Certain brain chemicals called neurotransmitters are associated with depression — particularly serotonin (ser-o-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-meen). Most antidepressants relieve depression by affecting these neurotransmitters. Each type (class) of antidepressant affects these neurotransmitters in slightly different ways.
Stay Socially Engaged. The core symptoms of depression push people to stop participating with others socially and emotionally and motivate them to isolate. It is important to work to resist these urges to isolate as best you can. Let your family, friends and associates help you. Accept invitations to social events and maintain your typical social schedule as best you can even if you are not enjoying your participation as much as you used to. Staying socially engaged provides you with social support, offers you a distraction from the repetitive negative ruminations you are otherwise going to be prone to experiencing, may offer some pleasure even if that feeling is fleeting for a while, and can provide you with opportunities for reality testing (so that you don't take your depressive ideas about how worthless you are too seriously).
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.
If the depressed person is taking more than one medication for depression or medications for any other medical problem, each of the patient's doctors should be aware of the other prescriptions. Many of these medications clear from the body (metabolized) in the liver. This means that the multiple treatments can interact competitively with the liver's biochemical clearing systems. Therefore, the actual blood levels of the medications may be higher or lower than would be expected from the dosage. This information is especially important if the patient is taking anticoagulants (blood thinners), anticonvulsants (seizure medications), or heart medications, such as digitalis (Crystodigin). Although multiple medications do not necessarily pose a problem, all of the patient's doctors may need to be in close contact to adjust dosages accordingly.
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.
Mirtazapine (Remeron), another antidepressant, is a tetracyclic compound (four-ring chemical structure). It works at somewhat different biochemical sites and in different ways than the other medications. It affects serotonin but at a postsynaptic site (after the connection between nerve cells). It also increases histamine levels, which can cause drowsiness. For this reason, patients take mirtazapine at bedtime; physicians often prescribe mirtazapine for people who have trouble falling asleep. Like the SNRIs, it also works by increasing levels in the norepinephrine system. Other than causing sedation, this medication has side effects that are similar to those of the SSRIs.
People from different cultures—Depending on your cultural background, you may have certain beliefs about depression that can affect the way you deal with it. For example, people from some cultures notice more of the physical symptoms of depression and only think of the emotional ones when a professional asks them. Attitudes from our cultures can also affect who we may ask for help. For example, in one BC study Chinese youth were twice as reluctant to talk to their parents about depression as their non-Chinese counter parts. Aboriginal people, on and off-reserve, may also have higher rates of depression, from 12–16% in a year, or about double the Canadian average.
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.
Nurture yourself with good nutrition. Depression can affect appetite. One person may not feel like eating at all, but another might overeat. If depression has affected your eating, you'll need to be extra mindful of getting the right nourishment. Proper nutrition can influence a person's mood and energy. So eat plenty of fruits and vegetables and get regular meals (even if you don't feel hungry, try to eat something light, like a piece of fruit, to keep you going).
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.
Everyone worries or gets scared sometimes. But if you feel extremely worried or afraid much of the time, or if you repeatedly feel panicky, you may have an anxiety disorder. Anxiety disorders are among the most common mental illnesses, affecting roughly 40 million American adults each year. This Special Health Report, Anxiety and Stress Disorders, discusses the latest and most effective treatment approaches, including cognitive behavioral therapies, psychotherapy, and medications. A special section delves into alternative treatments for anxiety, such as relaxation techniques, mindfulness meditation, and biofeedback.
For many people with SAD, simply waiting for spring to arrive is not an option. Light therapy, which generally involves sitting in front of a light box first thing in the morning, can help; so can cognitive behavior therapy, a type of psychotherapy. Physicians also prescribe antidepressants, usually an SSRI (selective serotonin reuptake inhibitor), a category of drug that includes Prozac and Zoloft, or Wellbutrin (bupropion). Combining a number of different approaches under the oversight of a physician may be your smartest move.
Smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population.6 About 3 out of every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions.6 Why smokers are more likely than nonsmokers to experience depression, anxiety, and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause‚ smoking is not a treatment for depression or anxiety. Getting help for your depression and anxiety and quitting smoking is the best way to feel better.
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.

Symptoms of depression and anxiety are most common among people with chronic migraine, which is when headache attacks occur on 15 or more days a month. For people with fewer headaches, depression or anxiety puts them at risk for more headaches over time. Symptoms of depression and anxiety also impact other areas of health. Migraine patients with depression or anxiety have higher medical costs, are at increased risk for suicide, and have higher levels of disability than migraine patients without depression or anxiety. Also, and perhaps most importantly, headache treatments don’t work as well when the depression or anxiety is not also being treated. Untreated patients are less likely to follow medicine or behavior treatment plans. They also show less response to headache medications, and are more likely to relapse. For these reasons, treating all these conditions is very important.

