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Depression Is A Treatable Illness
Depression is a serious illness, but it can be successfully treated with the help of a health professional. If you think you are depressed. there are many places to get the help you need. You can:
- Call your family physician or other health care provider.
- Call your local health department, community mental health center, hospital, or clinic. They can help you or tell you where else you can go for help.
- Contact a local university medical center (many have special programs for the treatment of depression).
- Contact one of the national health groups listed below. They can refer you to a health professional where you live. They can also give you more information about depression, provide you with books and pamphlets, and tell you about support groups.
National Alliance for the Mentally Ill (NAMI)
2101 Wilson Blvd, Suite 302 Arlington, VA 22201
Toll free: 800-950-6264
National Depressive and Manic Depressive Association (NDMDA)
730 N. Franklin St., Suite 501 Chicago, IL 60610
Toll free: 800-82-NDMDA
National Foundation for Depressive Illness, Inc. (NFDI)
P.O. Box 2257
New York, NY 10116-2257
Toll free: 800-248-4344
National Mental Health Association (NMHA)
National Mental Health Information
Center 1021 Prince Street Alexandria, VA 23314-297 1
Toll free: 800-969-6642
A Patient's Guide
This information talks about major depressive disorder, which is only one form of depressive illness. If you are not sure that you have major depressive disorder, this may help to answer your questions and give you information.
There are two sections:
Section 1 answers some of the common questions about depression and gives some basic information.
Section 2 gives more detailed information about depression and its treatment.
Use this information any way that will help you. You may want to:
Print this information and take it with you when you Visit your health care provider. Your notes and records can help you get the best possible treatment for your depression.
Share this information with a family member or close friend. It can help them to better understand your depression and its treatment.
This information is based on evaluation of research studies. Other treatments for depression that are available, while effective for some people, have not been carefully studied.
Here, the word "depression" is used to describe major depressive disorder.
Who gets depressed?
Major depressive disorder--often referred to as depression--is a common illness that can affect anyone. About 1 in 20 Americans (over 11 million people) get depressed every year. Depression affects twice as many women as men.
What is depression?
Depression is not just "feeling blue" or "down in the dumps." It is more than being sad or feeling grief after a loss. Depression is a medical disorder (just like diabetes, high blood pressure, or heart disease are medical disorders) that day after day affects your thoughts, feelings, physical health, and behaviors.
Depression may be caused by many things, including:
Family history and genetics.
Certain life conditions (such as extreme stress or grief), may bring on a depression or prevent a full recovery. In some people, depression occurs even when life is going well.
Other general medical illnesses.
Drugs or alcohol.
Other psychiatric conditions.
Depression is not your fault. It is not a weakness. It is a medical illness. Depression is treatable.
How will I know if I am depressed?
People who have major depressive disorder have a number of symptoms nearly every day, all day, for at least 2 weeks. These always include at least one of the following:
Loss of interest in things you used to enjoy.
Feeling sad, blue, or down in the dumps.
You may also have at least three of the following symptoms:
Feeling slowed down or restless and
unable to sit still.
Feeling worthless or guilty.
Increase or decrease in appetite or weight.
Thoughts of death or suicide.
Problems concentrating, thinking,
remembering, or making decisions.
Trouble sleeping or sleeping too much.
Loss of energy or feeling tired all of the time.
With depression, there are often other physical or psychological symptoms, including:
Other aches and pains.
Feeling pessimistic or hopeless.
Being anxious or worried.
What should I do if I have these symptoms?
Too often people do not get help for their depression because they don't recognize the symptoms, have trouble asking for help, blame themselves, or don't know that treatments are available.
Family practitioners, clinics, or health maintenance organizations are often the first
places that people go for help. These health care providers will:
Find out if there is a physical cause for your depression.
Treat the depression.
Refer you to a mental health specialist for further evaluation and treatment.
If you do not have a regular health care provider, contact your local health department, community mental health clinic, or hospital. University medical centers also provide treatment for depression.
How will treatment help me?
