Trending Clinical Topic: Antidepressant

Trending Clinical Topic: Antidepressant

Trending Clinical Topic: Antidepressant

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Ryan Syrek

December 04, 2020

Each week, we identify one top search term, speculate about what caused its popularity, and provide an infographic on a related condition. If you have thoughts about what’s trending and why, share them with us on Twitter or Facebook. Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

From encouraging news about use in patients with COVID-19 and dementia prevention to new findings about routine indications, various information about antidepressants resulted in this week’s top trending clinical topic.

Although most treatments for COVID-19 have been targeted at the sickest patients, a recent study of patients with mild symptomatic disease found encouraging results with the use of the antidepressant fluvoxamine (see Infographic below). The preliminary randomized controlled trial of 152 nonhospitalized adults found that the drug may help prevent respiratory deterioration. Although the study was small and had a short follow-up, the findings are encouraging, as fluvoxamine is safe, widely available, and affordable and can be orally administered. Further investigation is likely to be met with great interest, as tools to prevent mild COVID-19 from progressing to severe disease are desperately needed.

A different antidepressant may have the potential to prevent another significant disease. A recent study found that the selective serotonin reuptake inhibitor (SSRI) escitalopram lowers amyloid-beta-42 levels in the cerebrospinal fluid of cognitively normal older adults, suggesting a potential role for these drugs in the prevention of Alzheimer’s disease. Whether this reduction will translate to significant clinical benefit is unclear. However, researchers suggest that the findings may lead to the development of more targeted therapy or point to drug combinations that could promote   amyloid reduction. The role of SSRIs in the prevention of dementia, specifically Alzheimer’s disease, is ongoing.

A recent study found that adding a second-generation antipsychotic to an antidepressant used to treat depression increases mortality risk for middle-aged adults. The large, observational study included 39,582 patients who had been diagnosed with depression. After at least 3 months of treatment with a single antidepressant, for more than half of the patients (56.6%), treatment was augmented with an atypical antipsychotic (quetiapine, risperidone, aripiprazole, or olanzapine). For the remainder (43.4%), a second antidepressant was added. The group taking antipsychotics had a 45% increased risk of dying compared with those who received a second antidepressant. Experts say these findings suggest that physicians should carefully consider whether adding antipsychotics in patients taking antidepressants outweighs the risks.

In more encouraging news, psilocybin, the psychedelic compound found in “magic mushrooms,” may represent an alternative to antidepressants for some patients. Psilocybin was recently found to improve symptoms and produce remissions in patients with major depression. Results of a small randomized trial showed that psilocybin treatment was associated with a greater than 50% reduction in depressive symptoms in 67% of study participants. Although further research is needed, the potential for rapid response may make it a promising alternative to antidepressants in certain settings.

From off-label uses to new findings related to their traditional indication, antidepressants received a great deal of attention this week, becoming the top trending clinical topic.



Read more about other investigational treatments for COVID-19.

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Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Ryan Syrek. Trending Clinical Topic: Antidepressant – Medscape – Dec 04, 2020.

Senior Editor, Medical Students, Medscape Drugs & Diseases

Disclosure: Ryan Syrek has disclosed no relevant financial relationships.

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Fast Five Quiz: Depression and Cognition

Fast Five Quiz: Depression and Cognition

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Stephen Soreff, MD

December 31, 2019

Clinical depression, also referred to as major depressive disorder (MDD), is an extremely disabling, multifaceted psychiatric illness. Highly prevalent, it affects more than 300 million individuals worldwide. MDD involves symptoms (which can be recurring) of both affect and cognition. Cognitive impairment is among the most frequent enduring symptoms of MDD. MDD is also associated with short- and long-term functional impairments that affect mood and motivation; patients frequently experience significantly reduced quality of life and psychosocial functioning as well as physical health problems. MDD is a significant contributor to suicide and, on rare occasions, homicide.

It has been estimated that 70% of patients do not achieve remission following first-line antidepressant medication, and that full functional recovery may be compromised even after achieving symptomatic remission.

How much do you know about depression and cognition? Test your knowledge with this short quiz.

Medscape © 2019 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Stephen Soreff. Fast Five Quiz: Depression and Cognition – Medscape – Dec 31, 2019.

