What is depression

Depression is more than occasionally feeling blue, sad, or down in the dumps, though. Depression is a strong mood involving sadness, discouragement, despair, or hopelessness that lasts for weeks, months, or even longer. Depression affects more than your mood. Depression affects your thinking, too. It interferes with your ability to notice or enjoy the good things in life. Depression drains the energy, motivation, and concentration you needs for normal activities.

It’s natural to feel sad, down, or discouraged at times. We all feel these human emotions, they’re reactions to the hassles and hurdles of life.

You may feel sad over an argument with a friend, a breakup, or a best friend moving out of town. You might be disappointed about doing poorly on a test or discouraged if your team can’t break its losing streak. The death of someone close can lead to a specific kind of sadness — grief.

Most of the time, people manage to deal with these feelings and get past them with a little time and care.

Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more-severe form of depression, also known as major depression or major depressive disorder. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.

To diagnose clinical depression, many doctors use the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ¹, published by the American Psychiatric Association.

• Depression Test

Screening for Adult Depression

Screening for Child/Adolescent

Screening for Child/Adolescent (Parent Version)

• According to the Centers for Disease Control and Prevention, about 8 million adults in the U.S. are diagnosed with depression each year. That number may be just the tip of the iceberg, since many people with depression go undiagnosed and untreated.

Depression Is Different From Sadness or Grief/Bereavement

The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

• In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.
• In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
• For some people, the death of a loved one can bring on major depression. Losing a job or being a victim of a physical assault or a major disaster can lead to depression for some people. When grief and depression co-exist, the grief is more severe and lasts longer than grief without depression. Despite some overlap between grief and depression, they are different. Distinguishing between them can help people get the help, support or treatment they need.

Trying to tell the difference between what expected behaviors are and what might be the signs of a mental illness isn’t always easy. There’s no easy test that can let someone know if there is mental illness or if actions and thoughts might be typical behaviors of a person or the result of a physical illness.

Suicide causes immeasurable pain, suffering, and loss to individuals, families, and communities nationwide. On average, 100 Americans die by suicide each day. Suicide is the third leading cause of death among 15-24 year olds and more than 8 million adults in the United States had serious thoughts of suicide within the past 12 months.

Depression Can Go Unrecognized

People with depression may not realize they are depressed. Because self-critical thinking is part of depression, some people might mistakenly think of themselves as a failure, a bad student, a quitter, a slacker, a loser, or a bad person.

Because depression can affect how a person acts, it might be misunderstood as a bad attitude. Other people may think the person isn’t trying or not putting in any effort. For example, a negative or irritable mood can cause someone to act more argumentative, disagreeable, or angry. That can make the person seem difficult to get along with or cause others to keep their distance. Low motivation, low energy, difficulty concentrating, and thoughts of “why bother?” can lead someone to skip classes or school.

Some people with depression have other problems as well. These can intensify feelings of worthlessness or inner pain. For example, people who cut themselves or who have eating disorders or who go through extreme mood changes may have unrecognized depression.

When depression is recognized and treated, it often clears the way for other problems to get treated, too.

What Helps Depression Get Better?

Depression can get better with the right attention and care — sometimes more easily than a person thinks. But if it’s not treated, things can stay bad or get worse. That’s why people who are depressed shouldn’t wait and hope it will go away on its own.

If you think you might be depressed, talk to a parent or other adult about getting the right help. The right help can mean doing all of these things:

Get a Medical Checkup

A doctor can check for any health conditions that might cause symptoms of depression. For example, hypothyroidism can cause a depressed mood, low energy, and tiredness. Mono can make a person feel tired and depressed.

Talk to a Counselor

Having meetings with a counselor or therapist is called talk therapy. Talk therapy can help people overcome depression. Talk therapy works by helping people to:

• understand their emotions, put feelings into words, and feel understood and supported
• build the confidence to deal with life’s struggles
• work out problems they face
• change negative thinking patterns that are part of depression
• increase self-esteem and become more self-accepting
• increase their positive emotions and feel happier

Overcoming depression might include talk therapy, medication, or both. A therapist might also recommend daily exercise, exposure to daylight, or better ways of eating. A therapist might teach relaxation skills to help someone get a good night’s sleep.

Get Support

Many people find that it helps to open up to parents or other adults they trust. Simply saying something like, “I’ve been feeling really down lately and I think I’m depressed” can be a good way to begin the discussion.

If a parent or family member can’t help, turn to your school counselor, school nurse, or a helpline.

Let friends and other people who care about you offer their support. They can:

• listen and talk, showing that they understand what you’re feeling
• remind you that things can get better, and that they are there for you through the downs and ups
• help you see the things that are already good about your life, even when it’s hard for you to notice
• keep you company and do enjoyable or relaxing things with you
• give you honest compliments and help you find things to laugh or smile about

Help Yourself

Try these simple actions. They can have a powerful effect on mood and help with depression:

• eat healthy foods
• get the right amount of sleep
• walk, play, or do something else to get exercise every day
• take time to relax
• take time to notice the good things about life, no matter how small

Focusing on positive emotions and being with positive people can help, too. Do yoga, dance, and find creative self-expression through art, music, or journaling. Daily exercise, meditation, daylight, and positive emotions all can affect the brain’s activity in ways that restore mood and well-being.

Depression can be treated if you take the right steps:

• Do what you can to care for yourself.
• See a doctor or counselor.
• Don’t wait for depression to just go away.

Teen depression

Teen depression is a serious mental health problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenager thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although depression can occur at any time in life, symptoms may be different between teens and adults.

Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings — they’re a symptom of depression.

Teen depression isn’t a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling.