Treatment reduces the pain and suffering of depression. Successful treatment removes all of the symptoms of depression and returns you to your normal life. The earlier you get treatment for your depression, the sooner you will begin to feel better. As with other medical illnesses, the longer you have the depression before you seek treatment, the more difficult it can be to treat.
Most people who are treated for depression feel better and return to daily activities in several weeks. Because it takes several weeks for treatment to work fully, it is important to get treatment early before your depression gets worse.
As with any medical condition, you may have to try one or two treatments before finding the best one. It is important not to get discouraged if the first treatment does not work. In almost every case, there is a treatment for the depression that will work for you.
What type of treatment will I get? The major treatments for depression are:
Antidepressant medicine combined with psychotherapy.
In some cases of depression. other treatments, such as electroconvulsive therapy (ECT) and light therapy, are also useful.
Thoughts of suicide or death are often a part of depression. If you have these thoughts, tell someone you trust now. Ask them to help you find professional help right away. Once your depression is properly treated, these thoughts will go away.
Who should see a mental health specialist?
Many people with depression can be successfully treated by their general health care provider. However, some people need specialized treatment because the first treatment does not work, because they need a combination of treatments, or because the depression is severe or it lasts a long time. Many times, a second opinion or consultation is all that is needed. If the mental health specialist provides treatment, it is most often on an outpatient basis (not in the hospital). If you think you need to see a mental health specialist, tell your health care provider, or contact one of the mental health organizations listed at the beginning of this document.
Section 2 will tell you more about depression, its diagnosis, and its treatment.
People Who Treat Depression
The following health care providers can treat depression:
Here, the term "health care provider" is used to describe any general health care provider or mental health specialist listed above.
When someone is depressed, that person has several symptoms nearly every day, all day, that last at least 2 weeks.
You can use the chart to check off any symptoms you have had for 2 weeks or more.
If you have had five or more of these symptoms including at least one of the first two symptoms marked with an asterisk (*) for at least 2 weeks, you may have major depressive disorder. See your health care provider for diagnosis.
If you have some depressive symptoms, you should also tell your health care provider.
Sometimes a few symptoms can go on to become major depressive disorder. Some forms of depression are mild, but persistent or chronic. Chronic symptoms of depression also need treatment.
Another form of depression
Some people with depression have mood cycles. They have terrible "lows" (depression) and inappropriate "highs" (mania) that can last from several days to months. In between the highs and lows, they feel completely normal. This condition is called bipolar disorder or manic-depressive disorder.
Bipolar disorder affects about 1 in 100 people. Just as eye or hair color are inherited, bipolar disorder in most cases is inherited. It can also be caused by other general medical problems, such as head injury or neurologic or other general medical conditions.
You can use this list to learn the symptoms of mania and to check off any you might have.
If you have had four of these symptoms at one time for at least 1 week. including the first symptom marked with an asterisk(*), you may have had a manic episode. Tell your health care provider about the episode. There are effective treatments for this form of depression.
Causes of Depression
Major depressive disorder is not caused by any one factor. It is probably caused by a combination of biological, genetic, psychological, and other factors. Certain life conditions (such as extreme stress or grief) may bring out a natural psychological or biological tendency toward depression. In some people, depression occurs even when life is going well.
Drinking too much alcohol or using drugs can sometimes cause depression. When the drug and alcohol use is stopped, the depression usually goes away. Talk to your health care provider if you have a problem with drugs or alcohol. It can be treated.
Remember, major depressive disorder is not caused by personal weakness, laziness, or jack of will power, it is a medical illness that can be treated.
Before depression can be treated, it must be accurately diagnosed. Your health care provider will:
Ask about your symptoms.
Ask about your general health.
Ask about your family history of general
medical and mental disorders.
Give you a physical examination.
Conduct some basic laboratory tests.
Preparing For Your First Visit
You can help your health care provider diagnose and treat you by giving as much information as possible about your health. Write down some of that information. Information that you share with a health care provider is confidential.
If your depression is causing you to have a hard time talking and remembering, take a family member or friend along on your first visit to help.
A general medical history, physical examination, and basic laboratory tests can help find out if a general medical disorder is the cause of your depression. About 10 to 15 percent of all depressions are caused by general medical illness (such as thyroid disease, cancers, or neurologic diseases) or medicines. Once the condition is treated or
the medicines are changed or adjusted, the
depression will usually go away.
