What is depression?

Depression

Depression treatment: Overview

Depression is a condition that affects the way you feel, think, and act. It causes symptoms such as low energy, loss of interest in daily activities, and sadness or grouchiness that goes on for a long time. Depression is very common and affects men and women of all ages.

Depression is a medical illness caused by changes in the natural chemicals in your brain. It is not a character flaw, and it does not mean that you are a bad or weak person. It does not mean that you are going crazy.

It is important to know that depression can be treated. Medicines, counseling, and self-care can all help. Many people do not get help because they are embarrassed or think that they will get over the depression on their own. But some people do not get better without treatment.

Depression

Depression is an illness that makes you feel sad, lose interest in things you used to enjoy, withdraw from others, and have little energy. It's more than normal sadness, grief, or low energy. Most people get better with medicine, counseling, or a combination of the two.

After you have had an episode of depression, you are more likely to have it again.

What do you need to know to lower the chance of depression coming back?

Know your risk of depression coming back

Many things can make a person more likely to have depression again. These include having depression symptoms that continue after treatment, a previous episode of depression, and a history of childhood abuse or neglect.

It is important to know your risk and to recognize warning signs of depression symptoms returning. Once you know these things, you will be better able to keep it from happening to you.

Know the warning signs of depression returning

The two main symptoms of depression coming back are:

  • Feeling sad or hopeless.
  • Losing interest in your daily activities.

You may have other symptoms, such as:

  • You eat more or less than usual.
  • You sleep too much or not enough.
  • You feel restless and unable to sit still.
  • You feel unable to move.
  • You feel tired all the time.
  • You feel unworthy or guilty without an obvious reason.
  • You have problems concentrating, remembering, or making decisions.
  • You think often about death or suicide.

What are the symptoms of depression?

The symptoms of depression may be hard to notice at first. They vary among people, and it's easy to confuse them with just feeling "off." The two most common symptoms are:

  • Feeling sad or hopeless nearly every day for at least 2 weeks.
  • Losing interest in or not getting pleasure from most activities that used to be enjoyable, and feeling this way nearly every day for at least 2 weeks.

Other symptoms may appear. A person with depression may, almost every day:

  • Eat or sleep more or less than usual.
  • Feel tired.
  • Feel unworthy or guilty.
  • Find it hard to focus, remember things, or make decisions.

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.

How is depression treated?

Counseling and medicine usually work well to treat depression. Sometimes counseling alone is enough. Often a combination of the two works best.

How is brain stimulation used to treat depression?

Brain stimulation for depression includes:

Electroconvulsive therapy (ECT).

This may be used to treat severe depression or depression that doesn't get better with medicine and counseling or therapy.

Deep brain stimulation.

A device that uses electricity to stimulate the brain is put in your head. It is used for Parkinson's disease. But it hasn't been well studied for depression.

Vagus nerve stimulation.

A generator the size of a pocket watch is placed in your chest. Wires go up from the generator to the vagus nerve in your neck. The generator sends tiny electric shocks through the vagus nerve to the brain.

Transcranial magnetic stimulation.

An electromagnet is placed on your head. It sends magnetic pulses that stimulate your brain.

The last three items in the list above have not been well studied, and they may be expensive. They usually are considered only if other treatment doesn't work.

How can you help prevent depression?

Little is known about how to prevent depression, but getting exercise and avoiding alcohol and drugs may help. You can also take steps to help prevent depression from coming back (relapse) or to help your symptoms. Steps include taking your medicine as prescribed and continuing counseling after your symptoms improve.

How is depression diagnosed?

If your doctor thinks you are depressed, he or she will ask you questions about your health and feelings. Your doctor also may do a physical exam and tests to make sure your depression isn't caused by another disease.

Medicines for Depression

How can you care for yourself when you have depression?

You can try many things to help yourself when you feel depressed. These things may also help lower the chance of depression coming back.

Things to think about

Be realistic.

Set goals you can meet. If you have a big task to do, break it up into smaller steps you can handle. Don't take on more than you can handle. Be realistic in what you expect and what you can do.

Don't blame yourself or others for your depression.

Build your self-esteem, and try to keep a positive attitude.

Think about putting off big decisions until your depression has lifted.