President, Education Initiatives, Nottingham, New Hampshire; Faculty, Boston University, Boston, Massachusetts, and Daniel Webster College, Nashua, New Hampshire

Disclosure: Stephen Soreff, MD, has disclosed no relevant financial relationships.

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Trending Clinical Topic: Suicide Prevention

Trending Clinical Topic: Suicide Prevention

Trending Clinical Topic: Suicide Prevention

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Ryan Syrek

September 20, 2019

Each week, we identify one top search term, speculate as to what caused its popularity, and provide an infographic on a related condition. If you have thoughts about what’s trending and why, feel free to share them with us on Twitter or Facebook.

An annual effort to raise awareness, information about a rapid treatment option, and several new guidelines helped make suicide prevention this week’s top trending clinical topic. In the United States, September is National Suicide Prevention Awareness month. The intention is to help further reduce the stigma surrounding mental health issues that can lead to suicide. The suicide rate in America increased 30% from 2000 to 2016. Worldwide, one person dies by suicide every 40 seconds.

Some news from Denmark is potentially encouraging. Patients with major depressive disorder (MDD) at imminent risk for suicide were shown to have experienced rapid benefit from esketamine nasal spray. More than 450 patients with MDD at risk for suicide were included in two phase 3 trials of the medication, which was recently approved by the US Food and Drug Administration. Reduction in suicidal thoughts between the treatment group compared with the placebo group emerged as early as 4 hours after esketamine use and lasted for 25 days. Although these differences were not significant, researchers said that the results were generally encouraging, especially for future studies.

In terms of guidelines for prevention, the Department of Veterans Affairs and the Department of Defense updated clinical practice guidelines for the assessment and management of patients at risk for suicide and published a systematic review of the literature upon which the update is based. The guidelines include algorithms and recommendations for assessment and management that also clearly appraise the strength of the recommendations. The National Institute for Health and Care Excellence  also recently released new guidelines to reduce suicide rates and help people affected by a suspected suicide. The guidance suggests an emphasis on prevention partnerships to help those at risk, as well as tailored support for those who are grieving the loss of a loved one or are otherwise affected by suicide.

Although the increased incidence and challenges in providing care can be discouraging, a recent commentary served as a reminder that steps can be taken in healthcare settings to reduce suicide risk in patients. One of those steps is increasing awareness of important information related to suicide prevention, which makes the fact that it is this week’s top trending clinical topic all the more encouraging.



Read more about suicide prevention.

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Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Ryan Syrek. Trending Clinical Topic: Suicide Prevention – Medscape – Sep 20, 2019.

Senior Editor, Medical Students, Medscape Drugs & Diseases

Disclosure: Ryan Syrek has disclosed no relevant financial relationships.

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A 45-Year-Old Woman Who Feels ‘Like a Zombie’

A 45-Year-Old Woman Who Feels ‘Like a Zombie’

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Jeffrey S. Forrest, MD; Alexander B. Shortridge

June 24, 2019

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 45-year-old woman presents to her primary care physician stating that she feels “like a zombie.” The patient tearfully reports that she has been unable to work or even drive because her mind has not been functioning like it had before a recent illness.

The patient reported that her symptoms began 3 weeks earlier, when she was diagnosed with influenza A. She reported several urgent care visits, in which she had been instructed to take a promethazine/codeine cough syrup, albuterol inhaler, oseltamivir for influenza attenuation, doxycycline for antibiotic coverage, prednisone for respiratory symptom control, and guaifenesin/dextromethorphan for cough symptom control. In the first 2 weeks of her presentation, her coughing was constant and productive, keeping her awake at night. The patient states that she believes her thoughts began slowing a few days into her recent upper respiratory illness; however, she was unsure because of how acutely ill she had been feeling. She has also had increased nightmares about war zones and death.

The patient reports that she has continued to experience confusion and sedation for weeks, even after her upper respiratory symptoms abated. The patient states that she had not felt this sedated since she had taken trazodone (50 mg) for insomnia a few years before. The patient stated she had been knocked out for most of the day after she took that medication.

