Feeling Depressed

Life is full of changes. Everyday events and our reactions to them sometimes interfere with our sense of well-being and peace of mind. It is common to get the blues or become sad when disappointed. Symptoms of depression are the most common medical problems seen by health professionals. It is estimated that feelings of depression will affect about one-third of all adults in the United States at some time in their lives.

Most people experience feelings of sadness over such losses as divorce or separation, the death of a friend or loved one, or a job change or layoff. These feelings are an expected reaction to a "triggering event," and most people get over them in time.

Several factors increase your risk of developing feelings of depression, such as:

• Female sex. Women are twice as likely as men to experience feelings of depression. Hormonal changes may play a role in these feelings, which may be more evident during pregnancy, especially shortly after the birth of a baby (postpartum depression) or shortly before or during menopause. Some women experience feelings of sadness or depression shortly before the start of menstruation (premenstrual syndrome, or PMS).
• Age older than 60. Feelings of depression in this age group are frequently overlooked because the symptoms are similar to other diseases and problems experienced by older adults. Adults in this age group are more likely to experience social isolation. Feelings of sadness may accompany other life events, such as retirement, death of a spouse or child, or declining physical abilities.
• Personal or family history. You are more likely to experience feelings of depression if you have a history of previous depression, an anxiety disorder, or another mental illness. You are also 2 to 3 times more likely to experience feelings of depression if one or both of your parents were diagnosed with depression.
• Medical problems—such as cancer, kidney disease, heart disease, or Parkinson's disease—or alcohol or substance abuse or withdrawal.
• Stressful life events, such as changing jobs, the loss of a job, or children leaving home.
• Lack of family or social support.

Symptoms of depression that may indicate a need for treatment vary from person to person. If you experience feelings of sadness or loss of interest in pleasurable activities plus 4 or more of the following symptoms for 2 weeks or longer, you may be depressed.

• Changes in appetite or weight
• Restlessness or decreased activity that is noticed by others
• Feeling tired or sleepy all of the time
• Trouble sleeping or sleeping more than usual
• Inability to concentrate or make decisions
• Feelings of hopelessness
• Feelings of worthlessness or guilt
• Preoccupation with death or recurrent thoughts of suicide

People who feel depressed may also have physical symptoms, such as body aches or stomach problems.

Because "mood swings" and other emotional changes are considered a normal part of growing up, depression in children and teens often goes unrecognized. Children and teens do develop depression, and it can affect a child's quality of life. If prolonged or severe depression is left untreated, it can lead to serious outcomes, including suicide attempts and even completed suicide.

Depression is the most important risk factor for suicide. For more information, see the topic Depression.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

	Actionsets are designed to help people take an active role in managing a health condition.
	Depression: Helping someone get treatment
	Depression: Supporting someone who is depressed
	Positive thinking: Stopping unwanted thoughts

Emergencies

Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.

• Seriously considering suicide with a plan that includes:
  • Having the means, such as weapons or medicines, available to commit suicide or do harm to another person
  • Having set a time and place to commit suicide
  • Thinking there is no other way to solve your problem or end your pain

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Thoughts of suicide: Go to the topic Suicidal Thoughts or Threats.
  • If you are unable to reach your health professional immediately, go directly to the nearest hospital emergency department.
  • If you are not able to talk with your health professional immediately, call your local suicide hotline or the national suicide hotline (1-800-SUICIDE or 1-800-273-TALK or 1-800-273-8255).
• Feelings of extreme sadness after having a baby: Go to the topic Problems After Delivery of Your Baby.

Yes

Do you feel sad or blue?

See significance of feeling sad or blue if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to the following question.

Yes

Do you have frequent thoughts of death or suicide?

Call your health professional today if you answer "Yes" to any of the following questions.

Yes

Are you no longer interested in activities that you once enjoyed?

Yes

Have you had feelings of unusual sadness for 2 weeks or longer?

Yes

Do you find it difficult to concentrate?