Wait a bit on making decisions about marriage, divorce, or jobs. Talk it over with friends and loved ones who can help you look at the whole picture.

Think positively.

How you think can affect how you feel. Challenge negative thoughts with statements such as "I am hopeful," "Things will get better," and "I can ask for the help I need." Write down these statements and read them often, even if you don't believe them yet.

Things to do

Get regular exercise.

Even something as easy as walking can help you feel better.

Eat a balanced diet.

Include plenty of fresh fruits and vegetables, whole grains, and lean protein. If you have lost your appetite, eat small snacks rather than large meals.

Get enough sleep.

A good night's sleep can help mood and stress levels. Avoid sleeping pills unless your doctor prescribes them.

Find ways to cope with stress.

Too much stress may trigger depression. Using positive coping skills, such as listening to music or talking things over with a friend, can help you with your stress level.

Avoid drinking alcohol or using illegal drugs.

Also avoid taking medicines that have not been prescribed to you. Having a substance use problem makes treating depression harder.

Be thankful.
  • Thank people for the small and big things they do for you.
  • Be thankful for big things like having a home, family, and friends.
  • Be thankful for little things like making people laugh, enjoying a piece of music, or finding warm gloves for the winter.
Do things with others.

Try to be part of spiritual, social, holiday, or other activities. Help others who are not as well off as you are.

Get support from others.

Let your family and friends help you. Find someone you can trust and confide in, and talk to that person. This includes telling people you trust about depression. It is usually better than being alone and keeping it a secret.

Taking good care of yourself is important as you recover from depression. If your doctor prescribed medicines, take them exactly as they are prescribed. Be sure to make and go to all appointments, including counseling. And call your doctor if you are having problems.

Depression: Outside Looking In

What puts you at risk for depression?

You may be more likely to get depressed if:

  • Someone in your family has had depression. You may have inherited a trait that makes you more likely to have depression.
  • You have had depression before.
  • You have another mental health problem, such as post-traumatic stress disorder (PTSD), substance abuse disorder, or anxiety.

Other things that can increase your risk of depression include getting older, having a chronic health problem, and having a history of physical or sexual abuse.

Some people become depressed after a stressful life event, like losing a job or getting a divorce. Sometimes even happy life events, like getting married or a promotion, can trigger depression. This is because of the stress that comes with change.

You also may get depressed even if there is no reason you can think of.

Depression: Getting exercise

When you have depression, it may be hard to find the energy to be active. But being active on a regular basis may help you feel better. Here are some tips:

  • Start slowly.

    If you haven't been active in a while, try parking farther away from the store or taking the stairs. Or you could start with 5 to 10 minutes of exercise at a time. Over time you will be able to do more and more.

  • Find an activity you enjoy.

    You might try activities that increase your heart rate (aerobic exercise) and strength training (lifting weights).

  • Be active regularly.

    Aim for at least 3 days of exercise a week with a goal of being active for 45 minutes each time. This plan may help you get the most benefit for depression. It's okay to skip a day now or then or to cut back on your exercise if you're too tired or aren't feeling well. But keep trying.

  • Keep a record of your daily exercise.

    Also take time to notice how your depression symptoms change.

You may find that exercise helps you feel better emotionally and mentally. Some people may feel better within a few weeks. But the benefits are more likely to last if you stick with your exercise plan.

What is the connection between depression and suicide?

People who have depression may feel so bad that they think about suicide. They may feel hopeless, helpless, and worthless. They may see suicide as a way to solve their problems or end their pain.

Other symptoms of depression, besides suicidal behavior, include:

  • Feeling sad, empty, or tearful nearly every day.
  • Losing interest in activities that the person enjoyed in the past.
  • Sleeping or eating more or less than usual.
  • Having trouble thinking and concentrating.
  • Having headaches or stomachaches.
  • Feeling very tired.
  • Feeling guilty and/or not letting others praise or reward them.
Take any mention of suicide seriously. If someone talks about suicide, self-harm, or feeling hopeless, get help right away.

Depression: Making food choices to reduce stress

Avoiding certain foods and eating a balanced diet helps your body deal with tension and stress, which contribute to depression.

  • Avoid or limit caffeine and power drinks.

    Coffee, tea, some soda pops, and chocolate have caffeine. If you drink a lot of caffeine, slowly reduce how much you drink. If you stop drinking caffeine suddenly, you may have headaches and find it hard to focus.

