Depressive Disorders | Psychology Today

Major depressive disorder, or major depression, is manifested in a persistently sad mood accompanied by a number of other symptoms that ... Skiptomaincontent DepressiveDisorders ReviewedbyPsychologyTodayStaff Depressivedisordersarecharacterizedbypersistentfeelingsofsadnessandworthlessnessandalackofdesiretoengageinformerlypleasurableactivities.Depressionisnotapassingbluemood,whichalmosteveryoneexperiencesfromtimetotime,butacomplexmind-bodyillnessthatinterfereswitheverydayfunctioning.Itnotonlydarkensone'soutlook,butitisalsocommonlymarkedbysleepproblemsandchangesinenergylevelsandappetite.Italtersthestructureandfunctionofnervecellssothatitdisruptsthewaythebrainprocessesinformationandinterpretsexperience.Despitefeelingsofhopelessnessandworthlessness,depressionisatreatablecondition.Itcanbetreatedwithpsychotherapyormedication,oracombinationofboth. Depressionisacommonconditioninmodernlife.AccordingtotheNationalInstitutesofHealth,eachyearmorethan16millionadultsintheUnitedStatesexperienceatleastoneepisodeofmajordepression.Thelikelihoodthatapersonwilldevelopdepressionatsomepointinlifeisapproximately10percent.Prolongedsocialstressandmajordisruptionofsocialtiesareknownriskfactorsfordepression,andmajornegativelifeeventssuchaslossofalovedone,orlossofajob,increasethesubsequentriskofdepression.Significantadversityearlyinlife,suchasseparationfromparentsorparentalneglectorabuse,maycreatevulnerabilitytomajordepressionlaterinlifebysettingthenervoussystemtoover-respondtostress. Contents Definition Symptoms Causes Treatment Definition Adepressivedisorderisaconditionthatinvolvesthebody,mood,andthoughts.Itsapsmotivationandinterfereswithnormalfunctioningofdailylife.Ittypicallycausespainbothtothepersonexperiencingthemooddisturbanceandthosewhocareabouthimorher. Bydefinition,thesymptomsmustbepresentforatleasttwoweeks.Itisnotasignofpersonalweaknessoraconditionthatcanbewilledorwishedaway.Depressiontendstobeepisodic,withboutslastingweeksormonths.Althoughsymptomstendtoremitspontaneouslyovertime,someformoftreatmentisimportanttoreducethelikelihoodofrecurrentepisodes.Appropriatetreatmentcanhelpmostpeoplewhosufferfromdepression. Depressivedisorderscomeindifferentforms,asisthecasewithotherillnessessuchasheartdisease.Threeofthemostcommontypesofdepressivedisordersaredescribedhere.However,allformsaremarkedbyvariationinthenumberofsymptomsaswellastheirseverityandpersistence. Majordepressivedisorder,ormajordepression,ismanifestedinapersistentlysadmoodaccompaniedbyanumberofothersymptomsthatinterferewiththeabilitytowork,study,sleep,eat,andenjoyoncepleasurableactivities.Adisablingepisodeofdepressionmayoccuronlyoncebutmorecommonlyoccursseveraltimesinalifetime.Depressionismorethanadisorderonlyfromtheneckup.Italsoaffectsthefunctionofmanysystemsinthebody.Researchershaveestablished,forexample,thatimmunefunctionisoftencompromisedindepressivestates,andimpairedimmunefunctionmayinpartunderliethelinkofdepressiontosuchotherdisordersasheartdisease. Dysthymicdisorder,orpersistentdepressivedisorder,alsocalleddysthymia,involvessymptomsofsadordownmoodmostdaysformostofthedayoveralongterm(twoyearsorlonger)butthedepressedmoodisnotdisabling,althoughitimpairsfunctioningtosomedegree.Manypeoplewithdysthymiaalsoexperiencemajordepressiveepisodesatsometimeintheirlives. Someformsofdepressivedisorderinvolveaslightvariationoffeaturesordevelopunderspecificcircumstances. Premenstrualdysphoricdisordermanifestsintheweekbeforetheonsetofmenses,subsideswithindaysafteronsetofmenstruation,andremitsintheweekaftermenstruation.AccordingtotheNationalInstitutesofHealth,3to8percentofwomenofreproductiveagemeetstrictcriteriaforpremenstrualdysphoricdisorder. Majordepressionwithpsychoticfeatures,orpsychoticdepression,occurswhenaseveredepressiveillnessisaccompaniedbydelusionsandhallucinations,Thepsychoticfeaturesmaybemood-congruentwiththedepression—thatis,consistentwiththedepressivethemesofpersonalinadequacy,guilt,nihilism,ordeath.Orthedelusionsandhallucinationsmaybemood-incongruent,notinvolvingsuchdepressivethemes. Majordepressionwithpostpartumonset,orpostpartumdepression,isdiagnosedifawomandevelopsamajordepressiveepisodeduringpregnancyorwithinfourweeksafterdelivery.Itisestimatedthat3to6percentofwomenexperiencepostpartumdepression. Majordepressionwithseasonalpatterns,orseasonalaffectivedisorder(SAD),ischaracterizedbytheonsetofadepressiveillnessduringparticulartimesoftheyear.Typically,thedepressiondevelopsduringthewintermonths,whenthereislimitednaturalsunlight,andcompletelyremitsinthespringandsummermonths.Inaminorityofcasesofmajordepressionwithseasonalpatterns,thedepressionoccursduringthesummermonths.SADmaybeeffectivelytreatedwithlighttherapy,butnearlyhalfofthosewithSADdonotrespondtolighttherapyalone.AntidepressantmedicationandpsychotherapycanreduceSADsymptoms,eitheraloneorincombinationwithlighttherapy. articlecontinuesafteradvertisement Symptoms ThefollowingsignsandsymptomsarecatalogedbytheDSM-5assignifiersofmajordepressivedisorderandatleastfivemustbepresentduringtheextendedperiodoflowmoodorlossofpleasureinonce-enjoyablepursuits. Persistentsad,anxious,oremptymoodmostoftheday,mostdays Feelingsofworthlessnessorexcessiveguilt Lossofinterestorpleasureinactivitiesthatwereonceenjoyed,includingsex Persistentlossofenergyorfatigue Difficultythinking,concentrating,remembering,ormakingdecisions Insomnia,early-morningawakening,oroversleeping(hypersomnia) Asignificantchangeinappetite,resultinginunintendedweightlossorweightgain Observablepsychomotoragitationorrestlessness,orpsychomotorslowing Feelingsofhopelessnessorpessimism;recurrentthoughtsofdeathorsuicide,suicideattempts Aredepressivesymptomsdifferentfordifferentpeople? CreatedwithSketch. Noteveryoneexperienceseverysymptom,nordopeopleexperiencethesamesymptomstothesamedegree.Symptomsmayvarynotonlybetweenindividualsbutovertimeinthesameindividual.Somepeoplehaveobservablebehavioralchanges,includingdisruptedsleepandappetitechanges.Othershavenophysicalsymptomsbuttheiroutlookonlifegrowsnotablymorepessimistic.  Whatisthemostcommonsymptomofdepression? CreatedwithSketch. Themostwidelyreportedsymptomofdepressionislowmoodandasenseofhopelessnessaboutlifeandone'sownprospects.Manypeoplecanrelatetosuchsentimentsandhaveexperiencedthematsomepoint.Butforapersonwhoisexperiencingdepression,thisoutlookispersistentanddoesnotremit.Ifsomeonereportsthattheyhavefeltthiswayfortwoweeksormore,theyshouldbeencouragedtoseekprofessionalhelp.  