Depression

Alternative Names

Blues; Discouragement; Gloom; Mood changes; Sadness; Melancholy

Home Care

If you are depressed for 2 weeks or longer, you should contact your doctor, who can offer treatment options. Regardless of whether you have mild or major depression, the following self-care steps can help:

• Get enough sleep.
• Follow a healthy, nutritious diet.
• Exercise regularly.
• Avoid alcohol, marijuana, and other recreational drugs.
• Get involved in activities that make you happy, even if you don't feel like it.
• Spend time with family and friends.
• Try talking to clergy or spiritual advisors who may help give meaning to painful experiences.
• Consider prayer, meditation, tai chi, or biofeedback as ways to relax or draw on your inner strengths.
• Add omega-3 fatty acids to your diet, which you can get from cold-water fish like tuna, salmon, or mackerel.
• Take folate (vitamin B9) in the form of a multivitamin (400 to 800 micrograms).

If your depression occurs in the fall or winter months, try light therapy using a special lamp that mimics the sun.

Many people try a popular over-the-counter herb called St. John's wort. Some studies do suggest that this herbal remedy may be helpful for mild depression, but not moderate or severe. Be aware that St. John's wort has potential drug interactions and should NOT be taken with prescription antidepressants, birth control pills, protease inhibitors for HIV, theophylline, warfarin, digoxin, reserpine, cyclosporine, or loperamide. Talk to your doctor if you are thinking about trying this herb for mild depression.

If you have moderate to severe depression, the most effective treatment plan will likely be a combination of counseling and medication.

When to Contact a Medical Professional

Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others.

Call your doctor right away if:

• You hear voices that are not there
• You have frequent crying spells with little or no provocation
• You have had feelings of depression that disrupt work, school, or family life for longer than 2 weeks
• You have 3 or more depressive symptoms
• You think that one of your current medications may be making you feel depressed -- DO NOT change or stop any medications without consulting your doctor
• You believe that you should cut back on drinking, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning

A complete history, a psychiatric interview, and a physical examination will be performed to try to classify your depression as mild, moderate, or severe and to see if there is an underlying, treatable cause (such as alcohol abuse or an underactive thyroid). Hospitalization is usually recommended if suicide seems possible.

Expect some exploration of the issues and events associated with your feelings of depression. Your doctor will ask you about:

• Your depressive moods and other symptoms (sleep, appetite, concentration, energy)
• Possible stressors in your life, and support systems in place
• Whether thoughts about ending your life have ever crossed your mind
• Drug and alcohol use, and about the medications you are currently taking, if any

Treatment will vary according to the cause and severity of your depressive symptoms, as well as your personal preference. The most effective therapy for moderate or severe depression is a combination of antidepressant medication and psychotherapy.

For mild depression, counseling and self-care measures without medication may be enough.

If you are taking medications for other purposes that could cause depression as a side effect, these may need to be changed. DO NOT change or stop any of your medications without consulting your doctor.

For people who are so severely depressed as to be unable to function, or who are suicidal and cannot be safely cared for in the community, psychiatric hospitalization may be necessary.

Prevention

Healthy lifestyle habits can help prevent depression, or lessen the chances of it happening again. These habits include eating properly, sleeping adequately, exercising regularly, learning to relax, and not drinking alcohol or using drugs.

Counseling may help you through times of grief, stress, or low mood. Family therapy may be particularly important for teens who feel blue.

If you feel socially isolated or lonely, try volunteering or getting involved in group activities.

References

Moore D, Jefferson J. Major Depressive Disorder. In: Handbook of Medical Psychiatry. 2nd ed. Mosby, Inc., 2004; 134-141.

Screening for Depression Recommendations and Rationale. US Preventive Services Task Force, Guidelines from Guide to Clinical Preventive Services: 3rd ed. Rockville, Md. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; May 1, 2002.

World Health Organization. The World Health Report 2001 - Mental Health: New Understanding, New Hope. Geneva World Health Organization, 2001.

Guide to Clinical Preventive Services: Screening for Depression, Recommendations and Rationale. Rockville, Md. US Preventive Services Task Force, Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. Ann Intern Med. 2002; 136(10): 760–764.

Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd ed. Arlington, VA: American Psychiatric Association; 2000.