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Depression (major depression)


Disease: Depression (major depression) Depression (major depression)
Category: Psychiatric diseases

Disease Definition:

One of the most famous health conditions worldwide is depression. Depression is not “weakness” and definitely nothing a person can “escape” easily. Formally called major depression, major depressive disorder, or clinical depression, depression is a medical illness that involves the mind and body.


Depression has a great impact on the way a person thinks, behaves and performs, causing a variety of emotional and physical problems. A person suffering from depression may not be able to perform his/her daily tasks and may feel like life isn't worth living.


Just like diabetes and high blood pressure, health professionals consider depression a serious illness that necessitates long-term treatment. Although most people suffer from repeated episodes of depression throughout their lives, but some people experience only one episode of depression in their whole life.


Even the most severe depression symptoms can be reduced with effective diagnosis and treatment. When effectively treated, depression may go away within a few weeks, and people may start feeling better and performing the activities that they used to enjoy.

Work Group:

Symptoms, Causes


Some of the symptoms of depression may be:


  • Irritability
  • Restlessness
  • Feeling hopeless
  • Feeling worthless
  • Having sleeping problems
  • Feeling sad or down
  • Being easily upset
  • Loss of interest in sex
  • Feeling fatigued or weak
  • Difficulty making decisions
  • Unintentional weight gain or loss
  • Trouble focusing or concentrating
  • Crying spells for no apparent reason
  • Loss of interest in normal daily activities
  • Suicidal behavior or having thoughts of suicide
  • Unexplained physical problems, such as back pain or headaches.


People experience depression in different ways, meaning that the symptoms of depression vary. Some people may feel generally miserable or unhappy without really knowing why, while others may experience severe symptoms.


The exact cause of depression is still not known. A variety of genetic, biochemical and environmental factors are thought to cause depression, just like any other mental illness.



High-tech imaging studies show that physical changes to the brain happen to people with depression. The importance of this discovery is unknown but it could help later on in pinpointing the causes. Other factors that may play a role in depression are hormonal imbalances and the naturally occurring brain chemicals that are linked to mood, called neurotransmitters.



People who have biological family members with depression are more likely to also experience it. The exact genes that cause depression still haven't been identified.



In one way or another, environment plays a causal role in depression. High stress, the death of a loved one and financial problems are some of the environmental situations that are difficult to deal with.



Depression could lead to descending twists of disability, addiction and suicide if it is left untreated. Depression could lead to severe emotional behavioral, health and even legal and financial problems. It could even destroy many aspects of a person's life.
Some of the complications that depression could lead to are:


  • Suicide
  • Anxiety
  • Alcohol abuse
  • Family conflicts
  • Substance abuse
  • Relationship difficulties
  • Work or school problems
  • Social isolation
  • Heart disease and other medical conditions.


Lots of treatments are available for depression; some of the standard treatments are:


  • Psychotherapy
  • Medications
  • ECT (electroconvulsive therapy)


Emerging and less-studied treatments include:


  • Brain stimulation
  • Complementary and alternative treatments


A primary health doctor or qualified mental health provider could help treat depression,   such as a psychiatrist, psychologist or social worker. The patient should also take part in treating their depression. Working as a team with the doctor or therapist helps the patient decide what treatment options work best. This decision is done depending on the patient's situation, symptoms and their severity, personal preferences, insurance coverage, affordability, treatment side effects and other factors. In severe cases of depression, until the patient is well enough to take part in decision making, the doctor, a loved one or a guardian might care for him/her.


Treatment options for depression:



There are dozens of medications available. To some people, the best relief of depression symptoms is by mixing medications with psychotherapy.  Some of the medications used to treat depression are antidepressants approved by the Food and Drug Administration (FDA). Doctors may also prescribe medications that aren't approved by the FDA but are effective in treating depression. This is called off-label use and is perfectly legal.


There are many antidepressants that are categorized by how effective they are on the naturally occurring biochemicals in the brain in changing mood. Doctors follow general practice guidelines to determine the best antidepressant for a particular person.  Sometimes a blood test known as cytochrome P450 test is called upon to help identify inherited factors that influence a person's response to some antidepressants and other medications.


Some factors must be taken into consideration when choosing an antidepressant such as the patient's family history of depression, their symptoms, and other conditions the patient may have.


The patient should keep searching until he/she finds an antidepressant that works best for them with only a few side effects, even if it takes a period of trial and error.


Although some antidepressants pose a higher risk of serious side effects than others, but usually most antidepressants are equally effective.

Usual first choice medications:

SSRIs (selective serotonin reuptake inhibitors) such as citalopram, escitalopram, fluoxetine, sertraline and paroxetine are usually the first medications that are prescribed for depression because they work well and their side effects are more bearable than others.
NDRIs (norepinephrine and dopamine reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), tetracyclic antidepressants, and combined reuptake inhibitors and receptor blockers are some of the other common first choice medications for depression.

Usual second choices:

TCAs (tricyclic antidepressants) work well and have been around longer than the SSRIs. However, TCAs are usually prescribed after the patient has tried SSRIs without any improvements because TCAs have more numerous and severe side effects than SSRIs.

