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Depression

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being. Depressed people may feel sad, anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt, or restless. They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details, or making decisions, and may contemplate or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains, or digestive problems that are resistant to treatment may also be present.

Depressed mood is not necessarily a psychiatric disorder. It may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments. Depressed mood is also a primary or associated feature of certain psychiatric syndromes such as clinical depression.

Signs and symptoms of depression

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted—the more likely it is that you’re dealing with depression. When these symptoms are overwhelming and disabling, that's when it's time to seek help.

Common signs and symptoms of depression

Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
Concentration problems. Trouble focusing, making decisions, or remembering things.
Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Depression and suicide

Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. Thoughts of death or suicide are a serious symptom of depression, so take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide: it's a cry for help.

Warning signs of suicide include:
• Talking about killing or harming one’s self
• Expressing strong feelings of hopelessness or being trapped
• An unusual preoccupation with death or dying
• Acting recklessly, as if they have a death wish (e.g. speeding through red lights)
• Calling or visiting people to say goodbye
• Getting affairs in order (giving away prized possessions, tying up loose ends)
• Saying things like “Everyone would be better off without me” or “I want out”
• A sudden switch from being extremely depressed to acting calm and happy.
 
If you think a friend or family member is considering suicide, express your concern and seek professional help immediately. Talking openly about suicidal thoughts and feelings can save a life!

The faces of depression

Depression
often looks different in men and women, and in young people and older adults. An awareness of these differences helps ensure that the problem is recognized and treated.

Depression in men
 
 
Depression is a loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. This is especially true with men. Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Other signs and symptoms of depression in men include anger, aggression, violence, reckless behavior, and substance abuse. Even though depression rates for women are twice as high as those in men, men are a higher suicide risk, especially older men.

Depression in women

 Rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression. As for signs and symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.

Depression in teens
 
While some depressed teens appear sad, others do not. In fact, irritability—rather than depression—is frequently the predominant symptom in depressed adolescents and teens. A depressed teenager may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains are also common symptoms of depression in young people.
 
Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide. But with help, teenage depression is highly treatable.

Depression in older adults
 
The difficult changes that many older adults face—such as bereavement, loss of independence, and health problems—can lead to depression, especially in those without a strong support system. However, depression is not a normal part of aging. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression, and so the problem often goes unrecognized. Depression in older adults is associated with poor health, a high mortality rate, and an increased risk of suicide, so diagnosis and treatment are extremely important.

Postpartum Depression
 
Many new mothers suffer from some fleeting form of the “baby blues.” Postpartum depression, in contrast, is a longer lasting and more serious depression triggered, in part, by hormonal changes associated with having a baby. Postpartum depression usually develops soon after delivery, but any depression that occurs within six months of childbirth may be postpartum depression.
 
Types of depression

Depression comes in many shapes and forms. The different types of depression have unique symptoms, causes, and effects. Knowing what type of depression you have can help you manage your symptoms and get the most effective treatment.

Major depression

Major depression is characterized by the inability to enjoy life and experience pleasure. The symptoms are constant, ranging from moderate to severe. Left untreated, major depression typically lasts for about six months. Some people experience just a single depressive episode in their lifetime, but more commonly, major depression is a recurring disorder. However, there are many things you can do to support your mood and reduce the risk of recurrence.

Dysthymia (recurrent, mild depression)
 
Dysthmia is a type of chronic “low-grade” depression. More days than not, you feel mildly or moderately depressed, although you may have brief periods of normal mood. The symptoms of dysthymia are not as strong as the symptoms of major depression, but they last a long time (at least two years). These chronic symptoms make it very difficult to live life to the fullest or to remember better times. Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.” If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.” However, dysthymia can be treated, even if your symptoms have gone unrecognized or untreated for years.

Bipolar Disorder: When Depression is Just One Side of the Coin
  
Bipolar disorder, also known as manic depression, is characterized by cycling mood changes. Episodes of depression alternate with manic episodes, which can include impulsive behavior, hyperactivity, rapid speech, and little to no sleep. Typically, the switch from one mood extreme to the other is gradual, with each manic or depressive episode lasting for at least several weeks. When depressed, a person with bipolar disorder exhibits the usual symptoms of major depression. However, the treatments for bipolar depression are very different. In fact, antidepressants can make bipolar depression worse.

