What is Depression?
Depression (also known as major depression, major depressive disorder, or clinical depression) is a complex mood disorder lasting at least 2 weeks, with sad, “blue” mood that may or may not be accompanied by the loss of interest or pleasure in nearly all activities, nearly every day.
People with depression describe a wide variety of negative emotional experiences, ranging from sadness to disinterest in pleasurable activities to self-hate. No description of depression is complete without addressing the psychological pain and suffering of depression. Yet the pain of depression can be difficult to express. The depressed person may make vague references to “hurting or “feeling bad.” Other common presentations can also include unexplained fatigue, irritability, anger, anxiety, and hyperactivity. While symptoms of depression may vary, the two most prominent are sadness and apathy.
Symptoms
Symptoms must be present in the same 2-week period and represent a change from previous functioning and can include the following:
- Depressed mood – feelings of “sadness” or “hopelessness”
- Irritability
- Diminished interest or pleasure in most activities
- Insomnia or hypersomnia
- Change in appetite – weight loss or gain
- Fatigue or loss of energy
- Indecisiveness or lack of concentration
- Difficulty or slowed thinking
- Slowed movements or speech
- Feelings of worthlessness or guilt
- Thoughts of death or suicide
Risk Factors
Recent stressful life events are the most powerful predictors of onset of a depressive disorder. The other risk factors might be:
- Prior episodes of depression
- People without close interpersonal relationships
- Losing a parent before age 11
- Strong family history of depression
- Alcohol abuse or other substance abuse
- Current or past medical condition – migraines, back pain, recent heart attack, insomnia
- Stress
- Postpartum period
- Significant psychosocial stressors such as divorce, job loss, trauma, financial issues or abuse
Treatment
The use of suitable antidepressant medication and/or psychotherapy are the mainstays of treatment for depression today.
Identification of support needs and establishing a routine can also be a highly effective adjunct therapy for many.
Symptom relief and symptom remission should be the standard for successful treatment of depression. With medical treatment alone, about 7 out of 10 individuals with major depression will obtain symptom relief. It should be noted that, in some cases, the combination of psychotherapy and pharmacotherapy may be more effective than either alone.
When considering how long to continue medication, several factors need to be evaluated, like the number of depression episodes and symptom worsening. Generally, medical therapy for depression might take about 4-12 months for the 1st episode of the condition until remission is reached. Individuals with recurrent depressive disorder may undergo a longer treatment that can last for 2-3 years until symptom remission. Remission is defined to be a two-month period devoid of major depressive signs and symptoms.
Medications that are effective in the front-line treatment of depression are:
- Selective Serotonin Reuptake Inhibitors (SSRIs) such as Escitalopram (Lexapro), Fluoxetine (Prozac), Sertraline (Zoloft).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Norepinephrine reuptake inhibitors (NRIs) (might be a better option to patients who are sensitive to the powerful serotonin activity produced by the SSRIs.)
- Tricyclic antidepressants (TCAs) such as amitriptyline (Elavil), (They are used less frequently as a first-line agents, however they are not less effective than newer antidepressant medications. )
New Medications
There have been important advances in the last years relating to new understanding of the mechanism of depression and to the development of new drugs. As a result, more drugs for depression therapy were introduced to the market, providing patients with more treatment alternatives.
In 2019, the FDA approved Esketamine, an anesthetic spray for people with treatment-resistant depression. The spray must be used in conjunction with a conventional antidepressant, and treatment has to be done under doctor observation.
Another notable development is Auvelity, a rapid-acting treatment approved for the treatment of major depressive disorder. In addition, it serves as an oral alternative to Esketamine with fewer side effects.
Another breakthrough drug, Brexanolone (Zulresso), came out in 2019. It is the first drug that treats postpartum depression, which is a type of depression that occurs after giving birth. The drug is administered through a vein at a clinic over the course of 60 hours. The drug is designed to work quickly, and an improvement in depressive symptoms can be observed at the end of the first treatment.
Help is Available
If you have been feeling down or have had little interest in doing things over past month, it is important to discuss your feelings this with a licensed medical health professional.
We invite you to use the following depression questionnaire to self-assess your level of distress. However, this assessment should not be used as a replacement for professional help.
If you are having suicidal thoughts, call or text the National Suicide Prevention Line (https://www.samhsa.gov/find-help/988) at 988 for 24/7 crisis counseling.
If you or loved one are in immediate danger, call 911
Personalized Depression Self-Assessment.
