daily responsibilities because of a lack of
energy.
- Feelings of guilt and hopelessness; wondering if life is
worth living (common).
- Slowed thoughts and
speech.
- Preoccupation with thoughts of death or
suicide.
- Complaints that have no physical cause (somatic
complaints) such as headache and stomachache.
All of these symptoms can interfere with your quality of life.
Even if you don't have major depression, if you have experienced a few of these
symptoms for at least 2 weeks you may have a less severe form of depression
that still requires treatment. How is it treated?Depression is usually treated successfully with professional
counseling, antidepressant medication, or a combination of the two. Often a
combination of the two is most effective. People with depression usually can be
treated as outpatients, but in severe cases a period of hospitalization may be
necessary. If you have mild or moderate depression, you may be diagnosed and
treated by your family health professional and a therapist or psychologist. If
you have severe depression or other psychological disorders or do not respond
to treatment, a
psychiatrist, a doctor who specializes in the
diagnosis and treatment of mental health problems, may be helpful. Let your health professional know if you suspect that you have
depression, because it is often overlooked. If you are diagnosed with
depression, you and your health professional can decide on the best treatment.
The earlier you are treated, the more quickly you will recover.1 How common is depression?If you have symptoms of depression, you are not alone. In the
United States, an estimated 15% of people will have depression at some point in
life, and chances of becoming depressed are even higher for certain people. For
example: - Women experience depression twice as often as
men, although men are more likely to commit suicide as a result of
depression.2
- Separated or divorced
individuals, especially men, are more likely than married people to become
depressed.
- People who have a serious illness are more likely to
suffer from depression.
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Health tools help you make wise health decisions or take action to improve your health.
The cause of
depression is the subject of intense study. Experts
believe genetic traits, along with stressful events, illness, medications, or
other factors, can lead to an imbalance of certain brain chemicals called
neurotransmitters, causing depression. Conditions that
may trigger an episode of depression include: - Some medications can trigger
depression, such as steroids or narcotics for pain relief. Once the medication
is stopped, the depressive symptoms usually disappear.
- Problems
with
hormones, such as imbalances in the
thyroid or
adrenal glands.
- Chemical imbalances, such
as imbalances in blood calcium levels or low iron levels (anemia).
- Long-term (chronic) diseases,
such as
arthritis,
heart disease, or cancer.
- Infections, such
as
viral infections or infections in the liver or
brain.
- Social stressors, such as the death of a loved
one.
- Chronic stressors, such as living in poverty, having family
difficulties, or having serious medical problems or living with someone who
does. Older adults who move from an independent lifestyle to one that is more
dependent upon others often experience depression.
- Social and peer
pressures in children and teens. For more information, see the topic
Depression in Childhood and
Adolescence.
- Drinking alcohol, using illegal drugs, or
having a
substance abuse problem.
- Chronic
premenstrual syndrome (PMS).
- Other
conditions, such as menopause or chronic pain, stress, or
fatigue.
- Recent childbirth. For more information, see the topic
Postpartum Depression.
If you have
depression, you may feel hopeless and sad or stop
feeling pleasure from almost everything you do. You may feel “down in the
dumps,” tearful, or discouraged. You may also be irritable or anxious or have
low energy levels. The symptoms of depression are often subtle at first. It can
be hard to recognize that symptoms may be connected and that you might have
depression. The two most significant symptoms of depression are:3 - Sadness or hopelessness.
- Loss of
interest in or pleasure from most daily activities.
Other symptoms include: - Losing or gaining weight because of changes in
appetite.
- Sleeping too much or not enough.
- Feeling
restless and unable to sit still, or feeling that moving takes a great
effort.
- Feeling tired all the time.
- Feeling unworthy or
guilty without an obvious reason.
- Having problems concentrating,
remembering, or making decisions.
- Thinking often about death or
suicide.
