How can I tell if I'm depressed?
It's normal to feel a little down every once in a while. But depression is a condition that can go on for weeks or months with no end in sight. Depression makes it hard to go about your normal activities and get through the day. It makes you think there's no more joy in life.
Depressive disorders affect the way you eat, sleep, and think. Depressed people can't snap out of it. Really serious depressive symptoms can last weeks, months, or years. It can also affect work, friends, and family.
What are the types of depressive disorders?
Types of depression vary by the symptoms' number, severity, and persistence.
Major depression is a combination of symptoms (see the list below) that's disabling and makes daily functioning extremely difficult if not impossible.
Dysthymia is marked by chronic symptoms (see the list below) that aren't disabling. You never feel you can function fully and never have sustained periods of feeling good.
Bipolar disorder (formerly called manic-depressive illness) is less common than depression and involves cycles of depression and elation. The change in mood is usually gradual, though it can be rapid. Bipolar disorder is often a recurring condition.
How can I tell if I'm truly depressed?
If you feel down for two weeks or longer and you experience at least five of the following symptoms every day you're probably depressed:
- feeling overwhelming sadness, anxiety, or "empty" feelings
- feeling hopeless and despairing about the future
- feeling guilty, ashamed, worthless, or helpless
- loss of interest in normal activities such as eating and sex; lack of enjoyment in activities that used to be pleasurable
- trouble making decisions, remembering, and concentrating
- changes in sleep patterns -- usually waking extra early or difficulty falling asleep, but sometimes oversleeping
- loss of appetite and weight loss, or overeating and weight gain
- fatigue, loss of energy, lack of motivation
- feeling unusually irritable and restless or slow and lethargic
- thoughts of suicide or death
- recurrent physical symptoms, such as chronic pain, headaches, or digestive disorders that don't go away with treatment
Depression can also cause you to withdraw from friends and family (a young person may act rebellious or antisocial) or to lose touch with reality (in an older person, depression may resemble dementia).
Symptoms of bipolar disorder may include:
- inappropriate elation
- inappropriate irritability
- severe insomnia
- disconnected and racing thoughts
- grandiose notions
- inappropriate social behavior
- dramatic increases in energy or talking
Who's most likely to get depressed?
Women are more than twice as likely as men to become depressed. If you're a woman, chances are 1 in 8 that you'll go through an episode of depression at least once. If you're a man, the odds are 1 in 14. You're also more likely to suffer depression if a parent or other close relative did, since depression often runs in families.
What causes depression?
Depression can be triggered by a traumatic event, such as the death of a loved one or the loss of a job. Or it can appear spontaneously, without any obvious reason. Researchers aren't sure whether malfunctioning neurotransmitters (brain chemicals that regulate mood) cause depression or whether it's changes in mood that affect brain chemistry. Some types of depression are present in families over generations. Generally, a combination of psychological, environmental, and genetic factors is involved in a depressive disorder.
What should I do if I think I'm depressed?
A good place to start is with your doctor. He or she may do an exam and run tests to rule out underlying physical conditions, such as hypothyroidism, that can cause similar symptoms. If your doctor thinks you may be depressed, you'll probably want to talk to a therapist to discuss your options.
What if someone I care about seems to be depressed?
It can be difficult to help someone who's depressed, since he may withdraw from family and friends and resist your attempts to help. Your best bet is to lend a sympathetic ear and -- without offering unsolicited advice or judgment -- encourage him to see a doctor or another healthcare professional. If there is a possibility that your loved one might try to take his life, you should urge him to call a suicide prevention hotline, or call yourself. If he is in immediate danger of harming himself, call 911.
Which treatments work?
You have at least four good options, including these:
Therapy (psychotherapy) provides long-term benefits by helping you to understand the sources of your depression and learn to cope with inner conflicts and stresses. If your depression was triggered by a recent crisis, therapy may involve talking about the event and related issues. If there are long-standing emotional conflicts, you and your therapist may need to explore past experiences going back to childhood. Interpersonal psychotherapy addresses problems in your relationships and helps you overcome negative relationship patterns that may contribute to depression. Cognitive behavioral therapy strives to change negative thinking patterns that can push you toward depression.
Drug therapy (antidepressant medications, such as Prozac and Zoloft) can alleviate symptoms, usually within two to six weeks. It is often used in conjunction with talk therapy. However, these drugs can have side effects, including dry mouth, nervousness, and insomnia.
