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Depression
What is depression?

Everyone feels sad or low sometimes, but these feelings usually pass.
Depression (also called major depression, major depressive disorder, or
clinical depression) is different. It can cause severe symptoms that
affect how a person feels, thinks, and handles daily activities, such as
sleeping, eating, or working.
Depression can affect anyone regardless of age, sex, race or ethnicity,
income, culture, or education. Research suggests that genetic,
biological, environmental, and psychological factors play a role in the
disorder.
Women are diagnosed with depression more often than men, but men can
also be depressed. Because men may be less likely to recognize, talk
about, and seek help for their negative feelings, they are at greater
risk of their depression symptoms being undiagnosed and under treated.
In addition, depression can co-occur with other mental disorders or
chronic illnesses, such as diabetes, cancer, heart disease, and chronic
pain. Depression can make these conditions worse and vice versa.
Sometimes, medications taken for an illness cause side effects that
contribute to depression symptoms as well.
What are the different types of depression?
The American Psychiatric Association’s Diagnostic
Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5) classifies depressive disorders as the following:
-
Clinical depression (major depressive disorder): A
diagnosis of major depressive disorder means you’ve felt
sad, low or worthless most days for at least two weeks
while also having other symptoms such as sleep problems,
loss of interest in activities or change in appetite.
This is the most severe form of depression and one of
the most common forms.
-
Persistent depressive disorder (PDD): Persistent
depressive disorder is mild or moderate depression that
lasts for at least two years. The symptoms are less
severe than major depressive disorder. Healthcare
providers used to call PDD dysthymia.
-
Disruptive mood dysregulation disorder (DMDD): DMDD
causes chronic, intense irritability and frequent anger
outbursts in children. Symptoms usually begin by the age
of 10.
-
Premenstrual dysphoric disorder (PMDD): With PMDD,
you have premenstrual syndrome (PMS) symptoms along with
mood symptoms, such as extreme irritability, anxiety or
depression. These symptoms improve within a few days
after your period starts, but they can be severe enough
to interfere with your life.
-
Depressive disorder due to another medical
condition: Many medical conditions can create changes in
your body that cause depression. Examples include
hypothyroidism, heart disease, Parkinson’s disease and
cancer. If you’re able to treat the underlying
condition, the depression usually improves as well.
There are also specific forms of major depressive
disorder, including:
-
Seasonal affective disorder (seasonal depression):
This is a form of major depressive disorder that
typically arises during the fall and winter and goes
away during the spring and summer.
-
Prenatal depression and postpartum depression:
Prenatal depression is depression that happens during
pregnancy. Postpartum depression is depression that
develops within four weeks of delivering a baby. The DSM
refers to these as “major depressive disorder (MDD) with
peripartum onset.”
-
Atypical depression: Symptoms of this condition,
also known as major depressive disorder with atypical
features, vary slightly from “typical” depression. The
main difference is a temporary mood improvement in
response to positive events (mood reactivity). Other key
symptoms include increased appetite and rejection
sensitivity.
People with bipolar disorder also experience episodes of
depression in addition to manic or hypomanic episodes.
Causes
It's not known exactly what causes depression. As with many mental
disorders, a variety of factors may be involved, such as:
-
Biological differences. People with depression appear to
have physical changes in their brains. The significance of these
changes is still uncertain, but may eventually help pinpoint causes.
-
Brain chemistry. Neurotransmitters are naturally occurring
brain chemicals that likely play a role in depression. Recent
research indicates that changes in the function and effect of these
neurotransmitters and how they interact with neurocircuits involved
in maintaining mood stability may play a significant role in
depression and its treatment.
-
Hormones. Changes in the body's balance of hormones may be
involved in causing or triggering depression. Hormone changes can
result with pregnancy and during the weeks or months after delivery
(postpartum) and from thyroid problems, menopause or a number of
other conditions.
-
Inherited traits. Depression is more common in people whose
blood relatives also have this condition. Researchers are trying to
find genes that may be involved in causing depression.
Risk factors
Depression often begins in the teens, 20s or 30s, but it can
happen at any age. More women than men are diagnosed with
depression, but this may be due in part because women are
more likely to seek treatment.
Factors that seem to increase the risk of developing or
triggering depression include:
- Certain personality traits, such as low self-esteem and
being too dependent, self-critical or pessimistic
- Traumatic or stressful events, such as physical or
sexual abuse, the death or loss of a loved one, a
difficult relationship, or financial problems
- Blood relatives with a history of depression, bipolar
disorder, alcoholism or suicide
- Being lesbian, gay, bisexual or transgender, or having
variations in the development of genital organs that
aren't clearly male or female (intersex) in an
unsupportive situation
- History of other mental health disorders, such as
anxiety disorder, eating disorders or post-traumatic
stress disorder
- Abuse of alcohol or recreational drugs
- Serious or chronic illness, including cancer, stroke,
chronic pain or heart disease
- Certain medications, such as some high blood pressure
medications or sleeping pills (talk to your doctor
before stopping any medication)
Who does depression affect?
