Depression in Adults

Dealing with Depression



About 10 percent of all Americans will suffer from depression at some
point in their lives. Depression can occur at any age and can cause great
pain for the people who have the condition and those who care about
People who are depressed can usually get better with treatment. But most
never seek help for their condition. Learning about the many treatment
options that are available can help you find a way to ease the pain if you or
someone you care about suffers from depression.
What is depression?
Everyone occasionally feels sad or blue, but these feelings are usually short-term
and pass within a couple of days. When a person is experiencing depression, the
condition interferes with daily life and normal functioning. Depression is a
serious illness, and most people who have it need treatment to get better.
Types of depression
There are several types of depression, which doctors call depressive disorders. The
two most common types are major depression and dysthymia:
•  Major depression is characterized by a combination of symptoms that interfere
with the ability to work, sleep, eat, and enjoy activities that used to be a pleasure.
This type of depression is disabling and keeps a person from functioning
normally. An episode of major depression may occur only once or twice, but it
can also recur throughout a lifetime. 
•  Dysthymia, a less-severe type of depression, involves long-term, chronic
symptoms that last for two years or more. The symptoms are not disabling, but
they keep a person from functioning at “full steam” or from feeling good.
Sometimes people with dysthymia also experience major depressive episodes. 
Some forms of depression have slightly different characteristics than these two or
may develop under unique circumstances. Not all researchers agree on how to
define these other forms of depression.
•  Psychotic depression occurs when severe depression is accompanied by a form of
psychosis, such as delusions, hallucinations, or a break with reality.
•  Postpartum depression is diagnosed when a new mother has a major depressive
episode within one month of giving birth.
Understanding the
symptoms of depression
and how to treat
• What is depression?
• Types of depression
• Symptoms of depression
• Causes of depression
• Treatment options
• Antidepressant
• Psychotherapy
• Helping yourself
• Where to get help 2  z  Depression 
•  Seasonal affective disorder (SAD) involves depression during the winter months,
when there is less sunlight. It generally eases in the spring and summer.
•  Bipolar disorder, also known as manic-depressive illness, causes severe mood swings -
- from extreme highs (mania) to extreme lows (depression).
Symptoms of depression
People who are depressed may not have all symptoms of the condition. Some
people experience a few symptoms, and some have many. Their frequency and
severity of the symptoms may vary from one person to the next.
Symptoms of depression include the following:
•  persistent sad, anxious, or “empty” moods
•  feelings of hopelessness or pessimism
•  feelings of guilt, worthlessness, or helplessness
•  loss of interest or pleasure in hobbies and once-enjoyable activities, including sex
•  sleeping difficulties, such as trouble falling asleep or staying asleep
•  eating too much or too little
•  fatigue, lack of energy, or feeling “slowed down”
•  thoughts of death or suicide, or suicide attempts
•  restlessness or irritability
•  difficulty concentrating, remembering, or making decisions
•  persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain
•  exaggerated sense of responsibility for events outside a person’s control
Causes of depression 
Depression has no single cause. It may result from a combination of genetic,
biochemical, environmental, and psychological factors.
•  Some types of depression run in families, suggesting a genetic link. But depression can
also occur in people with no family history of the disorder. 
•  Major depressive disorder is often associated with having too little or too much of certain
brain chemicals, known as neurochemicals.
•  Some stressful situations can trigger depression. Such situations include chronic
illness, financial problems, and relationship difficulties. But any unwelcome 3  z  Depression 
change in life activities can trigger a depressive episode -- a divorce, the loss of a
job, the death of a friend or family member, or a move to a new community. 
•  Psychological factors may play a role. Because some people survive very difficult
situations without becoming depressed, some researchers think a person’s overall
psychological makeup plays a role in ways that are not yet understood.
Treatment options
Most people with depression -- even those with the severe disorders -- can be
helped with treatment. The earlier treatment begins, the more effective it is and
the greater the chance that you can avoid a recurrence. Effective treatment
begins with visiting a doctor, who can rule out medical causes of the problem.
