Depression Sourcebook, 5th Ed.

By Omnigraphics

Consumer health information about the causes, symptoms, diagnosis, and treatment of various forms of depression, along with coping tips and strategies for building resilience and self-esteem.  Includes index, glossary of related terms, and other resources.

• Language: English
• Publisher: Omnigraphics
• Release date: Nov 1, 2019
• ISBN: 9780780817364

Book preview

Part One

Introduction to Mental-Health Disorders and Depression

Chapter 1

What Are Mental-Health Disorders?

What Is Mental Illness?

Mental illnesses are conditions that affect a person’s thinking, feeling, mood or behavior. These conditions, which include depression, anxiety, bipolar disorder, or schizophrenia, may be occasional or long-lasting (chronic) and affect someone’s ability to relate to others and function each day.

What Is Mental Health?

Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

Although the terms are often used interchangeably, poor mental health and mental illness are not the same things. A person can experience poor mental health and not be diagnosed with a mental illness. Likewise, a person diagnosed with a mental illness can experience periods of physical, mental, and social well-being.

How Common Are Mental Illnesses?

Mental illnesses are among the most common health conditions in the United States:

More than 50 percent will be diagnosed with a mental illness or disorder at some point in their lifetime.

1 in 5 Americans will experience a mental illness in a given year.

1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness.

1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.

What Causes Mental Illness

There is no single cause for mental illness. A number of factors can contribute to risk for mental illness, such as:

Early adverse life experiences, such as trauma or a history of abuse (for example, child abuse, sexual assault, witnessing violence, etc.)

Experiences related to other ongoing (chronic) medical conditions, such as cancer or diabetes

Biological factors, such as genes or chemical imbalances in the brain

Use of alcohol or recreational drugs

Having a few friends

Having a feeling of loneliness or isolation

Types of Mental Illness

People can experience different types of mental illnesses or disorders, and they can often occur at the same time. Mental illnesses can occur over a short period of time or be episodic. This means that the mental illness comes and goes with discrete beginnings and ends. Mental illness can also be ongoing or long-lasting.

There are more than 200 classified types of mental illness. Some of the main types of mental illness and disorders are listed below:

Anxiety Disorders

People with anxiety disorders respond to certain objects or situations with fear and dread or terror. Anxiety disorders include generalized anxiety disorder, social anxiety, panic disorders, and phobias.

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood mental disorders. It can continue through adolescence and adulthood. People diagnosed with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Disruptive Behavioral Disorders

Behavioral disorders involve a pattern of disruptive behaviors in children that last for at least six months and cause problems in school, at home, and in social situations. Behavioral symptoms can also continue into adulthood.

Depression and Other Mood Disorders

While bad moods are common, and usually pass in a short period, people suffering from mood disorders live with more constant and severe symptoms. People living with this mental illness find that their mood impacts both mental and psychological well-being, nearly every day, and often for much of the day.

It is estimated that 1 in 10 adults suffer from some type of mood disorder, with the most common conditions being depression and bipolar disorder. With proper diagnosis and treatment, most of those living with mood disorders lead to healthy, normal and productive lives. If left untreated, this illness can affect role functioning, quality of life and many long-lasting physical health problems such as diabetes and heart disease.

Eating Disorders

Eating disorders involve obsessive and sometimes distressing thoughts and behaviors, including:

Reduction of food intake

Overeating

Feelings of depression or distress

Concern about weight, body shape, poor self-image

Common types of eating disorders include anorexia, bulimia, and binge eating.

Personality Disorders

People with personality disorders have extreme and inflexible personality traits that cause problems in work, school, or social relationships. Personality disorders include antisocial personality disorder and borderline personality disorder (BPD).

Posttraumatic Stress Disorder

A person can get posttraumatic stress disorder (PTSD) after living through or seeing a traumatic event such as war, a hurricane, physical abuse, or a serious accident. PTSD can make someone feel stressed and afraid after the danger is over. People with PTSD may experience symptoms like reliving the event over and over, sleep problems, become very upset if something causes memories of the event, constantly looking for possible threats, and changes in emotions such as irritability, outbursts, helplessness, or feelings of numbness.

Schizophrenia Spectrum and Other Psychotic Disorders

People with psychotic disorders hear, see, and believe things that are not real or true. They may also show signs of disorganized thinking, confused speech, and muddled or abnormal motor behavior. An example of a psychotic disorder is schizophrenia. People with schizophrenia may also have low motivation and blunted emotions.

