ACCESS FAMILY HEALTH, PA
WELLNESS PRACTICES OF AMERICA, PLLC
300 NORTH ALAMO
MARSHALL, TEXAS 75670
PH: 903.472.4800
1800 JUDSON RD, STE 400
LONGVIEW, TX 75605
FAX: 903.927.2880
Depression
Depression can be very different in different people or in the same person over time. It is a common but
serious illness. Treatment can help those with even the most severe depression get better.
Everyone occasionally feels blue or sad, but these feelings usually pass within a couple of days. When a
person has depression, it interferes with his or her daily life and routine, such as going to work or school,
taking care of children, and relationships with family and friends. Depression causes pain for the person
who has it and for those who care about him or her.
What are the different forms of depression?
There are several forms of depressive disorders. The most common are major depressive disorder and
dysthymic disorder.

Major depressive disorder, also called major depression, is a combination of symptoms that
interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities.
Major depression is disabling and prevents a person from functioning normally. An episode of major
depression may occur only once in a person's lifetime, but more often, it recurs throughout a

person's life.
Dysthymic disorder, also called dysthymia, is characterized by long-term (two years or longer) but
less severe symptoms that may not disable a person but can prevent one from functioning normally
or feeling well. People with dysthymia may also experience one or more episodes of major
depression during their lifetimes.
Some forms of depressive disorder exhibit slightly different characteristics than those described above, or
they may develop under unique circumstances. However, not all scientists agree on how to characterize
and define these forms of depression.
They include:

Psychotic depression, which occurs when a severe depressive illness is accompanied by some

form of psychosis, such as a break with reality, hallucinations, and delusions.
Postpartum depression, which is diagnosed if a new mother develops a major depressive episode
within one month after delivery. It is estimated that 10 to 15 percent of women experience

postpartum depression after giving birth.
Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness
during the winter months, when there is less natural sunlight. The depression generally lifts during
spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with
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SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can

reduce SAD symptoms, either alone or in combination with light therapy.
Bipolar disorder, also called manic-depressive illness, is not as common as major depression or
dysthymia. Bipolar disorder is characterized by cycling mood changes-from extreme highs (e.g.,
mania) to extreme lows (e.g., depression).
Why do people get depression?
There is no single cause of depression. Depression happens because of a combination of things
including:

Genes - some types of depression tend to run in families. Genes are the "blueprints" for who we are,
and we inherit them from our parents. Scientists are looking for the specific genes that may be

involved in depression.
Brain chemistry and structure - when chemicals in the brain are not at the right levels, depression
can occur. These chemicals, called neurotransmitters, help cells in the brain communicate with each
other. By looking at pictures of the brain, scientists can also see that the structure of the brain in
people who have depression looks different than in people who do not have depression. Scientists

are working to figure out why these differences occur.
Environmental and psychological factors - trauma, loss of a loved one, a difficult relationship,
and other stressors can trigger depression. Scientists are working to figure out why depression
occurs in some people but not in others with the same or similar experiences. They are also studying
why some people recover quickly from depression and others do not.
When does depression start?
Young children and teens can get depression but it can occur at other ages also. Depression is more
common in women than in men, but men do get depression too. Loss of a loved one, stress and
hormonal changes, or traumatic events may trigger depression at any age.
What are the symptoms of depression?
People with depressive illnesses do not all experience the same symptoms. The severity, frequency and
duration of symptoms will vary depending on the individual and his or her particular illness. Symptoms
include:

Persistent sad, anxious or "empty" feelings

Feelings of hopelessness and/or pessimism

Feelings of guilt, worthlessness and/or helplessness

Irritability, restlessness

Loss of interest in activities or hobbies once pleasurable, including sex

Fatigue and decreased energy

Difficulty concentrating, remembering details and making decisions

Insomnia, early–morning wakefulness, or excessive sleeping

Overeating, or appetite loss
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
Thoughts of suicide, suicide attempts

Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with
treatment
How is depression diagnosed?
A diagnosis of depression can be made when four or more of the above symptoms have been present
continually, or most of the time, for more than two weeks. The term clinical depression merely means the
episode of depression is serious enough to require treatment. Major depression is marked by far more
severe symptoms, such as literally being unable to drag oneself out of bed.
What illnesses might occur with depression?
Depressed people are often afflicted with other illnesses. Sometimes other illnesses come first, but other
times the depression comes first. Each person and situation is different, but it is important not to ignore
these illnesses and to get treatment for them and the depression. Some illnesses or disorders that may
occur along with depression are:

Anxiety disorders, including post-traumatic stress disorder (PTSD), obsessive-compulsive disorder
(OCD), panic disorder, social phobia, and generalized anxiety disorder (GAD)


Alcohol and other substance abuse or dependence
Heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson's disease
Studies have found that treating depression can help in treating these other illnesses.
How is depression treated?
Even in severe cases, depression is highly treatable. The first step is to visit a doctor. A doctor can
make sure that the symptoms of depression are not being caused by another medical condition. A doctor
may refer you to a mental health professional.
The most common treatments of depression are psychotherapy and medication.
What is psychotherapy?
Psychotherapy is sometimes referred to as "talk-therapy". It involves speaking to a trained professional
about your thougts, feelings, life events and reactions to them.
There are several types of psychotherapy that can help people with depression. There are two main types
of psychotherapy commonly used to treat depression: cognitive-behavioral therapy and interpersonal
therapy.

