Depression

Depression

Overview

What is depression?

When doctors talk about depression, they mean the medical illness called major depression. Someone who has major depression has symptoms like those listed in the Symptoms section nearly every day, all day, for 2 weeks or longer. There is also a minor form of depression that causes less severe symptoms. Both kinds of depression have the same causes and treatment.

Depression causes a person to feel sad, angry or hopeless, have low self-esteem, or lose interest in things they used to enjoy. Depression can affect people of all ages and is different for every person. A person who has depression can't control his or her feelings. If your child or teen is depressed, it's not his or her fault.

If you're depressed, in addition to emotional symptoms you may also have physical symptoms, like fatigue, problems with too much or too little sleep, increased or decreased appetite, headaches, other aches and pains, digestive problems and problems with sex. An older person who has depression may feel confused or have trouble understanding simple requests.

Is depression more common in women than in men?

Yes. Women are twice as likely as men to experience depression. The reason for this is unknown, but changes in a woman's hormone levels may be related to depression.

Symptoms

What are the symptoms of depression?

  • Feeling sad, numb or hopeless
  • Frequent crying spells
  • Losing interest or pleasure in things you used to enjoy (including sex)
  • Feeling guilty or worthless
  • Thinking about death or suicide
  • Sleeping too much, or having problems sleeping
  • Unintended weight loss or gain
  • Feeling very tired all the time
  • Having trouble paying attention, recalling things, concentrating and making decisions
  • Having aches and pains that don't get better with treatment
  • Feeling restless, irritated and easily annoyed

What are some of the signs of depression in children and teens?

The signs of depression are different for every person. Infants and preschool children who are depressed may have a poor appetite and may lose weight. You may notice that they don't seem to enjoy playing.

School-aged children who are depressed may seem less confident. They might feel like they can't do anything right. Older children and teens who are depressed may seem to stop caring about themselves or family members, may not want to go to school and, in general, may lose interest in life activities. Older children may also show signs of eating more and sleeping more, or eating less and sleeping less.

In some children, the only signs of depression may be having a headache or stomachache, not wanting to go to school or losing their temper. If you notice these signs everyday for several weeks, they might mean your child is depressed.

Causes & Risk Factors

What causes depression?

Depression may be caused by an imbalance of chemicals in the brain. Sometimes there aren't enough chemical messengers (called neurotransmitters) in the brain. Examples of neurotransmitters that affect your mood are serotonin (say "sair-a-tone-in"), norepinephrine (say "nor-ep-in-ef-rin") and dopamine (say “dope-a-mean). The imbalance could be caused by your genes or by events in your life. Sometimes depression is a side effect of another illness. Depression can be hereditary (meaning it can run in families).

Depression can be triggered by stressful events in your life, such as the death of someone you love, a divorce, chronic illness or loss of a job. Taking certain medicines, abusing drugs or alcohol or having other illnesses can also lead to depression. Depression is not caused by personal weakness, laziness or lack of willpower.

Depression is not a normal part of growing older, but it is common in adults who are 65 years of age and older. Retirement, health problems and the loss of loved ones are things that happen to older adults. Feeling sad at these times is normal. But if these feelings persist and keep you from your usual activities, you should talk to your doctor.

Can giving birth cause depression?

In the days following the birth of a baby, it is common for some mothers to have mood swings. They may feel a little depressed, have a hard time concentrating, lose their appetite or find that they can't sleep well even when the baby is asleep. This is called the baby blues and goes away within 10 days after delivery. However, some women have worse symptoms or symptoms that last longer. This is called postpartum depression.

Why do young people get depressed?

The following are some of the reasons children and teens might get depressed:

  • The family moves to a new place to live.
  • The child has to change to a new school.
  • A pet, friend or family member dies.
  • Someone in the family is very sick.

The child experiences the hormonal changes of puberty.

Diagnosis & Tests

How is depression diagnosed?

Sometimes depression is first recognized by friends or family members. If you're having symptoms of depression, be sure to tell your doctor so you can get help. Don't expect your doctor to be able to guess that you're depressed just by looking at you. Sometimes when people are depressed, they have a hard time imagining that treatment can actually help. But, the sooner you seek treatment, the sooner the depression will lift.

Once you tell your doctor how you're feeling, he or she may ask you some questions about your symptoms, about your health and about your family history. Your doctor may also give you a physical exam and do some tests. It is important to tell your doctor about any medicines that you are taking.

Why is depression in older adults hard to recognize?

In older adults, it can be hard to tell the difference between depression and illnesses such as dementia. Also, older adults may not talk to their doctor about their sad or anxious feelings because they are embarrassed. But depression is nothing to be embarrassed about. It is not a personal weakness. It's a medical illness that can be treated.

Treatment

How is depression treated?

Depression can be treated with medicines, with counseling, or with both. A nutritious diet, exercising on a regular basis and avoiding alcohol, drugs and too much caffeine can also help.

What about medicines?

Medicines that treat depression are called antidepressants. They help increase the number of chemical messengers (serotonin, norepinephrine, dopamine) in your brain.

Antidepressants work differently for different people. They also have different side effects. So, even if one medicine bothers you or doesn't work for you, another may help. You may notice improvement as soon as 1 week after you start taking the medicine. But you probably won't see the full effects for about 8 to 12 weeks. You may have side effects at first but they tend to decrease after a couple of weeks. Don't stop taking the medicine without checking with your doctor first.

Reasons to get help for depression

  • Early treatment helps keep depression from getting worse or lasting a long time.
  • Thoughts of suicide are common in people with depression. The risk of suicide is higher if you don't get treatment for your depression. When depression is successfully treated, the thoughts of suicide will go away.
  • Treatment can help you return to your "normal" self, enjoying life.
  • Treatment can help prevent depression from coming back.