Substance-Use Disorders

Substance-use disorders (SUD) occur when frequent or repeated use of alcohol and/or drugs causes significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Substance-use problems can be fatal to the user or others. Examples include drunk driving fatalities and drug overdoses.

Mental illnesses and substance use disorders often occur together. Sometimes one disorder can be a contributing factor to or can make the other worse. Sometimes they simply occur at the same time.

This chapter includes text excerpted from Learn about Mental Health, Centers for Disease Control and Prevention (CDC), January 26, 2018.

Chapter 2

Brain Function and Mental Health

The brain is the most complex part of the human body. This three-pound organ is the seat of intelligence, interpreter of the senses, initiator of body movement, and controller of behavior. Lying in its bony shell and washed by protective fluid, the brain is the source of all the qualities that define our humanity. The brain is the crown jewel of the human body.

For centuries, scientists and philosophers have been fascinated by the brain, they viewed the brain as nearly incomprehensible. Now, however, the brain is beginning to relinquish its secrets. Scientists have learned more about the brain in the last 10 years than in all previous centuries because of the accelerating pace of research in neurological and behavioral science and the development of the research techniques. As a result, Congress named the 1990s the Decade of the Brain. At the forefront of research on the brain and other elements of the nervous system is the National Institute of Neurological Disorders and Stroke (NINDS), which conducts and supports scientific studies in the United States and around the world.

This chapter is a basic introduction to the human brain. It may help you understand how the healthy brain works, how to keep it healthy, and what happens when the brain is diseased or dysfunctional.

Figure 2.1. Human Brain

The Architecture of the Brain

The brain is like a committee of experts. All the parts of the brain work together, but each part has its own special properties. The brain can be divided into three basic units: the forebrain, the midbrain, and the hindbrain.

The hindbrain includes the upper part of the spinal cord, the brain stem, and a wrinkled ball of tissue called the cerebellum (1). The hindbrain controls the body’s vital functions such as respiration and heart rate. The cerebellum coordinates movement and is involved in learned rote movements. When you play the piano or hit a tennis ball you are activating the cerebellum. The uppermost part of the brainstem is the midbrain, which controls some reflex actions and is part of the circuit involved in the control of eye movements and other voluntary movements. The forebrain is the largest and most highly developed part of the human brain: it consists primarily of the cerebrum (2) and the structures hidden beneath it.

When people see the brain it is usually the cerebrum that they notice. The cerebrum sits at the topmost part of the brain and is the source of intellectual activities. It holds your memories, allows you to plan, enables you to imagine and think. It allows you to recognize friends, read books, and play games.

The cerebrum is split into two halves (hemispheres) by a deep fissure. Despite the split, the two cerebral hemispheres communicate with each other through a thick tract of nerve fibers that lies at the base of this fissure. Although the two hemispheres seem to be mirror images of each other, they are different. For instance, the ability to form words seems to lie primarily in the left hemisphere, while the right hemisphere seems to control many abstract reasoning skills.

For some as-yet-unknown reason, nearly all of the signals from the brain to the body and vice-versa cross over on their way to and from the brain. This means that the right cerebral hemisphere primarily controls the left side of the body and the left hemisphere primarily controls the right side. When one side of the brain is damaged, the opposite side of the body is affected. For example, a stroke in the right hemisphere of the brain can leave the left arm and leg paralyzed.

Figure 2.2. The Forebrain

Figure 2.3. The Midbrain

Figure 2.4. The Hindbrain

The Geography of Thought

Each cerebral hemisphere can be divided into sections, or lobes, each of which specializes in different functions. To understand each lobe and its specialty we will take a tour of the cerebral hemispheres, starting with the two frontal lobes (3), which lie directly behind the forehead. When you plan a schedule, imagine the future, or use reasoned arguments, these two lobes do much of the work. One of the ways the frontal lobes seem to do these things is by acting as short-term storage sites, allowing one idea to be kept in mind while other ideas are considered. In the rearmost portion of each frontal lobe is a motor area (4), which helps control voluntary movement. A nearby place on the left frontal lobe called Broca’s area (5) allows thoughts to be transformed into words.

