How Much We Know About Depression


What is depression?

Depression is a treatable medical illness that causes a person to have a very low mood for an extended period of time. It interferes with one’s ability to function in the home, work, and social environment.

Depression lasts longer and is more severe than a person’s normal response to disappointment or failure. It is important to realize that depression is an illness and not a character flaw.

In 15% of untreated cases, depression can become so debilitating it leads to suicide. About 10% of the population in North America experience depression at any given time. Globally, more than 264 million people of all ages suffer from depression.

Photo by Jonathan Rados on Unsplash

How do I know it is depression?

People experiencing major depressive disorder report feeling five or more of the following symptoms, with depressed mood or no interest in normal activities being one of their symptoms.

  • Depressed mood
  • No interest in normal activities
  • Feeling hopeless, guilty, worthless, or helpless
  • Decreased sexual desire or pleasure
  • Decreased energy, feeling tired
  • Difficulty concentrating, remembering, or making decisions
  • Restless or irritable
  • Sleeping too much or unable to sleep
  • Increased or decreased appetite with weight loss or gain
  • Psychomotor retardation (slowed down), agitation
  • Chronic pain or increase in somatic complaints not caused by illness or injury
  • Suicidal thoughts, feelings, or attempts

What causes depression?

Research into the causes of depression is ongoing. There are several factors that can increase the risk of a person developing depression. These are both genetic and environmental in nature. However, it is important to realize that many people with risk factors never do develop this illness.

Risk factors include:

  • Family history
  • Social factors
  • Developmental factors

There are several neurotransmitters found in the brain that are important for maintaining a normal mood. When these chemicals get out of balance or become depleted, depression can result. Three neurotransmitters that are often focused on are:

  • Norepinephrine
  • Serotonin
  • Dopamine

Sometimes, although not always, a stressful event might cause a person who is inclined to depression to develop an episode. As time goes on, with frequent episodes of illness, depression may be caused by relatively mild stressors or with no stressor present.

Drugs and Other Toxic Causes of Depression

The cause of your depression may be as close as your medicine cabinet. That’s right, people might be getting poisoned by their medicine, cleaning chemicals, or contaminants in their drinking water. Take a look around your home to see if these toxins might be contributing to your depression.


Believe it or not, hundreds of medications list depression as a possible side effect. Check your medicine labels to see if the drugs you are taking might be some of them. Depression caused by medication might be more prevalent in those who have a family history of depression but can still affect anyone.

Metals & Minerals

There are several metals and minerals that can poison your body: lead, copper, aluminum, and mercury being the most common. Look around your home for items that contain these metals and minerals. You might find them in your drinking water, food cans, eating utensils, paint, plumbing, water heaters, cook wear, spices, antiperspirants and deodorants, thermometers, antiseptics, cosmetics, and more!


Petrochemicals are chemicals found in synthetic products like paint, fuels, and plastic. Depending on the petrochemical, it can poison your body in several ways: breathing its fumes, allowing it to touch your skin, or being accidentally swallowed. Take caution when handling these materials, which can include paint thinner, permanent markers, glues, varnishes, processed wood, and natural gas and oil. This can include working on a gas stove; you may need to change to an electric one to prevent adverse effects from the fumes.


Obviously, pesticides are dangerous; they kill bugs! But they can harm you, too. When using pesticides, be sure to follow the directions on the label. You may also need to be aware of pesticides that farmers or grocery stores spray on produce.

Chemicalized Carpets and Other Materials

Stain-resistant carpet and upholstery, sun-proof draperies, and some wood furniture have been treated with chemicals to ensure it lasts a long time and won’t be easily damaged. Take a look around your home. Are these materials present? If you or your family experience headaches, fatigue, or confusion, you may want to consider changing out some of these items, even if it means re-carpeting your entire house.

Cosmetics and Personal Care Products

Many products contain scents and other chemicals that may actually cause you to be depressed. Examine your cosmetics, lotions, soaps, and other personal care products. Aim to keep their ingredients as naturally as possible, which means you may need to skip the delicious scent for an unscented version instead.