If you have at least five of these symptoms for 2 weeks or longer,
and one of the symptoms is either sadness or loss of interest, you are
diagnosed with major depression. But, if you have fewer than five symptoms, you
may still be depressed and need treatment. If you have 2 to 4 symptoms for a period of at least 2 years (1
year for a child), you may have a long-term form of depression called
dysthymic disorder (dysthymia). Many women experience mood changes before menstruation. Physical
and emotional premenstrual symptoms that interfere with relationships or
responsibilities are known as
premenstrual syndrome (PMS). However, women who have
emotional and physical premenstrual symptoms that seriously interfere with
daily life may have a type of depression known as
premenstrual dysphoric disorder (PMDD). For more
information see the topic
Premenstrual Syndrome (PMS). Many health professionals see people with general symptoms that
may be difficult to link to depression. These symptoms, which commonly occur
with depression, include: - Having headaches and other body aches and
pains.
- Having digestive problems, including constipation or
diarrhea.
- Losing interest in sex or being unable to perform
sexually.
- Feeling anxious or worried without an obvious
reason.
- Blaming yourself or others for your
depression.
- Not moving or talking for hours.
Other symptoms of depression may include:4, 3 - Overeating and weight gain (rather than loss of
appetite).
- Oversleeping (rather than
insomnia).
- Increased tearfulness, anger, and generally not feeling
well, along with anxiety and tension.
- Sometimes, a feeling of
heaviness in the arms and legs.
- Sensitivity to rejection.
Depression is a serious problem for people of any age, and older
adults with symptoms of depression should seek treatment right away. Depression
in older adults can cause confusion or forgetfulness (although some medications
can cause these symptoms as well). Depression has also been identified as a
significant risk factor for death in older adults with heart problems.5 It is important to recognize the early warning signs of depression
so that you can get treatment. If you think you may have depression, take a
short quiz to evaluate your symptoms: - Interactive Tool: Are You
Depressed?
The symptoms of depression are often subtle at first. It can be
hard to recognize that symptoms may be connected and that you might have
depression. Symptoms of depression in
children and teens are sometimes different than adult
symptoms, which can make it more difficult to diagnose and treat. For more
information, see the topic
Depression in Childhood and Adolescence. Depression can lead to suicide. The warning signs of suicide change
with age.
Depression may begin with symptoms of
anxiety (such as excessive worrying) or symptoms such
as sadness or lack of energy that last for days or months before the onset of
full-blown depression. You may have trouble concentrating or remembering,
experience a loss of pleasure in things you used to enjoy, feel hopeless, and
have low energy and changes in sleeping and eating patterns. You may withdraw
socially from others and lose interest in sexual activity. The course of depression varies from one person to another. You
might have mild or severe symptoms of depression for a long time, or you may
have them for a brief time. A small number of people feel depressed for most of
their lives and require ongoing treatment. Most people who have depression can
be treated successfully with medication, professional counseling, or a
combination of the two. Depressive disorders are classified according to their severity and
duration. Depression may be mild, moderate, or severe. It may start suddenly
(acute) or be long-lasting (chronic).
Dysthymic disorder, for example, is chronic mild
depression. Some people may experience an episode of major depression on top of
dysthymic disorder (double depression). For severe depression, you may need to be admitted to a hospital
for a short time, especially if you are having thoughts of suicide. Because
depression puts you at a higher risk for attempting suicide, you should seek
immediate treatment if you are having self-destructive thoughts. Recurring illnessDepression often recurs. If you have one episode of depression,
you are more likely to become depressed again at some point in your life than
someone who has never been depressed. The risk of having another episode of
depression increases with each additional episode.3 Related illnessDepression can contribute to the development of certain diseases
such as
coronary artery disease.6, 7 Depressed people who have a chronic
illness such as diabetes or coronary artery disease suffer more from symptoms
of their illnesses, are less able to function, have a decreased quality of
life, and pay more in medical costs. People with depression are less likely to
take good care of themselves, and this may worsen their health.8 Sometimes episodes of depression are preceded or followed by
periods of high energy (mania). If you cycle between depression
and mania, you may have a condition called
bipolar disorder. For more information, see the topic
Bipolar Disorder. If you have depression only during certain seasons of the year,
such as the fall and winter months, you may have
seasonal affective depression. For more information,
see the topic
Seasonal Affective Disorder (SAD).
Several factors increase your risk for
depression. Your risk of developing depression is up
to three times greater than that of the general population if you have a
father, mother, or sibling with depression. If you have had depression before,
you are much more likely to have depression again.3 Other risk factors for depression include: - A history of heart problems, such as coronary
artery disease.
