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Depression

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Take control before it controls you

A person who's depressedDepression is not a sign of weakness or a character flaw. It is a true medical condition like diabetes or hypertension, and it is often an overwhelming disease.

Depression deeply affects not only the person who is depressed, but close family and friends are usually greatly impacted as well.

More people suffer from depression than you might think. Twenty-five percent of all women and up to 12% of all men in the U.S. will experience an episode of major depression some time in their lives.

A person who is depressed to the point that it interferes with daily activities should seek medical care.

Causes


Depression occurs in waves, or spells, and can last for months or even years if left untreated.  Sometimes people who are depressed try to feel better by using alcohol or drugs. This doesn't help the depression in the long run; in fact, alcohol and illegal drug use are well known for making depression worse and can easily lead to a viscious downhill path of substance abuse and addiction. 

Depression strikes people of all ages, backgrounds, and ethnic groups. The exact cause of depression is not entirely certain, but we do know: depression tends to run in families, it is usually triggered by a stressful event, it tends to recur, and it is associated with an imbalance of chemicals in the brain. Normal function of the brain involves a complex interaction of chemicals, called neurotransmitters. Depression is associated with an imbalance of these neurotransmitters.

Symptoms

  • Persistent sad mood (Feeling sad is a normal reaction to troubling situations. Sadness becomes depression when a person feels sad all the time and it starts interfering with family life and work.)
  • Loss of interest or pleasure in activities and hobbies that were once enjoyable.
  • Irritability or restlessness (grouchy!)
  • Loss of energy or feeling tired all the time
  • Lack of motivation
  • Difficulty concentrating, remembering or making decisions
  • Changes in appetite that causes either weight gain or weight loss
  • Changes in sleep patterns—sleeping too much or not enough
  • Feelings of worthlessness or guilt without an obvious reason
  • Thinking often of death or suicide
    • If you or someone you care about is in crisis, please seek help immediately, either
      • call 911,
      • visit a nearby emergency department or your healthcare provider's office, or
      • call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor
       

Not everyone who is depressed will experience every symptom (above). Many of these symptoms alone are not significant for depression. It's important to seek professional advice from your primary health care provider if you think you have persistent symptoms of depression, particularly if the symptoms are interfering with your daily life. Prior to your office visit, it would be helpful to complete a confidential questionnaire (click here) and show it to your health care provider at your first visit.

Diagnosis

Many health care providers utilize a depression questionnaire that is quick and easy. Can be completed by patient. Scoring analysis is included at the bottom of assessment tool. It can be used for initial diagnosis, and also to monitor severity over time in patients under treatment for depression.

Treatment

Most cases of depression are highly treatable. It's important to be aware, however, that early treatment is more effective and helps prevent the likelihood of serious recurrences.

Treatment for depression may include regular exercise, antidepressant medication, professional counseling, or a combination of all therapies. Some people with mild depression are able to control their symptoms by following a regular aerobic exercise program. For some, professional counseling may be all that is needed for mild depression. However, if symptoms are moderate to severe, treatment of depression most likely will include both antidepressants and professional counseling. Hospitalization may be necessary if there are warning signs of suicide, such as thoughts or plans about self harm or harm to another person, detachment from reality (psychosis), or excessive use of alcohol or drugs. If you or someone you know has thoughts of death or suicide, contact a medical professional, clergy member, loved one, friend or crisis line such as 1-800-273-8255 (TALK) immediately, or go to your nearest hospital emergency room.

Medications: Often a person who is depressed will need an antidepressant medication. Some people do well taking the antidepressant for 6 to 12 months after the symptoms subside, but some people fare better continuing on the medication indefinitely. Antidepressants can improve or completely relieve the symptoms of depression. Although antidepressants are nonaddicting, quitting them abruptly can cause withdrawal symptoms.

  • Medications affect your brain chemistry in different ways and the side effects of the medications differ, so it is important that you work with your health care provider in finding the best one for you. Antidepressant medication should always be taken as prescribed.
  • It may take several weeks before you notice the medication working.
  • Several medication options are available. If one medication does not seem to work, there are many others to try before giving up.
  • If you decide to quit taking antidepressants, it is important that you contact your health care provider and obtain advice about gradually reducing the dose over a period of several weeks. Quitting antidepressants abruptly can cause withdrawal symptoms.
  • Antidepressant medications should be taken for 6 to 12 months after the symptoms of depression subside. Some people do well if antidepressant medications are gradually tapered at that point. However, some people feel better on continuous low-dose maintenance.

Home Treatment: While therapy and antidepressant medication are the most effective treatments for depression, there are many steps you can take to help yourself during a depressive episode and to prevent future episodes:

  • Regular aerobic exercise can be very helpful in relieving symptoms of depression. Aerobic exercise involves continuous activity that will increase Exercise on a bike is an excellent way to get aerobic exercise your heart rate and maintain it at a higher rate for a sustained period of time, such as for 20-60 minutes.  Check with your health care provider before beginning an exercise program. More information about Starting an Exercise Program.

  • Set realistic goals for yourself, and take on a reasonable amount of responsibility.

  • Break large tasks into small ones, and set priorities. Do what you can when you are able.

  • Postpone major life decisions (such as changing jobs, moving, or getting married or divorced) when you are depressed.

  • Try to share your feelings with someone. It is usually better than being alone and secretive.

  • Even if you don't feel motivated, try to participate in religious, social, or other activities.

  • Eat a balanced diet. If you lack an appetite, eat small snacks rather than large meals.

  • Avoid drinking alcohol or using illegal drugs or medications that have not been prescribed to you. They may interfere with your medications or worsen your depression.

  • Get adequate sleep. If you have problems sleeping:Sleeping woman
    • Go to bed at the same time every night and, more importantly, get up at the same time every morning.
    • Keep your bedroom dark and free of noise.
    • Don't exercise after 5:00 p.m.
    • Avoid caffeinated beverages after 5:00 p.m.
    • Avoid the use of nonprescription sleeping pills or alcohol, because they can make your sleep restless and may interact with your depression medications.
 

News

Video Tutorial on Depression

Depression from Medline Plus, a service of the National Library of Medicine and the National Institute of Health

Internet References

(1) How to find help through psychotherapy from the American Psychological Association
(2) Depression from the National Mental Health Association
(3) Locate Mental Health Services, Find a Psychiatrist or Psychologist and Check State Credentials from Bay Area Medical Information
(4) Antidepressants from Medline Plus

--Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Updated March 2010

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