The symptoms of depression include:

• Sadness
• Empty feeling
• Anger
• Irritability
• Withdrawal from activities that make you happy
• Trouble sleeping or excessive sleeping
• No energy; feeling tired all the time
• Lack of appetite
• Food cravings
• Weight loss or gain
• Restlessness
• Anxiety and worry
• Slow thoughts and slowed speech
• Feeling worthless
• Guilt
• Self-blame
• Foggy thinking
• Inability to concentrate
• Memory loss
• Suicidal thoughts
• Physical pain that cannot be explained; migraines; joint pain

If you do have thoughts of suicide, it is important to tell someone you trust. Emergency intervention can help you learn strategies to get through these difficult episodes.

You are not alone! You can get through this. The National Suicide Prevention Lifeline answers calls for help 24 hours a day at 1-800-273-8255.

Depression is a period of sadness, feeling blue, or withdrawal from usual activities that lasts more than a few days. The symptoms prevent you from going about your usual routine and affect eating and sleeping habits. Chronic depression is a group of depressive disorders that are categorized into the following types:

Major depressive disorder. This may happen only once or reoccur several times over your lifetime. During an episode of major depression, the symptoms may last anywhere from a couple of weeks to up to a year. This depressive disorder may affect your ability to perform work, eat, sleep, and engage in social activities.

Persistent depressive disorder. This is an episode of mild to severe depression that lasts for at leasttwo years.

Seasonal affective disorder. This is commonly known as, SAD and affects people during the dark half of the year from October through February. Studies have attributed SAD to less sunlight and vitamin  D levels in the body which affect the levels of serotonin and dopamine (the “happy” chemicals) in the body.

Bipolar disorder. Characterized by mood cycles that range from severe depression to extremely good moods and hyperactivity. The cycles may last from days to weeks to months long. Others can experience “rapid cycling” where moods swing quickly from one extreme to the other.

Psychotic depressive episodes. During an episode of severe depression, people may experience delusions or hallucinations. They may be out of touch with reality, hear things, or see things that are not happening.

Postpartum depression. Around 10 to 15% of new mothers go through a period after the birth of a baby where they suffer severe depression. This is thought to be due to hormonal shifts in the body and the physical burden of healing and caring for a newborn in a culture that isolates the mother. Postpartum depression can either be mild “baby blues” or severe depression that needs treatment.

Depression can have many different causes. Factors that contribute to episodes of depression include:

Genetics. There is ongoing research into the family history of depression. Researchers have found that depression is more common when there is a family history, which suggests a genetic component.

Brain chemicals. Researchers have found that people with long-lasting depression have biological and chemical differences in the brain. Symptoms of depression are often caused by a chemical imbalance of the neurotransmitters serotonin, epinephrine, and dopamine.

Emotional trauma. Depression can be triggered by emotional trauma including divorce, stress, a recent death, relationship break-up, or abuse.

Hormonal changes. Hormonal changes can bring on symptoms of depression including thyroid disease, pregnancy, birth, or menopause.

Brain structure. There is an association between decreased frontal lobe activity and depression.However, it not clear whether this causes depression or vice versa.

Your risk for depression is higher if you have one or more of the following:

• Family history of depression
• Chronic physical illness (heart attack, cancer, stroke, thyroid disease)
• Previous major depressive episode
• Traumatic life changes
• Stress
• Lack of supportive relationships
• Low self-esteem
• Anxiety disorder
• Lowincome
• You are female
• You are either elderly or a young adult
• History of a sleep disorder
• Medication use (pain medications, tranquilizers, steroid use, seizure medications)

There are several treatments for depression depending on the type and severity. Often, mild depression can be treated with counseling, while more severe cases may need medications, The ideal treatment is a combination of talk therapy and medications to improve symptoms. In some cases, hospitalization may be required to stabilize the episode. Possible treatments may include one or more of the following:

Counseling/therapy. A counselor will talk with you about your symptoms and how you are feeling. They may ask about life events that trigger episodes. After you learn about your triggers, the therapist may teach you coping skills using techniques such as:

• Cognitive-behavioral therapy (CBT)
• Dialectic behavioral therapy (DBT)
• Mindfulness technique
• Interpersonal therapy
• Acceptance and commitment therapy

Medication therapy. Medications for depression include antidepressants, mood stabilizers, and possible antipsychotic medications.

Antidepressants come in many different forms. These include:

Selective serotonin reuptake inhibitors (SSRIs). These are the most prescribed antidepressants. They work by blocking the reabsorption of serotonin in the brain.

