Depression

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk?
	When to Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Therapy
	Medicines
	Living With Depression
	Other Treatment
	For Family and Friends
	Other Places To Get Help
	Related Information
	References
	Credits
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Is this topic for you?

This topic covers depression in adults. For information on:

• Depression in young people, see the topic Depression in Children and Teens.
• Depression after childbirth, see the topic Postpartum Depression.
• Depression followed by times of high energy, see the topic Bipolar Disorder.
• Depression and suicide, see Depression and suicide.

What is depression?

Depression is an illness that causes you to feel sad, to lose interest in activities that you've always enjoyed, to withdraw from others, and to have little energy. It's different from normal feelings of sadness, grief, or low energy. Depression can also cause people to feel hopeless about the future and even to think about suicide.

Many people, and sometimes their families, feel embarrassed or ashamed about having depression. Don't let these feelings stand in the way of getting treatment. Remember that depression is a common illness. Depression affects the young and old, men and women, all ethnic groups, and all professions.

If you think you may be depressed, tell your doctor. Treatment can help you enjoy life again. The sooner you get treatment, the sooner you will feel better.

What causes depression?

Depression is a disease. It's not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Most experts believe a combination of family history (your genes) and stressful life events may cause depression. Life events can include:

• Childbirth, a death in the family, work, or relationships.
• Finding out you have a long-term health problem, such as arthritis, heart disease, or cancer.
• Health problems, such as anemia and an underactive thyroid gland (hypothyroidism). Treating the health problem can usually cure the depression.

Just because you have a family member with depression or have stressful life events doesn't mean you'll get depression.

You also may get depressed even if there is no reason you can think of.

What are the symptoms?

The symptoms of depression may be hard to notice at first. They vary among people, and you may confuse them with just feeling "off" or with another health problem.

The two most common symptoms of depression are:

• Feeling sad or hopeless nearly every day for at least 2 weeks.
• Losing interest in or not getting pleasure from most daily activities nearly every day for at least 2 weeks.

A serious symptom of depression is thinking about death or suicide. If you or someone you care about talks about this or feeling hopeless, get help right away.

You also may:

• Lose or gain weight. You also may feel like eating more or less than usual almost every day.
• Sleep too much or not enough almost every day.
• Feel restless and not be able to sit still, or you may sit quietly and feel that moving takes great effort. Others can easily see this behavior.
• Feel tired or as if you have no energy almost every day.
• Feel unworthy or guilty nearly every day. You may have low self-esteem and worry that people don't like you.
• Find it hard to focus, remember things, or make decisions nearly every day. You may feel anxious about things.

If you have some of these symptoms for at least 2 weeks, talk to your doctor. Treatment may be right for you.

If you think you may have depression, take a short quiz to check your symptoms:

Interactive Tool: Are You Depressed?

How is it treated?

Depression can be treated in various ways. Counseling, psychotherapy, and/or antidepressant medicines are all used. Lifestyle changes, such as getting more exercise, also may help. Your doctor or mental health professional will help you find the best treatment.

If you have mild or moderate depression, your family doctor or a mental health professional, such as a counselor or psychologist, may treat you. If you have severe depression or if treatment is not helping, you may need to see a psychiatrist. Some people need to be treated in the hospital, especially if they have thoughts of suicide.

Work with your health care team to find the best treatment for you. It may take a few tries, and it can take several weeks for the medicine to start working. Try to be patient and keep following your treatment plan.

Depression can return (relapse). How likely you are to get depression again increases each time you have a bout of depression.¹ Taking your medicines and continuing some types of therapy after you feel better can help keep that from happening. Some people need to take medicine for the rest of their lives. This does not stop them from living full and happy lives.

Let your doctor know if you think you are depressed. Depression is easy to overlook. The earlier you are treated, the more quickly you will get better.²

What can you do if a loved one has depression?

If someone you care for is depressed, the best thing you can do is help the person get or stay in treatment. Learn about the disease. Talk to the person and gently encourage him or her to do things and see people. Don't get upset with the person. The behavior you see is the disease, not the person.

Is suicide a concern?

Many people who have depression have thoughts of death or thoughts of suicide, and depression can lead to suicide. Learn the warning signs of suicide, which include talking a lot about death, giving things away, or using a lot of alcohol or drugs or both. If you see these signs in yourself or a loved one, get help.

Call 911 or the national suicide hotline at 1-800-273-TALK (1-800-273-8255) or other emergency services if you (or someone you care about who has depression):

• Plan to harm yourself or others.
• Talk, write, read, or draw about death, including writing suicide notes and talking about items that can harm you, such as pills, guns, or knives.
• Buy guns or bullets, stockpile medicines, or take other action to prepare for a suicide attempt. You may have a new interest in guns or other weapons.
• Hear or see things that aren't real.
• Think or speak in a bizarre way that is not like your usual behavior.