Mental health conditions can also begin to develop in young children and teens. Because they’re still learning how to identify and talk about thoughts and emotions, their most obvious symptoms are behavioral. Symptoms in children may include the following:

• Changes in school performance
• Excessive worry or anxiety, for instance fighting to avoid bed or school
• Hyperactive behavior
• Frequent nightmares
• Frequent disobedience or aggression
• Frequent temper tantrums

It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

If depression symptoms continue or begin to interfere in your teen’s life, talk to a doctor or a mental health professional trained to work with adolescents. Your teen’s family doctor or pediatrician is a good place to start. Or your teen’s school may recommend someone.

Depression symptoms likely won’t get better on their own — and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don’t appear to be severe.

• If you’re a teen and you think you may be depressed — or you have a friend who may be depressed — don’t wait to get help. Talk to a health care provider such as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust.

Symptoms of depression in teens and children

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

Teen depression signs and symptoms include a change from the teenager’s previous attitude and behavior that can cause significant distress and problems at school or home, in social activities or other areas of life.

Depression symptoms can vary in severity, but changes in your teen’s emotions and behavior may include the examples below.

Emotional changes

Be alert for emotional changes, such as:

• Feelings of sadness, which can include crying spells for no apparent reason
• Feeling hopeless or empty
• Irritable or annoyed mood
• Clinginess, worry, aches and pains
• Frustration or feelings of anger, even over small matters
• Loss of interest or pleasure in normal activities
• Loss of interest in, or conflict with, family and friends
• Low self-esteem
• Feelings of worthlessness or guilt
• Fixation on past failures or exaggerated self-blame or self-criticism
• Extreme sensitivity to rejection or failure, and the need for excessive reassurance
• Trouble thinking, concentrating, making decisions and remembering things
• Ongoing sense that life and the future are grim and bleak
• Frequent thoughts of death, dying or suicide
• Being underweight

Behavioral changes

Watch for changes in behavior, such as:

• Tiredness and loss of energy
• Refusing to go to school
• Poor performance or poor attendance at school
• Insomnia or sleeping too much
• Changes in appetite — decreased appetite and weight loss, or increased cravings for food and weight gain
• Use of alcohol or drugs
• Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
• Slowed thinking, speaking or body movements
• Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
• Social isolation
• Poor school performance or frequent absences from school
• Neglected appearance
• Angry outbursts, disruptive or risky behavior, or other acting-out behaviors
• Self-harm — for example, cutting, burning, or excessive piercing or tattooing
• Making a suicide plan or a suicide attempt

Types of depression

Symptoms caused by major depression can vary from person to person. To clarify the type of depression you have, your doctor may add one or more specifiers. A specifier means that you have depression with specific features, such as:

• Anxious distress — depression with unusual restlessness or worry about possible events or loss of control
• Mixed features — simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy
• Melancholic features — severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or sluggishness
• Atypical features — depression that includes the ability to temporarily be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in the arms or legs
• Psychotic features — depression accompanied by delusions or hallucinations, which may involve personal inadequacy or other negative themes
• Catatonia — depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture
• Peripartum onset — depression that occurs during pregnancy or in the weeks or months after delivery (postpartum)
• Seasonal pattern — depression related to changes in seasons and reduced exposure to sunlight.

Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.

Postpartum baby blues – Many new moms experience the “postpartum baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks.

Postpartum baby blues symptoms

Signs and symptoms of baby blues — which last only a few days to a week or two after your baby is born — may include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying
• Reduced concentration
• Appetite problems
• Trouble sleeping

Perinatal depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

Seasonal affective disorder (SAD) is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Examples of other types of depressive disorders newly added to the diagnostic classification of Diagnostic and Statistical Manual of Mental Disorders (DSM–5) ¹ include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

Other disorders that cause depression symptoms

Several other disorders, such as those below, include depression as a symptom. It’s important to get an accurate diagnosis, so you can get appropriate treatment.

Bipolar I and II disorders. These mood disorders include mood swings that range from highs (mania) to lows (depression). It’s sometimes difficult to distinguish between bipolar disorder and depression.

Cyclothymic disorder. Cyclothymic disorder involves highs and lows that are milder than those of bipolar disorder.

Disruptive mood dysregulation disorder. This mood disorder in children includes chronic and severe irritability and anger with frequent extreme temper outbursts. This disorder typically develops into depressive disorder or anxiety disorder during the teen years or adulthood.

Persistent depressive disorder. Sometimes called dysthymia, this is a less severe but more chronic form of depression. While it’s usually not disabling, persistent depressive disorder can prevent you from functioning normally in your daily routine and from living life to its fullest.

Premenstrual dysphoric disorder. This involves depression symptoms associated with hormone changes that begin a week before and improve within a few days after the onset of your period, and are minimal or gone after completion of your period.

Other depression disorders. This includes depression that’s caused by the use of recreational drugs, some prescribed medications or another medical condition.

Postpartum depression

Postpartum depression is a more severe, long-lasting form of depression some new moms experience after childbirth. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Postpartum depression symptoms

Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, eventually interfering with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin later — up to six months after birth.

Postpartum depression symptoms may include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Fear that you’re not a good mother
• Feelings of worthlessness, shame, guilt or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

Untreated, postpartum depression may last for many months or longer.

Postpartum psychosis

With postpartum psychosis — a rare condition that typically develops within the first week after delivery — the signs and symptoms are even more severe. Signs and symptoms may include:

• Confusion and disorientation
• Obsessive thoughts about your baby
• Hallucinations and delusions
• Sleep disturbances
• Paranoia
• Attempts to harm yourself or your baby

Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

Causes of postpartum depression

There’s no single cause of postpartum depression, but physical and emotional issues may play a role.

