Major depression
Depression - major; Depression - clinical; Clinical depression; Unipolar depression; Major depressive disorderDepression is feeling sad, blue, unhappy, or down in the dumps. Most people feel this way once in a while.
Major depression is a mood disorder. It occurs when feelings of sadness, loss, anger, or frustration get in the way of your life over a long period of time. It also changes how your body works.
Causes
Health care providers do not know the exact causes of depression. It is believed that chemical changes in the brain are responsible. This may be due to how your genes work. Or it may be triggered by certain stressful events. More likely, it is a combination of both.
Some types of depression run in families. Other types occur even if you have no family history of the illness. Anyone can develop depression, including children and teens.
Teens
Depression is a serious medical condition that you need help with until you feel better. Know that you are not alone. One in five teenagers will be...
Depression may be brought on by:
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Alcohol or drug use
Alcohol
Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to f...
ImageRead Article Now Book Mark ArticleDrug use
Substance use is the continued use of alcohol, illegal drugs, or the misuse of prescription or over-the-counter medicines with negative consequences....
Read Article Now Book Mark Article - Certain medical problems, such as underactive thyroid, cancer, or long-term pain
Underactive thyroid
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
ImageRead Article Now Book Mark Article - Some kinds of medicines, such as steroids or beta-blockers
- Sleeping problems
- Stressful life events, such as death or illness of someone close to you, divorce, medical problems, childhood abuse or neglect, loneliness (common in older people), and relationship breakup
Older people
Depression is a mental health condition. It is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with daily life f...
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Symptoms
Depression can change or distort the way you see yourself, your life, and those around you.
With depression, you often see everything in a negative way. It is hard for you to imagine that a problem or situation can be solved in a positive way.
Symptoms of depression can include:
- Agitation, restlessness, irritability, and anger
- Becoming withdrawn or isolated
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Fatigue and lack of energy
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Feeling hopeless, helpless, worthless, guilty, and self-hate
- Loss of interest or pleasure in activities that were once enjoyed including sex
- Sudden change in appetite, often with weight gain or loss
- Thoughts of death or suicide
Suicide
Suicide is the act of taking one's own life on purpose. Suicidal behavior is any action that could cause a person to die, such as taking a drug over...
ImageRead Article Now Book Mark Article - Trouble concentrating
- Trouble sleeping or sleeping too much
Depression in teens may be harder to recognize. Problems with school, behavior, or alcohol or drug use can all be signs.
Depression in teens
One in five teenagers have depression at some point. Your teen may be depressed if they are feeling sad, blue, unhappy, or down in the dumps. Depre...
If depression is very severe, you may have hallucinations or delusions (false beliefs). This condition is called depression with psychotic features.
Hallucinations
Hallucinations involve sensing things such as visions, sounds, or smells that seem real but are not. These things are created by the mind.
Exams and Tests
Your provider will ask about your medical history and symptoms. Your answers can help your provider diagnose depression and determine how severe it may be.
Blood and urine tests may be done to check for other medical conditions that have symptoms similar to depression.
Treatment
Depression can be treated. The choice of treatment depends on the severity of the depression and what you or your provider prefer. Treatment often includes medicines, with or without talk therapy but sometimes, talk therapy is used alone.
If you are thinking about suicide or are very depressed and cannot function, you may need to be treated in a hospital.
After you have been on treatment, if you feel your symptoms are getting worse, talk with your provider. Your treatment plan may need to be changed.
MEDICINES
Antidepressants are medicines used to treat depression. They work by bringing back the chemicals in your brain to the right levels. This helps relieve your symptoms.
The antidepressant medicines typically used are:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
If you have delusions or hallucinations, your provider may prescribe additional medicines.
Tell your provider about any other medicines you take. Some medicines can change the way antidepressants work in your body.
Allow your medicine time to work. It may take a few weeks before you feel better. Keep taking your medicine as instructed. Do not stop taking it or change the amount (dosage) you are taking without talking to your provider. Ask your provider about possible side effects, and what to do if you have any.
Do not stop taking it
Antidepressants are prescription medicines you may take to help with depression, anxiety, or pain. Like any medicine, there are reasons you may take...
If you feel your medicine is not working or causing side effects, tell your provider. The medicine or its dosage may need to be changed. Do not stop taking medicines on your own.
WARNING
Children, teens, and young adults should be watched closely for suicidal behavior. This is especially true during the first few months after starting medicines for depression.
Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their provider.
Beware of natural remedies such as St. John's wort. This is an herb sold without a prescription. It may help some people with mild depression. But it can change the way other medicines work in your body, including antidepressants. Talk to your provider before trying this herb.
If you feel your medicine is making you worse or causing new symptoms (such as confusion), tell your provider right away. Go to an emergency room if you are concerned about your safety.
TALK THERAPY
Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.
