Alternate Names: Blues; Dejection; Discouragement; Gloom; Mood changes; Sadness

Considerations:

Most depression (depressed mood) is a reaction to an unhappy event. It is natural to have some depressionfeel sad after a loss such as the death of a relative, or after a major disappointment at home or at work. Depression is more prevalent in women than men and is especially common among adolescents.

Mild depression comes and goes and is characterized by downheartedness, sadness, and dejection. Short-term episodes of depression or other mood changes can occur with hormone changes, including those that accompany pregnancy or premenstrual syndrome (PMS), and those occurring shortly after the birth of a baby (postpartum depression). Sleep disruption and lack of sunlight during the winter months are other biological factors that can precipitate depressive symptoms.

Distorted thought patterns, characterized by excessive self-blame, pessimism, and lack of a sense of control over one’s life are called "depressive cognition," and can be a risk factor for depression.

It appears that a tendency toward depression is often genetic, but that stressful life circumstances usually play a major role in bringing on depressive episodes. Problems with depression usually begin in adolescence, and are about twice as common in women as in men.

Noticeably disturbed thought processes, poor communication and socialization, and sensory dysfunction indicate moderate depression.

People with severe depression are withdrawn, without expression, indifferent toward their surroundings, and may show signs of delusional thinking and limited physical activity.

Common Causes:

• loss of a friend or relative
• substantial disappointment at home or at work
• prolonged or chronic illness or pain
• medical conditions, such as hypothyroidism, cancer, or hepatitis
• drugs such as tranquilizers, high blood pressure medications, steroids (prednisone), codeine, and indomethacin
• alcohol intoxication
• alcohol withdrawal
• drug intoxication
• drug withdrawal

Home Care:

Time and activity can reverse most depression. For mild or short-lived depressive symptoms, improving health habits to provide adequate and regular sleep and good nutrition may bring relief. Regular exercise is probably more has been proven effective in reversing mild depression, and is also important in relieving more severe depression. Decrease the use of alcohol and other drugs, since these can aggravate depressive symptoms. Involvement with healthy pleasures such as recreation and creative activities is a better alternative. than medication. Stay involved with others and let them help.

Get support from people in your family and social network. Being reminded that other people care helps to relieve the isolation that often accompanies depressed feelings. Talking to someone about your worries or concerns can put them into perspective. Discussion with clergy or spiritual advisers may give meaning to painful experiences, and prayer or meditation can access internal sources of strength.

If you recognize that you are chronically pessimistic and self-critical, self-help workbooks to combat depressive thinking may be helpful. These usually involve a program of exercises to identify distorted perceptions and substitute more realistic ones.

Some people find the use of herbs or nutritional supplements beneficial. Research supports the usefulness of St. John’s Wort (hypericum) in treating mild to moderate depression. However, since herbal products are not regulated as closely as medications, the amount of active ingredient may vary from one preparation of hypericum to another.

Decrease the use of alcohol and other drugs.

Tell someone about the problem - often talking about it eases the burden.

Call If:

• depression disrupts work and family life for more than two weeks
• depression is so severe that suicide is contemplated. Do not hesitate to call for help immediately! If your primary health-care provider can’t be reached, many communities have telephone hotlines for such situations. If there is no such service nearby, call the nearest emergency room or health-care facility
• you think that current medication may be causing depression

What To Expect:

The medical history will be obtained and a physical examination performed to determine if the cause of depression is physical or psychological. Hospitalization is usually recommended if suicide seems possible.

There will probably be a detailed questioning about the medical history.Expect some exploration of the issues and events associated with depression. Medical history questions may include such questions as:

• type
• Has there been a suicide attempt?
• How often has suicide been attempted?
• Are there plans to commit suicide?
• quality
• Is the person extremely depressed?
• Is the depression severe enough to impair occupational or social functioning?
• time pattern
• How long has the depression lasted?
• Is depression constant or through most of the day?
• aggravating or triggering factors
• What is the person’s social life network like?
• What events have occurred in the person’s lifestressors has the person experienced?
• What are the relationship(s) with significant other(s) like?
• other
• What medications does the person take?
• Is alcohol used?
• What street drugs are used?
• What other symptoms are also present (difficulty thinking and concentrating, changes in sleep, appetite, etc.)?
• suicidality
• Has there been a suicide attempt?
• How often has suicide been attempted?
• Are there plans to commit suicide?

The use of drugs will be avoided if possible. Treatment will vary according to the cause and severity of the depressive symptoms, as well as patient preference. If drugs medications are being used that could cause depression, they may be changed. DO NOT CHANGE YOUR MEDICATIONS WITHOUT CONSULTING WITH YOUR HEALTH-CARE PROVIDER.

For mild depressive symptoms, counseling may be recommended, as well as some of the self-care measures mentioned above.

For moderate to severe depression, antidepressant medication may be prescribed (see major depression) for more information about antidepressants). Psychotherapy may also be recommended. Several types of focused psychotherapies have been developed that are as effective as medication in treating depression. The choice of medications, psychotherapy, or both can be made based on patient preference and the availability of these treatments. In order to avoid recurrent bouts of depression, it is important to finish the course of treatment.

For people who are so severely depressed as to be unable to function, or who are so acutely suicidal they cannot be safely cared for in the community, psychiatric hospitalization may be necessary.