Depression

Alternative names:

blues; dejected; discouragement; gloom; mood changes; sadness

Home care:

For mild or short-lived depressive symptoms, improving health habits to provide adequate and regular sleep and good nutrition may bring relief. Regular exercise has been proven effective in reversing mild depression, and is also important in relieving more severe depression. Decrease the use of alcohol and other drugs, since these can aggravate depressive symptoms. Involvement with healthy pleasures such as recreation and creative activities is a better alternative.

Get support from people in your family and social network. Being reminded that other people care helps to relieve the isolation that often accompanies depressed feelings. Talking to someone about your worries or concerns can put them into perspective. Discussion with clergy or spiritual advisers may give meaning to painful experiences, and prayer or meditation can access internal sources of strength.

If you recognize that you are chronically pessimistic and self-critical, self-help workbooks to combat depressive thinking may be helpful. These usually involve a program of exercises to identify distorted perceptions and substitute more realistic ones.

Some people find the use of herbs or nutritional supplements beneficial. Research supports the usefulness of St. John's Wort (hypericum) in treating mild to moderate depression. However, since herbal products are not regulated as closely as medications, the amount of active ingredient may vary from one preparation of hypericum to another.

Call your health care provider if:

• depression disrupts work and family life for more than 2 weeks.
• depression is so severe that suicide is contemplated. Do not hesitate to call for help immediately! If your primary health care provider can't be reached, many communities have telephone hotlines for such situations. If there is no such service nearby, call the nearest emergency room or health-care facility.
• you think that current medication may be causing depression.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed to determine if the cause of depression is physical.

Expect some exploration of the issues and events associated with depression. Medical history questions may include such questions as:

• quality
  • Is the person extremely depressed?
  • Is the depression severe enough to impair occupational or social functioning?
• time pattern
  • How long has the depression lasted?
  • Is depression constant or through most of the day?
• aggravating or triggering factors
  • What is the social life like?
  • What events have occurred in the person's life?
  • What are the relationship(s) with significant other(s) like?
• other
  • What medications does the person take?
  • Is alcohol used?
  • What street drugs are used?
  • What other symptoms are also present? (difficulty thinking and concentrating, changes in sleep, appetite, etc.)?
• suicidality
  • Has there been a suicide attempt?
  • How often has suicide been attempted?
  • Are there plans to commit suicide?

Treatment will vary according to the cause and severity of the depressive symptoms, as well as patient preference. If medications are being used that could cause depression, they may be changed. DO NOT CHANGE YOUR MEDICATIONS WITHOUT CONSULTING WITH YOUR HEALTH-CARE PROVIDER.

For mild depressive symptoms, counseling may be recommended, as well as some of the self-care measures mentioned above.

For moderate to severe depression, antidepressant medication may be prescribed (see major depression (hyperlink) for more information about antidepressants). Psychotherapy may also be recommended. Several types of focused psychotherapies have been developed that are as effective as medication in treating depression. The choice of medications, psychotherapy, or both can be made based on patient preference and the availability of these treatments. In order to avoid recurrent bouts of depression, it is important to finish the course of treatment.

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

After seeing your health care provider:
You may want to add a diagnosis related to depression to your personal medical record.

Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director, Utah Health Informatics and adam.com editorial