Depression generally takes one of two major forms. Unipolar depression is what most people mean when they talk about depression: an unremitting state of sadness, apathy, or hopelessness, and loss of energy. It is sometimes called major depression. Bipolar depression, or bipolar disorder, is a condition marked by periods of depression and periods of high-energy mania; people swing between the two poles of mood states, sometimes over the course of days, sometimes over years, often with stable periods in between. 

Because depression can affect how a person acts, it might be misunderstood as a bad attitude. Other people may think the person isn't trying or not putting in any effort. For example, a negative or irritable mood can cause someone to act more argumentative, disagreeable, or angry. That can make the person seem difficult to get along with or cause others to keep their distance. Low motivation, low energy, difficulty concentrating, and thoughts of "why bother?" can lead someone to skip classes or school.
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. 

But with all three of these treatments, there is the promise of alternative medications to treat depression that might help people feel better — sometimes faster — and hopefully with fewer troubling side effects. No one treatment is right for everyone (that’s why we made our iPhone app called Start, to help people figure out if their antidepressant works), so better research into safe alternatives is important.


Depression is a serious mental health disorder that affects the whole body including mood and thoughts. It touches every part of one’s life. It is important to know that depression is not a weakness or character flaw—it is a chemical imbalance in the brain that needs to be treated. If you have one episode of depression, you are at risk of having more throughout life. Without treatment, depression can happen more often and become more serious. Scientists believe that depression doesn’t have a singular cause, but may be brought on by a traumatic event, changes in life circumstances, genetics, changes in the brain, or alcohol or drug abuse.
Research utilizing brain-imaging technologies, such as magnetic resonance imaging (MRI), shows that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behavior appear to function abnormally. It is not clear which changes seen in the brain may be the cause of depression and which ones the effect.
Perimenopause, which is the time of life immediately before and after menopause, can last as long as 10 years. While perimenopause and menopause are normal stages of life, perimenopause increases the risk of depression during that time. Also, women who have had depression in the past are five times more likely to develop major depression during perimenopause.
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Depression drains your energy, hope, and drive, making it difficult to take the steps that will help you to feel better. But while overcoming depression isn’t quick or easy, it’s far from impossible. You can’t just will yourself to “snap out of it,” but you do have more control than you realize—even if your depression is severe and stubbornly persistent. The key is to start small and build from there. Feeling better takes time, but you can get there by making positive choices for yourself each day.
Despite the popularity of social media platforms and the rapidity with which they’ve inserted themselves into nearly all facets of our lives, there’s a remarkable lack of clear data about how they affect us personally: our behaviors, our social relationships, and our mental health. In many cases, the information that’s available isn’t pretty. Studies have linked the use of social media to depression, anxiety, poorer sleep quality, lower self-esteem, inattention, and hyperactivity — often in teens and adolescents.
When in the depressed cycle, the person can experience any or all of the symptoms of a depressive condition. When in the manic cycle, any or all of the symptoms listed later in this article under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, indiscriminate or otherwise unsafe sexual practices or unwise business or financial decisions may be made when an individual is in a manic phase.
Depression and Anxiety, the official journal of the Anxiety and Depression Association of America (ADAA), welcomes original research and synthetic review articles covering neurobiology (genetics and neuroimaging), epidemiology, experimental psychopathology, and treatment (psychotherapeutic and pharmacologic) aspects of mood and anxiety disorders and related phenomena in humans.
On the other end of the spectrum, researchers are exploring a salvage medication for people with suicidal depression: ketamine, a street drug that can induce hallucinations and out-of-body experiences but that can also provide astonishingly swift relief from depression. Ketamine is currently undergoing clinical trials; meanwhile, physicians warn that this drug can be abused.
Bupropion inhibits neuronal dopamine reuptake and decreases the rate of norepinephrine activity. In addition to major depressive disorder, the indications for bupropion include smoking cessation. Off-label indications include attention-deficit/hyperactivity disorder and depression associated with bipolar disorder. Common side effects include headache and mild weight loss. Unlike other antidepressants, bupropion does not cause sexual dysfunction.