The road to depression recovery
 
Just as the symptoms and causes of depression are different in different people, so are the ways to feel better. What works for one person might not work for another, and no one treatment is appropriate in all cases. If you recognize the signs of depression in yourself or a loved one, take some time to explore the many treatment options. In most cases, the best approach involves a combination of social support, lifestyle changes, emotional skills building, and professional help.

Ask for help and support


If even the thought of tackling your depression seems overwhelming, don’t panic. Feeling helpless and hopeless is a symptom of depression—not the reality of your situation. It does not mean that you’re weak or you can’t change! The key to depression recovery is to start small and ask for help. Having a strong support system in place will speed your recovery. Isolation fuels depression, so reach out to others, even when you feel like being alone. Let your family and friends know what you’re going through and how they can support you.

Make healthy lifestyle changes

Lifestyle changes are not always easy to make, but they can have a big impact on depression. Lifestyle changes that can be very effective include:

• Cultivating supportive relationships
• Getting regular exercise and sleep
• Eating healthfully to naturally boost mood
• Managing stress
• Practicing relaxation techniques
• Challenging negative thought patterns

Build emotional skills
 
Many people lack the skills needed to manage stress and balance emotions. Building emotional skills can give you the ability to cope and bounce back from adversity, trauma, and loss. In other words, learning how to recognize and express your emotions can make you more resilient.

Seek professional help

If support from family and friends, positive lifestyle changes, and emotional skills building aren’t enough, seek help from a mental health professional. There are many effective treatments for depression, including therapy, medication, and alternative treatments. Learning about your options will help you decide what measures are most likely to work best for your particular situation and needs.

Are antidepressants right for you?

Medication can help relieve the symptoms of depression in some people, but they aren’t a cure and they come with drawbacks of their own. Learning the facts about antidepressants and weighing the benefits against the risks can help you make an informed and personal decision about whether medication is right for you.

Effective treatment for depression often includes some form of therapy. Therapy gives you tools to treat depression from a variety of angles. Also, what you learn in therapy gives you skills and insight to prevent depression from coming back.

Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.

Dealing with Depression

Self-Help and Coping Tips to Overcome Depression

Depression drains your energy, hope, and drive, making it difficult to do what you need to feel better. But while overcoming depression isn’t quick or easy, it’s far from impossible. You can’t beat it through sheer willpower, but you do have some control—even if your depression is severe and stubbornly persistent. The key is to start small and build from there. Feeling better takes time, but you can get there if you make positive choices for yourself each day.

The road to depression recovery
 
Recovering from depression requires action, but taking action when you’re depressed is hard. In fact, just thinking about the things you should do to feel better, like going for a walk or spending time with friends, can be exhausting.

It’s the Catch-22 of depression recovery:

The things that help the most are the things that are the most difficult to do. There’s a difference, however, between something that's difficult and something that's impossible.

Start small and stay focused

The key to depression recovery is to start with a few small goals and slowly build from there. Draw upon whatever resources you have. You may not have much energy, but you probably have enough to take a short walk around the block or pick up the phone to call a loved one.

Take things one day at a time and reward yourself for each accomplishment. The steps may seem small, but they’ll quickly add up. And for all the energy you put into your depression recovery, you’ll get back much more in return.

Depression self-help tip 1: Cultivate supportive relationships

Getting the support you need plays a big role in lifting the fog of depression and keeping it away. On your own, it can be difficult to maintain perspective and sustain the effort required to beat depression, but the very nature of depression makes it difficult to reach out for help. However, isolation and loneliness make depression even worse, so maintaining your close relationships and social activities are important.

The thought of reaching out to even close family members and friends can seem overwhelming. You may feel ashamed, too exhausted to talk, or guilty for neglecting the relationship. Remind yourself that this is the depression talking. You loved ones care about you and want to help.