If you have a general medical illness and feel
depressed, it is important to tell your health
care provider. Sometimes depression is a
reaction to a life-threatening condition.
Getting help during a difficult time in your
life may help you to cope with your general
If your first episode of major depressive
disorder occurred after age 40, a very
thorough medical evaluation is important.
Severe? Moderate? Mild?
In the treatment section, the
terms severe, moderate, and mild depression
are used. In general...
Severe depression is present when a
person has nearly all of the symptoms of
depression, and the depression almost
always keeps them from doing their
regular day-to-day activities.
Moderate depression is present when a
person has many symptoms of depression
that often keep them from doing things
that they need to do.
Mild depression is present when a person
has some of the symptoms of depression
and it takes extra effort to do the things
they need to do.
For each type of depression there is a
treatment that works best. You should talk
with your health care provider about your
depression and the best treatment for you.
Depression is usually treated in two steps.
First: Acute treatment.
Second: Continuation treatment.
The aim of acute treatment is to remove the
symptoms of depression until you feel well.
Continuation treatment (continuing the
treatment for some time even after you are
well) is important because it keeps the
episode of depression from coming back.
Depending on the type of treatment you
have, your chances of staying well for 6
months on continuation treatment are
In cases of recurrent depression (three or
more episodes), a third step, called
maintenance treatment, is used to treat the
depression. In maintenance treatment, you
stay on the treatment for a longer period of
time. The purpose of maintenance treatment
is to prevent a recurrence of the depression.
With maintenance treatment, the chances of
staying well are also extremely good.
The major types of treatment for
Antidepressant medicine combined with
Other treatments, including
electroconvulsive therapy (ECT) and
For severe depression, research studies show
hat medicine is very effective. Psychotherapy
s not been well studied for the more severe
forms of depression.
How Treatment Works
Treatment for depression works gradually
over several weeks. With medicine, most
people see some benefits by 3 or 4 weeks:
with psychotherapy alone, it can sometimes
take longer. There is a very good chance that
your first treatment will work well for you. If
treatment is not effective after a certain
amount of time, it can be changed or
adjusted. There are other treatments to try,
and your chances for effective treatment are
still very good.
Choosing a Treatment
You and your health care provider can work
together to find the best treatment for you.
In choosing which acute treatment is best for
you, you should weigh the chances of getting
better (benefits) against the chances of
possible harms, as well as the expense of the
treatment offered and the costs of the
depression (time from work, effect on
personal relationships, etc.) Here are some
questions you may want to ask when
1. What are the chances of getting better
with this treatment?
2. What are the possible risks and side
effects of treatment?
3. What are the costs of treatment?
Most people with depression get their treatment through regular outpatient visits to a health care provider. However, sometimes treatment in the hospital is needed. This is because other medical conditions could affect your treatment. Another reason is that people with severe depression may need hospital care (for example, to adjust medicine). Also, people who are at great risk for suicide are hospitalized until those feelings pass and treatment begins to work.
If you must go to the hospital for treatment, it is often only for a few days or a week or two. Early treatment, before the depression becomes severe or chronic, can lower the chances of hospitalization.
Why Depression Must be Treated
Without treatment, a major depressive
episode can last 6 to 12 months. In between
the episodes, most people feel better
completely well (without symptoms). or are
Even though some people are able to
struggle through an episode of depression
without treatment, most find that it is much
easier to get some help for their pain and
suffering. It is important to get treatment for
your depression because:
Early treatment may help to keep the
depression from becoming more severe
Thoughts of suicide are common in
depression, and the risk of suicide is
increased when patients are not treated
and the depression recurs. When
depression is successfully treated, the
thoughts of suicide will go away.
Between episodes, about 1 out of 4
people with depression will still have
some symptoms and trouble doing their
daily activities. These people, if not
treated, have a greater chance of having
another episode of depression.
