About depression

What is depression?

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called 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 sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

What are the symptoms for depression?

Symptoms of Depression can vary from person to person. Key signs and symptoms may include:

  • Depression that temporarily lifts in response to good news or positive events
  • Increased appetite that can cause weight gain
  • Increased desire to sleep, usually more than 10 hours a day
  • Heavy, leaden feeling in your arms or legs that lasts an hour or more in a day — a feeling that is different from fatigue
  • Sensitivity to rejection or criticism, which affects your relationships, social life or job

Other symptoms also may be part of atypical depression, such as:

  • Insomnia
  • Disordered eating, such as bulimia, bingeing or extreme food restrictions
  • Poor body image and Fear of being fat
  • Headaches and other aches and pains

Some researchers are beginning to think of atypical Depression as part of a larger subgroup of reactive depressive disorders — Depression caused as a reaction to external events or circumstances.

Atypical Depression may occur as a feature of major Depression or of mild, long-lasting Depression (dysthymia). Symptoms of atypical Depression may overlap with other subtypes of depression, such as melancholic or anxious distress depression.

For some people, signs and symptoms of atypical Depression can be severe, such as feeling suicidal or not being able to do basic day-to-day activities.

When to see a doctor

If you feel depressed, make an appointment to see your doctor as soon as you can. Atypical Depression may get worse if it isn't treated. 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.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

  • Call your mental health specialist
  • Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
  • Seek help from your primary doctor or other health care provider
  • Reach out to a close friend or loved one
  • Contact a minister, spiritual leader or someone else in your faith community

If a loved one or friend is in danger of attempting suicide or has made an attempt:

  • Make sure someone stays with that person
  • Call 911 or your local emergency number immediately
  • Or, if you can do so safely, take the person to the nearest hospital emergency room

What are the causes for depression?

It's not known exactly what causes atypical depression or why some people have different features of depression. Atypical depression often starts in the teenage years, earlier than other types of depression, and can have a more long-term (chronic) course.

As with other types of depression, a combination of factors may be involved. These include:

  • Brain differences. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems change, leading to depression.
  • Inherited traits. Depression is more common in people whose blood relatives also have the condition.

What are the treatments for depression?

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

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.

Here's a closer look at depression treatment options.

Medications

Many types of antidepressants are available, including those below. Be sure to discuss possible major side effects with your doctor or pharmacist.

  • Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These drugs are considered safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
  • Atypical antidepressants. These medications don't fit neatly into any of the other antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).
  • Tricyclic antidepressants. These drugs — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and protriptyline (Vivactil) — can be very effective, but tend to cause more-severe side effects than newer antidepressants. So tricyclics generally aren't prescribed unless you've tried an SSRI first without improvement.
  • Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, typically when other drugs 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 ā€• such as certain cheeses, pickles and wines ā€• and some medications and herbal supplements. Selegiline (Emsam), a newer MAOI that sticks on the skin as a patch, may cause fewer side effects than other MAOIs do. These medications can't be combined with SSRIs.
  • Other medications. Other medications may be added to an antidepressant to enhance antidepressant effects. Your doctor may recommend combining two antidepressants or adding medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications also may be added for short-term use.

Finding the right medication

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 or a combination of 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.

Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of genetic tests (done by a blood test or cheek swab) may offer clues about how your body may respond to a particular antidepressant. However, other variables besides genetics can affect your response to medication.

Risks of abruptly stopping medication

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.

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 with your doctor if you become pregnant or you're planning to become pregnant.

Antidepressants and increased suicide risk

Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires all antidepressants to carry a box warning, the strictest warning for prescriptions. In some cases, children, teenagers and young adults under age 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, especially when starting a new medication or with a change in dosage. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact a 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

Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. Psychotherapy is also known as talk therapy or psychological therapy.

Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy. Your mental health professional may also recommend other types of therapies. Psychotherapy can help you:

  • Adjust to a crisis or other current difficulty
  • Identify negative beliefs and behaviors and replace them with healthy, positive ones
  • Explore relationships and experiences, and develop positive interactions with others
  • Find better ways to cope and solve problems
  • Identify issues that contribute to your depression and change behaviors that make it worse
  • Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
  • Learn to set realistic goals for your life
  • Develop the ability to tolerate and accept distress using healthier behaviors

Alternate formats for therapy

Formats for depression therapy as an alternative to face-to-face office sessions are available and may be an effective option for some people. Therapy can be provided, for example, as a computer program, by online sessions, or using videos or workbooks. Programs can be guided by a therapist or be partially or totally independent.

Before you choose one of these options, discuss these formats with your therapist to determine if they may be helpful for you. Also, ask your therapist if he or she can recommend a trusted source or program. Some may not be covered by your insurance and not all developers and online therapists have the proper credentials or training.

Smartphones and tablets that offer mobile health apps, such as support and general education about depression, are not a substitute for seeing your doctor or therapist.

Hospital and residential treatment

In some people, depression is so severe that a hospital stay is needed. This may be necessary if you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves.

Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.

Other treatment options

For some people, other procedures, sometimes called brain stimulation therapies, may be suggested:

  • Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain to impact the function and effect of neurotransmitters in your brain to relieve depression. ECT is usually used for people who don't get better with medications, can't take antidepressants for health reasons or are at high risk of suicide.
  • Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven't responded to antidepressants. During TMS, a treatment coil placed against your scalp sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.

What are the risk factors for depression?

Many factors seem to increase the risk of developing or triggering depression, whether it's atypical or not. Risk factors may include:

  • History of bipolar disorder
  • Abuse of alcohol or recreational drugs
  • Physical or sexual abuse
  • Traumatic childhood experiences
  • Certain personality traits, such as low self-esteem or being overly dependent
  • Serious illness, such as cancer or heart disease
  • Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)
  • Environmental stressors

Your risk of depression may also increase if you have:

  • Blood relatives with a history of depression, bipolar disorder or alcoholism
  • Stressful life events, such as the death of a loved one
  • Depression after giving birth (postpartum depression)
  • Family members who committed suicide
  • Few friends or other personal relationships

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