Depression can affect anyone — including children and
adults.
Having certain risk factors makes it more likely that you
may develop depression.
For example, the following
conditions are associated with higher rates of depression:
- Neurodegenerative diseases like Alzheimer’s disease and
Parkinson’s disease.
- Stroke.
- Multiple sclerosis.
- Seizure disorders.
- Cancer.
- Macular degeneration.
- Chronic pain.
What are the signs and symptoms of depression?
Common signs and symptoms of depression include:
- Persistent
sad, anxious, or “empty” mood
- Feelings of
hopelessness or pessimism
- Feelings of
irritability, frustration‚ or restlessness
- Feelings of
guilt, worthlessness, or helplessness
- Loss of
interest or pleasure in hobbies and activities
- Fatigue,
lack of energy, or feeling slowed down
- Difficulty
concentrating, remembering, or making decisions
- Difficulty
sleeping, waking too early in the morning, or oversleeping
- Changes in
appetite or unplanned weight changes
- Physical
aches or pains, headaches, cramps, or digestive problems without a
clear physical cause that do not go away with treatment
- Thoughts of
death or suicide or suicide attempts
Depression can also involve other changes in mood or behavior that
include:
- Increased
anger or irritability
- Feeling
restless or on edge
- Becoming
withdrawn, negative, or detached
- Increased
engagement in high-risk activities
- Greater
impulsivity
- Increased
use of alcohol or drugs
- Isolating
from family and friends
- Inability
to meet responsibilities or ignoring other important roles
- Problems
with sexual desire and performance
Depression symptoms in children and teens
Common signs and symptoms of depression in children and
teenagers are similar to those of adults, but there can be
some differences.
- In younger children, symptoms of depression may include
sadness, irritability, clinginess, worry, aches and
pains, refusing to go to school, or being underweight.
- In teens, symptoms may include sadness, irritability,
feeling negative and worthless, anger, poor performance
or poor attendance at school, feeling misunderstood and
extremely sensitive, using recreational drugs or
alcohol, eating or sleeping too much, self-harm, loss of
interest in normal activities, and avoidance of social
interaction.
Depression symptoms in older adults
Depression is not a normal part of growing older, and it
should never be taken lightly. Unfortunately, depression
often goes undiagnosed and untreated in older adults, and
they may feel reluctant to seek help. Symptoms of depression
may be different or less obvious in older adults, such as:
- Memory difficulties or personality changes
- Physical aches or pain
- Fatigue, loss of appetite, sleep problems or loss of
interest in sex — not caused by a medical condition or
medication
- Often wanting to stay at home, rather than going out to
socialize or doing new things
- Suicidal thinking or feelings, especially in older men
Not everyone who is depressed shows all these symptoms. Some people
experience only a few symptoms, while others experience many. Depression
symptoms interfere with day-to-day functioning and cause significant
distress for the person experiencing them.
If you show signs or symptoms of depression and they persist or do not
go away, talk to a health care provider. If you see signs of depression
in someone you know, encourage them to seek help from a mental health
professional.
How is depression diagnosed?
To be diagnosed with depression, a person must have symptoms most of the
day, nearly every day, for at least 2 weeks. One of the symptoms must be
a depressed mood or a loss of interest or pleasure in most activities.
Children and adolescents may be irritable rather than sad.
Although several persistent symptoms, in addition to low mood, are
required for a depression diagnosis, people with only a few symptoms may
benefit from treatment. The severity and frequency of symptoms and how
long they last vary depending on the person.
If you think you may have depression, talk to a health care provider,
such as a primary care doctor, psychologist, or psychiatrist. During the
visit, the provider may ask when your symptoms began, how long they have
lasted, how often they occur, and if they keep you from going out or
doing your usual activities. It may help to take some notes about your
symptoms before the visit.
Certain medications and medical conditions, such as viruses or thyroid
disorders, can cause the same symptoms as depression. A provider can
rule out these possibilities by doing a physical exam, interview, and
lab tests.
Your doctor may determine a diagnosis of depression based
on:
-
Physical exam. Your doctor may do a physical
exam and ask questions about your health. In some cases,
depression may be linked to an underlying physical
health problem.
-
Lab tests. For example, your doctor may do a
blood test called a complete blood count or test your
thyroid to make sure it's functioning properly.
-
Psychiatric evaluation. Your mental health
professional asks about your symptoms, thoughts,
feelings and behavior patterns. You may be asked to fill
out a questionnaire to help answer these questions.
-
DSM-5. Your mental health professional may use
the criteria for depression listed in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5),
published by the American Psychiatric Association.
