Everyone experiences a range of emotions over the course of days and weeks, typically varying based on events and circumstances. When disappointed, we usually feel sad. When we suffer a loss, we grieve. Normally these feelings ebb and flow. They respond to input and changes. By contrast, depression tends to feel heavy and constant. People who are depressed are less likely to be cheered, comforted or consoled. People who recover from depression often welcome the ability to feel normal sadness again, to have a “bad day,” as opposed to a leaden weight on their minds and souls every single day. More
It sometimes happens that a person who starts taking an anti-depressant will start exhibiting the signs of manic mood. In such cases, it's believed that the person had a latent, or hidden case of bipolar disorder which only became evident when the depressive mood was relieved by medication. Jane Pauley, the television reporter and talk show hostess, has written of her personal experience with this problem.
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.
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.
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.

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.

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]


Believed to be caused in part by a malfunction of brain chemistry, generalized anxiety is not the normal apprehension one feels before taking a test or awaiting the outcome of a biopsy. A person with an anxiety disorder suffers from what President Franklin Roosevelt called "fear itself." For a reason that is only partially known, the brain's fight-or-flight mechanism becomes activated, even when no real threat exists. Being chronically anxious is like being stalked by an imaginary tiger. The feeling of being in danger never goes away.
Reach out to other people. Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or don’t want to be a burden to others. The simple act of talking to someone face-to-face about how you feel can be an enormous help. The person you talk to doesn’t have to be able to fix you. He or she just needs to be a good listener—someone who’ll listen attentively without being distracted or judging you.

Doctors at NIMH are dedicated to mental health research, including clinical trials of possible new treatments as well as studies to understand the causes and effects of depression. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with one of our clinicians. Find NIMH studies currently recruiting participants with depression by visiting Join a Research Study: Depression.
It's also common for people who are having a difficult time with an anxiety disorder to feel depressed as a result of the way anxiety is interfering with their lives. It's my experience that most patients who experience this will find that their depression lifts naturally as a result of doing better with anxiety, and no special treatment for the depression is necessary.
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.

ECT involves the application of a brief electric current to carefully selected sites on the scalp. These electric currents, which are administered by a psychiatrist and anaesthetist, produce a minor seizure in the brain. Prior to the procedure, the person is given a short-acting general anaesthetic and a muscle relaxant to reduce awareness of the procedure and to prevent a physical seizure.
All patients are unique biochemically. Therefore, the occurrence of side effects or the lack of a satisfactory result with one SSRI does not mean that another medication in this group will not be beneficial. However, if someone in the patient's family has had a positive response to a particular drug, that drug may be the preferable one to try first.
Medical problems. Dealing with a serious health problem, such as stroke, heart attack, or cancer, can lead to depression. Research shows that people who have a serious illness and depression are more likely to have more serious types of both conditions.4 Some medical illnesses, like Parkinson’s disease, hypothyroidism, and stroke, can cause changes in the brain that can trigger depression.

The side effects of tricyclic antidepressants are often worse than the side effects of SSRIs and SNRIs. As a result, more people tend to stop taking tricyclic antidepressants: Studies found that about 15 out of 100 people did so, compared with around 10 out of 100 people who were taking SSRIs. Taking an overdose of tricyclic antidepressants is also more likely to lead to severe side effects than taking an overdose of the other antidepressants.
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.
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.

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.


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. 

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Anxiety disorders are the most common type of mental disorder. 50-60% of migraine patients will suffer from an anxiety disorder. Most anxiety disorders involve chronic worry or fear and avoiding things that trigger these feelings. In panic disorder, the patient has recurrent, unexpected feelings of intense fear or terror that seem to come from out of the blue. The heart starts beating rapidly and breathing becomes strained. Other symptoms may involve sweating, fear of dying, or losing control. Although attacks don’t last very long and are not dangerous, many people develop significant anxiety between attacks and come to fear normal body sensations.

