Depression
Depression is a serious medical illness. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, depression is persistent and can interfere significantly with an individual's ability to function.
What Are the Symptoms of Depression?
Symptoms of depression include persistent sad mood, loss of interest or pleasure in activities that were once enjoyed, change in appetite or weight, difficulty sleeping or oversleeping, physical slowing or agitation, energy loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide. A diagnosis of unpolar major depression (or major depressive disorder) is made if a person has five or more of these symptoms and impairment in usual functioning nearly every day during the same two-week period. Major depression often begins between ages 15-30 or even earlier. Episodes typically recur. An estimated 5.3 percent of American adults ages 18 to 54 suffer from unipolar major depression in a given year.
Some people have a chronic but less severe form of depression, called dysthymia (or dysthymic disorder), that is diagnosed when depressed mood persists for at least two years and is accompanied by at least two other symptoms of depression. An estimated 1.6 percent of American adults ages 18 to 54 have dysthymia in a given year. Many people with dysthymia also have major depressive episodes. While unipolar major depression and dysthymia are the primary forms of depression, a variety of other subtypes exist.
Depression can be devastating to all areas of a person's everyday life, including family relationships, friendships, and the ability to work or go to school. Many people still believe that the emotional symptoms caused by depression are "not real," and that a person should be able to shake off the symptoms if only he or she were trying hard enough. Because of these inaccurate beliefs, people with depression either may not recognize that they have a treatable disorder or may be discouraged from seeking or staying on treatment because of feelings of shame and stigma. Too often, untreated or inadequately treated depression leads to suicide.
Research has shown that stress in the form of loss, especially death of close family members or friends, may trigger major depression in vulnerable individuals. In addition, research supports existence of a genetic component to risk of depression.
What Treatments Are Available for Depression?
Antidepressant medications are widely used, effective treatments for depression. Antidepressant drugs are known to influence the functioning of certain neurotransmitters (chemicals used by brain cells to communicate), primarily serotonin, norepinephrine, and dopamine, known as monoamines. Older medications - tricyclic antidepressants (TCAs) and monoamine oxidase Inhibitors (MAOIs) - affect the activity of all of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions. Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients to adhere to treatment. Both generations of medications are effective In relieving depression, although some people will respond to one type of drug, but not another. Medications that take entirely different approaches to treating depression are now in development.
Psychotherapy is also effective for treating depression. Certain types of psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80 percent of people with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination.
Recently there has been enormous interest in herbal remedies for various medical conditions including depression. One herbal supplement, hypericum or St. John's wort, has been promoted as having antidepressant properties. However, no carefully designed studies have determined the antidepressant efficacy of this supplement. NIMH is currently enrolling patients in the first large-scale, multi-site, controlled study of St. John's wort conducted in the U.S. as a potential treatment for depression.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
National Institute of Mental Health
Office of Communications and Public Liaison
Information Resources and Inquiries Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail: nimhinfo@nih.gov
NIMH home page address: www.nimh.nih.gov
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
Office of External Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville, MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page address: www.samhsa.gov
CMHS Knowledge Exchange Network (KEN)
P.O. Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX: 301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address: www.mentalhealth.org/cornerstone
