Cognitive-behavioral therapy (CBT) is one form of psychotherapy that has been shown to be successful in treating depression and anxiety disorders. CBT combines the fundamental concepts of behavioral therapy and cognitive therapy. The term “cognitive” refers to our thought process and reflects what we think, believe and perceive. Put together, CBT focuses on our behaviors and thoughts and how they are contributing to our current symptoms and difficulties.
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
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.
Physicians continue to investigate how to most effectively make treatment of depression available and acceptable to all who need it. This is particularly important for children and adolescents, minorities, individuals who are economically disadvantaged or live in rural areas, the elderly and for people with developmental disabilities, who suffer from lack of adequate access to mental health treatment that is knowledgeable and respectful of what may be their unique needs and preferences. While sadness will always be part of the human condition, hopefully we will be able to lessen or eradicate the more severe mood disorders from the world to the benefit of all of us.
High scores on the personality domain neuroticism make the development of depressive symptoms as well as all kinds of depression diagnoses more likely,[10] and depression is associated with low extraversion.[11] Other personality indicators could be: temporary but rapid mood changes, short term hopelessness, loss of interest in activities that used to be of a part of one's life, sleep disruption, withdrawal from previous social life, appetite changes, and difficulty concentrating.[12]
Bipolar Disorder: Formerly known as Manic Depression or Manic Depressive Disorder. While different from depression, bipolar disorder is often included in discussions around depressive disorders as it involves episodes of extreme lows similar to major depression. Someone with bipolar disorder, however, will swing in the opposite direction towards mania or extreme highs.
The SSRIs work by keeping serotonin present in high concentrations in the synapses. These drugs do this by preventing the reuptake of serotonin back into the sending nerve cell. The reuptake of serotonin is responsible for turning off the production of new serotonin. Therefore, the serotonin message keeps on coming through. This, in turn, helps arouse (activate) cells that have been deactivated by depression, thereby relieving the depressed person's symptoms. SSRIs have fewer side effects than the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). SSRIs do not interact with the chemical tyramine in foods, as do the MAOIs, and therefore do not require the dietary restrictions of the MAOIs. Also, SSRIs do not cause orthostatic hypotension (sudden drop in blood pressure when sitting up or standing) and are less likely to predispose to heart-rhythm disturbances like the TCAs do. Therefore, SSRIs are often the first-line treatment for depression. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), escitalopram (Lexapro), vortioxetine (Trintellix), and vilazodone (Viibryd).
Monoamine oxidase inhibitors (MAOIs) are the earliest developed antidepressants. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). MAOIs elevate the levels of neurochemicals in the brain synapses by inhibiting monoamine oxidase. Monoamine oxidase is the main enzyme that breaks down neurochemicals, such as norepinephrine. When monoamine oxidase is inhibited, the norepinephrine is not broken down and, therefore, the amount of norepinephrine in the brain is increased.
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.
See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor’s expertise, so it’s important to choose the most qualified physician.
MAOIs are older drugs that treat depression. They work by stopping the breakdown of norepinephrine, dopamine, and serotonin. They’re more difficult for people to take than most other antidepressants because they interact with prescription drugs, nonprescription drugs, and some foods. They also can’t be combined with stimulants or other antidepressants.
Women are twice as likely to become depressed as men. However, scientists do not know the reason for this difference. Psychological factors also contribute to a person's vulnerability to depression. Thus, persistent deprivation in infancy, physical or sexual abuse, exposure to community violence, clusters of certain personality traits, and inadequate ways of coping (maladaptive coping mechanisms) all can increase the frequency and severity of depressive disorders, with or without inherited vulnerability.
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

Bear in mind that while effective treatment for anxiety or depression need not be a long-term commitment, it is likely to require regular, ongoing appointments at least in the short-term (e.g., 6-12 months). Therefore, it is critical to find a professional you trust and with whom you feel comfortable speaking about your symptoms. It is equally important to make sure that you find a clinician that you can afford. Before making the commitment for ongoing care, you may want to meet with a couple of providers to get a feel for therapeutic styles/approaches and their treatment recommendations; you can then use this information to determine which path forward feels best to you.
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They are highly effective and generally cause fewer side effects than the other antidepressants. SSRIs help to alleviate symptoms of depression by blocking the reabsorption or reuptake of serotonin in the brain. Serotonin is a naturally occurring neurotransmitter (chemical) that is used by brain cells to communicate. As SSRIs mainly affect the levels of serotonin and not levels of other neurotransmitters, they are referred to as “selective.”