  • Avoid skipping meals or eating on the run.

    Skipping meals can make depression-related symptoms such as headaches or stomach tension worse. Skipping meals also may set you up to overeat at the next meal. Overeating often leads to feelings of guilt and sadness. These feelings don't help depression.

  • Avoid eating to relieve stress.

    Eating to relieve stress can lead to overeating and guilt. If you tend to eat this way, replace eating with other actions that relieve stress. Try taking a walk, playing with a pet, or taking a bath.

Notice how you feel when you avoid doing things that can make your depression worse.

Depression: When to call

Call 911 or other emergency services right away if:

  • You feel you cannot stop from hurting yourself or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

  • Call the Suicide and Crisis Lifeline at 988.
  • Call 1-800-273-TALK (1-800-273-8255).
  • Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Call your doctor now or seek immediate medical care if:

  • You hear voices.
  • You feel much more depressed.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You are having problems with your medicine.
  • You are not getting better as expected.

Depression: Using Your Inner Strengths

Do you have depression?

Read the following information to help you decide whether you might have depression. It does not take the place of a doctor's diagnosis.

Depression causes you to feel sad or hopeless much of the time. It's different from normal feelings of sadness, grief, or low energy. Depression is a medical problem that needs treatment. If you think you may be depressed, see your doctor for diagnosis and treatment right away. Untreated depression may get worse.

You may have major depression if you have at least five of the symptoms listed below for 2 weeks or longer and one of the symptoms is either sadness or loss of interest. You may:

  • Feel sad, hopeless, or empty. Others might have noticed that you appear sad or tearful.
  • Lose interest in or not get pleasure from most daily activities.
  • Lose or gain weight because of changes in how hungry you feel.
  • Sleep too much or not enough.
  • Feel restless and not able to sit still, or sit quietly and feel that moving takes great effort.
  • Feel tired all the time.
  • Feel unworthy or guilty for no reason. You may worry that people don't like you.
  • Find it hard to focus, remember things, or make decisions.
If you have fewer symptoms, you may still be depressed and need treatment. No matter how many symptoms you have, it's important to see your doctor. The sooner you get treatment, the better your chance for a quick and full recovery.
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. Learn the warning signs of suicide, which include talking a lot about death, giving things away, or using a lot of alcohol, drugs, or both.

If you have just lost someone you care about, you may have symptoms similar to those of depression. Feelings of sadness, sorrow, and grief are normal. And most people start to feel better over several months. But if you feel very sad or depressed, your symptoms don't go away, or you think about killing or hurting yourself, see your doctor. You may need treatment.

Supporting someone who is depressed

If someone you care about has been diagnosed with depression, here are some things you can do to support them.

  • Learn about depression.

    Know what is true about depression, and know the myths about depression. Myths include thinking that depression isn't real or that a person who is depressed is weak. Be aware of your own and other people's negative attitudes (stigma) toward depression. Do what you can to fight stigma and teach people about depression.

  • Help the person set up and get to visits with a doctor or other health professional.

    Reassure them that they will get better with the right kind of treatment. Treatment depends on how severe the depression is and includes medicine, counseling, self-care, or a combination of these.

  • Help the person manage medicines.

    Remind the person with depression that medicine is important and that the dose or medicine can be changed to reduce or get rid of side effects. Know the side effects of medicines and contact the doctor if needed.

  • Keep in mind other health issues.

    Be aware of other health problems the person may have, such as diabetes or heart problems. And help the person have good health habits. Encourage the person to seek treatment if they show signs they may be struggling with alcohol or drug use.

  • Listen when the person wants to talk.

    If you're there to help the person talk things through, it may help the person feel better or continue treatment.

  • Avoid giving advice.

    But gently point out that not everything is bad, and offer hope. Urge the person to continue treatment. Don't tell the person that they are lazy or should be able to get over it.

  • Keep your relationship as normal as you can.

    But don't pretend that depression doesn't exist or that there isn't a problem.

  • Encourage the person to do things.

    Ask the person to do things with you, such as go for walks or to a movie, and encourage the person to continue with favorite activities. If the person says no, then that's okay. But be sure to ask again in the future. Don't push too much, which may make the person feel worse.