Treatment (especially medicines)can
prevent recurrences of depression. The
more episodes of depression you have
had, the greater the chance that you will
have another. About half of the people who have one episode of depression will have a second. Without treatment, after two episodes, the chances of having a third episode (recurrent depression) are even greater. After three episodes, the chances of having a fourth are 90 percent.
If You Have Concerns About Your Treatment
If at any time you are worried about your
treatment or you don't think that things are
going well, tell someone about your
concerns. You can:
Talk to your health care provider.
Ask for a second opinion.
Talk to someone you trust.
Health care providers are interested in your
concerns and will help you. This may mean
getting a second opinion or even finding
another health care provider.
There are many different types of
antidepressant medicines that can be used to
treat depression. Each of these types of
medicine work a little differently. Your
symptoms, medical history, and family
history often give clues about the best
medicine for you. Still, it may take some time
to find the one that works best for you and
has the least side effects. Together, you and
your health care provider will find the exact
type and amount of medicine that you need.
Antidepressant medicines are not addictive
or habit forming. They work in severe
depression and may be useful in mild to
Many people begin to feel the effects of
medicine even in the first few weeks of
treatment. After about 6 weeks, more than
half of the people who begin antidepressant
medicine will feel more like their usual self.
At the beginning of treatment, your health
care provider will want to see you more
often (possibly every week). The purpose of
these visits is to check the dosage (how
much and how often you take the medicine), to watch for side effects (problems caused by the medicine), and to see how the treatment is working on your depression.
Once you begin to feel better, you probably will visit the health care provider less often. In continuation treatment. you will probably visit your health care provider every month or two. In maintenance treatment, visits are usually every 22 to 3 months.
You will get the most help from your treatment if you do five things:
1.. Keep all of your appointments.
2. Ask questions.
3. Take your medicine as your health care
provider tells you.
4. Tell your health care provider right away about any side effects you have.
5. Tell your health care provider how the medicine is working.
Keep all of your appointments whether you are feeling better or worse. If you are taking antidepressant medicines, you must keep all of your appointments to check the dosage and watch for side effects. It may help to keep a record of this information.
Ask questions. Talk to your health care provider if you have concerns about the medicine. The answer to some of your questions may help you and your health care provider to choose the treatment that is best for you personally. Remember: There is no such thing as a "dumb" question when it comes to your health.
Take your medicine as directed, even when
you begin to feel better. It is important to
continue to take the medicine in order to
keep feeling well. You may want to write
down the name of the medicine you are
Tell your health care provider right away
about any side effects you have. Even
though all medicines have some side effects,
not all people get them. Some patients have
different side effects than others. With
antidepressant medicines, up to half of the
people have some side effects early in
treatment (in the first 4 to 6 weeks). Side
effects are usually not a problem after that.
For a small number of people, side effects
are bad enough to stop the medicine.
The side effects you might get depend on
many things. These are:
The type and amount of medicine you
Your body chemistry.
Other medicines you take.
Other medical conditions you may have.
If side effects are a problem for you, there are a number of things your health care provider can do. Changes can be made in:
The amount of medicine you take. Sometimes side effects can be lessened by reducing the amount of medicine you take.
The type of medicine you take. Your health care provider may try a different medicine to see if there are fewer or less bothersome side effects.
The time of day you take your medicine. Sometimes side effects can be lessened
by taking medicine at night instead of in
How the medicine is taken. Your health
care provider may suggest dividing a
single daily dose into smaller amounts to
take more than once a day.
Changing medicine is a complicated
medical decision, It is dangerous to
make changes in your medicine
Here are some common side effects of
More serious side effects are rare. As with minor side effects, they usually happen in the first few weeks of treatment. They include difficulty passing urine, heart trouble, sexual problems, seizures, fainting, or other effects. Both the common and rare side effects are nearly always treatable.
If you are having side effects, call your health care provider. Do not wait for the next appointment.
About 1 in 10 people who have a close relative with bipolar disorder can develop manic symptoms in the first few weeks of taking the medicine. Only a very small number (1 or 2 out of 100) of people without a relative with bipolar disorder experience manic symptoms when taking antidepressant medicine. An early sign that manic symptoms may be coming is that vou feel that you have a lot of energy or feel very "high" or euphoric. Tell your health care Provider about these changes right away.
