Depression, which is also called major depression or major depressive disorder, is a mental health condition that falls under the category of mood disorders. Depression is characterized by intense feelings of sadness, hopelessness, and sometimes anger and irritability, as well as physical symptoms like pain and fatigue. It goes well beyond typical sadness and persists for much longer.

Major depression is not something that will simply go away on its own. It is a chronic condition that requires treatment. Treatment strategies usually include a combination of therapy and medication. Antidepressants have made a huge difference in the lives of people who struggle with depression, but they also cause side effects, some of which may be serious.

Depression: Definition and Symptoms

Major depression is defined as a mood disorder, which means it is a mental health condition that affects your daily mood. Depression is a set of feelings and physical symptoms, primarily sadness, lethargy, and hopelessness, that persist for long periods of time and that recur after periods of improved mood. It is more than simply ‘feeling blue’ or being down for a day or two. It interrupts a person’s life and ability to function normally. Depression is also a chronic condition, meaning it has no cure and may recur after a period of relief. Symptoms will vary by person, but may include:

• Feeling sad, empty or hopeless.
• Irritability, frustration, and anger.
• Restlessness, anxiety, and agitation.
• Changes in sleeping and eating habits.
• Loss of interest in normal activities, lethargy.
• Extreme fatigue.
• Physical symptoms that can’t be explained by something else, like headaches or indigestion.
• Difficulty thinking or concentrating.
• Feelings of guilt and worthlessness.
• Dwelling on past mistakes and feeling at blame for things.
• Thoughts of death or suicide.

Depression in Men vs. Women

Many more women than men are diagnosed with depression, and part of the reason for that may be that men are less likely to reach out for help. This can be explained by a larger stigma for men, but also because men experience different symptoms that may not obviously be depression. Men with depression are more likely to feel physical pain or to have other physical symptoms, like sexual dysfunction, difficulty sleeping, or indigestion. Men are also more likely to be angry, frustrated, irritable, and even violent, and are more likely to act out in reckless ways when depressed.

Depression in Children and Teens

Children and adolescents may also struggle with depression, and again, the signs and symptoms may be different than those seen in adults. With teens it may be particularly difficult to distinguish between normal teenage moodiness and real depression. Young people with depression may cry a lot or lose interest in activities they used to enjoy. They may exhibit signs of difficulty in school, such as slipping grades, getting in trouble, or missing class. They may have frequent physical complaints, like headaches or upset stomach. In general, children or teens that show changes in behavior that are troubling or unexplained may be suffering from depression.

Causes and Risk Factors

Exactly what causes depression is not fully understood, but experts believe it may be related to the balance of chemicals in the brain. Neurotransmitters, signaling chemicals in the brain, can become imbalanced, which affects mood. Hormones and genetics may also play a role in developing depression.

While causes are still being explored, there are some well-defined risk factors. Genetics and a family history seem to be major risk factors for having depression, as are traumatic incidents. Someone who experienced some type of trauma as a child is at an increased risk for depression. Drug and alcohol abuse, having a chronic or terminal illness, having low self-esteem, or lacking social support can all be risk factors.

In some cases, depression may be triggered or worsened by a medication. Benzodiazepines like Valium and Xanax treat anxiety, but depress the central nervous system, and can therefore trigger depression. Birth control medications, which rely on hormones to prevent pregnancy, may put women at risk for depression. Stimulants, like Adderall and Ritalin used to treat ADHD, and statins for lowering cholesterol may also contribute to depression.

Treatment

For most people struggling with major depression, treatment is an ongoing and two-pronged approach: therapy combined with medications. Various types of psychotherapy can be used to treat depression. One common type of therapy is cognitive behavioral therapy, or CBT. CBT practitioners teach patients to be more aware of their thoughts and behaviors and to stop negative thoughts as they arise while also consciously changing behaviors.

Most patients will not get enough relief from therapy alone and may rely on medications to treat the condition. There are several categories of antidepressant drugs, but doctors may combine these with anti-anxiety drugs, mood stabilizers, or antipsychotics for maximum effects. In addition to therapy and medication, some patients try alternative therapies and lifestyle changes. These may be of some use to supplement traditional treatment and include exercise and nutrition, herbal supplements, art therapy, and acupuncture.

Antidepressants

The most common way to treat depression is with antidepressant medications. There are several categories of these drugs, but the two most commonly used are SSRIs and SNRIs. SSRIs are selective serotonin reuptake inhibitors. These drugs blog the uptake of a neurotransmitter called serotonin and examples include Paxil, Zoloft, Prozac, and Lexapro. SNRIs are serotonin-norepinephrine reuptake inhibitors. They act on two neurotransmitters: serotonin as well as norepinephrine. Examples of SNRIs are Effexor and Cymbalta. Older, less commonly used antidepressants are tricyclic antidepressants and monoamine oxidase inhibitors.

Antidepressants are safe for most patients, but they take time to work. It may take several weeks for a patient to feel the effects of an antidepressant. It also may take time to find one that works for an individual patient. Some work for some people, but not for others. Over time, a medication that worked for someone may stop working. This can be frustrating and it takes patience and time to find the right medication that works and causes minimal side effects.

Side Effects of Antidepressants

All antidepressants come with some risks, which must be balanced against the potential benefits. Patients also need to understand that while it takes a few weeks to determine if a new medication will work, it also may take that amount of time to see if side effects will diminish. Potential side effects of antidepressants include nausea, vomiting, diarrhea, constipation, appetite loss, weight loss, dry mouth, dizziness, sexual dysfunction, excessive sweating, headaches, and drowsiness.

Withdrawal

Although antidepressants are not considered habit-forming, this stance is controversial because people often experience withdrawal when discontinuing use of an antidepressant. Officially called discontinuation syndrome, it may cause headaches, anxiety, vomiting, insomnia, nightmares, irritability, and an unusual symptom called a brain zap. Patients are warned to never stop an antidepressant suddenly for this reason. Discontinuation should only be done under the supervision of a doctor.

Young People and Suicide

SSRI and SNRI antidepressants carry a black box warning, the U.S. Food and Drug Administration’s most serious level of warning, for the risk of suicide. Although rare, children, teens, and adults into their 20s are at risk of these antidepressants causing suicidal thoughts and behaviors or worsening existing suicidal thoughts. This is a very serious and life-threatening potential side effect, so prescribing antidepressants to young people is done very carefully and by balancing the risk against benefits.

Makers of antidepressants have faced lawsuits over this scary risk. One example is Forest Laboratories, the maker of Celexa. The company was found guilty of off-label marketing of the drug to young people. The company was forced to pay $313 million in the case. Other companies have faced similar suits for off-label marketing or for failing to warn patients of the risks in cases in which a young person committed suicide after using an antidepressant.

Birth Defects

Another very serious potential side effect of antidepressants is the possibility of birth defects. Women may suffer from depression during pregnancy, and research has connected the use of certain antidepressants to treat it with later birth defects. Birth defects associated with antidepressants like Paxil, Prozac, Lexapro, and others include heart defects, skull defects, cleft palate, and others. There may even be a connection to developmental delays including autism. Many women have filed lawsuits over these birth defects, claiming that the drug companies did not adequately warn them of the risks of using antidepressants during pregnancy.

Major depression is a serious mental health condition. It is persistent and chronic and will not go away without professional treatment. Many patients living with depression have to rely on antidepressant medications, which can be risky. For all the benefits, patients risk uncomfortable side effects, but also dangerous and life-threatening side effects, like suicide and birth defects. Drug companies continue to work on developing new and better antidepressants, but also have a responsibility to warn patients and doctors of all the risks associated with their drugs.