• Physical changes. After childbirth, a dramatic drop in hormones (estrogen and progesterone) in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed.
• Emotional issues. When you’re sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive, struggle with your sense of identity or feel that you’ve lost control over your life. Any of these issues can contribute to postpartum depression.

Risk factors for postpartum depression

Postpartum depression can develop after the birth of any child, not just the first. The risk increases if:

• You have a history of depression, either during pregnancy or at other times
• You have bipolar disorder
• You had postpartum depression after a previous pregnancy
• You have family members who’ve had depression or other mood stability problems
• You’ve experienced stressful events during the past year, such as pregnancy complications, illness or job loss
• Your baby has health problems or other special needs
• You have difficulty breast-feeding
• You’re having problems in your relationship with your spouse or significant other
• You have a weak support system
• You have financial problems
• The pregnancy was unplanned or unwanted

Complications of postpartum depression

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems.

• For mothers. Untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder. Even when treated, postpartum depression increases a woman’s risk of future episodes of major depression.
• For fathers. Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby’s father may also increase. And new dads are already at increased risk of depression, whether or not their partner is affected.

For children. Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as sleeping and eating difficulties, excessive crying, and attention-deficit/hyperactivity disorder (ADHD). Delays in language development are more common as well.

Prevention of postpartum depression

If you have a history of depression — especially postpartum depression — tell your doctor if you’re planning on becoming pregnant or as soon as you find out you’re pregnant.

• During pregnancy, your doctor can monitor you closely for signs and symptoms of depression. He or she may have you complete a depression-screening questionnaire during your pregnancy and after delivery. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants may be recommended — even during pregnancy.
• After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier it’s detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment or psychotherapy immediately after delivery.

Diagnosis of Postpartum depression

Your doctor will usually talk with you about your feelings, thoughts and mental health to distinguish between a short-term case of postpartum baby blues and a more severe form of depression. Don’t be embarrassed. Share your symptoms with your doctor so that a useful treatment plan can be created for you.

As part of your evaluation, your doctor may:

• Ask you to complete a depression-screening questionnaire
• Order blood tests to determine whether an underactive thyroid is contributing to your signs and symptoms
• Order other tests, if warranted, to rule out other causes for your symptoms

The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is often used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Treatment of Postpartum depression

Treatment and recovery time vary, depending on the severity of your depression and your individual needs. If you have an underactive thyroid or an underlying illness, your doctor may treat those conditions or refer you to the appropriate specialist. Your doctor also may refer you to a mental health provider.

Baby blues

The baby blues usually fade on their own within a few days to one to two weeks. In the meantime:

• Get as much rest as you can
• Accept help from family and friends
• Connect with other new moms
• Create time to take care of yourself
• Avoid alcohol and recreational drugs, which can make mood swings worse

Postpartum depression

Postpartum depression is often treated with psychotherapy (also called talk therapy or mental health counseling), medication or both.

Psychotherapy. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health provider. Through therapy, you can find better ways to cope with your feelings, solve problems, set realistic goals and respond to situations in a positive way. Sometimes family or relationship therapy also helps.
Antidepressants. Your doctor may recommend an antidepressant. If you’re breast-feeding, any medication you take will enter your breast milk. However, some antidepressants can be used during breast-feeding with little risk of side effects for your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants.

With appropriate treatment, postpartum depression usually goes away within six months. In some cases, postpartum depression lasts much longer, becoming chronic depression. It’s important to continue treatment after you begin to feel better. Stopping treatment too early may lead to a relapse.

Postpartum psychosis

Postpartum psychosis requires immediate treatment, often in the hospital. Treatment may include:

Medication. When your safety is assured, a combination of medications — such as antidepressants, antipsychotic medications and mood stabilizers — may be used to control your signs and symptoms.
Electroconvulsive therapy (ECT). If your postpartum depression is severe and does not respond to medication, ECT may be recommended. During ECT, a small amount of electrical current is applied to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of psychosis and depression, especially when other treatments have failed.

Treatment for postpartum psychosis can challenge a mother’s ability to breast-feed. Separation from the baby makes breast-feeding difficult, and some medications used to treat postpartum psychosis aren’t recommended for women who are breast-feeding. If you’re experiencing postpartum psychosis, your doctor can help you work through these challenges.

Lifestyle and home remedies for Postpartum depression

Postpartum depression isn’t generally a condition that you can treat on your own — but you can do some things for yourself that build on your treatment plan and help speed recovery.

• Make healthy lifestyle choices. Include physical activity, such as a walk with your baby, in your daily routine. Try to get adequate rest. Eat healthy foods and avoid alcohol.
• Set realistic expectations. Don’t pressure yourself to do everything. Scale back your expectations for the perfect household. Do what you can and leave the rest.
• Make time for yourself. If you feel like the world is coming down around you, take some time for yourself. Get dressed, leave the house, and visit a friend or run an errand. Or schedule some time alone with your partner.
• Avoid isolation. Talk with your partner, family and friends about how you’re feeling. Ask other mothers about their experiences. Breaking the isolation may help you feel human again.
• Ask for help. Try to open up to the people close to you and let them know you need help. If someone offers to baby-sit so you can take a break, take them up on it. If you can sleep, take a nap, or maybe you can catch a movie or meet for coffee with friends.

Remember, the best way to take care of your baby is to take care of yourself.

Coping and support for Postpartum depression

The already stressful, exhausting period following a baby’s birth is more difficult when depression occurs. But remember, postpartum depression is never anyone’s fault. It’s a common medical condition that needs treatment.