If a suicide threat seems real, call 911 , a suicide hotline, or the police. Stay with the person, or ask someone you trust to stay with the person, until the crisis has passed. Don't argue or challenge the person. Tell the person you don't want him or her to die.

Frequently Asked Questions

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Depression: Should I stop taking my antidepressant?
	Depression: Should I take an antidepressant?
	Depression: Should I take antidepressants while I'm pregnant?
	Actionsets are designed to help people take an active role in managing a health condition.
	Depression: Dealing with medicine side effects
	Depression: Helping someone get treatment
	Depression: Managing postpartum depression
	Depression: Supporting someone who is depressed
	Depression: Taking antidepressants safely
	Depression: Using Positive Thinking
	Positive thinking: Stopping unwanted thoughts
	Stress Management: Doing Meditation
	Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
	Interactive Tool: Are You Depressed?

Depression is a disease. It is not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Most experts believe a combination of family history (your genes) and stressful life events may cause depression.

• Genes: Your chance of having a bout of depression is greater if other family members have had depression. You may have inherited a trait that makes you more likely to get depressed. If this is true for you, a stressful life event is more likely to trigger depression.
• Life events: Stressful life events can trigger depression. For example, you could become depressed if you have:
  • Lost a loved one.
  • Had a baby (depression after childbirth).
  • Recently divorced.
  • Been diagnosed with a long-term (chronic) disease such as diabetes or heart disease.

Sometimes even happy life events, such as a marriage or promotion, can trigger depression because of the stress that comes with change.

Just because you have a family member with depression or have stressful life events doesn't mean you'll get depression. You also may get depression without going through a stressful event.

Other causes

Health problems also can cause depression. For example, both anemia and an underactive thyroid gland (hypothyroidism) can lead to depression. Treating the health problem usually cures the depression.

Certain medicines, such as steroids or narcotics, can cause depression. If you stop using the medicine, the depression may go away.

• For more information on events that could trigger depression, see the What Increases Your Risk section.
• Read more about postpartum depression or depression, anxiety, and other health problems.

The symptoms of depression may be hard to notice at first. They can be different from person to person, and you may confuse them with just feeling "off" or "down." You also may confuse the symptoms with another health problem.

The two most common symptoms of depression are:

• Feeling sad or hopeless nearly every day.
• Losing interest in or not getting pleasure from most daily activities, and you feel this way nearly every day.

A serious symptom of depression is thinking about death and suicide. If you or someone you care about talks about suicide or feeling hopeless, get help right away.

You also may:

• Lose or gain weight. You may also feel like eating more or less than usual almost every day.
• Sleep too much or not enough almost every day.
• Feel restless and not be able to sit still, or you may sit quietly and feel that moving takes great effort. Others can easily see this behavior.
• Feel tired or as if you have no energy almost every day.
• Feel unworthy or guilty nearly every day. You may have low self-esteem and worry that people don't like you.
• Find it hard to focus, remember things, or make decisions nearly every day. You may feel anxious or worried about things.

Are you depressed?

Experts say that if you have at least five of the above symptoms for 2 weeks or longer, and one of the symptoms is either sadness or loss of interest, you may have depression and may need treatment.¹ If you have 2 to 4 symptoms for a period of at least 2 years (1 year for a child), you may have a long-term form of depression called dysthymic disorder (dysthymia).¹

Even if you have fewer symptoms, you may still be depressed and may benefit from treatment. No matter how many symptoms you have, it's important to see your doctor. The sooner you get treatment, the better your chance for a quick and full recovery.

It's possible to have periods of both energy and elation (mania) and depression. This may be bipolar disorder. If this happens to you, tell your doctor. The treatments for depression and bipolar disorder are different. For more information, see the topic Bipolar Disorder.

If you think you may have depression, take a short quiz to check your symptoms:

Interactive Tool: Are You Depressed?

Symptoms can vary

Symptoms can be mild, moderate, or severe:

• In mild depression, you have few symptoms. They affect your life, but you can deal with them with treatment.
• In moderate depression, you have more symptoms, and they are beginning to change your life.
• In severe depression, the symptoms change your life and affect your job or career and your relationships.

Depression can affect your physical health. You may have headaches or other aches and pains or have digestive problems such as constipation or diarrhea. You may have trouble having sex or may lose interest in it. If you notice any of these changes, talk to your doctor. Your doctor may be able to help.

Depression, PMS, and childbirth

Many women have mood changes before menstruation. This may be a sign of premenstrual syndrome (PMS). But if your premenstrual mood changes and other PMS symptoms are making daily life hard or harming your relationships, you may have a type of depression known as premenstrual dysphoric disorder (PMDD). To learn more about this, see the topic Premenstrual Syndrome (PMS).

Women also may feel sad after having a baby. But if you feel very sad after you've had your baby, see your doctor. You may have postpartum depression. For more information, see the topic Postpartum Depression.