• Turn to trusted friends and family members. Share what you’re going through with the people you love and trust. Ask for the help and support you need. You may have retreated from your most treasured relationships, but they can get you through this tough time.
• Try to keep up with social activities even if you don’t feel like it. Often when you’re depressed, it feels more comfortable to retreat into your shell, but being around other people will make you feel less depressed.
• Join a support group for depression. Being with others dealing with depression can go a long way in reducing your sense of isolation. You can also encourage each other, give and receive advice on how to cope, and share your experiences.

10 tips for reaching out and building relationships


• Talk to one person about your feelings.
• Help someone else by volunteering.
• Have lunch or coffee with a friend.
• Ask a loved one to check in with you regularly.
• Accompany someone to the movies, a concert, or a small get-together.
• Call or email an old friend.
• Go for a walk with a workout buddy.
• Schedule a weekly dinner date.
• Meet new people by taking a class or joining a club.
• Confide in a counselor, therapist, or clergy member.

Depression self-help tip 2: Challenge negative thinking


Depression puts a negative spin on everything, including the way you see yourself, the situations you encounter, and your expectations for the future.

But you can’t break out of this pessimistic mind frame by “just thinking positive.” Happy thoughts or wishful thinking won’t cut it. Rather, the trick is to replace negative thoughts with more balanced thoughts.

Ways to challenge negative thinking:

• Think outside yourself. Ask yourself if you’d say what you’re thinking about yourself to someone else. If not, stop being so hard on yourself. Think about less harsh statements that offer more realistic descriptions.
• Allow yourself to be less than perfect. Many depressed people are perfectionists, holding themselves to impossibly high standards and then beating themselves up when they fail to meet them. Battle this source of self-imposed stress by challenging your negative ways of thinking
• Socialize with positive people. Notice how people who always look on the bright side deal with challenges, even minor ones, like not being able to find a parking space. Then consider how you would react in the same situation. Even if you have to pretend, try to adopt their optimism and persistence in the face of difficulty.
• Keep a “negative thought log." Whenever you experience a negative thought, jot down the thought and what triggered it in a notebook. Review your log when you’re in a good mood. Consider if the negativity was truly warranted. Ask yourself if there’s another way to view the situation. For example, let’s say your boyfriend was short with you and you automatically assumed that the relationship was in trouble. It's possible, though, he’s just having a bad day.

Types of negative thinking that add to depression

All-or-nothing thinking –

Looking at things in black-or-white categories, with no middle ground (“If I fall short of perfection, I’m a total failure.”)

Overgeneralization – Generalizing from a single negative experience, expecting it to hold true forever (“I can’t do anything right.”)

The mental filter – Ignoring positive events and focusing on the negative. Noticing the one thing that went wrong, rather than all the things that went right.

Diminishing the positive – Coming up with reasons why positive events don’t count (“She said she had a good time on our date, but I think she was just being nice.”)

Jumping to conclusions – Making negative interpretations without actual evidence. You act like a mind reader (“He must think I’m pathetic”) or a fortune teller (“I’ll be stuck in this dead end job forever”)

Emotional reasoning – Believing that the way you feel reflects reality (“I feel like such a loser. I really am no good!”)

‘Shoulds’ and ‘should-nots’ – Holding yourself to a strict list of what you should and shouldn’t do, and beating yourself up if you don’t live up to your rules.

Labeling – Labeling yourself based on mistakes and perceived shortcomings (“I’m a failure; an idiot; a loser.”)

Depression self-help tip 3: Take care of yourself

In order to overcome depression, you have to take care of yourself. This includes following a healthy lifestyle, learning to manage stress, setting limits on what you’re able to do, adopting healthy habits, and scheduling fun activities into your day.

