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.
A key feature of depression is inactivity. People find that they are doing less and then feel even worse because they are doing less. Behavioural strategies for depression aim to identify and change aspects of behaviour that may worsen depression. People are encouraged to act against the depression by increasing activities, even though this is the last thing that they feel like doing. Relevant behavioural strategies include activity scheduling, social skills training, structured problem solving, and goal planning. One of the advantages of this form of treatment for depression is that once acquired, these new behavioural styles can be applied throughout life, minimising relapse or recurrence of depression.
Another brain stimulation therapy, transcranial magnetic stimulation (TMS) involves a physician passing an electrical current through an insulated coil that is placed on the surface of the depression sufferer's scalp. That induces a brief magnetic field that can change the electrical flow of the brain that is effective in easing symptoms of depression or anxiety. TMS does not require anesthesia; doctors perform TMS for a few minutes per session, five times per week over the course of four to six weeks. Side effects are usually mild and fade quickly, including scalp discomfort or headaches. It is unusual for side effects to be severe enough to cause the recipient to stop treatment prematurely. Serious side effects are rare, including worsened depression, suicidal thoughts, or actions.
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.
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.
While the majority of individuals with depression have a full remission of the disorder with effective treatment,only about a third (35.3%) of those suffering from severe depression seek treatment from a mental health professional. Too many people resist treatment because they believe depression isn't serious, that they can treat it themselves or that it is a personal weakness rather than a serious medical illness.
Parents may need to provide more comfort and support than usual for their children. It is not unusual for a child to regress to an earlier stage of development following a traumatic event. Children may find it hard to separate from parents, become clingy or emotionally needy during a hospital stay. Children usually show signs of greater independence by the time of discharge. Please talk to your physician if these problems do not improve.
Patients with generalized anxiety disorder can’t control their constant worry. They worry about life events that may never even happen. They are “worry warts” who often expect the worst possible outcome of every situation. Physical symptoms such as fatigue, trouble concentrating, and having tense muscles are common in these patients. Phobias are fears of specific objects or places, such as an intense fear of social interactions that causes the patient to avoid most social situations (social phobia). Physicians and mental health professionals assess these symptoms through interviews, surveys, and observing patient behavior.
Exercise. As mentioned above, regular vigorous physical exercise is thought to have an antidepressant effect. Exercise offers many other benefits as well, including general improvements to your health and an opportunity to socialize (e.g., in a gym or with teammates), or to be alone (e.g., on a bike or solitary hike). Exercise is also a great way to distract yourself from your thoughts as the need to attend to the physical demands of what you are doing tend to drive out self-critical thinking (at least for a little while). Check with your doctor before starting a new physical exercise program just to make sure your body is up to handling it.
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.
Tricyclic antidepressants (TCAs) were one of the first approved antidepressants. Although they are effective, they have been replaced by newer antidepressants that generally cause fewer side effects. Like SNRIs, TCAs work by blocking the reabsorption of the neurotransmitters serotonin and norepinephrine in the brain. Additionally, they block muscarinic M1, histamine H1, and alpha-adrenergic receptors.
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.
Crisis lines aren’t only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information.
Prioritize. Depression is frequently an overwhelming situation. At the same time that you are depressed and suffering, life demands do not stop. One way to reduce the amount of stress you experience is to prioritize the demands you are facing and then to attend to only the most pressing tasks. Enlist the help of other family members or friends to get the rest of your responsibilities done, or simply let them ride for a while. For instance, if you normally cook the evening meal for your family after returning home from a full day's work, perhaps you can figure out an easier way to get dinner on the table for a while (working to support the family is a higher priority than making sure that every meal the family eats is nicely balanced and well-presented).
Anxiety disorders involve more than common nervousness and worry. They can cause terrifying fear about things other people wouldn’t think twice about. Many people with anxiety disorders fully comprehend that their thoughts are irrational. But they still can’t stop them. Feelings of losing inner control haunt them. This angst is one of the entry ways for depression.2
Whether or not someone has side effects, which side effects they have, and how frequent they are will depend on the drug and on the dose used. And everyone reacts slightly differently to drugs as well. The risk of side effects increases if other medication is also being taken. One of the drugs may make the side effects of the other worse. These kinds of drug interactions are common in older people and people with chronic illnesses who are taking several different kinds of medication.
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.
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.
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
Once diagnosed, a person with depression can be treated a number of ways. The most common treatments are medication and psychotherapy. Many studies show that cognitive behavioral psychotherapy is highly effective, alone or in combination with drug therapy. Psychotherapy addresses the thinking patterns that precipitate depression, and studies show that it prevents recurrence. Drug therapy is often helpful in relieving symptoms, such as severe anxiety, so that people can engage in meaningful psychotherapy.
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.
In the practice of evidence-based medicine, it’s considered less wise to prescribe treatments that rely too heavily on hypothetical explanations for how they might work in the body. Instead, we should rely on high-quality, low-bias research that proves which treatments work best. In that light, take the Botox research — and for that matter, Celebrex and ketamine too — with a few grains of salt. The Botox review looked at a very small number of patients, and the researchers were looking at their own original clinical trials. A couple of them have ties to Botox’s maker, Allergan. All three approaches need more research on benefits and harms.
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.
The ADAA 2020 40th Annual Conference (March 19-22, San Antonio, Texas) will bring together clinicians and researchers who want to improve treatments and find cures for anxiety, depression and related disorders. Join more than 1,400 peers from across the US and around the world. Connect, share and collaborate. Choose from 160+ sessions, hear engaging keynotes, learn about cutting-edge thinking in research and clinical practice, and earn continuing education credits (CEs and CMEs). Find your professional home and leave more connected to your peers, and better able to integrate research, practice, and community. #ADAA2020
Towards the end of the treatment, the dose is gradually reduced over the course of several weeks. You may experience temporary sleep problems, nausea or restlessness while coming off the medication. These problems are especially common if you stop taking antidepressants suddenly. Sometimes people stop taking their medication as soon as they start feeling better. But doing so increases the likelihood of the depression returning. Unlike many sleeping pills and sedatives, though, antidepressants do not cause physical dependence.
You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.