an illness that causes you to feel sad, lose interest in activities that
you’ve always enjoyed, withdraw from others, and have little energy. It’s
different from normal feelings of sadness, grief, or low energy. Depression can also cause people
to feel hopeless about the future and even think about suicide.
Many people, and sometimes their families, feel embarrassed or ashamed
about having depression. Don’t let these feelings stand in the way of getting
treatment. Remember that depression is a common illness. It affects the
young and old, men and women, all ethnic groups, and all professions.
If you think you may be depressed, tell your doctor. Treatment can help
you enjoy life again. The sooner you get treatment, the sooner you will feel
What causes depression?
Depression is a disease.
It’s not caused by personal weakness and is not a character flaw. When you have
depression, there may be problems with activity levels in certain parts of your brain, or chemicals in your brain called neurotransmitters may be out of balance.
Most experts believe that a combination of family history (your
genes) and stressful life events may cause depression.
Life events can include a death in the family or having a long-term health problem.
Just because you have a family member with depression or
have stressful life events doesn’t mean you’ll get depression.
You also may get depressed even if there is no reason you can think of.
What are the symptoms?
The symptoms of depression
may be hard to notice at first. They vary among people, and you may confuse
them with just feeling “off” or with another health problem.
two most common symptoms of depression are:
Feeling sad or hopeless nearly every day for
at least 2 weeks.
Losing interest in or not getting pleasure from
most daily activities that you used to enjoy, and feeling this way nearly every day for at least 2 weeks.
A serious symptom of depression is thinking about death
or suicide. If you or someone you care about talks about this or about feeling
hopeless, get help right away.
If you think
you may have depression, take a short quiz to check your symptoms:
Depression can be treated in
various ways. Counseling, psychotherapy, and antidepressant medicines can all be used. Lifestyle changes, such as getting more exercise, also may help.
your health care team to find the best treatment for you. It may take a few
tries, and it can take several weeks for the medicine and therapy to start working. Try to
be patient and keep following your treatment plan.
return (relapse). How likely you are to get depression again
increases each time you have a bout of depression.
Taking your medicines and continuing some types of therapy after you feel
better can help keep that from happening. Some people need to take medicine for
the rest of their lives. This doesn’t stop them from living full and happy
What can you do if a loved one has depression?
someone you care for is depressed, the best thing you can do is help the person
get or stay in treatment. Learn about the disease. Talk to the person, and
gently encourage him or her to do things and see people. Don’t get upset with
the person. The behavior you see is the disease, not the person.
Depression is a disease. It isn’t caused by personal
weakness, and it isn’t a character flaw. When you have depression, there may be problems with activity levels in certain parts of your brain, or chemicals in
your brain called neurotransmitters may be out of balance.
Most experts believe that a combination of family history (your
genes) and stressful life events may cause depression.
Genes: Your chance of having a bout of
depression is greater if other family members have had depression. You may have
inherited a trait that makes you more likely to get depressed. If this is true
for you, a stressful life event is more likely to trigger depression.
Thinking styles: How you think can affect how you feel. You may be more likely to become depressed if you tend to:
Think in extremes. For example, thinking, “If I can’t do something perfectly, I might as well quit.”
Concentrate on your weaknesses and ignore your strengths.
Take things personally that have little or nothing to do with you. For example, if your boss has a stern look on his or her face, you think “My boss must be mad at me, because he (or she) is not smiling.”
Pay attention to the dark side of things, or exaggerate the chances of a bad outcome. For example, thinking “If I make a mistake, I will be fired from my job.”
Life events: Stressful life events can trigger depression. For
example, you could become depressed if you have:
Been diagnosed with a long-term disease such as
Sometimes even happy life events, such as a marriage or
promotion, can trigger depression because of the stress that comes with
Just because you have a family member with depression or
have stressful life events doesn’t mean you’ll get depression. You also may get
depression without going through a stressful event.
Most health problems do not cause depression. But some such as anemia or an underactive thyroid gland (hypothyroidism) can make you tired, which may seem like depression. Treating the
health problem usually cures the fatigue. And sometimes health problems can make depression worse.
such as steroids or opioids, can cause depression. If you stop using the
medicine, the depression may go away.
The symptoms of
depression may be hard to notice at first. They can be
different from person to person. You may confuse them with just feeling
“off” or “down.” You also may confuse the symptoms with another health
The two most common symptoms of depression are:
Feeling sad, empty, or tearful nearly every
Losing interest in or not getting pleasure from most daily
activities that you used to enjoy, and feeling this way nearly every day.
