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A Closer Look at Major Depression

The article is one of a series of articles about depression by the American Psychiatric Association (APA). For more information about this condition, please review the "Find More Information About" section at the end of this article.

What Is Major Depression?

Major depression is a common and serious medical illness that affects your mood, behavior, thinking and health. Major depression is different from the passing feelings of unhappiness that everyone experiences in life. It is also different from the intense grief brought about by the death of a loved one.

Feelings of unhappiness or grief decrease as time goes by. Depression, on the other hand, usually does not get better without medical treatment. A person's ability to go to work or school and to function productively at home or on the job is reduced. Being with other people is stressful and often avoided, causing problems with relationships. Depression can be especially dangerous when it leads to thoughts of suicide.

Some people with major depression do not understand that they are ill. Some people mistakenly think that depression is a sign of personal weakness. In reality, the symptoms of depression are signals that medical help is needed.

What Are the Signs and Symptoms of Depression?

The signs and symptoms of depression differ from normal feelings and behaviors in their intensity and the ability to change how one feels. The signs and symptoms of major depression are:

  • Ongoing sad, anxious or empty feelings
  • A loss of interest in activities that normally are pleasurable, including sex
  • Appetite and weight changes (either loss or gain)
  • Sleep problems (insomnia, early morning wakening or oversleeping)
  • Irritability
  • A loss of energy and a sense of fatigue, or being "slowed down"
  • Feelings of guilt, worthlessness and helplessness
  • Feelings of hopelessness and pessimism
  • Difficulty in concentrating, remembering, making decisions
  • Thoughts of death or suicide, or suicide attempts
  • Ongoing body aches and pains or problems with digestion that are not caused by physical disease

If you have experienced five or more of these symptoms for at least two weeks, you may have a depressive illness. You should speak with your family or primary care physician or a psychiatrist to get help.

Who Gets Depression? 

Depression is a common illness. Some people are more likely than others to have major depression.

  • Women are about two times more likely to suffer from depression than men.
  • Depression often starts during the late 20s (although people of all ages suffer from depression).
  • Elderly people have high rates of depression when they suffer from other illnesses, such as heart disease, cancer and stroke.
  • The children, brothers, sisters and parents of a person with depression are up to three times more likely to suffer major depression than those with no family history of the illness.
  • People with other medical illnesses or substance abuse problems also are at higher-than-average risk for depression.

What Causes Depression? 

Experts believe that there are many factors that cause depression. Chemical and nerve cell disturbances within the brain, sometimes genetically inherited, play an important role in depression. Other factors can include stressful life events, another medical illness, drinking too much alcohol or abusing drugs.

A depressive illness is not caused by personal weakness or a lack of will power.

How Is Depression Treated?

First, a psychiatrist gets more information about:

  • Your symptoms
  • Your physical health
  • Your history of mental and physical illness
  • Your family members' histories of mental and physical illness
  • This process is called a diagnostic evaluation and may involve a physical examination or lab tests.

If the diagnostic evaluation shows that you have major depression, your doctor will develop a treatment plan for you. Most depressed people can be treated in the doctor's office or clinic. When a person is not safe, he or she may be hospitalized for a short time.

Your psychiatrist may recommend one or more treatments for depression. The most common treatments for major depression are antidepressant medications and psychotherapy.

  • Antidepressant medications include serotonin reuptake inhibitors (SRIs), tricyclic antidepressants (TCAs) and other medications that affect brain chemical and cell functioning. Your psychiatrist will work closely with you to choose the best medication and to adjust the dosing if necessary to get the best results. It is important for you to tell your psychiatrist or family or primary care physician about side effects so that another dosage or other medications which may have fewer side effects can be tried.
  • Psychotherapy is a series of private talks with a psychiatrist where you discuss the feelings, thoughts and behavior that cause difficulty. The goal of psychotherapy is to help you understand and master your problems so you can function better. These discussions will educate you about depression, help you understand your emotions and personality and help you cope with stresses and relationships. They also can restore your hope.
What type of doctor should I talk to?

Mild to moderate depression often can be treated by a family or primary care physician (PCP), sometimes in consultation with a psychiatrist. Some people prefer to see a psychiatrist right away because a psychiatrist offers psychotherapy and medication management. If you are seeing a PCP and aren't getting better after approximately one month of treatment, you may benefit from seeing a psychiatrist.


Other treatments that are used for depression include light therapy (for depression related to seasonal changes) and electroconvulsive therapy. St. John's wort is a plant product that may be helpful for treating mild to moderate depression.

People suffering from depression for the first time usually continue treatment for at least six to nine months. People are likely to become depressed again if treatment is stopped too soon.

Some people are more likely than others to become depressed more than one time. These include people who:

  • Had dysthymia (an ongoing state of moderate depression) before their first episode of major depression
  • Develop dysthymia after treatment for major depression (sometimes called double depression)
  • Have a psychiatric illness, such as an anxiety disorder, in addition to major depression
  • Have a chronic, general medical illness

For these people, treatment is needed for a longer period of time to help keep them from becoming depressed again in the future.

Review

Major depression is a common illness that affects people of all ages and backgrounds. It is a medical illness, not a sign of personal weakness. Depression requires treatment by a psychiatrist or other medical doctor. Effective treatments are available so every effort should be made to help depressed people get the help they need. If you think you may have depression, make an appointment to speak with your family or primary care physician or with a psychiatrist.

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