Depression

Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.

Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.

More than 17 million U.S. adults—over 7% of the population—had at least one major depressive episode in the past year. People of all ages and all racial, ethnic and socioeconomic backgrounds experience depression, but it does affect some groups more than others.

Symptoms

Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks.

 

Common symptoms include:

  • Changes in sleep

  • Changes in appetite

  • Lack of concentration

  • Loss of energy

  • Lack of interest in activities

  • Hopelessness or guilty thoughts

  • Changes in movement (less activity or agitation)

  • Physical aches and pains

  • Suicidal thoughts

 

Treatment

Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plans can include any or a combination of the following:

 

Types of

Depression

Some forms of depression are slightly different, or they may develop under unique circumstances. The most common types of depression include:

Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.

 

Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

 

Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

 

Psychotic 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). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

 

Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

 

Co-Occurring

Mental Illness

A co-occurring disorder refers to when one person has two or more mental health disorders or medical illnesses. These co-occurring disorders may overlap and begin at the same time, or one may appear before or after the other.

Social anxiety & bipolar disorder

 

Medication

Guide

(Prescription, Experimental, &

Natural Herbs and Medicines)

Traditional Prescriptions:

For some people, antidepressant medications may help reduce or control symptoms. Antidepressants often take 2-4 weeks to begin having an effect and up to 12 weeks to reach full effect. Most people will have to try various doses or medications to find what works for them. Here are some antidepressants commonly used to treat depression:

Selective serotonin reuptake inhibitors (SSRIs) act on serotonin, a brain chemical. They are the most common medications prescribed for depression.

 

​Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second most common antidepressants. These medications increase serotonin and norepinephrine.

 

Norepinephrine-dopamine reuptake inhibitors (NDRIs) increase dopamine and norepinephrine. Bupropion (Wellbutrin) is a popular NDRI medication, which causes fewer (and different) side effects than other antidepressants. For some people, bupropion causes anxiety symptoms, but for others it is an effective treatment for anxiety.

 

Mirtazapine (Remeron) targets specific serotonin and norepinephrine receptors in the brain, thus indirectly increasing the activity of several brain circuits. Mirtazapine is used less often than newer antidepressants (SSRIs, SNRIs and bupropion) because it is associated with more weight gain, sedation and sleepiness. However, it appears to be less likely to result in insomnia, sexual side effects and nausea than the SSRIs and SNRIs.

 

Second-generation antipsychotics (SGAs), or “atypical antipsychotics,” treat schizophrenia, acute mania, bipolar disorder and bipolar mania and other mental illnesses. SGAs can be used for treatment-resistant depression.

 

Tricyclic antidepressants (TCAs) are older medications, seldom used today as initial treatment for depression. They work similarly to SNRIs but have more side effects. They are sometimes used when other antidepressants have not worked. TCAs may also ease chronic pain.

  • Amitriptyline (Elavil)

  • Desipramine (Norpramin)

  • Doxepin (Sinequan)

  • Imipramine (Tofranil)

  • Nortriptyline (Pamelor, Avantyl)

  • Protriptyline (Vivactil)

 

Monoamine oxidase inhibitors (MAOIs) are less used today because newer, more effective medications with fewer side effects have been found. These medications can never be used in combination with SSRIs. MAOIs can sometimes be effective for people who do not respond to other medications.

Experimental:

Although in the early stages of testing, experimental procedures and substances have shown promising results towards helping those with mental health. Please consult with your doctor before moving forward with any new or experimental medicine. 

  • Ketamine - A new study suggests that ketamine may not only be helpful for those with clinical depression but also bipolar depression. Ketamine differs from traditional antidepressants in its mechanism of action – it affects different brain systems, neurotransmitters, and neural pathways.

  • Spravato A nasal spray used in conjunction with an oral antidepressant for the treatment of depression in adults who have tried other antidepressant medicines but have not benefited from them.

  • Ayahuasca - Ayahuasca is a psychoactive Amazonian brew which has emerging data indicating that it has antidepressant and anxiolytic properties.

  • Psychedelics - The psychedelic substance psilocybin may be more effective in patients who suffer from major depression than previously appreciated.

Natural Herbs and Medicines:  

 

Medical

Procedures

Vagus Nerve Stimulation (VNS)- VNS uses a pulse generator, about the size of a stopwatch, placed in the upper left side of the chest to stimulate the vagus nerve, which carries messages to parts of the brain that control mood and sleep, with electrical impulses. 

Electroconvulsive Therapy (ECT)- ECT is a procedure where controlled electric currents are passed through the brain while the person is under general anesthesia. This results in a brief, controlled seizure that affects neurons and chemicals in the brain. It is most often used to treat severe depression and depression with psychosis that has not responded to medications. 

 

Deep Brain Stimulus (DBS) -  Deep brain stimulation is currently being studied as treatment for Tourette’s syndrome and major depression. DBS involves two electrodes put surgically directly in the brain and a pulse generator put in a person’s chest.

 

Transcranial Magnetic Stimulation (TMS) - TMS is a procedure that creates magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS should not be used to treat anyone experiencing depression with psychosis or bipolar disorder or having a high risk of suicide. 

Systematic Treatment EnhancementThe NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a long-term outpatient study designed to find out which treatments, or combinations of treatments, are most effective for treating episodes of depression and mania and for preventing recurrent episodes in people with bipolar disorder. 

 
 

Sleep, Diet and Exercise for Better Mental Health

 

Additional

Resources

Support Programs

Blogs

Videos

Books

Articles

 

Websites

Podcasts

Handouts

Apps

  • MindDoc - Monitoring and self-management app for promoting emotional well-being and coping

  • Headspace - Guided meditations, animations, articles, and videos