•  Depression Center •  Quiz: Can You Recognize Depression? •  Quiz: How Much Do You Know About Depression?

Not necessarily. Everyone goes through an occasional glum spell; that's normal. Depression is gloom that goes on for weeks or months -- you can't seem to pull yourself out of it. Depression saps the life out of you, making it difficult to go about your normal activities and get through the day. It renders previously enjoyable activities dull and uninteresting and takes the joy out of living.

A depressive disorder affects your whole being -- the way you eat, sleep, and think. The condition is not a sign of personal weakness, and it can't be wished away. Depressed people can't just pull themselves out of it. Without treatment, serious symptoms can last weeks, months, or years. Having a depressive disorder affects your work, friends, and family, too.

Yes, the types vary by the symptoms' number, severity, and persistence.

Major depression is a combination of symptoms (see the list below) that's disabling and makes daily functioning extremely difficult if not impossible.

Dysthymia is marked by chronic symptoms (see the list below) that aren't disabling. You never feel you can function fully and never have sustained periods of feeling good.

Bipolar disorder (formerly called manic-depressive illness) is less common than depression and involves cycles of depression and elation. The change in mood is usually gradual, though it can be rapid. Bipolar disorder is often a recurring condition.

You're probably depressed if for two weeks or longer you experience at least five of the following symptoms every day for most of the day:

•overwhelming sadness, anxiety, or "empty" feelings

•hopelessness and pessimism

•feeling guilty, worthless, or helpless

•loss of interest in normal activities such as eating and sex; lack of enjoyment in activities that used to be pleasurable

•trouble making decisions, remembering, and concentrating

•changes in sleep patterns -- usually waking extra early or difficulty falling asleep, but sometimes oversleeping

•loss of appetite and possibly weight, or overeating and weight gain

•fatigue, loss of energy, lack of motivation

•feeling irritable and restless or slow and lethargic

•thoughts of suicide or death

•recurrent physical symptoms, such as chronic pain, headaches, or digestive disorders, that don't go away with treatment

In addition, depression can cause you to withdraw from friends and family (a young person may act rebellious or antisocial) or to lose touch with reality (in an older person, depression may resemble dementia).

Symptoms of bipolar disorder may include:

•inappropriate elation

•inappropriate irritability

•severe insomnia

•disconnected and racing thoughts

•grandiose notions

•inappropriate social behavior

•dramatic increases in energy

•dramatic increases in talking

Women are more than twice as likely as men to become depressed. If you're a woman, chances are one in eight that you'll go through an episode of depression at least once. If you're a man, the odds are one in fourteen. You're also more likely to suffer depression if a parent or other close relative did, since depression often runs in families.

Depression can be triggered by a traumatic event, such as the death of a loved one or the loss of a job. Or it can appear spontaneously, without any obvious reason. Researchers aren't sure whether malfunctioning neurotransmitters (brain chemicals that regulate mood) cause depression or whether it's changes in mood that affect brain chemistry. Some types of depression are present in families over generations. Generally, a combination of psychological, environmental, and genetic factors is involved in a depressive disorder.

A good place to start is with your doctor. He or she may do an exam and run tests to rule out underlying physical conditions, such as hypothyroidism, that can cause similar symptoms. If your doctor thinks you may be depressed, you'll probably want to talk to a therapist to discuss your options.

It can be difficult to help someone who's depressed, since he may withdraw from family and friends and resist your attempts to help. Your best bet is to lend a sympathetic ear and -- without offering unsolicited advice or judgment -- encourage him to see a doctor or another healthcare professional. If there is a possibility that your loved one might try to take his life, you should urge him to call a suicide prevention hotline, or call yourself. If he is in immediate danger of harming himself, call 911.

You have at least four good options, including these:

•Therapy (psychotherapy) provides long-term benefits by helping you to understand the sources of your depression and learn to cope with inner conflicts and stresses. If your depression was triggered by a recent crisis, therapy may involve talking about the event and related issues. If there are long-standing emotional conflicts, you and your therapist may need to explore past experiences going back to childhood. Interpersonal psychotherapy addresses problems in your relationships and helps you overcome negative relationship patterns that may contribute to depression. Cognitive behavioral therapy strives to change negative thinking patterns that can push you toward depression.

