Major Depression

What Is It?

Major depression is an illness that usually causes severe and persistent low mood sadness or a sense of despair. It is considered a mood disorder. The mood change can also appear as irritability or an inability to take pleasure in activities that usually are enjoyable.

Major depression is more than just a passing blue mood, a "bad day" or temporary sadness over a specific event. The mood changes that come with major depression last for at least two weeks and usually much longer.

A variety of symptoms usually accompany the mood change, and the symptoms can vary significantly among different people.

Many people with depression also have anxiety and tend to worry more about their physical health. They may have problems in their relationships and may function less well at work. Sexual functioning may be a problem. People with depression are more likely to abuse alcohol or other substances.

Depression probably involves chemicals called neurotransmitters that carry messages between brain cells. Changes in some hormones may play a role in depression. An episode of depression can be triggered by a stressful life event, such as the death of a loved one. But in many cases, depression does not appear to be related to a specific event.

Major depression may occur just once in a person's life or may return periodically. Some people who have repeated episodes of major depression also have a long pattern of a milder depressed mood called dysthymia. When major depression alternates with periods of great exuberance and energy, the illness is called bipolar disorder. If a woman has a major depressive episode within the first two to three months after giving birth to a baby, it is called postpartum depression. Depression that occurs mainly during the winter months is called seasonal affective disorder, or SAD.

Episodes of depression can occur at any age. Depression affects women twice as often as men. People who have a family member with major depression are more likely to develop depression or drinking problems.

Symptoms

A depressed person may gain or lose weight, eat more or less than usual, have difficulty concentrating, and have trouble sleeping or sleep more than usual. He or she may feel tired and have no energy for work or play. The person can appear slowed down or agitated and restless. The symptoms can be quite noticeable to others.

Perhaps the most painful and dangerous symptom of this illness is an unshakable feeling of worthlessness and guilt. The person may feel guilty about a specific life experience or may feel general guilt not related to anything specific.

Small burdens or obstacles may appear impossible to manage. If pain and self-criticism become great enough, they can lead to feelings of hopelessness, self-destructive behavior, or thoughts of death and suicide. The vast majority of people who suffer severe depression do not attempt or commit suicide, but they are more likely to do so than people who are not depressed.

People with major depression often have distorted thinking. For example, they are likely to be pessimistic out of proportion with the reality of their situation. Sometimes, the thinking of a depressed person becomes psychotic; that is, the person has great difficulty recognizing reality. Sometimes, depressed people develop delusions (false beliefs) or hallucinations (false perceptions).

Symptoms of major depression include:

• Distinctly depressed or irritable mood
• Loss of interest or pleasure
• Decreased or increased weight or appetite
• Increased or decreased sleep
• Appearing slowed or agitated
• Fatigue and loss of energy
• Feeling worthless or guilty
• Poor concentration
• Indecisiveness
• Thoughts of death, suicide attempts or plans

Diagnosis

A primary care physician or a mental health professional usually can diagnose depression by asking questions about medical history and symptoms. Major depression is diagnosed when a person has many of the symptoms listed above for at least two weeks. Many people with depression do not seek treatment because of society's attitudes about depression. The person may feel the depression is his or her fault or may worry about what others will think. Also, the depression itself may distort a person's ability to recognize the problem.

There are no specific tests for depression. However, it is important to be evaluated by a primary care physician to make sure the problems are not being caused by a medical condition or medication.

Expected Duration

Episodes of major depression last an average of four to eight months, but they can last for any length of time. Symptoms can vary in intensity during an episode. If depression is not treated, it can become chronic (long-lasting). Treatment can shorten the length and severity of a depressive episode.

Prevention

There is no way to prevent major depression, but detecting it early can diminish symptoms and help to prevent the illness from returning.

Treatment

A combination of psychotherapy and medication is most helpful. The most commonly prescribed antidepressants are known as selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). They are fairly easy to take and relatively safe compared with previous generations of antidepressants.

No medication is without side effects. SSRIs are known to cause problems with sexual functioning, some nausea, and an increase in anxiety in the early stages of treatment. Concerns about an increased risk of suicide in people taking SSRIs have remained a focus of researchers, although the evidence is not clear. However, a very small number of people taking these medications may feel worse rather than better. All troubling changes should be reported immediately to your doctor.