After evaluating your symptoms, a doctor may prescribe medication,
psychotherapy, or both.
•  Medication. A doctor may prescribe antidepressants or other medications that may
be helpful.
•  Psychotherapy or “talk therapy.” Psychotherapy is a form of treatment that can help
a person solve life issues, reduce feelings of anxiety and depression, improve
relationships and social skills, and even improve job performance. Research
shows that psychotherapy is effective in treating most common mental health
problems. For example, about 80 percent of people suffering from depression
make significant progress in psychotherapy.
Some people do best with medication and some with psychotherapy. Other
people need a combination of both. Another form of treatment, such as
electroconvulsive therapy (ECT), may be recommended when depression is
severe or life-threatening or if a person can’t take antidepressants.
Antidepressant medications
Antidepressants work to normalize the natural brain chemicals known as
neurotransmitters, especially serotonin and norepinephrine. Other
antidepressants work on the neurotransmitter dopamine. Some people take
antidepressant medication as part of short-term treatment; others take it over the
longer-term. Antidepressants include the following:
•  Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake
inhibitors (SNRIs). SSRIs are the newest and most often prescribed
antidepressants. SNRIs are relatively new and are commonly prescribed.
•  Tricyclics. Tricyclics are an older group of antidepressants, named for their
chemical structure. They may be prescribed for people who can’t take SSRIs or
SNRIs or for whom those medications don’t work well.
•  Monoamine oxidase inhibitors (MAOIs). Like tricyclics, MAOIs are older
antidepressants that work better for some people than SSRIs or SNRIs. 4  z  Depression 
Another medication, lithium, is used to treat bipolar disorder and some forms of
recurring major depression. A doctor may need to try a variety of antidepressants
and adjust the dosage to find one that works for you. 
If an antidepressant is prescribed for you:
•  Ask about the side effects. Find out also about any testing that may need to be done
to monitor the effects of the medication on your body.
•  Be patient. Finding the right medication can take time. Work closely with your
doctor and report any side effects and benefits that you experience.
•  Always talk with your doctor before you stop taking a medication, even if you feel better.
Some medications must be stopped gradually to give your body time to adjust. If
you have bipolar disorder or chronic major depression, you may need to take
medication daily to avoid disabling symptoms.
•  If you are taking MAOIs, remember that you will have to avoid certain foods, including
cheeses, wines, and pickles. Get a complete list of foods to avoid from your
doctor and always carry the list with you. 
•  Never mix medications -- prescribed, over-the-counter, or borrowed -- without talking
with your doctor. Tell your dentist or any other medical professional who
prescribes a drug that you are taking antidepressants. Some drugs that are safe
when taken alone can be dangerous if taken with other medications.
•  Avoid alcohol, including beer, wine, and hard liquor. Alcohol can reduce the
effectiveness of antidepressants. Talk with your doctor about how to plan for
situations in which alcohol may be served. 
•  Call your doctor if you have a question about any drug or if you are having a problem you
believe is drug-related.
Side effects
Antidepressants may cause mild and usually temporary side effects. Typically,
these are annoying but not serious. However, unusual side effects or those that
interfere with functioning should be reported to your doctor. 
The most common side effects of SSRIs and SNRIs include the following: 
•  Headache. Headaches will usually go away.
•  Nausea. Even when it occurs, nausea lasts only a short time.
•  Nervousness and sleep difficulties. These side effects may occur during the first few
weeks, and dosage reductions or time will usually resolve them.  5  z  Depression 
•  Agitation. If you become agitated for the first time after you take the drug, and
the agitation is more than transient, consult your doctor.
•  Sexual problems. Both men and women may have sexual problems, including a
lower sex drive. A doctor can suggest how to deal with these problems.
The side effects of tricyclics may include the following:
•  Dry mouth. Drink lots of water, chew sugarless gum, and clean teeth daily.
•  Constipation. Eat bran cereals, prunes, fruit, and vegetables.
•  Bladder problems. Emptying your bladder may be troublesome, and your urine
stream may not be as strong as usual. Call your doctor if there is any pain.