Yes

Do you often feel restless or anxious?

Yes

Are you troubled with feelings of worthlessness or guilt?

Yes

Have you had a change in your sleep pattern, either an inability to sleep or wanting to sleep all the time?

Yes

Have you had a recent change in your appetite?

Yes

Have you gained or lost 10 lb (4.5 kg) or more in the past 6 weeks without trying?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Are you being treated for depression, but you are not getting better?

See significance of not getting better with treatment for depression if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Note:

Be sure to follow your health professional's instructions about when to call if you are not feeling better. It may take several weeks before you notice much of a change, especially if you have been depressed for a long time. But you should start to feel better in 2 to 3 weeks and see the full effects in 12 weeks.

Call your health professional immediately if you answer "Yes" to the following question.

Yes

Do you have frequent thoughts of death or suicide?

Call your health professional today if you answer "Yes" to any of the following questions.

Yes

Have your symptoms of depression gotten worse since starting treatment or a medicine for depression?

Yes

Have your symptoms of depression not gotten better as expected?

Yes

Have your symptoms of depression not gotten better after starting treatment or medicine for depression, but you are not sure about when you should start to feel better?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Yes

Do you think that your feelings of sadness may be caused by a medicine?

See significance of a medicine causing feelings of depression if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional today if you answer "Yes" to the following question.

Yes

Do you think that your feelings of sadness may be caused by a medicine?

Note:

If you answered "Yes": Call the health professional who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking it. Call your health professional if you feel you need to continue taking the medicine.

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Feelings of anxiety: Go to the topic Anxiety.
• Inability to sleep or early waking: Go to the topic Sleep Problems, Age 12 and Older.
• Feelings of profound weakness or fatigue: Go to the topic Weakness and Fatigue.
• Problems with alcohol or substance abuse: Go to the topic Alcohol and Drug Problems.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Positive actions and feelings can help lift your spirits. Although thinking positively may be very difficult when you are feeling depressed, try to consider the positive side of situations and events in your life.

Appreciate any moments when you have positive thoughts. The following tips may help.

• Practice positive thinking. Make statements that promote good thoughts. Replace negative self-talk with positive comments.

  Positive thinking: Stopping unwanted thoughts

• Take action to put more fun into your life:
  • Exercise. Running, brisk walking, and other forms of aerobic exercise improve symptoms of mild to moderate depression.
  • Work in the garden or play with a pet. Plants and pets can be very therapeutic. When you pet an animal, your blood pressure goes down and your heart rate slows. Filling the needs of animals and plants can help you feel useful.
  • Visit a friend. Spending time with a good friend may help you forget about your problems for a while and help you see the brighter side of life.
  • Have a massage or a manicure, or get your hair cut.
  • Rearrange your furniture.
• Talk with your health professional about nonprescription medicines, such as St. John's wort or SAM-e.
  • Talk to your health professional or pharmacist before taking St. John's wort if you are taking any other medicines. St. John's wort may change the way other medicines work. In some cases, it may decrease how well medicines work. In other cases, it may make medicines poisonous.
  • Do not use alcohol or other mood-altering drugs while you are taking a nonprescription medicine.
  • Follow the directions on the label. Do not exceed the recommended dose.
  • If you are or could be pregnant, talk with your health professional before taking any medicine or supplement.
  • For more information on dietary supplements, visit the Web site of the Office of Dietary Supplements, within the National Institutes of Health, at http://ods.od.nih.gov/index.aspx.
• Take a class or go to a free lecture at the public library or local hospital.
• Take a vacation. Sometimes just getting away for the afternoon will brighten your mood.
• Go to the movies or rent a funny movie.
• If nothing feels fun, try doing something that you used to enjoy.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• You feel sad, lonely, or unhappy for weeks.
• Your symptoms become more severe or frequent.
• You are not getting better as expected after starting treatment for depression.

For a friend or loved one

If you think a friend or loved one is depressed, you may feel helpless. But you still may want to do something to help. For suggestions, see:

Depression: Helping someone get treatment.

