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This topic covers depression in adults. For information on:
Depression is an illness that causes you to feel sad, lose interest in activities that you've always enjoyed, withdraw from others, and have little energy. It's different from normal feelings of sadness, grief, or low energy. Depression can also cause people to feel hopeless about the future and even think about suicide.
Many people, and sometimes their families, feel embarrassed or ashamed about having depression. Don't let these feelings stand in the way of getting treatment. Remember that depression is a common illness. It affects the young and old, men and women, all ethnic groups, and all professions.
If you think you may be depressed, tell your doctor. Treatment can help you enjoy life again. The sooner you get treatment, the sooner you will feel better.
Depression is a disease. It's not caused by personal weakness and is not a character flaw. When you have depression, there may be problems with activity levels in certain parts of your brain, or chemicals in your brain called neurotransmitters may be out of balance.
Most experts believe that a combination of family history (your genes) and stressful life events may cause depression. Life events can include a death in the family or having a long-term health problem.
Just because you have a family member with depression or have stressful life events doesn't mean you'll get depression.
You also may get depressed even if there is no reason you can think of.
The symptoms of depression may be hard to notice at first. They vary among people, and you may confuse them with just feeling "off" or with another health problem.
The two most common symptoms of depression are:
A serious symptom of depression is thinking about death or suicide. If you or someone you care about talks about this or about feeling hopeless, get help right away.
If you think you may have depression, take a short quiz to check your symptoms:
Depression can be treated in various ways. Counseling, psychotherapy, and antidepressant medicines can all be used. Lifestyle changes, such as getting more exercise, also may help.
Work with your health care team to find the best treatment for you. It may take a few tries, and it can take several weeks for the medicine and therapy to start working. Try to be patient and keep following your treatment plan.
Depression can return (relapse). How likely you are to get depression again increases each time you have a bout of depression. Taking your medicines and continuing some types of therapy after you feel better can help keep that from happening. Some people need to take medicine for the rest of their lives. This doesn't stop them from living full and happy lives.
If someone you care for is depressed, the best thing you can do is help the person get or stay in treatment. Learn about the disease. Talk to the person, and gently encourage him or her to do things and see people. Don't get upset with the person. The behavior you see is the disease, not the person.
Learning about depression:
Living with depression:
For family and friends:
Health Tools help you make wise health decisions or take action to improve your health.
|Decision Points focus on key medical care decisions that are important to many health problems.|
|Depression: Should I Stop Taking My Antidepressant?|
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|Interactive Tool: Are You Depressed?|
Depression is a disease. It isn't caused by personal weakness, and it isn't a character flaw. When you have depression, there may be problems with activity levels in certain parts of your brain, or chemicals in your brain called neurotransmitters may be out of balance.
Most experts believe that a combination of family history (your genes) and stressful life events may cause depression.
Sometimes even happy life events, such as a marriage or promotion, can trigger depression because of the stress that comes with change.
Just because you have a family member with depression or have stressful life events doesn't mean you'll get depression. You also may get depression without going through a stressful event.
Health problems also can cause depression. For example, both anemia and an underactive thyroid gland (hypothyroidism) can lead to depression. Treating the health problem usually cures the depression.
The symptoms of depression may be hard to notice at first. They can be different from person to person. You may confuse them with just feeling "off" or "down." You also may confuse the symptoms with another health problem.
The two most common symptoms of depression are:
If you have felt this way for at least two weeks, it is possible you are experiencing depression.
A serious symptom of depression is thinking about death and suicide. If you or someone you care about talks about suicide or feeling hopeless, get help right away.
You also may:
It's possible to have periods of both energy and elation (mania) and depression. This may be bipolar disorder. If this happens to you, tell your doctor. The treatments for depression and bipolar disorder are different.
Symptoms can be mild, moderate, or severe:
Depression can affect your physical health. You may have headaches or other aches and pains or have digestive problems such as constipation or diarrhea. You may have trouble having sex or may lose interest in it. If you notice any of these changes, talk to your doctor. He or she may be able to help.
One Woman's Story:
"I woke up every day with suicide on my mind, and I went to bed with suicide on my mind."—Martha
If you think you may have depression, take a short quiz to check your symptoms:
Depression is different for everyone.