The patient also reports numbness on the left side of her face and an unusual sensation in her left eyeball. She is worried that she has had a stroke. The patient also reports continuing waves of a “fast heartbeat” that she can feel. She further attests to having to change her sheets at night because of night sweats. These night sweats had slowly started to decrease in frequency before her presentation. The patient also stated that she has occasionally been experiencing hallucinations of “men singing” at night.

In addition to the medications for influenza listed here, the patient reports taking oral contraceptive pills, fluoxetine (60 mg daily) for major depression, topiramate XR (150 mg) daily for migraine prophylaxis, and erenumab injection monthly for migraine prophylaxis.

Her past medical history includes major depression that was diagnosed 20 years prior; it has been stable on fluoxetine. She also reports scoliosis (four childhood surgeries), posttraumatic stress disorder, appendectomy, and a cesarean delivery 15 years prior.

Medscape © 2019 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Jeffrey S. Forrest, Alexander B. Shortridge. A 45-Year-Old Woman Who Feels ‘Like a Zombie’ – Medscape – Jun 24, 2019.

Staff Psychiatrist, Orange County Health Care Agency, Santa Ana, California

Disclosure: Jeffrey S. Forrest, MD, has disclosed no relevant financial relationships.

Disclosure: Alexander B. Shortridge has disclosed no relevant financial relationships.

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Types of Depression

Types of Depression

It’s normal to feel down once in a while, but if you’re sad most of the time and it affects your daily life, you may have clinical depression. It’s a condition you can treat with medicine, talking to a therapist, and changes to your lifestyle.

World Health Organization: “Depression.”; Mayo Clinic: “Depression.”; American Psychiatric Association: “What Is Depression?”; Anxiety and Depression Association of America: “Understand the Facts: Depression.”; Getty; Comstock Images;i Stock/Getty Images Plus; Thinkstock; AudioJungle; Rike; Vanessa Clara Ann Vokey; Somos/Veer; KatarzynaBialasiewicz; funduck

There are many different types of depression. Events in your life cause some, and chemical changes in your brain cause others.

Whatever the cause, your first step is to let your doctor know how you’re feeling. She may refer you to a mental health specialist to help figure out the type of depression you have. This diagnosis is important in deciding the right treatment for you.

You may hear your doctor call this “major depressive disorder.” You might have this type if you feel depressed most of the time for most days of the week.

Some other symptoms you might have are:

Your doctor might diagnose you with major depression if you have five or more of these symptoms on most days for 2 weeks or longer. At least one of the symptoms must be a depressed mood or loss of interest in activities.

Talk therapy can help. You’ll meet with a mental health specialist who will help you find ways to manage your depression. Medications called antidepressants can also be useful.

When therapy and medication aren’t working, two other options your doctor may suggest are:

ECT uses electrical pulses and rTMS uses a special kind of magnet to stimulate certain areas of brain activity. This helps the parts of your brain that control your mood work better.

If you have depression that lasts for 2 years or longer, it’s called persistent depressive disorder. This term is used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.

You may have symptoms such as:

You may be treated with psychotherapy, medication, or a combination of the two.

Someone with bipolar disorder, which is also sometimes called “manic depression,” has mood episodes that range from extremes of high energy with an “up” mood to low “depressive” periods.

When you’re in the low phase, you’ll have the symptoms of major depression.

Medication can help bring your mood swings under control. Whether you’re in a high or a low period, your doctor may suggest a mood stabilizer, such as lithium.

The FDA has approved three medicines to treat the depressed phase:

Doctors sometimes prescribe other drugs “off label” for bipolar depression, such as the anticonvulsant lamotrigine or the atypical antipsychotic Vraylar .

Traditional antidepressants are not always recommended as first-line treatments for bipolar depression because there’s no proof from studies that these drugs are more helpful than a placebo (a sugar pill) in treating depression in people with bipolar disorder. Also, for a small percentage of people with bipolar disorder, some traditional antidepressants may increase the risk of causing a “high” phase of illness, or speeding up the frequency of having more episodes over time.

Psychotherapy can also help support you and your family.

Seasonal affective disorder is a period of major depression that most often happens during the winter months, when the days grow short and you get less and less sunlight. It typically goes away in the spring and summer.

