Pepa Plisek/ShutterstockDepression is more than just the result of a chemical imbalance in the brain—there are a lot of surprising mysteries about the brain. According to the National Institutes of Health, depression is most likely the result of a combination of biological, genetic, psychological, and social factors. "We don't really know what causes depression," says Victor Schwartz, MD, chief medical officer for the JED Foundation, a nonprofit that works to protect emotional health and prevent suicide for teens and young adults. For many people, the episodes can be precipitated by a loss or a life change that is disturbing, he says, while others have internally driven episodes that come out of the blue. Certain medical conditions such as an under-active thyroid, cancer, and heart disease can trigger depression, as can hormonal imbalances that happen after childbirth and at menopause. "Medications (such as sedatives, sleeping pills, and high blood pressure medication) and substance abuse can also precipitate symptoms of depression," says Dr. Schwartz.
OTOBOR/ShutterstockDepression comes in many forms, but the most prominently diagnosed form and the one that most often requires medication is major depressive disorder (MDD), also known as clinical depression. According to the American Anxiety and Depression Association of America, MDD affects more than 6 percent of adults in the United States (16 million people) and is the leading cause of disability in the United States in the 15 to 44 age group. "Diagnosing depression is not easy," says Peter Economou, PhD, cognitive behavioral therapy specialist and director at the Counseling and Wellness Center based in New York and New Jersey. "It's not like a strep test—there is no positive or negative result with mental health because there are an infinite number of variables that can contribute to depression." To diagnose clinical depression, many doctors use the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Patients have to exhibit five or more of the listed symptoms over a two-week period to be diagnosed.
An overwhelming feeling of sadness
Yuriy Seleznev/ShutterstockFeeling sad is an emotion that is part of everyday life, but when sadness won't lift for more than two weeks, turns to feelings of emptiness and hopelessness, or if others start to recognize and comment on the severity of your sadness, then it may be time to seek professional help for depression medication. Check out how to determine the difference between depression and everyday sadness. A good rule of thumb says Dr. Schwartz is to recognize if the sadness feels different from the way you typically experience it. Signs that things are worsening can include substance or alcohol abuse, trouble in your relationships, or not being able to get up and go to work. "The reality is, if the sadness is interfering with the way a person lives their life, it may call for medication."
Diminished interest or pleasure in activities
MentlaStore/ShutterstockAlong with feelings of sadness, a loss of interest in previously rewarding or enjoyable activities, also known as anhedonia, is one of two required symptoms for a diagnosis of major depressive disorder. Recent reports estimate that approximately 37 percent of individuals diagnosed with MDD experience clinically significant anhedonia. The two main types of anhedonia are social (lack of pleasure in social situations) and physical (inability to enjoy tactile pleasures such as food or touching). (Here are 10 ways to beat social anxiety, by the way.) While there is no cure for anhedonia, psychotherapy can help, followed by medication.
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Significant weight changes
NinaMalyna/ShutterstockOne of the most common symptoms of major depressive disorder is a change in appetite. While some people lose weight because they feel nauseous or lack the interest and energy for cooking and eating, others turn to food for comfort and overeat. Numerous studies show that depression is linked to obesity and vice versa—those who are obese are more likely to be depressed. Along with weight gain, weight loss is associated with depression and one study links dieting to an increase in depression. While antidepressants are often prescribed for those with MDD, some of them come with weight gain as a side effect—in fact, here are six common medications linked to weight gain. Exercise, which can activate chemicals in your brain to impact mood, is also often recommended to help treat depression. "What we see in the research is that exercise is the most effective treatment for mild and moderate depression when compared to medication," says Dr. Economou.
Insomnia or hypersomnia
F8 studio/ShutterstockSleep disturbance is a core symptom of clinical depression—here are other warning signs of depression to be aware of. According to research, about 75 percent of depressed patients have symptoms of insomnia, and hypersomnia (excessive sleepiness) affects nearly half of depressed adults. A lot of people have sleep problems because they feel edgy and uneasy about life—this is a functional impairment, says Dr. Schwartz. If the feelings persist and get in the way of being productive, they interfere with life, he says. Not getting enough sleep can cause distress and increase the risk for suicide. "About 95 percent of my patients—whether they have depression or not—have sleep problems," says Dr. Economou. Along with sleep aids and depression medication, these tips from the Centers for Disease Control are recommended for those suffering from insomnia. "Often people begin to negatively relate to sleep and condition themselves to dread going to bed," says Dr. Economou. At certain levels, sleep aids and other medication are helpful as research shows that sleep deprivation can lead to psychosis.