How common is depression?
Depression is common. Researchers estimate that nearly 7% of
adults in the United States have depression every year. More
than 16% of U.S. adults — around 1 in 6 people — will
experience depression at some point in their lifetime.
However, researchers believe that these estimates are lower
than reality, as many people don’t seek medical help for
symptoms of depression and don’t receive a diagnosis.
Approximately 4.4% of children in the United States have
depression.
Does depression look the same in everyone?
Depression can affect people differently depending on their age.
-
Children may
be anxious or cranky, pretend to be sick, refuse to go to school,
cling to a parent, or worry that a parent may die.
-
Older
children and teens may get into trouble at school, sulk, be
easily frustrated‚ feel restless, or have low self-esteem. They may
have other disorders, such as anxiety, an eating disorder,
attention-deficit/hyperactivity disorder, or substance use disorder.
Older children and teens are also more likely to experience
excessive sleepiness (called hypersomnia) and increased appetite
(called hyperphagia).
-
Young
adults are more likely to be irritable, complain of weight
gain and hypersomnia, and have a negative view of life and the
future. They often have other disorders, such as generalized anxiety
disorder, social phobia, panic disorder, or substance use disorder.
-
Middle-aged adults may have more depressive episodes,
decreased libido, middle-of-the-night insomnia, or early morning
waking. They often report stomach problems, such as diarrhea or
constipation.
-
Older
adults often feel sadness, grief, or other less obvious
symptoms. They may report a lack of emotions rather than a depressed
mood. Older adults are also more likely to have other medical
conditions or pain that can cause or contribute to depression.
Memory and thinking problems (called pseudodementia) may be
prominent in severe cases.
Depression can also look different in men versus women, such as the
symptoms they show and the behaviors they use to cope with them. For
instance, men (as well as women) may show symptoms other than sadness,
instead seeming angry or irritable.
For some people, symptoms manifest as physical problems (for example, a
racing heart, tightened chest, chronic headaches, or digestive issues).
Many men are more likely to see a health care provider about these
physical symptoms than their emotional ones. While increased use of
alcohol or drugs can be a sign of depression in any person, men are also
more likely to use these substances as a coping strategy.
How is depression treated?
Depression treatment typically involves psychotherapy (in person or
virtual), medication, or both. If these treatments do not reduce
symptoms sufficiently, brain stimulation therapy may be another option.
Choosing the right treatment plan is based on a person’s needs,
preferences, and medical situation and in consultation with a mental
health professional or a health care provider. Finding the best
treatment may take trial and error.
For milder forms of depression, psychotherapy is often tried first, with
medication added later if the therapy alone does not produce a good
response. People with moderate or severe depression usually are
prescribed medication as part of the initial treatment plan.
Psychotherapy
Psychotherapy (also called talk therapy or counseling) can help people
with depression by teaching them new ways of thinking and behaving and
helping them change habits that contribute to depression. Psychotherapy
occurs under the care of a licensed, trained mental health professional
in one-on-one sessions or with others in a group setting.
Psychotherapy can be effective when delivered in person or virtually via
telehealth. A provider may support or supplement therapy using digital
or mobile technology, like apps or other tools.
Evidence-based therapies to treat depression include cognitive
behavioral therapy and interpersonal therapy. Using other forms of
psychotherapy, such as psychodynamic therapy, for a limited time also
may help some people with depression.
-
Cognitive
behavioral therapy (CBT): With CBT, people learn to
challenge and change unhelpful thoughts and behaviors to improve
their depressive and anxious feelings. Recent advances in CBT
include adding mindfulness principles and specializing the therapy
to target specific symptoms like insomnia.
-
Interpersonal therapy (IPT): IPT focuses on interpersonal
and life events that impact mood and vice versa. IPT aims to help
people improve their communication skills within relationships, form
social support networks, and develop realistic expectations to
better deal with crises or other issues that may be contributing to
or worsening their depression.
Medication
Antidepressants are medications commonly used to treat depression. They
work by changing how the brain produces or uses certain chemicals
involved in mood or stress.
Antidepressants take time—usually 4−8 weeks—to work, and problems with
sleep, appetite, and concentration often improve before mood lifts.
Giving a medication a chance to work is important before deciding
whether it is right for you.
Treatment-resistant depression occurs when a person doesn’t get better
after trying at least two antidepressants. Esketamine is a medication
approved by the U.S. Food and Drug Administration (FDA) for
treatment-resistant depression. Delivered as a nasal spray in a doctor’s
office, clinic, or hospital, the medication acts rapidly, typically
within a couple of hours, to relieve depression symptoms. People will
usually continue to take an antidepressant pill to maintain the
improvement in their symptoms.
