Overview, Causes, & Risk Factors

Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings don't go away on their own. They are not necessarily related to a particular life event.

What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.

Here are some of the common types of depression:

Bipolar disorder: Also called manic depression, bipolar disorder is a type of depression that has either subtle or extreme "high" periods alternating with "low" periods of depression.

Dysthymia: This type of depression is characterized by ongoing yet mild symptoms of depression.

Major depressive disorder: This type of clinical depression is characterized by a severe lack of interest in the things that were once enjoyed or nonstop feelings of sadness.

Seasonal affective disorder: This type of depression occurs seasonally and is caused by lack of sunlight.

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of these things:

certain illnesses

certain medicines, including antibiotics and medicines used to treat acne

changes in brain chemicals

heredity

hormonal changes

lack of sunlight

major stresses

negative thinking patterns

Risk factors for depression include:

alcohol abuse

drug abuse and addiction

job strain

personal history of a suicide attempt

personal or family history of depression

stress

Risk factors for depression can also be specific to an age group, such as children, adolescents, and seniors. Women who have just given birth may be at risk for postpartum depression.

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Symptoms & Signs

What are the signs and symptoms of the condition?

Some symptoms are common in people of all ages with depression. These symptoms include:

appetite problems

decreased energy

difficulty paying attention or making decisions

feeling very sensitive emotionally

feelings of irritability

feelings of sadness, despair, and emptiness

inability to feel pleasure

low self-esteem

loss of motivation and withdrawal from others

pessimism, negativity

sleeping problems

thoughts about suicide and death

Children, adolescents, or elderly people who are depressed may have other symptoms.

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Diagnosis & Tests

How is the condition diagnosed?

Screening tests for depression include:

the Beck Depression Inventory (BDI) 19

the Center for Epidemiologic Studies Depression (CES-D) Scale

the Children's Depression Inventory (CDI) 18

A person who screens positively on one of these tests should have a comprehensive evaluation for depression. The evaluation may include a medical history, physical examination, and laboratory tests.

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Prevention & Expectations

What can be done to prevent the condition?

Depression may not be preventable. However, some of these steps may be helpful in preventing it:

avoiding alcohol and illegal drugs

avoiding cigarette smoking

getting prompt treatment for other psychiatric disorders

seeking effective treatment for chronic diseases

talking with a counselor after experiencing a major trauma

Depression can lead to suicide. It is important to recognize and treat the condition early. Individuals should be encouraged to talk to someone if they are concerned about depression. There are many people to whom they can talk, including:

a clergy member

a family doctor

parents or a trusted family member

a professional at a mental health center

a psychologist

a school counselor

What are the long-term effects of the condition?

With good treatment, many people recover from depression. Some people experience it only once in their lives. Others have periodic bouts of depression.

If depression is not effectively treated, a person can experience serious difficulties in every area of life. Depression often hurts relationships. It also impairs work or academic performance. In some cases, it leads to suicide.

People with depression are at higher risk for many chronic diseases and conditions, including:

coronary artery disease

heart attack

personality disorders

stroke

What are the risks to others?

Depression is not contagious.

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Treatment & Monitoring

What are the treatments for the condition?

The two most common ways of treating depression are with antidepressant medicines and psychotherapy. Often a combination is used. Occasionally, a person must be hospitalized for intense treatment or for his or her own safety.

Antidepressant medicines are effective in:

increasing the person's ability to function in daily life

lowering the risk of suicide

making the person feel better

The following types of medicines are used to treat depression:

monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate and tranylcypromine sulfate

other antidepressants, such as nefazodone and venlafaxine

selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl and fluoxetine HCl

tetracyclic antidepressants, such as maprotiline HCl and mirtazapine

tricyclic antidepressants (TCAs), including amitripyline HCl and desipramine HCl

Psychotherapy can help people:

cope better with having depression

feel less alone

improve relations with family, friends, and coworkers

learn about depression and how it affects them

learn to recognize and avoid situations that can bring on a depressive episode

learn to view the world and others more positively and more realistically

positively address problems that they may be facing

stop episodes of depression early by recognizing warning signs and symptoms

What are the side effects of the treatments?

Antidepressants may cause mild and usually temporary side effects in some people. The most common side effects are:

agitation

constipation

dizziness

drowsiness

dry mouth

nausea

What happens after treatment for the condition?

An individual can help prevent relapses by living a healthy lifestyle. Some important parts of the healthy lifestyle include:

avoiding alcohol, illegal drugs, and smoking

doing regular exercise

eating a balanced diet, following the food guide pyramid

finding a support system for dealing with depression

finding ways to manage stress

getting enough rest

How is the condition monitored?

Once a person has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medicines.

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