Depression is a mental disorder, characterized by continued feelings of sadness and lack of interest or enjoyment in daily activities. In addition to mood problems, people with depression are prone to physical symptoms such as fatigue, sleep problems, and changes in appetite. An estimated 14 million Americans suffer from major (or clinical) depression, according to the National Alliance on Mental Illness. Twice as many women as men suffer from depression.

What Causes Depression?
While the exact causes of depression are not yet known, it appears to be caused by a combination of genetic, psychological, biological, and social factors. Many people experience situational depression in response to stressful or traumatic events or losses. Situational depression often responds to psychotherapy. Clinical depression, however, is triggered by our bodies' brain chemistry and may require additional treatment such as medication. Neuroscientists (who study the brain and nervous system) are learning more about the biochemistry of depression, specifically how the disorder may involve an imbalance of certain brain chemicals, including neurotransmitters such as serotonin. Scientists also continue to study the extent to which some people are genetically predisposed to experiencing depression.

What Are the Symptoms of Depression?
Symptoms of depression, which may vary at different times, include:

  • Sad, hopeless, empty, and/or helpless feelings.
  • Loss of interest in previously pleasurable activities.
  • Feeling tired or run-down.
  • Loss of sex drive.
  • Sleep problems.
  • Difficulty with concentration, memory, or decision-making.
  • Loss or increase of appetite (and, therefore, weight loss or weight gain).
  • Anxiety, restlessness, and irritability.
  • Suicidal thoughts or preoccupation with death.

Caution: If you or a loved one is having thoughts of suicide, please consult your physician or mental health professional immediately.

Who Is at Risk for Depression?
Depression affects people in every ethnic, social, and economic group. Women are twice as likely to suffer from depression as men are. Adolescents appear to be at greater risk for depression than adults. People with chronic illnesses, such as heart disease and diabetes, and caregivers of people with illness or disability may also be at higher risk for depression.

What Are the Treatments for Depression?
Psychotherapy: Different types of psychotherapy, alone or in combination with medication and lifestyle changes, may be effective in treating depression. For example, Cognitive-Behavioral Therapy (CBT), may help patients examine emotional instincts and ingrained thought patterns, and can teach them to reframe (reinterpret) events, and develop new coping strategies. Talk therapy, where patients talk through their problems with their therapists, can also be helpful.

A Note About Medications:

  • Before taking any medication, discuss dosages and potential adverse effects with your health care provider.
  • Take all medication as directed.
  • Because some medications may interact with one another, and because some medications may interact with herbs and dietary supplements, inform your health care provider of all supplements, herbs, and medications that you are taking or are considering.
  • Consult your health care provider before stopping your medication or changing its dosage.
  • In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory regarding the potential risks to adults and children of taking certain antidepressants. These risks include increased depression and suicidal thoughts, especially among children and adolescents. Please discuss potential risks of these medications with your or your child's health care provider.

 Here are some of the common medications used to treat depression:

Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs appear to help relieve symptoms of depression by making more of the neurotransmitter (brain chemical) serotonin available in the brain for reuptake (reabsorption) by nerve cells. SSRIs include:

  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Escitalopram Oxalate (Lexapro)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)  

Serotonin and Norepinephrine Reuptake Inhibitors (SRNIs)
SNRIs are thought to improve mood by making available more of the brain chemical norepinephrine as well as serotonin. SNRIs include:

  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)

Tricyclic Antidepressants
Tricyclics, which have been used in the treatment of depression since the 1950s, are so-named because their molecular structure contain three rings of atoms. They include:

  • Doxepin (Adapin, Sinequan)
  • Clomipramine (Anafranil)
  • Nortriptyline (Aventyl, Pamelor)
  • Amitriptyline (Elavil)
  • Imipramine (Janimine, Tofranil)
  • Maprotiline (Ludiomil)
  • Desipramine (Norpramin, Pertofrane)
  • Trimipramine (Surmontil)
  • Protriptyline (Vivactil)

Monoamine Oxidase Inhibitors (MAOIs)
MAOIs block the breakdown of chemical compounds called monoamines, which play a role in mood disorders when present at high levels. People taking MAOIs must restrict their diets by avoiding foods with a high content of the substance tyramine—such as cheese, alcohol, pickled, smoked, and fermented foods, and many others. MAOIs include:

  • Isocarboxid (Marplan)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Other Antidepressants

  • Trazodone (Desyrel)
  • Bupropion (Wellbutrin) 
  • Quetiapine Fumarate (Seroquel)
  • Aripiprazole (Abilify)
    Lifestyle Changes
  • Exercise--Moderate aerobic exercise has been shown to enhance mood, possibly by releasing calming brain chemicals called endorphins (this chemical is also responsible for the "runner's high").
  • Meditation--Meditative practices such as mindfulness, deep breathing, and yoga may help to calm the mind and reduce stress, easing the symptoms of depression.
  • Social Support--A social network of friends, family, and people with similar interests can help buffer the effects of depression.
  • Spiritual Support--Religious and spiritual beliefs, meditation, prayer, and involvement in a religious or spiritual community may provide meaning and comfort during emotionally challenging times.
  • Dietary Supplements

    • St. John's wort: an herbal remedy that has been used shown to be effective in treating mild to moderate depression (but not severe depression). Caution: St. John's wort may have adverse interactions with certain drugs including SSRI antidepressants.
    • SAMe (S-adenosylmethionine) has been shown to improve mood in people suffering from depression.
    • B vitamins: Studies suggest that B vitamins such as folic acid and B12 may help reduce depression as well as improving the effectiveness of antidepressant drugs.
    • Fish oils: These supplements, rich in omega-3 essential fatty acids, may help improve mood, according to research studies.

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