Discuss all medical advice, diagnosis, and treatment with your healthcare provider.

The Basics

What is depression?

Depression is a medical illness that affects the body, mind, and spirit. It affects how you feel about yourself, how you function in your everyday life, and how you relate to others. While everyone experiences ups and downs in life, depression is characterized by a long period of down times, when you are unable to live a “normal” life because of deep feelings that will not go away.

Depression is not a sign of personal weakness or ingratitude. It is a chemical imbalance in the brain and, when left untreated, it can persist for days, months, or even years. Major depressive disorders are usually associated with changes in the brain structure or brain function. People who suffer from depression must seek out help because if they think they will be able to just “pull it together,” they may suffer needlessly for a long time. Furthermore, untreated depression is potentially dangerous because some people who have depression have feelings of wanting to harm themselves and may form a suicide plan.


Symptoms

• No interest or pleasure in things you used to enjoy
• Feeling sad or empty
• Crying easily or crying for no reason
• Feeling slowed down or feeling restless and unable to sit still
• Feeling worthless or guilty
• Weight gain or loss
• Thoughts of death or suicide
• Trouble thinking, recalling things, or focusing on what you're doing
• Trouble making everyday decisions
• Problems sleeping, especially in the early morning, or wanting to sleep all of the time
• Feeling tired all the time
• Feeling numb emotionally, perhaps even to the point of not being able to cry
• Persistent headaches, digestive disorders, chronic pain, or other physical symptoms

What are the different types of depression?

Depression comes in many different forms, each of which affects sufferers in different ways. The three most common forms of depression are:

Major Depression: Also known as clinical depression or unipolar depression, this type of depression is characterized by a combination of symptoms (above) that interfere with the ability to function normally and to enjoy activities that were once pleasurable, including sex. Treatment should be sought if any of these symptoms occur at once, if symptoms persist for 2 weeks or more, or if symptoms interfere with ordinary functioning. Major depression may occur once in a lifetime or may recur.

Dysthymia: This type of depression is less severe than major depression, but the symptoms are long-term and chronic. While a person suffering from dysthymia won't be disabled by the illness, he/she will not function well or feel good. Many people who battle dysthymia may also experience major depression in their lives.

Bipolar Personality Disorder (BPD): This illness is characterized by cycling mood swings with severe highs (mania) and severe lows (depression).  The mood swings may be dramatic and sudden, but more often they are gradual. When the person is in a depressed phase, he/she may experience any or all of the symptoms of depression.

Symptoms of mania

• Abnormal or excessive elation
• Unusual irritability or restlessness
• Grandiose notions
• Increased talking
• Racing thoughts, jumping from one idea to another
• Increased sexual desire
• Markedly increased energy and reduced sleep requirements
• Poor judgment
• Inappropriate social behavior
• Impulsive activity (for example, spending sprees or drug use)

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What causes depression?

There is no single identifiable cause of depression. Like most illnesses that affect the brain, there are various contributing factors.

• Heredity: There is proof that some forms of depression are inherited, and if you have family members who suffer from certain types of depression, you are more susceptible to developing depression. This is especially true with bipolar disorder. Studies of families in which members of different generations have bipolar disorder show that those with the illness have different genetic makeups than those who do not have the illness. However, this does not mean that if you have a genetic makeup similar to someone with depression that you will definitely experience depression. Outside factors, such as family life and stress levels, may trigger depression in these people.
• Hormonal factors: Hormonal fluctuations like menstrual cycle changes, pregnancy, miscarriage, postpartum period, perimenopause, and menopause.cfm?portalid=0&layoutID=0" target="blank_">menopause may bring on depression. Hormone irregularities, which affect processes such as eating and insomnia, can cause depression.
• Stress: Our mind’s reaction to stressful situations can trigger depression. The death of a loved one, the loss of a job, and even an upcoming marriage can all be major stressors. This does not mean, of course, that everyone will experience depression after such events. However, particularly if there is already a genetic predisposition to depression, such stressful events may cause depression. There is a healthy period of mourning that goes along with loss and change, and this is normal. But when it becomes a chronic condition, it may be depression.
• Medical illness: Illness can be very difficult to endure. Stroke, heart attacks, and cancer all take away a sense of control from the sufferer and can cause great emotional distress and sometimes depression. Clinical depression should not be considered a normal reaction to illness.
• Chemical imbalances: The part of the brain related to emotions is the limbic system. In the limbic system are 30 identified neurotransmitters, though there are suspected to be many more. Of these identified neurotransmitters, three are linked with depression: serotonin, norepinephrine, and dopamine. These three neurotransmitters help regulate emotions, reactions to stress, and physical drives such as sleep, appetite, and sexuality. When they are imbalanced, depression may result.
• Personality: People with certain personality traits such as negative thinking, low self-esteem, and excessive worrying are more likely to become depressed.
• Diet: Deficiencies in certain vitamins>, such as B-12 and folic acid, are associated with depression.

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Depression and Women

The statistics

• In any given 1-year period, 9.5% of the population, or about 20.9 million American adults, suffer from a depressive illness.
• The prevalence of major depression in women is about two times higher than in men—this difference begins in early adolescence and persists through one's mid-50s, corresponding to the reproductive years in women.
• The prevalence of postpartum depression (PPD) is 5% to 10%, which is the same prevalence of depression in nonpregnant women of the same age.

How does depression affect women differently?

Certain side effects of depression occur much more prevalently in women than in men. For example, symptoms such as anxiety and eating disorders are much more common in women. Men have an increased risk of completed suicide and alcohol or drug abuse.

• Episodes of depression may be longer in women; depression may be more chronic and recurrent.
• Factors that contribute to depression for women include stressful The goals of treatment in depression involve reducing your current symptoms as well as preventing chronic symptoms and relapse of your depression. While there are specific recommendations for preventing chronic symptoms and relapse, preventing the development of depression altogether is not as clear cut. There are many different treatments available for depression, however, many people with depression are not properly diagnosed and treated, perhaps due to the social stigma surrounding depression. In addition, many healthcare professionals find it difficult to diagnose depression if people do not talk about their symptoms and can hide the signs. However, you should understand that the earlier depression is treated the shorter duration of the illness and the less likely it is to become chronic and relapsing. events, seasonal changes, and hormonal changes such as menopause.
• In terms of treatment, women seem to respond better to selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) than tricyclic antidepressants (TCAs).
• Both men and women can be treated to remission with therapy, and remission rates are higher for both men and women when accompanied by a serotonin-norephinephrine reuptake inhibitor (SNRI).