Another option for treatment-resistant depression is to combine an
antidepressant with a different type of medication that may make it more
effective, such as an antipsychotic or anticonvulsant medication.
All medications can have side effects. Talk to a health care
provider before starting or stopping any medication.
Note:
In some cases, children, teenagers, and young adults under 25 years may
experience an increase in suicidal thoughts or behavior when taking
antidepressants, especially in the first few weeks after starting or
when the dose is changed. The FDA advises that patients of all ages
taking antidepressants be watched closely, especially during the first
few weeks of treatment.
Information about medication changes frequently. Learn more about
specific medications like esketamine, including the latest approvals,
side effects, warnings, and patient information, on the FDA
website .
Brain stimulation therapy
Brain stimulation therapy is an option when other depression treatments
have not worked. The therapy involves activating or inhibiting the brain
with electricity or magnetic waves.
Although brain stimulation therapy is less frequently used than
psychotherapy and medication, it can play an important role in treating
depression in people who have not responded to other treatments. The
therapy generally is used only after a person has tried psychotherapy
and medication, and those treatments usually continue. Brain stimulation
therapy is sometimes used as an earlier treatment option when severe
depression has become life-threatening, such as when a person has
stopped eating or drinking or is at a high risk of suicide.
The FDA has approved several types of brain stimulation therapy. The
most used are electroconvulsive therapy (ECT) and repetitive
transcranial magnetic stimulation (rTMS). Other brain stimulation
therapies are newer and, in some cases, still considered experimental.
Learn more about brain
stimulation therapies.
Natural products
The FDA has not approved any natural products for treating depression.
Although research is ongoing and findings are inconsistent, some people
report that natural products, including Vitamin D and the herbal dietary
supplement St. John’s wort, helped their depression symptoms. However,
these products can come with risks, including, in some cases,
interactions with prescription medications.
Do not use Vitamin D, St. John’s wort, or other dietary supplements or
natural products without first talking to a health care provider.
Rigorous studies must test whether these and other natural products are
safe and effective.
Hospital and residential treatment
In some people, depression is so severe that a hospital stay
is needed. This may be necessary if you can't care for
yourself properly or when you're in immediate danger of
harming yourself or someone else. Psychiatric treatment at a
hospital can help keep you calm and safe until your mood
improves.
Partial hospitalization or day treatment programs also may
help some people. These programs provide the outpatient
support and counseling needed to get symptoms under control.
Medications for Major Depressive Disorder
The medications listed below are related to or used in the
treatment of this condition
Drug name |
Rating |
Rx/OTC |
Preg |
CSA |
Alcohol |
Wellbutrin XL
|
7.4 |
Rx |
C |
N |
X |
Zoloft
|
6.8 |
Rx |
C |
N |
X |
bupropion
|
6.9 |
Rx |
C |
N |
X |
Prozac
|
6.4 |
Rx |
C |
N |
X |
Lexapro
|
6.5 |
Rx |
C |
N |
X |
Trintellix
|
6.2 |
Rx |
C |
N |
X |
Rexulti
|
6.6 |
Rx |
|
N |
X |
sertraline
|
6.8 |
Rx |
C |
N |
X |
Cymbalta
|
6.2 |
Rx |
C |
N |
X |
Abilify
|
6.1 |
Rx |
C |
N |
X |
Pristiq
|
6.3 |
Rx |
C |
N |
X |
Vraylar
|
7.2 |
Rx |
|
N |
X |
Effexor XR
|
6.6 |
Rx |
C |
N |
X |
trazodone
|
6.3 |
Rx |
C |
N |
X |
brexpiprazole
|
6.5 |
Rx |
|
N |
X |
Remeron
|
7.4 |
Rx |
C |
N |
X |
Wellbutrin SR
|
7.9 |
Rx |
C |
N |
X |
fluoxetine
|
6.6 |
Rx |
C |
N |
X |
venlafaxine
|
6.5 |
Rx |
C |
N |
X |
cariprazine
|
7.2 |
Rx |
|
N |
X |
mirtazapine
|
7.0 |
Rx |
C |
N |
X |
duloxetine
|
6.2 |
Rx |
C |
N |
X |
escitalopram
|
6.6 |
Rx |
C |
N |
X |
Viibryd
|
5.5 |
Rx |
C |
N |
X |
Effexor
|
5.8 |
Rx |
C |
N |
X |
aripiprazole
|
6.2 |
Rx |
C |
N |
X |
quetiapine
|
6.6 |
Rx |
C |
N |
X |
Seroquel XR
|
6.4 |
Rx |
C |
N |
X |
Paxil
|
7.2 |
Rx |
D |
N |
X |
Auvelity
|
8.5 |
Rx |
|
N |
X |
nefazodone
|
8.9 |
Rx |
C |
N |