If you have felt this way for at least two weeks, it is possible you are experiencing depression.
A serious symptom of depression is thinking about death and
suicide. If you or someone you care about talks about suicide or feeling
hopeless, get help right away.
You also may:
Lose or gain weight. You may also feel like eating more or less
than usual almost every day.
Sleep too much or not enough almost every day.
Feel restless and not be able to sit still, or you may sit
quietly and feel that moving takes great effort. Others can easily see this
Feel tired or as if you have no energy almost every day.
Feel unworthy or guilty nearly every day. You may have low self-esteem and worry that people don’t like you.
Find it hard to focus, remember things, or make decisions nearly
every day. You may feel anxious or worried about things.
to have periods of both energy and elation (mania) and
depression. This may be bipolar disorder. If this happens to you, tell your
doctor. The treatments for depression and bipolar disorder are different.
Symptoms can vary
Symptoms can be mild, moderate,
In mild depression, you have few symptoms.
In moderate depression, you have more symptoms, and they are
beginning to change your life.
In severe depression, the symptoms change your life and affect
your job or career and your relationships.
Depression can affect your physical health. You may have
headaches or other aches and pains or have digestive problems such as
constipation or diarrhea. You may have trouble having sex or may lose interest
in it. If you notice any of these changes, talk to your doctor. He or she may
be able to help.
One Woman’s Story:
“I woke up every day with
suicide on my mind, and I went to bed with suicide on my mind.”-Martha
some people, a bout of depression begins with symptoms of anxiety (such as worrying a lot), sadness, or lack of
energy. This may go on for days or months before the person or others think that depression could be the problem.
And other people may feel depressed suddenly. This may happen after
a big change in life, such as the loss of a loved one or a serious accident.
How long does depression last?
If you don’t get
treated, depression may last from months to a year or longer.
A small number of
people feel depressed for most of their lives and always need treatment.
Depression can return, which is called a
relapse. At least half of the people who have
depression once get it again.footnote 1 How likely you are to
get depression again increases each time you have a bout of depression. You can make having another bout of depression less likely by
following your treatment plan and using your medicines.
Depression and other health concerns
linked with many health concerns. These include other diseases, drug or alcohol
use, and pregnancy. If you have depression and another health
concern, you need to deal with both of them.
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), or other emergency services right away if:
You or someone you know is thinking seriously of committing suicide or has recently tried to commit suicide. Serious signs include these thoughts:
You have decided on how to kill yourself, such as with a weapon or medicines.
You have set a time and place to do it.
You think there is no other way to solve the problem or end the pain.
You feel you cannot stop from hurting yourself or someone else.
Call a doctor right away if:
You hear voices.
You have been thinking about death or suicide a lot, but you do not have a plan to commit suicide.
You are worried that your feelings of depression or thoughts of suicide are not going away.
Seek care soon if:
You have symptoms of depression, such as:
Feeling sad or hopeless.
Not enjoying anything.
Having trouble with sleep.
Feeling guilty or worthless.
Feeling anxious or worried.
You have been treated for depression for more than 3 weeks, but you are not getting better.
If you have not been diagnosed with depression but you think you may be depressed, use the Feeling Depressed topic to check your symptoms.
Who to see
Your family doctor can help you with depression. If treatment by your doctor doesn’t help you, the
next step is to see a mental health professional.
No matter who you
see, it is important that this person has experience treating people who have
depression and is trained in proven therapies. It is also important that you
establish a good long-term relationship. If you don’t feel comfortable with one
doctor or therapist, try another one.
Health professionals who can
diagnose depression and prescribe medicine include:
be diagnosed when you talk to your doctor about feeling sad or when your doctor
asks you questions and discovers that you are feeling sad. You may be seeing
your doctor because you feel sad or because you have another health problem or
If your doctor thinks you are depressed, he or she will
ask you questions about your health and feelings. This is called a mental health assessment. Your doctor also may:
Treatment for depression includes counseling, medicines, and lifestyle changes. Your treatment will depend on you and your symptoms. You and your health care team will work together to find the best treatment for you.
If you are using medicine,
your doctor may have you try different medicines or a combination of medicines.
You may need to go to the hospital if you show warning signs of suicide, such as having thoughts
about harming yourself or another person, not being able to tell the difference
between what is real and what is not (psychosis), or
using a lot of alcohol or drugs.
