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What is depression?

Low moods are a normal part of life but usually they don't last long and they do not interfere with our full participation in life. Depression, by contrast, is not just a brief blue mood or a feeling of sadness that lifts in a few hours or days. Rather, depression is a mood disturbance marked by feelings of hopelessness, sadness and negative thoughts that are more severe or prolonged than the usual range of sadness that most people experience. Many people with untreated depression find facing life is very difficult. They can't "snap out of it" any more than a diabetic can regulate his or her blood sugar using willpower.

How common is depression?

Low-grade depression is a quite common emotional experience and most people feel "down in the dumps" from time to time. Moderate to severe depression affects 1 in 5 people some time in their lives. College students are at higher risk of developing depression because the college environment is often quite demanding and stressful. Some studies show that as many as 1 in 3 college students experience depression severe enough to impair their ability to function at some point during their undergraduate years. In fact, college students have a higher than average rate of suicide.

Causes:

Many factors can play a role in whether a person gets depressed. Some of these include:

  • Situational influences: Life events such as illness or disability, unemployment or financial stress, loss of relationships, death of a loved one, and failure or disappointment can trigger depression. Difficult family, work or social situations can also cause depression. 
  • Biochemical factors:  Chemical imbalances in the brain can cause depression. Depression can also be caused by certain medications, infections and illnesses.
  • Individual personality:  People who are self-critical and demanding, or those who are dependent or pessimistic, may be prone to depression.
  • Genetic patterns: Research indicates depression tends to run in families.
  • Substance use: Drug and alcohol use often results in depressed mood either as a side effect or as a withdrawal effect.
  • Seasonal influences: People may become depressed during dark winter months -- see Seasonal Affective Disorder.
  • Negative attitudes: Viewing yourself and the world in a negative manner can lead to depression.

Symptoms:

Depression is not just one disorder. Clinicians classify depressive disorders differently depending on factors such as severity, duration, life stressors, and the presence of other medical problems. However, all depressive disorders are identified by the presence of some combination of the following symptoms that represent a change from a person's usual mood or behavior:

  • Depressed or irritable mood most days for the majority of each day
  • Total or very noticeable loss of pleasure or interests most of the time
  • Significant change in appetite, weight or both
  • Sleep problems (insomnia or excessive sleepiness) nearly every night
  • Feelings of agitation or a sense of intense slowness
  • Loss of energy and an overwhelming feeling of fatigue
  • Sense of guilt and worthlessness nearly all the time
  • Feelings of hopelessness and helplessness
  • Inability to concentrate nearly every day
  • Recurrent thoughts of death or suicide

If you suffer from any of these symptoms—even for a week—please consider getting help. You don't have to "go it alone!" See Resources for Stress and Mental Health.

Treatment:

Fortunately, most depressive disorders are treatable using a variety of approaches, including medications, several well-tested forms of psychotherapy and light therapy (for seasonal affective disorder).

The psychotherapeutic and pharmaceutical treatments currently available are up to 80% effective at reducing or eliminating depressive symptoms. Consult with a clinician who can help you to decide on treatment options  and screen for other relevant medical conditions. Depending on your preferences and the severity of your disorder, a clinician can prescribe medication and/or refer you to a psychotherapist or psychiatrist for further evaluation and treatment. See Resources for Stress and Mental Health.

Self-care is an important part of managing depression:

  • Exercise alone has been shown to decrease some symptoms of depression.
  • Eat well to support body, mind and spirit.
  • Avoid the use of alcohol and other drugs, which may trigger or complicate depression.
  • Sleep helps recovery from depression and may help prevent recurrences.
  • Light therapy has proven effective for Seasonal Affective Disorder.

Frequently Asked Questions:

How can I help a friend who is depressed?
See Helping a Friend for suggestions for talking to a friend about depression or other concerns.

What place does psychotherapy have in the treatment of depression? 
Research shows that several forms of therapy, including cognitive behavioral therapy and interpersonal therapy, are as effective as medication for treatment of mild to moderate depression. People with severe depression tend to respond best to either medication or a combination of medication and psychotherapy.

How long will I need to take medication before I feel better? 
Some medications may show effects in as little as two weeks but full effects aren't usually expected for up to eight weeks. Also, be sure to ask your clinician about side effects.

Can I stop taking medication once I feel better? 
There isn't a standard and short course of treatment for managing depression. If you have never experienced a depressive episode before, your clinician may find it appropriate for you to stop taking medication after 6-12 months. The more depressive episodes you have experienced, the more likely it is that you will experience another episode. Current guidelines suggest that if you have had three or more episodes, you are better off not stopping your medication regimen.

Will I be on medication for the rest of my life?
While it may be uncomfortable to consider taking medication indefinitely, many people feel it's a better option than repeated bouts of depression. Also, there are psychotherapeutic treatments that are almost as effective as medication. Antidepressants can help depressed people the way that eyeglasses can help nearsighted people. Both are tools to help people function more effectively.

Can alcohol or other drugs take the edge off depression?
Some people turn to substances in an effort to relieve depressive symptoms. However self-medicating with alcohol or other drugs is not a reliable way to address anxiety or depression and in many cases may actually complicate or make these issues worse. 

For more information:

See Resources for Stress and Mental Health