Patient Information
Q: WHAT IS DEPRESSION?
Depression is more than just sadness. It takes over your life, and it makes it hard to work, study, eat, sleep, and have fun. It can make you feel lifeless, empty, helpless, hopeless, and/or worthless. If you have clinical depression, you may have some of these signs and symptoms:
- You can't sleep or sleep too much.
- You can't concentrate or find that you have trouble with easy tasks.
- You feel hopeless and/or helpless.
- You have negative thoughts and can't stop thinking them.
- You don't feel like eating, or you eat all the time.
- You feel short-tempered and irritable.
- You have thoughts that life may not be worth living.
Depression comes in many shapes and forms. Different types of depression have unique symptoms, causes, and effects. Knowing what type of depression you have helps you get better treatment.
WHAT CAUSES DEPRESSION?
Depression is complex. It is caused by a chemical imbalance in the brain and by biological, psychological, and social factors. Your lifestyle choices, relationships, and coping skills also play a role. The causes and risk factors can include loneliness, lack of social support, recent stressful experiences, relationship problems, and financial strain. Other risk factors are childhood trauma or abuse, alcohol or drug abuse, unemployment, health problems, or chronic pain.
HOW IS DEPRESSION TREATED?
The treatment for your depression must be tailored to you. Treatment may include counseling, medicine, or both. If your depression is severe, you may have to take one or more medicines. You may need counseling at the same time. If you have been depressed before, you may need both counseling and medications. If your depression is mild to moderate, you can probably be treated with either counseling or drugs. You and your health care provider will decide together whether to use medicine or counseling. When you receive the best treatment for your depression, you can expect it to last for a shorter time. You will be less likely to have ongoing symptoms or have a relapse.
HOW DOES TREATMENT WORK?
There are different types of counseling. All involve you and a licensed health care professional talking together about your feelings, relationships, and worries. During therapy, you and the therapist can discuss different ways of thinking or feeling about a situation. This often helps you to cope with your symptoms, improve your social skills, and become more self-confident.
Drugs help to restore the normal balance of chemicals in the brain. Different types of drugs—called antidepressants—can relieve symptoms. It is important to allow enough time for a drug to work. New research indicates that it may take up to 14 weeks to learn whether a medicine is working for you. You should take the medicine for at least 6 to 9 months to prevent symptoms from returning.
WHICH ANTIDEPRESSANT SHOULD I TAKE?
Many types of drugs can treat depression. The choice of which to use depends on many things, which you and your health care provider can discuss.
One type of antidepressant increases levels of a brain chemical called serotonin. Low levels of this substance may be one cause of depression. This class of drugs includes fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro). These drugs have relatively few side effects.
Another class of drugs includes venlafaxine (Effexor) and duloxetine (Cymbalta). They may work well in persons with depression and physical pain.
Mirtazapine (Remeron) is a newer antidepressant that increases the activity of two chemicals in the brain.
Bupropion (Wellbutrin) may work in people who are tired or cannot concentrate.
WHAT IF THE DRUG DOES
NOT WORK?
Many studies have been done to find out why a drug might not work and what can be done. You may need both a medication and counseling. Or you may need to address some lifestyle issues. It is also important to make sure the correct diagnosis has been made for you.
If the problem is that you are just not responding to your antidepressant, many things can be done. The dosage of the medicine may need to be increased. A drug from a different class altogether may need to be started. Or a second drug from the same class or from a different class may need to be added.
BOTTOM LINE
Depression can be treated. Together, you and your health care provider can find a way to ease your symptoms and help you return to a rich and productive life. There is help for you. JAAPA