Depression across the female life cycle

Premenstrual phase

• There is increased vulnerability toward depression during the premenstrual phase, which could be a symptom of premenstrual syndrome (PMS) or premenstrual dysphoric disoroder (PMDD).
• Women who suffer severe PMS (mood swings, anxiety, irritability, depressed mood) experience levels of impairment comparable to levels observed in major depression.
• Studies show that intermittent treatment (day 14 or 15 of the cycle) with an antidepressant is effective for PMDD.

Pregnancy
If you have been consistently treated for depression and become pregnant, you will need to alter your treatment so that you can continue to deal with your symptoms without affecting the physical well-being of the fetus. Depression before or during pregnancy is the strongest indicator of postpartum depression (PPD).

There are both risks and benefits of continuing depression treatment during pregnancy and of discontinuing treatment. Medication ingested during pregnancy does reach the fetus. In rare cases, some antidepressants have been associated with breathing and heart problems in newborns, as well as jitteriness after delivery. However, if you stop medication during pregnancy, you may be at increased risk for a relapse in your depression. Talk to your healthcare provider about the best method for ensuring your health and the health of your baby.

Menopause
Women experinecing menopause are at increased risk of developing depression, especially if there is a history of depression or depressive tendencies.

Some studies show that an increase in estrogen levels improves depressive and physical symptoms. Estrogen therapy improves both response and remission rates for antidepressants in perimenopausal and postmenopausal women.

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Diagnosis and Treatment

Diagnosis

Ask yourself the following questions if you think you may have depression in the perimenopause phase. If you answer yes to either one, report this to your doctor.

• In the last month, have you lost pleasure in the activities you normally enjoy?
• In the last month, have you felt sad, down, depressed, or hopeless?

There are physical causes of depression that may be removed from your life to alleviate depression. The first thing your healthcare professional will do is take a detailed medical history and perform a physical exam to determine whether a medical condition is causing your symptoms. If so, treating your condition may take away your symptoms. If a physical cause is ruled out, your physician may refer you to a psychiatrist or a psychologist.

A good diagnostic evaluation should include a complete history of symptoms as follows:

• When did the symptoms start?
• How long they have lasted ?
• How severe are they
• Have you had them before
• Were the symptoms treated previously?
• Was there any alcohol or drug use?
• Any thoughts of self-harm?
• Is there a family history of depression?

Another diagnostic technique doctors employ is the BATHE technique:

Background: “What is going on in your life?”
Affect/feeling: “How are you feeling about that?”
Trouble: “What troubles you most?”
Handling: “How are you handling that?”
Empathy: “That must be very difficult.”

The goals of treatment in depression involve reducing your current symptoms as well as preventing chronic symptoms and relapse of your depression. While there are specific recommendations for preventing chronic and relapse, preventing the development of depression altogether is not as clear cut.

There are many different treatments available for depression, however, many people with depression are not properly diagnosed and treated, perhaps due to the social stigma surrounding depression. In addition, many healthcare professionals find it difficult to diagnose depression if people do not talk about their symptoms and can hide the signs. However, you should understand that the earlier depression is treated the shorter duration of the illness and the less likely it is to become chronic and relapsing.

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Prevention

Even though anyone can develop depression, certain factors increase a person's risk for developing the condition. However, some of these factors can be modified to reduce a person's risk.

These are risk factors for depression which can be modified:

• Poor social supports
• Significant stressful life events
• Alcohol or substance (drug) abuse
• Physical illness or medical condition
• Postpartum: there is some research to suggest that professional counseling provided postnatally to women can reduce depression symptoms and risk. Furthermore, some experts recommend restarting antidepressant medication therapy early (such as in the 3rd trimester or soon after delivery) to reduce the risk of postpartum depression in women previously treated for depression.

These are risk factors for depression which can't be modified:

• Female gender
• A history of depression in a first degree relative (parent, sibling, or child)
• A prior episode of major depression. A prior episode of postpartum depression, for example, leaves a woman with a 50% risk of developing postpartum depression in subsequent pregnancies. Using hormone therapy after delivery has not been proven to be effective in reducing this risk.
• A history of depression in a family member who is not a first degree relative

Accepted treatments

Your healthcare professional will able to diagnose whether you are suffering from depression and its severity (mild, moderate, or severe) and he or she will be able to advise you on the best treatment approach. The goals of the treatment of depression include treating the symptoms as well as addressing the psychological, social, and physical issues that may have contributed to its development.

In order to assist you in finding the best approach to treatment your healthcare professional may refer you to a mental health specialist like a psychiatrist, who specializes in the diagnosis and treatment of mental illnesses. Your healthcare professional is more likely to refer you to a mental health specialist if your depression is severe, if you are expressing suicidality, if you experience a relapse, or if you need specialized treatments such as psychotherapy. He or she might also refer you if your depression is part of another mental illness such as bipolar disorder, or if its not clear whether your symptoms represent depression.

The two most common approaches to treating depression are psychological treatments and medications. If depression is mild, psychological treatment alone may improve symptoms. However, in most cases a combination of therapy and medication is recommended. Exercise and relaxation therapies, for example, yoga, Tai chi, and meditation will be also helpful in recovering from depression.

Self-care and lifestyle changes

Taking care of yourself and making some lifestyle changes may be effective in reducing your symptoms of depression and helping you recover. Some suggested lifestyle and self-care approaches include:

• Eating a healthful balanced diet
• Exercising daily
• Meditation
• Breathing exercises to reduce stress
• Avoiding smoking, drugs and excessive alcohol
• Surrounding yourself with a supportive friends and family
• Making sure you get enough sleep
• Planning pleasant events into your day

Psychological treatments

There are various types of psychological treatments that your healthcare professional can discuss with you. The treatments will involve seeing a trained therapist for several sessions over a period of time. Some people may feel uncomfortable about this form of treatment as it involves revealing personal details to a healthcare professional and it carries a certain social stigma in our society. However, psychological treatments have been proven beneficial in treating depression and reducing the risk of relapse.

Research has shown that various forms of psychological treatment are effective in the treatment of depression including:

• Cognitive-behavioral therapy
• Interpersonal psychotherapy
• Brief dynamic therapy
• Marital therapy
• Family therapy

The research however has not revealed exactly how long people should receive these therapies. The two most common types of psychological treatment for depression are:

Cognitive-behavioral therapy

Cognitive behavioral therapy involves seeing a therapist to understand how your thoughts and behaviors are linked. In cognitive behavioral therapy, techniques such as goal setting, problem solving, and keeping a diary of thoughts and emotions are used. Such techniques help you learn about your thought processes and how to change them as well as your response to them.