After years of working hard at your job each day, you’ve just been laid off. You feel sad, tired and emotionally drained. The last thing you feel like doing is getting out of bed in the morning. This sadness is a natural part of being human and feeling this way for a few days is normal. In fact, many people hear people say “I’m depressed” in their day-to-day life when they are talking about that low feeling that we can all have from time to time. But if these sad feelings last for more than a couple of weeks and you start noticing that it’s affecting your life in a big way, you may be suffering from an illness called depression.
The key to living with depression is ensuring you’re receiving adequate treatment for it (usually most people benefit from both psychotherapy and medication), and that you are an active participant in your treatment plan on a daily basis. This requires a lot of effort and hard work for most people, but it can be done. Establishing new, healthier routines are important in many people’s management of this condition. Getting regular emotional support — for instance, through an online support group — can also be extremely beneficial.

After years of working hard at your job each day, you’ve just been laid off. You feel sad, tired and emotionally drained. The last thing you feel like doing is getting out of bed in the morning. This sadness is a natural part of being human and feeling this way for a few days is normal. In fact, many people hear people say “I’m depressed” in their day-to-day life when they are talking about that low feeling that we can all have from time to time. But if these sad feelings last for more than a couple of weeks and you start noticing that it’s affecting your life in a big way, you may be suffering from an illness called depression.

It may be dangerous to take St. John’s wort if you also take other medicines. St. John’s wort can make many medicines not work at all or may cause dangerous or life-threatening side effects. The medicines used to treat heart disease, HIV, depression, seizures, certain cancers, and organ transplant rejection may not work or may have dangerous side effects if taken with St. John’s wort. St. John’s wort may also make birth control pills not work, which increases the chance you will get pregnant when you don’t want to.12 It is crucial that you tell your doctor or nurse if you take St. John’s wort.
Regular appointments with the doctor are important during treatment. There you can talk about whether the symptoms have improved and whether there are any side effects. The dose will be adjusted if necessary. By no means should you increase or reduce the dose on your own. If you do, the tablets might not work properly or they may cause more side effects.
Exercise and pleasurable activities are natural ways to improve mood. Exercise increases the levels of endorphins which can elevate mood. Foods high in omega-3-fatty acids may increase serotonin levels in the brain and contribute to relieving depression. During winter months some people may suffer from seasonal depression. Increasing exposure to light alleviates seasonal depression.
High scores on the personality domain neuroticism make the development of depressive symptoms as well as all kinds of depression diagnoses more likely,[10] and depression is associated with low extraversion.[11] Other personality indicators could be: temporary but rapid mood changes, short term hopelessness, loss of interest in activities that used to be of a part of one's life, sleep disruption, withdrawal from previous social life, appetite changes, and difficulty concentrating.[12]
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Patients often are tempted to stop their medication too soon, especially when they begin feeling better. It is important to keep taking medication therapy until the doctor says to stop, even if the patient feels better beforehand. Doctors often will continue the antidepressant medications for at least six to 12 months after symptoms are alleviated because the risk of depression quickly returning when treatment is stopped decreases after that period of time in those people experiencing their first depressive episode. Patients must stop some medications gradually to give the body time to adjust (see discontinuation of antidepressants below). For individuals with bipolar disorder, recurrent or chronic major depression, medication may have to become a part of everyday life for an extended period of years in order to avoid disabling symptoms.
For full recovery from a mood disorder, regardless of whether there is a precipitating factor or it seems to come out of the blue, treatments with medication, phototherapy and/or brain stimulation therapies, like electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), as well as psychotherapy and participation in support groups are often necessary.
^ Jeronimus BF, Kotov R, Riese H, Ormel J, et al. (October 2016). "Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. doi:10.1017/S0033291716001653. PMID 27523506.
Esketamine (Spravato) is a unique medicine originally developed as an anesthetic and thought to treat depression though its effects on a brain chemical called glutamate. It is administered as a nasal spray and is for use in those who have not responded to treatment by other antidepressants. Its most common side effects include sedation, dissociation (having strange perceptions about time and space, or feeling as if things around you are not real), problems with thinking, and high blood pressure. If any of these side effects occur they are usually mild and temporary.
Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.
Encourage the person to get a clinical evaluation. You can start by helping them to fill out our Depression and Bipolar Test. When finished, you can print the results so that the person can bring them to a clinician for further evaluation. Mention that depression and bipolar disorder are both treatable medical conditions. Often, people feel relieved to learn that they are suffering from a medical condition. Ask the person to see a medical professional, offer to make an appointment, and go with the person or call the doctor in advance to state the person’s symptoms.
In addition to seeking help from someone you trust or a mental health professional, there are other things you can do to help yourself with depression. You might not notice a difference straight away, but practising these skills each day can help overcome the ‘cycle’ of depression, where feeling bad about yourself leads you to doing less and feeling worse. Here are some self help strategies for depression.
Obsessive Compulsive Disorder (OCD) is when a person has unwanted, intrusive, persistent or repetitive thoughts (whakaaro), feelings, ideas, or sensations (obsessions) which cause anxiety. So they then carry out actions to reduce the anxiety or get rid of those thoughts. For example, the person may be afraid of germs and try to relieve the anxiety through repeated hand washing or avoiding touching things like door knobs. They may know these thoughts (whakaaro) are unreasonable but be unable to stop them. When OCD is severe and left untreated, it can be very distressing, and get in the way of work (mahi), school (kura) and normal life at home. 
Spend Time With Pets. Many depressed people find that it is comforting to spend time with their pets. Pets offer unconditional love and do not make complicated demands on depressed people. They are often great listeners (even though they don't really understand what you are saying). Feeding pets is a loving act. Taking pets for a walk (if that is appropriate) can become a regular exercise routine with multiple benefits for both pet and owner.