Last choices:

When other medications haven't worked, doctors can prescribe the class of antidepressants called MAOIs (monoamine oxidase inhibitors) as a last resort. These medications have some serious harmful side effects despite the fact that they are effective. Additionally, they have rare but potentially fatal interactions with certain foods, meaning that they require strict dietary restrictions. There are newer versions of MAOIs that have fewer side effects; rather than swallowing them, the patient sticks them on their skin like a skin patch.

Other medication strategies:

Antipsychotics, mood-stabilizing medications, stimulants and anti-anxiety medications are some of the other medications that can treat depression. Augmentation is when the doctor recommends two or more antidepressants or other medications for better effect.



Unwanted side effects are caused by all antidepressants despite the fact that not all people experience the same number or intensity of side effects. In some cases, the side effects may go away or become less intense within several weeks of starting the medication, while in other cases the side effects may be so mild that the patient won't need to stop taking the medication. There are also coping strategies that can help people in managing their side effects.


Patients shouldn't stop taking their antidepressants without talking to their doctor first even if they experience unpleasant or intolerable side effects. Some antidepressants may cause withdrawal-like symptoms unless the dose is gradually decreased.



People should take some precautions when using antidepressants despite the fact that these medications have shown to be generally safe. All antidepressants are required by the FDA to carry black box warnings, which are the most strict warnings that the FDA can issue for prescription medications.


The warning notes that in some cases, particularly in the first few weeks after starting an antidepressant or when the dose is changed, children, adolescents and young adults between the ages of 18 and 24 may have increased suicidal thoughts and behavior. The warning also mentions that people in these age groups should be monitored closely by loves ones, health care providers and caregivers while taking antidepressants because of the risks mentioned above.


A dangerous drop in white cell count and liver failure are some of the serious and maybe even life-threatening conditions that some antidepressants have the potential of causing. Getting blood work or other tests on schedule and sticking to the treatment regimen is very important despite the fact that the complications mentioned above are rare. Patients should make sure that they are being properly monitored and that they understand the risks of the medications they are taking.


There are some antidepressants that may pose an increased health risk to babies in case the woman who is taking these medications is pregnant or breast-feeding. In this case, to get the symptoms of depression under control, the patient and doctor will have to work together.


In order to gain the full benefits of an antidepressant, people should continue to take antidepressants for as long as 8 to 12 weeks.


Whether or not an antibiotic will work for a person and how long it will take for the symptoms to improve are influenced by certain genetic factors. The doctor may suggest increasing the dose of the medication, switching to a new medication or combining medications in case the patient hasn't experienced an improvement in his/her mood and thoughts.



Another important treatment for depression is psychotherapy, which is usually used with medications. Psychotherapy is a general term for the type of treatment in which the patient talks to a mental health provider about his/her condition and the issues that are related to it.


Also called counseling, therapy, psychosocial therapy and talk therapy, the patient in this therapy learns about the things that are causing his/her depression in order to understand it better, finds better ways to cope and solve problems, identifies the unhealthy behavior and thoughts and changes them, sets realistic goals and explores relationships and experiences. This type of therapy will help the patient adjust to a crisis or other current difficulties, and will help them alleviate depression symptoms such as anger and hopelessness, regain a sense of happiness and take control of their lives.


Depression could be treated with several types of psychotherapy. Some of the commonly used types of therapies in treating depression are psychodynamic psychotherapy and interpersonal therapy. However, cognitive therapy in which the patient identifies negative and pessimistic beliefs and behaviors, and replaces them with positive and healthy ones, is the most commonly used therapies to treat depression.
This type of therapy believes that the way a person behaves is determined by that person's thoughts and not by the thoughts of other people or by situations. This therapy says that a person can change the way they think and start behaving in a positive way even if an unwanted situation doesn't change.



Psychiatric hospitalization for depression is needed only in some rare cases. The doctor probably won't recommend hospitalization in case the patient can be treated just as effectively or even better outside of the hospital. Usually, when a person can't care for themselves or when they're in an immediate danger of harming themselves or others, they will be recommended psychiatric hospitalization.


Residential treatment that offers a supportive place to live, partial or day hospitalization and a 24-hour inpatient care are some of the options of psychiatric hospitalization.



Electrical currents are passed through the brain in ECT in order to trigger a seizure. This will quickly stop the symptoms of depression in an effective way. However, experts don't know exactly how this therapy relieves the symptoms of depression and many people don't trust ECT and are worried of its side effects. Confusion that lasts from a few minutes to several hours is the most common side effect of this therapy. Some people may also experience a partial memory loss, which usually returns. The neurotransmitters in the brain are thought to be affected by ECT.


The only treatment for older adults who have severe depression but can't take medications due to heart disease may be ECT. Additionally, people who are at high risk of suicide and those who don't get better with medications can turn to ECT.



Someone may try these nontraditional options, also called neurotherapeutic treatments, in case standard treatments for depression don't work. They involve a direct stimulation of the brain:

TMS (transcranial magnetic stimulation):

To alter brain activity, magnetic fields are used in this experimental procedure. To produce an electrical current in the patient's brain, a large electromagnetic coil is held against his/her scalp.

VNS (vagus nerve stimulation):

In order to affect the mood centers in the brain, electrical impulses with a surgically implanted pulse generator are used in VNS. For certain cases of chronic or severe, treatment-resistant depression, the FDA has approved VNS in July 2005.

Deep brain stimulation:

The brain is stimulated with surgically implanted electrodes in this highly experimental treatment for depression.


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