- A serious, ongoing (chronic) illness, such as
diabetes, cancer, or chronic pain.
- Problems in your
marriage.
- Use of drugs or alcohol.
- Use of
certain medications that might trigger depression,
such as steroids or narcotics for pain relief.
- A stressful life
event, such as losing a job or a loved one. This is especially true for older
people who have many social stressors, such as becoming dependent upon others
for care.
- Certain medical conditions, such as
anemia and
thyroid disease.
- Recent serious illness or
surgery.
- A childhood history of physical or sexual
abuse.
- Constantly worrying or being overly anxious.
- An
eating disorder or
anxiety disorder.
Additional risk factors for depression in women include: - Recent childbirth. For more information, see
the topic
Postpartum Depression.
- Use of birth
control pills (oral contraceptives). However, for some women, birth control
pills can improve mood.
- A history of
premenstrual dysphoric disorder (severe premenstrual
syndrome, or PMS).
Call
911 or other emergency
services if: - You think you cannot keep from harming yourself
or someone else.
- You hear voices.
- Someone you know
attempts suicide, or shows
warning signs of suicide, such as talking about
suicide or harming someone else, showing signs of detachment from reality
(psychosis), or is using alcohol or drugs
excessively.
Depression can lead to suicide. The warning signs of suicide change
with age. Watchful WaitingWatchful waiting is a period of time during which you and your
health professional observe your symptoms or condition without using medical
treatment. Watchful waiting may be appropriate if you have feelings of grief,
sadness, or melancholy. However, if symptoms do not improve after 2 weeks, talk
with a health professional. Who To SeeTreatment for
depression usually involves medication, some form of
professional counseling, or a combination of the two. It is important that you
establish a long-term and comfortable relationship with your health
professionals for treatment of depression. Health professionals who can diagnose depression and prescribe
medications include a: Professional counseling can be provided by a: To prepare for your appointment, see the topic
Making the Most of Your Appointment.
If
you
think you have depression, your health professional will ask questions
about your health and give you a thorough physical exam. He or she may also
order other tests such as: Your health professional may ask questions to determine how
severely
depression might be affecting you, including whether
you are having any suicidal thoughts. If you have ever experienced a period of abnormal happiness,
irritability, or intense energy that lasts 4 days or more, be sure to tell your
health professional.
Manic episodes, or milder hypomanic episodes, along
with depression, could mean that you have
bipolar disorder. Some types of antidepressant
medications can worsen symptoms of bipolar disorder, so it is important to
diagnose your symptoms accurately. Anytime you visit your health professional, it is important to
discuss any symptoms that may be caused by depression. About half of all cases
of depression are undiagnosed or undertreated.2 Health
professionals are being encouraged to ask routine questions about depression at
all office visits.
Initial treatmentTreatment of
depression may include antidepressant medication,
professional counseling such as
cognitive-behavioral therapy, or a combination of the
two. - Professional counseling may be all that you
need for mild to moderate depression.9
- If
your early symptoms are severe, your initial treatment most likely will include
both antidepressants and professional counseling.
- Hospitalization
may be necessary if you show
warning signs of suicide, such as thoughts or plans
about harming yourself or another person, detachment from reality (psychosis), or
excessive use of alcohol or drugs.
Depression can lead to suicide. The warning signs of suicide
change with age. Depression usually can be successfully treated with medication,
professional counseling, or a combination of the two. However, it sometimes
takes several attempts to find the medication and type of counseling that work
best for you. It can take 4 to 12 weeks for medications to take effect,
although they often work more quickly. You and your health professional will
work together to find the right treatment. If you think you may have depression, take a short quiz to
evaluate your symptoms: - Interactive Tool: Are You
Depressed?
 Should I take medications to treat
depression?- Should I take antidepressants during pregnancy?
If you have recently given birth, learning how to manage
postpartum depression may help you recover more quickly.  How can I manage postpartum
depression?