When you enjoy a good meal—the taste, aroma, and texture of the food—two sections behind the frontal lobes called the parietal lobes (6) are at work. The forward parts of these lobes, just behind the motor areas, are the primary sensory areas (7). These areas receive information about temperature, taste, touch, and movement from the rest of the body. Reading and arithmetic are also functions in the repertoire of each parietal lobe.

As you look at the words and pictures on this page, two areas at the back of the brain are at work. These lobes, called the occipital lobes (8), process images from the eyes and link that information with images stored in memory. Damage to the occipital lobes can cause blindness.

The last lobes on our tour of the cerebral hemispheres are the temporal lobes (9), which lie in front of the visual areas and nest under the parietal and frontal lobes. Whether you appreciate symphonies or rock music, your brain responds through the activity of these lobes. At the top of each temporal lobe is an area responsible for receiving information from the ears. The underside of each temporal lobe plays a crucial role in forming and retrieving memories, including those associated with music. Other parts of this lobe seem to integrate memories and sensations of taste, sound, sight, and touch.

The Cerebral Cortex

Coating the surface of the cerebrum and the cerebellum is a vital layer of tissue the thickness of a stack of two or three dimes. It is called the cortex, from the Latin word for bark. Most of the actual information processing in the brain takes place in the cerebral cortex. When people talk about gray matter in the brain they are talking about this thin rind. The cortex is gray because nerves in this area lack the insulation that makes most other parts of the brain appear to be white. The folds in the brain add to its surface area and, therefore, increase the amount of gray matter and the quantity of information that can be processed.

The Inner Brain

Deep within the brain, hidden from view, lie structures that are the gatekeepers between the spinal cord and the cerebral hemispheres. These structures not only determine our emotional state, they also modify our perceptions and responses depending on that state, and allow us to initiate movements that you make without thinking about them. Like the lobes in the cerebral hemispheres, the structures described below come in pairs: each is duplicated in the opposite half of the brain.

The hypothalamus (10), about the size of a pearl, directs a multitude of important functions. It wakes you up in the morning, and gets the adrenaline flowing during a test or job interview. The hypothalamus is also an important emotional center, controlling the molecules that make you feel exhilarated, angry, or unhappy. Near the hypothalamus lies the thalamus (11), a major clearinghouse for information going to and from the spinal cord and the cerebrum.

An arching tract of nerve cells leads from the hypothalamus and the thalamus to the hippocampus (12). This tiny nub acts as a memory indexer—sending memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieving them when necessary. The basal ganglia (not shown) are clusters of nerve cells surrounding the thalamus. They are responsible for initiating and integrating movements. Parkinson disease, which results in tremors, rigidity, and a stiff, shuffling walk, is a disease of nerve cells that lead into the basal ganglia.

Making Connections

The brain and the rest of the nervous system are composed of many different types of cells, but the primary functional unit is a cell called the neuron. All sensations, movements, thoughts, memories, and feelings are the result of signals that pass through neurons. Neurons consist of three parts. The cell body (13) contains the nucleus, where most of the molecules that the neuron needs to survive and function are manufactured. Dendrites (14) extend out from the cell body like the branches of a tree and receive messages from other nerve cells. Signals then pass from the dendrites through the cell body and may travel away from the cell body down an axon (15) to another neuron, a muscle cell, or cells in some other organ. The neuron is usually surrounded by many support cells. Some types of cells wrap around the axon to form an insulating sheath (16). This sheath can include a fatty molecule called myelin, which provides insulation for the axon and helps nerve signals travel faster and farther. Axons may be very short, such as those that carry signals from one cell in the cortex to another cell less than a hair’s width away. Or axons may be very long, such as those that carry messages from the brain all the way down the spinal cord.

Figure 2.5. The Inner Brain

Scientists have learned a great deal about neurons by studying the synapse—the place where a signal passes from the neuron to another cell. When the signal reaches the end of the axon it stimulates the release of tiny sacs (17). These sacs release chemicals known as neurotransmitters (18) into the synapse (19). The neurotransmitters cross the synapse and attach to receptors (20) on the neighboring cell. These receptors can change the properties of the receiving cell. If the receiving cell is also a neuron, the signal can continue the transmission to the next cell.

Figure 2.6. Neurons

Figure 2.7. Neurons Cell Passes

Some Key Neurotransmitters at Work

Acetylcholine is called an excitatory neurotransmitter because it generally makes cells more excitable. It governs muscle contractions and causes glands to secrete hormones. Alzheimer disease, which initially affects memory formation, is associated with a shortage of acetylcholine.

