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Depression

Definition

Depression is a mental illness characterized by feelings of profound sadness and disinterest in enjoyable activities. It may cause a wide range of symptoms, both physical and emotional. Depression is not the same as a blue mood. It can last for weeks, months, or years. People with depression rarely recover without treatment.

Causes

The precise cause of depression is not known. Causes may be mental, physical, or environmental, including:

Stressful life events
Chronic stress
Low self-esteem
Imbalances in brain chemicals and hormones
Lack of control over circumstances (helplessness and hopelessness)
Negative thought patterns and beliefs

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Chronic physical or mental illness
Major life changes or stressful life events
Post-partum depression
Little or no social support
Low self-esteem
Lack of personal control over circumstances
Family history of depression (parent or sibling)
Feelings of helplessness

Symptoms

Symptoms of depression are highly variable from person to person. Some people have only a few symptoms, while others have many. Symptoms also vary over time.

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, 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 had depression
Sleep patterns

The doctor may also perform a mental status examination or neuropsychiatric evaluation to obtain detailed information about your speech, thoughts, memory and mood. A physical examination and other diagnostic tests can help rule out other causes your symptoms.

Treatment

Treatment usually includes medication, psychotherapy, or a combination of the two. Medicine helps relieve symptoms. Psychotherapy helps you learn more effective ways to deal with problems or to identify and resolve the conflicts contributing to your depression.

Antidepressant Medications

Up to 70% of depressed patients find relief from their symptoms with antidepressants. These medications, which can take 2 to 6 weeks to reach their maximum effectiveness include:

Selective serotonin reuptake inhibitors (SSRIs)

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Fluvoxamine (Luvox)

Tricyclic antidepressants

Imipramine (Tofranil, Janimine)
Doxepin (Adapin, Sinequan)
Clomipramine (Anafranil)

Monoamine oxidase inhibitors (MAOIs)

Phenelzine (Nardil)
Tranylcypromine (Parnate)

Other antidepressants

Venlafaxine (Effexor)
Nefazodone (Serzone)
Mirtazapine (Remeron)
Buproprion (Wellbutrin)

Psychotherapy

Short-term (10-20 week) therapy can help some depressed people. Psychotherapy is designed to help you:

Cope with difficulties in relationships
Change negative thinking and behavior patterns
Resolve difficult feelings

Herbal Therapy St. John's wort is an herb that is available without prescription. It is widely used in Europe for the treatment of mild to moderate depression. There is conflicting evidence as to its effectiveness, however.

Electroconvulsive Therapy (ECT) ECT may be used in people with severe or life-threatening depression. It is also used for people who cannot take or do not respond to antidepressants. It is considered a safe and effective procedure.

Exercise

Regular exercise has been shown to relieve some of the symptoms of depression. In the absence of physical restrictions, exercise should play an integral role in the overall management of depression.