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.


Depressive signs and symptoms not only include negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, excessive crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). Neurovegetative signs are the changes in functioning associated with clinical depression. This means that the nervous system changes in the brain are thought to cause many physical symptoms that result in a decreased or increased activity level and other problems with functioning.

Measures of depression as an emotional disorder include, but are not limited to: Beck Depression Inventory-11 and the 9-item depression scale in the Patient Health Questionnaire. Both of these measures are psychological tests that asks on personal questions of the participant, and have mostly been used to measure the severity of depression. Several studies, however, have used these measures to also determine healthy individuals who are not suffering from depression as a mental disorder, but as an occasional mood disorder. This is substantiated by the fact that depression as an emotional disorder displays similar symptoms to minimal depression and low levels of mental disorders such as Major Depressive Disorder, thus researchers were able to use the same measure interchangeably. In terms of the scale, participants scoring between 0-13 and 0-4 respectively were considered healthy individuals.[27] Another measure of depressed mood would be the IWP multi-affect indicator.[28] It is a psychological test that indicates various emotions, such as enthusiasm and depression, and asks for the degree of the emotions that the participants have felt in the past week. There are studies that have used lesser items from the IWP Multi-affect Indicator which was then scaled down to daily levels to measure the daily levels of depression as a emotional disorder.[29]

From 1991-2006, the suicide rate was consistently higher among males. Suicide rates declined among both sexes from 1991-2000; the rate among males decreased from 24.64 to 20.67 suicides per 100,000 and 5.48 to 4.62 suicides per 100,000 among females. From 2000-2006, however, the suicide rates gradually increased among females. Note: All rates are age-adjusted to the standard 2000 population. Rates based on less than 20 deaths are statistically unreliable. Source: Centers for Disease Control and Prevention. National suicide statistics at a glance: Trends in suicide rates among persons ages 10 years and older, by sex, United States, 1991-2006. Available at: http://www.cdc.gov/violenceprevention/suicide/statistics/trends01.html. Accessed: May 5, 2010.
Over the years, the technique of ECT has improved from the procedure that still invokes stigma in the minds of many. Physicians administer the treatment in the hospital under anesthesia so that people receiving ECT do not hurt themselves or feel emotional or physical pain during the induced seizures or at any other time. Most patients undergo six to 10 treatments. A health care professional passes an electrical current through the brain to cause a controlled seizure, which typically lasts for 20-90 seconds. The patient is awake in five to 10 minutes. The most common side effect is short-term memory loss, which usually resolves quickly. Doctors safely perform ECT as an outpatient procedure.
Some of the classic "adult" symptoms of depression may also be more or less obvious during childhood compared to the actual emotions of sadness, such as a change in eating or sleeping patterns. (Has the child or teen lost or gained weight or failed to gain appropriate weight for their age in recent weeks or months? Does he or she seem more tired than usual? Does the minor have a sense of low self-worth?)

The nerve cells in our brain use various chemicals to pass on impulses. Even though not all details are known, experts believe that depression is caused by an imbalance of certain chemicals like serotonin which then affects some nerve connections. Antidepressants aim to increase the availability of these chemicals. The various drugs do that in different ways.

The so-called "baby blues" happen in many women in the days right after childbirth. A new mother can have sudden mood swings, such as feeling very happy and then feeling very sad or angry. She may cry for no reason and can feel impatient, irritable, restless, anxious, lonely, and sad. The baby blues may last only a few hours or as long as one to two weeks after delivery. The baby blues do not always require treatment from a health care professional. Often, sharing childcare duties, maintaining contacts with loved ones, joining a support group of new moms, or talking with other moms helps.
Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Stressors that contribute to the development of depression sometimes affect some groups more than others. For example, minority groups who more often feel impacted by discrimination are disproportionately represented. Socioeconomically disadvantaged groups have higher rates of depression compared to their advantaged counterparts. Immigrants to the United States may be more vulnerable to developing depression, particularly when isolated by language.
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.
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).
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.
McLean Hospital offers comprehensive mental health services to help children and adults living with mood disorders such as depression and anxiety. We utilize evidence-based treatment and therapy models informed by cutting-edge research conducted at McLean and around the world. By incorporating various approaches, treatment can be customized for each individual to help ensure recovery.
As of today, there is no laboratory test, blood test, or X-ray that can diagnose a mental disorder. Even the powerful CT, MRI, SPECT, and PET scans, which can help diagnose other neurological disorders such as stroke or brain tumors, cannot detect the subtle and complex brain changes in psychiatric illness. However, these techniques are currently useful ruling out the presence of a number of physical disorders and in research on mental health and perhaps in the future they will be useful for the diagnosis of depression, as well.
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.
The new world of pharmacogenetics holds the promise of actually keeping the genes responsible for depression turned off so as to avoid the illnesses completely. Also, by studying genes, we are learning more about the matching of patients with treatment. This kind of information can tell us which patients do well on which types of drugs and psychotherapy regimens.
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).
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.

