Depression

What Are the Symptoms of Depression?

They include feeling several of the following for at least 2 weeks:

  • Feeling sad, anxious, or empty
  • Feeling hopeless or pessimistic
  • Feeling guilty, worthless, or helpless
  • Not enjoying things you used to enjoy
  • Trouble with concentration, memory, or making decisions
  • Sleeping too much or too little
  • Appetite changes
  • Gaining or losing weight
  • Feeling restless or irritable
  • Thoughts of suicide or death

You might not have all of these. Doctors call it “major depression” if you have at least 5 of these symptoms for at least 2 weeks. People with major depression might also have other physical symptoms, such as painor other illnesses that get worse, stomachaches, headaches, or digestive problems.

Depression

Definition

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

  • Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
  • Perinatal depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
  • Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
  • Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
  • Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5  include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).Image result for depression

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

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.

Risk Factors

Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medications

    Depression and College Students

  • Feeling moody, sad, or grouchy? Who doesn’t once in a while? College is an exciting time, but it can also be very challenging. As a college student, you might be leaving home for the first time, learning to live independently, taking tough classes, meeting new people, and getting a lot less sleep. Small or large setbacks can seem like the end of the world, but these feelings usually pass with a little time.

    But if you have been feeling sad, hopeless, or irritable for at least 2 weeks, you might have depression. You’re not alone. Depression is the most common health problem for college students.1 You should know:

    • Depression is a medical illness.
    • Depression can be treated.
    • Early treatment is best.
    • Most colleges offer free or low-cost mental health services to students.

     What is depression?

    A: Depression is a medical illness with many symptoms, including physical ones. Sadness is only a small part of depression. Some people with depression may not feel sadness at all, but be more irritable, or just lose interest in things they usually like to do. Depression interferes with your daily life and normal function. Don’t ignore or try to hide the symptoms. It is not a character flaw, and you can’t will it away.

    Q: Are there different types of depression?

    A: Yes. The most common depressive disorders include major depression (a discrete episode, clearly different from a person’s usual feeling and functioning), persistent depressive disorder (a chronic, low-grade depression that can get better or worse over time), and psychotic depression (the most severe, with delusions or hallucinations). Some people are vulnerable to depression in the winter (“seasonal affective disorder”), and some women report depression in the week or two prior to their menstrual period (“premenstrual dysphoric disorder”). You can learn about these and other types of depression athttp://www.nimh.nih.gov/health/topics/depression/index.shtml.

     What are the signs and symptoms of depression?

    A: If you have been experiencing any of the following signs and symptoms nearly every day for at least 2 weeks, you may have major (sometimes called “clinical”) depression:

    • Persistent sad, anxious, or “empty” mood
    • Feelings of hopelessness, pessimism
    • Feelings of guilt, worthlessness, helplessness
    • Loss of interest or pleasure in hobbies and activities
    • Decreased energy, fatigue, being “slowed down”
    • Difficulty concentrating, remembering, making decisions
    • Difficulty sleeping, early-morning awakening, or oversleeping
    • Appetite and/or unwanted weight changes
    • Thoughts of death or suicide; suicide attempts
    • Restlessness, irritability
    • Persistent physical symptoms, such as muscle pain or headaches

      What are “co-occurring” disorders?

      A: Depression can occur at the same time as other health problems, such as anxiety, an eating disorder, or substance abuse. It can also co-occur with other medical conditions, such as diabetes or thyroid imbalance. Certain medications—for example, those for the treatment of severe acne—may cause side effects that contribute to depression; although some women are very sensitive to hormonal changes, modern birth control pills are not associated with depression for most users.

       If I think I may have depression, where can I get help?

      A: If you have symptoms of depression that are getting in the way of your ability to function with your studies and your social life, ask for help. Depression can get better with care and treatment. Don’t wait for depression to go away by itself or think you can manage it all on your own, and don’t ignore how you’re feeling just because you think you can “explain” it. As a college student, you’re busy—but you need to make time to get help. If you don’t ask for help, depression may get worse and contribute to other health problems, while robbing you of the academic and social enjoyment and success that brought you to college in the first place. It can also lead to “self-medication” with high-risk behaviors with their own serious consequences, such as binge drinking and other substance abuse and having unsafe sex.