Gamma-aminobutyric acid (GABA) is called an inhibitory neurotransmitter because it tends to make cells less excitable. It helps control muscle activity and is an important part of the visual system. Drugs that increase GABA levels in the brain are used to treat epileptic seizures and tremors in patients with Huntington disease (HD).

Serotonin is a neurotransmitter that constricts blood vessels and brings on sleep. It is also involved in temperature regulation. Dopamine is an inhibitory neurotransmitter involved in mood and the control of complex movements. The loss of dopamine activity in some portions of the brain leads to the muscular rigidity of Parkinson disease. Many medications used to treat behavioral disorders work by modifying the action of dopamine in the brain.

Mental Illness Defined as Disruption in Neural Circuits

The National Institute of Mental Health (NIMH) mantra to describe mental disorders as brain disorders. What does this mean? Is it accurate to group schizophrenia, depression, and attention deficit hyperactivity disorder (ADHD) together with Alzheimer disease (AD), Parkinson disease (PD), and HD? Is a neurologic approach to mental disorders helpful or does this focus on the brain lead to less attention to the mind?

First, mental disorders appear to be disorders of brain circuits, in contrast to classical neurological disorders in which focal lesions are apparent. By analogy, heart disease can involve arrhythmias or infarction (death) of the heart muscle. Both can be fatal, but the arrhythmia may not have a demonstrable lesion. In past decades, there was little hope of finding abnormal brain circuitry beyond the coarse approach of an electroencephalogram (EEG), which revealed little detail about regional cortical function. With the advent of imaging techniques such as positron emission tomography (PET), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and high-resolution EEG, we can map the broad range of cortical function with high spatial and temporal resolution. For the first time, we can study the mind via the brain. Mapping patterns of cortical activity reveals mechanisms of mental function that are just not apparent by observing behavior.

Has brain imaging been useful for understanding mental disorders? While we are still in the early days of using these powerful technologies, a survey of the literature reveals some excellent examples of how studying the brain forces us to rethink mental disorders. For instance, studies of brain development demonstrate delays in cortical maturation in children with attention deficit hyperactivity disorder. How curious that this disorder, which is defined by cognitive (attention) and behavioral (hyperactivity) symptoms, increasingly appears to be a disorder of cortical development. Viewing ADHD as a brain disorder raises, important questions: What causes delayed maturation? What treatments might accelerate cortical development?

A brain disorder approach also may transform the way we diagnose mental disorders. The NIMH Research Domain Criteria (R-DoC) project is involved in rethinking diagnosis based on understanding the underlying brain changes. As an example, what we now call major depressive disorder (MDD) probably represents many unique syndromes, responding to different interventions. Neuroimaging is beginning to yield biomarkers, that is, patterns that predict response to treatment or possibly reflect changes in physiology prior to changes in behavior or mood. And studies with deep brain stimulation addressing depression as a brain arrhythmia are demonstrating how changing the activity of specific circuits leads to remission of otherwise treatment-refractory depressive episodes.

An important implication of this approach is that abnormal behavior and cognition (e.g., mood, attention) may be late and convergent outcomes of altered brain development. This is a familiar lesson from neurodegenerative disorders: the symptoms of Alzheimer, Parkinson, and Huntington diseases emerge years after changes in the brain. Could the same be true of these circuit disorders that appear early in life? If so, could imaging allow earlier detection and preemption of the behavioral and cognitive changes from the social isolation of autism to the psychosis of schizophrenia? This preemptive approach, which has transformed outcomes in heart disease and cancer, could also transform psychiatry, by focusing on prevention for those at risk rather than the partial amelioration of symptoms late in the process.

But we need to recognize the range of unknowns that remain. In truth, we still do not know how to define a circuit. Where does a circuit begin or end? How do the patterns of activity on imaging scans actually translate to what is happening in the brain? What is the direction of information flow? In fact, the metaphor of a circuit in the sense of the flow of electricity may be woefully inadequate for describing how mental activity emerges from neuronal activity in the brain. Hence the need for continuing research into fundamental neuroscience. The advent of the tools, such as optogenetics, which uses light for precise manipulation of cells in awake, behaving animals will take us a long way towards understanding the characteristics of a neuronal circuit.