For some people, a bout of depression begins with symptoms of anxiety (such as worrying a lot), sadness, or lack of energy. This may go on for days or months before the person or others think that depression could be the problem.
And other people may feel depressed suddenly. This may happen after a big change in life, such as the loss of a loved one or a serious accident.
If you don't get treated, depression may last from months to a year or longer.
A small number of people feel depressed for most of their lives and always need treatment.
Depression can return, which is called a relapse. At least half of the people who have depression once get it again.1 How likely you are to get depression again increases each time you have a bout of depression. You can make having another bout of depression less likely by following your treatment plan and using your medicines.
Depression is linked with many health concerns. These include other diseases, drug or alcohol use, and pregnancy. If you have depression and another health concern, you need to deal with both of them.
Experts don't know why some people get depression and others don't. But certain things make you likely to get depression. These are called risk factors.
Important risk factors for depression include:
Other risk factors include:
Medical problems also may cause depression or make it worse. These problems include:
Women have more risk factors. These include:
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), or other emergency services right away if:
Call a doctor right away if:
Seek care soon if:
If you have not been diagnosed with depression but you think you may be depressed, use the Feeling Depressed topic to check your symptoms.
Your family doctor can help you with depression. If treatment by your doctor doesn't help you, the next step is to see a mental health professional.
No matter who you see, it is important that this person has experience treating people who have depression and is trained in proven therapies. It is also important that you establish a good long-term relationship. If you don't feel comfortable with one doctor or therapist, try another one.
Health professionals who can diagnose depression and prescribe medicine include:
Treatment such as professional counseling or therapy can be provided by:
Other health professionals who also may be trained in treating depression include:
Depression may be diagnosed when you talk to your doctor about feeling sad or when your doctor asks you questions and discovers that you are feeling sad. You may be seeing your doctor because you feel sad or because you have another health problem or concern.
If your doctor thinks you are depressed, he or she will ask you questions about your health and feelings. This is called a mental health assessment. Your doctor also may:
The U.S. Preventive Services Task Force recommends that all people, starting at age 12, be screened for depression.2 Screening for depression helps find depression early. And early treatment may help you get better faster.
Treatment for depression includes counseling, medicines, and lifestyle changes. Your treatment will depend on you and your symptoms. You and your health care team will work together to find the best treatment for you.
If you don't get treated, depression may last from months to a year or longer. A small number of people feel depressed for most of their lives and always need treatment.
If you need help deciding whether to talk to your doctor about depression, see some common reasons people don't get help and how to overcome them.
Other treatments for depression include:
One Man's Story:
"...[T]his was the first time I was willing to do anything to recover. It's changed my whole life."—Stan
Little is known about how to prevent depression, but getting exercise and avoiding alcohol and drugs may help. Exercise may also help prevent depression from coming back (relapse) and may improve symptoms of mild depression.
You also may be able to prevent depression by avoiding alcohol and drugs. Alcohol and drugs can contribute to depression. And using them can be a sign that you have depression.
You may be able to prevent a relapse or keep your symptoms from getting worse if you:
Counseling and psychotherapy are important parts of treatment for depression. You will work with a mental health professional such as a psychologist, licensed professional counselor, clinical social worker, or psychiatrist. Together you will develop an action plan to treat your depression.
When you hear "counseling" or "therapy," you may think of lying on a couch and talking about your childhood. But most of these treatments don't look for hidden memories. They deal with how you think about things and how you act each day.
The first step is finding a therapist you trust and feel comfortable with. The therapist also should have experience treating people who have depression and should be trained in proven therapies. These therapies include:4
Other treatments you may have heard of include problem-solving therapy, which looks at your current problems and helps you solve them, and family therapy, which brings you and your family together to discuss your relationships and depression. Experts don't know how well these therapies work for depression.4 Problem-solving therapy may be especially helpful for older adults.7
One Woman's Story:
"I walked into the therapist's office crying, mute. I felt as if no one heard me."—Debbie
How long your treatment lasts depends on how severe your depression is and how well you respond to treatment. Short-term counseling or therapy usually lasts from 10 to 20 weeks, and you usually see your mental health professional once a week. But you may need to meet with your health professional more often or for a longer time.
Antidepressant medicines may improve or completely relieve the symptoms of depression. Whether you need to take medicine depends on your symptoms. You and your doctor can decide if you need medicine and which medicine is right for you.