X |
Zyprexa
|
5.2 |
Rx |
C |
N |
X |
vortioxetine
|
6.3 |
Rx |
C |
N |
X |
Fetzima
|
5.3 |
Rx |
C |
N |
X |
paroxetine
|
7.5 |
Rx |
D |
N |
X |
Aplenzin
|
8.5 |
Rx |
C |
N |
X |
desvenlafaxine
|
6.2 |
Rx |
C |
N |
X |
Budeprion SR
|
6.0 |
Rx |
C |
N |
X |
doxepin
|
7.6 |
Rx |
N |
N |
X |
olanzapine
|
5.8 |
Rx |
C |
N |
X |
Paxil CR
|
10 |
Rx |
D |
N |
X |
Forfivo XL
| |
Rx |
C |
N |
X |
vilazodone
|
5.5 |
Rx |
C |
N |
X |
Irenka
| |
Rx |
C |
N |
X |
Raldesy | |
Rx |
C |
N |
X |
Spravato |
7.2 |
Rx |
|
3 |
X |
bupropion / dextromethorphan |
8.5 |
Rx |
|
N |
X |
fluoxetine / olanzapine |
7.8 |
Rx |
C |
N |
X |
Remeron SolTab |
7.0 |
Rx |
C |
N |
X |
Emsam |
6.6 |
Rx |
C |
N |
X |
esketamine |
7.1 |
Rx |
|
3 |
X |
Opipza | |
Rx |
C |
N |
X |
Symbyax |
7.0 |
Rx |
C |
N |
X |
levomilnacipran |
5.3 |
Rx |
C |
N |
X |
selegiline |
6.5 |
Rx |
C |
N |
X |
Exxua | |
Rx |
|
N |
|
gepirone | |
Rx |
|
N |
|
Legend |
Rating | For ratings, users
were asked how effective they found the medicine while
considering positive/adverse effects and ease of use (1 =
not effective, 10 = most effective). |
Rx | Prescription only. |
OTC | Over-the-counter. |
Rx/OTC | Prescription or Over-the-counter. |
Pregnancy Category |
Controlled Substances Act (CSA) Schedule |
Alcohol |
B | Animal reproduction studies have failed to demonstrate a
risk to the fetus and there are no adequate and
well-controlled studies in pregnant women.
| U |
CSA Schedule is unknown. |
X |
Interacts with Alcohol. |
C |
Animal reproduction studies have shown an adverse effect on
the fetus and there are no adequate and well-controlled
studies in humans, but potential benefits may warrant use in
pregnant women despite potential risks. |
N |
Is not subject to the Controlled Substances Act. |
Complications
Depression is a serious disorder that can take a terrible
toll on you and your family. Depression often gets worse if
it isn't treated, resulting in emotional, behavioral and
health problems that affect every area of your life.
Examples of complications associated with depression
include:
- Excess weight or obesity, which can lead to heart
disease and diabetes
- Pain or physical illness
- Alcohol or drug misuse
- Anxiety, panic disorder or social phobia
- Family conflicts, relationship difficulties, and work or
school problems
- Social isolation
- Suicidal feelings, suicide attempts or suicide
- Self-mutilation, such as cutting
- Premature death from medical conditions
How can I take care of myself?
Most people with depression benefit from mental health treatment. Once
you begin treatment, you should gradually start to feel better. Go easy
on yourself during this time. Try to do things you used to enjoy. Even
if you don’t feel like doing them, they can improve your mood.
Depression generally isn't a disorder that you can treat on
your own. But in addition to professional treatment, these
self-care steps can help:
-
Stick to your treatment plan. Don't skip
psychotherapy sessions or appointments. Even if you're
feeling well, don't skip your medications. If you stop,
depression symptoms may come back, and you could also
experience withdrawal-like symptoms. Recognize that it
will take time to feel better.
-
Learn about depression. Education about your
condition can empower you and motivate you to stick to
your treatment plan. Encourage your family to learn
about depression to help them understand and support
you.
-
Pay attention to warning signs. Work with your
doctor or therapist to learn what might trigger your
depression symptoms. Make a plan so that you know what
to do if your symptoms get worse. Contact your doctor or
therapist if you notice any changes in symptoms or how
you feel. Ask relatives or friends to help watch for
warning signs.
-
Avoid alcohol and recreational drugs. It may
seem like alcohol or drugs lessen depression symptoms,
but in the long run they generally worsen symptoms and
make depression harder to treat. Talk with your doctor
or therapist if you need help with alcohol or substance
use.
-
Take care of yourself. Eat healthy, be
physically active and get plenty of sleep. Consider
walking, jogging, swimming, gardening or another
activity that you enjoy. Sleeping well is important for
both your physical and mental well-being. If you're
having trouble sleeping, talk to your doctor about what
you can do.
Prevention
Can I prevent depression?