• Aim for eight hours of sleep. Depression typically involves sleep problems. Whether you’re sleeping too little or too much, your mood suffers. Get on a better sleep schedule by learning healthy sleep habits.
• Expose yourself to a little sunlight every day. Lack of sunlight can make depression worse. Make sure you’re getting enough. Take a short walk outdoors, have your coffee outside, enjoy an al fresco meal, people-watch on a park bench, or sit out in the garden. Aim for at least 15 minutes of sunlight a day to boost your mood. If you live somewhere with little winter sunshine, try using a light therapy box.
• Keep stress in check. Not only does stress prolong and worsen depression, but it can also trigger it. Figure out all the things in your life that stress you out. Examples include: work overload, unsupportive relationships, taking on too much, or health problems. Once you’ve identified your stressors, you can make a plan to avoid them or minimize their impact.
• Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress, and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.
• Care for a pet. While nothing can replace the human connection, pets can bring joy and companionship into your life and help you feel less isolated. Caring for a pet can also get you outside of yourself and give you a sense of being needed—both powerful antidotes to depression.

Do things you enjoy (or used to)

While you can’t force yourself to have fun or experience pleasure, you can choose to do things that you used to enjoy. Pick up a former hobby or a sport you used to like. Express yourself creatively through music, art, or writing. Go out with friends. Take a day trip to a museum, the mountains, or the ballpark.

Push yourself to do things, even when you don’t feel like it. You might be surprised at how much better you feel once you’re out in the world. Even if your depression doesn’t lift immediately, you’ll gradually feel more upbeat and energetic as you make time for fun activities.

Develop a wellness toolbox

Come up with a list of things that you can do for a quick mood boost. Include any strategies, activities, or skills that have helped in the past. The more “tools” for coping with depression, the better. Try and implement a few of these ideas each day, even if you’re feeling good.
 
• Spend some time in nature
• List what you like about yourself
• Read a good book
• Watch a funny movie or TV show
• Take a long, hot bath
• Take care of a few small tasks
• Play with a pet
• Write in your journal
• Listen to music
• Do something spontaneous

Depression self-help tip 4: Get regular exercise
 
When you’re depressed, exercising may be the last thing you feel like doing. But exercise is a powerful tool for dealing with depression. In fact, studies show that regular exercise can be as effective as antidepressant medication at increasing energy levels and decreasing feelings of fatigue.

Scientists haven’t figured out exactly why exercise is such a potent antidepressant, but evidence suggests that physical activity triggers new cell growth in the brain, increases mood-enhancing neurotransmitters and endorphins, reduces stress, and relieves muscle tension—all things that can have a positive effect on depression.

To gain the most benefits, aim for 30 minutes of exercise per day. You can start small, though, as short 10-minute bursts of activity can have a positive effect on your mood. Here are a few easy ways to get moving:

• Take the stairs rather than the elevator
• Park your car in the farthest spot in the lot
• Take your dog for a walk
• Pair up with an exercise partner
• Walk while you’re talking on the phone

As a next step, try incorporating walks or some other enjoyable, easy form of exercise into your daily routine. The key is to pick an activity you enjoy, so you’re more likely to keep up with it.

Exercise as an Antidepressant

The following exercise tips offer a powerful prescription for boosting mood:

• Exercise now…and again. A 10-minute walk can improve your mood for two hours. The key to sustaining mood benefits is to exercise regularly.
• Choose activities that are moderately intense. Aerobic exercise undoubtedly has mental health benefits, but you don't need to sweat strenuously to see results.
• Find exercises that are continuous and rhythmic (rather than intermittent). Walking, swimming, dancing, stationery biking, and yoga are good choices.
• Add a mind-body element. Activities such as yoga and tai chi rest your mind and increase your energy. You can also add a meditative element to walking or swimming by repeating a mantra (a word or phrase) as you move.
• Start slowly, and don't overdo it. More isn't better. Athletes who over train find their moods drop rather than lift. 

Depression self-help tip 5: Eat a healthy, mood-boosting diet

What you eat has a direct impact on the way you feel. Aim for a balanced diet of low-fat protein, complex carbohydrates, fruits and vegetables. Reduce your intake of foods that can adversely affect your brain and mood, such as caffeine, alcohol, trans fats, saturated fats, and foods with high levels of chemical preservatives or hormones (such as certain meats).