Cognitive behavioral therapy (CBT) teaches people to change negative styles of thinking and
behaving that may contribute to their depression. Cognitive behavioral therapy is used to treat a
variety of disorders, including anxiety.
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
Interpersonal therapy helps people understand and work through troubled personal relationships
that may cause their depression or make it worse.
For mild to moderate depression, psychotherapy may be the best treatment option. However, for major
depression or for certain people, psychotherapy may not be enough.
For adolescents, a combination of medication and psychotherapy may work the best to treat
major depression and help keep the depression from happening again. Also, a study about
treating depression in older adults found that those who got better with medication and
interpersonal therapy were less likely to have depression again if they continued their
combination treatment for at least two years.
Medications for Depression
Medications help balance chemicals in the brain called neurotransmitters. Although scientists are not sure
exactly how these chemicals work, they do know they affect a person's mood. Types of antidepressant
medications that help keep neurotransmitters at the correct levels are:

SSRIs (selective serotonin reuptake inhibitors)

SNRIs (serotonin and norepinephrine reuptake inhibitors)


MAOIs (monoamine oxidase inhibitors)
Tricyclics
These different types of medications affect different chemicals in the brain.
Medications affect everyone differently. Sometimes several different types have to be tried before finding
the one that works. If you start taking a medication to treat depression, tell your doctor about any side
effects right away. Depending on which type of medication, possible side effects include:

Headache

Nausea

Insomnia and nervousness

Agitation or feeling jittery

Sexual problems

Dry mouth

Constipation

Bladder problems


Blurred vision
Drowsiness during the day
Other therapies
St. John's wort
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The extract from St. John's wort (Hypericum perforatum) has been used for centuries in many folk and
herbal remedies. The National Institutes of Health conducted a clinical trial to determine the effectiveness
of the herb in treating adults who have major depression. The trial found that St. John's wort was no more
effective than a "sugar pill" (placebo) in treating major depression. Another study is looking at whether St.
John's wort is effective for treating mild or minor depression.
Other research has shown that St. John's wort may interfere with other medications, including those used
to control HIV infection. In 2000, the FDA issued a Public Health Advisory letter stating that the herb may
interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and
organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives.
Because of these potential interactions, patients should always consult with their doctors before taking
any herbal supplement.
The path to getting treated
Reaping the benefits of treatment begins by recognizing the signs of depression. The next step is to be
evaluated by a qualified professional.
Depressive illnesses make you feel exhausted, worthless, helpless, and hopeless. Such feelings make
some people want to give up. It is important to realize that these negative feelings are part of the
depression and will fade as treatment begins to take effect.
Along with professional treatment, there are other things you can do to help yourself get better.
Some people find participating in support groups very helpful. It may also help to spend some
time with other people and to participate in activities that make you feel better, such as mild
exercise or yoga. Just don't expect too much from yourself right away.
FEELING BETTER TAKES TIME.
How can I help a friend or relative who is depressed?
If you know someone who is depressed, it affects you too. The first and most important thing you can do
to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and
treatment. You may need to make an appointment on behalf of your friend or relative and go with him or
her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no
improvement occurs after six to eight weeks.
To help a friend or relative:

Offer emotional support, understanding, patience and encouragement.

Engage your friend or relative in conversation, and listen carefully.

Never disparage feelings your friend or relative expresses, but point out realities and offer hope.

Never ignore comments about suicide, and report them to your friend's or relative's therapist or
doctor.
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
Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she
declines, but don't push him or her to take on too much too soon. Although diversions and company

are needed, too many demands may increase feelings of failure.
Remind your friend or relative that with time and treatment, the depression will lift.
How can I help myself if I am depressed?
If you have depression, you may feel exhausted, helpless and hopeless. It may be extremely difficult to
take any action to help yourself. But it is important to realize that these feelings are part of the depression
and do not accurately reflect actual circumstances. As you begin to recognize your depression and begin
treatment, negative thinking will fade.
To help yourself:

Engage in mild activity or exercise. Go to a movie, a ballgame, or another event or activity that you
once enjoyed.

Participate in religious, social or other activities.

Set realistic goals for yourself.

Break up large tasks into small ones, set some priorities and do what you can as you can.

Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate
yourself, and let others help you.

Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of"
your depression. Often during treatment for depression, sleep and appetite will begin to improve
before your depressed mood lifts.

Postpone important decisions, such as getting married or divorced or changing jobs, until you feel
better. Discuss decisions with others who know you well and have a more objective view of your
situation.

Remember that positive thinking will replace negative thoughts as your depression responds to
treatment.
What if I or someone I know is in crisis?
If you are thinking about harming yourself, or know someone who is, tell someone who can help
immediately.

Call your doctor.

Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member
to help you do these things.

Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-

800-273-8255) [or TTY: 1-800-799-4TTY (4889)] to talk to a trained counselor.
Make sure you or the suicidal person is not left alone.
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