Depression: Symptoms and Treatment Patient Education Handout associated with UMHS Clinical Care Guideline

This information is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your health-care provider or make an appointment to be seen if you have questions or concerns about this information or your medical condition.

What is depression?

Depression is when you feel sad and lose interest in daily life. You may have other symptoms as well. Depression can be mild to severe. It can last for a short time or a long time.

We all have times when we feel sad and blue. On the other hand, when you feel this way for more than 2 weeks in a row, it is called clinical depression. Clinical depression is a medical problem.

How does it occur?

Depression can begin at any age. It usually begins in the late teenage through young adult years unless it is caused by medical or substance abuse problems. It may come on slowly over weeks or months, but it can also come on very quickly.

The exact cause of depression is not known. It may result from chemical imbalances in the brain and nervous system. You may have abnormal levels of the chemicals that your nervous system uses to send signals to and from the brain. Depression tends to run in families. Daily social and psychological factors also play a part.

What are the symptoms?

Besides feeling sad and losing interest in things you used to enjoy, you may also:

• Be irritable.
• Have trouble falling asleep, wake up very early, or sleep too much.
• Notice changes in your appetite and weight, either up or down.
• Notice changes in your energy level, usually down but sometimes feeling agitated.
• Lose interest in sex.
• Feel worthless and guilty.
• Have trouble concentrating or remembering things.
• Feel hopeless or just not care about anything.
• Have unexplained pain or get headaches.
• Think often about death or suicide.

How is it diagnosed?

Your health care provider or a mental health professional can tell you if your symptoms are caused by clinical depression. He or she will ask about your symptoms and any drug or alcohol use. You may have some lab tests to rule out medical problems such as hormone imbalances. There are no lab tests that directly diagnose depression.

How is it treated?

Depression is a physical illness as well as a psychological one. It makes you feel bad physically, but the problems start with your emotions. Do not expect yourself to "snap out of it." It will take time to treat depression. Depression can be successfully treated with psychotherapy, antidepressant medicine, or both. Discuss this with your health care provider or therapist.

Medicine

Several types of medicines can help treat clinical depression. Your health care provider will carefully select one for you. Some medicines are:

• selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and several other newer antidepressants
• tricyclic antidepressants such as imipramine (Tofranil), nortriptyline (Aventyl HCl, Pamelor), and desipramine (Norpramin)
• monoamine oxidase inhibitors (MAOs) such as tranylcypromine (Parnate), and phenelzine (Nardil)
• trazodone (Desyrel), an antidepressant chemically unrelated to the other groups
• mood stabilizers (primarily for bipolar and cyclothymic disorders) such as lithium (Eskalith, Lithobid, Lithonate, Lithotabs), carbamazepine (Tegretol), and valproic acid (Depakene, Depakote), lamotrigine (Lamictal), and topiramate (Topamax).

You must take antidepressant medicines daily for 3 to 6 weeks for them to work properly.

Certain medicines such as Accutane, benzodiazepines, digitalis, and some beta blockers can add to the symptoms of depression. If you have been or are being treated for depression, it is important to check with your health care provider before taking any new medicines, either nonprescription drugs or drugs prescribed by other health care providers.

There are no nonprescription medicines to treat depression. There are some natural or herbal remedies, though, that have been marketed as treating depression.

Psychotherapy

Seeing a psychologist, psychiatrist, or psychotherapist can help with all forms of depression. Therapy may last a short time or may need to go on for many months. Cognitive behavioral therapy (CBT) is a way to help you become aware of and change thoughts that can lead to depression. Replacing negative thoughts with more positive ones can help you with depression.

Natural and Alternative Treatments

Claims have been made that many herbal and nutrition products help depression. Some research indicates that St. John's wort may help mild symptoms of depression, but more recent, studies suggest that St. John’s Wort it does not work any better than placebo (sugar pill). St. John’s wort may interact with antidepressant and other medications. This can result in a greater risk of side effects.

Many types of alternative treatments are said to help depression. Some of them are:

• Biofeedback. You learn to control body functions such as muscle tension or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration.
• Massage Therapy. Massage therapy may help lower stress.
• Relaxation Therapies. Learning special relaxation methods can help with depression, along with medicines and psychotherapy. Yoga and meditation may also be helpful.
• Art and Music Therapies. Some people find art and music therapy, along with medicines and psychotherapy, are helpful in treating depression.

How long will the effects last?

Different kinds of clinical depression last for different amounts of time. Experts do not fully know why. Often depression lasts a few weeks and never comes again. It can also last months or years. Some people experience depression over and over all their lives.

What can I do to help myself or my loved one?

Prevention

Living a healthy lifestyle can help to prevent depression. A healthy lifestyle includes:

• Exercise for at least 20 minutes every day, for example, take a brisk walk.
• Learn which actions make you feel better and do them often.
• Talk to your family and friends.
• Eat a healthy diet.
• Get 6-8 hours sleep per night.
• Do not abuse alcohol or drugs.
• Learn ways to lower stress, such as breathing exercises or relaxation techniques.

When should I seek help?

Do not try to treat depression all by yourself. Seek professional help if you believe that you or a loved one have the symptoms of clinical depression.

When should I seek help right away?

Get emergency care if you or a loved one have serious thoughts of suicide or harming others.

You may wish to contact the Depression and Bipolar Support Alliance (DBSA) or the National Mental Health Association (NMHA).

• DBSA's toll-free information number is 1-800-826-3632. Their Web site address is http://www.dbsalliance.org.
• NMHA's toll-free Information Center number is 1-800-969-NMHA. NMHA's Web site address is http://www.NMHA.org.

Written by Gayle Zieman, PhD, for McKesson Health Solutions LLC.

Published by McKesson Health Solutions LLC.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

December 2003