Depression

Definition

Depression is a mood disorder. It is marked by a lasting low mood, sadness, and lack of interest in activities. It disrupts functioning. Bouts of depression can last for weeks, months, or years. Treatment often helps people recover.

Causes

The exact cause of depression is not known. It is likely due to environment, personal traits, and stress.

The Brain

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Risk Factors

Depression is more common in women. Many things raise the risk. Examples are:

• A personal or family history of depression
• Long term illness
• Childhood abuse, neglect, or trauma
• Alcohol and drug abuse
• Stress, loss, or major life changes
• Other mental illnesses or brain injury
• Partner abuse
• Little or no social support

Symptoms

Depression can differ from person to person. Some have only a few symptoms, while others have many.

Symptoms can change over time. They may include:

• Lasting sadness, anxiety, or emptiness
• Loss of interest in hobbies, activities, or sex
• Feeling helpless, hopeless, or guilty
• Sleeping too much or too little
• Feeling tired, restless, or irritable
• Trouble with focus, memory, or decisions
• Changes in eating or weight
• Thoughts of death or suicide

Sometimes there are physical symptoms. Examples are aches and pains that cannot be explained.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam may be done. The doctor may give mental health exams. Tests may be done to rule out other causes.

Treatment

The goal is to ease symptoms and improve function. Treatment depends on the type and severity of depression. Severe depression may need hospital care. Care is urgent if someone might hurt themselves or others.

Options may be:

• Medicines, such as:
  • Antidepressants
  • Mood stabilizers and antipsychotics—if needed
  • Sedatives for anxiety—usually short term
  • Ketamine as a nasal spray or IV—may be used if other options do not work
  • Other medicines
• Counseling such as cognitive-behavior therapy and others—to improve coping
• Lifestyle changes such as:
  • Healthy diet with B vitamins and omega-3 fatty acids—may help ease symptoms
  • Daily exercise—may help boost mood
• Supplements, such as St. John's wort and DHEA—may help some

Other treatments may be:

• Light therapy—sitting near an ultra-bright light for a certain time each day
• Sleep deprivation therapy—a short term option that may improve mood

Sometimes symptoms are severe and other treatments do not work. In this case, options may be:

• Electroconvulsive therapy ECT—a brief electric pulse to the brain to help reset it
• Vagus nerve stimulation (VNS)—an implanted device that may alter signals to the brain

Prevention

To reduce the risk of depression:

• If at risk, seek treatment.
• Build strong friendships.
• Eat healthy food, including fruits, vegetables, and whole grains.
• Learn coping skills.
• Get regular sleep, exercise, and fun.
• Do not abuse alcohol or drugs.