suggests exercise can be an effective treatment for depression because it’s a natural mood booster and releases feel-good hormones. However, for some people, exercise or a gym can trigger anxiety and fear. If that’s the case for you, look for more natural ways to move, such as walking around your neighborhood or looking for an online exercise video you can do at home.
People living with high-functioning anxiety and depression usually do not fit the stereotype of either disorder. In fact, many appear to be overachievers. The anxiety can serve as an energizer, driving the person towards achieving his or her goals. It’s later, when in private, that the symptoms of depression tend to emerge. Feelings of self-doubt and self-criticism, fatigue, helplessness or guilt, moodiness, and a desire to avoid interaction with others become intensified. Because the stereotypical image of depression or anxiety doesn’t match up with what people living with high-functioning anxiety and depression “look like,” it is hard to spot, even for sufferers to recognize in themselves. However, the symptoms of high-functioning anxiety and depression are the same as for non-high functioning anxiety and depression. The main difference is the ability to suppress or diminish the appearance of disruptions in life activities.
Stewart, D., & Vigod, S. (2017, August 11). Antenatal use of antidepressants and risk of teratogenicity and adverse pregnancy outcomes: Selective serotonin reuptake inhibitors (SSRIs). Up-To-Date. Retrieved from https://www.uptodate.com/contents/antenatal-use-of-antidepressants-and-risk-of-teratogenicity-and-adverse-pregnancy-outcomes-selective-serotonin-reuptake-inhibitors-ssris
All antidepressants on the market are potentially effective. [120] Usually, 2–6 weeks at a therapeutic-dose level are needed to observe a clinical response. The choice of medication should be guided by anticipated safety and tolerability, which aid in compliance; physician familiarity, which aids in patient education and anticipation of adverse effects; and history of previous treatments. Often, treatment failures are caused not by clinical resistance but by medication noncompliance, inadequate duration of therapy, or inadequate dosing.
Imipramine is one of the oldest agents available for the treatment of depression. It is demethylated in the liver to desipramine. Imipramine inhibits the reuptake of norepinephrine and, more potently, serotonin at the presynaptic neuronal membrane. It has a strong affinity for alpha-adrenergic, H1, and M1 receptors. Common side effects include orthostasis, sedation, weight gain, and anticholinergic effects. It is also used off-label in the treatment of panic disorder, posttraumatic stress disorder, and attention deficit/hyperactivity disorder.
Antidepressants are usually taken daily. The goal in the first few weeks and months is to relieve the symptoms and, if possible, make the depression go away. Once that has been achieved, the treatment is continued for at least four to nine months. This continuation therapy is necessary to stop the symptoms from coming back. The medication is sometimes taken for longer to prevent relapses. The duration of treatment also depends on how the symptoms develop over time and whether there is an increased risk of relapse. Some people take antidepressants for several years.
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.

Talk therapy involves discussing your problems and how you feel with a trained therapist. Your therapist can help you detect patterns of thought or behavior that contribute to your depression. You may be given homework, such as tracking your moods or writing in journals. This will help you to continue your treatment outside of appointments. Your therapist can also teach you exercises to reduce stress and anxiety, and help you understand your illness.
Focus on behaviors. If the person is reluctant to seek help, then don’t try to convince the person that a mood disorder is causing the problems. Instead, talk about their behaviors and the ways in which treatment can help. For example, after you have listened and sympathized with the person’s feelings, try to agree on wellness goals (e.g., consistent sleep and feeling less irritable). Then, try to assign some action steps that you can agree on to reach these goals (e.g., after two weeks, if the person does not improve, you will set up a medical evaluation).
I'm 12 years out from my TBI,and am here now reading for a recently injured friend. My heart goes out to you, those fighting through this darkness. I almost gave up. My healing really turned the corner for the better when I made exercise and slow flow, meditative yoga a daily priority. Please, please make movement a part of every single day! I'm only one voice, but research agrees: aerobic exercise reduces anxiety and depression. Group yoga was the hardest to join, but I believe it was the most beneficial. All good yoga teachers will offer modifications to help you practice safely and within any limitations. I also started daily morning walks and some gentle swimming. Sometimes I hated it, but i stuck to a routine, invited those closest to me to join sometimes, and fought to stay with it. I could feel I slept better. I now run or lap swim 5 days a week. Always. Its not about speed ( I'm super slow!) it's about brain oxigenation and cell renewal - essential for your brain's recovery, and your very soul's happiness. Yoga emphasizes rhythmic breathing, stretch, positive self acceptance, and quiet social interaction. At my lowest, I forced myself to go. Sometimes my husband even walked me in to class. We laugh about that now! No matter how low the day, I was always glad AFTERWARDS that I had gone. Believe, this will get better! Eat only healthful food, lots of fresh veggies, and add yoga and walking/running at any speed. Trust, no one is watching! I was afraid to look disabled in front of my neighbors. Really, most folks just didn't care... and now I know some are just like me: rooting for you every step of the way. There are more silent suffers of all kinds out there than we admit. My compassion for other humans grew because of the understanding this struggle forced upon me. Trust, with healthy living our brains do slowly heal. I may never be quite the same, but by golly I am plenty good enough. <3 I now run with a group too once or twice a week, and those folks have become the very best medicine I've ever encountered. Shared endorphins and sweat bring out the best in people - we were made for teamwork . Whether it's a walking group at the mall or a yoga class at the Y, please gift yourself the medicine of exercise. Namaste and love. You're going to make it past this. Lynn- TBI, 07/03/2002
Imipramine is one of the oldest agents available for the treatment of depression. It is demethylated in the liver to desipramine. Imipramine inhibits the reuptake of norepinephrine and, more potently, serotonin at the presynaptic neuronal membrane. It has a strong affinity for alpha-adrenergic, H1, and M1 receptors. Common side effects include orthostasis, sedation, weight gain, and anticholinergic effects. It is also used off-label in the treatment of panic disorder, posttraumatic stress disorder, and attention deficit/hyperactivity disorder.
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.
Many migraine patients suffer from symptoms of depression and anxiety. Migraine patients are between two to five times more likely to have these symptoms than patients without migraine. About 25% of patients with migraine have depression, and about 50% have anxiety. Some patients have symptoms of these disorders after living with migraine for years. Others develop them before migraine. At this time, scientists don’t know the exact answer why all are so common. One of the brain chemicals involved in all these conditions is called serotonin. Hormone changes in women can also trigger both conditions.