Interpersonal psychotherapy

This type of therapy involves seeing a trained psychotherapist in order to gain an increased understanding of your relationships and how they affect your life.

Medication

Medications to relieve symptoms of depression are called antidepressants. They work by altering levels of certain neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. A neurotransmitter is a brain chemical that enables messages to pass from nerve cell to nerve cell in the central nervous system. Many people with depression have low levels of one or more of these neurotransmitters and antidepressant medications help to boost levels.

The most common types of antidepressant medication are:

• Selective serotonin reuptake inhibitors
• Serotonin and norepinephrine reuptake inhibitors
• Tricyclic antidepressants
• Combined reuptake inhibitors and receptor blockers
• Monoamine oxidase inhibitors
• Norepinephrine and dopamine reuptake inhibitors

Your healthcare professional will be able to provide you with information on each medication, which one to take, and possible side effects.

Antidepressants sometimes cause mild side effects, some of which may be transient. See your healthcare professional to discuss any side effects you may experience, because stopping your medication abruptly will worsen side effects.

Here is a detailed description of the antidepressant medications that you may be prescribed:

• Selective serotonin reuptake inhibitors
  
  • citalopram (Celexa^®)
  • escitalopram (Lexapro^®)
  • fluoxetine (Prozac^®, Prozac Weekly™)
  • paroxetine (Paxil^®, Paxil CR^®, Pexeva^®)
  • sertraline (Zoloft^®)

Selective serotonin reuptake inhibitors are the most commonly prescribed medication in the USA for depression, because their side effects are more tolerable and they are safe if taken accidentally in excessive quantities. However, there has been some concern in the press about an increased suicide risk with this medication, but the evidence linking this form of medication to suicide is weak.

Common side effects include diarrhea, nausea, insomnia, headache, and feeling jittery. Often these side effects are transient and will resolve within a few days of commencing treatment. One troublesome side effect is sexual problems, whereby people can experience a reduced libido.

Antidepressants sometimes cause mild and, usually, temporary side effects in some patients. These side effects are usually not serious. However, any unusual reactions or side effects or reactions that interfere with functioning should be immediately reported to your healthcare professional.

• Serotonin and norepinephrine reuptake inhibitors
  
  • venlafaxine (Effexor^®)
  • duloxetine (Cymbalta^®)

Some common side effects of these medications include nausea and loss of appetite, nervousness, headache, and insomnia; dry mouth, constipation and sexual problems can also occur.

• Tricyclic antidepressants
  
  • amitriptyline (Elavil^®)
  • desipramine (Norpramin^®)
  • doxepin (Sinequan^®)
  • imipramine (Tofranil^®)
  • nortriptyline (Aventyl^®, Pamelor^®)
  • protriptyline (Vivactil^®)
  • trimipramine (Surmontil^®)

Common side effects of tricyclic antidepressants include:

• Dry mouth
• Constipation: ensure there is plenty of fiber in the diet
• Bladder problems: emptying the bladder may become difficult
• Sexual problems: such as reduced desire and difficulties with orgasm
• Blurred vision: usually transient
• Dizziness: due to the blood pressure dropping when you stand up
• Drowsiness: instead taking the medicine at bedtime can help with sleep and reduce problems with daytime drowsiness

• Combined reuptake inhibitors and receptor blockers
  
  • trazodone (Desyrel^®)
  • nefazodone (Serzone^®)
  • maprotiline
  • mirtazpine (Remeron^®)

These medications are similar to selective serotonin reuptake inhibitors in treating depression, and may be used in people who do not tolerate the side effects of selective serotonin reuptake inhibitors.

Side effects of these medications include dry mouth, constipation, nausea, sedation, and dizziness.

Nefazodone may cause serious liver damage and is no longer available in Europe.

• Monamine oxidase inhibitors
  
  • phenelzine (Nardil^®)
  • tranylcypromine (Parnate^®)
  • isocarboxazid (Marplan^®)
  • selegiline (Emsam^®)

Monoamine oxidase inhibitors were the first generation of antidepressants. However, today they are not used as initial treatment for depression because of significant problems with dietary restrictions, side effects, and interactions with other drugs.

• Norepinephrine and dopamine reuptake inhibitors
  

Bupropion (Wellbutrin XL/XR) has common side effects that include headache and an appetite-supressing effect caused by a stimulant ingredient. It is much less likely to cause sexual dysfunction that selective serotonin reuptake inhibitors.

Bupropion is not to be used in people with anorexia nervosa or bulimia.

What to expect once you have started an antidepressant

It is very important that you discuss with your healthcare professional what to expect with treatment and especially treatment duration. Antidepressants generally take 4 to 6 weeks to have an effect, so don't give up on the medication immediately. See you healthcare professional for a regular checkup during the first 6 weeks to determine whether the treatment is working. Sometimes you may need to start on a lower dose and taper the dosage upwards to reach the medication's full effectiveness.

Talk to your healthcare professional if you experience side effects from your antidepressant medication; he or she may suggest one of the following approaches:

• Starting the medication at a low dose and slowly tapering it up
• Sticking to low doses of the medication and adding in another medication for an increased effect, if needed
• Taking the medication at a different time of the day. To reduce, for example, the feeling of tiredness or sleepiness, you might try taking the medication at night instead of in the morning.
• Try a different medication

If you have no improvement at all in your symptoms your healthcare professional will recommend trying a different medication or perhaps even adding a second medication to augment the effect of the first. If you are changing from one medication to another, it is important to slowly taper down the dose of one before starting the other. Stopping a medication abruptly can cause unpleasant side effects, including dizziness, nervousness, or insomnia due withdrawal. You should also have a break between stopping a drug and starting a new one for depression. This time period is called the "wash out" period. Your healthcare professional will be able to advise you on the duration of the wash out period.

A process of "trial and error" is to be expected when trying to find the most effective treatment for your depression symptoms. Be aware that some people do not respond to common antidepressant medications and they may need other treatments like multiple medications and/or electroconvulsive therapy (described below).

Your healthcare professional will be able to advise you on how long to stay on your antidepressant. Usually for people with moderate-to-severe depression a period of at least 2 years is recommended, after which time your healthcare professional can assess whether you need to remain on it. Some people may need to stay on it long-term, for example, if they have ongoing symptoms, have ongoing stressful situations in their life, or have comorbidities like other mental health conditions.


Other treatments for depression

Exercise
Exercise can improve symptoms of depression and your healthcare professional will recommend that regular exercise to help in your recovery. However, it should not be used to replace other treatments like medication and/or psychological therapies.