There are a range of ways to deal with depression, and often they are best used in conjunction with each other. The primary medical options are Cognitive Behavioural Therapy (CBT), antidepressant medication, and in some severe cases, Electroconvulsive Therapy (ECT). Education and coping strategies are also important when learning to manage your depression.
Interpersonal and cognitive/behavioral therapies are two of the short-term psychotherapies that research has shown to be helpful for some forms of depression. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with depression. A form of cognitive behavioral therapy, dialectical behavior therapy (DBT) tends to focus on intensive, simultaneous acceptance of the depression sufferer's abilities, while motivating emotionally healthy changes using a highly structured approach. This form of therapy treats severely or chronically depressed people. Psychodynamic therapies sometimes treat depression. They focus on resolving the patient's internal psychological conflicts rooted in childhood. Long-term psychodynamic therapies are particularly important if there seems to be a lifelong history and pattern of inadequate ways of coping (maladaptive coping mechanisms) by using negative or self-injurious behavior.

Another type of depression is bipolar disorder, which encompasses a group of mood disorders formerly called manic-depressive illness or manic depression. These conditions often show a particular pattern of inheritance. Not nearly as common as the other types of depressive illnesses, bipolar disorders involve cycles of mood that include at least one episode of mania or hypomania and may include episodes of depression, as well. Bipolar disorders are often chronic and recurring. Sometimes, the mood switches are dramatic and rapid, but most often they are gradual, in that they usually take place over several days, weeks, or longer.
National Institute of Mental Health: "Mental Health Medications," "Antidepressants.", Mayo Clinic: "Antidepressants: Selecting one that's right for you.", The New York Times: "Meditation Plus Running as a Treatment for Depression," "To Treat Depression, Drugs or Therapy?"; Pond5; Guido Vrola; Rocketclips, Inc.; pertusinas; Andrey Popov; Thinkstock; EpicStockMedia; AudioJungle.
Life events and changes that may precipitate depressed mood include (but are not limited to): childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, family, living conditions etc.), a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, and catastrophic injury.[6][7][8] Adolescents may be especially prone to experiencing depressed mood following social rejection, peer pressure, or bullying.[9]
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
Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition which may benefit from treatment. The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-benefit ratio is poor.[36] Physical activity can have a protective effect against the emergence of depression.[37]
There are a number of potential reasons for this. Women may be reluctant to reveal negative feelings at a time in their lives when society, family, and friends all expect them to be joyful. Women who are poor or who became pregnant unintentionally may regard symptoms of depression as a realistic response to their situation. Plus, some of the signs of depression — fatigue, changes in eating habits, sleep disturbances —are similar to the changes that many women experience as a typical part of pregnancy, making it harder to spot depression.
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
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
There are a number of potential reasons for this. Women may be reluctant to reveal negative feelings at a time in their lives when society, family, and friends all expect them to be joyful. Women who are poor or who became pregnant unintentionally may regard symptoms of depression as a realistic response to their situation. Plus, some of the signs of depression — fatigue, changes in eating habits, sleep disturbances —are similar to the changes that many women experience as a typical part of pregnancy, making it harder to spot depression.