Symptoms in older adults

Symptoms of depression may be different for older adults. Depression can make older adults confused or forgetful or cause them to stop seeing friends and doing things. It can be confused with problems like dementia.

Symptoms in children and teens

Symptoms of depression in children and teens can be different from adult symptoms. These symptoms include doing poorly in school, having temper tantrums, and becoming sexually active. For more information, see the topic Depression in Children and Teens.

Warning signs of suicide

Thoughts of suicide are common in people who have depression. Most people do not act on these thoughts, but they must be taken seriously.

Call 911 or the national suicide hotline at 1-800-273-TALK (1-800-273-8255) or other emergency services if you (or someone you care about who has depression):

• Plan to harm yourself or others.
• Talk, write, read, or draw about death, including writing suicide notes and talking about items that can harm you, such as pills, guns, or knives.
• Buy guns or bullets, stockpile medicines, or take other action to prepare for a suicide attempt. You may have a new interest in guns or other weapons.
• Hear or see things that aren't real.
• Think or speak in a bizarre way that is not like your usual behavior.

Learn about depression and suicide and the warning signs of suicide, such as giving away things or suddenly using lots of alcohol or drugs or both.

Warning signs of suicide in children and teens may include running away from home or doing risky or dangerous things, such as driving drunk or abusing drugs. If you see warning signs in yourself or a loved one, get help.

Depression is different for everyone.

For some people, a bout of depression begins with symptoms of anxiety (such as worrying a lot), sadness, or lack of energy. This may go on for days or months before you or others think you are depressed. And other people may feel depressed suddenly. This may happen after a big change in life, such as the loss of a loved one or a serious accident.

It's possible to have periods of both energy and elation (mania) and depression. This may be bipolar disorder. If this happens to you, tell your doctor. The treatments for depression and bipolar disorder are different. For more information, see the topic Bipolar Disorder.

How long does depression last?

If you don't get treated, depression may last from months to a year or longer. A small number of people feel depressed for most of their lives and always need treatment.

Depression can return, which is called a relapse. At least half of the people who have depression once get it again.³ How likely you are to get depression again increases each time you have a bout of depression.¹ You can make having another bout of depression less likely by following your treatment plan and using your medicines.

Depression and other health concerns

Depression is linked with many health concerns. These include other diseases, drug or alcohol use, and pregnancy.

If you have depression and another health concern, you need to deal with both of them. Read about:

• Depression, anxiety, and other health problems.
• Depression and problems with drugs or alcohol.
• Depression and aging.
• Depression and post-traumatic stress disorder (PTSD).
• Depression and suicide.
• Depression during pregnancy and after having a baby (postpartum depression).

  Depression: Managing postpartum depression

Experts don't know why some people get depression and others don't. But certain things make you likely to get depression. These are called risk factors.

Important risk factors for depression include:

• Having a father, mother, brother, or sister who has had depression.
• Having had depression before.
• Having post-traumatic stress disorder (PTSD).
• One-time stressful events, such as the death of a loved one, losing your independence or your job, or having a serious accident.

Other risk factors include:

• Long-term (chronic) stressful situations, such as living in poverty, having marriage or family problems, or helping someone who has a long-term medical problem.
• Physical or sexual abuse in childhood or in a relationship, such as domestic abuse or violence.
• Getting older.

Medical risk factors

Medical problems also may cause depression or make it worse. These problems include:

• Abusing drugs or alcohol.
• Having a long-term (chronic) health problem, such as coronary artery disease, diabetes, cancer, or chronic pain. Read more about depression and chronic illness.
• Having a mental health problem or behavior disorder, such as post-traumatic stress disorder (PTSD), dementia, anxiety disorder, or an eating disorder.
• Having had a recent serious illness or surgery.
• Having a health problem such as anemia or an underactive thyroid gland (hypothyroidism). Treating the health problem usually cures the depression.
• Using certain medicines, such as steroids or narcotics. If you stop using the medicine, the depression will probably go away.

Other risk factors for women

Women may have other risk factors. These include:

• Menopause.
• Pregnancy or recent childbirth. For more information on depression after childbirth, see the topic Postpartum Depression.
• Use of birth control pills (oral contraceptives).
• A history of premenstrual dysphoric disorder (severe premenstrual syndrome).

Call 911 or the national suicide hotline at 1-800-273-TALK (1-800-273-8255) or other emergency services if you (or someone you care about who has depression):

• Plan to harm yourself or others.
• Talk, write, read, or draw about death, including writing suicide notes and talking about items that can harm you, such as pills, guns, or knives.
• Buy guns or bullets, stockpile medicines, or take other action to prepare for a suicide attempt. You may have a new interest in guns or other weapons.
• Hear or see things that aren't real.
• Think or speak in a bizarre way that is not like your usual behavior.

Suicide is much more likely in people who have depression than in people who are not depressed. If someone you know has depression, know the warning signs of suicide and what to do.