• Don’t skip meals. Going too long between meals can make you feel irritable and tired, so aim to eat something at least every three to four hours.
 • Minimize sugar and refined carbs. You may crave sugary snacks, baked goods, or comfort foods such as pasta or French fries, but these “feel-good” foods quickly lead to a crash in mood and energy.
• Focus on complex carbohydrates. Foods such as baked potatoes, whole-wheat pasta, oatmeal, and whole grain breads can boost serotonin levels without a crash.
• Boost your B vitamins. Deficiencies in B vitamins such as folic acid and B-12 can trigger depression. To get more, take a B-complex vitamin supplement or eat more citrus fruit, leafy greens, beans, chicken, and eggs.
• Try super-foods rich in nutrients that can boost mood, such as bananas (magnesium to decrease anxiety, vitamin B6 to promote alertness, tryptophan to boost feel-good serotonin levels), brown rice (serotonin, thiamine to support sociability), and spinach (magnesium, folate to reduce agitation and improve sleep).
• Consider taking a chromium supplement. Some depression studies show that chromium picolinate reduces carbohydrate cravings, eases mood swings, and boosts energy. Supplementing with chromium picolinate is especially effective for people who tend to overeat and oversleep when depressed.

Omega-3 fatty acids play an essential role in stabilizing mood.


• Foods rich in certain omega-3 fats called EPA and DHA can give your mood a big boost. The best sources are fatty fish such as salmon, herring, mackerel, anchovies, sardines, and some cold-water fish oil supplements. Canned albacore tuna and lake trout can also be good sources, depending on how the fish were raised and processed. When cooking fish, grill or bake rather than fry.
• You may hear a lot about getting your omega-3s from foods rich in ALA fatty acids, such as vegetable oils and nuts (especially walnuts), flax, soybeans, and tofu. Be aware that our bodies generally convert very little ALA into EPA and DHA, so you may not see as big of a benefit.
• Some people avoid seafood because they worry about mercury or other possible toxins, but most experts agree that the benefits of eating one or two servings a week of cold-water fatty fish outweigh the risks.


Depression self-help tip 6: Know when to get additional help

If you find your depression getting worse and worse, seek professional help. Needing additional help doesn’t mean you’re weak. Sometimes the negative thinking in depression can make you feel like you’re a lost cause, but depression can be treated and you can feel better!

Don’t forget about these self-help tips, though. Even if you’re receiving professional help, these tips can be part of your treatment plan, speeding your recovery and preventing depression from returning. Helping a Depressed Person

How to Reach Out and Help Someone While Taking Care of Yourself

When a family member or friend suffers from depression, your support and encouragement can play an important role in his or her recovery. However, depression can also wear you down if you neglect your own needs. These guidelines can help you support a depressed person while maintaining your own emotional equilibrium.

Helping a depressed friend or family member


Depression is a serious but treatable disorder that affects millions of people, from young to old and from all walks of life. It gets in the way of everyday life, causing tremendous pain, hurting not just those suffering from it, but also impacting everyone around them.

If someone you love is depressed, you may be experiencing any number of difficult emotions, including helplessness, frustration, anger, fear, guilt, and sadness. These feelings are all normal. It’s not easy dealing with a friend or family member’s depression. And if you don’t take care of yourself, it can become overwhelming.

That said, there are steps you can take to help your loved one. Start by learning about depression and how to talk about it with your friend or family member. But as you reach out, don’t forget to look after your own emotional health. Thinking about your own needs is not an act of selfishness—it’s a necessity. Your emotional strength will allow you to provide the ongoing support your depressed friend or family member needs. Depression Treatment

Therapy, Medication, and Lifestyle Changes That Can Help Depression

When you’re depressed, it can feel like you’ll never get out from under a dark shadow. However, depression is a treatable problem. So, if your depression is keeping you from living the life you want to, don’t hesitate to seek help. Learning about your depression treatment options will help you decide what approach is right for you. From therapy to medication to healthy lifestyle changes, there are many effective treatments that can help you overcome depression and reclaim your life.

Exploring your depression treatment options
 

Just as no two people are affected the exact same way by depression, there is no “one size fits all” treatment that cures depression. What works for one person might not work for another. The best way to treat depression is to become as informed as possible about the treatment options, and then tailor them to meet your needs.