Serotonin and norepinephrine reuptake inhibitors. (SNRIs)SNRIs block both the reabsorption of serotonin and norepinephrine in the brain.

Norepinephrine and dopamine reuptake inhibitors (NDRIs).NDRIs block the reabsorption of norepinephrine and dopamine and have fewer sideeffects.

Atypical antidepressants. Atypical antidepressants can help with insomnia and sleep problems because they cause sedation and are taken at bedtime.

Tricyclic antidepressants. These are older antidepressants with an elevated risk of sideeffects and are not as commonly used at this time. Newer SSRIs and SNRIs tend to have fewer sideeffects. These medications are not used unless SSRIs are ineffective.

Monoamine oxidase inhibitors (MAOIs).These are rarely used because of severe sideeffects that can have serious complications. A special diet must be followed, and many medications interact with MAOIs.

You may have to try several medications to find the right one. It also takes two to six weeks to adjust to many of these medications and feel the benefits.

Inpatient treatment. Severe episodes may require inpatient hospitalization, therapy, and medications. If you have felt suicidal or are unable to take care of yourself, you will need to be in a safe setting. Inpatient treatment usually offers group therapy, private therapy, and activities. You may likely be started on medication trials to works best for you. When you are feeling stable you will be discharged home and referred for outpatient care.

There are some alternative remedies for depression that may be helpful in mild cases. Negative side effects and interactions with current medications can occur, so remember to talk to your doctor before incorporating any alternative remedies into your treatment plan. These include:

St. John’s wort. This herbal remedy is an ancient treatment for depression. The Food and Drug Administration (FDA) has not approved it for depression in the United States, but some European countries use it as a medical treatment. Some research shows that it may help with mild depression, but it does have sideeffects and drug interactions. It cannot be taken with other antidepressants, immunosuppressant medications, blood-thinners, AIDSmedications, chemotherapy, or contraceptive pills.

Omega-3 fatty acids. This supplement is safe in small amounts but can interact with blood-thinning drugs. The best way to get Omega-3 fatty acids is to eat foods high in this fatty oil like salmon, walnuts, and flax seeds.

SAMe. SAMe is naturally made by your own body, but there are synthetic forms that some people use to treat depression. It is not approved by the FDA. This supplement is still under clinical evaluation for depression.

Saffron. There may be some benefits with saffron for depression. It needs to be used in very small amounts because too much can cause major sideeffects.

Vitamin C. Some studies show that if you have low levels of vitamin C in your body, taking extra vitamin C may help improve low mood symptoms.

Talk to a trusted source. If you find yourself stressed, feeling down, or withdrawing from usual activities, talk to someone you trust. Sometimes just talking about your feelings to someone can help prevent the onset of depression.

Find ways to relieve stress. Take up activities that relieve stress and keep your mind busy.

Eat healthily. Certain deficiencies in vitamins and nutrients lower how your body deals with stress. Make sure you eat plenty of foods that are high in B vitamins, vitamin C, and healthy fats.

Get enough sleep. Being sleep deprived can increase the chances of depression. Your body needs time to rest and recharge both physically and emotionally. Sleep deprivation in new mothers is one of the factors that contribute to postpartum depression. Ask for help when you need it.

Get to know your triggers. Talk with your therapist to identify any triggers which lead to episodes and develop a plan to avoid them. You will always plan your approach to handling them when they cannot be avoided. Form a plan of action.

Exercise. Exercise can help relieve anxiety and give you energy.

Diet. Eat plenty of fresh fruits and vegetables. Increase your intake of fish that contain high amounts of Omega-3 fatty acids, like salmon.

Spend time outdoors. Spend time outside in nature to improve your sense of wellbeing.

Create a support system. Surround yourself with supportive people by engaging in support groups and community events.

Meditate. Meditation can help you connect with yourself and improve your emotional state. Studies show meditation improves brain function and thinking.

Take time for yourself. If you are overstressed, take time for yourself and break away from the things that are getting you down.

The National Institute of Mental Health (NIMH) is a central research center that conducts several research studies for mental health. If you are interested in joining a mental health research study you can contact the NIMH information resource center at 1-866-615-6464. The steps to taking part in a study include calling the research study team to find out about the details of the study. You will be evaluated for eligibility and,if you are selected, sign a consent form to participate. Most studies take place at the NIH Clinical Center hospital in Bethesda, Maryland. If you qualify for a study and receive treatment you may have transportation provided at no cost to you or your insurance plan.

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