If you have been diagnosed with depression, call your doctor if:

• You find it hard or it's getting harder to deal with your job, family, and friends.
• You think your treatment is not helping or you are not getting better.
• Your symptoms get worse or you get new symptoms.
• You have any problems with your antidepressant medicines, such as side effects, or you are thinking about stopping your medicine.
• You are having manic behavior, such as having very high energy, needing less sleep than normal, or showing risky behavior such as spending money you don't have or abusing others verbally or physically.

If you have not been diagnosed with depression, but you think you may be depressed, use the Feeling Depressed topic to check your symptoms.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you may not need treatment. If you get worse, you and your doctor will decide what to do next. Watchful waiting may be right for you if you have feelings of grief or sadness because you have lost a loved one or have had a stressful life event.

If symptoms do not improve after 2 weeks, or if you think about suicide, talk with your doctor as soon as you can.

It also may help to discuss your symptoms with a close and trusted friend or family member. Sometimes another person can see changes in your mood or behavior sooner than you can.

Who to see

There any many types of professionals who treat depression and many types of treatments. A good place to start is with your family doctor. If treatment by your doctor does not help you, the next step is to see a mental health professional.

Whomever you see, it is important that this person has experience treating people with depression and is trained in proven therapies. It is also important that you establish a good long-term relationship. If you don't feel comfortable with one doctor or therapist, try another one.

Health professionals who can diagnose depression and prescribe medicine include:

• Family medicine physicians.
• Internists.
• Psychiatrists.
• Physician assistants.
• Nurse practitioners.
• Obstetricians or gynecologists.

Treatment such as professional counseling or therapy can be provided by:

• Psychiatrists (who can also diagnose and prescribe medicines).
• Psychologists.

Other health professionals who also may be trained in treating depression include:

• Social workers.
• Licensed professional counselors.
• Psychiatric nurses.
• Nurse practitioners.

Depression may be diagnosed when you talk to your doctor about feeling sad or when your doctor asks you questions and discovers that you are feeling sad. You may be seeing your doctor because you feel sad or because you have another health problem or concern.

If your doctor thinks you are depressed, he or she will ask you questions about your health and feelings. This is called a mental health assessment. Your doctor also may:

• Do a physical exam.
• Do tests to make certain your depression is not caused by a disease such as an underactive thyroid (hypothyroidism) or vitamin B12 deficiency anemia.
• Ask you about suicide.

Depending on your history and risk factors, your doctor may order other tests.

If you are depressed, your doctor may treat you or refer you for therapy to treat your symptoms.

Tell your doctor

Always tell your doctor if you feel sad or have other symptoms of depression. Many times, people are embarrassed by these feelings and say nothing. Depression can be treated, and the sooner you get treatment, the better your chance for a quick and full recovery.

It's possible to have periods of both energy and elation (mania) and depression. This may be bipolar disorder. If this happens to you, tell your doctor. The treatments for depression and bipolar disorder are different. For more information, see the topic Bipolar Disorder.

If you have depression only during certain seasons of the year, such as the fall and winter months, tell your doctor. You may have seasonal affective disorder. For more information, see the topic Seasonal Affective Disorder (SAD).

Early detection

The U.S. Preventive Services Task Force recommends that all people, starting at age 12, be screened for depression. Screening for depression helps find depression early. And early treatment may help you get better faster.

Depression can be treated in various ways. Counseling, psychotherapy, and antidepressant medicines may all be used. Lifestyle changes, such as getting more exercise, also may help.

Your doctor or mental health professional will help you find the best treatment. For severe depression, a very small number of people may need to stay in a hospital for a short time, especially if they are thinking about suicide.

Work with your health care team to find the best treatment for you. To get the most benefit, be sure you find a therapist who has experience treating people who have depression and who is trained in proven therapies, and use your medicines as your doctor directs.

• If your depression is mild, you may need only therapy.⁴
• If you have moderate to severe symptoms, your doctor probably will suggest medicine and/or therapy.
• If you are using medicine, your doctor may have you try different medicines or a combination of medicines. Evidence shows that adding medicines to therapy for severe depression works better than therapy alone.⁵
• You may need to go to the hospital if you show warning signs of suicide, such as having thoughts about harming yourself or another person, not being able to tell the difference between what is real and what is not (psychosis), or using a lot of alcohol or drugs.

If you don't get treated, depression may last from months to a year or longer. A small number of people feel depressed for most of their lives and always need treatment.

For more information, see the Therapy and Medications sections of this topic.

Lifestyle decisions

You can help yourself by getting support from family and friends, eating a balanced diet, avoiding alcohol, staying active, and getting enough sleep.

If you need help deciding whether to talk to your doctor about depression, see some common reasons people don't get help and how to overcome them.

For more information on making changes in your lifestyle to help with depression, see the Living With Depression section of this topic.

