We all feel sad or get "the blues" now and again. And we may feel sad and depressed following the death of a loved one or the breakup of a love relationship. Generally our sadness lessens in time and with the support of friends. However, if the depression leads to difficulty in thinking, greatly disrupts a person's daily routine, and persists with no symptom relief, it can be evidence of a serious psychiatric problem.

Changes in mood characterized by feelings of sadness, pessimism, guilt, hopelessness and worthlessness may be caused by normal sadness resulting from a loss, chronic low self-esteem and limited self-confidence, a reaction to a medication or drug, prolonged stress, major depression, or biposal depressive illness or a complication of another psychiatric illness or medical condition. Thyroid dysfunction, for example, can cause symptoms that mimic depression.

Depression may occur as a result of biochemical changes in the body. Alcohol, amphetamines, cocaine, and LSD can bring on depression or worsen an existing depression. Some people have a greater risk of depression, such as those who have a family history of depression, or who have gone through a major loss of losses (death, economic failure, dimished social status, etc.). Persons with "perfectionistic personality," persons who suppress their emotions, persons who are more passive, dependent, or pessimistic in attitudes, and persons who abuse alcohol or other drugs are also at higher risk for experiencing depression. So too are women, survivors of sexual or physical abuse, and adolescents.

The exact causes of depression are not completely understood, but research on psychotherapy for mood disorders is expanding, and new medications are introduced every year as our knowledge of the neurophysiological basis of disturbed mood and its relation to other states of mind and body are explored.

What are the symptoms?

The symptoms of depression include the following:

• feeling sad, "blue," or "empty"
• experiencing crying spells, anxiety, agitation, restlessness, or irritability
• changes in appetite and/or weight
• changes in sleep patterns such as insomnia, early awakening, or an increase in time spent sleeping
• fatigue or loss of energy
• loss of interest or pleasure in usual activities
• feelings of self-reproach, inappropriate guilt, or worthlessness
• difficulty in thinking clearly, or in concentration
• thoughts of suicide or death

Personality changes are common because of the psychological stress on the depressed person. Depressed people often have difficulty in maintaining normal relationships with others, and they may withdraw socially.

How is it diagnosed?

Depression can be diagnosed by a health care provider at Student Health or Counseling and Psychological Services (CAPS). Your provider will discuss with you your symptoms, your personal history, and a physical examination and laboratory studies may be performed to rule out a physical cause for your symptoms. Generally, if you have experienced five of the symptoms listed above most of the day, nearly every day for at least two weeks, a diagnosis of depression would be considered. Criteria for the American Psychiatric Association's Diagnostic and Statistical Manual, DSM-IV (1994), are used to classify mood disorders for purposes of research and choice of treatment.

How is it treated?

Since major depression and its milder chronic form, dysthymia, can interfere with clear thinking it is unwise to try to overcome depression by yourself. Fewer than half of the people with mood disorders receive treatment. In some cases, they do not seek treatment because of fear of social stigma, fears about confidentiality, a sense of hopelessness, or due to incorrect diagnosis. The standards treatments for depression are psychotherapy, antidepressant medication, or a combination of both. Depression can generally be treated on an outpatient basis, with hospitalization only necessary when a danger to self (suicide) or others exists, when your living environment contributes to your depression, or when you cannot carry out the activities of daily living by yourself.

Psychotherapy can give you support and help you regain control. One approach to treating depression is called "cognitive-behavioral therapy," which usually lasts 12 to 20 weeks. During counseling sessions, the therapist will help you identify unrealistic views you may hold of yourself, the world, and the future. Therapy will help you recognize depressive thought processes and develop thought and behavior patterns that counteract depressive thought.
Another form of psychotherapy is directed at helping you gain insight and understanding about events in your life which may have contributed to your depression. With growing insight you can often learn more effective ways of coping with your feelings and changing your behavior.

Antidepressant medications are often used to treat depression, sometimes in combination with psychotherapy. Although many different drugs can be used, there are three main classes of antidepressants: tricyclics (TCAs), which alter the brain's response to neurotransmitters norepinephrine and serotonin; monoamine oxidase inhibitors (MAOIs), which block the action of an enzyme that breaks down the transmitters norepinephrine and dopamine; and the most recent addition, selective serotonin reuptake inhibitors (SSRIs), which enhance the activity of the neurotransmitter serotonin by preventing its reabsorption at nerve endings.

TCAs and MAOIs were the first antidepressants available and for years they were the most widely prescribed. Their use is still common but slowly declining because of side effects and the availability of alternatives.

SSRIs such as Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine) have gained increasing populatiry and use because of effective results with minimal side effects. What is reliably known about SSRIs is neither as exciting nor as frightening as some of the publicity suggests. Expect possibly in the most severe depressions, they are as effective as TCAs, with fewer side effects that may otherwise cause patients to discontinue their use.

Antidepressant medications often take several weeks to begin working, and must be taken long enough to stop the symptoms of depression, usually 3-6 months. It usually takes 2 to 4 weeks following the start of medication before you start to feel better. These medications do have side effects which will be reviewed with you by your health care provider.

How long will the effects of depression last?

Most depression ends spontaneously in 3 to 6 months. A combination of psychotherapy and antidepressant medication should help you feel better in a few weeks. However, sometimes depression is a recurring problem. If symptoms of depression return, call your therapist or health care provider immediately.

How can I take care of myself?

Follow the treatment recommended by your health care provider, including antidepressant medication (if prescribed) and counseling. In addition, you can:

• Join a support group.
• Express your feelings through talk, journaling, or even art.
• Participate in activities even when it may be difficult to do so.
• Exercise on a regular basis.
• Do something special just for yourself (when you feel like you deserve it the least is when you need it the most!)
• Get adequate rest.
• Eat nutritious, well-balanced meals
• Call for help IMMEDIATELY if you feel suicidal or are having thoughts of suicide or death.

Certain medications and alcohol can add to the symptoms of depression. If you have been or are being treated for depression, it is important to check with your provider before taking any new medications, either over-the-counter or prescribed by other providers. For example, patients taking an SSRI should not use an over-the-counter cough syrup that contains dextromethorphan, a common ingredient in many cough syrups.

What can be done to help prevent depression?

Remember "Mom's advice:" eat nutritious meals, get plenty of rest, and exercise at least 3 times a week. Find a hobby or a positive recreational activity to participate in once or twice a week. Talk to your friends or a support group about what you are feeling. Laugh. Reduce caffeine and alcohol intake. Develop and maintain a positive attitude. Learn how to manage the stress in your life. Ask for help if the load is too heavy to handle. And seek professional help for talking about events in your life that cause you to feel anxious or depressed and developing positive ways to cope with problems.