Thyroid disease and disorder symptoms and signs depend on the type of the thyroid problem. Examples include heat or cold intolerance, sweating, weight loss or gain, palpitations, fatigue, dry skin, constipation, brittle hair, joint aches and pains, heart palpitations, edema, feeling bloated, puffiness in the face, reduced menstrual flow, changes in the frequency of bowel movements and habits, high cholesterol, hoarseness, brittle hair, difficulty swallowing, shortness of breath, a visible lump or swelling in the neck, tremors, memory problems, depression, nervousness, agitation, irritability, or poor concentration.
Sticking to your treatment plan is one of the most important things you can do. It’s easy to get discouraged in the first few weeks of treatment. You may not want to continue. All types of treatment can take a few months before you notice a difference. It’s also easy to feel like you’re doing much better and stop treatment all together. Never stop treatment without consulting your doctor first.
Another potential complication is that chronic high-functioning anxiety and depression can lead to a variety of other medical and mental health issues when left untreated. Research has shown a correlation between mental health disorder and chronic illness. Evidence points toward changes in the way certain body systems function when mental health disorders are present. Some changes include fluctuations in heart rate and circulation, increased inflammation in the body, metabolic changes, and irregularities with stress hormones. There are also increased risks of diabetes, stroke, cardiovascular disease, and substance abuse. Getting treatment quickly can help prevent high-functioning anxiety and depression from getting worse, or developing into additional medical and mental health issues.

Atypical antidepressants work in a variety of ways. Thus, atypical antidepressants are not TCAs, SSRIs, or SNRIs, but they can be effective in treating depression for many people nonetheless. More specifically, they increase the level of certain neurochemicals in the brain synapses (between nerves, where nerves communicate with each other). Examples of atypical antidepressants include nefazodone (Serzone), trazodone (Desyrel), and bupropion (Wellbutrin). Serzone has come under scrutiny due to rare cases of life-threatening liver failure that have occurred in some individuals while taking it. The United States Food and Drug Administration (FDA) has also approved bupropion (Zyban) for use in weaning from addiction to cigarettes. This drug is also being studied for treating attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). These problems affect many children and adults and restrict their ability to manage their impulses and activity level, focus, or concentrate on one thing at a time.

Rebecca, age 57, struggled with depression and had a few wake-up calls as a smoker. She felt depressed and smoked cigarettes to help her cope with her feelings. The more Rebecca smoked, the harder it seemed to quit. Rebecca finally quit smoking after getting care for her depression and realizing that she had to take care of her own health. She now leads a new, smokefree life.
Buspirone is marketed as an antianxiety medication; however, it may have antidepressant effects at doses above 45 mg/day. The antidepressant effects may increase when buspirone is used in combination with SSRIs and TCAs in patients with treatment-resistant depression. Buspirone is a partial 5-HT1A agonist with serotonergic and some dopaminergic effects in the CNS. It has anxiolytic effects but may take up to 2-3 weeks for full efficacy.
There is no shame in taking medication to manage your depression. People routinely take medication for physical ailments, and a mental illness isn’t any different. If you’re worried about the possible side effects, call your doctor to discuss them. Any medication can be tapered down or ceased, and there are different types available to suit your individual needs and chemistry.
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