Electroconvulsive therapy
Electroconvulsive therapy is reserved for people with severe depression who are not responding to other treatments, and for depression with psychotic symptoms. This treatment involves restoring the balance of neurotransmitters in the brain and careful monitoring. Electroconvulsive therapy involves having an electric current pass through the brain via electrodes that are placed at precise sites on the head while you are under a general anesthetic. It has few side effects and can provide rapid relief from symptoms.

Light therapy
Light therapy is useful for treating the depression of seasonal affective disorder. This therapy is given in daily sessions of 10 to 45 minutes for a few days/weeks depending on the response.

St. John's wort
St. John's wort or has been used by some people for the treatment of depression. However, there is no consistent scientific data to back up its benefit and it is not approved by the United States Food and Drug Administration for the treatment of depression. Side effects of St. John's wort may include gastrointestinal symptoms, dizziness, tiredness, and dry mouth; long-term side effects are not known. Other herbal supplements that have not been evaluated in large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng.

Pregnancy and postpartum depression

As with nonpregnant women, mild depression in pregnancy and postpartum can be treated with psychological therapies.

If medication is required and a woman is pregnant, she should discuss this with her healthcare provider, as some medications carry a risk of affecting the fetus. This risk needs to be weighed against the risk of the mother's depression symptoms being untreated or getting worse.

Postpartum depression is usually treated with a mixed approach including psychological treatment, medication, and addressing specific issues in the postpartum period, such as sleep deprivation and family stressors. Psychological treatment can be given in group settings as well as individually. Education on looking after the newborn is useful, too. When deciding on an antidepressant medication, it is important to remember that some medications can be secreted into breast milk and, therefore, may not be the first choice for a breastfeeding woman.

Dealing with chronic symptoms of depression and relapse

There are various factors that will influence how well a person with depression is treated will respond to treatment and what his or her chances of relapse. Generally, after one episode of depression there is a 50% chance of relapse.

The following factors are important in predicting how well someone will respond to antidepressant treatment.

• Ongoing life stressors as an adult such as relationship or marital difficulties will place an increased burden on the recovery process and will need to be addressed with psychological therapy.
• Major childhood stressors, such as experiences of child abuse, need to be addressed with psychological therapy at the same time as depression is treated with medication to help improve a child's coping abilities and recovery.
• Alcohol and/or drug abuse may need to be treated separately from the symptoms of depression. This can be achieved by seeking specialized drug and alcohol counseling and treatment programs. Alcohol and/or drug abuse is a common comorbidity with depression and the prognosis of depression with this comorbidity is not good.
• Psychiatric comorbidities may be treated in addition to the symptoms of depression itself. Common comorbidities to depression are:
  • Anxiety disorders (panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder)
  • Cognitive disorders (specifically dementia)
  • Eating disorders
  • Somatoform disorders
  • Personality disorders
  • Sleep disorders (for example, obstructive sleep apnea)
  • Substance use disorders (drug abuse)
  
  
• Chronic physical pain due to arthritis or injury can lead to problems such as insomnia, reduced physical activity, and extra psychological stress, all of which can impact on recovery process of depression.
  
  In order to minimize the chances of relapse after a person is diagnosed and treated for depression the following factors should be considered and/or noted:
  • Close monitoring for response to treatment
  • Close monitoring of side effects from treatment
  • If response to treatment is less than adequate and symptoms are not resolving then people should have their treatment altered as soon as possible
  • After a person becomes symptom-free they should still have regular checkups and screening to avoid relapse

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Emerging Treatments

Medication

There are many medications currently under investigation for treatment in depression. We have listed just a few of them here:

Serotonin and norepinephrine reuptake inhibitors

• Pristiq™ (desvenlafaxine succinate)

Triple uptake inhibitors (serotonin, norepinephrine, and selective dopamine reuptake inhibitor

• Preclinical studies and clinical trials indicate that a drug inhibiting the uptake of all three neurotransmitters could produce a more rapid onset of action and possess greater efficacy than traditional antidepressants.

CRF₁ receptor inhibitors

• A new kind of antidepressant medication that acts on corticotropin-releasing factor receptors

NK₁ receptor antagonists

• A novel antidepressant medication that acts on another type of neurotransmitter called neurokines

Others

• Triiodothyronine (a type of thyroid hormone)

Genetic advances

Research is underway into genetic links to why some people respond to certain antidepressants and others do not. One discovery has been that the main response and resistance to antidepressant medications may be associated with a alterations in the BDNF gene.

Other treatments

Repetitive transcranial magnetic stimulation is a form of magnetic therapy administered to the brain and is being researched for the treatment of depression.

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Empower Yourself

Dealing with depression

Once you begin your depression treatment with your healthcare provider, you are on your way to feeling better. But there are things you can do on your own that will help you manage your depression. It's important to remember that you can manage your depression. You are not helpless, and you are not alone.

• See your healthcare professional regularly. He or she can monitor your progress, provide support and encouragement, and adjust your medication if necessary.
• Take your medications. Finding the best medication for you may take several tries. It may take several weeks for you to start seeing results. Once you feel better, continue to take your medication as prescribed.
• Don’t become isolated. Try to participate in normal activities and be sure to do the things you love.
• Take care of yourself. Eat a healthy diet and get the right amount of sleep and exercise. Exercise can help treat some forms of depression, ease stress, and help you relax.
• Avoid alcohol and recreational drugs. Abuse of alcohol and drugs will slow or prevent your recovery.
• Join a support group where people will understand what you are going through.
• If you need help, call a professional:
  • National Mental Health Association (NMHA): (800) 969-6642; or, in a crisis: (800) SUICIDE (784-2433)
  • National Alliance for the Mentally Ill (NAMI): (800) 950-6264
  • Depression and Bipolar Support Alliance: (800) 826-3632

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Frequently asked questions

Are you suffering from depression?
Life is full of ups and downs. But when the down times last for weeks or months at a time or keep you from living “normally,” you may be suffering from depression. Depression is a medical illness that involves the body, mood, and thoughts. It affects 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 for a few hours or a couple of days. It is not a condition that can be willed or wished away.

What causes depression?
There is no single cause of depression. There are many reasons why a woman may become depressed:

• Hormonal factors—menstrual cycle changes, pregnancy, miscarriage, postpartum period, perimenopause, and menopause
• Stress—at work and home, single parenthood, caring for children and for aging parents
• Family history—inherited (it's in your genes); it can also occur in people with no family history
• Medical illness—stroke, heart attacks, cancer
• Chemical imbalance—changes in the brain chemistry

What are the signs of depression?
Not all people with depression have the same symptoms. Some people might only have a few, and others a lot. If you have one or more of these symptoms for more than 2 weeks or for months at a time, see your healthcare professional.