Causes Thereisnosinglecauseofdepression.Rather,evidenceindicatesitresultsfromacombinationofgenetic,biological,environmental,andpsychologicalfactors. Researchdeployingbrain-imaging—suchasmagneticresonanceimaging(MRI)—andothertechnologiesshowsthatthebrainsofpeoplewhohavedepressionlookdifferentthanthoseofpeoplewithoutdepression.Thepartsofthebrainresponsibleforregulatingmood,thinking,sleep,appetite,andbehaviorappeartofunctionabnormally.Butthesechangesdonotrevealwhythedepressionhasoccurred. Therearemanypathwaystodepression.Geneticfactorsmayplayacomplexroleinsettingthelevelofsensitivitytocertainkindsofevents,includingthelevelofnervoussystemreactivitytostressandotherchallenges.Scientistsknowthereisnosinglegeneinvolved:manygeneslikelyplayasmallroleincontributingtovulnerability;actingtogetherwithenvironmentalorotherfactors. However,depressioncanoccurinpeoplewithoutfamilyhistoriesofitaswell.Thereissignificantevidencethatharshearlyenvironments—especiallyexperiencesofsevereadversitysuchasabuseorneglectinchildhood—cancreatevulnerabilitytolaterdepressionbyalteringthesensitivityofthenervoussystemtodistressingorthreateningevents. Experiencesoffailure,rejection,socialisolation,lossofalovedone,orfrustrationordisappointmentinachievingahealthyrelationshiporanyotherlifegoaloftenprecedeanepisodeofdepression.Forthatreason,manyresearchersregardthenegativemoodstateofdepressionasapainfulsignalthatbasicpsychologicalneedsarenotbeingmetandthatnewstrategiesareneeded.Theyalsosuggestthatdepressiontosomedegreeresultsfromalackofskillsinprocessingnegativefeelings;someofthemosteffectivetherapiesfordepressionteachwhatcanbeconsideredbasicmentalhygiene,cognitiveandemotionaltoolsfordealingwithnegativefeelings.Trauma,whichcanoverwhelmemotionalprocessingmechanisms,isanothercommontriggerfordepressiveepisodes. DepressioninWomen Womenexperiencedepressionabouttwiceasoftenasmen.Biological,lifecycle,hormonal,andotherfactors—includingexperientialones—uniquetowomenmaybelinkedtotheirhigherdepressionrate.Researchershaveshownthathormonesdirectlyaffectbrainregionsthatinfluenceemotionsandmood,andtheyarefurtherexploringhowhormonecyclescangiverisetodepressivestates.Somewomenmaybesusceptibletothesevereformofpremenstrualsyndromecalledpremenstrualdysphoricdisorder(PMDD).Womenarealsovulnerabletodepressionaftergivingbirth,whenhormonalandphysicalchanges,alongwiththenewresponsibilityofcaringforahelplessinfantcanbeoverwhelming.Manywomenalsouniquelyfacesuchprovenchronicstressesasjugglingworkandhomeresponsibilities,singleparenthood,domesticabuse,andcaringforchildrenandagingparents. Ongoingresearchprobeswhysomepeoplefacedwithenormouschallengesdevelopdepression,whileotherswithsimilarchallengesdonot. DepressioninMen MillionsofmenintheU.S.andaroundtheworldalsosufferthepsychicpainofdepression.Researchandclinicalevidenceestablishthatwhilebothwomenandmencandevelopthestandardsymptomsofdepression,theyoftenexperiencedepressiondifferentlyandmayhavedifferentwaysofcopingwiththesymptoms.Menmaybemorewillingtoacknowledgefatigue,irritability,lossofinterestinworkorhobbies,andsleepdisturbancesratherthanfeelingsofsadness,worthlessness,andexcessiveguilt.Someresearchersquestionwhetherthestandarddefinitionofdepressionandthediagnostictestsbaseduponitadequatelycapturetheconditionasitoccursinmen. Depressioncanalsoaffectthephysicalhealthofmendifferentlyfromwomen.Onestudyshowsthat,althoughdepressionisassociatedwithanincreasedriskofcoronaryheartdiseaseinbothmenandwomen,onlymenexperienceanelevateddeathrate. Insteadofacknowledgingtheirfeelingsorseekinghelpintheformofappropriatetreatment,menmayturntoalcoholordrugswhentheyaredistressed.Theymayalsobeangry,irritable,and,sometimes,violentlyabusive.Somemendealwithemotionaldistressbythrowingthemselvescompulsivelyintotheirwork,attemptingtohidetheirdepressionfromthemselves,family,andfriends.Othermenmayrespondtodepressionbyengaginginrecklessbehavior,takingrisks,andputtingthemselvesinharm'sway. Encouragementandsupportfromconcernedfamilymemberscanbelifesaving.Intheworkplace,employeeassistanceprogramsorworksitementalhealthprogramscanbeparticularlyimportantinhelpingmenunderstanddepressionasarealdisorderthatneedstreatment. DepressionintheElderly Contrarytosomepopularthinking,depressionisnotanormalaccompanimenttoaging.Onthecontrary,olderpeopletendtoexperiencerisinglevelsofsatisfactionwiththeirlives.However,whenolderadultsdodevelopdepression,theconditionmaybeoverlookedbecauseitcanmanifestlessinfeelingsofsadnessorgriefandmoreinirritabilityorgeneralapathy.Eldersoftenvoicefeelingsoftiredness.Also,depressiontendstoaffectmemory,andintheelderlydepressioncanshowupasconfusionorproblemswithattention.Agingbringsmanylifechangesthatcanbetriggersfordepression,includinglossofalovedone,lossofemploymentandsenseofpurpose,lossofrobustness,orgoodhealth. Inaddition,medicalconditionsthatoccurmorefrequentlywithage,suchasheartdisease,stroke,andcancer,maycausedepressivesymptoms.Orthemedicationsusedforsuchconditionsmaycarrysideeffectsthatcontributetodepression. Thereisatypeofdepressionthatdevelopsinlaterlife,knownasvasculardepression,sometimesalsocalledarterioscleroticdepressionorsubcorticalischemicdepression.Itresultsfromcerebrovasculardamagethatoccurswithcardiovasculardisease.Brain-imagingstudiesshowthatareasofbloodvesseldamagerestrictbloodflowtoregionsofthebraininvolvedinemotionandmoodregulationortothebrain'swhitematter.Thosewhodevelopvasculardepressionoftenhaveahistoryofhypertensionorhighbloodpressure.Vasculardepressionmaymanifestinparanoia,aggressivetendencies,apathy,andslowingofmovement.Therearedeficitsinexecutivefunction.Diagnosismayinvolvemagneticresonanceimaging(MRI)todetectvascularpathologyinspecificpartsofthebrain.Vasculardepressiontendsnottorespondtoantidepressantmedication;instead,thefirstlineofapproachmaybeformsofpsychosocialsupportandorcognitivebehavioraltherapy. Themajorityofolderadultswithdepressionimprovewhentheyreceivetreatmentwithpsychotherapy,antidepressantmedication,oracombinationofthetwo.Researchhasshownthatpsychotherapyalonecanbeeffectiveinprolongingperiodsfreeofdepression. Aredepressedmenmorelikelytoattemptsuicidethandepressedwomen? CreatedwithSketch. MorethanfourtimesasmanymenaswomendiebysuicideintheU.S.,eventhoughwomenmakemoresuicideattemptsduringtheirlives.Inlightoftheresearchindicatingthatsuicideisoftenassociatedwithdepression,thehighsuiciderateamongmenmayreflectthefactthatmanymenwithdepressiondonotseekadequatediagnosisandtreatment. WhatcanIdoifI'mconcernedthatsomeonemayattemptsuicide? CreatedwithSketch. Reportremarksaboutsuicidetothedepressedperson'stherapist,iftheyhaveone.Invitethedepressedpersonforwalks,outings,tothemovies,andotheractivities.Keeptrying.Althoughdiversionsandcompanyareneeded,toomanydemandsmayincreasefeelingsoffailure.Remindyourfriendorrelativethatwithtimeandtreatment,thedepressionwilllift.PsychologyTodaymaintainsalistofsuicidepreventionhotlineresourcesinvariouscountriesaswellasanextensivetherapydirectory.  