Major Depression

What is major depression?

Depression is a condition in which you feel sad, hopeless, and uninterested in daily life. Major depression is severe depression that lasts for at least 2 full weeks.

Major depression usually improves within a few weeks. Some people have it only once, while others have many episodes. Major depression can be shortened, and possibly prevented, with treatment.

What is the cause?

Major depression may start after some event or it may not be caused by anything specific. You may have major depression after a period of having dysthymia. Dysthymia is being mildly depressed almost every day for 2 or more years. If major depression develops from dysthymia, you are more likely to have major depression in the future.

People are more likely to develop depression if they:

• have family members who have had depression, bipolar disorder, or anxiety problems
• are female. Women are twice as likely as men to have major depression
• have a major medical problem such as heart disease or cancer

The chemicals in your nervous system and the way that brain cells communicate changes with major depression. Exactly how this works and what it means are not fully understood.

Major depression may start at any age. Teenagers and young adults, as well as older adults, are more likely to have this condition than middle-aged adults.

What are the symptoms?

Besides feeling very sad and uninterested in things you usually enjoy, you may also:

• be irritable
• have trouble falling asleep, wake up very early, or sleep too much
• feel more anxiety or panic
• notice changes in your appetite and weight, either up or down
• notice changes in your energy level, usually down but sometimes feeling overexcited
• lose sexual desire and function
• feel worthless and guilty
• have trouble concentrating or remembering things
• feel hopeless or just not care about anything
• have unexplained physical symptoms
• think often about death or suicide

Other symptoms may vary with age. If you are a teenager, you may be irritable, get angry, abuse substances, and cause trouble with parents and at school. If you are a young or middle-aged adult, you may abuse substances such as drugs or alcohol, have physical problems (like pain or stomach upsets), or feel nervous.

Depressed older people are more likely to complain of physical problems than that they are feeling sad, anxious, or hopeless. Tiredness, mood changes, sleepiness, and memory problems may be side effects of medicines rather than symptoms of depression. Other medical conditions, such as diabetes, heart disease, and Alzheimer's disease, can also cause similar symptoms.

How is it diagnosed?

Your healthcare provider or a mental health professional will ask about your symptoms and any drug or alcohol use. You may have lab tests to rule out medical problems such as hormone imbalances. There are no lab tests that directly diagnose depression.

How is it treated?

Do not try to overcome clinical depression by yourself. It can usually be successfully treated with psychotherapy, antidepressant medicine, or both. Discuss this with your healthcare provider or therapist.

Medicine

Several types of prescription medicines can help treat major depression. Your healthcare provider will work with you to carefully select the right medicine for you.

You must take these medicines daily for 3 to 6 weeks to get full benefit from them. Most people benefit from taking these medicines for at least 6 months.

No nonprescription medicines are effective to treat major depression.

Psychotherapy

Seeing a mental health therapist can help with all forms of depression. You may need therapy for a short time or for many months. One very helpful form of psychotherapy is cognitive behavioral therapy (CBT). CBT helps you identify and change thought processes that can lead to depression. Replacing negative thoughts with more positive ones reduces depression. Interpersonal therapy has also been shown to work very well.

Natural Remedies and Alternative Treatments

Diets rich in fruits and vegetables are recommended for people with depression. A multivitamin and mineral supplement may also be recommended.

Claims have been made that certain herbal and dietary products help control depression symptoms. Omega-3 fatty acids may help to reduce symptoms of depression. St. John's wort may help mild symptoms of depression. It will not help severe cases of depression. It may worsen bipolar disorder. No herb or dietary supplement has been proven to consistently or completely relieve depression. Supplements are not tested or standardized and may vary in strengths and effects. They may have side effects and are not always safe.

Learning ways to relax may help. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and psychotherapy.

How can I take care of myself?

Seeking treatment quickly is the best thing to do. Watch closely for the signs of depression. Get treatment before the symptoms become bad. Maintaining a healthy lifestyle and social activities are also important.

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, take walks. Try deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs, because they can make your symptoms worse. Exercise according to your healthcare provider's instructions.
• Check your medicines. Certain medicines can add to the symptoms of depression. If you have had depression, tell all healthcare providers who treat you about all medicines you are taking, including nonprescription products and natural remedies.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

When should I seek help?

If you are showing the signs of major depression, seek professional help quickly. Do not try to treat your depression by yourself. Professional treatment is necessary.

Most of the time, you will feel much better after a few weeks of treatment. Some people with untreated major depression commit suicide. Many more attempt suicide or try to hurt themselves. After treatment and feeling better, these same people usually cannot believe that once they felt so bad and wanted to die.

Get emergency care if you or a loved one has serious thoughts of suicide or harming others.