• Feeling sad, anxious, or “empty”
• Feeling hopeless
• Loss of interest in hobbies and activities that you once enjoyed
• Decreased energy
• Difficulty staying focused, remembering, making decisions
• Sleeplessness, early morning awakening, or oversleeping and not wanting to get up
• No desire to eat and weight loss or eating to “feel better” and weight gain
• Thoughts of hurting yourself
• Thoughts of death or suicide
• Easily annoyed, bothered, or angered
• Constant physical symptoms such as headaches, upset stomach, and pain that do not get better with treatment

What if I have thoughts of hurting myself?
Depression can make you think about hurting yourself or suicide. You may hurt yourself to:

• Take away emotional pain and distress
• Avoid, distract from, or hold back strong feelings
• Try to feel better
• Stop a painful memory or thought
• Punish yourself
• Release or express anger that you’re afraid to express to others

Yet, hurting yourself does just that—it hurts you. At first, it may make you feel better; but it ends up making things worse. If you are thinking about hurting or even killing yourself, PLEASE ASK FOR HELP! Call 911, 1-800-273-TALK (8255) or 1-800-SUICIDE, or check in your phone book for the number of a suicide crisis center. The centers offer experts who can help callers talk through their problems and develop a plan of action. These hotlines can also tell you where to go for more help in person. You also can talk with a family member you trust, a clergyperson, or healthcare professional. There is nothing wrong with asking for help—everyone needs help sometimes.

You might feel as though your pain is too overwhelming to cope with, but those times don’t last forever. People do make it through suicidal thoughts. If you can’t find someone to talk with, write down your thoughts. Try to remember and write down the things you are grateful for. List the people who are your friends and family and those who care for you. Write about your hopes for the future. Read what you have written when you need to remind yourself that your life is IMPORTANT!

How is depression treated?
Most people with depression get better with treatment. Once identified, depression almost always can be treated either by therapy or medicine called antidepressants, or both. Some people with milder forms of depression do well with therapy alone. Others with moderate-to-severe depression might benefit from antidepressants. It may take a few weeks or months before you begin to feel a change in your mood. Some people do best with combined treatment—therapy and antidepressants.

Should I stop taking my antidepressant while I am pregnant?
The decision of whether to stay on medications is a complicated one that should be discussed with your healthcare professional. Medication taken during pregnancy does reach the fetus. In rare cases, some antidepressants have been associated with breathing and heart problems in newborns, as well as jitteriness after delivery. However, mothers who stop medications can be at increased risk for a relapse of their depression. Talk to your healthcare provider about the risks and benefits of taking antidepressants during pregnancy. He or she can help you decide what is best for you and your baby.

Should I stop taking my antidepressant while breast-feeding?
If you stopped taking your medication during pregnancy, after delivery you may need to begin taking it again. Be aware that because your medication can be passed into your breast milk, breast-feeding may pose some risk for a nursing infant.

However, a number of research studies indicate that certain antidepressants, such as some of the selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants for treating depression and anxiety disorders that includes medications such as Zoloft^®, have been used relatively safely during breast-feeding. You should discuss with your healthcare provider whether breast-feeding is an option or whether you should plan to feed your baby formula. Although breast-feeding has some advantages for your baby, most importantly, as a mother, you need to stay healthy so you can take care of your baby.

How can I get help for my depression?

Below are some people and places that can help you get treatment:

• Family doctor, or another healthcare professional
• Counselors or social workers
• Family service, social service agencies, or clergyperson
• Employee assistance programs (EAP)
• Psychologists and psychiatrists

If you are unsure where to go for help, check the Yellow Pages under “mental health,” “health,” “social services,” “suicide prevention,” “crisis intervention services,” “hotlines,” “hospitals,” or “physicians” for phone numbers and addresses.

How long will I need medicine?
How long you’ll need to take medication depends on your depression. Your doctor may want you to take medicine for 4 to 6 months or longer. You need to take medicine long enough to reduce the chance that the depression will return. Talk with your doctor or healthcare provider about any questions you have about your medicine.

What is psychotherapy?
In psychotherapy, you talk with your family doctor, a psychiatrist, or a therapist about things that are going on in your life. The focus may be on your thoughts and beliefs or on your relationships. Or the focus may be on your behavior, how it's affecting you, and what you can do differently.

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Glossary of terms

Acetylcholine: A key chemical in neurons (nerve cells) that acts as a neurotransmitter and carries information across the synaptic cleft, the space between two nerve cells. Abbreviated ACh.

Alprazolam: A benzodiazepine sedative that causes dose-related depression of the central nervous system. Alprazolam is useful in treating anxiety, panic attacks, insomnia, and muscle spasms. The brand name is Xanax^®. A generic version is available.

Amitriptyline: An antidepressant medication. In some patients with depression, abnormal levels of brain chemicals called neurotransmitters may relate to the depression. Amitriptyline elevates mood by raising the level of neurotransmitters in brain tissue. Amitriptyline is also a sedative that is useful for depressed patients with insomnia, restlessness, and nervousness. It is sometimes used to treat fibromyalgia and symptoms related to chronic pain. Brand names are Elavil^® and Endep^®. A generic version is available.

Anesthesia: Loss of feeling or awareness. A general anesthetic puts the person to sleep. A local anesthetic causes loss of feeling in a part of the body, such as a tooth or an area of skin, without affecting consciousness.

Anorexia nervosa: A condition of disordered eating and distorted body image whereby people reduce their intake of food and often exercise excessively, resulting in a state on being underweight and often malnourished.

Antidepressant: Anything, and especially a drug, used to prevent or treat depression.

Anxiety/Anxiety Disorder: A feeling of apprehension and fear characterized by physical symptoms such as palpitations, sweating, and feelings of stress. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people’s lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Arthritis: Condition in which the joints of the body are inflammed and due to a variety of causes such as osteoarthritis and gout.

Baby blues: A common, temporary psychological state right after childbirth when a new mother may have sudden mood swings, feeling very happy, then feeling very sad, cry for no apparent reason, feeling impatient, unusually irritable, restless, anxious, and lonely. The baby blues may last only a few hours or as long as 1 to 2 weeks after delivery. The baby blues in this sense are less severe than a postpartum depression. The baby blues do not always require treatment from a healthcare provider. Often, joining a support group of new mothers or talking with other mothers helps.

Bipolar disorder: A form of depressive disease that characteristically involves cycles of depression and elation or mania. Sometimes the mood swings from high to low and back again are dramatic and rapid, but more often they are gradual and slow.

