Depression is characterized by at least two consecutive weeks of a depressed mood or a markedly reduced interest in previously enjoyed activities. Other symptoms include poor appetite, sleeplessness, and poor concentration Table 02Table 03.
Depression often involves a sense of overwhelming sadness. Sometimes a depressed person may instead experience a profound loss of interest and pleasure in normal activities such as eating, sex, work, hobbies, and being with family and friends. Other typical symptoms include changes in basic body functions such as appetite (with accompanying weight loss or gain) and sleep patterns (either too much sleep or insomnia, often with early morning wakening). Depressed people may feel restless, irritable, or agitated. At the other extreme, some depressed individuals feel overwhelming fatigue. Depressed people often feel worthless, hopeless, or excessively guilty. If untreated, depressive episodes commonly last from six months to two years.
Table 2. Common Emotional Symptoms of Depression
Sadness Feeling "down in the dumps," sad, or discouraged. Feeling "blah" or anxious, or having no feelings. Apathy (loss of interest or pleasure in usual activities) Decreased interest in hobbies, "not caring anymore," or not enjoying activities that were previously enjoyable to the person. Anxiety (feeling apprehensive or uneasy for no reason) Continual tension, apprehension, or foreboding (feeling that ?something bad? is going to happen). Inappropriate guilt Feeling that "it is their fault" that they are depressed, and that they would feel better if they tried harder. Guilty feelings have been reported by 75% of depressed patients. Shame (worthlessness and loss of self-esteem) From feelings of inadequacy to a completely unrealistic negative self-image. Loss of confidence in the ability to perform well at work or school. Hopelessness or despair (inability to see a brighter future) Thoughts that no one and nothing can help now or is likely to help in the future. Suicidal feelings or attempts Recurrent suicidal thoughts occur in up to 40% of depressed patients. Specific plans to commit suicide occur in many depressed patients, particularly the severely ill. Successful suicide attempts occur in about 4%-15% of severely depressed patients. Other symptoms Tearfulness (crying spells), irritability, excessive concern with physical health, panic attacks, and phobias.
Depression can cause physical symptoms.
Many people who are diagnosed with depression complain to their clinician of vague physical symptoms rather than sadness or depression. This is especially common in the elderly population.
The most common physical symptoms of depression include fatigue, unexplained pain, cramping, bloating, heartburn, and headache. Other possible physical symptoms related to depression include heart palpitations, premenstrual syndrome, dizziness, or numbness.
Table 3. Other Common Symptoms of Depression
Pain (vague aches and pains) Muscle aches, backaches, and headaches. Changes in appetite or weight A loss of or increase in appetite. Unintentional weight gain or loss. Problems with sleep Difficulty falling asleep. Waking up and then having trouble returning to sleep. Waking up too early in the morning. Oversleeping. Sleeping for longer than usual. Excessive daytime sleepiness. Fatigue (loss of energy, general tiredness) Decreased energy, tiredness, and fatigue. Difficulty completing tasks, reduced efficiency, and impaired performance at school or work. Gastrointestinal (abdominal) complaints Cramping, bloating, or heartburn. Constipation or diarrhea. Agitation or retardation of actions or movement Agitation: the inability to sit still; pacing; hand-wringing; or pulling or rubbing the hair, skin, clothing, or other objects. Retardation: slowed speech and thinking, long pauses before speaking, slowed body movements, and/or soft, scant speech. Change in desire for or ability to have sex Diminished interest in sex. In men, the inability to ejaculate, difficulty with erection, or even total impotence. In women, a loss of sexual interest or orgasm. Other physical symptoms Menstrual cycle disturbances, generalized itching, dry mouth, dizziness, numbness, palpitations, or blurred vision. Changes in thinking (slowed thinking, indecisiveness) Slowness or difficulty thinking, often accompanied by a shortage of ideas. Indecisiveness and lack of confidence. Changes in concentration Difficulty concentrating. Difficulty staying focused on tasks or activities. Poor memory Decreased ability to remember things.
Depressed people may consider suicide Table 04[
Depressed people often have recurrent thoughts of death. These thoughts may include contemplating taking one's own life (suicide). Suicidal thoughts may or may not include a specific plan to carry it out.