If you don’t get treated, depression may last from months
to a year or longer. A small number of people feel depressed for most of their
lives and always need treatment.
If you need help
deciding whether to talk to your doctor about depression, see some common reasons people don’t get help and how to overcome them.
Little is known about how to prevent depression, but getting exercise and avoiding alcohol and drugs may help. Exercise may also help prevent depression from coming back
(relapse) and may improve symptoms of mild depression.
You also may be able to prevent depression by
avoiding alcohol and drugs. Alcohol and drugs can contribute to depression. And using
them can be a sign that you have depression.
Preventing depression from coming back
You may be
able to prevent a relapse or keep your symptoms from getting worse if
Take your medicine as prescribed. Depression often returns if
you stop taking your medicine or don’t take it as your doctor advises.
Continue to take your medicine after your symptoms improve.
Taking your medicine for at least 6 months after you feel better can help keep
you from getting depressed again. If this isn’t the first time you have been
depressed, your doctor may want you to take medicine even longer. You may
benefit from long-term treatment with antidepressants.
Continue cognitive-behavioral therapy after your symptoms
improve. Research shows that people who were treated with this type of therapy had less
chance of relapse than those who were treated only with antidepressants.footnote 2
psychotherapy are important parts of treatment for
depression. You will work with a mental health
professional such as a psychologist, licensed professional counselor, clinical
social worker, or psychiatrist. Together you will develop an action plan to
treat your depression.
When you hear “counseling” or “therapy,” you may think of lying on a
couch and talking about your childhood. But most of these treatments don’t
look for hidden memories. They deal with how you think about things and how you
act each day.
The first step is finding a therapist you trust and feel comfortable
with. The therapist also should have experience treating people who have
depression and should be trained in proven therapies. These therapies
Cognitive-behavioral therapy (CBT), which teaches you
how to change the ways you think and behave. This can help you stop thinking
bad thoughts about yourself and your life. You can take part in CBT with a
therapist or in a group setting.
Acceptance and commitment therapy (ACT).
In ACT, you work with a therapist to learn to accept your negative feelings but
not let them run your life. You learn to make choices and act based on your
personal values, not negative feelings.
Mindfulness-based therapies, such as Mindfulness-Based Stress Reduction or Mindfulness-Based Cognitive Therapy. These treatments help you to focus your attention on what is happening
at the moment without trying to change it. These strategies teach you to let go
of past regrets and not worry about the future. For people who have had more than one episode of depression, Mindfulness-Based Cognitive Therapy may help reduce the risk of relapse.
Other treatments you may have heard of include problem-solving therapy, which looks at your current
problems and helps you solve them, and family therapy, which brings you and your family
together to discuss your relationships and depression. Experts don’t know how
well these therapies work for depression.footnote 3 Problem-solving therapy may be especially helpful for older adults.footnote 6
One Woman’s Story:
“I walked into the
therapist’s office crying, mute. I felt as if no one heard me.”-Debbie
How long your treatment lasts depends on how severe your
depression is and how well you respond to treatment. Short-term counseling or
therapy usually lasts from 10 to 20 weeks, and you usually see your mental
health professional once a week. But you may need to meet with your health
professional more often or for a longer time.
Antidepressant medicines may improve or
completely relieve the symptoms of
depression. Whether you need to take medicine depends on your symptoms. You and your doctor can decide if you need medicine and which medicine is right for you.
Antidepressant medicines work in different ways. No
antidepressant works better than another, but different ones work better or
worse for different people. The side effects of antidepressant medicines are
different and may lead you to choose one instead of another.
may have to try different medicines or take more than one to help your
symptoms. Most people find a medicine that works within a few tries. Other
people take longer to find the right one and may need to take the
antidepressant and another type of medicine, such as an antiseizure, mood
stabilizer, antipsychotic, or antianxiety medicine.
and your doctor will decide if you need medicine, what things you’ll need to
think about if you need medicine, and which medicine is right for you.
have side effects. You may notice the side effects before you notice that the
medicine is helping you. Side effects vary depending on the medicine you
People who are taking medicines for other health problems
need to know about medicine interactions. Talk with your doctor about the best
way to track whether a combination of medicines is harming you. People who are
taking a lot of medicines also are more likely to have harmful side effects.