Bipolar personality disorder (BPD): A mental illness primarily characterized by mood instability, extreme “black and white” thinking, and chaotic relationships. The disorder also typically includes instability in self-image and identity, as well as a disturbance in the individual’s sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of disassociation.

Brief dynamic therapy: A type of short-term therapy involving discussion and understanding in order to address specific goals.

Bulimia: Bulimia is a type of eating disorder whereby a person eats a lot of food in a short period of time and then tries to prevent weight gain by purging or making themselves vomit. One might also try to prevent weight gain by taking laxatives or exercising excessively.

Chronic illness: An illness that persists for a long period of time. The term “chronic” comes from the Greek word for time, chronos, and means lasting a long time.

Clinical trial: A type of research study that sets out to test the benefit of one medication in comparison to another medication (usually called a placebo) used to treat the same condition.

Child abuse: This refers to maltreatment or neglect of children in terms of their physical, sexual, or emotional wellbeing. Abusers can be parents or guardians.

Comorbidities: Medical conditions that exist simultaneously in a patient.

Cognitive disorder: A disease in brain function such as memory, thinking, problem solving, and organization.

Cymbalta: Brand name for duloxetine hydrochloride, a drug approved by the FDA to treat major depression in adults and to manage the pain associated with diabetic peripheral neuropathy, or nerve damage in diabetes. The drug acts as a serotonin and norepinephrine reuptake inhibitor, increasing the levels of serotonin and norepinephrine, the two neurotransmitters, or chemical messengers, believed to be important in regulating a person’s emotions as well as reducing the sensitivity to pain.

Dependent personality disorder (DPD): A personality disorder that is characterized by extreme psychological dependence on other people. The difference betwen a “dependent personality” and a “dependent personality disorder” is somewhat subjective, and when making the diagnosis, it is important to consider factors such as cultural influences and gender role expectations.

Depression: An illness that involves the body, mood, and thoughts, and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.

Diagnosis: 1. The nature of a disease; the identification of an illness. 2. A conclusion or decision reached by diagnosis. For example, “the diagnosis is rabies.” 3. The identification of any problem. For example, the diagnosis was a plugged IV.

Diarrhea: State of having bowel motions that are loose and otherwise watery.

Dopamine: An important neurotransmitter (messenger) in the brain.

Dry mouth: The condition of not having enough saliva to keep the mouth wet. This is due to inadequate function of the salivary glands. Everyone has dry mouth once in a while when they are nervous, upset, or under stress. But if someone has a dry mouth most or all of the time, it can be uncomfortable and lead to serious health problems.

Dysthymia: A type of depression involving long-term, chronic symptoms that are not disabling, but keep a person from functioning at “full steam” or from feeling good. Dysthymia is a less severe type of depression than what is accorded the diagnosis of major depression. However, people with dysthymia may also sometimes experience major depressive episodes, suggesting that there is a continuum between dysthymia and major depression.

Electroconvulsive therapy (ECT): A procedure in which an electric current is passed through the brain to produce controlled convulsions (seizures) to treat patients with depression, particularly those who cannot take or are not responding to antidepressants, have severe depression, or are at high risk for suicide. ECT is believed to act by a massive neurochemical release in the brain caused by the controlled seizure. The most common side effect is short-term memory loss, which usually resolves quickly. ECT typically relieves depression within 1 to 2 weeks after beginning treatments.

Euphoria: Elevated mood. Euphoria is a desirable and natural occurrence when it results from happy or exciting events. An excessive degree of euphoria that is not linked to events is characteristic of hypomania or mania, abnormal mood states associated with bipolar disorders.

Family history: The family structure and relationships within the family, including information about diseases in family members.

Family therapy: A form of therapy whereby the therapist works with family members in a group setting to understand and try to promote change in family relationships experiencing difficulties.

Fetus: The unborn offspring from the end of week 8 after conception (when the major structures have formed) until birth. Up until the eighth week, the developing offspring is called an embryo.

Food and Drug Administration: The FDA, an agency within the US Public Health Service, which is a part of the Department of Health and Human Services.

Genes: The basic biological units of heredity. Segments of deoxyribonucleic acid (DNA) needed to contribute to a function.

Genetic: Having to do with genes and genetic information.

Grief: The normal process of reacting to a loss. The loss may be physical (such as a death), social (such as divorce), or occupational (such as a job). Emotional reactions of grief can include anger, guilt, anxiety, sadness, and despair. Physical reactions of grief can include sleeping problems, changes in appetite, physical problems, or illness.

Hormone: A chemical substance produced in the body that controls and regulates the activity of certain cells or organs.

Hyperactivity: A higher than normal level of activity. An organ can be described as hyperactive if it is more active than usual. Behavior can also be hyperactive.

Hypomania: A condition similar to mania but less severe. The symptoms are similar with elevated mood, increased activity, decreased need for sleep, grandiosity, racing thoughts, and the like. However, hypomanic episodes differ in that they do not cause significant distress or impair one’s work, family, or social life in an obvious way while manic episodes do.

Incidence: The frequency with which something, such as a disease, appears in a particular population or area. In disease epidemiology, the incidence is the number of newly diagnosed cases during a specific time period. Incidence is distinct from prevalence, which refers to the number of cases alive on a certain date.

Inheritance: In medical terms, a gene, chromosome, or genome that is transmitted from parent to child.

Insomnia: The perception or complaint of inadequate or poor-quality sleep because of one or more of the following: difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep.

Libido: 1. Sexual drive. 2. In psychoanalysis, the psychic energy from all instinctive biological drives.

Lithium: Lithium carbonate (brand names: Eskalith^®; Lithobid^®), a drug used as a mood stabilizer for the treatment of manic/depressive (bipolar) disorder. It prevents or diminishes the intensity of episodes of mania in bipolar patients. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, elation, poor judgment, aggressiveness, and possibly hostility.

Low blood pressure: Any blood pressure that is below the normal expected for an individual in a given environment. Low blood pressure is also referred to as hypotension.

Major depression: A disease with certain characteristic signs and symptoms that interferes with the ability to work, sleep , eat, and enjoy once pleasurable activities.

Mania: An abnormally elevated mood state characterized by such symptoms as inappropriate elation, increased irritability, severe insomnia, grandiose notions, increased speed and/or volume of speech, disconnected and racing thoughts, increased sexual desire, markedly increased energy and activity level, poor judgment, and inappropriate social behavior. A mild form in mania that does not require hospitalization is termed hypomania. Mania that also features symptoms of depression (“agitated depression”) is called mixed mania.

Manic: Refers to a mood disorder in which a person seems “high,” euphoric, expansive, sometimes agitated, hyperexcitable, with flights of ideas and speech.

MAOI: Monoamine oxidase inhibitor. One of a potent class of medications used to treat depression.

Marital therapy: This therapy aims at improving the relationship of the married couple.

Maternal: 1. Pertaining to the mother as, for example, the maternal mortality rate. 2. Related through the mother as, for example, the maternal grandparents. 3. Inherited from the mother as, for example, the maternal X chromosome.

Medication: 1. A drug or medicine. 2. The administration of a drug or medicine. (Note that “medication” does not have the dangerous double meaning of “drug.”)

Melancholia: Old term for depression.

Memory: 1. The ability to recover information about past events or knowledge. 2. The process of recovering information about past events or knowledge. 3. Cognitive reconstruction. The brain engages in a remarkable reshuffling process in an attempt to extract what is general and what is particular about each passing moment.

Mind: That which thinks, reasons, perceives, wills, and feels. The mind now appears in no way separate from the brain. In neuroscience, there is no duality between the mind and body. They are one.

Morbidity: Illness, disease.

Nausea: Sensation of wanting to vomit.

Neurological: Having to do with the nerves or the nervous system.

Neuron: A nerve cell that sends and receives electrical signals over long distances within the body. A neuron may send electrical output signals to muscle neurons (called motor neurons or motoneurons) and to other neurons. A neuron may receive electrical input signals from sensory cells (called sensory neurons) and from other neurons. A neuron that simply signals another neuron is called an interneuron.

Neurotransmitter: A chemical that is released from a nerve cell which thereby transmits an impulse from a nerve cell to another nerve, muscle, organ, or other tissue. A neurotransmitter is a messenger of neurologic information from one cell to another.

NIMH: The National Institute of Mental Health, one of the National Institutes of Health in the US, whose mission is to “provide national leadership dedicated to understanding, treating, and preventing mental illnesses through basic research on the brain and behavior, and through clinical, epidemiological, and services research.”

Onset: In medicine, the first appearance of the signs or symptoms of an illness as, for example, the onset of rheumatoid arthritis. There is always an onset to a disease but never to the return to good health. The default setting is good health.

Perimenopause: A period of time leading to menopause characterized by menstrual cycle changes such as shorter or longer periods and even irregular periods. This is caused by rising and falling estrogen and progesterone levels.

Personality disorders: These are a type of mental disorders characterized by rigid and dysfunctional patterns of thought and behavior that lead a person to have difficulties getting along with others, having relationships, and operating day-to-day in society.

Postpartum depression (PPD): A form of severe depression after delivery that requires treatment. It is sometimes said that PPD occurs within 4 weeks of delivery, but it can happen a few days or even months after childbirth. A woman with PPD may have feelings similar to the baby blues—sadness, despair, anxiety, irritability—but she feels them much more strongly than she would with the baby blues. PPD often keeps her from doing the things she needs to do every day. When a woman’s ability to function is affected, this is a sure sign that she needs treatment. If a woman does not get treatment for PPD, it can get worse and last for as long as a year. Although PPD is a serious condition, it can be effectively treated with antidepressant medications and counseling.

Postpartum psychosis: A very serious mental illness that can affect a new mother. The episode of psychosis usually begins within 1 to 3 months of delivery. A woman with postpartum psychosis may lose touch with reality and have auditory hallucinations (hearing things that are not actually happening, like a person talking) and delusions (perceiving things differently from the way they are).

PPD: Postpartum depression.

Predispose: To make more likely or render susceptible. Smoking predisposes to a number of diseases, including esophageal cancer.


Premenstrual dysphoric disoroder (PMDD): A severe form of premenstrual syndrome in which symptoms affect a person's daily functioning and may include severe mood swings, depression, anxiety, tiredness, and irritability. Symptoms occur during the week before the menstrual cycle and subside once menses begins.

Premenstrual syndrome: A condition with symptoms related to the menstrual cycle that usually occur during the 2 weeks prior to bleeding and may continue after bleeding commences. Some symptoms include bloating, headache, ache, mood swings, anxiety, breast tenderness, and insomnia, and food cravings.

Prevalence: The total number of cases of the disease in the population at a given time.

Psychiatry: The medical specialty concerned with the prevention, diagnosis, and treatment of mental illness.

Psychosis: In the general sense, a mental illness that markedly interferes with a person’s capacity to meet life’s everyday demands. In a specific sense, it refers to a thought disorder in which reality testing is grossly impaired.

Psychotherapy: The treatment of a behavior disorder, mental illness, or any other condition by psychological means. Psychotherapy may utilize insight, persuasion, suggestion, reassurance, and instruction so that patients may see themselves and their problems more realistically and have the desire to cope effectively with them.

Recurrent: Back again. A recurrent fever is a fever that has returned after an intermission: a recrudescent fever.

Referral: The recommendation of a medical or paramedical professional. If you get a referral to ophthalmology, for example, you are being sent to the eye doctor.

Relapse: When a person is affected again by a condition that they were once able to overcome.

Reuptake: The reabsorption of a secreted substance by the cell that originally produced and secreted it. The process of reuptake, for example, affects serotonin.

SAD: Seasonal affective disorder, a form of depression that tends to occur as the days grow shorter in the fall and winter. It is believed that affected persons react adversely to the decreasing amount of light and the colder temperature as autumn and winter progress.

Schizophrenia: One of several brain diseases whose symptoms that may include loss of personality (flat affect), agitation, catatonia, confusion, psychosis, unusual behavior, and withdrawal. The illness usually begins in early adulthood.

Sedation: A medication or procedure that induces sleep and drowsiness.

Scientific data: Data or results that have been taken from scientific or medical research studies such as clinical trials.

Seizure: Uncontrolled electrical activity in the brain, which may produce a physical convulsion, minor physical signs, thought disturbances, or a combination of symptoms.

Serotonin: A hormone, also called 5-hydroxytryptamine, in the pineal gland, blood platelets, the digestive tract, and the brain. Serotonin acts both as a chemical messenger that transmits nerve signals between nerve cells and that causes blood vessels to narrow.

Sexual dysfunction: Sexual dysfunction is difficulties experienced during any stage of sexual activity. Difficulties include desire, arousal, orgasm, and/or resolution, resulting in significant stress and reduced sexual enjoyment for both people involved.

Side effects: Problems that occur when treatment goes beyond the desired effect. Or problems that occur in addition to the desired therapeutic effect.

Somatoform disorder: A condition where physical symptoms such as pain, nausea, and weakness are thought to be caused by psychological factors. Even though no adequate medical explanation is available the sufferer may believe his or her symptoms to be the result of a physical illness.

