Depression

Overview

People who feel sad over a period of time – weeks, months, or even years – may have a depressive disorder. When symptoms of depression interfere with your functioning at home or at work, you may isolate yourself from others. You may be unable to perform your daily activities, and depression may affect your ability to sleep, eat, and enjoy life. If any of these signs and symptoms are occurring, we recommend that you be screened for depression. 

Most people feel sad or down in the dumps from time to time. A good friend moves away, or a teen leaves for college, or you did not get a promotion you had hoped for, so you feel sad. If someone close to you dies, even a pet, you will grieve. These feelings usually pass, and you eventually feel better. However, if you are experiencing depression, these feelings may persist.

We have effective treatments for depression. Treatment can include medication or self-change strategies, or both. Most people who seek treatment for their depression will get better.

Depression is a serious condition, and it is very common. About 3 to 5 percent of men and 8 to 10 percent of women experience at least one episode of depression.

Anxiety disorders are also very common, and they can be related to depression. There are effective treatments for anxiety as well.

Symptoms

Symptoms of depression vary from person to person. Knowing how often you experience symptoms, for how long and how severely, can help us determine the best approach to treatment for you. The common symptoms of depression include the following:

  • Feeling sad or "blue" most of the time
  • Sleeping problems – either difficulty falling asleep or staying asleep, or sleeping too much
  • Difficulty concentrating
  • Eating problems – eating either too much or too little
  • Thoughts of suicide or attempts at suicide
  • Weight gain or loss without trying
  • Loss of interest in sex
  • Loss of interest in previously enjoyable activities
  • Withdrawal from friends, other people, or social events
  • Aches and pains, headaches, or digestive problems that do not get better with treatment

You may also suffer from other symptoms along with your depression. These include:

  • Feeling anxious
  • Being angry
  • Getting "stuck" on certain thoughts
  • Feelings of excessive guilt
  • Low energy
  • Feeling slowed down or more excitable than usual
  • Using alcohol or other drugs to manage symptoms 

Types

There are different types of depressive disorders that are categorized based on their symptoms, including the following:

Major depressive disorder is a severe form of depression in which you may experience symptoms nearly every day for at least 2 weeks. The symptoms can interfere with your ability to function at home and at work, to sleep, to eat, or to take interest or pleasure in your usual activities. You may have only one episode of major depression in your life, or you may have more than one episode.

Bipolar disorder (manic depression) is a severe disorder in which you experience more than one episode of an abnormally elevated mood called mania. These episodes may or may not alternate with episodes of depression or irritability. This disorder is treated with medicine prescribed by a psychiatrist and may also be managed using self-change strategies introduced by a therapist.

Peripartum or postpartum depression (PPD) is common in about 10 percent of mothers in the first year after giving birth. Changes in hormones cause "baby blues" – mood swings that can last a few hours to a few days and may occur on and off for several weeks. These symptoms are normal, but when they persist for more than several weeks, you may have postpartum depression (PPD). Postpartum depression can be very serious and may risk the health of both the mother and the baby. PPD can be diagnosed and treated. Counseling, support groups, and medications can effectively help relieve these symptoms.

Premenstrual dysphoric disorder (PMDD) or premenstrual syndrome (PMS) causes women to have mood changes in the weeks before their period. Common symptoms of PMS are bloating, muscle aches, food cravings, sleep problems, irritability, anxiety, and moodiness. If these symptoms disrupt your work, relationships with others, or sense of well-being, you have PMS. Some women with PMS have very severe symptoms that interfere with their daily functioning. This condition is called premenstrual dysphoric disorder. There are a number of treatments that can help with this condition.

Dysthymia is a chronic mild depression that can last 2 years or more. You may feel less spontaneous, find it difficult to enjoy your life, or feel that you are not functioning to your fullest. The symptoms are not as severe as the symptoms of major depression and usually do not interfere with your normal functioning at home or at work.

Seasonal affective disorder (SAD) is an episode of depression that occurs during the winter months when there is less natural sunlight and goes away when spring arrives with longer days and more natural light.

Adjustment disorder is a milder form of depression that occurs when your response to an identifiable stressor is more intense than what would be expected. Typical symptoms are sadness, tearfulness, or feelings of hopelessness, and may also include nervousness, worry, or jitteriness. This disorder is treated with problem-solving and self-change strategies.

Screening and Diagnosis

Tell us if you think you are suffering from depression. We may ask you questions about your symptoms, when they started, how they affect your daily life, and whether you have had these symptoms before. We may order blood and urine tests to make sure your depression is not caused by a physical problem. We will also discuss whether you have had any thoughts of harming yourself.

Often we use a screening questionnaire, the PHQ-9, to help us with this assessment. The PHQ-9 is a powerful tool that helps us diagnose depression and select and monitor treatment.

 

Causes

Although we do not know the exact cause of depression, we think it is most likely the result of genes, brain chemistry, environment, and negative thinking.

Genetic influence. Some types of depression occur more often in families where other family members have a depressive disorder. This suggests that genes play a part in depression. However, depression can also occur among people who have no family history of depression. Research studies are looking for the gene or genes that might contribute to depression in some people. 

Biochemical factors. An imbalance of specific brain chemicals (neurotransmitters) involved with mood is found in people with depression. Antidepressant medication, exercise, changes in the way you think, and other self-management strategies can help correct the chemical imbalance.