Depression: Supporting someone who is depressed.

Prevention

Life is full of changes. Everyday events and our reactions to them sometimes interfere with our sense of well-being and peace of mind. While it is common to get the "blues" or to feel sad occasionally, you may be able to prevent feelings of depression.

• Have a regular checkup with your health professional. Your health professional may evaluate your thyroid function and other factors. Many other diseases, such as coronary artery disease and diabetes, can increase your risk of feeling depressed.
• Talk to your health professional about light therapy if you think that you feel worse during the winter months. Just 30 minutes of light therapy each day improves mood in many people with seasonal affective disorder (SAD). For more information, see the topic Seasonal Affective Disorder (SAD).
• Maintain regular sleep and eating patterns. Do not skip meals.
• Try to get some exercise every day. Walking is a good way to start.
• Get involved in social groups or volunteer to help others. Being alone makes things seem worse than they are.
• Do not use alcohol or illegal drugs, such as cocaine, amphetamines, or heroin, to "self-treat" your symptoms. A treatment plan that includes prescription medicine and regular visits to a health professional is much safer and more effective.
• Do not smoke or use other tobacco products. Smoking increases your risk of developing coronary artery disease. The use of smokeless (spit) tobacco increases your risk of developing cancer of the mouth, neck, throat, and digestive tract. Your risk of developing depression increases if you have coronary artery disease or cancer.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Before seeing your health professional, it may be helpful to keep a diary of your symptoms. You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• How long have you been troubled with a depressed mood? What is your major symptom?
• What was happening in your life when the depressed mood started?
• How long have you had your symptoms? Do they come and go or are they always present?
• Have you ever had a similar problem in the past? If so, how was it treated?
• What makes your symptoms better or worse?
• Do you have any other symptoms that may be related to your major symptom? Symptoms may include:
  • Rapid or irregular heartbeat.
  • Nausea or vomiting.
  • Numbness or weakness.
  • Excessive sweating.
  • Feeling like you are not able to get enough air (air hunger).
  • Restlessness, irritability, or feeling on edge.
  • Feelings of overwhelming anxiety or fear.
• What prescription or nonprescription medicines are you currently taking?
• Are you using alcohol or illegal drugs, such as marijuana or cocaine, to manage your symptoms?
• Have you ever attempted suicide?
• Has a family member or close friend attempted or committed suicide?
• Has anyone else in your family ever been diagnosed with a mental health problem, such as depression or an anxiety disorder?
• Are you taking a medicine to treat depression? What is the medicine? When did you start the medicine? What is the dose that you are taking? Have you or your health professional changed the dose?
• Do you have any health risks?

Other Places To Get Help

Organization

Mental Health America
2000 North Beauregard Street, 6th Floor
Alexandria, VA  22311
Phone:	1-800-969-NMHA (1-800-969-6642) hotline for help with depression (703) 684-7722
Fax:	(703) 684-5968
TDD:	1-800-433-5959
Web Address:	www.mentalhealthamerica.net
Mental Health America (formerly known as the National Mental Health Association) is a nonprofit agency devoted to help people of all ages live mentally healthier lives. Its Web site has information about mental health conditions. It also addresses issues such as grief, stress, bullying, and more. It includes a confidential depression screening test for anyone who would like to take it. The short test may help you decide whether your symptoms are related to depression.

Related Information

• Alcohol and Drug Problems
• Anxiety
• Depression
• Depression in Children and Teens
• Grief and Grieving
• Mental Health Problems and Mind-Body Wellness
• Problems After Delivery of Your Baby
• Seasonal Affective Disorder (SAD)
• Sleep Problems, Age 12 and Older
• Suicidal Thoughts or Threats
• Weakness and Fatigue

Credits

Author	Jan Nissl, RN, BS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Tracy Landauer
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Lisa S. Weinstock, MD - Psychiatry
Last Updated	December 8, 2008