You can’t always prevent depression, but you can help reduce
your risk by:
- Take steps to control stress, to increase your
resilience and boost your self-esteem.
- Reach out to family and friends, especially in times of
crisis, to help you weather rough spells
- Get treatment at the earliest sign of a problem to help
prevent depression from worsening.
- Consider getting long-term maintenance treatment to help
prevent a relapse of symptoms.
If you’ve had depression before, you may be more likely to
experience it again. If you have depression symptoms, get
help as soon as possible.
Prognosis
What is the prognosis of depression?
The prognosis (outlook) of depression varies depending on
certain factors, including:
- Its severity and type.
- If it’s temporary or long-lasting.
- If it’s treated or untreated.
- If you have co-occurring conditions, such as other mood
disorders, medical conditions or substance use disorder.
With proper diagnosis and treatment, the vast majority of
people with depression live healthy, fulfilling lives.
Depression can return after you get treatment, though, so
it’s important to seek medical help as soon as symptoms
begin again.
Without treatment, depression can:
- Become worse.
- Increase your chance of other health conditions, like
dementia.
- Lead to the worsening of existing health conditions,
like diabetes or chronic pain.
- Lead to self-harm or death.
Depression accounts for nearly 40,000 cases of suicide each
year in the United States. It’s essential to get medical
help as soon as possible if you’re having suicidal thoughts.
Call 911 or 988 (the Suicide and Crisis Lifeline) or go to
the emergency room.
How can I find help for depression?
The Substance Abuse and Mental Health Services Administration (SAMHSA)
also has an online tool to help you find
mental health services in
your area.
Living With Depression
When should I see my healthcare provider about depression?
If you have symptoms of depression, see a healthcare
provider or mental health professional. They can give you an
accurate diagnosis and suggest treatment options.
If you’ve started treatment for depression and it isn’t
working or you’re having unpleasant side effects, talk to
your provider. They can recommend a different treatment
plan. If you're reluctant to seek treatment, talk to a
friend or loved one, any health care professional, a faith
leader, or someone else you trust.
When to get emergency help
If you think you may hurt yourself or attempt suicide, call
911 in the U.S. or your local emergency number immediately.
Also consider these options if you're having suicidal
thoughts:
- Call your doctor or mental health professional.
- Contact a suicide hotline.
- Reach out to a close friend or loved one.
- Contact a minister, spiritual leader or someone else in
your faith community.
If you have a loved one who is in danger of suicide or has
made a suicide attempt, make sure someone stays with that
person. Call 911 or your local emergency number immediately.
Or, if you think you can do so safely, take the person to
the nearest hospital emergency room.
How can I help a loved one who is depressed?
If someone you know is depressed, help them see a health care provider
or mental health professional. You also can:
- Offer
support, understanding, patience, and encouragement.
- Invite them
out for walks, outings, and other activities.
- Help them
stick to their treatment plan, such as setting reminders to take
prescribed medications.
- Make sure
they have transportation or access to therapy appointments.
- Remind them
that, with time and treatment, their depression can lift.
How Your Diet Can Lead to Depression
The connection between diet and depression is stronger than many
realize. Explore how your diet may be the reason for your depression.
Diet and Depression
If you are what you eat, can that extend to your mood? The simple answer
is yes, say nutritionists and researchers who have looked into whether
what you eat can increase or decrease the risk for or symptoms of depression.
Diet may have a significant effect on preventing and
treating depression. First among these
potential effects is often seen on appetite.
Depression can either increase or decrease appetite, and negative mood
states have been shown to stimulate a preference for foods high in
sugar, fat and/or salt, so-called comfort
foods. It makes sense that your body might crave these
tried-and-true foods in times of stress or distress.
The problem with that, however, is frequently indulging in these less
nutritious foods can lead to a lower-than-recommended intake of
brain-essential nutrients, such as B Vitamins, zinc, folate and
magnesium. Your body needs those nutrients to be at optimal
levels to help make the brain chemicals that can make you feel better
and less depressed.
Emotional eating can also become a problem. Emotional
eating is eating in response to emotional need as opposed to
physiological need. If you reach for comforting food as a coping
mechanism when you’re feeling down or lonely, that can lead to weight
gain. This behavior can lead to further feelings of embarrassment,
disgust and guilt that can make the person even more depressed, leading
to a vicious cycle.
The Brain-Gut Connection
While the cause-and-effect relationship between food and mood seems
fairly straightforward, there is one complex communication that goes on
between the
brain and the gut that makes it all work.
Studies have suggested that the gut microbiota
– that’s the multitude of bacteria that live inside the gut
and contribute to overall health in a wide range of ways –
is significantly different in healthy people than it is in
depressed people.
The foods you eat feed the bacteria in the gut, and different strains of
these microbes prefer to eat different things. Generally, the human gut
microbiota consists of five phyla, or types of bacteria.
