Depression

Depression is a mental health illness when someone feels sad (including crying often), empty, or hopeless most of the time (or loses interest in or takes no pleasure in daily activities) for at least two weeks. Depression affects a person’s ability to work, go to school, or have relationships with friends and family. Depression is one of the most common mental health conditions in the United States. It is an illness that involves the body, mood, and thoughts. It can affect the way you eat and sleep, the way you feel about yourself, and the way you think about things.

It is different from feeling “blue” or “down” or just sad for a few hours or a couple of days. Depression is also different from grief over losing a loved one or experiencing sadness after a trauma or difficult event. It is not a condition that can be willed or wished away. People who have depression cannot just “pull themselves” out of it.

Yes. Different kinds of depression include:

• Major depressive disorder: Also called major depression, this is a combination of symptoms that affects a person’s ability to sleep, work, study, eat, and enjoy hobbies and everyday activities.
• Dysthymic disorder: Also called dysthymia, this kind of depression lasts for two years or more. The symptoms are less severe than those of major depression but can prevent you from living normally or feeling well.

Other types of depression have slightly different symptoms and may start after a certain event. These types of depression include:

• Psychotic depression, when a severe depressive illness happens with some form of psychosis, such as a break with reality, hallucinations, and delusions
• Postpartum depression, which is diagnosed if a new mother has a major depressive episode after delivery. Depression can also begin during pregnancy, called prenatal depression.
• Seasonal affective disorder (SAD), which is a depression during the winter months, when there is less natural sunlight
• Bipolar depression, which is the depressive phase of bipolar illness and requires different treatment than major depression

Women are twice as likely as men to be diagnosed with depression. It is more than twice as common for African-American, Hispanic, and white women to have depression compared to Asian-American women. Depression is also more common in women whose families live below the federal poverty line.

There is no single cause of depression. Also, different types of depression may have different causes. There are many reasons why a woman may have depression:

• Family history: Women with a family history of depression may be more at risk. But depression can also happen in women who don’t have a family history of depression.
• Brain changes: The brains of people with depression look and function differently from those of people who don’t have depression.
• Chemistry: In someone who has depression, parts of the brain that manage mood, thoughts, sleep, appetite, and behavior may not have the right balance of chemicals.
• Hormone levels: Changes in the female hormones estrogen and progesterone during the menstrual cycle, pregnancy, postpartum period, perimenopause, or menopause may all raise a woman’s risk for depression. Having a miscarriage can also put a woman at higher risk for depression.
• Stress: Serious and stressful life events, or the combination of several stressful events, such as trauma, loss of a loved one, a bad relationship, work responsibilities, caring for children and aging parents, abuse, and poverty, may trigger depression in some people.
• Medical problems: Dealing with a serious health problem, such as stroke, heart attack, or cancer, can lead to depression. Research shows that people who have a serious illness and depression are more likely to have more serious types of both conditions. Some medical illnesses, like Parkinson’s disease, hypothyroidism, and stroke, can cause changes in the brain that can trigger depression.
• Pain: Women who feel emotional or physical pain for long periods are much more likely to develop depression. The pain can come from a chronic (long-term) health problem, accident, or trauma such as sexual assault or abuse.

Not all people with depression have the same symptoms. Some people might have only a few symptoms, while others may have many. How often symptoms happen, how long they last, and how severe they are may be different for each person.

If you have any of the following symptoms for at least two weeks, talk to a doctor or nurse or mental health professional:

• Feeling sad, “down,” or empty, including crying often
• Feeling hopeless, helpless, worthless, or useless
• Loss of interest in hobbies and activities that you once enjoyed
• Decreased energy
• Difficulty staying focused, remembering, or making decisions
• Sleeplessness, early morning awakening, or oversleeping and not wanting to get up
• Lack of appetite, leading to weight loss, or eating to feel better, leading to weight gain
• Thoughts of hurting yourself
• Thoughts of death or suicide
• Feeling easily annoyed, bothered, or angered
• Constant physical symptoms that do not get better with treatment, such as headaches, upset stomach, and pain that doesn’t go away

Depression is linked to many health problems in women, including:

• Heart disease: People with heart disease are about twice as likely to have depression as people who don’t have heart disease.
• Obesity: Studies show that 43% of adults with depression have obesity. Women, especially white women, with depression are more likely to have obesity than women without depression are. Women with depression are also more likely than men with depression to have obesity.
• Cancer: Up to one in four people with cancer may also experience depression. More women with cancer than men with cancer experience depression.

Talk to your doctor or nurse if you have symptoms of depression. Certain medicines and some health problems (such as viruses or a thyroid disorder) can cause the same symptoms as depression. Sometimes depression can be part of another mental health condition.