      Most colleges provide mental health services through counseling centers, student health centers, or both. Check out your college website for information. If you think you might have depression, start by making an appointment with a doctor or health care provider for a checkup. This can be a doctor or health care provider at your college’s student health services center, a doctor who is off-campus in your college town, or a doctor in your hometown. Your doctor can make sure that you do not have another health problem that is causing your depression.

      If your doctor finds that you do not have another health problem, he or she can discuss treatment options or refer you to a mental health professional, such as a psychiatrist, counselor, or psychologist. A mental health professional can give you a thorough evaluation and also treat your depression.A: Besides seeing a doctor and a counselor, you can also help your depression by being patient with yourself and good to yourself. Don’t expect to get better immediately, but you will feel yourself improving gradually over time.

      • Daily exercise, spending time outside in nature and in the sun, and eating healthy foods can also help you feel better.
      • Get enough sleep. Try to have consistent sleep habits and avoid all-night study sessions.
      • Your counselor may teach you how to be aware of your feelings and teach you relaxation techniques. Use these when you start feeling down or upset.
      • Avoid using drugs and at least minimize, if not totally avoid, alcohol.
      • Break up large tasks into small ones, and do what you can as you can; try not to do too many things at once.
      • Try to spend time with supportive family members or friends, and take advantage of campus resources, such as student support groups. Talking with your parents, guardian, or other students who listen and care about you gives you support.
      • Try to get out with friends and try fun things that help you express yourself. As you recover from depression, you may find that even if you don’t feel like going out with friends, if you push yourself to do so, you’ll be able to enjoy yourself more than you thought.

      Remember that, by treating your depression, you are helping yourself succeed in college and after graduation.

       What are the warning signs for suicide?

      A: Depression is also a major risk factor for suicide. The following are some of the signs you might notice in yourself or a friend that may be reason for concern.

      • Talking about wanting to die or to kill oneself
      • Looking for a way to kill oneself, such as searching online or buying a gun
      • Talking about feeling hopeless or having no reason to live
      • Talking about feeling trapped or in unbearable pain
      • Talking about being a burden to others and that others would be better off if one was gone
      • Increasing the use of alcohol or drugs
      • Acting anxious or agitated; behaving recklessly
      • Giving away prized possessions
      • Sleeping too little or too much
      • Withdrawing or feeling isolated
      • Showing rage or talking about seeking revenge
      • Displaying extreme mood swingsDepression is a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings and sense of well-being.[1][2] People with a depressed mood can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, ashamed or restless. They may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, and may contemplate, attempt or commit suicideInsomniaexcessive sleepingfatigue, aches, pains, digestive problems or reduced energy may also be present.[3]Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder,[2] but it may also be a normal reaction to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments.

        Causes

        Historical legacy

        Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions.[4][5]

        Life events

        Adversity in childhood, such as bereavement, neglect, mental abuse, and unequal parental treatment of siblings can contribute to depression in adulthood.[6][7] Childhood physical or sexual abuse in particular significantly increases the likelihood of experiencing depression over the life course.[8]

        Life events and changes that may precipitate depressed mood include childbirthmenopause, financial difficulties, job problems, a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one,natural disasters, social isolation, relationship troubles, jealousy, separation, and catastrophic injury.[9][10][11] Adolescents may be especially prone to experiencing depressed mood following social rejection.[12]

        Medical treatments

        Certain medications are known to cause depressed mood in a significant number of patients. These include medications for hepatitis C (such as interferon), anxiety and sleep (such as benzodiazepines likealprazolamclonazepamlorazepam and diazepam), high blood pressure (such as beta-blockersmethyldopareserpine), and hormonal treatments (such as corticosteroidscontraceptives).[13][14][15][16]