Radiation and magnetic fields can contribute to your depression. Think you aren’t around anything like that? Check out any electronic device in your house. You will want to limit your exposure to radiation and the magnetic fields these devices give off. In other words, keep your distance from the television (3-4 feet from a small screen, 8-10 feet from a large one) and computer screen (stay an arm’s length away), don’t stand in front of the microwave when it’s on, don’t have rooms heated with cables, and limit your exposure to main power lines.

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Factors of Teenage Depression

Why is it that some teens are more likely to get depression than others? What causes it, exactly? Is there anything we can do to prevent ourselves from getting it?

There are some key factors that help determine if you are more likely to struggle with depression than others. Look over the following list. Do any seem to be particularly relevant in your life?

Other Family Members Experienced Depression

If you have parents or someone else in your family with depression, then you may have a genetic predisposition to it, as well. What this means is that when you face some of these other factors (i.e., stressful events, sexual abuse), you have a natural tendency to become depressed.

Stressful Events

A lot can happen in a teenager’s life: new schools, new friends, parents fighting or divorcing, losing a grandparent. Any of these events can cause an extreme amount of stress and anxiety. Those who are anxious tend to experience depression, too.

Conduct Disorder

Teens with a history of violence, bullying, destruction, and hurting others may have something called conduct disorder. They are often put into jail or otherwise punished by the court or school system. It seems like many teens with conduct disorder also have depression.

Sexual Abuse

Though any type of abuse is harmful to the person who experienced it, sexual abuse is one of the most damaging because it violates an individual’s sense of self and identity. If you have been abused, you are more likely to develop depression or post-traumatic stress disorder (PTSD).

Thoughts of Death and Suicide

Most teens who are thinking about ending their lives are depressed. If you are feeling this way, it is important that you find someone you trust and talk about it.

Even if you have experienced some of these factors, it does not mean you are DEFINITELY going to get depression; it just means that you are more likely. By being proactive in dealing with these factors, you can do your best to keep depression at bay. The most important thing is to have a strong support system. Have someone you can talk to about your experiences and feelings so you can try to manage those things in a healthy way.

Depression Treatment

Treatment Goals

Why do we talk about treatment goals? Wouldn’t everybody’s goal be to get completely better? This is a very important question. Our first goal in all cases is to bring depression into remission. In other words, we want to return people to their previous level of functioning before depression occurred. Unfortunately, many people choose to settle for only partial improvement.

Many people with depression prefer to settle for partial remission rather than increase the dose of their medication to achieve full remission. However, people who choose only partial remission have a higher likelihood of experiencing a relapse. They also have shorter depression-free periods than people who choose full remission.

Our second goal is to prevent relapse. This is best done by:

  • Achieving full remission;
  • And by keeping the patient on medication for a long enough period of time to prevent relapse.

Many people choose to go off treatment soon after their symptoms have gone away. People who do this too soon often experience a relapse. People who remain on medication treatment for a period of six months to one year after achieving remission have a much better prognosis. They have fewer relapses and longer periods of time between relapses.

It is recommended that people who have had two or more relapses of Major Depressive Disorder remain on medication treatment to prevent further relapses and to prevent relapses from becoming too severe if they do occur.

Depression Medication (Antidepressant)

There are a large number of antidepressant medications available for the treatment of depression. Each patient responds differently to a specific medication. Where one patient may experience minimal or no side effects another patient may be more sensitive. When trying a new medication it is important to realize that many medications take four to six weeks to become effective and that most side effects go away over time. It may take a little time and effort you and your health care provider to find the medication or medications that are most effective for you.