What about counseling?

For mild to moderate depression, counseling may be a good treatment option. For major depression and for some people with minor depression, counseling may not be enough. A combination of medicine and talk therapy is usually the most effective way of treating more severe depression. If you continue the combination treatment for at least two years you are less likely to have depression come back.

In psychotherapy, you talk with a trained therapist or counselor about things that are going on in your life. The focus may be on your thoughts and beliefs, about things that happened in your past, or on your relationships. Or the focus may be on your behavior, how it's affecting you and what you can do differently. Psychotherapy usually lasts for a limited time, such as 8 to 20 visits.

What should I do if I think my child is depressed?

Ask your child about his or her thoughts and feelings. It may also be a good idea to talk to your doctor about your child's behavior and your concerns about his or her depression. In most cases, taking your child to your family doctor is a good idea. A medical problem may be causing the depression. Your doctor may want to give your child a general medical check-up.

What can be done to help depressed children and teens?

Most depressed children and teens should talk to a counselor, therapist, psychologist or psychiatrist about what is making them feel the way they are feeling. Family counseling can help everyone in the family. Your family doctor can refer you and your child to someone for counseling. Most depressed children and teens do best when they get both counseling and medicine.

What is electroconvulsive therapy?

Electroconvulsive therapy (also called ECT or electroshock therapy) is a procedure used to help treat certain mental illnesses. Electric currents are passed through the brain in order to trigger a seizure (a short period of irregular brain activity), lasting about 40 seconds. Medicine is given during ECT to help prevent damage to muscles and bones.

Electroconvulsive therapy may help people who have the following conditions:

  • Severe depression that does not respond to antidepressants (medicines used to treat depression) or counseling.
  • Severe depression in patients who can't take antidepressants.
  • Severe mania that does not respond to medication. Symptoms of severe mania may include agitation, confusion, hallucinations or delusions.
  • Schizophrenia that does not respond to medication.

Will I need to go to the hospital?

Depression can usually be treated through visits to your doctor. Treatment in the hospital may be needed if you have other medical conditions that could affect your treatment or if you're at high risk of suicide.

How long will the depression last?

This depends on how soon you get help. Left untreated, depression can last for weeks, months or even years. The main risk in not getting treatment is suicide. Treatment can help depression lift in 8 to 12 weeks, or less.

Tips on getting through depression

  • Don't isolate yourself. Stay in touch with your loved ones and friends, your religious advisor and your family doctor.
  • Do pace yourself. Don't expect to do everything you normally can. Set a realistic schedule.
  • Don't believe negative thoughts you may have, such as blaming yourself or expecting to fail. This thinking is part of depression. These thoughts will go away as your depression lifts.
  • Don't blame yourself for your depression. You didn't cause it.
  • Do get involved in activities that make you feel good or feel like you've achieved something.
  • Don't make major life decisions (for example, about separation or divorce). You may not be thinking clearly while you are depressed, so the decisions you make at this time may not be the best ones for you. If you must make a big decision, ask someone you trust to help you.
  • Do avoid drugs and alcohol. Both make depression worse. Both can cause dangerous side effects with antidepressant medicines.
  • Do exercise often to make yourself feel better. Physical activity seems to cause a chemical reaction in the body that can improve your mood. Exercising 4 to 6 times a week for at least 30 minutes each time is a good goal. But even less activity can be helpful.
  • Do eat balanced meals and healthy food.
  • Do get enough sleep.
  • Do take your medicine and/or go to counseling as often as your doctor tells you to. Your medicine won't work if you only take it once in a while.
  • Do set small goals for yourself, because you may have less energy.
  • Do encourage yourself.
  • Do get as much information as you can about depression and how to treat it.
  • Do call your doctor or the local suicide crisis center right away if you start thinking about suicide.
  • Don't get discouraged. It will take time for your depression to lift fully. Be patient with yourself.
  • Don't give up.

Complications

Suicide

People who have depression sometimes think about suicide. This thinking is a common part of the depression. If you have thoughts about hurting yourself, tell someone. You could tell your doctor, your friends, your family, or call your local suicide hot line, such as the National Suicide Prevention Lifeline at 1-800-273-8255.

Get help right away. There are people who can help you, and depression can be successfully treated.

Other Organizations

Questions to Ask Your Doctor

  • What treatment is best for me?
  • How long will my depression last?
  • Should I see a therapist?
  • What antidepressant will be best for me?
  • I'm pregnant. Should I take antidepressants?
  • I'm breastfeeding. Should I take antidepressants?
  • Is there anything I can do at home to help myself?
  • Are there any support groups in my area?
  • Why do I have depression?
  • Will I have to take medicine the rest of my life?

Bibliography

Depression in Children and Adolescents by SE Son M.D. and JT Kirchner, D.O. (American Family Physician November 15, 2000, http://www.aafp.org/afp/20001115/2297.html)

Childhood and Adolescent Depression by SK Bhatia, M.D., and SC Bhatia, M.D. (American Family Physician January 01, 2007, http://www.aafp.org/afp/20070101/73.html)

Depression in Women: Diagnostic and Treatment Considerations by SC Bhatia, M.D. and SK Bhatia, M.D. (American Family Physician July 01, 1999, http://www.aafp.org/afp/990700ap/225.html)

Antidepressant Discontinuation Syndrome by CH Warner, MAJ, MC, USA; W Bobo, LCDR, MC, USN; C Warner, MAJ, MC, USA; S Reid, CPT, USAF, MC; and J Rachal, MAJ, USAF, MC (American Family Physician August 01, 2006, http://www.aafp.org/afp/20060801/449.html)

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