Other health conditions. Some antidepressants may cause problems if you have certain mental or physical health conditions. On the other hand, certain antidepressants may help treat other physical or mental health conditions along with depression. For example, bupropion (Wellbutrin, Aplenzin, Forfivo XL) may help relieve symptoms of both attention-deficit/hyperactivity disorder (ADHD) and depression. Other examples include using duloxetine (Cymbalta) to help with pain symptoms or fibromyalgia, or using amitriptyline to prevent migraines.
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.
Symptoms of both conditions usually improve with psychological counseling (psychotherapy), medications, such as antidepressants, or both. Lifestyle changes, such as improving sleep habits, increasing social support, using stress-reduction techniques or getting regular exercise, also may help. If you have either condition, avoid alcohol, smoking and recreational drugs. They can make both conditions worse and interfere with treatment.
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.
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.
Regardless of ethnicity, men appear to be particularly sensitive to the depressive effects of unemployment, divorce, low socioeconomic status, and having few good ways to cope with stress. Women who have been the victim of physical, emotional, or sexual abuse, either as a child or perpetrated by a romantic partner are vulnerable to developing a depressive disorder, as well. Men who engage in sex with other men seem to be particularly vulnerable to depression when they have no domestic partner, do not identify themselves as homosexual, or have been the victim of multiple episodes of antigay violence. However, it seems that men and women have similar risk factors for depression for the most part.

People are often unclear about the differences between anxiety and depression, and confused as to which is their primary problem. Here's an explanation of the differences between anxiety and depression, and some comments on the recovery process. However, as always, if you have the troubles described in this article, you are well advised to discuss these problems with a professional therapist.


It's often difficult to come to grips with the confusion and uncertainty that characterize the problems of anxiety and depression when you keep them to yourself and try to figure it out on your own. A consultation with a professional therapist can often help you through that doubt and uncertainty. If you are in need of a therapist, there are several good national organizations which can help you find a professional in your area.
A recent report from the Centers for Disease Control and Prevention (CDC) showed an increase in suicide among people not previously diagnosed with a mental disorder, but there is a link between mental illness and suicide. Depression and other mental health conditions such as bipolar disorder, anxiety disorders, and schizophrenia are associated with an elevated risk for suicidal behavior. Among the symptoms associated with major depression are recurrent thoughts of death and suicidal ideation with or without specific plans for committing suicide. (2)

Bennabi D, Yrondi A, Charpeaud T, Genty JB, Destouches S, et al. Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental). BMC Psychiatry. 2019 Jan 30. 19 (1):50. [Medline].

Behavioral activation is the practice of gradually increasing activity to experience more pleasure and mastery in life, according to Joel Minden, Ph.D., a clinical psychologist at the Chico Center for Cognitive Behavior Therapy. The therapeutic technique is relatively new, so it has a limited amount of research backing it. Nonetheless, it did spring from cognitive behavior therapy [CBT], which has mountains of research to support its efficacy.
Monoamine oxidase inhibitors (MAOIs) were among the earliest treatments for depression. The MAOIs block an enzyme, monoamine oxidase, that then causes an increase in brain chemicals related to mood, such as serotonin, norepinephrine and dopamine. Examples are phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAM skin patch). Although MAOIs work well, they're not prescribed very often because of the risk of serious interactions with some other medications and certain foods. Foods that can negatively react with the MAOIs include aged cheese and aged meats.
A complete physical and psychological diagnostic evaluation by professionals will help the depressed person decide the type of treatment that might be best for him or her, including if they are in need of treatment for a physical condition that is causing or contributing to their depressed mood. However, if the situation is urgent because a suicide seems possible, having loved ones take the person to the emergency room for evaluation by an emergency-room doctor is essential. If the patient makes a suicide gesture or attempt, call 911. The patient might not realize how much help he or she needs. In fact, he or she might feel undeserving of help because of the negativity and helplessness that is a part of depressive illness.

I have also suffered a recent brain injury (concussion). Medication is not an option for my panic and anxiety symptoms. I am now taking cranio- sacral therapy providing significant relief. How I recovered from my horrific addiction to phsyco meds 10 years ago is still a very painful memory not to be easily forgotten. I am convinced & am choosing a holistic safer route instead of the dead end road of pharmaceutical therapy. God Bless. Julie
Strengthen your social support. Although you cannot control your depression diagnosis, there are some things you can control. You can seek or create a positive support system for yourself. Whether your social network stems from your spouse, family members, close friends, co-workers, religious organizations, or community groups, support is available.
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.
Some types of depression run in families, indicating an inheritable biological vulnerability to depression. This seems to be the case, especially with bipolar disorder. Researchers have studied families in which members of each generation develop bipolar disorder. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Apparently, additional factors, like a stressful environment, are involved in its onset and protective factors, like good support from family and friends, are involved in its prevention.
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.