These include:
- Bacteroidetes.
- Firmicutes.
- Actinobacteria.
- Fusobacteriota.
- Proteobacteria.
Studies of fecal samples collected from both mice and
humans, for example, found that Bacteroidetes and Firmicutes were the predominant
phyla that appeared to be the most affected in depression.
In addition, your body needs adequate supplies of a whole bunch of
nutrients to help support its ability to manufacture neurotransmitters
such as serotonin, also sometimes called the feel-good chemical.
Neurotransmitters are chemicals that carry messages between neurons.
Serotonin is
a neurotransmitter that helps regulate sleep, appetite,
moods and inhibits pain. It is primarily produced in
the gastrointestinal
tract, which is lined with millions of nerve cells, or neurons. This
means that our digestive systems don’t just help us digest
and absorb our food, but also play a significant role in how
we feel.
How well your neurons function – and produce serotonin – is influenced
by your gut microbiome, which thrives on "good" bacteria. Good bacteria
species include Lactobacillus (in the phylum Firmicutes) and
Bifidobacterium (in the phylum Actinobacteria) and are often found in
probiotic supplements that aim to support gut
health. That good bacteria, in turn, thrives on whole foods that are
high in fiber and
full of nutrients such as leafy greens, healthy fats and whole
grains.
Is There a Best Diet for Depression?
If you have depression, what you eat might improve or worsen symptoms.
The idea is that eating a diet rich in high-quality foods
that provide significant nutrition, including Vitamins,
minerals and antioxidants, may help nourish the brain and
protect it from free radicals, or oxidative stress.
In general,
it's recommended to eat a diet featuring:
- Lots of plants, including
colorful fruits and vegetables.
- Whole grains.
- Nuts and seeds.
- Olive oil.
- Fish.
- Low-fat dairy.
This type of diet is often described as the Mediterranean
diet. Studies have shown that the risk of depression is 25% to 35%
lower in those who eat this type of diet.
A diet of whole, unrefined foods with protein, healthy fat
and fiber help to keep blood sugar stable after meals, which
positively contributes to mood.
While food won’t directly treat symptoms of depression,
following a healthy diet can support
your overall mental well-being.
Depression-Fighting Compounds
More specifically, there are a few compounds within these foods that
have also been studied and appear to have an effect on depressive
symptoms.
These include:
-
Omega-3 fatty acids, which are found in fatty fish like
salmon, sardines and mackerel. Omega-3 fatty acids are also found
in seeds and nuts, such as flaxseed, walnuts and chia seeds. Omega-3s and their role in potentially combating depression
have been studied for a long time, and some results have been mixed.
But A 2019
review study found that omega-3s do seem to help with symptoms
of depression.
-
B Vitamins found in meat, poultry, fish, eggs, dairy,
legumes, nuts, seeds and dark leafy greens. A 2020
review study found that supplementing with Vitamin B12 early can
delay the onset of depression and may improve the impact of
antidepressants when used together.
-
Vitamin D, which is also known as the "sunshine Vitamin"
because your body makes Vitamin D in the skin when it's exposed to
ultraviolet light. A 2022
study found that Vitamin D supplementation had a positive effect
on depression symptoms. Vitamin D is good for overall mood. It can be found in fortified foods such as orange juice and
cereal, dairy products, salmon, cod liver oil and eggs.
-
Magnesium, which is
a vital nutrient for supporting
brain health. It supports healthy neurons and the manufacture of
neurotransmitters the brain needs so those cells can relay messages
to each other. A 2017
study noted that magnesium supplementation was found to be very
helpful in alleviating symptoms of depression and anxiety. Whole
grains, dark leafy greens and dried beans and legumes are
good sources of magnesium.
-
Folic acid, a B
Vitamin that’s critical to brain health, especially in developing
babies, which is why it’s a key component of
prenatal Vitamin supplements. A 2021
review study found that folic acid can augment the effect of
some antidepressant medications.
-
Zinc, which is also an
important nutrient that supports normal neural function. An
association between zinc deficiency and psychiatric illness has
been noted.
A small 2013
study noted that zinc supplementation, when used in conjunction
with antidepressant medications, improve major depressive disorders
more than treatment with antidepressants alone.
-
Antioxidants, which are found in fruits and vegetables,
may also play a role in reducing anxiety and depression symptoms. A large,
longitudinal study recently conducted in Brazil found a clear
association between higher intakes of antioxidants and lower odds of
developing depression. Another 2020 review
study that looked at polyphenols, a type of antioxidant, also
found a positive connection between higher intake of these compounds
in the context of a Mediterranean
diet and reduced risk for and symptoms of depression.