So, if you’re having trouble coping with postpartum depression, talk with a therapist. Ask your doctor or therapist about local support groups for new moms or women who have postpartum depression.

The sooner you get help, the sooner you’ll be fully equipped to cope with depression and enjoy your new baby.

Seasonal depression

Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons — SAD begins and ends at about the same times every year. If you’re like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer.

Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy.

• Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

Symptoms of Seasonal depression

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.

Signs and symptoms of SAD may include:

• Feeling depressed most of the day, nearly every day
• Losing interest in activities you once enjoyed
• Having low energy
• Having problems with sleeping
• Experiencing changes in your appetite or weight
• Feeling sluggish or agitated
• Having difficulty concentrating
• Feeling hopeless, worthless or guilty
• Having frequent thoughts of death or suicide

Fall and winter SAD

Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:

• Oversleeping
• Appetite changes, especially a craving for foods high in carbohydrates
• Weight gain
• Tiredness or low energy

Spring and summer SAD

Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include:

• Trouble sleeping (insomnia)
• Poor appetite
• Weight loss
• Agitation or anxiety

Seasonal changes in bipolar disorder

In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression.

What Causes Seasonal depression

The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include:

• Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body’s internal clock and lead to feelings of depression.
• Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.
• Melatonin levels. The change in season can disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood.

Risk factors for Seasonal depression

Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults.

Factors that may increase your risk of seasonal affective disorder include:

• Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.
• Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
• Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased
• sunlight during the winter and longer days during the summer months.

Complications of Seasonal depression

Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, SAD can get worse and lead to problems if it’s not treated.

These can include:

• Social withdrawal
• School or work problems
• Substance abuse
• Other mental health disorders such as anxiety or eating disorders
• Suicidal thoughts or behavior

Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad.

Diagnosis of Seasonal depression

Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms.

To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes:

• Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it’s functioning properly.
• Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions.
• DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment of Seasonal depression

Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Light therapy

In light therapy, also called phototherapy, you sit a few feet from a special light box so that you’re exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.

Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that’s safe and effective. Also ask your doctor about how and when to use the light box.

Medications

Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.

An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD.

Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.

Psychotherapy

Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you:

• Identify and change negative thoughts and behaviors that may be making you feel worse
• Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities
• Learn how to manage stress

Mind-body connection

Examples of mind-body techniques that some people may choose to try to help cope with SAD include:

• Relaxation techniques such as yoga or tai chi
• Meditation
• Guided imagery
• Music or art therapy

Lifestyle and home remedies for Seasonal depression

In addition to your treatment plan for seasonal affective disorder:

• Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.
• Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
• Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.

Alternative medicine for Seasonal depression

Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it’s not clear how effective these treatments are for seasonal affective disorder.

Herbal remedies and dietary supplements aren’t monitored by the Food and Drug Administration (FDA) the same way medications are, so you can’t always be certain of what you’re getting and whether it’s safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements.

Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren’t a substitute for medical care.

Coping and support for Seasonal depression

These steps can help you manage seasonal affective disorder:

• Stick to your treatment plan. Follow your treatment plan and attend therapy appointments when scheduled.
• Take care of yourself. Get enough sleep to help you feel rested, but be careful not to get too much rest, as SAD symptoms often lead people to feel like hibernating. Participate in an exercise program or engage in another form of regular physical activity. Make healthy choices for meals and snacks. Don’t turn to alcohol or recreational drugs for relief.
• Practice stress management. Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
• Socialize. When you’re feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or shared laughter to give you a little boost.
• Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter SAD or to cooler locations if you have summer SAD.

Signs and symptoms of depression

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

• Memory difficulties or personality changes
• Physical aches or pain
• Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
• Often wanting to stay at home, rather than going out to socialize or doing new things
• Suicidal thinking or feelings, especially in older men

Signs of Depression

Here are some of the things people notice with depression:

Negative feelings and mood. People with depression might feel unusually sad, discouraged, or defeated. They may feel hopeless, helpless, or alone. Some people feel guilty, unworthy, rejected, or unloved. Some people with depression feel, angry, easily annoyed, bitter, or alienated.

Any or all of these negative emotions can be part of a depressed mood if they go on for weeks or more.

Negative thinking. People with depression get stuck in negative thinking. This can make people focus on problems and faults. It can make things seem bleaker than they really are. Negative thinking can make a person believe things will never get better, that problems are too big to solve, that nothing can fix the situation, or that nothing matters.

Negative thinking can be self-critical, too. People may believe they are worthless and unlovable — even though that’s not true. That can lead people with depression to think about harming themselves or about ending their own life. Negative thinking can block our ability to see solutions or realize that a problem is actually temporary.

Low energy and motivation. People with depression may feel tired, drained, or exhausted. They might move more slowly or take longer to do things. It can feel as if everything requires more effort. People who feel this way might have trouble motivating themselves to do or care about anything.

Poor concentration. Depression can make it hard to concentrate and focus. It might be hard to do schoolwork, pay attention in class, remember lessons, or stay focused on what others say.

Physical problems. Some people with depression have an upset stomach or loss of appetite. Some might gain or lose weight. People might notice headaches and sleeping problems when they’re depressed.

Social withdrawing. People with depression may pull away from friends and family or from activities they once enjoyed. This usually makes them feel more lonely and isolated — and can make negative thinking worse.