Other treatment

Other treatments for depression include electroconvulsive therapy (ECT) and alternative or complementary treatment. ECT involves an electric stimulation to the brain. Alternative treatments include the herb St. John's wort and omega-3 fatty acids. For more information on these treatments, see the Other Treatment section of this topic.

There is little research on whether you can prevent a first bout of depression. But several studies suggest that exercise may help prevent a first bout of depression.^{6, 7} Exercise also may help prevent depression from coming back (relapse) and may improve symptoms of mild depression.^{6, 7}

If you worry about getting depression, talk to your doctor. Regular screening for depression helps find depression early, and early treatment may help you get better faster.

You also may be able to prevent depression by avoiding alcohol and drugs. Alcohol and drugs can trigger depression. And using them is often a sign that you have depression.

Preventing depression from coming back

You may be able to prevent a relapse or keep your symptoms from getting worse if you:

• Take your medicine as prescribed. Depression often returns if you stop taking your medicine or don't take it as your doctor advises.
• Continue to take your medicine after your symptoms improve. Taking your medicine for at least 6 months after you feel better can help keep you from getting depressed again. If this is not the first time you have been depressed, your doctor may want you to take medicine even longer. You may benefit from long-term treatment with antidepressants.
• Continue cognitive-behavioral therapy after your symptoms improve. Research shows that those who continued this type of therapy had less chance of relapse.⁸
• Eat a balanced diet.
• Get regular exercise.
• Get treatment right away if you notice that symptoms of depression are coming back or getting worse.
• Have healthy sleep patterns.
• Avoid drugs and alcohol.

Counseling and psychotherapy are important parts of treatment for depression. You will work with a mental health professional such as a psychologist, licensed professional counselor, clinical social worker, or psychiatrist. Together, you will develop an action plan to treat your depression.

The first step is finding a therapist you trust and feel comfortable with. The therapist also should have experience treating people who have depression and should be trained in proven therapies. These therapies include:⁵

• Cognitive-behavioral therapy (CBT), which teaches you how to change the ways you think and behave. This can help you stop thinking bad thoughts about yourself and your life. You can take part in CBT with a therapist or in a group setting. Also see:

  Depression: Using positive thinking.

  Positive thinking: Stopping unwanted thoughts.

• Interpersonal therapy, which looks at your social and personal relationships and related problems.

Some therapists use acceptance and commitment therapy (ACT). In ACT, you work with a therapist to learn to accept your negative feelings but not let them run your life. You learn to make choices and act based on your personal values, not negative feelings.

Mindfulness strategies are another type of therapy. They seek to focus your attention on what is happening at the moment without trying to change it. These strategies teach you to let go of past regrets and not worry about the future. They may help with depression in some people.

Learn about:

Stress management: Doing meditation.

Other treatments you may have heard of include problem-solving therapy, which looks at your current problems and helps you solve them, and family therapy, which brings you and your family together to discuss your relationships and depression. Experts don't know how well these therapies work for depression.⁵

When you hear “counseling” or “therapy,” you may think of lying on a couch and talking about your childhood. But most of these treatments do not look for hidden memories. They deal with how you think about things and how you act each day.

How long will you need counseling or therapy?

How long your treatment lasts depends on how severe your depression is and how well you respond to treatment. Short-term counseling or therapy usually lasts from 10 to 20 weeks, and you usually see your mental health professional once a week. But you may need to meet with your health professional more often or for a longer time.

Antidepressant medicines may improve or completely relieve the symptoms of depression. If you are mildly depressed, you may not have to take them, but most people with moderate or severe depression need medicine.

Antidepressant medicines work in different ways. No antidepressant works better than another, but different ones work better or worse for different people. The side effects of antidepressant medicines are different and may lead you to choose one instead of another.

You may have to try different medicines or take more than one to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one and may need to take the antidepressant and another type of medicine, such as an antiseizure, mood stabilizer, antipsychotic, or antianxiety medicine.

Together you and your doctor will decide if you need medicine, what things you'll need to think about if you need medicine, and which medicine is right for you.

Should I take medicines to treat depression?

Antidepressant medicines include:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
• Tricyclic and tetracyclic antidepressants, such as doxepin (Sinequan) and nortriptyline (Aventyl, Pamelor).
• Other antidepressants, such as bupropion (Wellbutrin, Wellbutrin SR), mirtazapine (Remeron) and trazodone venlafaxine (Effexor, Effexor XR).
• Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan), phenelzine sulfate (Nardil), and selegiline (Emsam).

How long will you need medicines?

If you take antidepressants, you should take them for at least 6 months after you begin to feel better. This can help prevent you from feeling depressed again (relapse). If this is not the first time you have been depressed, your doctor may want you to take these medicines even longer.

You may start to feel better within 1 to 3 weeks after starting your antidepressant medicine. But it can take as many as 6 to 8 weeks to see a great deal of improvement. If you have questions or concerns about your medicines, or if you do not notice that you feel better by 3 weeks, talk to your doctor.