Depression treatment tips:

• Learn as much as you can about your depression. It’s important to determine whether your depression symptoms are due to an underlying medical condition. If so, that condition will need to be treated first. The severity of your depression is also a factor. The more severe the depression, the more intensive the treatment you're likely to need.
• It takes time to find the right treatment. It might take some trial and error to find the treatment and support that works best for you. For example, if you decide to pursue therapy it may take a few attempts to find a therapist that you really click with. Or you may try an antidepressant, only to find that you don't need it if you take a daily half hour walk. Be open to change and a little experimentation.
• Don’t rely on medications alone. Although medication can relieve the symptoms of depression, it is not usually suitable for long-term use. Studies show that other treatments, including exercise and therapy, can be just as effective as medication, often even more so, but don't come with unwanted side effects. If you do decide to try medication, remember that medication works best when you make healthy lifestyle changes as well.
• Get social support. The more you cultivate your social connections, the more protected you are from depression. If you are feeling stuck, don’t hesitate to talk to trusted family members or friends, or seek out new connections at a depression support group, for example. Asking for help is not a sign of weakness.
• Treatment takes time and commitment. All of these depression treatments take time, and sometimes it might feel overwhelming or frustratingly slow. That is normal. Recovery usually has its ups and downs.

Lifestyle changes: An essential part of depression treatment
 
Lifestyle changes are simple but powerful tools in treating depression. Sometimes they might be all you need. Even if you need other treatment, lifestyle changes go a long way towards helping lift depression. And they can help keep depression at bay once you are feeling better.

Lifestyle changes that can treat depression

• Exercise. Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Best of all, you don’t have to train for a marathon in order to reap the benefits. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of aerobic activity on most days.
• Nutrition. Eating well is important for both your physical and mental health. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. They'll get you going without the all-too-soon sugar crash.
• Sleep. Sleep has a strong effect on mood. When you don't get enough sleep, your depression symptoms will be worse. Sleep deprivation exacerbates irritability, moodiness, sadness, and fatigue. Make sure you're getting enough sleep each night. Very few people do well on less than 7 hours a night. Aim for somewhere between 7 to 9 hours each night.
• Social support. Strong social networks reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself.
• Stress reduction. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression. Take the aspects of your life that stress you out, such as work overload or unsupportive relationships, and find ways to minimize their impact.

Ruling out medical causes of depression

If you suspect that you may be depressed, and lifestyle changes haven’t worked, make an appointment to see your primary care doctor for a thorough checkup. If your depression is the result of medical causes, therapy and antidepressants will do little to help. The depression won’t lift until the underlying health problem is identified and treated.

Your doctor will check for medical conditions that mimic depression, and also make sure you are not taking medications that can cause depression as a side effect. Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. Hypothyroidism, or underactive thyroid, is a particularly common mood buster, especially in women. Older adults, or anyone who takes many different medications each day, are at risk for drug interactions that cause symptoms of depression. The more medications you are taking, the greater the risk for drug interactions.

Finding a therapist to treat your depression
 
If there is no underlying medical cause for your symptoms of depression, then finding a mental health specialist is the next best step for treatment. Although there are many types of mental health professionals, one of the most important things to consider when choosing a therapist is your connection with this person. The right therapist will be a caring and supportive partner in your depression treatment and recovery.

There are many ways to find a therapist. Word of mouth is one of the best ways to find a good therapist. Your friends and family may have some ideas, or your primary care doctor may be able to provide an initial referral. National mental health organizations can also help with referral lists of licensed credentialed providers. If cost is an issue, check out local senior centers, religious organizations, and community mental health clinics. Such places often offer therapy on a sliding scale for payment.

Psychotherapy for depression treatment

Talk therapy is an extremely effective treatment for depression. Therapy gives you tools to treat depression from a variety of angles. What you learn in therapy gives you skills and insight to help prevent depression from coming back. There are many types of therapy available. Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used. Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.