Treatment Depression,eveninthemostseverecases,isahighlytreatabledisorder.Thesoonertreatmentbegins,themoreeffectiveitisandthegreaterthelikelihoodthatrecurrencecanbeprevented. Appropriatetreatmentfordepressionstartswithaphysicalexaminationbyaphysician.Anumberofmedications,aswellassomemedicalconditions,includingviralinfectionsandthyroiddisorder,cancausedepression-likesymptomsandmustberuledout.Onceaphysicalcauseofdepressionisruledout,apsychologicalevaluationcanbeconducted,eitherbytheexaminingphysicianorviareferraltoamentalhealthprofessional. Anevaluationshouldincludeadetailedinquiryintothehistoryandnatureofcurrentsymptomsandpriorepisodesandtheirmanagementaswellasanyfamilyhistoryofdepressionanditstreatment.Fromthisinformation,theseverityofcurrentsymptomscanberated;thisinformationservesasabaselineformeasuringimprovementovertimeandguidesthecourseoftreatment. Oncediagnosed,depressioncanbetreatedwithpsychotherapy,medication,oracombinationofboth.Medicationmayhelpreducesymptomswhilepsychotherapyaddressesthenegativethoughts,feelings,andbeliefsthatgiverisetodistressandthatneedtobemanagedinmoreproductiveways. Psychotherapies Formildtomoderatedepression,psychotherapyisgenerallyconsideredthebesttreatmentoption.Psychotherapyisimportantinhelpingpatientsdevelopstrategiesfordealingwiththesituationsthatgiverisetodepressionandtoeffectivelymanagethenegativethoughtsandfeelingsthatmarkthedistress.Bothcognitive-behavioraltherapy(CBT),andinterpersonaltherapy(IPT)havebeenwidelytestedandshowntobeeffectiveintreatingdepression.Byteachingnewwaysofthinkingandbehaving,CBTgivespeopleskillstodisarmnegativestylesofthinkingandbehaving.IPThelpspeopleunderstandandworkthroughtroubledpersonalrelationshipsthatmaycauseorexacerbatetheirdepression. Studieshaveindicatedthatforadolescents,acombinationofmedicationandpsychotherapymaybethemosteffectiveapproachtotreatingmajordepressionandreducingthelikelihoodofrecurrence.Similarly,astudyexaminingdepressiontreatmentamongolderadultsfoundthatpatientswhorespondedtoinitialtreatmentofmedicationandIPTwerelesslikelytohaverecurringdepressioniftheycontinuedtheircombinationtreatmentforatleasttwoyears. Medications Antidepressantstargetvariousneurochemicals—notablyserotonin,norepinephrine,anddopamine—knowntobeinvolvedintherelayofsignalsthroughvariousbraincircuits.Nevertheless,itisnotentirelyclearhowtheyworkorwhytheycantakeweeksormonthstoproduceapositiveeffect—thebrainisahighlycomplexorgan. Themostpopularmedicationsarecalledselectiveserotoninreuptakeinhibitors(SSRIs).SSRIsincludefluoxetine(Prozac),citalopram(Celexa),andsertraline(Zoloft),amongothers.Serotoninandnorepinephrinereuptakeinhibitors(SNRIs)aresimilartoSSRIsandincludevenlafaxine(Effexor)andduloxetine(Cymbalta).Nowinusefordecades,SSRIsandSNRIscoexistwitholderclassesofantidepressants:tricyclics—namedfortheirchemicalstructure—