In rare cases,
electroconvulsive therapy (ECT) may be an initial
treatment choice for people who cannot take antidepressants, who have not
responded to other treatments, or whose depression is severe and includes
symptoms of
psychosis, suicidal behavior, or an inability to
eat.10 ECT involves an electric stimulation to the
temples which causes a brief seizure. This is thought to relieve depression by
altering brain chemicals known as
neurotransmitters. Ongoing treatmentAt least half of those who have one depressive episode will have
a recurrence of symptoms (relapse). Continuing to take medication
for at least 7 to 15 months after recovery reduces your risk of a
relapse. Ongoing treatment for depression also includes: - Eating a balanced diet.
- Avoiding
alcohol.
- Getting exercise.
- Getting quality
sleep.
It may also be helpful for you to obtain social support from
family and friends. If you have another illness along with
depression, you need to continue treatment for your
other illness. It is possible for other mood disorders such as
anxiety and anxiety disorders,
psychosis, or
mania to accompany depression. For more information,
see the topics
Social Anxiety Disorder and
Bipolar Disorder. Treatment if the condition gets worse If your
depression worsens while you are receiving
professional counseling alone, medication can be added to your treatment.
- Evidence shows that adding medications to
counseling for severe depression works better than counseling alone.11
- If you have recurrent depression, you may need
to take antidepressant medications for the rest of your life.
If your depression worsens while you are already taking
medications and receiving professional counseling, different or additional
medications may be tried. Electroconvulsive therapy (ECT) has been shown to be
an effective treatment for severe depression or depression that has not been
helped by other treatment.11, 10
ECT involves an electric stimulation to the temples that causes a brief
seizure. This is thought to relieve depression by altering brain chemicals
known as
neurotransmitters. ECT will need to be followed with
medications and counseling, because
relapse of symptoms is common.12 If your symptoms of depression get worse, it is essential to
work with your health professional to find effective treatment. Major
depression may be a risk factor for developing heart problems such as
coronary artery disease or
heart attack.6 However, the
greatest danger from depression is
suicide. Up to 15% of people with depression die by
suicide.3 Depression can lead to suicide. The warning signs of suicide
change with age. What To Think AboutFDA Advisories. The US Food and Drug
Administration (FDA) has issued: - An
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines, but
to watch for
warning signs of suicide in those using them. This is
especially important at the beginning of treatment or when doses are
changed.
- A
warning about the antidepressants Paxil and Paxil CR
and birth defects. Taking these medicines in the first 12 weeks of pregnancy
may increase your chance of having a baby with a birth defect.
- Should I take antidepressants during pregnancy?
Anyone can develop depression regardless of age, race, or social
status. As many as 1 out of every 10 people who visit a doctor has depression,
but it goes unrecognized or undertreated in about half of those cases.2 If left untreated, depression can lead to poor quality of
life and increased risk of suicide. Less than one-third of people with depression seek professional
treatment.13 Even when treatment is sought, health
professionals sometimes attribute the vague symptoms of depression to other
illnesses. You may not realize you are depressed, or you may be embarrassed to
seek treatment. However, it is important to seek treatment as soon as you
suspect that you or someone you love is depressed. The sooner you seek
treatment, the better your chance for a quick and full recovery. Preventing
recurrence of depression is also important. Depression is not normal at any age, and treatment is important.
- Depression is often underdiagnosed in
children and older adults. In children and adolescents, depression might be
mistaken for hormonal “moodiness.” For more information, see
Depression in Childhood and
Adolescence.
- Older adults may think it is normal to
experience feelings of depression along with aging. Early treatment of
depression in older adults can delay nursing home placement. The risk of death
associated with depression increases significantly during the first year an
older adult enters a nursing home.3
Family involvement and support in the treatment of depression can
be very important, especially for children, teens, and older adults. Sometimes
parents of depressed children and teens may also become depressed and need
treatment. If you have recently given birth, learning how to manage
postpartum depression early on may help you recover more quickly and prevent a
prolonged or serious problem with postpartum depression. - How can I manage postpartum
depression?
Although you may not be able to prevent an initial bout of
depression, you may be able to prevent a recurrence
(relapse) or worsening of symptoms by: - Taking your medications regularly as
prescribed. Depression often returns if medications are stopped too early or
are not taken as directed.
