Depression
Overview
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.
More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.
Symptoms
Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:
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Feelings of sadness, tearfulness, emptiness or hopelessness
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Angry outbursts, irritability or frustration, even over small matters
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Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
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Sleep disturbances, including insomnia or sleeping too much
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Tiredness and lack of energy, so even small tasks take extra effort
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Reduced appetite and weight loss or increased cravings for food and weight gain
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Anxiety, agitation or restlessness
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Slowed thinking, speaking or body movements
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Feelings of worthlessness or guilt, fixating on past failures or self-blame
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Trouble thinking, concentrating, making decisions and remembering things
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Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
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Unexplained physical problems, such as back pain or headaches
For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.
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Depression symptoms in children and teens
Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.
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In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
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In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.
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Depression symptoms in older adults
Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:
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Memory difficulties or personality changes
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Physical aches or pain
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Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
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Often wanting to stay at home, rather than going out to socialize or doing new things
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Suicidal thinking or feelings, especially in older men
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Causes
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It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:
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Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
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Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
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Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
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Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.
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Diagnosis
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Your doctor may determine a diagnosis of depression based on:
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Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.
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Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it's functioning properly.
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Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.
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DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
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​Types of depression
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Symptoms caused by major depression can vary from person to person. To clarify the type of depression you have, your doctor may add one or more specifiers. A specifier means that you have depression with specific features, such as:
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Anxious distress — depression with unusual restlessness or worry about possible events or loss of control
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Mixed features — simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy
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Melancholic features — severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or sluggishness
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Atypical features — depression that includes the ability to temporarily be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in the arms or legs
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Psychotic features — depression accompanied by delusions or hallucinations, which may involve personal inadequacy or other negative themes
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Catatonia — depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture
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Peripartum onset — depression that occurs during pregnancy or in the weeks or months after delivery (postpartum)
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Seasonal pattern — depression related to changes in seasons and reduced exposure to sunlight
Treatment
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Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.
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If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.
Reference
"Depression (Major Depressive Disorder)." Mayo Clinic, 14 Oct. 2022, www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013. Accessed 11 Jan. 2023.