It is important for the depressed person to know that their feelings of hopelessness and lack of self-worth are a result of their illness. If you are thinking of harming yourself or know someone who is thinking of harming themselves, it is important to get help right away. Call a trusted clinician, or if danger is imminent, call 9-1-1. More information is available from a variety of local sources or by calling 1-800-SUICIDE Table 04[
Table 4. Risk Factors and Signs of Suicide Risk
History of suicide attempt(s) History of psychiatric illness Alcoholism or substance abuse Psychotic symptoms (especially hallucinations, severe anxiety, panic attacks, or severe insomnia) Previous history of suicide in the family (especially parents) Living alone/social isolation Unemployment Physical illness (especially chronic pain or terminal illness) Increased age (peak risk in men is at age 75; in women it is at age 55 to 65) Gender (females make more suicide attempts, but males are 4 times more likely to die from suicide) Marital status (widowed, divorced, separated, married without children, and never married individuals are at greater risk) Communication to family, friends, or clinician of intent to harm self, financial plans after death, or specific means of suicide Giving away valued possessions
Those who have family members with mood disorders have an increased risk for depression Table 05.
Although the genetic pattern cannot be precisely determined, depression runs in families. Those who have family members with a history of depression are more likely to suffer from depression than people from families with no history of depression Table 05.
Some people are prone to depression during the winter months.
Seasonal affective disorder (SAD) is a type of depression that occurs during the winter months when hours of daylight are reduced. SAD occurs more often among populations living in more extreme latitudes (where there are unusual fluctuations in hours of sunlight throughout the year) than among other populations. People suffering from SAD typically experience extreme fatigue, sleep excessively, have sugar cravings, and gain weight.
Many people become depressed after a heart attack or after being diagnosed with a chronic illness or cancer.
Some people with serious illness become depressed. It is often difficult, however, to determine whether depression is caused by physical changes related to the illness, or if depression is a reaction to an altered lifestyle and concern about one's health. Whatever the cause, depression should be treated along with the accompanying illness.
People who abuse alcohol or illegal drugs are at high risk for depression.
It's often hard to know if a drug or alcohol problem causes depression, or if people turn to abuse of these substances in an attempt to alleviate depression. Treatment for depression should be a part of drug- and alcohol-addiction recovery efforts.
Age can be a risk factor for depression.
Most people experience their first depressive episode in their mid-20s, with most cases overall occurring between ages 25 and 44. However, in recent years there has been a growing number of cases of depression reported in people under the age of 20.
Table 5. Major Risk Factors for Depression
Prior episode(s) of depression Fifty percent to 85% of persons who experience one episode of depression will eventually have another episode. Family history of depressive disorder Major depressive disorders are 1.5 to 3 times more common among close biologic relatives of depressed patients than among the general population. Prior suicide attempts Suicide attempts are frequently associated with depression and other mood disorders. Female gender Depressive disorders are about twice as common in women as men. Women are particularly prone to depression before each menstrual period, immediately after childbirth, and at menopause. Some women become depressed when they use oral contraceptives. Age 25 to 44 years The average age of the first episode of depression is the mid-20s. Depression occurs most often between ages 25 and 44 years. Older age Depression is not a ?normal? part of aging. However, the elderly may be more prone to depression because of life stressors (loss of a loved one or loss of independence). Increased isolation may also make depression more likely in the elderly population. The elderly often take medications that can have depressive side effects. Postpartum period Twelve percent to 16% of women and up to 26% of adolescent girls have a major depressive episode following the birth of a baby. Postpartum depression usually starts within 1-3 months after giving birth. Lack of social support Depression occurs more often in individuals who are socially isolated or have no close interpersonal relationships. Being divorced or separated may also increase the risk of having depression. Current alcohol or substance abuse Alcohol and substance abuse may cause depression or may occur as a result of depression. Stressful life events Episodes of depression often follow severe emotional stress (e.g., following the death of a loved one, divorce, or job loss). However, depression commonly occurs without being triggered by a stressful life event. Chronic, debilitating medical condition Chronic pain (backache, headache), two or more chronic diseases, or obesity may contribute to depression. Central nervous system (CNS) disorder Up to 50% of older persons with Parkinson's or Alzheimer's disease develop a depressive disorder. Their caretakers are also at increased risk for depression.
- Alcohol and AntidepressantsThe dos and don'ts of drinking when you take antidepressants are mostly don'ts.
- Antidepressant Treatment TimelineYou can expect to feel some relief from depression symptoms as early as the first week, but the full response could take months.
- Medications to Avoid While on AntidepressantsCould your antidepressant interact with something else you're taking?