If you have SAD, antidepressants can help. So can light therapy. You’ll need to sit in front of a special bright light box for about 15-30 minutes each day.

People with psychotic depression have the symptoms of major depression along with “psychotic” symptoms, such as:

A combination of antidepressant and antipsychotic drugs can treat psychotic depression. ECT may also be an option.

Women who have major depression in the weeks and months after childbirth may have peripartum depression. Antidepressant drugs can help similarly to treating major depression that is unrelated to childbirth.

 

Women with PMDD have depression and other symptoms at the start of their period.

Besides feeling depressed, you may also have:

Antidepressant medication or sometimes oral contraceptives can treat PMDD.

This isn’t a technical term in psychiatry. But you can have a depressed mood when you’re having trouble managing a stressful event in your life, such as a death in your family, a divorce, or losing your job. Your doctor may call this “stress response syndrome.”

Psychotherapy can often help you get through a period of depression that’s related to a stressful situation.

This type is different than the persistent sadness of typical depression. It is considered to be a “specifier” that describes a pattern of depressive symptoms. If you have atypical depression, a positive event can temporarily improve your mood.

Other symptoms of atypical depression include:

Antidepressants can help. Your doctor may suggest a type called an SSRI (selective serotonin reuptake inhibitor) as the first-line treatment.

She may also sometimes recommend an older type of antidepressant called an MAOI (monoamine oxidase inhibitor), which is a class of antidepressants that has been well-studied in treating atypical depression.

 

SOURCES:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5, American Psychiatric Publishing, 2013.

National Institute of Mental Health: “What is Depression?” “What is Bipolar Disorder?” and “Brain Stimulation Therapies.”

National Alliance on Mental Illness: “Depression: Treatment, Services, and Support.”

Cleveland Clinic: “Seasonal Depression.”

University of Michigan Depression Center: “Premenstrual Dysphoric Disorder (PMDD).”

Agency for Healthcare Research and Quality: “Efficacy and Safety of Screening for Postpartum Depression.”

American Academy of Family Physicians. “Depression: How Electroconvulsive Therapy Works.”

CDC: “The Burden of Mental Illness.”

Morbidity and Mortality Weekly Report, Jan. 6, 2012.

Epperson, C.N The American Journal of Psychiatry, May 2012.

Goldberg, J. Current Psychiatry, May 2014.

National Alliance on Mental Illness: “Criteria for Major Depressive Episode: DSM-5,” “Psychotic Depression.”

Parker, G. The American Journal of Psychiatry, September 2002.

Rothschild, A. Schizophrenia Bulletin, April 2013.

Severus, E. International Journal of Bipolar Disorders, 2013.

Anxiety and Depression Association of America: “Depression.”

Pagination

Differences between feeling depressed and feeling blue.

Famous people who’ve struggled with persistent sadness.

Learn the truth about this serious illness.

Tips to stay the treatment course.

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WebMD does not provide medical advice, diagnosis or treatment.

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Major Depression (Clinical Depression)

Major Depression (Clinical Depression)

A constant sense of hopelessness and despair is a sign you may have major depression, also known as clinical depression.

World Health Organization: “Depression.”; Mayo Clinic: “Depression.”; American Psychiatric Association: “What Is Depression?”; Anxiety and Depression Association of America: “Understand the Facts: Depression.”; Getty; Comstock Images;i Stock/Getty Images Plus; Thinkstock; AudioJungle; Rike; Vanessa Clara Ann Vokey; Somos/Veer; KatarzynaBialasiewicz; funduck

With major depression, it may be difficult to work, study, sleep, eat, and enjoy friends and activities. Some people have clinical depression only once in their life, while others have it several times in a lifetime.

Major depression can sometimes occur from one generation to the next in families, but often it may affect people with no family history of the illness.

Most people feel sad or low at some point in their lives. But clinical depression is marked by a depressed mood most of the day, sometimes particularly in the morning, and a loss of interest in normal activities and relationships — symptoms that are present every day for at least 2 weeks. In addition, according to the DSM-5 — a manual used to diagnose mental health conditions — you may have other symptoms with major depression. Those symptoms might include:

Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Overall, between 20% and 25% of adults may suffer an episode of major depression at some point during their lifetime.