When your doctor recommends an antidepressant to fight depression—such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)—it's about more than just boosting your mood. Depression has many potential physical effects. "Most people aren't aware that depression can lead to other health problems," says Dr. Amanda Hernandez, a geriatrician at Harvard-affiliated Massachusetts General Hospital.


Mental health concerns among college students have increased in recent years—rates of depression, anxiety, substance use and suicidal behaviors have all increased. One in four college students had a psychiatric diagnosis in the past year, and racial-ethnic minority students maybe at high risk of undetected mental illnesses, according to new research published in Psychiatric Services.
A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD; commonly called major depression or clinical depression) where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Another mood disorder, bipolar disorder, features one or more episodes of abnormally elevated mood, cognition and energy levels, but may also involve one or more episodes of depression.[22] When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective disorder. Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode;[23]:355 and posttraumatic stress disorder, a mental disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[24]

Remember, antidepressants aren’t a cure. Medication may treat some symptoms of depression, but can’t change the underlying issues and situations in your life that are making you depressed. That’s where exercise, therapy, mindfulness meditation, social support and other lifestyle changes come in. These non-drug treatments can produce lasting changes and long-term relief.

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.
It is important to remember that many of these symptoms can occur with illnesses such as brain injury or stroke or even less serious problems like a cold or flu, but may not indicate depression. Even if you have trouble sleeping, lack of appetite and problems concentrating, there is no reason to be concerned about a separate mental health condition unless you also feel sad most of the time or rarely find enjoyment in life.
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.
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.
If the depressed person is taking more than one medication for depression or medications for any other medical problem, each of the patient's doctors should be aware of the other prescriptions. Many of these medications clear from the body (metabolized) in the liver. This means that the multiple treatments can interact competitively with the liver's biochemical clearing systems. Therefore, the actual blood levels of the medications may be higher or lower than would be expected from the dosage. This information is especially important if the patient is taking anticoagulants (blood thinners), anticonvulsants (seizure medications), or heart medications, such as digitalis (Crystodigin). Although multiple medications do not necessarily pose a problem, all of the patient's doctors may need to be in close contact to adjust dosages accordingly.
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.

When psychotherapy and antidepressants don’t work, clinicians may turn to other treatment options. Usually the first is to try and adjunct medication to the existing antidepressant medication. In more serious or treatment-resistant cases, additional treatment options may be tried (like ECT or rTMS). Ketamine infusion treatments also appear to be effective, but are generally not covered by insurance and the long-term risks are unknown.


One reason depression is difficult to identify is that its symptoms can vary depending on age and sex. Adults with depression generally feel overwhelmed by sadness, while depression in adolescents tends to express itself mainly as irritability. Women with depression are more likely to note symptoms like anxiety and indecisiveness, while men are more likely to report anger and aggression.

Opinions vary on how effective antidepressants are in relieving the symptoms of depression. Some people doubt they help, while others consider them to be essential. But as is true for many other treatments, these medications may help in some situations, and not in others. They are effective for moderate, severe and chronic depression, but probably not for mild cases. They can also have side effects. It is important to discuss the pros and cons of antidepressants with your doctor.


Certain medications used for a variety of medical conditions are more likely than others to cause depression as a side effect. Specifically, some medications that treat high blood pressure, cancer, seizures, extreme pain, and to achieve contraception can result in depression. Even some psychiatric medications, like some sleep aids and medications to treat alcoholism and anxiety, can contribute to the development of depression.
All antidepressants can have side effects, but some may be more problematic than others. Guided by your doctor, you may need to try several different drugs before you find the one that’s best for you. Keep in mind that they do not work immediately and usually take at least several weeks for maximal benefit. Combining the right medication with psychotherapy or another intervention, like a support group, might be what you need to feel better.
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

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.
Desipramine inhibits the reuptake of serotonin and, more potently, norepinephrine at the presynaptic neuronal membrane. It is a commonly used TCA that is relatively less sedating and tends to have fewer anticholinergic and antihistaminic adverse effects than other TCAs. It is sometimes used for off-label indications such as peripheral neuropathy and attention-deficit/hyperactivity disorder.
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.

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including depression. During clinical trials, some participants receive treatments under study that might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. Other participants (in the “control group”) receive a standard treatment, such as a medication already on the market, an inactive placebo medication, or no treatment. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
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