feelings of sadness, apathy, or hopelessness lasting more than
interest in most daily activities, particularly pleasurable ones.
appetite and subsequent weight loss; increased appetite and weight
sleep (insomnia), frequent awakening throughout the night, or
conversely, an increased need for sleep.
diminished ability to think or concentrate.
may initially focus on physical or cognitive complaints brought
on by their depression. Insomnia and agitation are also more
common in older patients.
When To Call
with symptoms of depression should see a doctor for an evaluation
and possible referral to a mental health professional.
who has persistent thoughts of suicide should get immediate
psychological or medical treatment.
What Is It?
Depression is a mood disorder characterized by
a persistent sad or empty feeling, irritability, and a loss of
interest in everyday activities. The condition is twice as common
in women as in men and is usually episodic. But unlike normal
sadness or grieving, most bouts of depression last for weeks,
months, or even years. Some people with depression have a chronic,
low-grade form of the condition called dysthymia. A smaller number
suffer from bipolar disorderbouts of depression interspersed
with periods of elevated (manic) mood (see
Although depression is usually not considered life
threatening, it can lead to thoughts of and attempts at suicide.
As many as 70% of suicides in the United States are related to
depression, and nearly 9% of severely depressed people commit
suicide. Fortunately, the overwhelming majority of people with
depression can be helped by counseling (psychotherapy), antidepressant
drugs, or other therapies, thus lowering the suicide risk.
What Causes It?
cause of most cases of depression is unknown, it is thought to
be associated with a combination of medical, genetic, and environmental
of chemicals that transmit nerve signals (neurotransmitters)
in the brain may play a role.
appears to run in families, although no specific genes have been
may be connected to a major life event, such as the death of
a loved one or loss of a job. Recurrent episodes, however, appear
unrelated to such events.
In about 15%
of cases, depression develops in response to a medical illness
(especially heart disease, cancer, or a neurological disorder
such as Parkinson disease or stroke) or from long-term use of
some medications, including beta-blockers for high blood pressure
and corticosteroids for arthritis. Other causes of this "secondary
depression" include alcoholism, an underactive thyroid gland,
vitamin deficiencies, and schizophrenia.
initial onset of depression cannot be prevented, recurrent episodes
may be controlled or avoided altogether with ongoing psychotherapy
and/or drug therapy. The longer a person stays in treatment,
the less likely he or she is to experience a relapse.
are no reliable laboratory tests to diagnose depression, physical
examination and psychological evaluation are essential.
of either of the first two symptoms of depression listed, in
conjunction with other symptoms, for a period of two or more
family history of depression or a prior depressive episode helps
establish the diagnosis.
How To Treat It
is as effective as drug treatment in mild cases. Psychotherapy
may also be used in conjunction with drug therapy.
medications, particularly selective serotonin reuptake inhibitors
(SSRIs) but also tricyclics and sometimes monoamine oxidase (MAO)
inhibitors, are often prescribed.
therapy (using an electric current to cause a brief convulsion)
is sometimes used in severe cases.
bright light, known as light therapy, may be effective, particularly
when depression is related to seasonal changes (seasonal affective
depression, the underlying cause is addressed, although antidepressant
therapy may also be prescribed.
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