Youth—More than a quarter of a million Canadian youth—6.5% of people between 15 and 24—experience major depression each year. Depression can be hard to recognize in youth because parents and caregivers often mistake a teen’s mood swings and irritability for normal adolescence, rather than depression. Studies have shown that gay, lesbian, bisexual or transgendered youth have higher rates of major depression.
Some of the newer antidepressant drugs, however, appear to have particularly robust effects on both the norepinephrine and serotonin systems. These medications seem to be very promising, especially for the more severe and chronic cases of depression. (Psychiatrists and other mental health professionals, rather than family practitioners, see such cases most frequently.) Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima) are four of these dual-action compounds. Effexor is a serotonin reuptake inhibitor that, at lower doses, shares many of the safety and low side-effect characteristics of the SSRIs. At higher doses, this drug appears to block the reuptake of norepinephrine. Thus, venlafaxine is an SNRI, a serotonin and norepinephrine reuptake inhibitor. Cymbalta and Pristiq tend to act as equally powerful serotonin reuptake inhibitors and norepinephrine reuptake inhibitors regardless of the dose, Fetzima even more so. They are, therefore, also SNRIs.
Common treatments for anxiety disorders 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 or anxiety, especially for those who have not found relief in symptoms through other treatment methods.
People who are depressed will usually show a style of thinking that focuses on negative views of the world. They often think of themselves as worthless and of the world as being a bad or unfair place, and they are without hope that their lives will improve in the future. When something bad happens, they blame themselves, but when good things happen, they tell themselves they are just lucky. Furthermore, people with depression are less likely to recognize and appreciate positive events when they happen; rather, they tend to be more tuned into the bad things in their lives and brood over those events.
Dr. John Grohol is the founder, Editor-in-Chief & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member and treasurer of the Society for Participatory Medicine. He writes regularly and extensively on mental health concerns, the intersection of technology and psychology, and advocating for greater acceptance of the importance and value of mental health in today's society. You can learn more about Dr. John Grohol here.
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.
There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease, in depression. In fact, the U.S. Food and Drug Administration (FDA) requires that all depression medications include a warning label about the increased risk of suicide in children and young adults. The suicide risk is particularly great during the first month to two months of treatment.

Many forms of psychotherapy are effective at helping depressed individuals, including some short-term (10-20 weeks) therapies. Talking therapies (psychotherapies) help patients gain insight into their problems and resolve them through verbal give-and-take with the therapist. Behavioral therapists help patients learn how to obtain more satisfaction and rewards through their own actions. These therapists conduct behavior therapy to help patients to unlearn the behavioral patterns that may contribute to their depression.
We’ve all felt “sad” or “blue” at one time or another. Rare bouts of depression that last only a few days are usually not a problem for most people. But, clinical depression—the type that people seek help for—is a different story. The DSM 5 uses the term “major depressive disorder” to classify and diagnose clinical depression. Major depressive episodes are the hallmark features of this type of depression. These episodes are characterized by extreme symptoms that interfere with daily functioning.

In comparison to men, women tend to develop depression at an earlier age and have depressive episodes that last longer and tend to recur more often. Women may more often have a seasonal pattern to depression, as well as symptoms of atypical depression (for example, eating or sleeping too much, carbohydrate craving, weight gain, a heavy feeling in the arms and legs, mood worsening in the evenings, and trouble getting to sleep). Also, women with depression more often have anxiety, eating disorders, and dependent personality symptoms compared to men.


See a depression expert. It's important to talk with a trained professional during your treatment. Although psychologists cannot prescribe medication, they are well-trained in psychiatric assessment and psychotherapy. You can work with a psychologist while taking antidepressants prescribed by your regular doctor, or you can see a psychiatrist for both your depression medication and talk therapy. Try to find someone who has a lot of experience helping people with treatment-resistant depression. Mood disorder experts can often be found through university-based hospitals or organizations such as the American Society of Clinical Psychopharmacology, the American Psychiatric Association, or the Depression and Bipolar Support Alliance (DBSA) "Find a Pro" online search engine.