Diagnosis of depression includes a mental health professional asking questions about your life, emotions, struggles, and symptoms. The doctor, nurse, or mental health professional may order lab tests on a sample of your blood or urine and do a regular checkup to rule out other problems that could be causing your symptoms.

Your doctor or mental health professional may treat depression with therapy, medicine, or a combination of the two. Your doctor or nurse may refer you to a mental health specialist for therapy.

Some people with milder forms of depression get better after a few months of therapy. People with moderate to severe depression might need therapy and a type of medicine called an antidepressant. Antidepressants change the levels of certain chemicals in your brain. It may take several weeks for antidepressants to work. There are different types of antidepressant medicines, and some work better than others for certain people. Some people get better only with both treatments — therapy and antidepressants. Learn what you can do if these treatments don't help.

Having depression can make some people more likely to turn to drugs or alcohol to cope. But drugs or alcohol can make your mental health condition worse and can affect how antidepressants work. Talk to your therapist or doctor or nurse about any alcohol or drug use.

Give treatments time to work. It may take several weeks for the antidepressants to start working. Do not suddenly stop taking medicine for depression without talking to your doctor or nurse first.

If you have major depressive disorder and have tried at least two types of antidepressants but your symptoms are not getting better, you may have treatment-resistant depression. If you have this type of depression, you may be able to try a treatment called esketamine. Esketamine is a nasal spray that has been approved by the Food and Drug Administration (FDA) for treatment-resistant depression when taken together with an antidepressant. Do not take esketamine if you are pregnant or breastfeeding. Talk to your doctor or nurse about the benefits and risks of esketamine. Learn more about esketamine from the FDA.

If you have severe depression, you can also ask your doctor or nurse if electroconvulsive therapy (ECT) and other brain stimulation therapies are treatment options. Learn more about ECT from the National Institutes of Mental Health.

Talk to someone like a doctor, nurse, psychiatrist, mental health professional, or social worker about your symptoms. You can also find no-cost or low-cost help in your state by using the mental health services locator.

If you are thinking about hurting or even killing yourself, get help now. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

You might feel like your pain is too overwhelming to bear, but those feelings don’t last forever. People do make it through suicidal thoughts. Many thoughts of suicide are impulses that go away after a short period of time.

Taking St. John’s wort for depression has not been approved by the Food and Drug Administration (FDA). Studies show mixed results about the plant’s ability to treat depression.

It may be dangerous to take St. John’s wort if you also take other medicines. St. John’s wort can make many medicines not work at all or may cause dangerous or life-threatening side effects. The medicines used to treat heart disease, HIV, depression, seizures, certain cancers, and organ transplant rejection may not work or may have dangerous side effects if taken with St. John’s wort. St. John’s wort may also make birth control pills not work, which increases the chance you will get pregnant when you don’t want to. It is crucial that you tell your doctor or nurse if you take St. John’s wort.

Depression is a serious mental illness that can be successfully treated with therapy and FDA-approved medicines. FDA-approved medicines and natural treatments can have side effects. It’s best to talk to a doctor or nurse about treatment for depression.

For some people, yes. Researchers think that exercise may work better than no treatment at all to treat depression. They also think that regular exercise can lower your risk of getting depression and help many depression symptoms get better. Researchers do not know whether exercise works as well as therapy or medicine to treat depression. People with depression often find it very difficult to exercise, even though they know it will help make them feel better. Walking is a good way to begin exercising if you haven’t exercised recently.

Researchers are studying natural and complementary treatments (add-on treatments to medicine or therapy) for depression. Currently, none of the natural or complementary treatments are proven to work as well as medicine and therapy for depression. However, natural or complementary treatments that have little or no risk, like exercise, meditation, or relaxation training, may help improve your depression symptoms and usually will not make them worse.

Maybe. Some medicines, such as some types of antidepressants, may make it more difficult for you to get pregnant, but more research is needed. Talk to your doctor about other treatments for depression that don’t involve medicine if you are trying to get pregnant. For example, a type of talk therapy called cognitive behavioral therapy (CBT) helps women with depression. This type of therapy has little to no risk for women trying to get pregnant. During CBT, you work with a mental health professional to explore why you are depressed and train yourself to replace negative thoughts with positive ones. Certain mental health care professionals specialize in depression related to infertility.

Women who are already taking an antidepressant and who are trying to get pregnant should talk to their doctor or nurse about the risks and benefits of stopping the medicine.

References

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Sources

The Office on Women's Health in the U.S. Department of Health and Human Services

Content last updated May 14, 2019