Some people need to remain on medicine for several months to years. Others will need medicine long-term. This is more likely if you have had several bouts of depression that you had to treat in the hospital or that led you to attempt suicide.

Don't quit taking your medicines without talking to your doctor. If you quit suddenly, it can cause dizziness, anxiety, fatigue, and headache. If you and your doctor decide you can quit using medicine, gradually reduce the dose over several weeks.

Should I stop taking my depression medicine?

Side effects and safety

Antidepressant medicines have side effects. You may notice the side effects before you notice that the medicine is helping you. Side effects vary depending on the medicine you take.

• Common side effects include diarrhea, headaches, loss of sexual desire, not feeling like eating, having an upset stomach, and feeling on edge.
• Most side effects are mild and will go away after you take the medicine for a few weeks.
• Call your doctor right away and stop taking the medicine if you have serious side effects such as chest pain, hives, shortness of breath, trouble swallowing, or swelling of your lips.
• If your side effects are less serious but bother you, talk with your doctor about how to deal with the side effects or to see whether you should try another antidepressant medicine.

Depression: Dealing with medicine side effects

Antidepressant medicines have helped many people and are considered safe. But like all medicines, they may cause problems in certain people.

People who are taking medicines for other health problems need to know about medicine interactions. Talk with your doctor about the best way to track whether a combination of medicines is harming you. People who are taking a lot of medicines also are more likely to have harmful side effects.

Should I take antidepressants during pregnancy?

Depression: Taking antidepressants safely

When you're going through depression, you can't just shake if off. You might have a couple of good days followed by a bad day or a string of bad days. And you don't know how long it will last. Depression is not like the flu or a sprained ankle, where your doctor can tell you about how long it will take to get better.

When you're getting better, many experts call it recovery. Recovery is finding your path to the life you care about. There are 10 principles of recovery(What is a PDF document?) that can help you recover from depression on your terms. They help you gain self-confidence and respect for yourself.

During your recovery, be patient and kind to yourself. Remember that depression is not your fault and is not something you can overcome with willpower alone. You need treatment for depression, just like for any other illness.

Continuing your treatment, helping yourself, getting support, and having a healthy lifestyle are all part of your recovery. Your symptoms will fade as your treatment starts to work. Don't give up. Focus your energy on getting better. Your mood will improve. It just takes some time.

Your self-care

You can take many steps to help yourself when you feel depressed or are waiting for your medicine to work. These steps also help prevent depression from coming back.

• Be real in what you expect and what you can do. Set goals you can meet. If you have a big task to do, break it up into smaller steps you can handle. Don't take on more than you can handle.
• Don't blame yourself or others for your depression.
• Think about putting off big decisions until your depression has lifted. Wait a bit on making decisions about marriage, divorce, or jobs. Talk it over with friends and loved ones who can help you look at the whole picture.
• Get support from others. Your family can help you get the right treatment and deal with your symptoms. Social support and support groups give you the chance to talk with people who are going through the same things you are.
• Tell people you trust about depression. It is usually better than being alone and keeping it a secret.
• Build your self esteem and try to keep a positive attitude.

  Depression: Using positive thinking

  Positive thinking: Stopping unwanted thoughts

• Try to be part of religious, social, holiday, or other activities.
• If you have any other health problems, like diabetes, heart disease, or high blood pressure, continue with your treatment for them. Tell your doctor about all of the medicines you take, with or without a prescription.

You also can help yourself by thinking about what is good in your life. You can:

• Help others who are not as well off as you are.
• Thank people for the small and big things they do for you.
• Be thankful for big things like having a home, family, and friends.
• Be thankful for little things like making people laugh, enjoying a piece of music, or finding warm gloves for the winter.

Remember the basics

• Get regular exercise. People who are fit usually have less anxiety, depression, and stress than people who aren't fit.⁹ Even something as easy as walking can help you feel better. Find a way you can be active.
• Eat a balanced diet. This helps your body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.
• Get enough sleep. A good night's sleep can help mood and stress levels. Avoid sleeping pills unless your doctor prescribes them.
• Deal with stress. Too much stress can help trigger depression. You can do a lot to help relieve stress. For more information, see the topic Stress Management.
• Avoid drinking alcohol or using illegal drugs or medicines that have not been prescribed to you. Having a substance abuse problem makes treating depression harder. Both problems need to be treated.
• Prevent depression from coming back. Take your medicine as your doctor advises. Depression often returns if you stop taking your medicine or don't take it as your doctor advises. For more information, see the Prevention section.

Other treatments for depression include brain stimulation and treatment with herbs or dietary supplements.

