Depression: Causes, Symptoms and Treatments

Despite the fact that 17 million adult Americans experience depression in any given year, the condition is still misunderstood and stigmatized, preventing many from seeking treatment.

Far from a fleeting case of the blues, major depression is marked by an extended sense of sadness and despair that distorts how sufferers think, feel and function, according to the Mayo Clinic. It significantly interferes with daily living tasks such as eating and sleeping and may prompt thoughts of suicide.

Symptoms & Causes

Depression symptoms cover a wide swath of moods, emotions and behaviors that vary from person to person and range from mild to severe. They include:

• Loss of interest and pleasure in normal activities
• Irritability
• Agitation or restlessness
• Lower sex drive
• Decreased concentration
• Insomnia or excessive sleeping
• Eating too much or too little
• Chronic fatigue and lethargy
• Unexplainable crying spells
• Unexplainable physical symptoms such as headaches or body aches
• Feeling hopeless and worthless
• Withdrawal from social situations and normal activities
• Thoughts of death
• In extreme cases, hallucinations and delusions

Depression can affect people of both genders as well as all ages, races and socio-economic classes. According to the National Institutes of Health (NIH), depression’s exact cause is unknown, though there are many clear predisposing factors.

An imbalance in brain chemistry – which can be genetic – is believed to produce many cases. A variety of distressing life situations are also associated, including early childhood trauma, a job loss, the death of a loved one, financial troubles, or a divorce. Often, a combination of factors exists.

Certain medical conditions may also trigger depression, including an underactive thyroid gland, cancer, prolonged pain and other significant illnesses. Hormonally-induced depression can arise after childbirth or at menopause as well.

Additionally, sedatives and high blood pressure medications are linked to depression, according to the NIH.

Complications

Left untreated, major depression can set off a chain of social, emotional and health complications that add to patients’ overall stress. According to the Mayo Clinic, these include:

• Alcohol and/or drug abuse
• Anxiety
• Social isolation and relationship conflicts
• Work or school difficulties
• Suicide

Depression also manifests in several other forms. According to the University of Maryland Medical Center and the Mayo Clinic, these include:

• Bipolar disorder, which is characterized by extreme high and low moods, which is believed to arise from a brain chemical imbalance.
• Dysthymia, a persistent, milder form of depression
• Seasonal affective disorder, which is related to lower light exposure in winter months
• Psychotic depression, when severe depression is tied with psychotic symptoms such as hallucinations and delusions

Diagnosis & Tests

Because of misperceptions and stigma surrounding depression, many sufferers never seek help. But unexpressed worries and feelings of isolation may worsen the condition, according to the American Psychological Association.

Doctors who suspect depression typically ask patients about their family health history, mood and behavior patterns (such as eating and sleeping), and thoughts of suicide. They may also ask patients to report their depression symptoms on a printed questionnaire.

Beyond that, physical illnesses that induce depression must be ruled out, so blood and thyroid tests may be done, according to the Mayo Clinic.

To pin down a diagnosis of depression, patients must experience five or more of the major depressive symptoms (listed above) over a two-week period, with one of the symptoms being low mood or lack of interest or pleasure in daily life.

Treatments & Medication

Depression treatment may involve psychotherapy therapy, medications, or both. Prescription drugs, called antidepressants, help alter mood by affecting naturally-occurring brain chemicals. Antidepressant categories include:

• Selective serotonin reuptake inhibitors (SSRIs): Often the first-line drugs prescribed by doctors, SSRIs include fluoxetine (commonly known as Prozac), sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro) and citalopram (Celexa). Sexual side effects are common, as well as digestive problems, headache, insomnia and nervousness. Side effects may wear off over time.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): Also commonly prescribed, SNRIs include venlafaxine (brand name Effexor), duloxetine (Cymbalta) and desvenlafaxine (Pristiq). Side effects are similar to SSRIs.
• Tricyclics: The first type of antidepressants available, tricyclics are typically prescribed now only if SSRIs don’t work. They can induce severe side effects such as low blood pressure, blurred vision, constipation, rapid pulse and confusion.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs): This category includes bupropion (brand name Wellbutrin), one of the few antidepressants with no sexual side effects.
• Atypical antidepressants: Characterized as atypical because they don’t easily fit another category, these drugs include mirtazapine (brand name Remeron) and trazodone (Desyrel). They are usually taken in the evening because of their sedative effect.