Medical problems. Dealing with a serious health problem, such as stroke, heart attack, or cancer, can lead to depression. Research shows that people who have a serious illness and depression are more likely to have more serious types of both conditions.4 Some medical illnesses, like Parkinson’s disease, hypothyroidism, and stroke, can cause changes in the brain that can trigger depression.
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.
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.
355 million people are affected by depression, making it one of the most common disorders in the world. Over 40 million American adults are affected by anxiety, making anxiety disorders the most common mental health conditions in the United States. At McLean Hospital, we are committed to providing support for individuals with depression and anxiety through world-class treatment, innovative research into causes and cures, and robust education for patients and families, clinicians, and the broader community.
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]
Side effects: TCAs affect several neurotransmitters in the brain and, as a result, cause numerous side effects. The most common side effects include dry mouth, constipation, blurred vision, urinary retention, dizziness, tachycardia, memory impairment, and delirium. Other side effects include orthostatic hypotension, weight gain, seizures, bone fractures, sexual dysfunction, increased sweating, and increased or irregular heartbeats.
When we see a friend or family member in distress, most of us want to reach out and offer a hand. But when it comes to this kind of mental illness, all too often we remain silent, fearful of the stigma associated with the diagnosis. There is nothing to be ashamed of, and no reason not to offer to help out someone who is going through the challenges of living with this disorder.
In a structured psychotherapy, like cognitive behavioral therapy (CBT), the treatment approach for anxiety and depression can vary slightly. Naturally, CBT for these issues will teach you how to work with unhelpful thought traps. And, for either problem, CBT is likely to ask that you do more behaviorally. For anxiety, however, this is to minimize avoidant behavior and to help you disconfirm a feared consequence. For depression, this is to help you experience positive emotion, a surge in energy (even if briefly), or another type of pleasant interaction with the world (the theory being that activating behavior, even when, or especially when your energy or mood is low can result in some type of positive reward).
Schizophrenia is associated with an imbalance of dopamine (too much) and serotonin (poorly regulated) in certain areas of the brain. Finally, the depressive disorders appear to be associated with altered brain serotonin and norepinephrine systems. Both of these neurochemicals may be lower in depressed people. Please note that depression is "associated with" instead of "caused by" abnormalities of these neurochemicals because we really don't know whether low levels of neurochemicals in the brain cause depression or whether depression causes low levels of neurochemicals in the brain.
Researchers once thought the relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.
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.

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.


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
With the ECT procedure, a brain stimulation therapy, a physician passes an electric current through the brain to produce controlled convulsions (seizures). ECT is useful for certain patients, particularly for those who cannot take or have not responded to a number of antidepressants, have severe depression, and/or are at a high risk for suicide. ECT often is effective in cases where trials of a number of antidepressant medications do not provide sufficient relief of symptoms. This procedure probably works, as previously mentioned, by a massive neurochemical release in the brain due to the controlled seizure. Often highly effective, ECT relieves depression within one to two weeks after beginning treatments in many people. After ECT, some patients will continue to have maintenance ECT, while others will return to antidepressant medications or have a combination of both treatments.
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.

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.
Depending on the nature of the anxiety problem, these mental markers can vary slightly. For example, someone with generalized anxiety disorder may worry about a variety of topics, events, or activities. An individual with social anxiety disorder is more apt to fear negative evaluation or rejection by others and to be apprehensive about meeting new people or other socially challenging situations. Obsessions — unrealistic thoughts or mental impulses (sometimes with a magical quality) that extend beyond everyday worries — are the hallmark mental manifestation of anxiety in people with ​obsessive-compulsive disorder.
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.[2]  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.
Women—Depression is diagnosed twice as much in women as it is in men. Some reasons for this difference include life-cycle changes, hormonal changes, higher rates of childhood abuse or relationship violence, and social pressures. Women are usually more comfortable seeking help for their problems than men which likely means that depression in men may be highly under-reported. Men generally feel emotionally numb or angry when they are depressed whereas women usually feel more emotional.
SSRIs relieve symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which improves mood. SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, and sertraline) generally produced fewer side effects when compared with tricyclic antidepressants.  However, common side effects include insomnia or sleepiness, sexual dysfunction, and weight gain. They are considered an effective treatment for all anxiety disorders, although the treatment of obsessive-compulsive disorder, or OCD, typically requires higher doses.
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.
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