Antidepressant medicines work in different ways. No antidepressant works better than another, but different ones work better or worse for different people. The side effects of antidepressant medicines are different and may lead you to choose one instead of another.
You may have to try different medicines or take more than one to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one and may need to take the antidepressant and another type of medicine, such as an antiseizure, mood stabilizer, antipsychotic, or antianxiety medicine.
Together you and your doctor will decide if you need medicine, what things you'll need to think about if you need medicine, and which medicine is right for you.
Antidepressant medicines include:
Antidepressant medicines have side effects. You may notice the side effects before you notice that the medicine is helping you. Side effects vary depending on the medicine you take.
People who are taking medicines for other health problems need to know about medicine interactions. Talk with your doctor about the best way to track whether a combination of medicines is harming you. People who are taking a lot of medicines also are more likely to have harmful side effects.
One Woman's Story
"It took about a year for me to not feel depressed at all."—Sherri
If you take antidepressants, you should take them for at least 6 months after you begin to feel better. This can help prevent you from feeling depressed again (relapse). If this isn't the first time you have been depressed, your doctor may want you to take these medicines even longer.
You may start to feel better within 1 to 3 weeks after starting your antidepressant medicine. But it can take as many as 6 to 8 weeks to see a great deal of improvement. If you have questions or concerns about your medicines, or if you don't notice that you feel better by 3 weeks, talk to your doctor.
Some people need to remain on medicine for several months to years. Others will need medicine long-term. This is more likely if you have had several bouts of depression that seriously affected your home life, work life, or both.
Don't quit taking your medicines without talking to your doctor. If you quit suddenly, it can cause your depression to return and it can cause dizziness, anxiety, fatigue, and headache. If you and your doctor decide you can quit using medicine, gradually reduce the dose over several weeks.
When you're going through depression, you can't just shake it off. You might have a couple of good days followed by a bad day or a string of bad days. And you don't know how long it will last. Depression isn't like the flu or a sprained ankle, where your doctor can tell you about how long it will take to get better.
When you're getting better, many experts call it recovery. Recovery is finding your path to the life you care about.
During your recovery, be patient and kind to yourself. Remember that depression isn't your fault and isn't something you can overcome with willpower alone. You need treatment for depression, just like for any other illness.
Continuing your treatment, helping yourself, getting support, and having a healthy lifestyle are all part of your recovery. Your symptoms will fade as your treatment starts to work. Don't give up. Focus your energy on getting better. Your mood will improve. It just takes some time.
You can take many steps to help yourself when you feel depressed or are waiting for your medicine to work. These steps also help prevent depression from coming back.
You also can help yourself by thinking about what is good in your life. You can:
One Woman's Story:
"If you keep your thoughts in, they will never be quiet. It helps my depression to express them."—Cheryl
Electroconvulsive therapy (ECT) may be used to treat severe depression or depression that doesn't get better with medicine and counseling or therapy.
Other types of brain stimulation have not been well studied and may be expensive. They usually are considered only if other treatment doesn't work. They include:
Complementary therapies are sometimes used for depression. Always tell your doctor if you are using any of them. These therapies include:
If someone you care about is depressed, you may feel helpless. Maybe you're watching a once-active or happy person slide into inactivity, or you're seeing a good friend lose interest in favorite activities. The change in your loved one's or friend's behavior may be so big that you feel you no longer know him or her.
Here are some things you can do to help:
One Woman's Story:
"Having a friend or loved one to help you can really help."—Susan
|Depression and Bipolar Support Alliance|
|730 North Franklin Street|
|Chicago, IL 60654-7225|
|Phone:||1-800-826-3632 includes a hotline for help with depression and bipolar disorder|
The Depression and Bipolar Support Alliance publishes brochures, books, and videotapes about the treatment of mood disorders, all available free of charge or for a nominal fee. It also has an information and referral line, and its website contains helpful tools and information, including personal wellness tools and links to research studies.
|Mental Health America|
|2000 North Beauregard Street, 6th Floor|
|Alexandria, VA 22311|
|Phone:||1-800-969-NMHA (1-800-969-6642) referral service for help with depression
Mental Health America (formerly known as the National Mental Health Association) is a nonprofit agency devoted to helping people of all ages live mentally healthier lives. Its website has information about mental health conditions. It also addresses issues such as grief, stress, bullying, and more. It includes a confidential depression screening test for anyone who would like to take it. The short test may help you decide whether your symptoms are related to depression.