andmonoamineoxidaseinhibitors(MAOIs).TheSSRIsandSNRIstendtohavefewermajorsideeffectsthantheolderdrugs.However,medicationsaffecteveryonedifferentlyandthereisnoone-size-fits-allmedication.TricyclicsandMAOIsremainimportantantidepressants.Findingamedicationregimenthatworksforanyparticularpatientmaytaketrialsofmorethanoneantidepressantandmorethanonetypeofantidepressant. Antidepressantstypicallytaketimetowork.Patientsmusttakeregulardosesforatleastthreetofourweeksbeforetheyarelikelytoexperienceafulltherapeuticeffectandcontinuetakingthemedicationtomaintainimprovedmoodandtopreventarelapseofthedepression.Althoughantidepressantsarenothabit-formingoraddictive,abruptlyendinganantidepressanttreatmentcancausewithdrawalsymptomsorleadtoarelapse.Someindividuals,suchasthosewithchronicorrecurrentdepression,mayneedtostayonthemedicationindefinitely. DespitetherelativesafetyandpopularityofSSRIsandotherantidepressants,somestudieshavesuggestedthattheymayhaveunintentionaleffectsonsomepeople,especiallyadolescentsandyoungadults.TheU.S.FoodandDrugAdministrationrequiresa"blackbox"warninglabelonallantidepressantmedicationstoalertthepublicaboutthepotentialincreasedriskofsuicidalthinkingorattemptsinchildren,adolescents,andyoungadultstakingantidepressants. SideeffectscanlimittheusefulnessofSSRIs,SNRIs,tricyclics,andMAOinhibitors.PeopletakingMAOIsmustadheretosignificantfoodandmedicinalrestrictions—fromwineandcheesetodecongestants—toavoidpotentiallyseriousinteractions.PatientstakinganMAOinhibitorshouldreceiveacompletelistofprohibitedfoods,medicines,andsubstancesatthetimeofprescription.Themostcommonsideeffectsoftricyclicantidepressantsincludedrymouth,constipation,difficultyemptyingthebladder,sexualproblems,blurredvision,dizziness,anddaytimedrowsiness.ThemostcommonsideeffectsassociatedwithSSRIsandSNRIsincludeheadache,nausea,nervousnessandinsomnia,agitation,anddecreasedlibido. Thenewestmedicationintheantidepressantarsenalisketamine,anagentlongusedsafelyasananesthetic.Inrandomized,controlledtrials,amolecularvariantofketamine,calledesketamine,hasrecentlybeenfoundsafeandeffectiveasatreatmentfordepression.Administeredbynasalspray,itactsveryrapidlytoimprovemood.Further,studiesshowthatitalsoreducessuicidalthinking.Itisnotfullyclearhowesketamineproducesitsantidepressanteffects,butthedrughasamechanismofactionthatisdifferentfromanyotheravailableantidepressant.ItbindstoNMDAreceptorsinthebrain,blockinguptakeoftheexcitatoryneurotransmitterglutamate,whichcausesarapidincreaseinglutamatelevels.Theglutamateburstultimatelystrengthensneuralcircuitsinareasofthebraininvolvedinmotivation,memory,andmood,knowntobeimpairedindepression.Thenewdrug,trade-namedSpravuto,isintendedforadultswithtreatment-resistantdepressionand,becauseofitspotentialforabuse,isadministeredindoctors'offices. HerbalTherapy Overtheyears,therehasbeenconsiderableinterestintheuseofherbsforthetreatmentofbothdepressionandanxiety.St.John'swort(Hypericumperforatum),oftenusedinEurope,hasarousedinterestintheUnitedStatesaswell,asithasbeenusedforcenturiesinmanyfolkandherbalremedies.AnumberofmodernstudieshavetestedtheeffectivenessofSt.John'swortfordepression. AccordingtotheNationalCenterforComplementaryandIntegrativeHealth:"St.John’swortisn’tconsistentlyeffectivefordepression.Donotuseittoreplaceconventionalcareortopostponeseeingyourhealthcareprovider.St.John’swortlimitstheeffectivenessofmanyprescriptionmedicines.CombiningSt.John’swortandcertainantidepressantscanleadtoapotentiallylife-threateningincreaseinyourbody’slevelsofserotonin,achemicalproducedbynervecells." NeurostimulationTherapies