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Major Depression

What is depression?

Depression is a serious mood disorder that affects your whole body, including your mood and thoughts. It touches every part of your life. It’s important to know that depression is not a personal weakness or character flaw. Treatment is often needed.

Once you've had an episode of depression, you are at risk of having more throughout life. If you don’t get treatment, depression can happen more often and be more serious.

What causes depression?

Researchers are studying the causes of depression. Several factors seem to play a role. It may be caused by chemical changes in the brain. It also tends to run in families. Depression can be triggered by life events or certain illnesses. It can also develop without a clear trigger.

What are the symptoms of depression?

While each person may experience symptoms differently, these are the most common symptoms of depression:

  • Lasting sad, anxious, or “empty” mood

  • Loss of interest in almost all activities

  • Appetite and weight changes

  • Changes in sleep patterns, such as inability to sleep or sleeping too much

  • Slowing of physical activity, speech, and thinking OR agitation, increased restlessness, and irritability

  • Decreased energy, feeling tired or "slowed down" almost every day

  • Ongoing feelings of worthlessness or feelings of undue guilt

  • Trouble concentrating or making decisions

  • Repeating thoughts of death or suicide, wishing to die, or attempting suicide ( Note: This needs emergency treatment.)

If you have 5 or more of these symptoms for at least 2 weeks, you may be diagnosed with depression. These symptoms would be a noticeable change from what’s “normal” for you.

The symptoms of depression may look like other mental health conditions. Always see a healthcare provider for a diagnosis.

How is depression diagnosed?

Depression can happen along with other medical conditions. These include heart disease or cancer, as well as other mental health conditions. Early diagnosis and treatment are key to recovery.

A diagnosis is made after a careful mental health exam and medical history. This is usually done by a mental health professional.

How is depression treated?

Treatment for depression may include one or a combination of the following:

  • Medicine. Antidepressants work by affecting the brain chemicals. Know that it takes 4 to 8 weeks for these medicines to have a full effect. Keep taking the medicine, even if it doesn’t seem to be working at first. Never stop taking your medicine or change your dose without first talking to your healthcare provider. Some people have to switch medicines or add medicines to get results. Work closely with your healthcare provider to find treatment that works for you.

  • Therapy. This is most often cognitive behavioral or interpersonal therapy. It focuses on changing the distorted views you have of yourself and your situation. It also works to improve relationships and identify and manage stressors in your life.

  • Electroconvulsive therapy (ECT). This treatment may be used to treat severe, life-threatening depression that has not responded to medicines. A mild electrical current is passed through the brain. This triggers a brief seizure. For unknown reasons, the seizures help restore the normal balance of chemicals in the brain and ease symptoms.

With treatment, you should start to feel better within a few weeks, but it can take longer. Stay connected with your healthcare provider and let them know if you are not starting to feel better. Without treatment, symptoms can last for weeks, months, or even years. Continued treatment may help to prevent depression from appearing again.

Depression can make you feel exhausted, worthless, helpless, and hopeless. It’s important to realize that these negative views are part of the depression and don't reflect reality. Negative thinking fades as treatment starts to take effect. Meanwhile, consider the following:

  • Get help. Being depressed is miserable and impacts all aspects of life, including your relationships and long-term health. If you think you may be depressed, see a healthcare provider as soon as possible.

  • Set realistic goals in light of the depression and don’t take on too much.

  • Break large tasks into small ones. Set priorities, and do what you can as you can.

  • Try to be with other people and confide in someone. It’s usually better than being alone and secretive.

  • Do things that make you feel better. Going to a movie, gardening, or taking part in religious, social, or other activities may help. Doing something nice for someone else can also help you feel better.

  • Get regular exercise. Studies show exercise can improve mood.

  • Expect your mood to get better slowly, not right away. Feeling better takes time.

  • Eat healthy, well-balanced meals.

  • Stay away from alcohol and drugs. These can often make depression worse.

  • It's best to delay important decisions until the depression has lifted. Before deciding to make a big change—such as changing jobs or getting married or divorced—discuss it with others who know you well and have a more objective view of your situation.

  • Remember: People don’t "snap out of" a depression. But they can feel a little better day-by-day.

  • Try to be patient and focus on the positives. This may help replace the negative thinking that is part of the depression. The negative thoughts will fade as your depression responds to treatment.

  • Let your family and friends help you.

When should I call my healthcare provider?

If you have 5 or more of these symptoms for at least 2 weeks, call your healthcare provider:

  • Lasting sad, anxious, or “empty” mood

  • Loss of interest in almost all activities

  • Appetite and weight changes

  • Changes in sleep patterns, such as inability to sleep or sleeping too much

  • Slowing of physical activity, speech, and thinking OR agitation, increased restlessness, and irritability

  • Decreased energy, feeling tired or "slowed down" almost every day

  • Ongoing feelings of worthlessness or feelings of undue guilt

  • Trouble concentrating or making decisions

  • Not eating or overeating

  • Repeating thoughts of death or suicide, wishing to die, or attempting suicide ( Note: This needs emergency treatment, please see below.)

In crisis

  • If you have thoughts of harming yourself or others, tell someone right away. Ask a friend or family member to stay with you. Don't stay alone. Call or text 988 . You will be connected to trained crisis counselors at the 988 Suicide & Crisis Lifeline. You can also call the Lifeline at 800-273-8255 (TTY: 800-799-4889). An online chat option is also available at 988lifeline.org. Lifeline is free and available 24/7. Until you feel better, ask a trusted family member or friend to remove all firearms from your home and secure them in a location unknown to you.

Key points about depression

  • Depression is a serious, treatable mood disorder that affects your whole body, including your mood and thoughts.

  • It’s likely caused by several factors, such as the environment or a chemical imbalance in the brain. Some types of depression seem to run in families.

  • Depression causes ongoing, extreme feelings of sadness, helplessness, hopeless, and irritability. These feelings are usually a noticeable change from what’s “normal” for you, and they last for more than 2 weeks.

  • Depression is most often treated with medicine or therapy, or a combination of both.

  • Sometimes people with severe depression have thoughts of harming themselves. Tell someone right away if you feel this way. Call or text 988 or go to an emergency room if you have a suicide plan and the means to carry it out.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.

  • At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.

  • Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your healthcare provider if you have questions, especially after office hours and on weekends and holidays.

Medical Reviewers:

  • L Renee Watson MSN RN
  • Marianne Fraser MSN RN
  • Sabrina Felson MD
    •