Brain stimulation

Electroconvulsive therapy (ECT) may be used to treat severe depression or depression that does not get better with medicine and counseling or therapy. In ECT, electricity is briefly sent to the brain through electrodes placed on your head. Studies have shown that ECT is an effective short-term treatment for depression.^{10, 11}

Other types of brain stimulation have not been well studied and may be expensive. They usually are considered only if other treatment does not work. They include:

• Deep brain stimulation. A device that uses electricity to stimulate the brain is put in your head. It is used for Parkinson's disease but has not been well studied for depression.
• Vagus nerve stimulation. A generator the size of a pocket watch is placed in your chest. Wires go up from the generator to the vagus nerve in your neck. The generator sends tiny electric shocks through the vagus nerve to the brain.
• Transcranial magnetic stimulation. An electromagnet is placed on your head and sends magnetic pulses that stimulate your brain.

Complementary therapies

Complementary therapies are sometimes used for depression. Always tell your doctor if you are using any of them.

• Massage therapy, yoga, and other relaxation exercises may help reduce stress.
• The herb St. John's wort can help treat depression. A review of studies found that the herb can work just as well as prescribed antidepressants in some people who have major depression.¹² St. John's wort also may have fewer side effects than prescribed medicines.
• Fish oil containing omega-3 fatty acids may help depression.^{13, 14}
• SAM-e ( S-adenosylmethionine) is sometimes used to treat depression. Some studies show that SAM-e may help with symptoms of depression, but more studies are needed to determine its safety and how well it works.¹⁵

If someone you care about is depressed, you may feel helpless. Maybe you're watching a once-active or happy person slide into inactivity or you're seeing a good friend lose interest in favorite activities. The change in your loved one's or friend's behavior may be so big that you feel you no longer know him or her.

Here are some things you can do to help:

• Help the person get treatment or stay in treatment. This is the best thing you can do.

  Depression: Helping someone get treatment

• Support and encourage the person.

  Depression: Supporting someone who is depressed

• Learn about depression. Know the facts and myths about it.
• Be aware of your own and other people's negative attitudes (stigma) toward depression. Do what you can to fight stigma and teach people about depression.
• Be aware of other health problems the person may have.
  • Read about depression and post-traumatic stress disorder (PTSD).
  • Read about depression and other health problems.

Help with the basics

You can also help the person have good health habits. Encourage him or her to:

• Limit alcohol and not use drugs. Having a substance abuse problem makes treating depression harder. Both problems need to be treated.
• Be active. People who are fit usually have less anxiety, depression, and stress than people who aren't fit.⁹
• Deal with stress. Too much stress can help trigger depression, but simple things can relieve stress. For more information, see the topic Stress Management.
• Get enough sleep. Sleep can help mood and stress levels.
• Eat a balanced diet. This helps the body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.

Depression and suicide

Depression can lead to suicide. Call 911 or the national suicide hotline at 1-800-273-TALK (1-800-273-8255) or other emergency services if the person:

• Plans to harm himself or herself or others.
• Talks, writes, reads, or draws about death, including writing suicide notes and talking about items that can harm him or her, such as pills, guns, or knives.
• Buys guns or bullets, stockpiles medicines, or takes other action to prepare for a suicide attempt. The person may have a new interest in guns or other weapons.
• Hears or sees things that aren't real.
• Thinks or speaks in a bizarre way that is not usual.

Learn about depression and suicide and the warning signs of suicide, such as giving away things or suddenly using alcohol or drugs.

If a person or family member who is depressed talks about suicide and has a plan and a way to carry it out, follow these guidelines.

• Stay with the person, or ask someone you trust to stay with the person, until the crisis has passed.
• Get professional help.
• Don't argue with the person ("It's not as bad as you think") or challenge him or her ("You're not the type to commit suicide").
• Tell the person you don't want him or her to die. Talk about the situation as openly as possible.

Helping yourself

If you are spending a lot of time helping or caring for someone who has depression, find your own support. This can help you deal with the illness. These caregiver tips also can help you.

• Don't help too much. A common mistake caregivers make is providing too much care. Even if they don't say so, people like to help themselves. Take some time off.
• Don't do it alone. Ask others to help you, or join a support group. The more support you have, the more help you can give.
• Get help from a local organization. Your city or state may have programs to help you. Ask at your local or state health department. The National Alliance on Mental Illness (NAMI) provides contact information for support organizations nationwide. Go to www.nami.org and choose "Find Support."

Organizations

Related Information

• Anorexia Nervosa
• Aromatherapy (Essential Oils Therapy)
• Bipolar Disorder
• Complementary Medicine
• Dealing With Medicine Side Effects and Interactions
• Depression in Children and Teens
• Feeling Depressed
• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder (OCD)
• Postpartum Depression
• Post-Traumatic Stress Disorder
• Premenstrual Syndrome (PMS)
• Reducing Medication Costs

Citations

1. American Psychiatric Association (2000). Depressive disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 349–381. Washington, DC: American Psychiatric Association.