Major depression also affects older adults, teens, and children, but frequently goes undiagnosed and untreated in these populations.

Almost twice as many women as men have major or clinical depression; hormonal changes during puberty, menstruation, pregnancy, miscarriage, and menopause, may increase the risk.

Other factors that boost the risk of clinical depression in women who are biologically vulnerable to it include increased stress at home or at work, balancing family life with career, and caring for an aging parent. Raising a child alone will also increase the risk.

Depression in men is significantly underreported. Men who suffer from clinical depression are less likely to seek help or even talk about their experience.

Signs of depression in men may include irritability, anger, or drug and alcohol abuse (substance abuse can also be a cause of depression rather than the result of it). Suppressing negative feelings can result in violent behavior directed both inwardly and outwardly. It can also result in an increase in illness, suicide, and homicide.

Some common triggers or causes of major depression include:

A health professional — such as your primary care doctor or a psychiatrist — will perform a thorough medical evaluation. You might receive a screening for depression at a regular doctor’s visit. The professional will ask about your personal and family psychiatric history and ask you questions that screen for the symptoms of major depression.

There is no blood test, X-ray, or other laboratory test that can be used to diagnose major depression. However, your doctor may run blood tests to help detect any other medical problems that have symptoms similar to those of depression. For example, hypothyroidism can cause some of the same symptoms as depression, as can alcohol or drug use and abuse, some medications, and stroke.

Major or clinical depression is a serious but treatable illness. Depending on the severity of symptoms, your primary care doctor or a psychiatrist may recommend treatment with an antidepressant medication. He or she may also suggest psychotherapy, or talk therapy, in which you address your emotional state.

Sometimes, other medications are added to the antidepressant to boost its effectiveness. Certain medicines work better for some people. It may be necessary for your doctor to try different drugs at different doses to determine which medicine works best for you.

There are other treatment options for clinical depression — such as electroconvulsive therapy, also called ECT or shock therapy — that can be used if drugs prove ineffective or symptoms are severe.

Once you have had an episode of major depression, you are at high risk of having another. The best way to prevent another episode of depression is to be aware of the triggers or causes of major depression (see above) and to continue taking the prescribed medication to avoid relapse. It is also important to know what the symptoms of major depression are and to talk with your doctor early if you have any of these symptoms.

SOURCES:

National Institute of Mental Health: “What Is Depression?” and “What Are the Different Forms of Depression?”

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Pub.

Fieve, R. Bipolar II, Rodale Books, 2006.

The Journal of the American Medical Association. “Recommendations for Screening Depression in Adults,” Vol. 315, No. 4, January 26, 2016.

Pagination

Differences between feeling depressed and feeling blue.

Famous people who’ve struggled with persistent sadness.

Learn the truth about this serious illness.

Tips to stay the treatment course.

{text}

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WebMD does not provide medical advice, diagnosis or treatment.

See additional information.

Major Depression (Clinical Depression)

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Causes of Depression

Causes of Depression

Have you ever wondered what causes clinical depression? Perhaps you have been diagnosed with major depression, and that’s made you question why some people get depressed while others don’t.

World Health Organization: “Depression.”; Mayo Clinic: “Depression.”; American Psychiatric Association: “What Is Depression?”; Anxiety and Depression Association of America: “Understand the Facts: Depression.”; Getty; Comstock Images;i Stock/Getty Images Plus; Thinkstock; AudioJungle; Rike; Vanessa Clara Ann Vokey; Somos/Veer; KatarzynaBialasiewicz; funduck

Depression is an extremely complex disease. No one knows exactly what causes it, but it can occur for a variety of reasons. Some people experience depression during a serious medical illness. Others may have depression with life changes such as a move or the death of a loved one. Still others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason.

There are a number of factors that may increase the chance of depression, including the following:

 

Researchers have noted differences in the brains of people who have a clinical depression as compared to those who do not. For instance, the hippocampus, a small part of the brain that is vital to the storage of memories, appears to be smaller in some people with a history of depression than in those who’ve never been depressed. A smaller hippocampus has fewer serotonin receptors. Serotonin is one of many brain chemicals known as neurotransmitters that allow communication across circuits that connect different brain regions involved in processing emotions.