        Substance-induced

        Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from chronic use. These include alcoholsedatives (including prescription benzodiazepines), opioids(including prescription pain killers and illicit drugs like heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants.[13] While many often report self-medicating depression with these substances, improvements in depression from drugs are usually short-lived (with worsening of depression in the long-term, sometimes as soon as the drug effects wear off) and tend to be exaggerated (e.g., “many people report euphoria after the fact with alcohol intoxication, even though at the time of intoxication they were tearful and agitated”).[16]

        Non-psychiatric illnesses

        Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions[17] and physiological problems, including hypoandrogenism (in men), Addison’s diseaseLyme diseasemultiple sclerosischronic painstroke,[18] diabetes,[19] and cancer.[20]

        Psychiatric syndromes

        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; anddysthymia, 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.[21] 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;[22]:355 andposttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[23] Depression is sometimes associated with substance use disorder. Both legal and illegal drugs can cause substance use disorder.[24]

        Assessment

        Questionnaires and checklists such as the Beck Depression Inventory or the Children’s Depression Inventory can be used by a mental health provider to detect and assess the severity of depression.[25]

        Treatment

        Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, 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.[26] Different sub-divisions of depression have different treatment approaches.[27] In the United States, it has been estimated that two thirds of people with depression do not actively try to receive treatment.[28]

        Sex differences

        Women have a higher rate of major depression than men. While women have a greater proportion of somatic symptoms, such as appetite, sleep disturbances and fatigue accompanied by pain and anxiety, than men, the gender difference is much smaller in other aspects of depression.[30] Instances of suicide in men is much greater than in women. In a report by Lund University in Sweden and Stanford University, it was shown that men commit suicide at a rate almost three times that of women in Sweden, and the Centers for Disease Control and Prevention and National Center for Injury Prevention and Control report that the rate in the US is almost four times as many males as females.[31] However, women have higher rates of suicide ideation and attempts.[citation needed] The difference is attributed to men choosing more effective methods resulting in the higher rate of success.[32][33]
         
      • Image result for depression

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medicationspsychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH website and in the NIMH publication Depression: 

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
  • Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
  • Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
  • ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.Here are other tips that may help you or a loved one during treatment for depression:
    • Try to be active and exercise.
    • Set realistic goals for yourself.
    • Try to spend time with other people and confide in a trusted friend or relative.
    • Try not to isolate yourself, and let others help you.
    • Expect your mood to improve gradually, not immediately.
    • Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
    • Continue to educate yourself about depression.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.                                                                                                                How is depression treated?

      A: Effective treatments for depression include talk therapy (also called psychotherapy), personalized for your situation, or a combination of talk therapy and medication. Early treatment is best.

       What is talk therapy?

      A: A therapist, such as a psychiatrist, a psychologist, a social worker, or counselor, can help you understand and manage your moods and feelings. You can talk out your emotions to someone who understands and supports you. You can also learn how to stop thinking negatively and start to look at the positives in life. This will help you build confidence and feel better about yourself as you begin to work with your therapist to find solutions to problems that may have seemed insurmountable when you were feeling depressed and maybe even hopeless. Research has shown that certain types of talk therapy or psychotherapy can help young adults deal with depression.

      These include:

      • Cognitive behavioral therapy, or CBT, which focuses on thoughts, behaviors, and feelings related to depression
      • Interpersonal psychotherapy, or IPT, which focuses on working on relationships
      • Dialectical behavior therapy, or DBT, which is especially useful when depression is accompanied by self-destructive or self-harming behavior

      All therapies can be adapted to each person’s issues, for example, if depression is associated with an anxiety or eating disorder. Your college counseling center may offer both individual and group counseling. Many also offer workshops and outreach programs to support you.

      Read more about talk therapies at http://www.nimh.nih.gov/health/topics/psychotherapies.

      What medications treat depression?