- Continuing to take medications for at
least 7 to 15 months after your symptoms improve. Taking your medications even
after you feel better can help keep you from getting depressed again.11
- Continuing with
cognitive-behavioral therapy even after medications
have been stopped. Research shows those who continued this type of counseling
for 2 years after medications were stopped had lower rates of relapse.10
- Eating a balanced
diet.
- Getting regular
exercise.
- Seeking treatment immediately when you first
notice new or worsening
symptoms of depression, such as feelings of
hopelessness or sadness or loss of interest or pleasure in most
activities.
- Maintaining a regular sleep
pattern.
- Avoiding drugs and alcohol.
It is difficult to prevent all recurrences of depression. However,
you may be able to prevent or reduce the severity of future episodes. If you
are on a maintenance dose of medication to treat ongoing depression, be sure to
take all of your medications as directed by your health professional. Keep your
counseling appointments. Seek help when you notice the first symptoms of
depression, especially if your depressive episodes are moderate to
severe.
While therapy and antidepressant medication are the most effective
treatments for
depression, home treatment is also important. There
are many steps you can take to help yourself during a depressive episode and to
prevent future episodes: - Set realistic goals for yourself, and take on
a reasonable amount of responsibility.
- Break large tasks into
small ones, and set priorities. Do what you can when you are
able.
- Postpone major life decisions (such as changing jobs, moving,
or getting married or divorced) when you are depressed.
- Try to
share your feelings with someone. It is usually better than being alone and
secretive.
- Let your family and friends help you.
- Even
if you don't feel motivated, try to participate in religious, social, or other
activities.
- Get regular exercise.
- Eat a
balanced diet. If you lack an appetite, eat small snacks rather than
large meals.
- Avoid drinking alcohol or using illegal drugs or
medications that have not been prescribed to you. They may interfere with your
medications or worsen your depression.
- Get adequate sleep. If you
have problems sleeping:
- Go to bed at the same time every night and,
more importantly, get up at the same time every morning.
- Keep your
bedroom dark and free of noise.
- Don't exercise after 5:00
p.m.
- Avoid caffeinated beverages after 5:00 p.m.
- Avoid the use of nonprescription sleeping pills or alcohol,
because they can make your sleep restless and may interact with your depression
medications.
- Be patient and kind to yourself. Remember that depression is not
your fault and is not something you can overcome with willpower alone.
Treatment is necessary for depression, just like for any other
illness.
- Try to maintain a positive attitude—remember that feeling
better takes time, and your mood will improve little by little.
Helping someone who is depressedIf you know someone who is depressed, it is important to be
supportive and encouraging. If you have never experienced it, it is difficult
to understand just how hopeless and discouraged depression can make you feel.
Remember that depression can be as disabling as other major illnesses and can
make it difficult to fulfill social, family, and work obligations. Like other
illnesses, depression requires treatment, time, and patience. Avoid offering advice, but encourage the person to seek and
continue treatment. You do not need to take responsibility for the person's
depression. However, if you notice any
warning signs of suicide, such as talking about
suicide or harming someone else, signs of detachment from reality (psychosis), or
excessive use of alcohol or drugs, you should seek professional help
immediately by calling the person's health professional. If you feel the person
is in immediate danger, call 911
or other emergency services immediately. Depression can lead to suicide. The warning signs of suicide
change with age.
Depression is often underdiagnosed and undertreated.
Most depressed people need antidepressant medications. Antidepressants can
improve or completely relieve the symptoms of depression. Several medication options are available. There is no evidence that
one medication works better than another; however, the side effects of the
medications differ.11 You and your health professional
can determine which medication is right for you. Keep in mind that medications
take 4 to 12 weeks to become fully effective, although they may work more
quickly. If one medication does not work, there are many others to try before
giving up. Medications affect your brain chemistry in different ways, so you
may try several different medications or combinations of medications to find
treatment that works for your depression. Most people find a drug that works
within a few tries, but for some people, depression can be more difficult to
treat. In some cases, a combination of antidepressants may be necessary.