Therapy and “the big picture” in depression treatment


One of the hallmarks of depression is feeling overwhelmed and having trouble focusing. Therapy helps you step back and see what might be contributing to your depression and how you can make changes. Here are some of the “big picture” themes that therapy can help with:
• Relationships. Understanding the patterns of your relationships, building better relationships, and improving current relationships will help reduce isolation and build social support, important in preventing depression.
• Setting healthy boundaries. If you are stressed and overwhelmed, and feel like you just can’t say no, you are more at risk for depression. Setting healthy boundaries in relationships and at work can help relieve stress, and therapy can help you identify and validate the boundaries that are right for you.
• Handling life’s problems. Talking with a trusted therapist can provide good feedback on more positive ways to handle life’s challenges and problems.

Individual or group therapy for depression treatment?

When you hear the word “therapy” you might automatically think of one-on-one sessions with a therapist. However, group therapy can be very useful in depression treatment as well. What are the benefits of each? Both group and individual therapy sessions usually last about an hour. In individual therapy, you are building a strong relationship with one person, and may feel more comfortable sharing some sensitive information with one person than with a group. You also get individualized attention. Don’t rule out group therapy, however. Listening to peers going through the same struggles can validate your experiences and help build self-esteem. Often group members are at different points in their depression, so you might get tips from both someone in the trenches and someone who has worked through a challenging problem. As well as offering inspiration and ideas, attending group therapy can also help increase your social activities and network.

When the going gets tough in therapy...

As with remodeling a house, when you take apart things that haven't worked well in your life, it often makes them seem worse before they get better. When therapy seems difficult or painful, don't give up. If you discuss your feelings and reactions honestly with your therapist, it will help you move forward rather than retreat back to your old, less effective ways. However, if the connection with your therapist consistently starts to feel forced or uncomfortable, don’t be afraid to explore other options for therapy as well. A strong trusting relationship is the foundation of good therapy.
 

 

Medication treatment for depression

Depression medication may be the most advertised treatment for depression, but that doesn’t mean it is the most effective. Depression is not just about a chemical imbalance in the brain. Medication may help relieve some of the symptoms of moderate and severe depression, but it doesn’t cure the underlying problem, and it’s usually not a long-term solution. Antidepressant medications also come with side effects and safety concerns, and withdrawal can be very difficult. If you're considering whether antidepressant medication is right for you, learning all the facts can help you make an informed decision. If you are taking medication for depression, don’t ignore other treatments. Lifestyle changes and therapy not only help speed recovery from depression, but also provide skills to help prevent a recurrence.

Should you get antidepressants from your family doctor?
 
Family doctors might be the first professionals to recognize your depression. However, while they can prescribe antidepressants, it’s a good idea to explore your options with other mental health professionals who specialize in depression. Ask for a referral. You might end up working with a therapist and not needing medication at all. If you do need medication, a psychiatrist has advanced training and experience in depression, treatments, and medications.

Alternative and complementary treatments for depression
 
Alternative and complementary treatments for depression may include vitamin and herbal supplements, acupuncture, and relaxation techniques, such as mindfulness meditation, yoga, or tai chi.

Vitamins and supplements for depression treatment

The jury is still out on how well herbal remedies, vitamins, or supplements work in treating depression. While many supplements are widely available over the counter, in many cases their efficacy has not been scientifically proven. If your depression symptoms are in part due to nutritional deficiency, you may benefit from vitamin supplements, but this should be on the advice of your healthcare professional.

If you decide to try natural and herbal supplements, remember that they can have side effects and drug or food interactions. For example, St. John’s Wort—a promising herb used for treatment of mild to moderate depression—can interfere with prescription drugs such as blood thinners, birth control pills, and prescription antidepressants. Make sure your doctor or therapist knows what you are taking.

Other alternative depression treatments

• Relaxation techniques. As well as helping to relieve symptoms of depression, relaxation techniques may also reduce stress and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.
• Acupuncture. Acupuncture, the technique of using fine needles on specific points on the body for therapeutic purposes, is increasingly being investigated as a treatment for depression, with some research studies showing promising results. If you decide to try acupuncture, make sure that you find a licensed qualified professional.