•  Sexual problems. Sexual functioning may change. If this bothers you, discuss the
problem with your doctor.
•  Blurred vision. This will pass soon. Do not get new glasses.
•  Dizziness. Rise from bed or chair slowly.
•  Drowsiness. This will pass soon. Do not drive or operate heavy equipment if you
are feeling drowsy or sedated.
Antidepressants may also increase the risk of suicidal thoughts in children,
adolescents, and young adults. People in all three groups need to be monitored
closely by doctors if they take antidepressants, especially in the first weeks of
Several types of psychotherapy can help with depression. Some types of
psychotherapy are short term, or designed to last about 10 to 20 weeks. Other
types of psychotherapy may require longer treatment over many months or even
years. The two main types of therapy that have been shown to help with
depression are the following:
•  Cognitive-behavioral therapy (CBT). This is a form of short-term therapy that has
been found to help with some types of depression. Cognitive-behavioral
therapists help clients change the negative styles of thinking and behaving often
associated with depression.
•  Interpersonal therapy (IPT). This type of therapy helps people understand and
work through difficulties in their personal relationships that may cause
depression or make it worse. Therapists may help you explore the causes of your
actions, such as past experiences.
 6  z  Depression 
Therapists often draw on different forms of psychotherapy, tailoring treatment to
the needs of a client. No one form of psychotherapy is best for everybody. The
comfort level and trust between the client and the therapist is more important
than the type of psychotherapy used.
Depression that is severe or keeps coming back will generally require both
medication (or ECT, under special conditions) and psychotherapy.
Helping yourself
Depression can make you feel exhausted, helpless, and hopeless. These feelings
can make it hard to keep trying to help yourself. But it’s important to realize that
these negative views are part of the depression and typically do not accurately
reflect your situation. Negative thinking will fade as treatment begins to take
In the meantime, you can take these steps to help yourself:
•  Engage in mild activity or exercise. Do things you’ve enjoyed in the past, like going
to the movies or a sports event. Take part in social, religious, and other activities
that have had meaning for you.
•  Set goals you can achieve. 
•  Break large tasks into small ones, set priorities, and do what you can as you can. Tell
yourself you will work at the task for 10 or 15 minutes. Then if want to work
longer that is great.
•  Keep your expectations realistic. Expecting too much too soon may increase feelings
of failure if you fall short. Give yourself credit for what you have accomplished
even if that seems small.
•  Try to spend time with other people. Talk with a trusted friend or relative, and try to
avoid becoming isolated.
•  Put off making major life decisions, such as whether to change jobs or get married
or divorced, until you feel better. If you need to make a big decision, talk about it
with people who know you well.
•  Expect to improve gradually, not overnight. Don’t assume you can “snap out of”
depression or see progress right away.
•  Remember that you can replace your negative thinking with positive thoughts. Negative
thinking is part of the depression. It will disappear as your depression responds to
treatment and you have more energy to challenge negative thought patterns that
may have become a habit.
 7  z  Depression 
Where to get help
If you aren’t sure where to turn for help with depression, start by talking with
your doctor. Others who can provide help or referrals include the following:
•  Mental health professionals, such as psychiatrists, psychologists, and social workers.
•  Community resources, including family and social service agencies and mental
health centers, programs, and clinics.
•  National organizations and agencies. Good places to start include National Alliance
on Mental Illness,, 800-950-NAMI (800-950-6264), and Mental
Health America (formerly the National Mental Health Association,, 800-969-6642. The National Institute of Mental Health,, has extensive information about depression on its Web site
that is frequently updated.
If you’re looking for help for depression, remember that the program that
provided this publication has many helpful resources.
Always take action right away if your depression is causing you to think of
hurting yourself or someone else. For immediate help:
•  Call your doctor.
•  Call 911 or go to a hospital emergency room. Ask a friend or relative to help you do
these things if you can’t do them yourself.
•  Call the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline,
800-273-TALK (800-273-8255), to talk with a trained counselor. 


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