These negative thoughts and feelings tend to focus your attention on things you do not like about yourself or your life situation. These thoughts also tend to make your problems seem worse than they really are. As well as concentrating on your negative features and experiences, when you are depressed, you tend to underestimate your positive characteristics and your ability to solve problems. A number of strategies may help you achieve a more balanced view of things:
Treatment for anxiety disorders and depression needs to be administered and managed by a psychiatrist, Connolly says. "It's really crucial for people with both [anxiety and depression] to have a good assessment to rule out bipolar disorder," she says. Bipolar disorder, a condition in which emotions can swing from very low to very high levels of mania and depression, is treated much differently than anxiety disorder with 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.

Tricyclic antidepressants – Tricyclics are known for causing more side effects than other types of antidepressants, so they are unlikely to be prescribed unless other medications are ineffective. Examples include amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil).


The presence of maternal-fetal stress is another risk factor for depression. It seems that maternal stress during pregnancy can increase the chance that the child will be prone to depression as an adult, particularly if there is a genetic vulnerability. Researchers believe that the mother's circulating stress hormones can influence the development of the fetus' brain during pregnancy. This altered fetal brain development occurs in ways that predispose the child to the risk of depression as an adult. Further research is still necessary to clarify how this happens. Again, this situation shows the complex interaction between genetic vulnerability and environmental stress, in this case, the stress of the mother on the fetus.
See a psychiatrist, not a family physician. Your family physician might help you or your loved one first realize that you need depression treatment. But although any medical doctor can prescribe medications, psychiatrists are doctors who specialize in mental health treatment. They are more likely to be familiar with the newest research on antidepressants and any safety concerns. Your health depends on your doctor’s expertise, so it’s important to choose the most qualified physician.

When these types of thoughts overwhelm you, it’s important to remember that this is a symptom of your depression and these irrational, pessimistic attitudes—known as cognitive distortions—aren’t realistic. When you really examine them they don’t hold up. But even so, they can be tough to give up. You can’t break out of this pessimistic mind frame by telling yourself to “just think positive.” Often, it’s part of a lifelong pattern of thinking that’s become so automatic you’re not even completely aware of it. Rather, the trick is to identify the type of negative thoughts that are fueling your depression, and replace them with a more balanced way of thinking.
Over the years, the technique of ECT has improved from the procedure that still invokes stigma in the minds of many. Physicians administer the treatment in the hospital under anesthesia so that people receiving ECT do not hurt themselves or feel emotional or physical pain during the induced seizures or at any other time. Most patients undergo six to 10 treatments. A health care professional passes an electrical current through the brain to cause a controlled seizure, which typically lasts for 20-90 seconds. The patient is awake in five to 10 minutes. The most common side effect is short-term memory loss, which usually resolves quickly. Doctors safely perform ECT as an outpatient procedure.
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.
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.
Tricyclic antidepressants – Tricyclics are known for causing more side effects than other types of antidepressants, so they are unlikely to be prescribed unless other medications are ineffective. Examples include amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil).

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.
Another type of depression is related to changes in the length of days or seasonality. This type of depression is called Seasonal affective disorder (SAD). People with SAD suffer the symptoms of a Major Depressive Disorder only during a specific time of year, usually winter. This appears to be related to the shorter days of winter, and the lack of sunlight in many parts of the country.

Depression can affect anybody; young or old, rich or poor, man or woman. While depression can affect anyone, at anytime, it does seem to strike most often when a person is going through changes. Changes can be negative life changes such as the loss of a loved one or a job, regular life changes such as starting university or a big move, or physical changes such as hormonal changes or the onset of an illness. Because depression can be linked to change, certain groups of people are at risk more often than others:


Therapists and physicians generally attempt to treat antenatal depression with non-medication methods first, as there is evidence that antidepressants may pose a risk to fetuses. For women with severe antenatal depression, however, antidepressants may be essential. Women need to educate themselves and work with their physicians to balance the risks and the benefits to both themselves and their infants.

“[If there was] certainty that an acute episode [of depression] will last only a week, a month, even a year, it would change everything. It would still be a ghastly ordeal, but the worst thing about it — the incessant yearning for death, the compulsion toward suicide — would drop away. But no, a limited depression, a depression with hope, is a contradiction. … [T]he conviction that it will never end except in death — that is the definition of a severe depression.”
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.

Depression symptoms take many forms, and no two people’s experiences are exactly alike. A person who’s suffering from this disorder may not seem sad to others. They may instead complain about how they just “can’t get moving,” or are feeling completely unmotivated to do just about anything. Even simple things — like getting dressed in the morning or eating at mealtime — become large obstacles in daily life. People around them, such as their friends and family, notice the change too. Often they want to help, but just don’t know how.


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.

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
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