What Is Depression? - Psychiatry.org

Persistent Depressive Disorder AsdescribedinthePrivacyPolicyoftheAmericanPsychiatricAssociation(APA),thiswebsiteutilizescookiesformultiplepurposesincludingtoprovideyouwithpersonalizedcontent,evaluateandanalyzetheuseofoursite,andtoidentifywhichadvertisementsbringuserstoAPA’swebsites.Byclosingthismessage,continuingthenavigation,orotherwisecontinuingtoviewtheAPA’swebsites&applications,youconfirmthatyouunderstandandacceptthetermsoftheAPA’sPrivacyPolicy,includingtheuseofcookies.ReadourfullPrivacyPolicyhere. Accept Skiptocontent Closealert Important!SystemUpdateComingSoon.Passwordresetwillberequired.Readmorehere. Closealert Important!SystemUpdateComingSoon. Passwordresetwillberequired. Readmorehere> Youarehere: PatientsandFamilies Depression WhatIsDepression? Share Print SubNavigation Depression TogglePageListing WhatIsDepression? ExpertQ&A:Depression OnThisPage WhatIsDepression? Depression(majordepressivedisorder)isacommonandseriousmedicalillnessthatnegativelyaffectshowyoufeel,thewayyouthinkandhowyouact.Fortunately,itisalsotreatable.Depressioncausesfeelingsofsadnessand/oralossofinterestinactivitiesyouonceenjoyed.Itcanleadtoavarietyofemotionalandphysicalproblemsandcandecreaseyourabilitytofunctionatworkandathome. Depressionsymptomscanvaryfrommildtosevereandcaninclude: Feelingsadorhavingadepressedmood Lossofinterestorpleasureinactivitiesonceenjoyed Changesinappetite—weightlossorgainunrelatedtodieting Troublesleepingorsleepingtoomuch Lossofenergyorincreasedfatigue Increaseinpurposelessphysicalactivity(e.g.,inabilitytositstill,pacing,handwringing)orslowedmovementsorspeech(theseactionsmustbesevereenoughtobeobservablebyothers) Feelingworthlessorguilty Difficultythinking,concentratingormakingdecisions Thoughtsofdeathorsuicide Symptomsmustlastatleasttwoweeksandmustrepresentachangeinyourpreviousleveloffunctioningforadiagnosisofdepression. Also,medicalconditions(e.g.,thyroidproblems,abraintumororvitamindeficiency)canmimicsymptomsofdepressionsoitisimportanttoruleoutgeneralmedicalcauses. Depressionaffectsanestimatedonein15adults(6.7%)inanygivenyear.Andoneinsixpeople(16.6%)willexperiencedepressionatsometimeintheirlife.Depressioncanoccuratanytime,butonaverage,firstappearsduringthelateteenstomid-20s.Womenaremorelikelythanmentoexperiencedepression.Somestudiesshowthatone-thirdofwomenwillexperienceamajordepressiveepisodeintheirlifetime.Thereisahighdegreeofheritability(approximately40%)whenfirst-degreerelatives(parents/children/siblings)havedepression. DepressionIsDifferentFromSadnessorGrief/Bereavement Thedeathofalovedone,lossofajobortheendingofarelationshiparedifficultexperiencesforapersontoendure.Itisnormalforfeelingsofsadnessorgrieftodevelopinresponsetosuchsituations.Thoseexperiencinglossoftenmightdescribethemselvesasbeing“depressed.” Butbeingsadisnotthesameashavingdepression.Thegrievingprocessisnaturalanduniquetoeachindividualandsharessomeofthesamefeaturesofdepression.Bothgriefanddepressionmayinvolveintensesadnessandwithdrawalfromusualactivities.Theyarealsodifferentinimportantways: Ingrief,painfulfeelingscomeinwaves,oftenintermixedwithpositivememoriesofthedeceased.Inmajordepression,moodand/orinterest(pleasure)aredecreasedformostoftwoweeks. Ingrief,self-esteemisusuallymaintained.Inmajordepression,feelingsofworthlessnessandself-loathingarecommon. Ingrief,thoughtsofdeathmaysurfacewhenthinkingoforfantasizingabout“joining”thedeceasedlovedone.Inmajordepression,thoughtsarefocusedonendingone’slifeduetofeelingworthlessorundeservingoflivingorbeingunabletocopewiththepainofdepression. Griefanddepressioncanco-existForsomepeople,thedeathofalovedone,losingajoborbeingavictimofaphysicalassaultoramajordisastercanleadtodepression.Whengriefanddepressionco-occur,thegriefismoresevereandlastslongerthangriefwithoutdepression. Distinguishingbetweengriefanddepressionisimportantandcanassistpeopleingettingthehelp,supportortreatmenttheyneed. RiskFactorsforDepression Depressioncanaffectanyone—evenapersonwhoappearstoliveinrelativelyidealcircumstances. Severalfactorscanplayaroleindepression: Biochemistry:Differencesincertainchemicalsinthebrainmaycontributetosymptomsofdepression. Genetics:Depressioncanruninfamilies.Forexample,ifoneidenticaltwinhasdepression,theotherhasa70percentchanceofhavingtheillnesssometimeinlife. Personality:Peoplewithlowself-esteem,whoareeasilyoverwhelmedbystress,orwhoaregenerallypessimisticappeartobemorelikelytoexperiencedepression. Environmentalfactors:Continuousexposuretoviolence,neglect,abuseorpovertymaymakesomepeoplemorevulnerabletodepression. HowIsDepressionTreated? Depressionisamongthemosttreatableofmentaldisorders.Between80%and90%percentofpeoplewithdepressioneventuallyrespondwelltotreatment.Almostallpatientsgainsomerelieffromtheirsymptoms. Beforeadiagnosisortreatment,ahealthprofessionalshouldconductathoroughdiagnosticevaluation,includinganinterviewandaphysicalexamination.Insomecases,abloodtestmightbedonetomakesurethedepressionisnotduetoamedicalconditionlikeathyroidproblemoravitamindeficiency(reversingthemedicalcausewouldalleviatethedepression-likesymptoms).Theevaluationwillidentifyspecificsymptomsandexploremedicalandfamilyhistoriesaswellasculturalandenvironmentalfactorswiththegoalofarrivingatadiagnosisandplanningacourseofaction. Medication Brainchemistrymaycontributetoanindividual’sdepressionandmayfactorintotheirtreatment.Forthisreason,antidepressantsmightbeprescribedtohelpmodifyone’sbrainchemistry.Thesemedicationsarenotsedatives,“uppers”ortranquilizers.Theyarenothabit-forming.Generallyantidepressantmedicationshavenostimulatingeffectonpeoplenotexperiencingdepression. Antidepressantsmayproducesomeimprovementwithinthefirstweekortwoofuseyetfullbenefitsmaynotbeseenfortwotothreemonths.Ifapatientfeelslittleornoimprovementafterseveralweeks,hisorherpsychiatristcanalterthedoseofthemedicationoraddorsubstituteanotherantidepressant.Insomesituationsotherpsychotropicmedicationsmaybehelpful.Itisimportanttoletyourdoctorknowifamedicationdoesnotworkorifyouexperiencesideeffects. Psychiatristsusuallyrecommendthatpatientscontinuetotakemedicationforsixormoremonthsafterthesymptomshaveimproved.Longer-termmaintenancetreatmentmaybesuggestedtodecreasetheriskoffutureepisodesforcertainpeopleathighrisk. Psychotherapy Psychotherapy,or“talktherapy,”issometimesusedalonefortreatmentofmilddepression;formoderatetoseveredepression,psychotherapyisoftenusedalongwithantidepressantmedications.Cognitivebehavioraltherapy(CBT)hasbeenfoundtobeeffectiveintreatingdepression.CBTisaformoftherapyfocusedontheproblemsolvinginthepresent.CBThelpsapersontorecognizedistorted/negativethinkingwiththegoalofchangingthoughtsandbehaviorstorespondtochallengesinamorepositivemanner. Psychotherapymayinvolveonlytheindividual,butitcanincludeothers.Forexample,familyorcouplestherapycanhelpaddressissueswithinthesecloserelationships.Grouptherapybringspeoplewithsimilarillnessestogetherinasupportiveenvironment,andcanassisttheparticipanttolearnhowotherscopeinsimilarsituations. Dependingontheseverityofthedepression,treatmentcantakeafewweeksormuchlonger.Inmanycases,significantimprovementcanbemadein10to15sessions. ElectroconvulsiveTherapy(ECT) ECTisamedicaltreatmentthathasbeenmostcommonlyreservedforpatientswithseveremajordepressionwhohavenotrespondedtoothertreatments.Itinvolvesabriefelectricalstimulationofthebrainwhilethepatientisunderanesthesia.ApatienttypicallyreceivesECTtwotothreetimesaweekforatotalofsixto12treatments.Itisusuallymanagedbyateamoftrainedmedicalprofessionalsincludingapsychiatrist,ananesthesiologistandanurseorphysicianassistant.ECThasbeenusedsincethe1940s,andmanyyearsofresearchhaveledtomajorimprovementsandtherecognitionofitseffectivenessasamainstreamratherthana"lastresort"treatment. Self-helpandCoping Thereareanumberofthingspeoplecandotohelpreducethesymptomsofdepression.Formanypeople,regularexercisehelpscreatepositivefeelingandimprovesmood.Gettingenoughqualitysleeponaregularbasis,eatingahealthydietandavoidingalcohol(adepressant)canalsohelpreducesymptomsofdepression. Depressionisarealillnessandhelpisavailable.Withproperdiagnosisandtreatment,thevastmajorityofpeoplewithdepressionwillovercomeit.Ifyouareexperiencingsymptomsofdepression,afirststepistoseeyourfamilyphysicianorpsychiatrist.Talkaboutyourconcernsandrequestathoroughevaluation.Thisisastarttoaddressingyourmentalhealthneeds. RelatedConditions Peripartumdepression(previouslypostpartumdepression) Seasonaldepression(Alsocalledseasonalaffectivedisorder) Bipolardisorders