|National Alliance on Mental Illness (NAMI)|
|3803 North Fairfax Drive|
|Arlington, VA 22203|
|Phone:||1-800-950-NAMI (1-800-950-6264) hotline for help with depression
The National Alliance on Mental Illness is a national self-help and family advocacy organization dedicated solely to improving the lives of people who have severe mental illnesses such as schizophrenia, bipolar disorder (manic depression), major depression, obsessive-compulsive disorder, and panic disorder. NAMI focuses on support, education, advocacy, and research. The mission of the organization is to "eradicate mental illness and improve the quality of life of those affected by these diseases."
|National Institute of Mental Health (NIMH)|
|6001 Executive Boulevard|
|Bethesda, MD 20892-9663|
The National Institute of Mental Health (NIMH) provides information to help people better understand mental health, mental disorders, and behavioral problems. NIMH does not provide referrals to mental health professionals or treatment for mental health problems.
|National Suicide Prevention Lifeline|
The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service. Crisis centers are located in 130 locations across the United States. Each caller is routed to the closest provider of mental health and suicide prevention services.
- Young JE, et al. (2008) Cognitive therapy for depression. In DH Barlow, ed., Clinical Handbook of Psychological Disorders, 4th ed., pp. 250–305. New York: Guilford Press.
- U.S. Preventive Services Task Force (2009). Screening for depression in adults: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf09/adultdepression/addeprrs.htm.
- Hollon SD, et al. (2005). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Archives of General Psychiatry, 62(4): 417–422.
- Butler R, et al. (2007). Depression in adults: Psychological treatments and care pathways, search date April 2006. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Khoury B, et al. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6): 763–771.
- Powers MB, et al. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2): 73–80.
- Arean P, et al. (2008). Effectiveness of problem-solving therapy for older, primary care patients with depression: Results from the IMPACT project. Gerontologist, 48(3): 311–323.
- Buchner DM (2012). Physical activity. In L Goldman, A Shafer, eds., Cecil Medicine, 24th ed., pp. 56–58. Philadelphia: Saunders.
Other Works Consulted
- Canadian Psychiatric Association and the CANMAT Depression Work Group (2001). Clinical practice guidelines for the treatment of depressive disorders. Canadian Journal of Psychiatry, 46(Suppl 1): S13–S89.
- American College of Obstetricians and Gynecologists (2008, reaffirmed 2009). Use of psychiatric medications during pregnancy and lactation. ACOG Practice Bulletin No. 92. Obstetrics and Gynecology, 111(4): 1001–1020.
- American Psychiatric Association (2010). Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 3rd ed. Available online: http://psychiatryonline.org/guidelines.aspx.
- Baloch HA, Soares JC (2010). Mood disorders. In EG Nabel, ed., ACP Medicine, section 13, chap. 2. Hamilton, ON: BC Decker.
- Lam RW, et al. (2004). Prescribing antidepressants for depression in 2005: Recent concerns and recommendations. Canadian Journal of Psychiatry, 49(12): 1–6 (insert). Also available online: http://publications.cpa-apc.org/media.php?mid=143.
- Matorin AA, Ruiz P (2009). Clinical manifestations of psychiatric disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1071–1107. Philadelphia: Lippincott Williams and Wilkins.
- Murray MT, Bongiorno PB. (2006). Affective disorders. In JE Pizzorno Jr, MT Murray, eds. Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 1427–1448. St. Louis: Churchill Livingstone Elsevier.
- Qaseem A, et al. (2008). Using second-generation antidepressants to treat depressive disorders: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 149(10): 725–733. Also available online: http://annals.org/article.aspx?articleid=743690.
- Sadock BJ, Sadock VA (2007). Depression and bipolar disorder. In Kaplan and Sadock's Synopsis of Psychiatry, 10th ed., pp. 527-562. Philadelphia: Lippincott Williams and Wilkins.
- Safety of SSRI in pregnancy (2008). Medical Letter on Drugs and Therapeutics, 50(1299): 89–90.
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Specialist Medical Reviewer||Lisa S. Weinstock, MD - Psychiatry|
|Last Revised||July 22, 2013|
Last Revised: July 22, 2013
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