Depression - major; Unipolar depression; Major depressive disorder
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.
True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.
The exact cause of depression is not known. Many researchers believe it is caused by chemical changes in the brain. This may be due to a problem with your genes, or triggered by certain stressful events. More likely, it's a combination of both.
Some types of depression run in families. But depression can also occur if you have no family history of the illness. Anyone can develop depression, even kids.
The following may play a role in depression:
See also: Adolescent depression
Depression can change or distort the way you see yourself, your life, and those around you.
People who have depression usually see everything with a more negative attitude, unable to imagine that any problem or situation can be solved in a positive way.
Symptoms of depression can include:
Depression can appear as anger and discouragement, rather than feelings of sadness.
Your health care provider will ask questions about your medical history and symptoms. Your answers and certain questionairres can help your doctor make a diagnosis of depression and determine how severe it may be.
Blood and urine tests may be done to rule out other medical conditions with symptoms similiar to depression.
In general, treatments for depression include:
If you have mild depression, you may only need one of these treatments. People with more severe depression usually need combination of both treatments. It takes time to feel better, but there are usually day-to-day improvements.
If you are suicidal or extremely depressed and cannot function you may need to be treated in a psychiatric hospital.
MEDICATIONS FOR DEPRESSION
Drugs used to treat depression are called antidepressants. Common types of antidepressants include:
Other medicines used to treat depression include:
If you have delusions or hallucinations, your doctor may prescribe additional medications.
WARNING: Children, adolescents, and young adults should be watched more closely for suicidal behavior, especially during the first few months after starting medications.
If you do not feel better with antidepressants and talk therapy, you may have treatment-resistant depression. Your doctor will often prescribe higher (but still safe) doses of an antidepressant, or a combination of medications. Lithium and thyroid hormone supplements also may be added to help the antidepressants work better.
St. John's wort is an herb sold without a prescription. It may help some people with mild depression. However, it can change the way other medicines work in your body, including antidepressants and birth control pills. Talk to your doctor before trying this herb.
CHANGES IN MEDICATIONS
Sometimes, medications that you take for another health problem can cause or worsen depression. Talk to your doctor about all the medicines you take. Your doctor may recommend changing your dose or switching to an alternative drug. Never stop taking your medications without first talkingt o your doctor.
Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their doctors.
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:
OTHER TREATMENTS FOR DEPRESSION
You can often ease the stress of illness by joining a support group whose members share common experiences and problems.
Some people with major depression may feel better after taking antidepressants for a few weeks. However, many people need to take the medicine for 4 - 9 months to fully feel better and prevent the depression from returning.
For people who have repeated episodes of depression, quick and ongoing treatment may be needed to prevent more severe, long-term depression. Sometimes people will need to stay on medications for long periods of time.
People who are depressed are more likely to use alcohol or illegal substances.
Complications of depression also include:
If you have thoughts of suicide or harming yourself or others, immediate call your local emergency number (such as 911) or go to the hospital emergency room.
You may also call a suicide hotline from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.
Call your doctor right away if:
Do not drink alcohol or use illegal drugs. These substances can make depression worse and might lead to thoughts of suicide.
Take your medication exactly as your doctor instructed. Ask your doctor about the possible side effects and what you should do if you have any. Learn to recognize the early signs that your depression is getting worse.
The following tips might help you feel better:
Fava M, Cassano P. Mood disorders: Major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusette General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.
American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007. Accessed January 22, 2010.
Little A. Treatment-resistant depression. Am Fam Physician. 2009;80:167-172.
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