Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living. More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment.

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When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

• Call Simcoe County Crisis Response Services at  (705)-728-5044 or 1-888-893-8333

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Symptoms:

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

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Causes:

It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

• Brain chemistry. 

  • Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. 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. 

• 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 this condition. Researchers are trying to find genes that may be involved in causing depression.

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Risk Factors:

Factors that seem to increase the risk of developing or triggering depression include:

• Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic

• Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems

• Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide

• Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation

• History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder

• Abuse of alcohol or recreational drugs

• Serious or chronic illness, including cancer, stroke, chronic pain or heart disease

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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.

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Lifestyle Management: 

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

• Massage therapy

• Music or art therapy

• Spirituality

• Aerobic exercise

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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

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Medications:

Many types of antidepressants are available, including those below. 

• Selective serotonin reuptake inhibitors (SSRIs). 

• Serotonin-norepinephrine reuptake inhibitors (SNRIs). 

• Atypical antidepressants. These medications don't fit neatly into any of the other antidepressant categories. 

• Tricyclic antidepressants. 

• Monoamine oxidase inhibitors (MAOIs). 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 - combining two antidepressants or adding medications such as mood stabilizers or antipsychotics. 

 

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.

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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. (meds that are safe in pregnancy - zoloft, escitalopram)

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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.

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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.