Each illness has its own symptoms, but common signs of mental illness in adults and adolescents can include the following:

• Excessive worrying or fear
• Feeling excessively sad or low
• Confused thinking or problems concentrating and learning
• Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
• Prolonged or strong feelings of irritability or anger
• Avoiding friends and social activities
• Difficulties understanding or relating to other people
• Changes in sleeping habits or feeling tired and low energy
• Changes in eating habits such as increased hunger or lack of appetite
• Changes in sex drive
• Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don’t exist in objective reality)
• Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia)
• Abuse of substances like alcohol or drugs
• Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
• Thinking about suicide
• Inability to carry out daily activities or handle daily problems and stress
• An intense fear of weight gain or concern with appearance.

What causes depression

It’s not known exactly what causes depression, but a variety of issues may be involved. These include:

Biological chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems change, leading to depression.

Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.

Hormones. Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.

Inherited traits. Depression is more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.

Early childhood trauma. Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that make a person more susceptible to depression.

Learned patterns of negative thinking. Teen depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life’s challenges.

Risk factors for depression

Many factors increase the risk of developing or triggering teen depression, including:

• Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term bullying or academic problems
• Having been the victim or witness of violence, such as physical or sexual abuse
• Having other conditions, such as bipolar disorder, an anxiety disorder, a personality disorder, anorexia or bulimia
• Having a learning disability or attention-deficit/hyperactivity disorder (ADHD)
• Having ongoing pain or a chronic physical illness such as cancer, diabetes or asthma
• Having a physical disability
• Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic
• Abusing alcohol, nicotine or other drugs
• Being gay, lesbian, bisexual or transgender in an unsupportive environment

Family history and issues with family or others may also increase your teenager’s risk of depression, such as:

• Having a parent, grandparent or other blood relative with depression, bipolar disorder or alcoholism
• Having a family member who committed suicide
• Having a dysfunctional family and conflict
• Having experienced recent stressful life events, such as parental divorce, parental military service or the death of a loved one.

Can a junk food diet increase your risk of depression?

Depression and diet may be related. Several studies have found that people who ate a poor quality diet — one that was high in processed meat, chocolates, sweet desserts, fried food, refined cereals and high-fat dairy products — were more likely to report symptoms of depression. The good news is that the people who ate a diet rich in fruits, vegetables and fish were less likely to report being depressed.

These results are in line with other research findings that healthy diets help protect against disease. For example, studies suggest that people who follow the Mediterranean diet — which emphasizes fruits, vegetables and fish, and limits meat and dairy products — have lower rates of depression and other diseases, such as Alzheimer’s disease, diabetes and heart disease.

More research is needed on the connection between depression and diet. In the meantime, it would be wise to cut back on the less nutritious options and make healthier choices.

Complications of depression

Untreated depression can result in emotional, behavioral and health problems that affect every area of your teenager’s life. Complications related to teen depression may include, for example:

• Alcohol and drug abuse
• Academic problems
• Family conflicts and relationship difficulties, and work or school problems
• Involvement with the juvenile justice system
• Suicide
• Excess weight or obesity, which can lead to heart disease and diabetes
• Pain or physical illness
• Anxiety, panic disorder or social phobia
• Social isolation
• Suicidal feelings, suicide attempts or suicide
• Self-mutilation, such as cutting
• Premature death from medical conditions

Prevention of depression

There’s no sure way to prevent depression. However, these strategies may help. Encourage your teenager to:

• Take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise
• Reach out for friendship and social support, especially in times of crisis
• Get treatment at the earliest sign of a problem to help prevent depression from worsening
• Maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms

Diagnosis of depression

Your doctor may determine a diagnosis of depression based on:

• Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it’s functioning properly.
• Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.
• DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ¹, published by the American Psychiatric Association.

Depression test

Screening for Adult Depression

Screening for Child/Adolescent

Screening for Child/Adolescent (Parent Version)

Depression treatment

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Here’s a closer look at depression treatment options.

Depression Medications

Many types of antidepressants are available, including those below. Be sure to discuss possible major side effects with your doctor or pharmacist.

Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These drugs are considered safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).

Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).

Atypical antidepressants. These medications don’t fit neatly into any of the other antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).

Tricyclic antidepressants. These drugs — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and protriptyline (Vivactil) — can be very effective, but tend to cause more-severe side effects than newer antidepressants. So tricyclics generally aren’t prescribed unless you’ve tried an SSRI first without improvement.

Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, typically when other drugs haven’t worked, because they can have serious side effects. Using MAOIs requires a strict diet because of dangerous (or even deadly) interactions with foods ― such as certain cheeses, pickles and wines ― and some medications and herbal supplements. Selegiline (Emsam), a newer MAOI that sticks on the skin as a patch, may cause fewer side effects than other MAOIs do. These medications can’t be combined with SSRIs.

Other medications. Other medications may be added to an antidepressant to enhance antidepressant effects. Your doctor may recommend combining two antidepressants or adding medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications also may be added for short-term use.

Finding the right medication

If a family member has responded well to an antidepressant, it may be one that could help you. Or you may need to try several medications or a combination of medications before you find one that works. This requires patience, as some medications need several weeks or longer to take full effect and for side effects to ease as your body adjusts.

Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of genetic tests (done by a blood test or cheek swab) may offer clues about how your body may respond to a particular antidepressant. However, other variables besides genetics can affect your response to medication.

Risks of abruptly stopping medication

Don’t stop taking an antidepressant without talking to your doctor first. Antidepressants aren’t considered addictive, but sometimes physical dependence (which is different from addiction) can occur.

Stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression. Work with your doctor to gradually and safely decrease your dose.

Antidepressants and pregnancy

If you’re pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk with your doctor if you become pregnant or you’re planning to become pregnant.

Antidepressants and increased suicide risk

Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the strictest warning for prescriptions. In some cases, children, teenagers and young adults under age 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior, especially when starting a new medication or with a change in dosage. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact a doctor or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Psychotherapy

Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. Psychotherapy is also known as talk therapy or psychological therapy.

Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy. Your mental health professional may also recommend other types of therapies. Psychotherapy can help you:

• Adjust to a crisis or other current difficulty
• Identify negative beliefs and behaviors and replace them with healthy, positive ones
• Explore relationships and experiences, and develop positive interactions with others
• Find better ways to cope and solve problems
• Identify issues that contribute to your depression and change behaviors that make it worse
• Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
• Learn to set realistic goals for your life
• Develop the ability to tolerate and accept distress using healthier behaviors

Alternate formats for therapy

Formats for depression therapy as an alternative to face-to-face office sessions are available and may be an effective option for some people. Therapy can be provided, for example, as a computer program, by online sessions, or using videos or workbooks. Programs can be guided by a therapist or be partially or totally independent.

Before you choose one of these options, discuss these formats with your therapist to determine if they may be helpful for you. Also, ask your therapist if he or she can recommend a trusted source or program. Some may not be covered by your insurance and not all developers and online therapists have the proper credentials or training.

Smartphones and tablets that offer mobile health apps, such as support and general education about depression, are not a substitute for seeing your doctor or therapist.

Cognitive Behavioral Therapy (CBT)

The Royal College of Psychiatrists defines cognitive behavioral therapy as a way of talking about:

• How you think about yourself, the world and other people
• How what you do affects your thoughts and feelings.

They say that CBT can help you to change how you think (the cognitive part) and what you do (the behavioral part). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

If you are not sure you want to commit to a long course of sessions with a clinical psychologist, there are various resources on the Internet which will provide an introduction to CBT or even a course of computer-aided CBT sessions:

• Developed by the Australian National University, MoodGYM (https://moodgym.com.au/) is a fun, free interactive web program that teaches the principles of CBT using flashed diagrams and online exercises. MoodGYM (https://moodgym.com.au/) demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques. It consists of five modules (why you feel the way you do, changing the way you think, changing ‘warped’ thoughts, knowing what makes you upset, assertiveness and interpersonal skills training), an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment. Scientific trials have shown that using two or more modules is linked to significant reductions in depression and anxiety symptoms. These benefits last after 12 months. MoodGYM has won several IT and health awards, and has over 1,000,000 users worldwide. MoodGYM (https://moodgym.com.au/)

• Living Life to the Full (https://llttf.com/) is a free online life skills course for people feeling distressed. It aims to provide easy access to CBT skills in a way that cuts through jargon. It helps you understand why you feel as you do, and to learn new ways of improving how you feel, by making changes in your thinking, activities, sleep and relationships. The course is based on the idea of helping you to help yourself. It is supported by a series of CBT self-help workbooks that can be used between the e-learning sessions. These encourage you to put what you are learning into practice, and to stop, think and reflect on what you are learning. Living Life to the Full (https://llttf.com/)

• FearFighter (http://www.fearfighter.com/) delivers CBT over the internet, useful for those who may be concerned about the stigma associated with seeing a therapist. Taking only three months to complete, with minimal telephone support, FearFighter helps you improve even if you have virtually no computer skills. You are encouraged to use FearFighter as often as you wish but for at least once a week. It helps you identify specific problems, work on realistic treatment goals, and monitor achievement of those goals by repeated self-exposure. You get scheduled brief helpline support to a total of one hour over 10 weeks. FearFighter helps you to work out exactly what brings on your fear, so you can learn how to face it until it subsides. This is called exposure therapy. It consists of nine steps that need to be worked through one by one to obtain the greatest benefits. Like a therapist, FearFighter asks you to return every week to report on how you’ve been doing. You can ask it to print out questionnaires and graphs of your progress. It guides you through CBT as much as a therapist does.
  • Step 1: Welcome to FearFighter – Introduces the system, asks you to rate your problem on the Fear Questionnaire (FQ) and Work & Social Adjustment Scale (WSA), and asks about suicidal feelings and alcohol misuse.
  • Step 2: How to Beat Fear – Explains the principles of CBT, with case examples. You are asked to keep a daily record of your triggers.
  • Step 3: Problem Sorting – Helps you identify your triggers, shows you scenarios relevant to your problem, and helps you personalise your triggers and rate them on a 0-8 scale.
  • Step 4: How to Get a Helper – Explains the value of recruiting a CBT co-therapist and gives hints on how to find one.
  • Step 5: Setting Goals – Guides you through the process of setting good goals and tests them. You record and rate these on the system and can print personalised homework diaries.
  • Step 6: Managing anxiety – Offers a menu of coping strategies for use during CBT homework.
  • Step 7: Rehearsing Goals – Guides you on how to practise personal coping strategies during both imagined and live CBT homework.
  • Step 8: Carrying On – Reviews progress with the help of graphs, allows new goals to be devised, and offers feedback and advice.
  • Step 9: Troubleshooting – Offers a menu of tips on overcoming common sticking points in treatment.

You may have found that when you avoid things that make you panic or feel uncomfortable, the situation tends to get worse and worse. FearFighter can teach you how to face your fear until you adapt and no longer want to run away from it. It helps you learn to face the things that make you panic, such that, with time, you’ll find that, one by one, they’ll get easier.

Self-exposure therapy guided by computer is as effective as clinician-guided therapy and both are superior to relaxation to improve phobia/panic. FearFighter has been tested in four clinical trials and is as effective as the best CBT therapists.

Approved by the National Institute of Clinical Excellence (NICE), free access can only be prescribed by your doctor in England and Wales. FearFighter (http://www.fearfighter.com/)

Hospital and residential treatment

In some people, depression is so severe that a hospital stay is needed. This may be necessary if you can’t care for yourself properly or when you’re in immediate danger of harming yourself or someone else. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves.

Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.

Other treatment options

For some people, other procedures, sometimes called brain stimulation therapies, may be suggested:

Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain to impact the function and effect of neurotransmitters in your brain to relieve depression. ECT is usually used for people who don’t get better with medications, can’t take antidepressants for health reasons or are at high risk of suicide.

Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven’t responded to antidepressants. During TMS, a treatment coil placed against your scalp sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.

Lifestyle and home remedies

Depression generally isn’t a disorder that you can treat on your own. But in addition to professional treatment, these self-care steps can help:

• Stick to your treatment plan. Don’t skip psychotherapy sessions or appointments. Even if you’re feeling well, don’t skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms. Recognize that it will take time to feel better.
• Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about depression to help them understand and support you.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask relatives or friends to help watch for warning signs.
• Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or substance use.
• Take care of yourself. Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you’re having trouble sleeping, talk to your doctor about what you can do.

Alternative medicine

Alternative medicine is the use of a nonconventional approach instead of conventional medicine. Complementary medicine is a nonconventional approach used along with conventional medicine — sometimes called integrative medicine.

Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Don’t replace conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren’t a substitute for medical care.

Supplements

Examples of supplements that are sometimes used for depression include:

• St. John’s wort. Although this herbal supplement isn’t approved by the Food and Drug Administration (FDA) to treat depression in the U.S., it may be helpful for mild or moderate depression. But if you choose to use it, be careful — St. John’s wort can interfere with a number of medications, such as heart drugs, blood-thinning drugs, birth control pills, chemotherapy, HIV/AIDS medications and drugs to prevent organ rejection after a transplant. Also, avoid taking St. John’s wort while taking antidepressants because the combination can cause serious side effects.
• SAMe. Pronounced “sam-E,” this dietary supplement is a synthetic form of a chemical that occurs naturally in the body. The name is short for S-adenosylmethionine. SAMe isn’t approved by the FDA to treat depression in the U.S. It may be helpful, but more research is needed. SAMe may trigger mania in people with bipolar disorder.
• Omega-3 fatty acids. These healthy fats are found in cold-water fish, flaxseed, flax oil, walnuts and some other foods. Omega-3 supplements are being studied as a possible treatment for depression. While considered generally safe, in high doses, omega-3 supplements may interact with other medications. More research is needed to determine if eating foods with omega-3 fatty acids can help relieve depression.

Nutritional and dietary products aren’t monitored by the FDA the same way medications are. You can’t always be certain of what you’re getting and whether it’s safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements.

Mind-body connections

Integrative medicine practitioners believe the mind and body must be in harmony for you to stay healthy. Examples of mind-body techniques that may be helpful for depression include:

• Acupuncture
• Relaxation techniques such as yoga or tai chi
• Meditation
• Guided imagery
• Massage therapy
• Music or art therapy
• Spirituality
• Aerobic exercise

Relying solely on these therapies is generally not enough to treat depression. They may be helpful when used in addition to medication and psychotherapy.

Coping and support

Talk with your doctor or therapist about improving your coping skills, and try these tips:

• Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.
• Write in a journal. Journaling, as part of your treatment, may improve mood by allowing you to express pain, anger, fear or other emotions.
• Read reputable self-help books and websites. Your doctor or therapist may be able to recommend books or websites to read.
• Locate helpful groups. Many organizations, such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance, offer education, support groups, counseling and other resources to help with depression. Employee assistance programs and religious groups also may offer help for mental health concerns.
• Don’t become isolated. Try to participate in social activities, and get together with family or friends regularly. Support groups for people with depression can help you connect to others facing similar challenges and share experiences.
• Learn ways to relax and manage your stress. Examples include meditation, progressive muscle relaxation, yoga and tai chi.
• Structure your time. Plan your day. You may find it helps to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.
• Don’t make important decisions when you’re down. Avoid decision-making when you’re feeling depressed, since you may not be thinking clearly.

Supporting a family member or friend with depression

Helping someone with depression can be a challenge. If someone in your life has depression, you may feel helpless and wonder what to do. Learn how to offer support and understanding and how to help your loved one get the resources to cope with depression. Here’s what you can do.

Learn the symptoms of depression

Depression signs and symptoms vary from person to person. They can include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Changes in appetite — reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent mention of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Other people may feel generally miserable or unhappy without knowing why. Children and teens may show depression by being irritable or cranky rather than sad.

Encourage treatment

People with depression may not recognize or acknowledge that they’re depressed. They may not be aware of signs and symptoms of depression, so they may think their feelings are normal.

All too often, people feel ashamed about their depression and mistakenly believe they should be able to overcome it with willpower alone. But depression seldom gets better without treatment and may get worse. With the right treatment approach, the person you care about can get better.

Here’s what you can do to help:

• Talk to the person about what you’ve noticed and why you’re concerned.
• Explain that depression is a medical condition, not a personal flaw or weakness — and that it usually gets better with treatment.
• Suggest seeking help from a professional — a medical doctor or a mental health provider, such as a licensed counselor or psychologist.
• Offer to help prepare a list of questions to discuss in an initial appointment with a doctor or mental health provider.
• Express your willingness to help by setting up appointments, going along to them and attending family therapy sessions.

If your loved one’s illness is severe or potentially life-threatening, contact a doctor, a hospital or emergency medical services.

Identify warning signs of worsening depression

Everyone experiences depression differently. Observe your loved one. Learn how depression affects your family member or friend — and learn what to do when it gets worse.