People should try to avoid mixing medications of any kind (prescribed, over the counter, or borrowed) without consulting their doctor. Patients should inform their dentist or any other medical specialist who prescribes a drug that he or she is taking antidepressants. Some medications that are harmless when taken alone can cause severe and dangerous side effects when taken with other medications. This may also be the case for individuals taking supplements or herbal remedies. Some addictive substances, like alcohol (including wine, beer, and liquor), tranquilizers, narcotics or marijuana, reduce the effectiveness of antidepressants and can cause mental health and/or physical symptoms. Patients should avoid these. These and other drugs can be dangerous when the person's body is either intoxicated with or withdrawing from their effects due to increasing the risk of seizure or heart problems in combination with antidepressants medications.
Light therapy—This treatment has been proven effective for people with seasonal affective disorder. It involves sitting near a special kind of light for about half an hour a day. Light therapy should not be done without first consulting your doctor because there are side effects to this treatment. It is being researched for use in other kinds of depression as well.
Not to be disrespectful of the good work you are providing here, but please don't say that medications help with the relief of depression and anxiety. It simply is not a true statement. These drugs cause severe damage to the human brain, nervous system, organs and are neurotoxins. I was severely damaged by them and now have a form of TBI caused by these drugs. In the online forums I'm in we call this a chemical brain injury. Psych meds should never be used to treat mental health disorders. There are alternative holistic treatments out there. The statement made that meds are not addictive is incorrect. Please do in depth research outside of mainstream websites. Contact me if you need valid true information about medications. Please don't go down the rabbit hole of psych meds. Please. They will cause you severe harm as they did me.
Left untreated, depression can be a debilitating illness for individuals and their families. Often, symptoms are not recognized for their severity and can worsen, and severe depression may lead to suicidal thoughts and actions. Common treatments for depression include individual and group therapy, and medications as appropriate. Other treatments may include TMS (transcranial magnetic stimulation) and ECT (electroconvulsive therapy), both of which have been found to have profound effects on individuals with depression, especially for those who have not found relief in symptoms through other treatment methods.
Cognitive behavioral therapy. Pain is demoralizing as well as hurtful. Cognitive behavioral therapy (CBT) is not only an established treatment for anxiety and depression, it is also the best studied psychotherapy for treating pain. CBT is based on the premise that thoughts, feelings, and sensations are all related. Therapists use CBT to help patients learn coping skills so that they can manage, rather than be victimized by, their pain.
Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These medications generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are. SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

Taking the first step is always the hardest. But going for a walk or getting up and dancing to your favorite music, for example, is something you can do right now. And it can substantially boost your mood and energy for several hours—long enough to put a second recovery step into action, such as preparing a mood-boosting meal or arranging to meet an old friend. By taking the following small but positive steps day by day, you’ll soon soon lift the heavy fog of depression and find yourself feeling happier, healthier, and more hopeful again.


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.

Invite the depressed person for walks, outings, and to the movies and other activities. Be gently insistent if the depressed individual refuses your invitation. Encourage participation in activities that once gave pleasure, such as hobbies, sports, or religious or cultural activities. However, do not push the depressed person to undertake too much too soon. The depressed person needs company and diversion, but too many demands can increase feelings of failure and exhaustion.
Selective serotonin reuptake inhibitors (SSRIs) were launched in the mid to late 1980s. This generation of antidepressants is now the most common class used for depression. Examples include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), and sertraline (Zoloft). Two medicines, classified as "serotonin modulators and stimulators" or SMS's (meaning they have some similar properties as SSRIs but also affect other brain receptors) are vilazodone (Viibryd) and vortioxetine (Trintellix) Side effects are generally mild, but can be bothersome in some people. They include nausea, stomach upset, sexual problems, fatigue, dizziness, insomnia, weight change, and headaches.
The most commonly diagnosed form of depression is Major Depressive Disorder. In 2015, around 16.1 million adults aged 18 years or older in the U.S. had experienced at least one major depressive episode in the last year, which represented 6.7 percent of all American adults. Depression is the leading cause of disability in the United States among people ages 15-44.  View the NIMH website for statistics from the 2016 National Survey on Drug Use and Health
Medication treatment of anxiety is generally safe and effective and is often used in conjunction with therapy. Medication may be a short-term or long-term treatment option, depending on severity of symptoms, other medical conditions, and other individual circumstances. However, it often takes time and patience to find the drug that works best for you.

Bipolar II disorder is a significant variant of the bipolar disorders. (The usual form of bipolar disorder is referred to as bipolar I disorder.) Bipolar II disorder is a syndrome in which the affected person has repeated depressive episodes punctuated by hypomania (mini-highs). These euphoric states in bipolar II do not completely meet the criteria for the full manic episodes that occur in bipolar I.


Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
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