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Major depression

Contents of this page:


Forms of depression
Forms of depression
St. John's Wort
St. John's Wort

Alternative Names    Return to top

Depression - major; Unipolar depression; Major depressive disorder

Definition    Return to top

Major depression is when a person has five or more symptoms of depression for at least 2 weeks. These symptoms include feeling sad, hopeless, worthless, or pessimistic. In addition, people with major depression often have behavior changes, such as new eating and sleeping patterns.

Causes    Return to top

The exact cause of depression is not known. Many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person's life.

Some types of depression seem to run in families, but depression can also occur in people who have no family history of the illness. Stressful life changes or events can trigger depression in some people. Usually, a combination of factors is involved.

Men and women of all ages, races, and economic levels can have depression. It occurs more often in women.

Women are especially vulnerable to depression after giving birth. This is a result of hormonal and physical changes. Although new mothers commonly experience temporary "blues," depression that lasts longer than 2 - 3 weeks is not normal and requires treatment.

Major depression can occur in children and teenagers, and they can also benefit from treatment.

See also: Adolescent depression

Symptoms    Return to top

Depression can appear as anger and discouragement, rather than as feelings of hopelessness and helplessness. If depression is very severe, there may also be psychotic symptoms, such as hallucinations and delusions. These symptoms may focus on themes of guilt, inadequacy, or disease.

Exams and Tests    Return to top

Major depression is diagnosed if a person reports having five or more depressive symptoms for at least 2 weeks. Beck's Depression Scale Inventory or other screening tests for depression can be helpful in making the diagnosis.

Before diagnosing depression, the health care provider should rule out medical conditions that can cause symptoms of depression.

Treatment    Return to top

Depression can be treated in a variety of ways, particularly with medications and counseling. Most people benefit from a combination of the two treatments. Some studies have shown that antidepressant drug therapy combined with psychotherapy has better results than either therapy alone.

Medications include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors (SSRIs), and some newer antidepressant drugs. Although antidepressant medications can be very effective, some may not be appropriate for everyone. For example, in 2007, the FDA proposed that all antidepressant medicines should warn of the risk of suicidal behavior in young adults ages 18 - 24 years.

Lithium and thyroid supplements may be needed to enhance the effectiveness of antidepressants. People with psychotic symptoms, such as delusions or hallucinations, may need antipsychotic medications. The antipsychotic medication quetiapine has also been approved for treating episodes of depression in people with bipolar disorder.

Electroconvulsive therapy (ECT) is a treatment that causes a seizure by means of an electrical current. ECT may improve the mood of severely depressed or suicidal people who don't respond to other treatments.

Research is now being conducted on transcranial magnetic stimulation (TMS), which alters brain function in a way similar to ECT, but with fewer side effects. Use of light therapy for depressive symptoms in the winter months and interventions to restore a normal sleep cycle may be effective for relieving depression.

As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements.

It is important to maintain a healthy lifestyle:

Many consumers try herbal products for depression. St. John's wort has a long history of use in Germany and has gained popularity as an herbal antidepressant in the United States. Most of the German studies indicated that St. John's wort was comparable to some antidepressants. However, a large study conducted by the National Center for Complementary and Alternative Medicine found that St. John's wort was NOT effective for treating major depression.

Because herbal products can have side effects, always tell your doctor if you are using them.

Support Groups    Return to top

For more information and resources, see depression support group.

Outlook (Prognosis)    Return to top

The outcome is usually good with treatment. Although most depressive episodes can be effectively treated with either medication, psychotherapy, or both, depression is a recurring problem for many people. For people who have experienced repeated episodes of depression, maintenance treatment may be needed to prevent future recurrences.

Possible Complications    Return to top

When to Contact a Medical Professional    Return to top

Call 911, a suicide hotline, or get safely to a nearby emergency room if you have thoughts of suicide, a suicidal plan, or thoughts of harming yourself or others.

Call your doctor right away if:

Prevention    Return to top

You may be able to avoid some episodes of depression by:

Counseling may help you through times of grief, stress, or low mood. Family therapy may be particularly important for teens who feel blue.

The elderly, or others who feel socially isolated or lonely can try volunteering or getting involved in group activities.

Medications and psychiatric counseling may prevent depression from returning. Some episodes of depression are not preventable.

References    Return to top

Moore DP, Jefferson JW. Mood disorders. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier;2004:chap 74.

US Preventive Services Task Force. Guide to clinical preventive services: screening for depression, recommendations and rationale. 2002;136. Accessed October 17, 2008.

Conway MW, Miller MN. Mood disorders. In: Rakel P, Bope ET, eds. Conn's Current Therapy 2008. 60th ed. Philadelphia, Pa:Saunders Elsevier;2008:chap 281.

American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007. Accessed October 27, 2008.

Schiffer RB. Psychiatric disorders in medical practice. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 420.

Update Date: 1/20/2009

Updated by: Paul Ballas, DO, Department of Psychiatry, Thomas Jefferson Uniersity Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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