Environment. A stressful life event such as the death of a loved one, divorce, financial loss, or intimate partner violence or abuse can spark an episode of depression. Research studies have also looked at childhood abuse, witnessing of a violent act, difficult relationships, and family violence in association with depression. An episode of depression can also occur for no obvious reason.

Negative thinking habits. What you say to yourself about your experience can create and maintain depression. If you tend to interpret yourself and the world with unrealistic negativity, you might come to faulty conclusions that can lead to or worsen depression. Cognitive-behavioral therapy can help address these rigid thinking patterns.

Prevention

Just as with physical well-being, a healthy lifestyle is important in the maintenance of your emotional well-being. Developing an awareness of your personal stressors and your response to those stressors is one key to preventing depression.

Choose a healthy lifestyle. Exercise can prevent or improve mild to moderate episodes of depression. Choose an activity you enjoy and exercise for at least 30 minutes at least 3 times per week. Exercise raises your mood and is good for your general health.

Become more aware of your thoughts. When you are depressed, your thoughts become negative and distorted. Even when something good happens, you can only see the negative. Be aware of your negative thoughts and substitute positive ones. Choose reading material, music, and activities that help you challenge your negative thinking. Reward yourself in small ways (a special coffee or tea, a relaxing walk, a designated time to relax or browse in a bookstore) each time you successfully challenge your negative thinking.

Make necessary changes. Choose to be with people who are supportive and productive and can provide you with support and encouragement. Allow them to help you. Sometimes just being with people who care about you can help you feel better and avoid isolation, whether or not you talk about your depression with them. Healthy relationships are safe, respectful, and loving. While close relationships can be supportive, prolonged stress from a difficult relationship can increase your risk for depression. Consider taking a couples communication class or talking to a therapist or counselor if needed. If you are being hit, hurt, or threatened by your spouse or partner, this can lead to serious health problems. Contact me or call the National Domestic Violence Hotline at 1-800-799-7233 or go to ndvh.org

Develop and maintain hobbies and interests. Interests and creative outlets are useful ways of engaging in interpersonal activities. Hobbies and interests can also help you focus on increasing your self-esteem and decreasing negative thoughts about perceived problems.

Lifestyle Management

Although treatment of depression may require medication, there are steps you can take at home to manage your depression. And if you are taking medication, these self-management strategies will help the medication work better for you.

Exercise regularly. Regular activity can prevent or improve mild to moderate episodes of depression. Choose an activity you enjoy and exercise for at least 30 minutes at least 3 times a week. Exercise raises your mood and is good for your general health.

Challenge your negative thinking. When you are depressed, your thoughts become negative and distorted. Even when something good happens, you can only see the negative. Be aware of your negative thoughts and substitute positive ones.

Spend time with family and friends. They can give you support and encouragement. Let them help you. Friends and family can also encourage you to socialize and participate in activities that you might enjoy, such as a movie, sporting event, or board game.

Develop and maintain hobbies and interests. Interests and creative outlets are useful ways of engaging in interpersonal activities. Hobbies and interests may help you increase self-esteem. Some hobbies allow you to interact with others in a positive environment.

Remember to take your medications. It takes time for depression to improve. Even when you feel better, continue to pay attention to your mood. At the first sign that your depression may be returning, contact your physician or therapist. You can also ask friends or family to tell you if they notice a change in your mood or behavior.

 

Treatment

Depression is a very treatable condition. Mild to moderate depression responds well to regular cardiovascular exercise and other self-change strategies. If your depression is moderate or severe, we usually also recommend antidepressant medication, which can help restore chemical imbalances if they are present.

We may recommend that you attend a behavioral medicine class to learn more about how to successfully manage depression. If your depression is severe, we will refer you to the Psychiatry department for further evaluation and treatment.

Medications

We may prescribe an antidepressant medication based on your medical history, preference, whether you have had any prior reactions to a specific antidepressant, and potential side effects. We may prescribe antidepressants, as appropriate, that can include:

  • Selective serotonin reuptake inhibitors (SSRIs): Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), or Zoloft (sertraline)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): Effexor (venlafaxine)

Allow 2 to 6 weeks before you feel their full effect. It is important to continue to take your medication as prescribed.

In addition, we usually recommend that you continue to take the antidepressant for at least 6 months after your depression has improved. This helps you avoid a relapse.

Most people have no side effects when taking antidepressant medications, while some do experience side effects. If side effects occur, they usually disappear after the first few weeks. If they don't go away, or you want to stop taking your medication because of the side effects, talk to us first. Common side effects are:

  • Restlessness
  • Headache 
  • Diarrhea
  • Nausea
  • Insomnia
  • Weight gain
  • Sexual performance problems

In addition to medication, our mental health professionals can work with you to help you learn how to manage your depression. You can also find about classes and other resources at our facilities in your area.

Medications during pregnancy and breastfeeding

Many antidepressant medications can be used safely in pregnancy and while breastfeeding. If you are considering getting pregnant and are already taking an antidepressant, we can determine whether you should stay on this medication, switch to another medication, or stop your current therapy. Although there may be some risk to the baby associated with these medications, the risks are minimal and should be weighed against the risks of stopping treatment.


If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following:
(1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.