Sometimes an antidepressant combined with a different type of medication, such
as a mood stabilizer or antianxiety drug, is effective. When taking antidepressant medication, it is important that you
take the medication as prescribed. It may take several weeks before you notice
the medication working. Side effects may improve once your body adjusts to the
medication. If you decide to quit taking antidepressants, it is important that
you gradually reduce the dose over a period of several weeks. Quitting
antidepressants abruptly can cause withdrawal symptoms. It is important to
discuss quitting (or changing) medications with your health professional.
Medication ChoicesAntidepressant medications include: - Selective serotonin reuptake inhibitors
(SSRIs), such as Prozac, Zoloft, or Paxil.
- Tricyclic
and tetracyclic antidepressants, such as Elavil, Pamelor, or
Ludiomil.
- Atypical antidepressants, such as Wellbutrin, Effexor,
or Remeron.
- Monoamine oxidase inhibitors (MAOIs),
such as Nardil, Marplan, or Parnate.
What To Think AboutIf you and your health professional decide that you need
medication, there are several considerations when choosing the right
medication: - Understand the side effects of the
medication.
- Tell your health professional about all of your current
medical conditions and all medications you are taking, including
nonprescription drugs, herbs, and supplements, so he or she can determine
whether there are potential drug interactions.
- If you are an older
person, you may need lower doses of medication, and it may take longer to be
effective.
- Your health professional will need to monitor your
progress to determine whether a particular medication is working for
you.
- Often the first medication you take will effectively treat
your depression. If not, there are other choices that will usually work well.
You may need to try several different medications before you find the one that
works best for you.
- Once you have begun to feel better, you will
need to continue taking your medication for 7 to 15 months or longer to help
reduce the likelihood of another episode of depression.
- Some people
need to remain on medication for several months to years (maintenance therapy),
while others need medication for the remainder of their lives, especially those
who have had several episodes of major depression.
When deciding which medication to prescribe, your health
professional will consider: - Your response to medications in previous
depressive episodes.
- Whether you have other illnesses, so you are
not given a depression medication that will interact poorly with other
medications you may be taking.
- Whether the medication used to treat
your depression will make any other illness you have worse or more difficult to
treat.
- Your age and overall physical health. Older adults may need
to take lower doses of medication for depression.
- How much the side
effects of the medication are likely to bother you.
- Should I take medications to treat
depression?
Some people with depression do not continue taking their
medications for depression or take them sporadically. It is important to
continue taking medications for depression as prescribed, even after symptoms
go away, to prevent recurrence of depression or worsening of symptoms. Side effects Antidepressant medications often need to be taken for as long as
4 to 12 weeks before they start to fully relieve the symptoms of depression,
although you may notice some benefit in 2 to 3 weeks. During this time, you may
experience side effects of the medication. Many of the side effects are
temporary and go away with continued use of the medication, although some (such
as dry mouth, constipation, and sexual effects) may continue. - Do not stop taking the medication on your own
unless you are having chest pain, hives, shortness of breath, trouble
swallowing, or swelling of your lips. Contact your health professional
immediately if you do experience any of these serious side effects.
- If your side effects are less serious but bothersome, talk with
your health professional to see whether you should continue the medication or
try another. There are many things you can do to
reduce bothersome side effects of medications.
Antidepressant medications may need to be started at low doses
and increased gradually, especially in most older adults. Medications should
also be stopped gradually by decreasing the dose over a period of time.
If certain antidepressant medications are stopped abruptly, you
may suffer negative effects or the symptoms of depression may
return. Older adults or others who are depressed and taking several
medications for other health conditions (not related to depression) need
careful monitoring of their medications. People are more likely to develop
harmful side effects from taking many different medications. FDA Advisories. The U.S. Food and Drug
Administration (FDA) has issued: - An
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines, but
to watch for
warning signs of suicide in those using them. This is
especially important at the beginning of treatment or when doses are
changed.
- A
warning about the antidepressants Paxil and Paxil CR
and birth defects. Taking these medicines in the first 12 weeks of pregnancy
may increase your chance of having a baby with a birth defect.
- Should I take antidepressants during pregnancy?
There is no surgical treatment for
depression.