  • Ask what you can do.

    Try to help with daily life. For example, you might help with housework or lawn care, getting the kids to school, or running errands.

  • Don't be offended.

    If you are a spouse or are very close to someone, you may feel hurt because the person isn't paying attention to you and may seem angry or uncaring. Remember that your loved one still cares for you but just isn't able to show it.

  • Take care of yourself.

    Spending a lot of time with someone who has depression may be hard on you too.

    • Take care of yourself first. Do things you enjoy, such as seeing family or going to movies.
    • Don't help too much. A common mistake caregivers make is providing too much care. Even if they don't admit it, people like to help themselves. Take some time off.
    • Don't do it alone. Ask others to help you, or join a support group. The more support you have, the more help you can give to the person.
  • Get help right away if you or someone you know talks about suicide, self-harm, or feeling hopeless.

    Where to get help 24 hours a day, 7 days a week

    If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

    • Call the Suicide and Crisis Lifeline at 988.
    • Call 1-800-273-TALK (1-800-273-8255).
    • Text HOME to 741741 to access the Crisis Text Line.

    Consider saving these numbers in your phone.

    Go to 988lifeline.org for more information or to chat online.

What are some myths and facts about depression?

People's ideas about depression have changed over the years. New technology and new research show that depression is a disease, just like asthma or heart failure.

Here are some myths and facts about depression.

Myths and facts about depression

Myth

Fact

“Depression isn't real.”

"It's something in your head."

"It's being lazy."

Depression is a disease of the brain. Experts believe that certain brain chemicals go out of balance to cause the disease. No single thing causes this. Many things, including your genes, stressful events, illness, and medicines, can cause the imbalance.

"Depression always will get better by itself."

"You usually can wait it out."

"Treatment doesn't really work."

A few people get over depression on their own, but most people need treatment. Most people with depression can be treated, and they return to their work and home routines. Without treatment, depression can last for months or even years.

"Children cannot get depression."

Depression can develop in any age group, ethnic group, economic group, and gender.

"Depression only happens if something bad happens to you. For example, you only get it after a bad divorce or losing your job."

Depression may start after something bad happens, but other things also may trigger it. Medicines, hormone problems, childbirth, and using alcohol and drugs all can trigger depression. Sometimes it happens for no clear reason.

"If you can't get over depression, you're weak."

Depression is a disease. It is a problem with your brain chemistry, not your character. You can't force yourself to get over it any more than you can make asthma or a heart attack go away.

"Only people who are very depressed or who think about suicide need medicine."

Many people with depression are helped by medicine. Medicine can improve or get rid of the symptoms of depression.

How do you overcome barriers to getting help for depression?

Many people hesitate to get help for depression. It can be hard to take that first step. Here are some common barriers and ideas for other ways that you might think about them. Maybe you'll see yourself in one of these.

Barrier

Solution

"See a shrink? I'm not crazy."

"People will think I'm weak."

"What will my family and friends think?"

  • You are looking for help so you will feel better. It takes strength and courage to seek help from others.
  • You may not need to see a psychiatrist or psychologist. Your family doctor or a counselor may be able to help you.
  • Mental health problems are real and can affect your physical health. They are not character flaws. They are often caused by chemicals in the brain or by genes passed down by families.
  • You can get better with the right kind of treatment. Treatment includes medicine, counseling, self-care, or a combination of these. The kind of treatment you have will depend on how severe your symptoms are.

"It might hurt my career."

  • You may think that it will hurt your career if people at your workplace know that you are depressed. But depression may make it hard for you to perform your job well. Treatment can help you perform better.

"I've had counseling before and didn't like it."

  • Learn about treatment for depression, and find someone you feel comfortable with. If you don't connect with one doctor or counselor, try another one.

"Aren't medicines for depression addictive?"

"These medicines make you crazy or uninterested in sex."

  • When you take medicines for depression for a period of time, your body gets used to the medicine. This is called physical dependence. This is different than a substance use disorder.
  • Medicines for depression have side effects, and some affect sexual desire. If you're worried about side effects, your doctor can find medicines with fewer or different side effects or can change your dose.

"Someone might get into my medical records and see this."

  • Doctors, counselors, hospitals, and clinics take privacy seriously. They won't share your records with anyone who's not involved in your treatment. If you have questions about your privacy, ask the doctor about it when you call for an appointment.