Jovan Gojkovic/ShutterstockIt's normal for everyday stresses to cause feelings of restlessness, agitation, and annoyance. But when the feelings happen for no specific reason and are persistent, you may need to see a doctor. Stop to think about how much these feelings are interfering with your ability to work and relate to others, says Dr. Schwartz. "Are these feelings disturbing sleep or concentration?" Agitation is often associated with clinical depression; when it's severe, you may be diagnosed with agitated depression. If you can't shake a constant sense of restlessness or irritation, Dr. Schwartz recommends starting with a type of targeted counseling called cognitive behavioral therapy. "For those who have more severe symptoms, or severe persistent anxiety, antidepressants are the treatment of choice." Check out these depression facts psychologists wish people knew.
Fatigue or loss of energy
akachai/ShutterstockFatigue is the most common symptom of depression. One study suggests that more than 90 percent of patients with MDD had severe fatigue despite the fact that eight out of 10 were taking antidepressants. Fatigue can detract from your performance at school or work, and it can interfere with your relationships with friends and family. While fatigue is a symptom of MDD, it can also be a side effect of depression medication used to treat MDD. Be sure to be aware of these everyday habits that up your risk for depression.
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Feelings of worthlessness
Roman Kosolapov/ShutterstockWhen people are depressed, they're the opposite of optimistic. While it's possible to improve your outlook—check the 10 things inherently optimistic people do every day—if you're battling depression you lose hope, says Dr. Economou, and that can lead to feelings of worthlessness. "The cause for these feelings could be the result of a life event, but what I see the most is that the feeling is the result of chronic exposure to stress," he says. After exploring the patient's past, says Dr. Economou, he often finds the patient didn't always battle self-doubt. "The feelings creep up on them over time and then become overwhelming—it begins to affect their lives and it becomes a stigma." While many people believe they can get through the loss of confidence on their own, many times it is too late, explains Dr. Economou. Treatment starts with therapy, but people often need depression medication to work regain a sense of worth. "In therapy, we raise awareness for the negative thoughts so they can be diffused."
Difficulty concentrating or indecisiveness
Liderina/ShutterstockA loss of confidence can make decisions difficult: If you don't trust yourself, how can you choose the right option? And continually battling self-doubt will also interfere with your concentration, according to Dr. Economu. If you really need to regain your focus, you could try these tricks designed to improve concentration in just 24 hours. If your inability to concentrate is due to depression—and statistics show that depression is now the leading cause of global mental and physical disability—your best option getting back on track is through a combination of psychotherapy and antidepressant medication, research shows.
Thoughts of death or suicidal intentions
DavidTB/Shutterstock"It is fine to say 'I'm having a bad day' or a bad few days, but if your thoughts are interfering with function, or you are having thoughts that life is not worth living or that you can't go on, you need to get professional help," says Dr. Schwartz. According to the Jed Foundation, people who struggle with depressive disorders are at increased risk of having suicidal thoughts or impulses for suicide, and an estimated 2 to 15 percent of people who have major depression die by suicide. Some common signs of suicidal thoughts and behavior include talking about ending one's life, withdrawal, changes in substance abuse, expression of guilt, and giving away personal possessions. People who are in a state of distress should reach out for help by seeing their primary care doctor or visiting various websites such as the American Foundation for Suicide Prevention. "The National Suicide Prevention Life Line is not just for people who are in a suicidal crisis, it can help them find a mental health professional," says Dr. Schwartz.
Zoran Temelkov/ShutterstockWhen people start hallucinating (seeing or hearing things) or become delusional, they're diagnosis could be psychotic depression, a combination of depression and psychosis. Psychotic depression is the severe end of the depression spectrum, says Dr. Schwartz. "People with this condition are at a fairly high risk of suicide or of doing something harmful because they are driven by delusion—they need to be treated with antidepressant and anti-psycotic medications." Read about what it's like to have schizophrenia.
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Kristina Vykhor/ShutterstockMake sure you're exercising and eating well—here are some natural ways to alleviate depression. The use of depression medication has increased dramatically over the years. According to a survey from the Centers for Disease Control, about one in nine Americans reported taking at least one antidepressant medication in the past month. Thirty years ago, fewer than one in 50 people did so. The drugs have changed—and improved over that time, says Dr. Schwartz: The first class of antidepressants to be developed, MAOIs (monoamine oxidase inhibitors) fell out of favor due to concerns about interactions with certain foods and other medications. Today, SSRIs (selective serotonin re-uptake inhibitors) are the most commonly prescribed type of antidepressants, followed by SNRIs (serotonin and norepinephrine re-uptake inhibitors). The new classes of drugs have more tolerable side effects than MAOIs and are often used to treat conditions other than depression, such as anxiety, sleep disorders, pain, premenstrual syndrome, and smoking cessation. One of the drawbacks of medication is that it may take weeks or months for the effects of the effects to kick in, but scientists are on the road to making anti-depressents work faster—here's how. If the drug you try doesn't relieve your symptoms or causes side effects, you may need to try another to find the right one for your condition.