      A: If your doctor thinks you need medication to help your depression, he or she may prescribe an antidepressant. There are a number of antidepressants that have been widely studied and proven to help. If your doctor recommends medication, it is important to see your doctor regularly and tell him or her about any side effects and how you are feeling, especially if you start feeling worse or have thoughts of hurting yourself. Although the doctor will attempt to “match” the best medication for your depression, sometimes it takes a little “trial and error” to find the best choice. If you or a close family member has done well on a particular medication in the past, that can be a good predictor of success again.

      Always follow the directions of the doctor or health care provider when taking medication. You will need to take one or more regular doses of an antidepressant every day, and it may not take full effect for a few weeks. To avoid having depression return, most people continue taking medication for some months after they are feeling better. If your depression is long-lasting or comes back repeatedly, you may need to take antidepressants longer.

      Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. Tell your doctor if you are often “sensitive” to medication; starting with a low dose and increasing it slowly to a full therapeutic level is the best way to minimize adverse effects. You may need to try more than one antidepressant medicine before finding the one that improves your symptoms without causing side effects that are difficult to live with.

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medicationspsychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH website and in the NIMH publication Depression: 

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
  • Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
  • Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
  • ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.Here are other tips that may help you or a loved one during treatment for depression:
    • Try to be active and exercise.
    • Set realistic goals for yourself.
    • Try to spend time with other people and confide in a trusted friend or relative.
    • Try not to isolate yourself, and let others help you.
    • Expect your mood to improve gradually, not immediately.
    • Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
    • Continue to educate yourself about depression.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.                                                                                                                How is depression treated?

      A: Effective treatments for depression include talk therapy (also called psychotherapy), personalized for your situation, or a combination of talk therapy and medication. Early treatment is best.

       What is talk therapy?

      A: A therapist, such as a psychiatrist, a psychologist, a social worker, or counselor, can help you understand and manage your moods and feelings. You can talk out your emotions to someone who understands and supports you. You can also learn how to stop thinking negatively and start to look at the positives in life. This will help you build confidence and feel better about yourself as you begin to work with your therapist to find solutions to problems that may have seemed insurmountable when you were feeling depressed and maybe even hopeless. Research has shown that certain types of talk therapy or psychotherapy can help young adults deal with depression.

      These include:

      • Cognitive behavioral therapy, or CBT, which focuses on thoughts, behaviors, and feelings related to depression
      • Interpersonal psychotherapy, or IPT, which focuses on working on relationships
      • Dialectical behavior therapy, or DBT, which is especially useful when depression is accompanied by self-destructive or self-harming behavior

      All therapies can be adapted to each person’s issues, for example, if depression is associated with an anxiety or eating disorder. Your college counseling center may offer both individual and group counseling. Many also offer workshops and outreach programs to support you.

      Read more about talk therapies at http://www.nimh.nih.gov/health/topics/psychotherapies.

      What medications treat depression?

      A: If your doctor thinks you need medication to help your depression, he or she may prescribe an antidepressant. There are a number of antidepressants that have been widely studied and proven to help. If your doctor recommends medication, it is important to see your doctor regularly and tell him or her about any side effects and how you are feeling, especially if you start feeling worse or have thoughts of hurting yourself. Although the doctor will attempt to “match” the best medication for your depression, sometimes it takes a little “trial and error” to find the best choice. If you or a close family member has done well on a particular medication in the past, that can be a good predictor of success again.

      Always follow the directions of the doctor or health care provider when taking medication. You will need to take one or more regular doses of an antidepressant every day, and it may not take full effect for a few weeks. To avoid having depression return, most people continue taking medication for some months after they are feeling better. If your depression is long-lasting or comes back repeatedly, you may need to take antidepressants longer.

      Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. Tell your doctor if you are often “sensitive” to medication; starting with a low dose and increasing it slowly to a full therapeutic level is the best way to minimize adverse effects. You may need to try more than one antidepressant medicine before finding the one that improves your symptoms without causing side effects that are difficult to live with.

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