Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depression, major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and depression may make you feel as if life isn't worth living.
More than just a bout of the blues, depression isn't a weakness, nor is it something that you can simply "snap out" of. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychological counseling or both. Other treatments also may help.
Although depression may occur only one time during your life, usually people have multiple episodes of depression. During these episodes, symptoms occur most of the day, nearly every day and may include:
- Feelings of sadness, emptiness or unhappiness
- Angry outbursts, irritability or frustration, even over small matters
- Loss of interest or pleasure in normal activities, such as sex
- Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy, so that even small tasks take extra effort
- Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
- Anxiety, agitation or restlessness — for example, excessive worrying, pacing, hand-wringing or an inability to sit still
- Slowed thinking, speaking or body movements
- Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that are not your responsibility
- Trouble thinking, concentrating, making decisions and remembering things
- Frequent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
For some people, depression symptoms are so severe that it's obvious something isn't right. Other people feel generally miserable or unhappy without really knowing why.
When to see a doctor
If you feel depressed, make an appointment to see your primary care doctor as soon as you can. Depression often gets worse if it isn't treated. Untreated depression can lead to other mental and physical health problems or troubles in other areas of your life. Feelings of depression can also lead to suicide.
If you're reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.
If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
- Reach out to a close friend or loved one.
- Contact a minister, a spiritual leader or someone in your faith community.
- Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
- Make an appointment with your doctor, mental health provider or other health care provider.
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.
If you have a loved one who is in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
Researchers have identified certain factors that seem to increase the risk of developing or triggering depression, including:
- Abuse of alcohol or illegal drugs
- Certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic
- Serious or chronic illness, such as cancer, diabetes or heart disease
- Traumatic or stressful events, such as physical or sexual abuse, the loss of a loved one, a difficult relationship or financial problems
- Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
You may see your primary care doctor, or your doctor may refer you to a health provider who specializes in diagnosing and treating mental health conditions (psychologist or psychiatrist).
These exams and tests can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and check for any related complications:
- Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
- Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly.
- Psychological evaluation. To check for signs of depression, your doctor or mental health provider asks about your symptoms, thoughts, feelings and behavior patterns.
Your primary care doctor or psychiatrist can prescribe medications to relieve depression symptoms. However, many people with depression also benefit from seeing a psychologist or other mental health counselor.
If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.
Many types of antidepressant medications are available to treat depression, including those below.
- Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples of SNRI medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq).
- Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It's one of the few antidepressants not frequently associated with sexual side effects.
- Atypical antidepressants. These medications don't fit neatly into any of the other antidepressant categories. They include trazodone and mirtazapine (Remeron). Both are sedating and usually taken in the evening. A newer medication called vilazodone (Viibryd) is thought to have a low risk of sexual side effects.
- Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine (Tofranil) and nortriptyline (Pamelor)
- Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — may be prescribed, typically when other medications haven't worked, because they can have serious side effects. Using MAOIs requires a strict diet because of dangerous (or even deadly) interactions with foods ― such as certain cheeses, pickles and wines ― and some medications including decongestants and certain herbal supplements.
If a family member has responded well to an antidepressant, it may be one that could help you. Or you may need to try several medications before you find one that works. This requires patience, as some medications need several weeks or longer to take full effect and for side effects to ease as your body adjusts.
Don't stop taking an antidepressant without talking to your doctor first. Antidepressants aren't considered addictive, but sometimes physical dependence, which is different from addiction, can occur. Stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression. Work with your doctor to gradually and safely decrease your dose.
Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of genetic tests (done by blood test or cheek swab) may offer clues about how your body may respond to a particular antidepressant.
Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as talk therapy, counseling or psychosocial therapy.
Depression generally isn't a disorder that you can treat on your own. But in addition to professional treatment, these self-care steps can help:
- Stick to your treatment plan. Don't skip psychotherapy sessions or appointments. Even if you're feeling well, don't skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms.
- Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about depression to help them understand and be more supportive of you.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask family members or friends to help watch for warning signs.
- Get exercise. Physical activity reduces depression symptoms. Consider walking, jogging, swimming, gardening or taking up another activity that you enjoy.
- Avoid alcohol and illegal drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or substance abuse.
- Get plenty of sleep. Sleeping well is important for both your physical and mental well-being. If you're having trouble sleeping, talk to your doctor about what you can do.
Make certain you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Don't replace conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for medical care. Examples of herbal remedies and supplements that are sometimes used for depression include:
- St. John's wort. This herb is not approved by the FDA to treat depression in the United States, but it's a popular depression treatment in Europe. It may be helpful if you have mild or moderate depression, but St. John's wort should be used with caution. It can interfere with a number of medications, including antidepressants, HIV/AIDS medications, drugs to prevent organ rejection after an organ transplant, birth control pills, blood-thinning medications and chemotherapy drugs.
- SAMe. Pronounced "sam-E," this dietary supplement is a synthetic form of a chemical that occurs naturally in the body. Like St. John's wort, SAMe isn't approved by the FDA to treat depression in the United States, but it's used in Europe as a prescription drug to treat depression. SAMe may be helpful, but more research is needed. SAMe may trigger mania in people with bipolar disorder.
- Omega-3 fatty acids. Omega-3 supplements are being studied as a possible treatment for depression. More research is needed to determine if eating foods with omega-3 fatty acids can help relieve depression.
Keep in mind that nutritional and dietary products aren't monitored by the FDA the same way medications are. You can't always be certain of what you're getting and if it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider before taking any supplements.
Talk to your doctor or therapist about improving your coping skills, and try these tips:
- Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.
- Write in a journal. Journaling, as part of your treatment, may improve mood by allowing you to express pain, anger, fear or other emotions.
- Locate helpful organizations. Many organizations, such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA), offer education, support groups, counseling and other resources to help with depression. Employee assistance programs and religious organizations also may offer help for mental health concerns.
- Don't become isolated. Try to participate in social activities, and get together with family or friends regularly.
- Take care of yourself. Eat a healthy diet, be physically active and get plenty of sleep.
- Learn ways to relax and manage your stress. Examples include meditation, progressive muscle relaxation, yoga and tai chi.
- Structure your time. Plan your day. You may find it helps to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.
- Don't make important decisions when you're down. Avoid decision-making when you're feeling depressed, since you may not be thinking clearly.