If you take
antidepressants, you should take them for at least 6 months after you begin to
feel better. This can help prevent you from feeling depressed again (relapse). If this isn’t the first time you have been
depressed, your doctor may want you to take these medicines even longer.
You may start to feel better within 1 to 3 weeks after starting your
antidepressant medicine. But it can take as many as 6 to 8 weeks to see a great
deal of improvement. If you have questions or concerns about your medicines, or
if you don’t notice that you feel better by 3 weeks, talk to your
Some people need to remain on medicine for several months
to years. Others will need medicine long-term. This is more likely if you have
had several bouts of depression that seriously affected your home life, work life, or both.
Don’t quit taking your medicines
without talking to your doctor. If you quit suddenly, it can cause your depression to return and it can cause dizziness,
anxiety, fatigue, and headache. If you and your doctor decide you can quit
using medicine, gradually reduce the dose over several weeks.
When you’re going through
depression, you can’t just shake it off. You might
have a couple of good days followed by a bad day or a string of bad days. And
you don’t know how long it will last. Depression isn’t like the flu or a
sprained ankle, where your doctor can tell you about how long it will take to
When you’re getting better, many experts call it
recovery. Recovery is finding your path to the life you
During your recovery, be patient and kind to yourself. Remember that
depression isn’t your fault and isn’t something you can overcome with
willpower alone. You need treatment for depression, just like for any other
Continuing your treatment, helping yourself, getting
support, and having a healthy lifestyle are all part of your recovery. Your
symptoms will fade as your treatment starts to work. Don’t give up. Focus your
energy on getting better. Your mood will improve. It just takes some
You can take many steps to help
yourself when you feel depressed or are waiting for your medicine to work.
These steps also help prevent depression from coming back.
Be realistic in what you expect and what you can do. Set goals you
can meet. If you have a big task to do, break it up into smaller steps you can
handle. Don’t take on more than you can handle.
yourself or others for your depression.
Think about putting off big decisions until your depression has
lifted. Wait a bit on making decisions about marriage, divorce, or jobs. Talk
it over with friends and loved ones who can help you look at the whole
Get support from others. Your family can help you get the right
treatment and deal with your symptoms. Social support and support groups give you the chance
to talk with people who are going through the same things you are.
Try to be part of religious, social, holiday, or other activities.
If you have any other health problems, like diabetes, heart
disease, or high blood pressure, continue with your treatment for them. Tell
your doctor about all of the medicines you take, with or without a
You also can help yourself by thinking about what is good in your
life. You can:
Help others who are not as well off as you
Thank people for the small and big things they do for you.
Be thankful for big things like having a home, family, and
Be thankful for little things like making people laugh,
enjoying a piece of music, or finding warm gloves for the winter.
One Woman’s Story:
“If you keep your thoughts in,
they will never be quiet. It helps my depression to express them.”-Cheryl
Other types of brain
stimulation have not been well studied and may be expensive. They usually are
considered only if other treatment doesn’t work. They include:
Deep brain stimulation. A device that uses electricity to
stimulate the brain is put in your head. It is used for Parkinson’s disease but
has not been well studied for depression.
Vagus nerve stimulation. A generator the size of a pocket watch
is placed in your chest. Wires go up from the generator to the vagus nerve in
your neck. The generator sends tiny electric shocks through the vagus nerve to
Transcranial magnetic stimulation. An electromagnet is placed
on your head. It sends magnetic pulses that stimulate your brain.
Complementary therapies are sometimes used for
depression. Always tell your doctor if you are using any of them. These therapies include:
If someone you care about is
depressed, you may feel helpless. Maybe you’re
watching a once-active or happy person slide into inactivity, or you’re seeing a
good friend lose interest in favorite activities. The change in your loved
one’s or friend’s behavior may be so big that you feel you no longer know him
Here are some things you can do to help:
Help the person get treatment or stay in treatment. This is the
best thing you can do.
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Butler R, et al. (2007). Depression in adults: Psychological treatments and care pathways, search date April 2006. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Khoury B, et al. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6): 763-771.
Powers MB, et al. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2): 73-80.
Arean P, et al. (2008). Effectiveness of problem-solving therapy for older, primary care patients with depression: Results from the IMPACT project. Gerontologist, 48(3): 311-323.
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ByHealthwise Staff Primary Medical ReviewerKathleen Romito, MD – Family Medicine E. Gregory Thompson, MD – Internal Medicine Specialist Medical ReviewerLisa S. Weinstock, MD – Psychiatry