While the neuroscience discoveries are coming fast and furious, one thing we can say already is that earlier notion of mental disorders as chemical imbalances or as social constructs are beginning to look antiquated. Much of what we are learning about the neural basis of mental illness is not yet ready for the clinic, but there can be little doubt that clinical neuroscience will soon be helping people with mental disorders to recover.

This chapter contains text excerpted from the following sources: Text in this chapter begins with excerpts from Brain Basics: Know Your Brain, National Institute of Neurological Disorders and Stroke (NINDS), August 13, 2019; Text under the heading Mental Illness Defined as Disruption in Neural Circuits is excerpted from Post by Former NIMH Director Thomas Insel: Mental Illness Defined as Disruption in Neural Circuits, National Institute of Mental Health (NIMH), August 12, 2011. Reviewed October 2019.

Chapter 3

Myths and Facts about Mental-Health Disorders

Mental-Health Problems Affect Everyone

Myth: Mental-health problems do not affect me.

Fact: Mental-health problems are very common. In 2014, about:

One in five American adults experienced a mental-health issue

One in 10 young people experienced a period of major depression

One in 25 Americans lived with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression

Suicide is the 10th leading cause of death in the United States. It accounts for the loss of more than 41,000 American lives each year, more than double the number of lives lost to homicide.

Myth: Children do not experience mental-health problems.

Fact: Even very young children may show early warning signs of mental-health concerns. These mental-health problems are often clinically diagnosable and can be a product of the interaction of biological, psychological, and social factors.

Half of all mental-health disorders show first signs before a person turns 14 years old, and three-quarters of mental-health disorders begin before age 24.

Unfortunately, less than 20 percent of children and adolescents with diagnosable mental-health problems receive the treatment they need. Early mental-health support can help a child before problems interfere with other developmental needs.

Myth: People with mental-health problems are violent and unpredictable.

Fact: The vast majority of people with mental-health problems are no more likely to be violent than anyone else. Most people with mental illness are not violent and only 3 to 5 percent of violent acts can be attributed to individuals living with a serious mental illness. In fact, people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population. You probably know someone with a mental-health problem and do not even realize it, because many people with mental-health problems are highly active and productive members of our communities.

Myth: People with mental-health needs, even those who are managing their mental illness, cannot tolerate the stress of holding down a job.

Fact: People with mental-health problems are just as productive as other employees. Employers who hire people with mental-health problems report good attendance and punctuality as well as motivation, good work, and job tenure on par with or greater than other employees.

When employees with mental-health problems receive effective treatment, it can result in:

Lower total medical costs

Increased productivity

Lower absenteeism

Decreased disability costs

Myth: Personality weakness or character flaws cause mental-health problems. People with mental-health problems can snap out of it if they try hard enough.

Fact: Mental-health problems have nothing to do with being lazy or weak and many people need help to get better. Many factors contribute to mental-health problems, including:

Biological factors, such as genes, physical illness, injury, or brain chemistry

Life experiences, such as trauma or a history of abuse

Family history of mental-health problems

People with mental-health problems can get better and many recover completely.

Helping Individuals with Mental-Health Problems

Myth: There is no hope for people with mental-health problems. Once a friend or family member develop mental-health problems, she or he will never recover.

Fact: Studies show that people with mental-health problems get better and many recover completely. Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. There are more treatments, services, and community support systems than ever before, and they work.

Myth: Therapy and self-help are a waste of time. Why bother when you can just take a pill?

Fact: Treatment for mental-health problems varies depending on the individual and could include medication, therapy, or both. Many individuals work with a support system during the healing and recovery process.

Myth: I cannot do anything for a person with a mental-health problem.

Fact: Friends and loved ones can make a big difference. Only 44 percent of adults with diagnosable mental-health problems and less than 20 percent of children and adolescents receive needed treatment. Friends and family can be important influences to help someone get the treatment and services they need by:

Reaching out and letting them know you are available to help

Helping them access mental-health services

Learning and sharing the facts about mental-health, especially if you hear something that is not true

Treating them with respect, just as you would anyone else

Refusing to define them by their diagnosis or using labels such as crazy

Myth: Prevention does not work. It is impossible to prevent mental illnesses.