Mood-Dampening Foods to Limit
Consulting with your primary care physician or a registered dietician
about foods to limit is recommended if you have depression. Knowing
what foods to eat less of for improved mental health is helpful, typically never avoid
foods. Instead, talk about knowing what are ‘sometimes’ foods and what
are ‘anytime’ foods so that you do not inadvertently set up
a system of food deprivation that might make certain foods
seem more tempting and, therefore, if you eat them, make you
feel guilty or have thoughts about being a ‘bad’ person.
Some foods to consider limiting include:
-
Added sugars. Sweets and
other foods with added refined sugar or flours, such as pastas,
white bread, pastries and rich desserts, can all impact brain health
and create spikes and crashes in blood sugar levels that can affect
your mood.
-
Highly processed meats. A 2020
review study found a significant connection between high levels
of consumption of red or highly processed meats and depression,
which may be related to these foods’ ability to increase inflammation throughout
the body. Since pro-inflammatory foods can worsen depression
symptoms, it's best to minimize your intake whenever
possible.
-
Alcohol. While alcoholic beverages might make you
feel festive in the moment, they actually have a depressant effect
on the body. If you feel down in the dumps the morning after a big
night out, you’re not alone. It’s not just the loss of sleep you’re
feeling; the depressive impact of the alcohol you consumed is also
likely causing a dip in your mood.
How to Start Eating Better When You’re Depressed
There’s never a bad time to start incorporating more whole
foods into your diet. Sometimes changing what you eat or how
you eat might feel overwhelming, especially if you are in
depression, when everything can feel overwhelming.
If that’s the case, making a small goal to eat just one
more piece of fruit, an additional vegetable or serving of whole grains
than you did the day before. That’s "significant progress, and if you
aren’t able to meet your goal, that’s OK; you can try again the next
day.
Over time, small changes start to add up, and you may notice that you’re
feeling better.
These improvements may include:
- Feeling more energetic.
- Sleeping better.
- Feeling less sluggish.
- Feeling lighter or more upbeat.
- Thinking more clearly.
Starting to notice these types of changes can help you recognize your
progress and give you the ability to keep up changes and introduce new
ones.
In addition to talking about what to eat,
proper nutrition also includes a discussion of the number of
meals to eat per day.
That number can vary based on individual goals; for example, someone
who’s trying to lose weight may be advised to eat five times per day.
For someone who is not wanting to lose weight and is wanting to follow
a healthy dietary regimen, eating three times per day is significantly
important, The time of the last meal is also very important. The last
meal of the day should be at least three hours before
someone is going to bed.
If you’re prone to emotional eating or using food to cope with difficult
emotions, You should learn to eat mindfully. Eating mindfully
means paying attention while you're eating, so taking your time,
savoring each bite and not eating in front of the television. He also
suggests addressing feelings and resolving to consume a healthy
diet because it can help you get out of that cycle of emotional
eating. A dietitian or therapist can help you learn to eat more
mindfully and find healthier coping strategies when the going gets
tough.
Food Can’t Do It All
Lastly, while eating a healthy diet can support your
efforts to manage depression, a dietary regimen alone is not sufficient
to promote good health. You should seek help from your primary care
provider or a mental health professional to get appropriate treatment
for any mental health concerns.
It's also recommended several other good living habits that can help
keep depression in check, such as:
-
Practicing good sleep hygiene. Good
sleep hygiene involves no blue-screen activities, including cell
phone, laptop or television, for two hours prior to going to sleep,. Instead, reading a book or listening to
soothing, soft music.
-
Controlling stress. Reducing
stress can help you better cope with feelings of depression. One way
to do that is by practicing
mindfulness at least twice a day. Mindful
activities that can help you reduce stress include taking
a walk, meditating, practicing yoga breathing or engaging in any other relaxing practice
that helps bring down your anxiety levels.
-
Exercising at least 30 minutes
per day. Any kind of exercise can help, even just a 30-minute
walk around the neighborhood, One way to get into that
discipline is to set your cell phone timer for 15 minutes and begin
walking away from your home at a fast, steady pace. Exercise does
not need to include a gym membership, at least in the
beginning. When the alarm goes off, head back home. As you get used
to that routine, you may want to expand or pick up a smartwatch
or fitness monitor to keep closer track of your exercise
statistics.
One Final Note..
Depression is a common condition that affects millions of
people every year. Anyone can experience depression — even
if there doesn’t seem to be a reason for it. The good news
is that depression is treatable. If you have symptoms of
depression, talk to your healthcare provider. The sooner you
get help, the sooner you can feel better.
Treatment of depression has become quite sophisticated and
effective. The prognosis with treatment is excellent. The
intensity of symptoms and the frequency of episodes often
are significantly reduced. Many people recover completely.
When treatment is successful, it is important to stay in
close touch with your doctor or therapist, because
maintenance treatment is often required to prevent
depression from returning.
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