Depression is a mental illness marked by feelings of profound sadness and lack of interest in activities. Depression is not the same as a blue mood. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment.
Causes
The precise cause is not known. It can be difficult to determine if an illness causes depression or depression caused the illness. Possible causes may be mental, physical, or environmental and include:
Stressful life events (usually in combination with one or more of the following causes)
Chronic stress
Low self-esteem
Imbalances in brain chemicals and hormones
Lack of control over circumstances (helplessness and hopelessness)
Seasonal affective disorder
is a type of depression or a worsening of symptoms thought to be due to the decreased exposure to sunlight that occurs during winter months
Depression can differ from person to person. Some people have only a few symptoms, while others have many.
Symptoms can change over time and may include:
Persistent feelings of sadness, anxiety, or emptiness
Hopelessness
Feeling guilty, worthless, or helpless
Loss of interest in hobbies and activities
Loss of interest in sex
Feeling tired
Trouble concentrating, remembering, or making decisions
Trouble sleeping, waking up too early, or oversleeping
Eating more or less than usual
Weight gain or weight loss
Thoughts of death or
suicide
with or without suicide attempts
Restlessness or irritability
Physical symptoms that defy standard diagnosis and do not respond well to medical treatments
Diagnosis
There is no blood test or diagnostic test for depression. The doctor will ask about your symptoms and medical history, giving special attention to:
Alcohol and drug use
Thoughts of death or suicide
Family members who have or have had depression
Sleep patterns
Previous episodes of depression
The doctor may also perform specific mental health exams. This will help get detailed information about your speech, thoughts, memory, and mood. A physical exam and other tests can help rule out other causes.
Treatment
Treatment may involve the use of medicine, psychotherapy, or the use of both.
Severe depression usually requires hospital care and the use of drugs, such as
olanzapine
.
Antidepressant Medications
Up to 70% of depressed patients find relief from their symptoms with medicine. They can take 2-6 weeks to reach their maximum effectiveness. The medications include:
The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.
Although the warning is for all antidepressants, of most concern are the SSRI class such as:
Short-term (10-20 weeks) therapy can help some people. Psychotherapy is designed to help you:
Cope with difficulties in relationships
Change negative thinking and behavior patterns
Resolve difficult feelings
Electroconvulsive Therapy (ECT)
ECT is the use of an electric stimulus to produce a generalized seizure. It may be used in people with severe or life-threatening depression. ECT is also used for people who cannot take or do not respond to medicine. It is considered a safe and effective procedure.
Exercise
A regular
exercise program
has been shown to relieve some of the symptoms. It should play a large role in the overall management of depression.
Phototherapy
Phototherapy
is done by sitting under special lights. It usually lasts about 30 minutes every morning.
Dietary Supplements and Herbal Therapy
St. John's wort
is an herb that is available without prescription. It is widely used in Europe for the treatment of mild to moderate depression. Studies have shown that the herb is as effective as standard antidepressants and has fewer side effects.
*¹
There is also recent evidence that DHEA, a dietary supplement, may help some people. DHEA is an ingredient in
fish oil
. Some experts disagree with these findings. Always discuss the use of dietary and herbal supplements with your doctor.
Dietary Manipulations
Research suggests that diets high in tryptophan, certain
B vitamins
, and fish oil may be helpful. They have shown promise in both relieving and preventing depression. Always discuss the use of such supplements with your doctor.
Vagal Nerve Stimulation (VNS)
VNS is used as therapy for depression when multiple trials of medicine do not work. A pacemaker-like device stimulates the vagus nerve in the neck.
Vagus Nerve
Stimulation of the vagus nerve (yellow) at the neck is a depression therapy option.
Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects.
Neurosci Biobehav Rev
. 2005;29:493-500.
Medical Letter, Inc. Treatment Guidelines from the Medical Letter.
Medical Letter
. 2003;1:11.
*¹12/16/2008 DynaMed's Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: Linde K, Berner M, Kriston L. St. John's wort for major depression.
Cochrane Database Syst Rev
. 2008;CD000448.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a
medical condition.
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