Depression can have a significant impact on the structure and function of many parts of the brain. This can result in many negative consequences. For example, people with severe depression are at higher risk of suffering from anxiety, chronic depression, other emotional issues, or having more medical problems or chronic pain. The trouble thinking (cognitive problems) that depression sufferers may experience can persist even after the illness resolves. People with a chronic illness, such as diabetes and heart disease, who also have depression tend to have worse outcome of their medical illness.
Some of the newer antidepressant drugs, however, appear to have particularly robust effects on both the norepinephrine and serotonin systems. These medications seem to be very promising, especially for the more severe and chronic cases of depression. (Psychiatrists and other mental health professionals, rather than family practitioners, see such cases most frequently.) Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima) are four of these dual-action compounds. Effexor is a serotonin reuptake inhibitor that, at lower doses, shares many of the safety and low side-effect characteristics of the SSRIs. At higher doses, this drug appears to block the reuptake of norepinephrine. Thus, venlafaxine is an SNRI, a serotonin and norepinephrine reuptake inhibitor. Cymbalta and Pristiq tend to act as equally powerful serotonin reuptake inhibitors and norepinephrine reuptake inhibitors regardless of the dose, Fetzima even more so. They are, therefore, also SNRIs.
Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA, Sampson N, Andrade LH, de Girolamo G, Demyttenaere K, Haro JM, Karam AN, Kostyuchenko S, Kovess V, Lara C, Levinson D, Matschinger H, Nakane Y, Browne MO, Ormel J, Posada-Villa J, Sagar R, Stein DJ. Age Differences in the Prevalence and Co-Morbidity of DSM-IV Major Depressive Episodes: Results From the WHO World Mental Health Survey InitiativeExternal. Depression and Anxiety 2010;27(4):351–64 [accessed 2018 Mar 22].
It’s the Catch-22 of depression recovery: The things that help the most are the things that are the most difficult to do. There is a big difference, however, between something that’s difficult and something that’s impossible. You may not have much energy, but by drawing on all your reserves, you should have enough to take a walk around the block or pick up the phone to call a loved one.
Different neuropsychiatric illnesses seem to be associated with an overabundance or a lack of some of these neurochemicals in certain parts of the brain. For example, a lack of dopamine at the base of the brain causes Parkinson's disease. There appears to be a relation between Alzheimer's dementia and lower acetylcholine levels in the brain. The addictive disorders are under the influence of the neurochemical dopamine. That is to say, drugs of abuse and alcohol work by releasing dopamine in the brain. The dopamine causes euphoria, which is a pleasant sensation. Repeated use of drugs or alcohol, however, desensitizes the dopamine system, which means that the system gets used to the effects of drugs and alcohol. Therefore, a person needs more drugs or alcohol to achieve the same high feeling (builds up tolerance to the substance). Thus, the addicted person takes more substance but feels less and less high and increasingly depressed. There are also some drugs whose effects can include depression (these include alcohol, narcotics, and marijuana) and those for whom depression can be a symptom of withdrawal from the substance (including caffeine, cocaine, or amphetamines).

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions[18] and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, Lyme disease, multiple sclerosis, Parkinson's disease, chronic pain, stroke,[19] diabetes,[20] and cancer.[21]
Sadness that lasts a long time and a loss of enjoyment in almost all activities are the central features of depression. Sadness is a symptom, but not the same thing as depression. Everyone is sad sometimes. The type of sadness that occurs in depression lasts all day or most of the day, every day for a long time (at least two weeks). Other symptoms include feelings of worthlessness or guilt, suicidal thoughts, loss of concentration, decreased energy, slowed thinking and movement, appetite loss and sleep problems.
In major depressive disorder, these types of thoughts are persistent most of the day, more days than not for weeks on end. If an individual vacillates between a very low and very high mood state, then a diagnosis of bipolar disorder may apply. However, for any variant of a mood disorder, the low mood state is likely to be characterized by the type of thinking described above.
For treatment with antidepressants to work, a careful diagnosis has to be made first. Experts believe that some people are prescribed antidepressants unnecessarily. The fact that significantly more people take antidepressants nowadays suggests that. These medications are sometimes already prescribed for milder cases, even though there is doubt about how well they work in mild 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.


"Even more than the depression, it was my anxiety and agitation that became the defining symptoms of my illness. Like epileptic seizures, a series of frenzied anxiety attacks would descend upon me without warning. My body was possessed by a chaotic, demonic force which led to my shaking, pacing and violently hitting myself across the chest or in the head. This self-flagellation seemed to provide a physical outlet for my invisible torment, as if I were letting steam out of a pressure cooker." ~ Douglas Bloch, M.A., author of "Healing From Depression"
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.
There is no single known cause of depression. Rather, it likely results from a combination of genetic, biologic, environmental, and psychological factors. Major negative experiences—trauma, loss of a loved one, a difficult relationship, or any stressful situation that overwhelms the ability to cope—may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger. Depression is not an inherent consequence of negative life events; research increasingly suggests that it is only when such events set in motion excessive rumination and negative thought patterns, especially about oneself, that mood enters a downward spiral.
In major depressive disorder, these types of thoughts are persistent most of the day, more days than not for weeks on end. If an individual vacillates between a very low and very high mood state, then a diagnosis of bipolar disorder may apply. However, for any variant of a mood disorder, the low mood state is likely to be characterized by the type of thinking described above.
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.

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 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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