Professional counseling is an important part of treatment for
depression. Complementary therapies such as
massage therapy and
yoga may also help you recover more quickly and
improve your quality of life. For information about relaxation techniques you
can do at home, see
relaxation exercises. Family therapy may help you and those who care about you deal with
depression. Electroconvulsive therapy (ECT) may be used for those who cannot
take antidepressant medications, who have not responded to other treatments, or
whose depression is severe and includes symptoms of
psychosis, suicidal behavior, or an inability to
eat.10 Other Treatment ChoicesCounseling is an important part of the treatment for depression.
The types of counseling most often used for effective treatment of depression
include: - Cognitive-behavioral
therapy, a type of counseling that teaches a person how to become
healthier by modifying certain thought and behavior patterns. This type of
therapy can be provided individually or in a group setting.
- Interpersonal therapy, which focuses on social and
personal relationships and related problems.
- Problem-solving
therapy, which focuses on the problems you are currently facing and on
helping you find solutions to those problems.
- Family therapy,
a type of counseling involving the entire family.
Electroconvulsive therapy (ECT) may be used to treat
severe depression or depression that has not responded well to medications and
counseling. ECT also may be a treatment choice for someone who cannot tolerate
the side effects of antidepressant medications. Modern ECT treatments consist
of mild electric brain stimulation while you are unconscious (under general
anesthetic) and are an effective treatment for depression. Side effects of ECT
include memory loss and confusion. Complementary therapies - The herb
St.
John's wort has been shown to work for mild to moderate depression, but
it can interact with other medications.
- Fish oil containing
omega-3 fatty acids is currently being studied for possible antidepressant
effects.
- SAM-e ( S-adenosylmethionine), a substance that occurs
naturally in plant and animal cells, is sometimes used to treat depression.
Some studies show SAM-e may help with symptoms of depression, but more studies
are needed to determine its safety and effectiveness.
What To Think AboutECTDeciding whether to try electroconvulsive therapy (ECT) can be
difficult. Although ECT can be a very effective treatment for depression, you
may experience short-term memory loss, confusion, nausea, headaches, and jaw
pain for several hours—and sometimes even several days—after the procedure. For
some people, ECT may cause long-term memory loss. For more information, see
electroconvulsive therapy (ECT). St. John's wort St. John's wort is being tested in the United States to determine
its safety and effectiveness. So far, the results have been mixed. High-quality
St. John's wort has been shown to work for mild to moderate depression as
effectively as other antidepressants and with fewer side effects. However, some
negative and dangerous interactions between St. John's wort and certain
medications have been discovered, especially between St. John's wort and
medications used to treat
AIDS.11 - Let your health professional know if you are
using St. John's wort, especially if you are taking other medications.
- Avoid taking St. John's wort along with other antidepressants,
because you could overmedicate yourself and have serious side effects.
Because St. John's wort is not currently regulated by the U.S.
Food and Drug Administration (FDA), its quality—and effectiveness—may
vary. Omega-3 fatty acids There is limited evidence that a small daily dose of omega-3
fatty acids may be beneficial either alone or when combined with an
antidepressant.14, 15 While
benefits for depression are still inconclusive, research does show that taking
omega-3 fatty acids can help fight other health problems, including arthritis
and cardiovascular disease. The American Heart Association (AHA) recommends eating fish at
least twice per week, plus other omega-3 rich foods. For people with heart
disease, the AHA suggests additional fish oil supplements if your health
professional thinks it is a good idea.16
Book| The Feeling Good Handbook | | Author/Editor: | D.D. Burns | | Publisher: | Plume | | Publication Date: | 1999 | | | This is a consumer's
guide to reshaping negative thoughts and responses to help avoid stress and
depression. |
|
Organizations| National Institute of Mental Health (NIMH) | | 6001 Executive Boulevard | | Suite 8184, MSC 9663 | | Bethesda, MD 20892-9663 | | Phone: | 1-866-615-6464 toll-free
(301) 443-4513 | | Fax: | (301) 443-4279 | | TDD: | 1-866-415-8051 toll-free | | E-mail: | nimhinfo@nih.gov | | Web Address: | http://www.nimh.nih.gov | | | The National Institute of Mental Health (NIMH) provides information
to help people better understand mental health and mental disorders. NIMH does
not provide referrals to mental health professionals or treatment for mental
health problems. |
| | National Mental Health Association
(NMHA) | | 2000 North Beauregard Street | | 6th Floor | | Alexandria, VA 22311 | | Phone: | (703) 684-7722
1-800-969-NMHA (1-800-969-6642). This is a hotline for help with depression. | | Fax: | (703) 684-5968 | | TDD: | 1-800-433-5959 | | Web Address: | http://depression-screening.org | | | The National Mental Health Association (NMHA) has launched a Web
site that has a confidential depression screening exam available to anyone who
would like to take the test. The short test may help you decide whether your
symptoms are related to depression. |
|
CitationsSchulberg HC, et al.