Fact: Prevention of mental, emotional, and behavioral disorders focuses on addressing known risk factors such as exposure to trauma that can affect the chances that children, youth, and young adults will develop mental-health problems. Promoting the social-emotional well-being of children and youth leads to:

Higher overall productivity

Better educational outcomes

Lower crime rates

Stronger economies

Lower healthcare costs

Improved quality of life (QOL)

Increased lifespan

Improved family life

This chapter includes text excerpted from Mental Health Myths and Facts, MentalHealth.gov, U.S. Department of Health and Human Services (HHS), August 29, 2017.

Chapter 4

Depression: What You Need to Know

Do you feel sad, empty, and hopeless most of the day, nearly every day? Have you lost interest or pleasure in your hobbies or being with friends and family? Are you having trouble sleeping, eating, and functioning? If you have felt this way for at least two weeks, you may have depression, a serious but treatable mood disorder.

What Is Depression?

Everyone feels sad or low sometimes, but these feelings usually pass with a little time. Depression—also called clinical depression or a depressive disorder—is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, symptoms must be present most of the day, nearly every day for at least two weeks.

What Are the Different Types of Depression?

Two of the most common forms of depression are:

Major depression—having symptoms of depression most of the day, nearly every day for at least two weeks that interfere with your ability to work, sleep, study, eat and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.

Persistent depressive disorder(PDD) (dysthymia)—having symptoms of depression that last for at least two years. A person diagnosed with this form of depression may have episodes of major depression along with periods of less severe symptoms.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

Perinatal depression: Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression).

Seasonal affective disorder (SAD): SAD is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer.

Psychotic depression: This type of depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

Other examples of depressive disorders include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD). Depression can also be one phase of bipolar disorder (formerly called manic-depression). But a person with bipolar disorder also experiences extreme high—euphoric or irritable—moods called mania or a less severe form called hypomania.

What Causes Depression

Scientists at the National Institute of Mental Health (NIMH) and across the country are studying the causes of depression. Research suggests that a combination of genetic, biological, environmental, and psychological factors play a role in depression.

Depression can occur along with other serious illnesses, such as diabetes, cancer, heart disease, and Parkinson disease (PD). Depression can make these conditions worse and vice versa. Sometimes medications taken for these illnesses may cause side effects that contribute to depression symptoms.

What Are the Signs and Symptoms of Depression?

Sadness is only one small part of depression and some people with depression may not feel sadness at all. Different people have different symptoms. Some symptoms of depression include:

Persistent sad, anxious, or empty mood

Feelings of hopelessness or pessimism

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in hobbies or activities

Decreased energy, fatigue, or being slowed down

Difficulty concentrating, remembering, or making decisions

Difficulty sleeping, early-morning awakening, or oversleeping

Appetite and/or weight changes

Thoughts of death or suicide or suicide attempts

Restlessness or irritability

Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Does Depression Look the Same in Everyone?

No. Depression affects different people in different ways. For example:

Women have depression more often than men. Biological, lifecycle and hormonal factors that are unique to women may be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.

Men with depression are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognize their depression and fail to seek help.

Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.

Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.

Older childrenand teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse.

How Is Depression Treated?

The first step in getting the right treatment is to visit a healthcare provider or mental-health professionals, such as a psychiatrist or psychologist. Your healthcare provider can do an exam, interview, and lab tests to rule out other health conditions that may have the same symptoms as depression. Once diagnosed, depression can be treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, brain stimulation therapy may be another treatment option to explore.

Medications

Medications called antidepressants can work well to treat depression. They can take two to four weeks to work. Antidepressants can have side effects, but many side effects may lessen over time. Talk to your healthcare provider about any side effects that you have. Do not stop taking your antidepressant without first talking to your healthcare provider.

Psychotherapy

Psychotherapy helps by teaching ways of thinking and behaving and changing habits that may be contributing to depression. Therapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse.

Brain Stimulation Therapies

Electroconvulsive therapy (ECT) and other brain stimulation therapies may be an option for people with severe depression who do not respond to antidepressant medications. ECT is the best-studied brain stimulation therapy and has the longest history of use. Other stimulation therapies discussed here are newer, and in some cases still experimental methods.

How Can I Help Myself If I Am Depressed?

As you continue treatment, you may start to feel better gradually. Remember that if you are taking an antidepressant, it may take two to four weeks to start working. Try to do things that you used to enjoy. Go easy on yourself. Other things that may help include:

Trying to be active and exercise

Breaking up large tasks into small ones, set priorities, and do what you can as you can

Spending time with other people and confide in a trusted friend or relative

Postponing important life decisions until you feel better. Discuss decisions with others who know you well

Avoiding self-medication with alcohol or with drugs not prescribed for you

How Can I Help a Loved One Who Is Depressed?