"It's hard to schedule and find time for an appointment."

"I can't get there."

  • Therapists, clinics, and hospitals may offer after-hours appointments or weekend hours. They may also offer virtual appointments.
  • Look at your schedule, and find when it would be easiest for you to see a doctor. Ask for this time when you call.
  • When you call for an appointment, explain your situation. Most doctors will try to find a time that works for both of you.
  • Ask a friend to help you get there, or check local bus schedules.

"I've tried to talk to people. They just don't get it and don't care."

  • It may be hard for some people to understand depression. But other people who have been through depression can understand. Consider finding a support group of people with similar experiences.

"I can't afford it."

  • Many towns and cities have resources that may be able to help you. Call your local social services department or welfare office to find out.
  • If you have insurance, check your policy to see if you have mental health benefits.
  • Ask your doctor for help. He or she may be able to find free or low-cost medicine or counseling.
  • Check to see if you qualify for Medicaid or Medicare. These programs may be able to help you.
  • Some universities, hospitals, and other institutions may have training programs and may offer reduced fees.

What is depression?

Depression is an illness that affects how a person feels, thinks, and acts. It's different from normal feelings of sadness or grief. A person who has depression may have less energy. He or she may lose interest in daily activities and may feel sad and grouchy for a long time. Depression is a common illness. It affects men and women of all ages and backgrounds.

Many people, and sometimes their families, feel embarrassed or ashamed about having depression. But it isn't a sign of personal weakness. It's not a character flaw. A person who is depressed is not "crazy." Depression is a medical illness. It's caused by changes in the natural chemicals in the brain. Most experts believe that a combination of family history (a person's genes) and stressful life events can cause depression.

Health problems may also cause depression or make it worse. It's common for people with long-term (chronic) health problems like coronary artery disease, diabetes, cancer, or chronic pain to feel depressed.

It's important to know that depression can be treated. The first step toward feeling better is often just seeing that the problem exists.

What medicines or substances can cause symptoms of depression?

Medicines can sometimes cause symptoms of depression. This may happen with medicines like interferons, opioids, and some steroid medicines. If you are worried about this, talk with your doctor.

Managing work stress if you have depression

Medicine and counseling are important treatments for depression. Getting treatment right away can help you feel better so you can focus on your job. In addition, there are ways to manage work stress if you are depressed.

  • Avoid stress.

    Be aware of what things lead to stress so you can avoid these "triggers" that make your depression worse.

  • Consider getting counseling.

    You may want to use an employee assistance program (EAP), if your work offers this service. This program helps you get counseling.

  • Manage your time.

    Learn to manage your time, and leave your work at the office. Balancing your work and personal life may help you feel better.

  • Talk with your supervisor or manager about possible changes.

    You may be able to:

    • Improve the environment around your office.
    • Work less from home if working from home makes your depression worse.
    • Get help managing difficult people or situations.
    • Schedule time off for personal time and depression treatment.
    • Maintain your privacy about your health issues.
    • Use company programs such as an EAP if available.

Some job situations may not improve even after you try these changes. You may want to consider looking for another job.

Martha's story: A voice for recovery from depression

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Martha, 60
Martha's recovery inspires her to help others.
"I woke up every day with suicide on my mind, and I went to bed with suicide on my mind."

Over coffee, Martha explains how severe depression left her wanting to end her life and unable to have normal conversations with people.

"I woke up every day with suicide on my mind, and I went to bed with suicide on my mind," Martha says.

Nearly broke, and without health insurance, she says her life became a "dark maze of mental illness."

She went into the hospital for treatment at least a dozen times. And she needed to get county assistance to help pay for her medicines. "I realized what it meant to be on the margins of society," she says.

Now recovered, Martha directs an agency that advocates for people who have mental illnesses. Her work allows her to be an "edgy voice" for those like her who need help to recover.

"People do get better," she says.

Martha's story reflects her experiences as told in an interview. The photograph is not of Martha, to protect her privacy.

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The content above contains general health information provided by Healthwise, Incorporated, and reviewed by its medical experts. This content should not replace the advice of your healthcare provider. Not all treatments or services described are offered as services by us. For recommended treatments, please consult your healthcare provider.