Tell your health care provider how the
medicine is working. One way to know how
the medicine is working is to keep a record
of your symptoms. If the medicine is not working for you
(your symptoms are getting worse or not
getting better), your health care provider
may recommend a blood test to see whether
you are getting the right amount of medicine
in your body.
There are many things that can be done if
the medicine is not working. These are:
Adjust the dose.
Change the medicine.
Add a medicine.
Continuation treatment. Once you are feeling better for awhile, you and your health care provider will decide if this episode of depression has ended. In most cases, you should continue to take the antidepressant medicine for several months. Research clearly shows that continuation treatment with medicine helps prevent a relapse (a return) of the depressive episode.
After 4 to 9 months of continuation treatment, if you continue to feel good, you have recovered from this episode of depression. If you have had only a single episode of depression, continuation treatment can be stopped with a good chance that you will remain well. Nearly all patients who are on continuation treatment will stay well during that time.
Maintenance treatment. Some people with depression need maintenance (long-term) treatment. If you have had at least three episodes of depression or if you have bipolar disorder, you will need maintenance treatment to stay well. Research clearly shows that maintenance treatment with
medicine prevents a new episode of
depression. Some antidepressant medicines
have been used by patients for 30 or more
years with no bad effects.
Before starting maintenance treatment, you
and your health care provider should discuss
its costs and benefits.
The aim of acute treatment with
psychotherapy alone is to remove all
symptoms of depression and return you to
your normal life. In psychotherapy, you work
with a qualified health care provider
(therapist) who listens, talks, and helps you
solve your problems. Psychotherapy is
usually brief and often has a time limit (for
example, 8 to 20 visits).
Types of Psychotherapy Psychotherapy can be individual (only you and a therapist); it can be group therapy (with a therapist, you, and other people with similar problems); or it can be family or marriage therapy (with a therapist, you, and family members, loved ones, or spouse).
Your health care provider will help you decide if psychotherapy is the right treatment for your depression.
Three psychotherapies have been most well studied for their effectiveness in reducing symptoms of major depressive disorder. They are:
Behavioral therapy--focuses on current behaviors.
Cognitive therapy--focuses on thoughts and beliefs.
Interpersonal therapy--focuses on current relationships.
Psychotherapy alone is not recommended as
the only treatment for severe depression or
for bipolar (manic-depressive) disorder.
Medicine is needed for these types of
If you choose psychotherapy you need to:
Keep your appointments.
Be honest and open.
Try to do the tasks if assigned to you as
part of your therapy.
Tell your health care provider how the treatment is working.
The cognitive, behavioral, and interpersonal therapies usually work gradually. Although psychotherapy may begin to work right away, for some people it may take 8 to 10 weeks to show a full effect. More than half of the patients with mild to moderate forms of major depression respond well to psychotherapy.
As with medicine, it is important to remember that people can react differently to similar treatments. While many people find psychotherapy effective, others do not. This usually means that another treatment is needed.
If you do not feel any better at all after 6 weeks, or if you are not completely well by 12 weeks. talk to your health care provider about other treatments.
Continuation psychotherapy. If your depression gets better with psychotherapy. you and your health care provider can decide if your therapy should continue and for how long.
Maintenance psychotherapy. In general, maintenance (long-term) psychotherapy by itself is not recommended unless there are reasons. such as pregnancy or severe side effects, that keep you from taking medicine. While maintenance psychotherapy does not prevent another episode of depression, some research suggests that it can delay a recurrence.
Combining Medicine and Psychotherapy
In combined treatment, medicine is used to
treat the symptoms of depression, and
psychotherapy is used to help with
which depression causes problems in your
life. Some people find that combining
treatment is very helpful. With combined
treatment, more than half of the patients
feel better after 6 to 8 weeks. Combined
treatment may be most helpful for longer
lasting depression, for those with symptoms
between episodes, or for those who do not
respond fully to medication or
Most depressions, even severe depressions, can be treated completely with medicine, psychotherapy, or the combination of both. Electroconvulsive therapy (ECT) works to remove the symptoms of depression. It is mostly used for severely depressed patients who have not responded to antidepressant medicines. It can also be used for patients who are severely depressed and have other severe general medical illnesses. ECT is much safer than in years past. General anesthesia and special muscle relaxing medicines are used to prevent physical harm and pain during the ECT. The choice of ECT as a treatment and the possible side
effects should be discussed with a psychiatrist. As with other treatments, the psychiatrist will monitor the ECT treatment and check for side effects.