If you know someone who has depression, first help her or him see a healthcare provider or mental-health professional. You can also:

Offer support, understanding, patience, and encouragement

Never ignore comments about suicide, and report them to your loved one’s healthcare provider or therapist

Invite her or him out for walks, outings, and other activities

Help her or him adhere to the treatment plan, such as setting reminders to take prescribed medications

Help her or him by ensuring that she or he has transportation to therapy appointments

Remind her or him that, with time and treatment, the depression will lift

This chapter includes text excerpted from Depression Basics, National Institute of Mental Health (NIMH), May 2016. Reviewed October 2019.

Chapter 5

Why Do People Get Depressed?

Depression Is Widespread

Depression is one of the most common disorders that affect people irrespective of age, race, or economic background. It is a pressing and widespread mental-health condition that requires treatment just like any other disease or illness. Factors such as genes, brain chemistry, and medical conditions often contribute to whether a person gets depressed. In addition to these physical causes of depression, other causes include adverse life events, available daylight hours during the seasons of the year, and cultural backgrounds.

Depression is caused when the neurotransmitters of the brain, which control mood, fail to function properly. A person’s viewpoint may intensify depression as well. You might have heard of the glass half-full or glass-half-empty test—that is, a person may get upset quickly and see the glass as half-empty while others let setbacks slide off easily and see the glass as half-full. The ways in which a person thinks, responds, and reacts to given situations may contribute to depression.

Genes Could Be a Reason for Depression

Studies show that depression may run in families and that some people inherit genes that put them at greater risk of becoming depressed. However, not all who acquire these genes get depressed (whereas all people whose ancestors suffer from diabetes are affected). Also, studies indicate that people who do not have any family history of depression can still get depressed. Hence, although genes may be one of the causes of depression, they are not a stand-alone factor to the disorder.

Brain Chemistry Could Be a Leading Cause of Depression

Depression primarily affects the brain’s fragile chemistry involving neurotransmitter signaling. Neurotransmitters send communications between the nerve cells in the brain. They help control the mood of a person. However, when a person is depressed, these neurotransmitters are low in secretion or are imbalanced. Genes and brain chemistry can be interrelated since people who are genetically susceptible to depression are more prone to developing the neurotransmitter activity imbalance, which leads to depression. It’s a vicious circle.

Various factors can affect the secretion and stability of the neurotransmitters, including stress and exposure to daylight. The use of alcohol and drugs can also cause chemical alterations in the brain that influence the mood. However, an imbalance of the neurotransmitters can be completely restored with appropriate medications prescribed by a doctor.

Seasons and Daylight Could Affect Neurotransmitters in the Brain

Exposure to daylight can affect the secretion and stability of the neurotransmitters melatonin and serotonin. The brain tends to produce more melatonin when there is less daylight. Similarly, when there is more daylight, the brain tends to secrete more serotonin.

Melatonin and serotonin play a vital role in balancing a person’s sleep and wake patterns, stamina, and mood. Longer hours of darkness and the shorter days in winter and fall may cause an increase in the secretion of melatonin and a simultaneous decrease in the level of serotonin. Such chemical imbalances can result in one type of depression, which is known as seasonal affective disorder (SAD). Light therapy, also called phototherapy, along with medications and talk therapy, can help improve the mood of people affected by SAD.

Adverse Life Events Could Trigger Depression

The death of a family member, friend, or peer results in grief that can lead to depression. Other adverse life experiences such as a marriage separation, divorce, or a remarriage can trigger depression. Even situations such as a change in school or a move can be so emotionally difficult that they can trigger depression in a person. However, many people are resilient and can endure adverse life experiences without being affected by depression.

Dismal Family and Social Environments Could Breed Mental Stress

For some people, a harmful, demanding, or troublesome family environment can affect their self-esteem and lead to depression. Various other stressful conditions, such as poverty, homelessness, or exposure to violence can play a part in this, too. Facing peer pressure, bullying, or harassment can often leave a person feeling upset, withdrawn, and victimized. And unhealthy or weak relationships could cause depression. Adverse circumstances, left unattended, can lead to depression.

Hormonal Changes