Symptoms   Overview   Risk Factors   Treatment and Therapies   Depression Treatment   Understanding Depression   Self-Care   Self-Love   Making Space for Self-Care   Medical Contact Info

DEPRESSION (Major Depressive Disorder)

Definition

Depression is a mood disorder stemming from a long term loss of interest and feelings of sadness. This is known as a major depressive disorder or a clinical depression. It causes a person to feel unhappy, lose interest in life, and in the elements surrounding them that used to be engaging. Consequently, the person begins to conclude that life isn’t worth living. People with this type of depression are unable to cope with the day-to-day complexities of life and cannot just sleep it off or get a “wake up” call to be back into their normal routines. These individuals require medications to assist in cogent chemical brain activity and/or therapeutic counseling to relieve the stress and frustrations occurring in their life.

In any given year, 7 percent of Americans will be diagnosed with this condition; women are 2 to 3 times more likely to be diagnosed than men (American Psychiatric Association).

Symptoms 

Most people have days that can be filled with sadness, yet people with depression have multiple episodes of these symptoms that can last days into weeks and road block one’s normal activities in life. Some people just feel miserable and unhappy, yet don’t know why.

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

Overview

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

• Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
• Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
• Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
• Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
• Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Risk Factors

Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

• Personal or family history of depression
• Major life changes, trauma, or stress
• Certain physical illnesses and medications

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

You may have heard about an herbal medicine called St. John’s wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH website and in the NIMH publication Depression: What You Need to Know.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

• ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
• Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
• Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
• ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
• ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

• Try to be active and exercise.
• Set realistic goals for yourself.
• Try to spend time with other people and confide in a trusted friend or relative.
• Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately.
• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
• Continue to educate yourself about depression..

Risk Factors

Depression is often seen in people who are in the age group of 20s and 30s. Yet, depression cuts through all barriers of social class, ethnicity, race, gender, etc. However, it has been reported that more women are diagnosed with depression than men, yet more women seek treatment than men. Thus, this report is skewed in favor of women.

Risk Factors of Developing or Triggering Depression

• Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
• Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
• Childhood trauma or depression that started when you were a teen or child
• Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
• Being lesbian, gay, bisexual or transgender in an unsupportive situation
• History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
• Abuse of alcohol or illegal drugs
• Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
• Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

UNDERSTANDING DEPRESSION

Trying to understand the underpinnings of depression can be a daunting and complex process. The brain’s mechanisms are carried out by neurotransmitters, that when stretched, damaged, traumatized, or abused, are unable to carry specific messages to its receptors, and therefore, leaves the brain without necessary information to keep it running like a finely tuned machine. Thus, begins the cycle of depression, whereby, lost information becomes a series of fatigue, sadness, lack of interest, mood swings, chemical imbalance, and emotional sensitivity. Hormonal levels for women becomes quite chaotic when the brain has been through trauma. This may cause extreme hot and cold flashes, emotional outbursts, overly sensitive to criticism, and needy. The brain may also shut down completely to protect itself from more trauma, leaving the individual in a coma and/or the desire to sleep more than necessary. Seeking a medical professional is extremely important to help mitigate this imbalance so the brain can regain its healthy balance and find harmony once again.

SELF-CARE

Having a healthy lifestyle is critical when you have depression. YOU are the only person that matters when you are depressed! Choose to take the necessary steps for having mental health care and live in the GLOW! Only YOU can make this happen! Self-care is choosing to find a balanced, depression-free lifestyle by LOVING YOURSELF FIRST! Find what makes you happy, brings joy to your heart and soul, and go DO IT! Your heart, mind, and divine spirit will engage in whatever brings you glow. This is your life… Live like it matters!?

SELF-LOVE

Self-Love makes it possible for patients in recovery to resist the temptations of addiction by improving mental and physical health, as well as increasing satisfaction and self-esteem.

What Is Self-Love?