Electroconvulsivetherapy(ECT)isuseful,particularlyforindividualswhosedepressionissevereorlife-threatening,orforthosewhocannottakeantidepressantmedication.ECTofteniseffectiveincaseswhereantidepressantmedicationsdonotprovidesufficientreliefofsymptoms.Inrecentyears,ECThasbeenmuchimproved.Amusclerelaxantisgivenbeforetreatment,whichisdoneunderbriefanesthesia.Electrodesareplacedatpreciselocationsontheheadtodeliverelectricalimpulses.Thestimulationcausesabrief(about30seconds)seizurewithinthebrain.ThepersonreceivingECTdoesnotconsciouslyexperiencetheelectricalstimulus.Forfulltherapeuticbenefit,atleastseveralsessionsofECT,typicallygivenattherateofthreeperweek,arerequired. LifestyleChanges Researchshowsthatanumberoffactorsindailylivinghaveapositiveeffectonmoodstates.Theseincludeanutrient-richdiet,physicalactivity,exposuretosunlightandoutdoors,andsocialactivity.Lifestylechangesthataddressthesefactorsareincreasinglyconsideredawisecourseinanytreatmentplan. HowtoHelpYourselfIfYouAreDepressed Depressivedisorderscanmakeapersonfeelexhausted,worthless,helpless,andhopeless.Suchnegativethoughtsandfeelingsmakepeoplefeellikegivingup.Itisimportanttorealizethatsuchnegativeviewsarepartofthedisorderandtypicallydonotreflectactualcircumstances.Negativethinkingfadesastreatmentbeginstotakeeffect.Inthemeantime: Trytobewithotherpeopleandtoconfideinsomeone;itisusuallybetterthanbeingaloneandsecretive. Participateinactivitiesthatmaymakeyoufeelbetter. Evenmildexercise,goingtoamovieoraballgame,orparticipatinginreligious,social,orotheractivitiescanhelp. Expectyourmoodtoimprovegradually;ittakestime. Becausedepressiondistortsthinking,itisadvisabletopostponeimportantdecisionsuntilthedepressionlifts.Beforedecidingtomakeasignificanttransition—changejobs,getmarried,ordivorce—discussitwithotherswhoknowyouwellandhaveamoreobjectiveviewofyoursituation. Letfamilyandfriendshelpyou. Howcanlovedoneshelpadepressedperson? CreatedwithSketch. Themostimportantthinganyonecandoforadepressedpersonistohelphimorhergetanappropriatediagnosisandtreatment.Itmayrequiremakinganappointmentontheirbehalfandaccompanyingthemtothedoctor.Encouragingalovedonetostayintreatmentishelpful.Emotionalsupportisalsoinvaluable.Thisinvolvesunderstanding,patience,affection,andencouragement.Engagethedepressedpersoninconversationandlistencarefully.Donotdisparagefeelingsexpressed,butpointoutrealitiesandofferhope.  References AmericanPsychiatricAssociation,DiagnosticandStatisticalManual,FifthEdition   NationalInstitutesofHealth NationalHealthandNutritionExaminationSurvey ArchivesofInternalMedicine PsychopharmacologyBulletin JournaloftheAmericanMedicalAssociation NationalInstituteofMentalHealth U.S.DepartmentofHealthandHumanServices BiologicalPsychiatry AltshulerLL,HendrichV,CohenLS.Courseofmoodandanxietydisordersduringpregnancyandthepostpartumperiod.JournalofClinicalPsychiatry,1998;59:29. 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