• Depression

    (Major Depressive Affective Disorder; Unipolar Disorder; Unipolar Mood Disorder)

    Definition

    Depression is a mental illness marked by feelings of profound sadness and lack of interest in activities. Depression is not the same as a blue mood. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment.

    Causes

    While the exact cause is not known, factors that may play a role in depression include:
    • Having a family history of depression (genetic link)
    • Having a certain type of brain chemistry
    • Experiencing stressful or traumatic life events (eg, death in the family, divorce, job loss)
    Brain
    Brain Man Face
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    There are a range of factors that may increase your risk of depression. Examples include:
    • Gender: female
    • Previous episode of depression
    • Hormonal changes
    • Chronic conditions (eg, hypothyroidism, type 2 diabetes, heart disease, cancer, chronic pain, stroke, Parkinson's disease)
    • Other conditions related to mental health (eg, anxiety, drug abuse, insomnia, personality disorder)
    • Emotional or social factors, such as:
      • Little or no social support
      • Negative thought patterns and beliefs
      • Low self-esteem
      • Lack of personal control over circumstances
      • Feelings of helplessness

    Symptoms

    Depression can differ from person to person. Some people have only a few symptoms, while others have many.
    Symptoms can change over time and may include:
    • Persistent feelings of sadness, anxiety, or emptiness
    • Hopelessness
    • Feeling guilty, worthless, or helpless
    • Loss of interest in hobbies and activities
    • Loss of interest in sex
    • Feeling tired
    • Trouble concentrating, remembering, or making decisions
    • Trouble sleeping, waking up too early, or oversleeping
    • Eating more or less than usual
    • Weight gain or weight loss
    • Thoughts of death or suicide with or without suicide attempts
    • Restlessness or irritability
    • Physical symptoms that defy standard diagnosis and do not respond well to medical treatments

    Diagnosis

    There is no blood test or diagnostic test for depression. The doctor will ask about your symptoms and medical history, giving special attention to:
    • Alcohol and drug use
    • Thoughts of death or suicide
    • Family members who have or have had depression
    • Sleep patterns
    • Previous episodes of depression
    Specific mental health exams may be done. This will help the doctor get detailed information about your speech, thoughts, memory, and mood. A physical exam and other tests can help rule out other causes.

    Treatment

    Treatment may involve the use of medicine and/or psychotherapy.
    Severe depression can require hospital care, especially if you are at risk of hurting yourself or others.

    Antidepressant Medications

    Antidepressant medicines may be most effective in people with severe depression. These medicines can take 2-6 weeks to reach their maximum effectiveness. There are many different types of medicines to treat depression. You will work with your doctor to find the medicine that benefits you the most and has the least side effects.

    Therapy

    Psychotherapy for depression consists of various types of counseling. These include cognitive-behavior therapy (CBT), interpersonal therapy, psychodynamic therapy, or a combination of these. Therapy is designed to help you cope with difficulties in relationships, change negative thinking and behavior patterns, and resolve difficult feelings.

    Diet and Exercise

    Dietary Changes
    Research suggests that diets high in tryptophan and certain B vitamins may be helpful. There is also mixed evidence that omega-3 fatty acids may reduce symptoms.
    If you want to take supplements or change your diet, talk to your doctor first.
    Dietary Supplements and Herbal Therapy
    The herb St. John's wort may be an effective alternative to standard medicines with fewer side effects. However, St. John's wort may reduce the effectiveness of many drugs, such as antidepressants, birth control pills, blood thinners, and other medicines. It is important that you talk to your doctor before trying any herb.
    There is also some evidence that dehydroepiandrosterone (DHEA), a hormone that is available as a dietary supplement, may help some people.
    Exercise
    A regular exercise program has been shown to relieve some of the symptoms. It should play a large role in the overall management of depression.

    Procedures

    Electroconvulsive Therapy (ECT)
    ECT is the use of an electric stimulus to produce a generalized seizure. It may be used in people with severe or life-threatening depression. ECT is also used for people who cannot take or do not respond to medicine. It is considered a safe and effective procedure.
    Vagus Nerve Stimulation (VNS)
    VNS is used as therapy for depression when multiple trials of medicine do not work. A pacemaker-like device stimulates the vagus nerve in the neck.
    Vagus Nerve
    Vagus Nerve
    Stimulation of the vagus nerve (yellow) at the neck is a depression therapy option.
    Copyright © Nucleus Medical Media, Inc.
    Transcranial Magnetic Stimulation (TMS)
    TMS involves the application of low-frequency magnetic pulses to the brain. The change in electrical field stimulates nerves. There are a number of studies that show the benefits of TMS for the treatment of depression. It may be used if you have not gotten better with medicines and psychotherapy.

    Other Treatment Options

    Bright Light Therapy
    Your doctor may recommend bright light therapy. This involves being exposed to high levels of light from a special "light box" that has a screen on it.
    Meditation
    Meditation may help to improve the symptoms of depression.

    Prevention

    Strategies to reduce your chance of becoming depressed include:
    • Being aware of your personal risk factors
    • Having a psychiatric evaluation and psychotherapy if needed
    • Developing social supports
    • Learning stress management techniques
    • Exercising regularly
    • Not abusing alcohol or drugs
    • Getting adequate sleep, rest, and recreation
    • Eating healthy food, including fruits, vegetables, and whole grains

    RESOURCES

    Depression and Bipolar Support Alliance http://www.dbsalliance.org/

    The National Mental Health Association http://www.nmha.org/

    CANADIAN RESOURCES

    Canadian Mental Health Association http://www.ontario.cmha.ca/

    Canadian Psychiatric Association http://www.cpa-apc.org/

    References

    Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Published May 22, 2009. Accessed August 23, 2012.

    Clinical depression is a common, real and treatable illness. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/information/mental-health-info/depression/depression-what-you-need-to-know/depression-what-you-need-to-know. Accessed August 23, 2012.

    Columbia University. Q&A on bright light therapy. Columbia University website. Available at: http://www.columbia.edu/~mt12/blt.htm. Accessed August 23, 2012.

    Depression. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us.. Updated July 19, 2012. Accessed August 23, 2012.

    Depression. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated July 25, 2012. Accessed August 23, 2012.

    Depression. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/depression. Accessed August 23, 2012.

    Depression. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed August 23, 2012.

    Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci Biobehav Rev. 2005;29:493-500.

    St. John's wort. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated July 25, 2012. Accessed August 23, 2012.

    St. John's wort for depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 26, 2012. Accessed August 23, 2012.

    St. John's wort and depression. National Center for Complementary and Alternative Medicine website. Available at: http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm#issues. Updated December 2007. Accessed August 23, 2012.

    12/16/2008 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Linde K, Berner M, Kriston L. St. John's wort for major depression. Cochrane Database Syst Rev. 2008;CD000448.

    10/9/2009 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean dietary pattern with the incidence of depression. Arch Gen Psychiatry. 2009;66:1090.

    7/26/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Lespérance F, Frasure-Smith N, St-André E, et al. The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. J Clin Psychiatry. 2010 Jun 15 early online.

    12/13/2010 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Britton WB, Haynes PL, Fridel KW, Bootzin RR. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med. 2010;72(6):539-548.

    3/28/2011 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry. 2011;198:11-16, sup 1.

    7/28/2011 DynaMed's Systematic Literature Surveillance. DynaMed's Systematic Literature Surveillance: Jakobsen JC, Hansen JL, Simonsen E, Gluud C. The effect of adding psychodynamic therapy to antidepressants in patients with major depressive disorder. A systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. J Affect Disord. 2011 Apr 16. [Epub ahead of print]

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