Scientists do not know why the hippocampus may be smaller in some people with depression. Some researchers have found that the stress hormone cortisol is produced in excess in depressed people. These investigators believe that cortisol has a toxic or “shrinking” effect on the development of hippocampus. Some experts theorize that depressed people are simply born with a smaller hippocampus and are therefore inclined to suffer from depression. There are many other brain regions, and pathways between specific regions, thought to be involved with depression, and likely, no single brain structure or pathway fully accounts for clinical depression.

One thing is certain — depression is a complex illness with many contributing factors. The latest scans and studies of brain structure and function suggest that antidepressants can exert what are called “neurotrophic effects,” meaning that they can help sustain nerve cells, prevent them from dying, and allow them to form stronger connections that withstand biological stresses. As scientists gain a better understanding of the causes of depression, health professionals will be able to make better “tailored” diagnoses and, in turn, prescribe more effective treatment plans.

We know that depression can sometimes run in families. This suggests that there’s at least a partial genetic link to depression. Children, siblings, and parents of people with severe depression are somewhat more likely to suffer from depression than are members of the general population. Multiple genes interacting with one another in special ways probably contribute to the various types of depression that run in families. Yet despite the evidence of a family link to depression, it is unlikely that there is a single “depression” gene, but rather, many genes that each contribute small effects toward depression when they interact with the environment.

In certain people, drugs may lead to depression. For example, medications such as barbiturates, benzodiazepines, and the acne drug isotretinoin (formerly sold as Accutane, now Absorica, Amnesteem, Claravis, Myorisan, Zenatane) have sometimes been associated with depression, especially in older people. Likewise, medications such as corticosteroids, opioids (codeine, morphine), and anticholinergics taken to relieve stomach cramping can sometimes cause changes and fluctuations in mood.

For in depth information, see WebMD’s Medicines That Cause Depression.

In some people, a chronic illness causes depression. A chronic illness is an illness that lasts for a very long time and usually cannot be cured completely. However, chronic illnesses can often be controlled through diet, exercise, lifestyle habits, and certain medications. Some examples of chronic illnesses that may cause depression are diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis (MS). Hypothyroidism may also lead to depressed feelings.

Researchers believe that treating the depression may sometimes also help the co-existing medical illness improve.

 

When pain lingers for weeks to months, it’s referred to as being “chronic.” Not only does chronic pain hurt, it also disturbs your sleep, your ability to exercise and be active, your relationships, and your productivity at work. Can you see how chronic pain may also leave you feeling sad, isolated, and depressed?

There is help for chronic pain and depression. A multifaceted program of medicine, psychotherapy, support groups, and more can help you manage your pain, ease your depression, and get your life back on track.

For in depth information, see Depression and Chronic Pain.

Grief is a common, normal response to loss. Losses that may lead to grief include the death or separation of a loved one, loss of a job, death or loss of a beloved pet, or any number of other changes in life, such as divorce, becoming an “empty nester,” or retirement.

Anyone can experience grief and loss, but not everyone will experience clinical depression, which differs from grief in that depression involves a range of other symptoms such as feelings of low self-worth, negative thoughts about the future, and suicide, whereas grief involves feelings of emptiness, loss and longing for a loved one, with an intact capacity to feel pleasure. Each person is unique in how he or she copes with these feelings.

For in depth information, see Grief and Depression.

SOURCES:

National Institute of Mental Health: “Causes of Depression” and “What is Depression?”

SAMSHA’s National Mental Health Information Center: “Mood Disorders.”

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R. Bipolar II, Rodale Books, 2006.

Pagination

Differences between feeling depressed and feeling blue.

Famous people who’ve struggled with persistent sadness.

Learn the truth about this serious illness.

Tips to stay the treatment course.

{text}

© 2005 – 2018 WebMD LLC. All rights reserved.

WebMD does not provide medical advice, diagnosis or treatment.

See additional information.

Causes of Depression

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Untreated Depression

Untreated Depression

Untreated clinical depression is a serious problem. Untreated depression increases the chance of risky behaviors such as drug or alcohol addiction. It also can ruin relationships, cause problems at work, and make it difficult to overcome serious illnesses.