•Drug therapy (antidepressant medications, such as Prozac and Zoloft) can alleviate symptoms, usually within two to six weeks. It is often used in conjunction with talk therapy. However, these drugs can have side effects, including dry mouth, nervousness, and insomnia.

While antidepressants are relatively safe, some reports of increased suicidal thoughts and suicide attempts in some depressed patients under the age of 18 resulted in an FDA investigation into a possible link. When the FDA reviewed published and unpublished clinical trials of children and teens taking antidepressants, the agency found 4 percent of them had thought about or attempted suicide (though none succeeded) compared to 2 percent of those taking placebos. This prompted the FDA to adopt a "black box" warning on all antidepressants for children, teens, and young adults through the age of 24.

•Herbal remedies for depression, the most promising of which is Saint John's wort, have gained considerable recognition in recent years. In an analysis of 23 randomized trials, researchers concluded that Saint John's wort was as effective in treating mild to moderate depression as some antidepressant drugs, but a study reported in the April 18, 2001 issue of the Journal of the American Medical Association questions those results. A few studies have indicated that Saint John's wort may help with depression-related insomnia and seasonal affective disorder (winter blues). Interestingly, only 20 percent of people taking the herb reported side effects, compared to 53 percent of those taking prescription medications. Widely used in Europe, Saint John's wort is available at many health food stores and pharmacies in this country.

Keep in mind, however, that just because Saint John's wort is natural doesn't mean it's benign; it's best to take potent herbal remedies under the supervision of a physician or other specialist. Don't use Saint John's wort if you are already taking antidepressants. This mix can lead to serotonin overdose syndrome, which can be fatal in severe cases. The Food and Drug Administration also cautions against using Saint John's wort if you're currently taking HIV drugs or had an organ transplant, and a recent study of five cancer patients found that St. John's wort interfered with the anti-cancer drug irinotecan (Camptosar) -- even three weeks after patients stopped taking the herb. And because there are still questions about Saint John's effectiveness, your doctor is likely to recommend drug therapy if you are suffering from severe depression.

•Regular exercise has been found to be a powerful tool in fighting depression, in large part by raising endorphin levels -- those "feel-good" chemicals responsible for "runner's high." In one study of moderately depressed people, those who took up exercise were 12 times less likely than nonexercisers to remain depressed ten years later. Another study found that as little as three months of regular exercise left patients significantly less depressed than those who didn't work out. It's not easy to motivate yourself to exercise when you're depressed, of course, but enlisting a workout buddy or joining a fitness class or other structured exercise program can help you clear this hurdle.

-- Kate Lee is a former associate editor at Consumer Health Interactive and researcher at Time Inc. Health. She is currently a senior editor at BabyCenter.

Further Resources

National Institute of Mental Health

5600 Fishers Lane

Rockville, MD 20857

Phone: (800) 421-4211

National Foundation for Depressive Illness, Inc.

P.O. Box 2257

New York, NY 10016

Phone: (800) 826-3632

National Depressive and Manic Depressive Association

730 N. Franklin, Suite 501

Chicago, IL 60601

Phone: (800) 248-4344

References

First published September 3, 1998
Last updated February 14, 2008
Copyright © 1998 Consumer Health Interactive

• Take our Depression Assessment to see whether you might have symptoms of depression. • Make an appointment with your doctor or a psychologist if you think you may be depressed. If you like, print out and take along our handy checklist of Questions for You and Your Doctor. • Consider beginning an exercise routine to help lift your mood. Check out our article on Depression and Exercise. • Realize that you're not alone. Click here to hear the voices of men struggling with depression, teens who overcame major depression, and an award-winning schoolteacher with bipolar illness. • If you find yourself entertaining thoughts of committing suicide, call your doctor, the National Suicide Hotline at 1-800-SUICIDE, or a local suicide hotline immediately. Tell your family and close friends as well. While you're awaiting treatment, ask a family member or close friend to keep you company.

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