Self-love is a practice that can give our lives the meaning and depth needed to remain healthy. With self-love, we instill healthy habits and live in accordance with our bliss and truth. Whether our self-love habits include getting massages, avoiding conflict, or venting frustrations to others, self-love creates a transformative inner-peace. Daily, we can include self-care rituals in our lives as we make ourselves a priority and remove self-judgement.

Developing Self-Compassion

Self-love often involves self-compassion. Compassion can be defined as a sensitivity to the suffering of others. Self-compassion is similar. With self-compassion, people can understand themselves in frustrating times, growth and perceived failures. This inner patience can carry us into being gentle with ourselves and allows us to give ourselves credit when we’re learning from mistakes.

Incorporating self-compassion into our daily lives creates space for self-transformation and the awareness needed to improve relationships. The practice of self-compassion reduces feelings of depression and anxiety which may be present after leaving a rehab facility. Self-compassion can be developed by embracing our humanity and listening to our inner-voice.

Self-compassion enables people to be themselves without beating themselves up for who they are. Kindness for self encourages people to make healthy long-term decisions to maintain a life of wellness. This may include leaving toxic relationships, investing in self-care routines, or leaving stressful jobs.

Healthy Self-Esteem

Healthy self-esteem impacts health and wellness, and studies report strong links between low self-esteem and addiction. It reveals insight on how people perceive themselves, as well as their perceived value. Healthy self-esteem can manifest in confidence, self-forgiveness, problem-solving skills, and trusting others.

Building self-esteem, particularly if it is low, is an empowering act to help people break free of addiction and self-harm. The lower your self-esteem, the more likely you’ll feel depressed, anxious, lonely, and incapable of achieving new goals. Exercising, for example, can provide people with the practice of safe habits and confidence building. As people discover their strength through physical fitness, they also uncover their inner-strength.

Words have power and can deeply impact us. Positive self-talk encourages us to maintain a healthy self-image. Think of positive attributes which define you that you can use to affirm a positive self-image. What affirmations or mantras can you use? Being mindful of how you label yourself can make a big difference in self-perception. For instance, instead of saying, “lazy” you can emphasize relaxing for balance. Instead of shaming negative emotions, embrace them as the evolution of expressing difficult emotions.

Consider times when you’ve heard how you positively impacted someone. How did the person describe you? Take time to reflect on positive and negative thoughts you may have about yourself. Shine your light by sharing your gifts as a reminder of your value, and be proud of your growth.

MAKING SPACE FOR SELF-CARE

Self-love involves upholding self-care. Self-care can vary from person to person yet include basic functions to enhance well-being. Investing in a wholesome diet full of vitamins and nutrients will sustain the physical body. Getting restful sleep is a simple part of self-care, as is tending to regular health checkups.

Another component of self-care is living for today to enhance mindfulness. With mindfulness, this can include taking inventory of how new activities can make us feel. As we explore new opportunities, we can look within and connect, further guiding us to know where are joys and sorrows are.

Practicing meditation will greatly allow us to manage anxiety or heightened stress levels, adding to our self-care routine. Mindful meditation, for instance, increases our connection to our higher self and our intuition. Following our intuition honors our inner truth and guides us to gain mental clarity over our lives. Self-care also includes looking your best, investing in your dreams and surrounding yourself with the warmth of caring friends.

Ready To Get the Healing You Deserve?

Living a life of self-love includes making the best decision to ensure progression and wellness. If are struggling in your quest for transformation, experts are standing by to better serve you. Contact an expert to determine the best treatment plan to get the care you deserve.

MEDICAL CONTACT INFORMATION

CALL 911 IMMEDIATELY, if you feel you may hurt yourself, or think you may want to end your life, or hurt anyone else due to your depression.

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). Use that same number and press “1” to reach the Veterans Crisis Line.
• 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.

RESOURCES

• Antidepressants, talk to your doctor and visit www.fda.gov.
• Bipolar Disorder
• Depression (Major Depressive Disorder)
• Depression Treatment
• National Complementary and Integrative Health
• National Institute of Mental Health
• Self-Love and Self-Care