Persistentdepressivedisorder(previouslydysthymia)(descriptionbelow) Premenstrualdysphoricdisorder(descriptionbelow) Disruptivemooddysregulationdisorder(descriptionbelow) PremenstrualDysphoricDisorder(PMDD) PMDDwasaddedtotheDiagnosticandStatisticalManualofMentalDisorders(DSM-5)in2013.AwomanwithPMDDhasseveresymptomsofdepression,irritability,andtensionaboutaweekbeforemenstruationbegins. Commonsymptomsincludemoodswings,irritabilityoranger,depressedmood,andmarkedanxietyortension.Othersymptomsmayincludedecreasedinterestinusualactivities,difficultyconcentrating,lackofenergyoreasyfatigue,changesinappetitewithspecificfoodcravings,troublesleepingorsleepingtoomuch,orasenseofbeingoverwhelmedoroutofcontrol.Physicalsymptomsmayincludebreasttendernessorswelling,jointormusclepain,asensationof“bloating,”orweightgain. Thesesymptomsbeginaweekto10daysbeforethestartofmenstruationandimproveorstoparoundtheonsetofmenses.Thesymptomsleadtosignificantdistressandproblemswithregularfunctioningorsocialinteractions. ForadiagnosisofPMDD,symptomsmusthaveoccurredinmostofthemenstrualcyclesduringthepastyearandmusthaveanadverseeffectonworkorsocialfunctioning.Premenstrualdysphoricdisorderisestimatedtoaffectbetween1.8%to5.8%ofmenstruatingwomeneveryyear. PMDDcanbetreatedwithantidepressants,birthcontrolpills,ornutritionalsupplements.Dietandlifestylechanges,suchasreducingcaffeineandalcohol,gettingenoughsleepandexercise,andpracticingrelaxationstechniques,canhelp. Premenstrualsyndrome(PMS)issimilartoPMDDinthatsymptomsoccursevento10daysbeforeawoman’speriodbegins.However,PMSinvolvesfewerandlessseveresymptomsthanPMDD. DisruptiveMoodDysregulationDisorder Disruptivemooddysregulationdisorderisaconditionthatoccursinchildrenandyouthages6to18.Itinvolvesachronicandsevereirritabilityresultinginsevereandfrequenttemperoutbursts.Thetemperoutburstscanbeverbalorcaninvolvebehaviorsuchasphysicalaggressiontowardpeopleorproperty.Theseoutburstsaresignificantlyoutofproportiontothesituationandarenotconsistentwiththechild’sdevelopmentalage.Theymustoccurfrequently(threeormoretimesperweekonaverage)andtypicallyinresponsetofrustration.Inbetweentheoutbursts,thechild’smoodispersistentlyirritableorangrymostoftheday,nearlyeveryday.Thismoodisnoticeablebyothers,suchasparents,teachers,andpeers. Inorderforadiagnosisofdisruptivemooddysregulationdisordertobemade,symptomsmustbepresentforatleastoneyearinatleasttwosettings(suchasathome,atschool,withpeers)andtheconditionmustbeginbeforeage10.Disruptivemooddysregulationdisorderismuchmorecommoninmalesthanfemales.Itmayoccuralongwithotherdisorders,includingmajordepressive,attention-deficit/hyperactivity,anxiety,andconductdisorders. Disruptivemooddysregulationdisordercanhaveasignificantimpactonthechild’sabilitytofunctionandasignificantimpactonthefamily.Chronic,severeirritabilityandtemperoutburstscandisruptfamilylife,makeitdifficultforthechild/youthtomakeorkeepfriendships,andcausedifficultiesatschool. Treatmenttypicallyinvolvespsychotherapy(cognitivebehaviortherapy)and/ormedications. PersistentDepressiveDisorder Apersonwithpersistentdepressivedisorder(previouslyreferredtoasdysthymicdisorder)hasadepressedmoodformostoftheday,formoredaysthannot,foratleasttwoyears.Inchildrenandadolescents,themoodcanbeirritableordepressed,andmustcontinueforatleastoneyear. Inadditiontodepressedmood,symptomsinclude: Poorappetiteorovereating Insomniaorhypersomnia Lowenergyorfatigue Lowself-esteem Poorconcentrationordifficultymakingdecisions Feelingsofhopelessness Persistentdepressivedisorderoftenbeginsinchildhood,adolescence,orearlyadulthoodandaffectsanestimated0.5%ofadultsintheUnitedStateseveryyear.Individualswithpersistentdepressivedisorderoftendescribetheirmoodassador“downinthedumps.”Becausethesesymptomshavebecomeapartoftheindividual’sday-to-dayexperience,theymaynotseekhelp,justassumingthat“I’vealwaysbeenthisway.” Thesymptomscausesignificantdistressordifficultyinwork,socialactivities,orotherimportantareasoffunctioning.Whiletheimpactofpersistentdepressivedisorderonwork,relationshipsanddailylifecanvarywidely,itseffectscanbeasgreatasorgreaterthanthoseofmajordepressivedisorder. Amajordepressiveepisodemayprecedetheonsetofpersistentdepressivedisorderbutmayalsoariseduring(andbesuperimposedon)apreviousdiagnosisofpersistentdepressivedisorder. 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