Although antidepressants are relatively safe, some reports of increased suicidal thoughts and suicide attempts in some depressed patients under the age of 18 resulted in an FDA investigation into a possible link. When the FDA reviewed published and unpublished clinical trials of children and teens taking antidepressants, the agency found 4 percent of them had thought about or attempted suicide (though none succeeded) compared to 2 percent of those taking placebos. This prompted the FDA to adopt a "black box" warning on all antidepressants for children, teens, and young adults through the age of 24.
Herbal remedies for depression, the most promising of which is St. John's wort, have gained considerable recognition in recent years. However, talk with your doctor before trying any on your own, because some can be dangerous when mixed with prescription or over-the-counter medication. In an analysis of 23 randomized trials, researchers concluded that St. John's wort was as effective in treating mild to moderate depression as some antidepressant drugs, but a study reported in the Journal of the American Medical Association questions those results. A few studies have indicated that St. John's wort may help with depression-related insomnia and seasonal affective disorder (winter blues). Interestingly, only 20 percent of people taking the herb reported side effects, compared to 53 percent of those taking prescription medications.
The National Center for Complementary and Alternative Medicine says St. John's wort may be minimally effective in treating major depression; however, the science showing its effectiveness has been inconsistent and so it cannot recommend the herb as a proven therapy. Widely used in Europe, Saint John's wort is available at many health food stores and pharmacies in this country.
Keep in mind, however, that just because St. John's wort is natural doesn't mean it's benign; it's best to take potent herbal remedies under the supervision of a physician or other specialist. Don't use St. John's wort if you are already taking antidepressants. This mix can lead to serotonin overdose syndrome, which can be fatal in severe cases. The Food and Drug Administration also cautions against using Saint John's wort if you're currently taking HIV drugs or had an organ transplant. And a study of five cancer patients found that St. John's wort interfered with the anti-cancer drug irinotecan (Camptosar) -- even three weeks after patients stopped taking the herb. And because there are still questions about Saint John's effectiveness, your doctor is likely to recommend drug therapy if you are suffering from severe depression.
Regular exercise can also fight depression, possibly by raising endorphin levels -- those "feel-good" chemicals responsible for "runner's high." In one study of moderately depressed people, those who took up exercise were 12 times less likely than nonexercisers to remain depressed 10 years later. Another study found that as little as three months of regular exercise left patients significantly less depressed than those who didn't work out. It's not easy to motivate yourself to exercise when you're depressed, of course, but enlisting a workout buddy or joining a fitness class or other structured exercise program can help you clear this hurdle.
National Institute of Mental Health 5600 Fishers Lane Rockville, MD 20857 Phone: (800) 421-4211
National Foundation for Depressive Illness, Inc. P.O. Box 2257 New York, NY 10016 Phone: (800) 826-3632
National Depressive and Manic Depressive Association 730 N. Franklin, Suite 501 Chicago, IL 60601 Phone: (800) 248-4344
National Institute of Mental Health. Depression -- Complete Publication. February 2008. http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, D.C. American Psychiatric Association
Effectiveness of St. John's Wort in Major Depression: A Randomized Controlled Trial, Ric Shelton et al, JAMA, April 18, 2001
Risk of Drug Interactions with St. John's Wort, JAMA Vol 283 No.13, April 5, 2000
St. John's wort for depression -- an overview and meta-analysis of randomized clinical trials, Linde et al, British Medical Journal, Vol. 313-253-258 (3 August)
FDA Statement Regarding the Anti-Depressant Paxil for Pediatric Population. June 19, 2003. FDA Talk Paper T03-43
FDA Issues Public Halth Advisory on Cautions for Use of Antidepressants in Adults and Children. FDA Talk Paper T04-08. March 22, 2004.
FDA MedWatch -- Wellbutrin (buproprion hydrochloride) warnings added concerning emergence of suicideal ideation and behavior. June 22, 2004.
FDA MedWatch --Paxil (paroxetine hydrochloride) warnings added concerning emergence of suicidal ideation and behavior. June 22, 2004.
Suicide and Mental Health Association International. Depression in Men and Women: Whats the Difference? March 2001. http://suicideandmentalhealthassociationinternational.org/depressionmenwomen.html
Mental Health America. Fact Sheet: Depression in Women. March 2007. http://www.nmha.org/go/information/get-info/depression/depression-in-women
Food and Drug Administration. Antidepressant Use in Children, Adolescents, and Adults. May 2007. http://www.fda.gov/CDER/Drug/antidepressants/default.htm
National Center for Complementary and Alternative Medicine. St. John's Wort and Depression. December 2007. http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm