A person whose primary problem is depression, rather than anxiety, generally doesn't show the same fear and uncertainty that people do with anxiety disorders. Depressed people are not so preoccupied with worrying about what might happen to them in the future. They think they already know what will happen, and they believe it will be bad, the same bad stuff that's happening to them now. The key symptoms of depression include:
Mental health researchers agree that the causes of depression are much more complex than the chemical imbalance theory suggests. A growing body of research points to other physiological factors, including inflammation, elevated stress hormones, immune system suppression, abnormal activity in certain parts of the brain, nutritional deficiencies, and shrinking brain cells. And these are just the biological causes of depression. Social and psychological factors—such as loneliness, lack of exercise, poor diet, and low self-esteem—also play an enormous role.
Some of the classic "adult" symptoms of depression may also be more or less obvious during childhood compared to the actual emotions of sadness, such as a change in eating or sleeping patterns. (Has the child or teen lost or gained weight or failed to gain appropriate weight for their age in recent weeks or months? Does he or she seem more tired than usual? Does the minor have a sense of low self-worth?)
If you tend to worry a lot, even when there’s no reason, you may have anxiety. It may be something you are so used to that you may think it’s just “how you are.” Common worries include health, money, family, or work. While everyone worries about these things once in a while, if you always expect the worst, it can get in the way of living a normal life. Though researchers are still investigating the causes of anxiety, they have identified the areas of the brain responsible for fear and anxiety and are using proven studies to increase knowledge in this field in an effort to create improved treatments for anxiety and related disorders.
Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of the neurochemical serotonin in the brain. (Remember that brain serotonin levels often are low in depression.) As their name implies, the SSRIs work by selectively inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the synapse, the place where brain cells (neurons) connect to each other. Serotonin is one of the chemicals in the brain that carries messages across these connections (synapses) from one neuron to another.
Postpartum depression (PPD) can happen a few days or even months after childbirth. PPD can happen after the birth of any child, not just the first child. A woman can have feelings similar to the baby blues -- sadness, despair, anxiety, irritability -- but she feels them much more strongly than she would with the baby blues. PPD often keeps a woman from doing the things she needs to do every day. If PPD affects a woman's ability to function, this is a sure sign that she needs to see her health care professional right away. If a woman does not get treatment for PPD, symptoms can get worse and last for as long as one year. While PPD is a serious condition, it can be treated with medication and counseling.
MOAIs are not considered first-line treatment for depression because of the side effects, drug-drug interactions, and dietary restrictions. Common side effects include hypotension, dizziness, dry mouth, gastrointestinal upset, urinary hesitancy, headache and myoclonic jerks. Because of the risk of hypertensive crisis with drugs that specifically inhibit MAOa in the gastrointestinal tract, patients on these medications must follow a low-tyramine diet.
Depressive disorders are mood disorders that come in different forms, just as do other illnesses, such as heart disease and diabetes. However, remember that within each of these types, there are variations in the number, timing, severity, and persistence of symptoms. There are sometimes also differences in how individuals express and/or experience depression based on age, gender, and culture.
The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This help may involve encouraging the individual to stay with treatment until symptoms begin to go away (usually several weeks) or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication for several months after symptoms have improved. Always report a worsening depression to the patient's physician or therapist.
Phobias are extreme and irrational fears about a particular thing. The can be so great that the person goes to great lengths to avoid it, even if it’s harmless. For example social phobia is fear of being judged or embarrassed in public, even in everyday situations like when eating, speaking at work or making small talk.  Another type is agoraphobia, often thought to be a fear of open spaces. It is also a fear of being closed in, or away from a safe place or person who makes you feel safe. It can be extremely disabling and frightening, and can leave people unable to leave their home.
Other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. For example, bupropion (Wellbutrin, Aplenzin, Forfivo XL) may help relieve symptoms of both attention-deficit/hyperactivity disorder (ADHD) and depression. Other examples include using duloxetine (Cymbalta) to help with pain symptoms or fibromyalgia, or using amitriptyline to prevent migraines.
Bipolar disorder, also known as manic depression, involves serious shifts in moods, energy, thinking, and behavior. Because it looks so similar to depression when in the low phase, it is often overlooked and misdiagnosed. This can be a serious problem as taking antidepressants for bipolar depression can actually make the condition worse. If you’ve ever gone through phases where you experienced excessive feelings of euphoria, a decreased need for sleep, racing thoughts, and impulsive behavior, consider getting evaluated for bipolar disorder.
There are various methods you could use to sooth the symptoms of depression. All of us could stand to exercise more often, but exercise is especially helpful for the depressed mind. It enables you to better handle stress, and the endorphins released during exercise give you a mental boost. Aside from the mental health benefits, the Centers for Disease Control and Prevention (CDC) report that physical activity helps you sleep better at night.
The main aim of treatment with antidepressants is to relieve the symptoms of depression, such as feeling very sad and exhausted, and prevent them from coming back. The medications are designed to restore emotional balance and help people to get on with everyday life. They are also taken to relieve symptoms such as restlessness, anxiety, sleep problems and suicidal thoughts.

An external event often seems to initiate an episode of depression. Thus, a serious loss, chronic illness, difficult relationship, exposure to abuse, neglect or community violence, financial problem, or any negative life events or unwelcome changes in life patterns can trigger a depressive episode and chronic exposure to such negative factors can result in persistent depression. People exposed to numerous and/or severe stressors as young children may develop changes in their brain structure that may make them prone to developing depression during adulthood.
A type of mild to severe depression that typically sets in as the hours of daylight wane in the fall, seasonal affective disorder (SAD) afflicts as many as 6 percent of Americans. Women are particularly at risk, experiencing SAD four times more often than men, as are people who have a relative with depression. People who live far from the equator tend to experience SAD in greater numbers — 9 percent of Alaskans versus 1 percent of Floridians, according to the National Institute of Mental Health (NIMH).
Some types of depression run in families, indicating an inheritable biological vulnerability to depression. This seems to be the case, especially with bipolar disorder. Researchers have studied families in which members of each generation develop bipolar disorder. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Apparently, additional factors, like a stressful environment, are involved in its onset and protective factors, like good support from family and friends, are involved in its prevention.
People get confused about the distinction between anxiety and depression for several reasons. The first is that, if they are receiving medication for an anxiety disorder, they're probably getting an anti-depressant medication. A group of anti-depressant medications known as the Selective Serotonin Reuptake Inhibitors (SSRI) have been demonstrated to be helpful with both anxiety and depression, and are now the preferred medication treatment for people who receive medication for anxiety disorders. Sometimes people with anxiety disorders receive these medications, find out they're taking an anti-depressant, and then wonder if that means they're depressed. It doesn't, not by itself.
Premenstrual dysphoric disorder is another manifestation of depression which is a severe and sometimes disabling extension of premenstrual syndrome (PMS). Although regular PMS and Premenstrual dysphoric disorder (PMDD) both have physical and emotional symptoms, the mood changes in PMDD are much more severe and can disrupt social, occupational, and other important areas of functioning. In both PMDD and PMS, symptoms usually begin seven to 10 days before the start of a menstrual period and continue for the first few days of the period. Both PMDD and PMS may also cause breast tenderness, bloating, fatigue, and changes in sleep and eating habits. PMDD is characterized by emotional and behavioral symptoms that are more severe, such as sadness or hopelessness, anxiety or tension, extreme moodiness, irritability or anger.
Not only does it take time to get an accurate depression diagnosis, finding the right medication to treat depression can be a complicated, delicate process. Someone may have a serious medical problem, such as heart disease or liver or kidney disease, that could make some antidepressants unsafe. The antidepressant could be ineffective for you or the dose inadequate; there may not have been enough time to see an effect, or the side effects could be too bothersome -- leading to a failure of treatment.
When you’re depressed, it can feel like there’s no light at the end of the tunnel. But there are many things you can do to lift and stabilize your mood. The key is to start with a few small goals and slowly build from there, trying to do a little more each day. Feeling better takes time, but you can get there by making positive choices for yourself.
Jacobsen PL, Mahableshwarkar AR, Serenko M, Chen Y, Trivedi M. A randomized, double-blind, placebo-controlled study of the efficacy and safety of vortioxetine 10 mg and 20 mg in adults with major depressive disorder. Program and abstracts of the 166th Annual American Psychiatric Association Meeting; May 18-22, 2013; San Francisco, California. Poster NR9-06.
Connect with others. It’s common to withdraw when you’re feeling depressed, but this can make you feel worse. Try to reconnect with friends. Again, make your goal realistic: if you’ve been avoiding your friends altogether, a starting point might be to send a text or (finally) to reply to one. If you don’t feel like leaving the house, you could ask them to come and hang out with you at home.
Nortriptyline blocks the reuptake of serotonin and, more potently, norepinephrine at the presynaptic neuronal membrane. It has less affinity for H1 and M1 receptors and, thus, is better tolerated than other TCAs. Although nortriptyline is FDA approved only for depression, it has also been prescribed for chronic pain, myofascial pain, anxiety disorders, and attention-deficit/hyperactivity disorder. As with desipramine, there is a therapeutic window for nortriptyline
Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings Cdc-pdf[PDF – 2.37MB]External. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2014 [accessed 2018 Mar 22].
If you have such thoughts, and find them disturbing, it's a good idea to discuss them with a qualified therapist. People often want to keep these thoughts to themselves, because they feel ashamed of them, and worry that a therapist will over-react and want to hospitalize them. However, these thoughts are a common part of anxiety disorders, and a therapist who is well versed in the treatment of anxiety disorders will probably be able to evaluate these thoughts and come to a realistic understanding of what they mean and don't mean. So review these with a therapist, in the same way you would review all the other symptoms you experience.
Some people with milder forms of depression get better after treatment with therapy. People with moderate to severe depression might need a type of medicine called an antidepressant in addition to therapy. Antidepressants change the levels of certain chemicals in your brain. It may take a few weeks or months before you begin to feel a change in your mood. There are different types of antidepressant medicines, and some work better than others for certain people. Some people get better only with both treatments — therapy and antidepressants.
We’ve all felt “sad” or “blue” at one time or another. Rare bouts of depression that last only a few days are usually not a problem for most people. But, clinical depression—the type that people seek help for—is a different story. The DSM 5 uses the term “major depressive disorder” to classify and diagnose clinical depression. Major depressive episodes are the hallmark features of this type of depression. These episodes are characterized by extreme symptoms that interfere with daily functioning.
People with substance use problems—There is a direct link between depression and problem substance use. Many people who are experiencing depression turn to drugs or alcohol for comfort. Overuse of substances can actually add to depression in some people. This is because some substances like alcohol, heroin and prescription sleeping pills lower brain activity, making you feel more depressed. Even drugs that stimulate your brain like cocaine and speed can make you more depressed after other effects wear off. Other factors, like family history, trauma or other life circumstances may make a person vulnerable to both alcohol/drug problems and depression.
Interestingly, the researchers propose that the way Botox may work is by preventing people from frowning. The facial feedback hypothesis — which dates back to Charles Darwin — proposes that using the muscles in your face can have an effect on your emotions. In other words, that smiling can make you happier, and frowning can make you sadder. Botox temporarily paralyzes the muscles that control frowning — and in effect, that might play a role in turning that frown upside down.
Sometimes people have prejudices about physical disability that make them feel like “second class citizens” when they become disabled themselves. Sometimes people with a disability get into the habit of letting other people do things for them and as a result they start to feel helpless. Sometimes people with a disability start to avoid situations that make them nervous (for example going out in public where others can see that they look or act differently). This makes those situations much more scary or upsetting when they can no longer be avoided.

Major depression is characterized by at least five of the diagnostic symptoms of which at least one of the symptoms is either an overwhelming feeling of sadness or a loss of interest and pleasure in most usual activities. The other symptoms that are associated with major depression include decrease or increase in appetite, insomnia or hypersomnia, psycho motor agitation or retardation, constant fatigue, feelings of worthlessness or excessive and inappropriate guilt, recurrent thoughts of death and suicidal ideation with or without specific plans for committing suicide, and cognitive difficulties, such as, diminished ability to think, concentrate and take decisions. The symptoms persist for two weeks or longer and represent a significant change from previous functioning. Social, occupational, educational, or other important functioning is also impacted. For instance, the person may start missing work or school, or stop going to classes or their usual social activities. 

There are two circumstances under which an anxiety patient may need specific help for depression. One is if he or she has become so depressed in response to anxiety that they no longer have the energy and motivation to overcome the anxiety disorder. In this case, either medication or cognitive behavioral methods can be used to help overcome the depression. The second is the case of a person who experienced a severe depression before the anxiety disorder appeared, a depression which was not just a reaction to the troubles imposed by the anxiety disorder. This depression, called a primary depression, is likely to require medication treatment.