In light therapy, a special kind of light called broad-spectrum light is used to give people the effect of having a few extra hours of daylight each day. Specially made light boxes or light visors are used to provide this light. Light therapy may help peopIe who have mild or moderate seasonal depression. This treatment should only be given by a specialist until it has been studied more thoroughly.
When you are depressed, it is important to:
Pace yourself. Do not expect to do all of the things you were able to do in the past. Set a schedule that is realistic for you.
Remember that negative thinking (blaming yourself. feeling hopeless, expecting failure, and other such thoughts) is part of a depression. As the depression lifts, the negative thinking will go away, too.
Avoid making major life decisions during a depression. If you must make a major decision about your life, ask your health care provider or someone you trust to help you.
Avoid drugs and alcohol. Research shows that drinking too much alcohol and use of drugs can cause or worsen a depression. It can also lower the effectiveness of antidepressant medicines or cause dangerous side effects.
Understand that it took time for the depression to develop and it will take time for it to go away.
There is some evidence in milder cases of depression that exercise can be a helpful addition to treatment.
You can get information about other ways to help yourself during treatment from the organizations listed on the inside front cover of this booklet. Your public library also has books about depression.
Benefits and Harms of Treatment
The treatments for major depressive disorder discussed in detail here are:
Antidepressant medicine combined with psychotherapy.
How well each of these treatments works depends on the type of depression, how severe the depression is, how long you have been depressed, how you as an individual may react to treatment. and other factors. The risks and benefits described below are based on current medical knowledge using studies of large numbers of depressed patients and expert opinion.
Talking to Others About Depression
When people have major depressive disorder, they often have difficulty at work, school, and with family members. With treatment, almost everyone returns to their normal life.
Some jobs (where the safety of others is involved) require that you report treatment for medical illnesses (including depression ). You and your health care provider should talk about how and what to tell your supervisor, teacher, or friends.
Ask your friends for their support, understanding, and patience during your depression. It may be helpful to talk to your friends about your feelings and treatment and to spend time with friends in social activities. Keep the name and phone number of people that you can talk to and to ask to help you. Some people with depression find it difficult to be with others during this time. If you feel this way, do whatever lifts your mood and makes you reel better. If you find yourself alone and unable to be with others, tell your health care provider. Many people find that family members are very supportive and helpful. especially those who have received education about depression.
Parents often worry about whether depression is inherited. Most children of people with depression will not get this illness. Overall, research shows that only about 1 in 7 children with one parent who has had several episodes of major depressive disorder or bipolar disorder will develop major depressive disorder. Another 1 in 7 children with one parent who has bipolar disorder will develop bipolar disorder. If you have questions about your child's mental health talk to a health care provider.
In the depth of winter,
I finally learned that within me
there lay an invincible summer.
In addition to the organizations listed at the beginning of this article, the National Institute of Mental Health, has free publications about depression for persons of all ages, including teenagers and the elderly. Write:
Depression Awareness, Recognition, and
Treatment (DART) Program
Department GL, Room 10-85
5600 Fishers Lane
Rockville, MD 20857
Toll free: 800-421-4211
The information contained here was taken from the Clinical Practice Guideline on Depression in Primary Care, Volumes I and 2. The guideline was developed by a private, non-Federal expert panel of physicians, psychologists, psychiatrists, social workers, nurses, counselors, and persons who have depression. The development of the guideline was sponsored by the Agency for Health Care Policy and Research (AHCPR), an agency of the U.S. Public Health Service. Other guidelines on common health problems are being developed and will be released in the near future.
To receive additional copies of this article or the depression guidelines call:
Toll free: 800-358-9295 or write:
AHCPR Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907