Types of talk therapy include:
- Cognitive behavioral therapy teaches you how to fight off negative thoughts. You learn how to become more aware of your symptoms and how to spot things that make your depression worse. You are also taught problem-solving skills.
- Psychotherapy can help you understand the issues that may be behind your thoughts and feelings.
- At group therapy, you share with others who have problems like yours. Your therapist or provider can tell you more about group therapy.
OTHER TREATMENTS FOR DEPRESSION
Your provider may also use the following treatments:
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Electroconvulsive therapy (ECT) may improve mood in people with severe depression or suicidal thoughts who do not get better with other treatments. ECT is generally safe.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) uses an electric current to treat depression and some other mental illnesses.
Read Article Now Book Mark Article - Transcranial magnetic stimulation (TMS) can also be a useful treatment if medicines are not helpful.
- Light therapy may relieve depression symptoms in the winter time. This type of depression is called seasonal affective disorder.
Seasonal affective disorder
Seasonal affective disorder (SAD) is a type of depression that occurs at a certain time of the year, usually in winter.
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Outlook (Prognosis)
You may start feeling better a few weeks after starting treatment. If you take medicine, you will need to stay on the medicine for several months to feel good and prevent depression from returning. If your depression keeps coming back, you may need to stay on your medicine for a long period.
Long-term (chronic) depression may make it harder for you to manage other illnesses such as diabetes or heart disease. Ask your provider for help in managing these health problems.
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
Heart disease
Coronary heart disease is a narrowing of the blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called co...
Alcohol or drug use can make depression worse. Talk to your provider about getting help.
When to Contact a Medical Professional
If you are thinking about hurting yourself or others, text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night..
You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.
If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.
Contact your provider right away if:
- You hear voices not coming from people around you.
- You have frequent crying spells with little or no reason.
- Your depression is disrupting work, school, or family life.
- You think that your current medicine is not working or is causing side effects. DO NOT stop or change your medicine without talking to your provider.
Prevention
Do not drink alcohol or use illegal drugs. These substances make depression worse and may lead to thoughts of suicide.
Take your medicine exactly as your provider instructed. Learn to recognize the early signs that your depression is getting worse.
Keep going to your talk therapy sessions.
The following tips may help you feel better:
- Get more exercise.
- Maintain good sleep habits.
- Do activities that bring you pleasure.
- Volunteer or get involved in group activities.
- Talk to someone you trust about how you are feeling.
- Try to be around people who are caring and positive.
Learn more about depression by contacting a local mental health clinic. Your workplace employee assistance program (EAP) is also a good resource. Online resources can also provide good information.
Online resources
Depression is a medical condition. If you think you may be depressed, see a health care provider. The following organizations are good sources of in...
References
American Psychiatric Association. Depressive disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR). Arlington, VA: American Psychiatric Publishing; 2022:chap 4.
Fava M, Østergaard SD, Cassano P. Mood disorders: depressive disorders (major depressive disorder). In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 29.
Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 369.
National Institute of Mental Health website. Major depression. www.nimh.nih.gov/health/statistics/major-depression. Updated January 2022. Accessed June 9, 2023.
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Depression
Animation
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Forms of depression - illustration
Depression is defined as a mood disorder, and there are several subtypes. Bipolar disorder, also known as manic-depressive illness, is considered in a separate category.
Forms of depression
illustration
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Depression and men - illustration
Depression is less reported in the male population, but this may be caused by male tendency to mask emotional disorders with behavior such as alcohol abuse.
Depression and men
illustration
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St. John's Wort - illustration
The herb St. John's Wort is believed to be helpful in relieving mild to moderate depression, but should only be taken under a physician's supervision. St. John's Wort may clash with other medications or foods a patient is taking, and the efficacy of the supplement is not regulated or assured.
St. John's Wort
illustration
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Walking for health - illustration
Exercise, including walking at least 30 minutes a day, decreases the risk of heart attacks, stroke, hypertension, some cancers, osteoporosis, depression and obesity.
Walking for health
illustration
-
Forms of depression - illustration
Depression is defined as a mood disorder, and there are several subtypes. Bipolar disorder, also known as manic-depressive illness, is considered in a separate category.
Forms of depression
illustration
-
Depression and men - illustration
Depression is less reported in the male population, but this may be caused by male tendency to mask emotional disorders with behavior such as alcohol abuse.
Depression and men
illustration
-
St. John's Wort - illustration
The herb St. John's Wort is believed to be helpful in relieving mild to moderate depression, but should only be taken under a physician's supervision. St. John's Wort may clash with other medications or foods a patient is taking, and the efficacy of the supplement is not regulated or assured.
St. John's Wort
illustration
-
Walking for health - illustration
Exercise, including walking at least 30 minutes a day, decreases the risk of heart attacks, stroke, hypertension, some cancers, osteoporosis, depression and obesity.
Walking for health
illustration
Review Date: 5/10/2023
Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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