2. Schulberg HC, et al. (1999). Best clinical practice: Guidelines for managing major depression in primary medical care. Journal of Clinical Psychiatry, 60(7): 19–28.

3. American Psychiatric Association (2000). Practice guidelines for the treatment of patients with major depressive disorder (revision). American Journal of Psychiatry, 157(4, Suppl): S1–S45.

4. Chilvers C, et al. (2001). Antidepressant drugs and generic counselling for treatment of major depression in primary care: Randomised trial with patient preference arms. BMJ, 322(7289): 772–775.

5. Butler R, et al. (2007). Depression in adults: Psychological treatments and care pathways, search date April 2006. Online version of BMJ Clinical Evidence (8). Available at: http://www.clinicalevidence.com.

6. Wiles NJ, et al. (2007). Physical activity and common mental disorders: Results from the Caerphilly study. American Journal of Epidemiology, 165(8): 946–954.

7. Butler R, et al. (2007). Depression in adults (drug and other physical treatments), search date April 2006. Online version of Clinical Evidence. Also available online: http://www.clinicalevidence.com.

8. Paykel ES (2007). Cognitive therapy in relapse prevention in depression. International Journal of Neuropsychopharmacology, 10: 131–136.

9. Buchner DM (2008). Physical activity. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., pp. 64–67. Philadelphia: Saunders.

10. Butler R, et al. (2007). Depression in adults (drug and other physical treatments), search date April 2006. Online version of Clinical Evidence: http://www.clinicalevidence.com.

11. UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. Lancet, 361(9360): 799–808.

12. Linde K, et al. (2008). St. John's wort for major depression. Cochrane Database of Systematic Reviews (4).

13. Peet M, Horrobin DF (2002). A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Archives of General Psychiatry, 59(10): 913–919.

14. Keller JR (2002). Omega-3 fatty acids may be effective in the treatment of depression. Topics in Clinical Nutrition, 17(5): 21–27.

15. Agency for Healthcare Research and Quality (2002). S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease. Summary. Evidence Report/Technology Assessment No. 64 (AHRQ Publication No. 02-E033). Rockville, MD: Agency for Healthcare Research and Quality.

Other Works Consulted

• Canadian Psychiatric Association and the CANMAT Depression Work Group (2001). Clinical practice guidelines for the treatment of depressive disorders. Canadian Journal of Psychiatry, 46(Suppl 1): S13–S89.

• American College of Obstetricians and Gynecologists (2008, reaffirmed 2009). Use of psychiatric medications during pregnancy and lactation. ACOG Practice Bulletin No. 92. Obstetrics and Gynecology, 111(4): 1001–1020.

• Compton MT, Nemeroff CB (2008). Depression and bipolar disorder. In DC Dale, DD Federman, eds., ACP Medicine, section 13, chap. 2. New York: WebMD.

• Fochtmann IJ, Gelenberg AJ (2005). Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd ed., pp. 1-15. Arlington, VA: American Psychiatric Association. Available online: http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.

• Hypericum Depression Trial Study Group, American Medical Association (2002). Effect of hypericum perforatum (St. John's wort) in major depressive disorder. JAMA, 287(14): 1807–1814.

• Lam RW, et al. (2004). Prescribing antidepressants for depression in 2005: Recent concerns and recommendations. The Canadian Journal of Psychiatry, 49(12):1–6 (insert). Also available online: http://www.cpa-apc.org/Publications/Position_Papers/2004-23s-en.pdf.

• Murray MT, Bongiorno PB. (2006). Affective disorders. In JE Pizzorno Jr, MT Murray, eds. Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 1427–1448. St. Louis: Churchill Livingstone Elsevier.

• Qaseem A, et al. (2008). Using second-generation antidepressants to treat depressive disorders: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 149(10): 725–733.

• Qaseem A, et al. (2008). Using second-generation antidepressants to treat depressive disorders: A clinical practice guidelines from the American College of Physicians. Annals of Internal Medicine, 149: 725-733.

• Roose SP, et al. (2001). Relationship between depression and other medical illnesses. JAMA, 286(14): 1687–1690.

• Sadock BJ, Sadock VA (2007). Depression and bipolar disorder. In Kaplan and Sadock's Synopsis of Psychiatry, 10th ed., pp. 527-562. Philadelphia: Lippincott Williams and Wilkins.

• Safety of SSRI in pregnancy (2008). Medical Letter on Drugs and Therapeutics, 50(1299): 89-90.

• Schatzberg AF, et al. (2002). Clinical use of nefazodone in major depression: A 6-year perspective. Journal of Clinical Psychiatry, 63(Suppl 1): S18–S31.

• Williams JW (2002). Is this patient clinically depressed? JAMA, 287(9): 1160–1170.

• Yager J, Gitlin MJ (2005). Depression section of Clinical manifestations of psychiatric disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 8th ed., vol. 1, pp. 991–992. Philadelphia: Lippincott Williams and Wilkins.