| IntroductionDepression is a serious medical condition. | | | | and monoamine oxidase inhibitors (MAOIs). Although |
| In contrast to the normal emotional experiences of | | | | both generations of medications are effective in |
| sadness, loss, or passing mood states, clinical | | | | relieving depression, some people will respond to one |
| depression is persistent and can interfere significantly | | | | type of drug, but not another. Other types of |
| with an individual's ability to function. There are three | | | | antidepressants are now in development.Certain |
| main types of depressive disorders: major depressive | | | | types of psychotherapy, specifically |
| disorder, dysthymic disorder, and bipolar disorder | | | | cognitive-behavioral therapy (CBT) and interpersonal |
| (manic-depressive illness).Symptoms and Types of | | | | therapy (IPT), have been found helpful for |
| DepressionSymptoms of depression include sad | | | | depression. Research indicates that mild to moderate |
| mood, loss of interest or pleasure in activities that | | | | depression often can be treated successfully with |
| were once enjoyed, change in appetite or weight, | | | | either therapy alone; however, severe depression |
| difficulty sleeping or oversleeping, physical slowing or | | | | appears more likely to respond to a combination of |
| agitation, energy loss, feelings of worthlessness or | | | | psychotherapy and medication. 7 More than 80 |
| inappropriate guilt, difficulty thinking or concentrating, | | | | percent of people with depressive disorders improve |
| and recurrent thoughts of death or suicide. A | | | | when they receive appropriate treatment.In situations |
| diagnosis of major depressive disorder is made if a | | | | where medication, psychotherapy, and the |
| person has 5 or more of these symptoms and | | | | combination of these interventions prove ineffective, |
| impairment in usual functioning nearly every day | | | | or work too slowly to relieve severe symptoms such |
| during the same two-week period. Major depression | | | | as psychosis (e.g., hallucinations, delusional thinking) or |
| often begins between ages 15 to 30 but also can | | | | suicidality, electroconvulsive therapy (ECT) may be |
| appear in children. 1 Episodes typically recur.Some | | | | considered. ECT is a highly effective treatment for |
| people have a chronic but less severe form of | | | | severe depressive episodes.The possibility of |
| depression, called dysthymic disorder, which is | | | | long-lasting memory problems, although a concern in |
| diagnosed when depressed mood persists for at | | | | the past, has been significantly reduced with modern |
| least 2 years (1 year in children) and is accompanied | | | | ECT techniques. However, the potential benefits and |
| by at least 2 other symptoms of depression. Many | | | | risks of ECT, and of available alternative |
| people with dysthymia develop major depressive | | | | interventions, should be carefully reviewed and |
| episodes.Episodes of depression also occur in people | | | | discussed with individuals considering this treatment |
| with bipolar disorder. In this disorder, depression | | | | and, where appropriate, with family or friends.One |
| alternates with mania, which is characterized by | | | | herbal supplement, hypericum or St. John's wort, has |
| abnormally and persistently elevated mood or | | | | been promoted as having antidepressant properties. |
| irritability and symptoms including overly-inflated | | | | Results from the first large-scale, controlled study of |
| self-esteem, decreased need for sleep, increased | | | | St. John's wort for major depression, which was |
| talkativeness, racing thoughts, distractibility, physical | | | | funded in part by NIMH, are expected in 2001. Note: |
| agitation, and excessive risk taking. Because bipolar | | | | There is evidence that St. John's wort can reduce |
| disorder requires different treatment than major | | | | the effectiveness of certain medications. Use of any |
| depressive disorder or dysthymia, obtaining an | | | | herbal or natural supplements should always be |
| accurate diagnosis is extremely important.Facts | | | | discussed with your doctor before they are |
| About DepressionMajor depression is the leading | | | | tried.Research FindingsBrain imaging research is |
| cause of disability in the U.S. and worldwide. 2 | | | | revealing that in depression, neural circuits responsible |
| Depressive disorders affect an estimated 9.5 percent | | | | for moods, thinking, sleep, appetite, and behavior fail |
| of adult Americans ages 18 and over in a given year, | | | | to function properly, and that the regulation of critical |
| 3 or about 18.8 million people in 1998. Nearly twice as | | | | neurotransmitters is impaired. Genetics research, |
| many women (12 percent) as men (7 percent) are | | | | including studies of twins, indicates that genes play a |
| affected by a depressive disorder each | | | | role in depression. Vulnerability to depression appears |
| year.Depression can be devastating to family | | | | to result from the influence of multiple genes acting |
| relationships, friendships, and the ability to work or go | | | | together with environmental factors.Other research |
| to school. Many people still believe that the emotional | | | | has shown that stressful life events, particularly in the |
| symptoms caused by depression are "not real," and | | | | form of loss such as the death of a close family |
| that a person should be able to shake off the | | | | member, may trigger major depression in susceptible |
| symptoms. Because of these inaccurate beliefs, | | | | individuals. The hypothalamic-pituitary-adrenal (HPA) |
| people with depression either may not recognize that | | | | axis, the hormonal system that regulates the body's |
| they have a treatable disorder or may be | | | | response to stress, is overactive in many people with |
| discouraged from seeking or staying on treatment | | | | depression. Research findings suggest that persistent |
| due to feelings of shame and stigma. Too often, | | | | overactivation of this system may lay the |
| untreated or inadequately treated depression is | | | | groundwork for depression.Studies of brain chemistry, |
| associated with suicide.TreatmentsAntidepressant | | | | mechanisms of action of antidepressant medications, |
| medications are widely used, effective treatments | | | | and the cognitive distortions and disturbed |
| for depression. Existing antidepressants influence the | | | | interpersonal relationships commonly associated with |
| functioning of certain chemicals in the brain called | | | | depression, continue to inform the development of |
| neurotransmitters. The newer medications, such as | | | | new and better treatments.New Clinical TrialsNIMH is |
| the selective serotonin reuptake inhibitors (SSRIs), | | | | funding two new, large-scale, multi-site clinical trials on |
| tend to have fewer side effects than the older | | | | treatments for major depression in adults and |
| drugs, which include tricyclic antidepressants (TCAs) | | | | adolescents. |