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Depression

Definition

Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too.

Also called major depression, major depressive disorder and clinical depression, it affects how you feel, think and behave. Depression 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 is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure. But don't get discouraged. Most people with depression feel better with medication, psychological counseling or other treatment.

Symptoms

Depression symptoms include:

Feelings of sadness or unhappiness
Irritability or frustration, even over small matters
Loss of interest or pleasure in normal activities
Reduced sex drive
Insomnia or excessive sleeping
Changes in appetite — depression often causes decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain
Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
Irritability or angry outbursts
Slowed thinking, speaking or body movements
Indecisiveness, distractibility and decreased concentration
Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren't going right
Trouble thinking, concentrating, making decisions and remembering things
Frequent thoughts of death, dying or suicide
Crying spells for no apparent reason
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.

Depression affects each person in different ways, so symptoms caused by depression vary from person to person. Inherited traits, age, gender and cultural background all play a role in how depression may affect you.

Depression symptoms in children and teens
Common symptoms of depression can be a little different in children and teens than they are in adults.

In younger children, symptoms of depression may include sadness, irritability, hopelessness and worry.
Symptoms in adolescents and teens may include anxiety, anger and avoidance of social interaction.
Changes in thinking and sleep are common signs of depression in adolescents and adults but are not as common in younger children.
In children and teens, depression often occurs along with behavior problems and other mental health conditions, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).
Schoolwork may suffer in children who are depressed.
Depression symptoms in older adults
Depression is not a normal part of growing older, and most seniors feel satisfied with their lives. However, depression can and does occur in older adults. Unfortunately, it often goes undiagnosed and untreated. Many adults with depression feel reluctant to seek help when they're feeling down.

In older adults, depression may go undiagnosed because symptoms — for example, fatigue, loss of appetite, sleep problems or loss of interest in sex — may seem to be caused by other illnesses.
Older adults with depression may have less obvious symptoms. They may feel dissatisfied with life in general, bored, helpless or worthless. They may always want to stay at home, rather than going out to socialize or doing new things.
Suicidal thinking or feelings in older adults is a sign of serious depression that should never be taken lightly, especially in men. Of all people with depression, older adult men are at the highest risk of suicide.
When to see a doctor
If you feel depressed, make an appointment to see your doctor as soon as you can. Depression symptoms may not get better on their own — and depression may get worse if it isn't treated. Untreated depression can lead to other mental and physical health problems or problems 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 have suicidal thoughts
If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

Contact a family member or friend.
Seek help from your doctor, a mental health provider or other health care professional.
Contact a spiritual leader or someone in your faith community.
When to get emergency help
If you think you may hurt yourself or attempt suicide, call your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.

Causes

It's not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:

Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.
Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result from thyroid problems, menopause or a number of other conditions.
Inherited traits. Depression is more common in people whose biological family members also have this condition. Researchers are trying to find genes that may be involved in causing depression.
Life events. Certain events, such as the death or loss of a loved one, financial problems, and high stress, can trigger depression in some people.
Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause permanent changes in the brain that make you more susceptible to depression.
Treatment & Drugs

Numerous depression treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most people.

In some cases, a primary care doctor can prescribe medications to relieve depression symptoms. However, many people need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist). Many people with depression also benefit from seeing a psychologist or other mental health counselor. Usually the most effective treatment for depression is a combination of medication and psychotherapy.

If you have severe depression, a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Here's a closer look at your depression treatment options.

Medications
A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood.

Finding the right medication
Everyone's different, so finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, don't stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off your dose, and quitting suddenly may cause a sudden worsening of depression. Don't give up until you find an antidepressant or medication that's suitable for you — you're likely to find one that works and that doesn't have intolerable side effects.

Antidepressants and pregnancy
If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk
Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.

The antidepressant warnings note that in some cases, children, adolescents 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 an antidepressant or when the dose is changed. Because of this risk, people in these age groups must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants. If you — or someone you know — have suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get your depression symptoms under control.

Psychotherapy
Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help ease depression symptoms such as hopelessness and anger. It may also help you adjust to a crisis or other current difficulty.

There are several types of psychotherapy that are effective for depression. Cognitive behavioral therapy is one of the most commonly used therapies. This type of therapy helps you identify negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you feel or behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way. Interpersonal therapy and psychodynamic psychotherapy are other types of counseling commonly used to treat depression.

Electroconvulsive therapy (ECT)
In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain. Although many people are leery of ECT and its side effects, it typically offers immediate relief of even severe depression when other treatments don't work. It's unclear how this therapy relieves the signs and symptoms of depression. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also have memory loss, which is usually temporary.

ECT is usually used for people who don't get better with medications and for those at high risk of suicide. ECT may be an option if you have severe depression when you're pregnant and can't take your regular medications. It can also be an effective treatment for older adults who have severe depression and can't take antidepressants for health reasons.

Hospitalization and residential treatment programs
In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Getting psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Partial hospitalization or day treatment programs also are helpful for some people. These programs provide the support and counseling you need while you get symptoms under control.

Other treatments for depression
If standard depression treatment hasn't been effective, your psychiatrist may consider whether you might benefit from a less commonly used procedure, such as:

Vagus nerve stimulation. This treatment uses electrical impulses with a surgically implanted pulse generator to affect mood centers of the brain. This may be an option if you have chronic, treatment-resistant depression.
Transcranial magnetic stimulation. These treatments use powerful magnetic fields to alter brain activity. A large electromagnetic coil is held against your scalp near your forehead to produce an electrical current in your brain. Transcranial magnetic stimulation may be an option for those who haven't responded to antidepressants.
Lifestyle & Home Remedies

Depression generally isn't an illness that you can treat on your own. But you can do some things for yourself that will help. In addition to professional treatment, follow these self-care steps:

Stick to your treatment plan.Don't skip psychotherapy sessions or appointments, even if you don't feel like going. Even if you're feeling well, resist any temptation to 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.
Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so that 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 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.


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