Clinical depression, also known as major depression, is an illness that involves the body, mood, and thoughts. Clinical depression affects the way you eat and sleep. It affects the way you feel about yourself and those around you. It even affects your thoughts.

People who are depressed cannot simply “pull themselves together” and be cured. Without proper treatment, including antidepressants and/or psychotherapy, untreated clinical depression can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.

There is mounting evidence that clinical depression takes a serious toll on physical health. The most recent studies exploring health and major depression have looked at patients with stroke or coronary artery disease. Results have shown that people with major depression who are recovering from strokes or heart attacks have a more difficult time making health care choices. They also find it more difficult to follow their doctor’s instructions and to cope with the challenges their illness presents. Another study found that patients with major depression have a higher risk of death in the first few months after a heart attack.

One of the most telling symptoms of clinical depression is a change in sleep patterns. Though the most common problem is insomnia (difficulty getting adequate sleep), people sometimes feel an increased need for sleep and experience excessive energy loss. Lack of sleep can cause some of the same symptoms as depression — extreme tiredness, loss of energy, and difficulty concentrating or making decisions.

In addition, untreated depression may result in weight gain or loss, feelings of hopelessness and helplessness, and irritability. Treating the depression helps the person get control over all of these depression symptoms.

Common signs of insomnia include:

Alcohol and drug abuse are common among people with clinical depression. They’re especially common among teens and among young and middle-age males. It is very important to encourage these people to get help, because they are more likely to attempt suicide.

Signs of drug and alcohol abuse include:

Those who suffer depression and abuse drugs or alcohol may need very specialized treatment.

Men who have untreated clinical depression may exhibit more anger, frustration, and violent behavior than women. In addition, men with untreated depression may take dangerous risks such as reckless driving and having unsafe sex. Men are not aware that physical symptoms, such as headaches, digestive disorders and chronic pain, can be symptoms of depression.

Depression can render people disabled in their work life, family life, and social life. Left untreated, clinical depression is as costly as heart disease or AIDS to the U.S. economy. Untreated depression is responsible for more than 200 million days lost from work each year. The annual cost of untreated depression is more than $43.7 billion in absenteeism from work, lost productivity, and direct treatment costs.

Living with a depressed person is very difficult and stressful for family members and friends. It’s often helpful to have a family member involved in the evaluation and treatment of a depressed relative. Sometimes marital or even family therapy is indicated.

Depression carries a high risk of suicide. This is the worst but very real outcome of untreated or under-treated depression. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 800-SUICIDE (800-784-2433) or 800-273-TALK (800-273-8255) — or the deaf hotline at 800-799-4889.

Most people who suffer from clinical depression do not attempt suicide. But according to the National Institute of Mental Health, more than 90% of people who die from suicide have depression and other mental disorders, or a substance abuse disorder. Men commit almost 75% of suicides, even though twice as many women attempt it.

The elderly experience more depression and suicide than you might think. Forty percent of all suicide victims are adults over the age of 60. Older adults suffer more frequently from depression because of the frequent loss of loved ones and friends as they age. They also experience more chronic illnesses, more major life changes like retirement, and the transition into assisted living or nursing care.

Warning signs of suicide include:

For in depth information, see WebMD’s Depression and Suicide.

More than 80% of people with clinical depression can be successfully treated with early recognition, intervention, and support.

Depression affects almost 19 million people each year, including a large portion of the working population. People with untreated depression can usually get to work. But once there, they may be irritable, fatigued, and have difficulty concentrating. Untreated depression makes it difficult for employees to work well.

Most people do best with depression treatment using psychotherapy, medications, or a combination of both. For treatment-resistant depression, one that does not respond to medication, there are alternative treatments. One example is electroconvulsive therapy or ECT.

SOURCES:

National Institute of Mental Health: “What is Depression?” and “Suicide in the US: Statistics and Prevention.”

The National Women’s Health Information Center: “Depression.”

National Cancer Institute: “Depression (PDQ).”

Food and Drug Administration: “The Lowdown on Depression.”

Mental Health America: “Facts about Depression and Suicide.”

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R. Bipolar II, Rodale Books, 2006.

National Alliance on Mental Illness:  “The Impact and Cost of Mental Illness: The Case of Depression.”

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