Other relatively new and effective antidepressants are bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron) and duloxetine (Cymbalta). The older classes of antidepressants, tricyclic antidepressants and monoamine inhibitors, are still in use and can be very effective for people who have not responded to other treatments.

It usually takes at least two to six weeks of taking any antidepressant to see improvement. Once the right medication is found, it may take up to a few months to find a proper dose and for the full positive effect to be seen.

Sometimes, two different antidepressants are prescribed together or a mood stabilizer, such as lithium (sold under several brand names) or valproic acid (Depakene, Depakote), is added. If psychotic symptoms are present, an antipsychotic medication is usually prescribed. These include haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa, Zydis), ziprasidone (Geodon) and aripiprazole (Abilify).

A number of psychotherapy techniques may be helpful, depending on the events that may have contributed to the depression, the availability of family and other social support, and personal preference. It is important to get education about depression and what support is available. A technique called cognitive behavioral therapy is designed to help a depressed person recognize fearful thinking and teach techniques for controlling symptoms. Psychodynamic, insight-oriented or interpersonal psychotherapy can help depressed people to sort out conflicts in important relationships or explore the history behind symptoms.

In some situations, a treatment called electroconvulsive therapy (ECT) can be a life-saving option. This treatment is controversial, but very effective. In ECT, an electrical impulse is applied to the person's scalp and passes to the brain, causing a seizure. The patient is under anesthesia and is monitored carefully. Medication is given before the procedure to prevent any outward signs of convulsions, which helps to prevent injury. Improvement is seen gradually over a period of days to weeks after the treatment. ECT is the quickest and most effective treatment for the most severe forms of depression, and in most people, it is not more risky than other antidepressant treatments.

When To Call A Professional

Depression is a painful and potentially dangerous illness, so you should contact a health care professional if you have any suspicion that you or a loved one is depressed.

Prognosis

Treatment of depression has become quite sophisticated and effective. The prognosis with treatment is excellent. The intensity of symptoms and the frequency of episodes often are significantly reduced. Many people recover completely.

When treatment is successful, it is important to stay in close touch with your doctor or therapist, because maintenance treatment is often required to prevent depression from returning.

Additional Info

Depression and Related Affective Disorders Association (DRADA)

2330 West Joppa Road

Suite 100

Lutherville, MD 21093

Phone: 410-583-2919

Email: drada@jhmi.edu

http://www.drada.org/

Depression and Bipolar Support Alliance (DBSA)

730 N. Franklin St.

Suite 501

Chicago, IL 60610-7224

Toll-Free: 1-800-826-3632

Fax: 312-642-7243

National Alliance for the Mentally Ill

Colonial Place Three

2107 Wilson Blvd.

Suite 300

Arlington, VA 22201-3042

Phone: 703-524-7600

Toll-Free: 1-800-950-6264

TTY: 703-516-7227

Fax: 703-524-9094

http://www.nami.org/

American Psychiatric Association

1000 Wilson Blvd.

Suite 1825

Arlington, VA 22209-3901

Phone: 703-907-7300

Toll-Free: 1-888-357-7924

Email: apa@psych.org

Web site: http://www.psych.org/

Public information site: http://www.healthyminds.org/

American Psychological Association

750 First St., NE

Washington, DC 20002-4242

Phone: 202-336-5510

Toll-Free: 1-800-374-2721

TTY: 202-336-6123

http://www.apa.org/

National Institute of Mental Health

Office of Communications

6001 Executive Blvd.

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Phone: 301-443-4513

Toll-Free: 1-866-615-6464

TTY: 301-443-8431

Fax: 301-443-4279

Email: nimhinfo@nih.gov

http://www.nimh.nih.gov/

National Mental Health Association

2001 N. Beauregard St., 12th Floor

Alexandria, VA 22311

Phone: 703-684-7722

Toll-Free: 1-800-969-6642

TTY: 1-800-433-5959

Fax: 703-684-5968

http://www.nmha.org/