(1999). Best clinical practice: Guidelines for managing major depression in
primary medical care. Journal
of Clinical Psychiatry, 60(7): 19–28. Whooley MA, Simon GE (2000). Managing depression in medical outpatients. New England Journal of Medicine, 343(26): 1942–1950. American Psychiatric Association (2000). Depressive disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 349–381. Washington, DC: American Psychiatric Association. Kornstein SG (2001). The evaluation and management of
depression in women across the life span. Journal of Clinical
Psychiatry, 62(Suppl 24): S11–S17. Schulz R, et al. (2000). Association between
depression and mortality in older adults: The cardiovascular health study.
Archives of Internal Medicine, 160(12):
1761–1768. Penninx BWJH, et al. (2001). Depression and cardiac
mortality. Archives of General Psychiatry, 58(3):
221–227. Januzzi JL, et al. (2000). The influence of anxiety
and depression on outcomes of patients with coronary artery disease.
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1913–1921. Katon WJ (2003). Clinical and health services
relationships between major depression, depressive symptoms, and general
medical illness. Biological Psychiatry, 54(3):
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generic counselling for treatment of major depression in primary care:
Randomised trial with patient preference arms. BMJ,
322(7289): 772–775. American Psychiatric Association (2000). Practice
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Suppl): S1–S45. Butler R, et al. (2005). Depressive disorders.
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Journal of Clinical Psychiatry, 60(Suppl 7):
S4–S11. Peet M, Horrobin DF (2002). A dose-ranging study of
the effects of ethyl-eicosapentaenoate in patients with ongoing depression
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Other Works Consulted Canadian Psychiatric Association and the CANMAT
Depression Work Group (2001). Clinical practice guidelines for the treatment of
depressive disorders. Canadian Journal of Psychiatry,
46(Suppl 1): S13–S89. Hypericum Depression Trial Study Group, American Medical Association (2002). Effect of hypericum perforatum (St. John's wort) in major depressive disorder. JAMA, 287(14): 1807–1814. Pignone, MP, et al. (2002). Screening for depression
in adults: A summary of the evidence for the U.S. Preventive Services Task
Force. Annals of Internal Medicine, 136(10):
765–776. Roose SP, et al. (2001). Relationship between depression and other medical illnesses. JAMA, 286(14): 1687–1690. Sadock BJ, Sadock VA (2003). Major depression and
bipolar disorder. In Kaplan and Sadock's Synopsis of Psychiatry, 9th ed., ch.
15, pp. 534–590. Philadelphia: Lippincott Williams and Wilkins. Schatzberg AF, et al. (2002). Clinical use of
nefazodone in major depression: A 6-year perspective. Journal
of Clinical Psychiatry, 63(Suppl 1): S18–S31. Williams JW (2002). Is this patient clinically
depressed? JAMA, 287(9): 1160–1170. Yager J, Gitlin, MJ (2000). Depression section of
Clinical manifestations of psychiatric disorders. In BJ Sadock, VA Sadock,
eds., Kaplan and Sadock's Comprehensive Textbook of
Psychiatry, 7th ed., vol. 1, pp. 813–814. Philadelphia: Lippincott
Williams and Wilkins.
| Author | Stuart J. Bryson | | Editor | Geri Metzger | | Associate Editor | Michele Cronen | | Associate Editor | Lila Havens | | Associate Editor | Terrina Vail | | Primary Medical Reviewer | Patrice Burgess, MD
- Family Medicine | | Specialist Medical Reviewer | Malin K. Clark, MD, FRCPC
- Psychiatry | | Last Updated | April 28, 2005 |
|