SSRI: Abbreviation for selective serotonin reuptake inhibitors, commonly prescribed drugs for treating depression. SSRIs affect the chemicals that nerves in the brain use to send messages to one another. These chemical messengers, called neurotransmitters, are released by one nerve and taken up by other nerves. Neurotransmitters that are not taken up by other nerves are taken up by the same nerves that released them. This process is termed “reuptake.” SSRIs work by inhibiting the reuptake of serotonin, an action which allows more serotonin to be available to be taken up by other nerves.

SNRI: Abbreviation for serotonin-norephinephrine reuptake inhibitor. SNRIs are a classs of antidepressant medications used in the treatment of clinical depression. They act on two neurotransmitters in the brain that play an important role in mood, serotonin and norephinephrine. SSRIs, which are more widely used, act only on serotonin.

Stress: Forces from the outside world impinging on the individual. Stress is a normal part of life that can help us learn and grow. Conversely, stress can cause us significant problems.

Stressors: Factors in life that may contribute to a person's stress.

Stroke: The sudden death of some brain cells due to a lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A stroke is also called a cerebrovascular accident or, for short, a CVA.

Substance abuse: The excessive use of a substance, especially alcohol or a drug. (There is no universally accepted definition of substance abuse.)

Suicide: The act of causing one’s own death. Suicide may be positive or negative and it may be direct or indirect. Suicide is a positive act when one takes ones own life.

Suicide prevention: Diminishing the risk of suicide. It may not be possible to eliminate entirely the risk of suicide but it is possible to reduce this risk. For example, the suicide rate among US Air Force personnel fell precipitously after the service launched a community-based suicide prevention program. Suicide should not be viewed solely as a medical or mental health problem since protective factors such as social support and connectedness appear to play significant roles in the prevention of suicide.

Surgeon: A physician who treats disease, injury, or deformity by operative or manual methods. A medical doctor specialized in the removal of organs, masses, and tumors and in doing other procedures using a knife (scalpel). The definition of a “surgeon” has begun to blur in recent years as surgeons have begun to minimize the cutting, employ new technologies that are “minimally invasive,” use scopes, etc.

Symptom: Any subjective evidence of disease. Anxiety, lower back pain, and fatigue are all symptoms. They are sensations only the patient can perceive. In contrast, a sign is objective evidence of disease. A bloody nose is a sign. It is evident to the patient, doctor, nurse, and other observers.

Synapse: The point of connection usually between two nerve cells. Specifically, a synapse is a specialized junction at which a nerve cell (a neuron) communicates with a target cell. The neuron releases a chemical transmitter (a neurotransmitter) that diffuses across a small gap and activates specific specialized sites called receptors situated on the target cell. The target cell may be another neuron or a specialized region of a muscle cell or a secretory cell (a cell than can make and secrete a substance). Neurons can also communicate through direct electrical connections (electrical synapses).

Syndrome: A set of signs and symptoms that tend to occur together and that reflect the presence of a particular disease or an increased chance of developing a particular disease.

Tai Chi: This is a Chinese martial art that is practiced to help with relaxation, overall health, and wellbeing.

Therapeutic: Relating to therapeutics, that part of medicine concerned specifically with the treatment of disease. The therapeutic dose of a drug is the amount needed to treat a disease.

Therapy: The treatment of disease.

Thyroid: 1. The thyroid gland. Also, pertaining to the thyroid gland. 2. A preparation of the thyroid gland used to treat hypothyroidism. 3. Shaped like a shield.

Thyroid hormone: A chemical substance made by the thyroid gland for export into the bloodstream. The thyroid gland needs iodine to make thyroid hormones. The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3).

Trigger: Something that either sets off a disease in people who are genetically predisposed to developing the disease or that causes a certain symptom to occur in a person who has a disease. For example, sunlight can trigger rashes in people with lupus.

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Depression Resources and Tools

Government Agencies

* Accepts Spanish calls

* National Women's Health Information Center, OWH, HHS
8270 Willow Oaks Corporate Drive
Fairfax, VA 22031
Phone: (800) 994-9662
TDD: (888) 220-5446
Fax: (703) 663-6942
http://www.4woman.gov/faq/depress.htm#e

National Institute of Mental Health
http://www.nimh.nih.gov

National Institute of Neurological Disorders and Stroke (NINDS), NIH, HHS
NIH Neurological Institute
PO Box 5801
Bethesda, MD 20824
Phone: (800) 352-9424
http://www.ninds.nih.gov
http://www.nimh.nih.gov/publicat/depression.cfm

National Library of Medicine
http://www.nimh.nih.gov//medlineplus/healthtopics.htlm


Private Organizations

American Psychiatric Association
http://www.psych.org

American Academy of Child and Adolescent Psychiatry
http://www.apa.org

Depression and Bipolar Support Alliance (DBSA)
http://www.DBSAlliance.org

National Foundation For Depressive Illness
http://www.depression.org

National Mental Health Association
http://www.nmha.org

National Alliance for the Mentally Ill
http://www.nami.org

National Mental Health Association
Mental Health America
2000 N. Beauregard Street, 6th Floor
Alexandria, Virginia 22311
Phone: (800) 969-6MHA (6642)
TTY: (800) 433-5959
Fax: (703) 684-5968
http://www.nmha.org


Newsletters, Magazines, Reports

Healthy Women Today
The National Women's Health Information Center
http://www.womenshealth.gov/newsletter

National Institute of Neurological Disorders and Stroke
Subscribe to the newsletter to get up-to-date news on research and breakthroughs.
http://www.ninds.nih.gov/funding/nindsnotes/nindsnoteslistserv.htm


Tools

National Institute of Mental Health
Download an information packet.
http://www.nimh.nih.gov/publicat/depression.cfm#ptdep9

Depression and Bipolar Support Alliance
Talk to others who have been there and can help you through it.
http://www.dbsalliance.org

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References

1. Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradioal for treatment of depressive disorders in perimenopausal women: a double-blind, randominzed, placebo-controlled trial. Arch Gen Psychiatry. 2001;58:529-534. [Evidence Level A]

2. Morrison MF, Kallan MJ, Ten Have T, Katz I, Tweedy K, Battistine M. Lack of efficacy of estradiol for depression in postmenopausal women: a randominzed, controlled trial. Biol Psychiatry. 2004;55;406-412. [Evidence Level A]

3. Steiner M, Dunn E, Born L. Hormones and mood: from menarche to menopause and beyond. J Affect Disord. 2003;74;67-83. [Evidence Level C]

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