McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

What is depression?

Depression is when you feel sad and uninterested in daily life. You may have other symptoms as well. Depression can be mild to severe. It can last for a short time or a long time.

We all have times when we feel sad and blue. However, when you feel this way for more than 2 weeks in a row, it is called clinical depression. Clinical depression is a medical problem.

How does it occur?

Depression can begin at any age. It usually begins in the late teenage through young adult years unless it is caused by medical or substance abuse problems. It may come on slowly over weeks or months, but it can also come on suddenly.

The exact cause of depression is not known. It may result from chemical imbalances in the brain and nervous system. You may have abnormal levels of the chemicals that your nervous system uses to send signals to and from the brain. Depression tends to run in families. Daily social and psychological factors also play a part.

What are the symptoms?

Besides feeling sad and uninterested in things you usually enjoy, you may also:

• Be irritable.
• Have trouble falling asleep, wake up very early, or sleep too much.
• Notice changes in your appetite and weight, either up or down.
• Notice changes in your energy level, usually down but sometimes feeling overexcited.
• Lose sexual desire and function.
• Feel worthless and guilty.
• Have trouble concentrating or remembering things.
• Feel hopeless or just not care about anything.
• Have unexplained pain in your back or abdomen, or get headaches.
• Think often about death or suicide.

How is it diagnosed?

Your health care provider or a mental health professional can tell you if your symptoms are caused by clinical depression. He or she will ask about your symptoms and any drug or alcohol use. You may have some lab tests to rule out medical problems such as hormone imbalances. There are no lab tests that directly diagnose depression.

How is it treated?

You should not try to overcome clinical depression by yourself. Depression can be successfully treated with psychotherapy, antidepressant medicine, or both. Discuss this with your health care provider or therapist.

Medicine

Several types of medicines can help treat clinical depression. Your health care provider will carefully select one for you. Some medicines are:

• selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and several other newer antidepressants
• tricyclic antidepressants such as imipramine (Tofranil), nortriptyline (Aventyl HCl, Pamelor), and desipramine (Norpramin)
• monoamine oxidase inhibitors (MAOs) such as tranylcypromine (Parnate), meprobamate (Equanil, Miltown), and phenelzine (Nardil)
• trazodone (Desyrel), an antidepressant chemically unrelated to the other groups
• mood stabilizers (primarily for bipolar and cyclothymic disorders) such as lithium (Eskalith, Lithobid, Lithonate, Lithotabs), carbamazepine (Tegretol), and valproic acid (Depakene).

You must take antidepressant medicines daily for 3 to 6 weeks for them to work properly.

There are no nonprescription medicines available to treat depression.

Psychotherapy

Seeing a psychologist, psychiatrist, or psychotherapist can help with all forms of depression. Therapy may last a short time or may need to go on for many months. Cognitive behavioral therapy (CBT) is a way to help you identify and change thought processes that can lead to depression. Replacing negative thoughts with more positive ones can help you with depression.

Natural and Alternative Treatments

Many herbal and dietary products are said to help depression. St. John's wort is the only one that research shows is effective. At 300 to 400 mg per day, hypericin (St. John's wort) can treat mild to moderately severe depression. It will not help severe cases of depression or bipolar disorder.

Many types of alternative treatments are said to help depression. Some of them are:

• Biofeedback. You learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration, but it does not help depression.
• Massage Therapy. Massage therapy may help lower stress, but it does not cure depression.
• Relaxation Therapies. Learning special relaxation methods can help with depression, along with medicines and psychotherapy. Yoga and meditation may also be helpful.
• Art and Music Therapies. Some people find art and music therapy, along with medicines and psychotherapy, are helpful in treating depression.

How long will the effects last?

Different kinds of clinical depression last for different amounts of time. Experts do not fully understand why. Often depression lasts a few weeks and never comes again. It can also last months or years. Some people experience depression over and over all their lives.

What can I do to help myself or my loved one?

Prevention

Maintaining a healthy lifestyle is important. To help prevent depression:

• Exercise for at least 20 minutes every day, for example, take a brisk walk.
• Learn which activities make you feel better and do them often.
• Talk to your family and friends.
• Eat a healthy diet.
• Do not abuse alcohol or drugs.
• Learn ways to lower stress, such as breathing exercises or relaxation techniques.

When should I seek help?

Do not try to overcome depression all by yourself. Seek professional help if you believe that you or a loved one have the symptoms of clinical depression.

When should I seek immediate help?

Get emergency care if you or a loved one have serious thoughts of suicide or harming others.

You may wish to contact the National Depressive and Manic-Depressive Association (NDMDA) or the National Mental Health Association (NMHA).

• NDMDA's toll-free information line number is 1-800-82-NDMDA. NDMDA's Web site address is http://www.ndmda.org.
• NMHA's toll-free Information Center number is 1-800-969-NMHA. NMHA's Web site address is http://www.NMHA.org.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.