Even though clinical depression tends to occur in episodes, most people who experience one such episode will eventually have another one. Also, it seems that any subsequent episodes of depression are more easily triggered than the first one. However, most depression sufferers recover from the episode. In fact, individuals who have mild depression and receive treatment with medication tend to respond equally as well to sugar pill (placebo). Those with more severe depression seem to be less likely to get better when taking placebo versus taking antidepressant medication. Other encouraging information is that research shows that even people from teenage through adulthood who do not improve when treated with a first medication trial can improve when switched to another medication or given another medication in addition to psychotherapy. For individuals who experience thoughts of suicide, preventing access to firearms and other highly lethal means of committing suicide are important ways to improve their safety and that of those around them.
See a depression expert. It's important to talk with a trained professional during your treatment. Although psychologists cannot prescribe medication, they are well-trained in psychiatric assessment and psychotherapy. You can work with a psychologist while taking antidepressants prescribed by your regular doctor, or you can see a psychiatrist for both your depression medication and talk therapy. Try to find someone who has a lot of experience helping people with treatment-resistant depression. Mood disorder experts can often be found through university-based hospitals or organizations such as the American Society of Clinical Psychopharmacology, the American Psychiatric Association, or the Depression and Bipolar Support Alliance (DBSA) "Find a Pro" online search engine.
MAOIs also impair the ability to break down tyramine, a substance found in aged cheese, wines, most nuts, chocolate, certain processed meats, and some other foods. Tyramine, like norepinephrine, can elevate blood pressure. Therefore, the consumption of tyramine-containing foods by a patient taking an MAOI drug can cause elevated blood levels of tyramine and dangerously high blood pressure. In addition, MAOIs can interact with over-the-counter cold and cough medications to cause dangerously high blood pressure. The reason for this is that these cold and cough medications often contain drugs that likewise can increase blood pressure. Because of these potentially serious drug and food interactions, MAOIs are usually only prescribed for people who are thought to be willing and able to manage the many dietary restrictions required by these medications and after other treatment options have failed.
Multiple sclerosis (MS) symptoms vary from person to person, and can last for days to months without periods of remission. Symptoms of MS include sexual problems and problems with the bowel, bladder, eyes, muscles, speech, swallowing, brain, and nervous system. The early symptoms and signs of multiple sclerosis usually start between age 20 and 40. MS in children, teens, and those over age 40 is rare. Treatment options for multiple sclerosis vary depending on the type and severity of symptoms. Medications may be prescribed to manage MS symptoms.
Depressive disorders are mood disorders that have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Literature and the arts have portrayed depression, also referred to as clinical depression, for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, people thought of depression as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his becoming clinically depressed.
More than 1in 6 Americans take a psychiatric drug (such as an antidepressant or a sedative). according to a 2013 Medical Expenditure Panel Survey (MEPS), which gathered information on the cost and use of health care in the United States. Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs, the study said.
Venlafaxine and its active metabolite inhibit neuronal serotonin and norepinephrine reuptake. They are weak inhibitors of dopamine reuptake. In addition, it causes beta-receptor down-regulation. Venlafaxine is sometimes prescribed for non–FDA-approved indications, such as obsessive-compulsive disorder, hot flashes, neuropathic pain, attention-deficit/hyperactivity disorder, and posttraumatic stress disorder.

Mindfulness-based therapy, self-practiced mindfulness, and meditation can reduce symptoms of depression and be effective coping tools. By living in the moment and getting in touch with your external surroundings, you can temporarily detach from the internal strife of your depression. You can also do this as part of yoga, another technique therapists frequently recommend.
Postpartum depression, in which mothers experience symptoms of major depression after giving birth. Mood impairment is much stronger, and lasts longer, than the “baby blues” — the relatively mild symptoms of depression and anxiety that many new mothers experience. Feelings of extreme sadness, anxiety, or exhaustion can make it difficult for the mother to bond with or care for her baby.
Antidepressant medications are not habit-forming, so there need not be concern about that. However, as is the case with any type of medication prescribed for more than a few days, physicians must carefully monitor antidepressant use to ensure that the patient is getting the correct dosage. The doctor will want to check the dosage and its effectiveness regularly.
Another type of depression is called Persistent depressive disorder (dysthymia). The essential feature of this mood disorder is a low, dark or sad mood that is persistently present for most of the day and on most days, for at least 2 years (children and adolescents may experience predominantly irritability and the mood persist for at least 1 year). For the individual to receive the diagnosis of persistent depressive disorder they should also have two of the diagnostic symptoms which include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, or feelings of hopelessness. During this period, any symptom-free intervals last no longer than two months. The symptoms are not as severe as with major depression. Major depression may precede persistent depressive disorder, and major depressive episodes may also occur during persistent depressive disorder.
Monoamine oxidase inhibitors (MAOIs) were among the earliest treatments for depression. The MAOIs block an enzyme, monoamine oxidase, that then causes an increase in brain chemicals related to mood, such as serotonin, norepinephrine and dopamine. Examples are phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAM skin patch). Although MAOIs work well, they're not prescribed very often because of the risk of serious interactions with some other medications and certain foods. Foods that can negatively react with the MAOIs include aged cheese and aged meats.
Total openness is important. You should talk to your doctor about all of your symptoms, important milestones in your life and any history of abuse or trauma. Also tell your doctor about past history of depression or other emotional symptoms in yourself or family members, medical history, medications you are taking — prescribed or over-the-counter, how depression has affected your daily life and whether you ever think about suicide. More
People living with high-functioning anxiety and depression may appear fine, but they are far from being as emotionally and mentally healthy as they could be. Seeking treatment is an important step to improving overall emotional and mental health to its potential level. High-functioning anxiety and depression is very treatable, but often the difficulty is in identifying the signs and symptoms and realizing there is a problem.
What we do know is certain medications that alter the levels of norepinephrine or serotonin can alleviate the symptoms of depression. Some medicines that affect both of these neurochemical systems appear to perform even better or faster. Other medications that treat depression primarily affect the other neurochemical systems. One of the most powerful treatments for depression, electroconvulsive therapy (ECT), is certainly not specific to any particular neurotransmitter system. Rather, ECT, by causing a seizure, produces a generalized brain activity that probably releases massive amounts of all of the neurochemicals.

Some 16 million Americans a year struggle with depression, an illness that comes in many forms—from major depression to dysthymia and seasonal affective disorder. In addition, depressive episodes are features of bipolar disorder. Depression is an illness that increasingly afflicts people worldwide, interfering with concentration, motivation, and many other aspects of everyday functioning. It is a complex disorder, involving many systems of the body, including the immune system, either as cause or effect. It disrupts sleep and it interferes with appetite, in some cases causing weight loss, in others weight gain. Because of its complexity, a full understanding of depression has been elusive.
The study has also gone beyond to compare the level of depressive mood between the victims and non-victims of the daily bullying. Although victims were predicted to have a higher level of depressive mood, the results have shown otherwise that exposure to negative acts has led to similar levels of depressive mood, regardless of the victim status. The results therefore have concluded that bystanders and non-victims feel as equally depressed as the victim when being exposed to acts such as social abuse.[29]
Persistent Depressive Disorder; refers to a longer lasting form of depression. While Major Depressive Disorder is diagnosed if an individual experiences symptoms for at least 2 weeks, Persistent Depressive Disorder is used when symptoms of depression are present on most days for at least two years, but do not reach the severity of a major depressive episode. (Prior to the release of the DSM-5 this was more commonly known as Dysthymia.)
Trial of sildenafil (Viagra) or other sexual-enhancement medication. Studies in men whose depression has responded to SSRI but have developed sexual dysfunction showed improvement in sexual function with Viagra. Men taking Viagra reported significant improvements in arousal, erection, ejaculation, and orgasm as compared to men who were taking placebo, although Viagra generally does not increase one's libido.
Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions[18] and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, Lyme disease, multiple sclerosis, Parkinson's disease, chronic pain, stroke,[19] diabetes,[20] and cancer.[21]
Post-traumatic Stress Disorder (PTSD) is a reaction to a highly stressful event outside the range of everyday experience when a person feels very unsafe or threatened. These are unsual experiences such as war, violent attack (verbal, physical or sexual) or a natural disaster. The symptoms usually include irritability, anxiety, flashbacks, repeated nightmares, and avoiding situations that might bring back memories of the event. 
For some people, the reduced daylight hours of winter lead to a form of depression known as seasonal affective disorder (SAD). SAD affects about 1% to 2% of the population, particularly women and young people. SAD can make you feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring.
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