Consider these issues:

• What are the typical signs and symptoms of depression in your relative or friend?
• What behaviors or language do you observe when depression is worse?
• What behaviors or language do you observe when he or she is doing well?
• What circumstances trigger episodes of more severe depression?
• What activities are most helpful when depression worsens?

Worsening depression needs to be treated as soon as possible. Encourage your loved one to work with his or her doctor or mental health provider to come up with a plan for what to do when signs and symptoms reach a certain point. As part of this plan, your loved one may need to:

• Contact the doctor to see about adjusting or changing medications
• See a psychotherapist, such as a licensed counselor or psychologist
• Take self-care steps, such as being sure to eat healthy meals, get an appropriate amount of sleep and be physically active.

Understand suicide risk

People with depression are at an increased risk of suicide. If your loved one is severely depressed, prepare yourself for the possibility that at some point he or she may feel suicidal. Take all signs of suicidal behavior seriously and act immediately.

Take action if necessary:

• Talk to the person about your concern. Ask if he or she has been thinking about attempting suicide or has a plan for how to do it. Having an actual plan indicates a higher likelihood of attempting suicide.
• Seek help. Contact the person’s doctor, mental health provider or other health care professional. Let other family members or close friends know what’s going on.
• Call a suicide hotline number. In the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 1-800-273-8255 to talk to a trained counselor. Use that same number and press “1” to reach the Veterans Crisis Line.
• Make sure the person is in a safe environment. If possible, eliminate things that could be used to attempt suicide. For example, remove or lock up firearms, other weapons and medications.
• Call your local emergency number immediately if the person is in danger of self-harm or suicide. Make sure someone stays with that person at all times.

Stay alert for warning signs of suicide

Learn and stay alert for common warning signs of suicide or suicidal thoughts:

• Talking about suicide — for example, making statements such as “I’m going to kill myself,” “I wish I were dead,” or “I wish I hadn’t been born”
• Getting the means to attempt suicide, such as buying a gun or stockpiling pills
• Withdrawing from social contact and wanting to be left alone
• Having mood swings, such as being emotionally high one day and deeply discouraged the next
• Being preoccupied with death, dying or violence
• Feeling trapped or hopeless about a situation
• Increasing use of alcohol or drugs
• Changing normal routine, including eating or sleeping patterns
• Doing risky or self-destructive things, such as using drugs or driving recklessly
• Giving away belongings or getting affairs in order when there’s no other logical explanation for why this is being done
• Saying goodbye to people as if they won’t be seen again
• Developing personality changes or being severely anxious or agitated, particularly when experiencing some of the warning signs listed above

Provide support

Remember that your loved one’s depression isn’t anyone’s fault. You can’t fix the person’s depression — but your support and understanding can help.

What you can do for your loved one:

• Encourage sticking with treatment. If your relative or friend is in treatment for depression, help him or her remember to take prescribed medications and to keep appointments.
• Be willing to listen. Let your loved one know that you want to understand how he or she feels. When the person wants to talk, listen carefully, but avoid giving advice or opinions or making judgments. Just listening and being understanding can be a powerful healing tool.
• Give positive reinforcement. People with depression may judge themselves harshly and find fault with everything they do. Remind your loved one about his or her positive qualities and how much the person means to you and others.
• Offer assistance. Your relative or friend may not be able to take care of certain tasks well. Give suggestions about specific tasks you’d be willing to do, or ask if there is a particular task that you could take on.
• Help create a low-stress environment. Creating a regular routine may help a person with depression feel more in control. Offer to make a schedule for meals, medication, physical activity and sleep, and help organize household chores.
• Locate helpful organizations. A number of organizations offer support groups, counseling and other resources for depression. For example, the National Alliance on Mental Illness, employee assistance programs and many faith-based organizations offer help for mental health concerns.
• Encourage participation in spiritual practice, if appropriate. For many people, faith is an important element in recovery from depression — whether it’s involvement in an organized religious community or personal spiritual beliefs and practices.
• Make plans together. Ask your loved one to join you on a walk, see a movie with you, or work with you on a hobby or other activity he or she previously enjoyed. But don’t try to force the person into doing something.

What you can do for yourself:

• Learn about depression. The better you understand what causes depression, how it affects people and how it can be treated, the better you’ll be able to talk to and help the person you care about.
• Take care of yourself. Supporting someone with depression isn’t easy. Ask other relatives or friends to help, and take steps to prevent becoming frustrated or burned out. Find your own time for hobbies, physical activity, friends and spiritual renewal.
• Finally, be patient. Depression symptoms do improve with treatment, but it can take time. Finding the best treatment may require trying more than one type of medication or treatment approach. For some people, symptoms quickly improve after starting treatment. For others, it will take longer.

1. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). https://www.psychiatry.org/psychiatrists/practice/dsm[↩][↩][↩]
2. National Mental Health Association. http://www.mentalhealthamerica.net/[↩][↩][↩][↩]
3. American Foundation for Suicide Prevention. http://www.afsp.org[↩][↩][↩][↩]
4. National Suicide Prevention Lifeline. https://suicidepreventionlifeline.org/[↩][↩][↩][↩]
5. Depression and Bipolar Support Alliance. http://www.dbsalliance.org[↩][↩][↩][↩]
6. National Alliance on Mentally Illness https://www.nami.org/[↩][↩][↩][↩]
7. National Institute of Mental Health. https://www.nimh.nih.gov/index.shtml[↩][↩][↩][↩]
8. National Strategy for Suicide Prevention. http://www.mentalhealth.org/what-to-look-for/suicidal-behavior[↩][↩][↩][↩]
9. National Association of Anorexia Nervosa and Associated Disorders. http://www.anad.org/[↩][↩][↩][↩]