Medications are frequently grouped according to how they work in the body or their chemical structure. Some groups of antidepressants that are popular today are:

  • SSRIs – Selective Serotonin Reuptake Inhibitors
  • SNRI – Serotonin-Norepinephrine Reuptake Inhibitors
  • Tri-cyclic antidepressants
  • MAOIs – (Irreversible) Monoamine Oxidase Inhibitors
  • RIMAs – Reversible Monoamine Oxidase Inhibitors
  • NDRIs – Norepinephrine-Dopamine Reuptake Inhibitors


Example: Celexa (citalopram)
Lexapro (escitalopram)
Paxil (paroxetin)
Prozac (fluoxetine)
Zoloft (sertraline)

SSRIs are one of the more commonly used groups of antidepressants. They are effective in treating a broad range of symptoms and are generally well tolerated. They have fewer side effects than some of the older medications. Patients tolerate these medications better when they start them at low doses and build up slowly. It is also important to withdraw these medications slowly when you are about to stop taking them to avoid withdrawal effects.


Example: Effexor XR (venlafaxine)

Effexor XR is a commonly used antidepressant. Like the SSRIs patients tolerate it better if they start on a low dose and build up slowly. People taking Effexor XR should have their blood pressure monitored regularly because this medication can cause an increase in blood pressure. The medication should be taken with food to reduce the chance of stomach upset. When Effexor XR is discontinued the dose should be reduced slowly.

Tetracyclic Antidepressants

Example: Maprotiline
Remeron (mirtazapine)

Remeron is a relatively new antidepressant on the market. It is sometimes used in patients who experience difficulty sleeping along with depression because it causes sedation. It causes less nausea or anxiety than the other newer agents. Because of the sedation, it is important to be careful to wait until drowsiness has disappeared before operating a motor vehicle, dangerous machinery, or participating in an activity requiring good focus. Sedation problems decrease after you have been on the medication for a while and with increased doses, contrary to what one might expect. It is important to monitor weight gain and increased cholesterol levels.

Tri-cyclic antidepressants

Example: Anafranil (clomipramine)
Aventyl (nortriptyline)
Elavil (amitriptyline)
Norpramin (desipramine)
Sinequan (doxepin)
Surmontil (trimipramine)
Tofranil (imipramine)

This is an older group of antidepressants still in use today. They are very effective and generally cheaper than newer medications. However, they are less popular because they have more side effects such as dry mouth, drowsiness, dizziness, and constipation. These medications should be started at low doses and built up slowly and when being stopped they should be tapered gradually.

Irreversible MAOIs

Example:Nardil (phenelzine)
Parnate (tranylcypromine)

MAOIs are one of the oldest classes of antidepressants. Like most antidepressants, they are tolerated best when a patient goes on the medication at a low dose and builds up slowly. These medications are very effective but chosen when other newer medications have not worked because of their side effects and drug-food interactions. When combined with food containing high amounts of tryamine a patient can experience what is known as “hypertensive crisis”. A hypertensive crisis is a rapid rise in blood pressure that can precipitate a stroke.

Foods high in tryamine include:

  • Aged cheese
  • Smoked meat
  • Sour cream
  • Pickled herring
  • Soya sauce
  • Canned figs
  • Meat prepared with tenderizers
  • Chocolate
  • Red wines and beer
  • Decongestants (Pseudephedrine, Phenylephrine)

Symptoms of the hypertensive crisis include:

  • A severe headache at the back of the head, possibly radiating forward
  • Stiff neck
  • Nausea, vomiting
  • Sweating or cold and clammy skin
  • Rapid heart rate
  • Agitation
  • Pale skin and then flushing
  • Photophobia (extreme sensitivity to light)

It is important to withdraw MAOI medications slowly to prevent withdrawal effects.

Reversible Monoamine Oxidase Inhibitors (RIMA)

Example: Manerix (moclobomide)

Unlike the irreversible monoamine oxidase inhibitors, reversible monoamine oxidase inhibitors do not require strict dietary restrictions. It is recommended that you avoid large quantities of foods containing tryamine and that you take the medication immediately after meals to minimize any tryamine related response to food.

Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)

Example: Wellbutrin (bupropion)

A side effect of many antidepressants is sexual dysfunction. Wellbutrin does not cause sexual dysfunction and may improve sexual function. It may lower the seizure threshold and therefore should not be used in people with seizure disorders or who are at risk for seizures such as people with bulimia, anorexia, or people undergoing withdrawal from alcohol or benzodiazepines. If you take more than 150 mg daily of this medication you should space the doses eight hours apart to prevent seizures. Wellbutrin can interfere with sleep so the last dose of the day should be taken no later than 4 PM to minimize sleep problems. The drug should be taken with food to avoid nausea. Tablets are formulated for slow release of the medication and therefore patients should not break, crush, or chew the tablets.

Side effects of antidepressants

Side effects are effects medication has in addition to the desired effect. Some side effects are unwanted but often side effects can be an additional benefit of the medication. For example, if a depressed person is having trouble sleeping, an antidepressant that has drowsiness as a side effect may be helpful if given at bedtime. If depression is causing increased tiredness, an antidepressant that causes wakefulness may be the best choice, if taken in the morning.

The list of side effects for most antidepressants is very similar. Medications primarily differ in how severe the side effects are and how likely they are to occur. For example, drowsiness may be listed as a side effect of two medications. In one medication it may occur in 80 % of patients and be severe and with another medication, it may occur in 2 % of patients and be very mild. Therefore one cannot compare medications by looking at their list of side effects.

Unwanted side effects can often be minimized by starting the antidepressant at a low dose and increasing the dose slowly until the best dose is reached. Many side effects disappear after the person has been on medication for a period of time.

Withdrawal effects of antidepressant

It is also important to lower the dose slowly when an antidepressant is being stopped to prevent withdrawal effects.

When an antidepressant is stopped too rapidly some withdrawal symptoms that may be experienced are:

  • Anxiety
  • Abnormal dreams
  • Dizziness
  • Agitation, restlessness
  • Nausea, vomiting
  • Sweating
  • Headache
  • Sensory disturbance such as shock-like symptoms

Switching Antidepressant Medications

Special precautions are necessary when switching from one antidepressant to another. Some medications require a ‘washout period’. This is a period of time between stopping one medication and starting the next. Other medications can be taken at the same time. It is important to follow your health care provider’s instructions when switching medications to avoid serious drug interactions or unnecessary delays in treatment.

Add-on treatments of depression

Depression is often treated with more than one medication. Examples of add-on treatments are when medications are added to treat a specific symptom, such as anxiety or sleep disturbance. In other instances, one medication may be working but not completely enough to achieve full remission of symptoms.

In this case, a second antidepressant may be added or a medication that will boost the effectiveness of the antidepressant. Lithium, thyroid medication, or buspirone are commonly added to treatment. Lithium or an anticonvulsant medication may be added to treatment as a mood stabilizer. It is important when new medications are being added to treatment to report side effects that are concerning to your health care provider.

Drug Interactions

Antidepressants frequently interact with other prescription medications, over-the-counter medications, and herbal medications. Some of these interactions can cause serious harm to your health. It is important to tell your prescribing doctor and pharmacist all the medications you are taking before starting an antidepressant. Some antidepressants can interact with food so you should follow the diet restrictions recommended by your health care providers.

Non-medication treatment of depression

Psychotherapy, commonly called ‘talking therapy’, used in combination with medication has been shown to be more effective in treating depression than either treatment alone. Psychiatrists, psychologists, counselors, social workers, and other health care providers are often trained in different forms of psychotherapy. There are a number of types of psychotherapy to choose from. The type used will depend on the patient’s personal and medical history.

Cognitive-Behavioral Therapy

Cognition refers to knowing or thinking. What we know or think about something affects how we respond to it. Cognitive-behavioral therapy tries to help people become more aware of their faulty or negative thinking patterns and teaches them to think about things in new and healthier ways.

Behavioral Therapy

Behavioral therapy is a talking therapy aimed at encouraging patients to do certain activities, teach problem-solving strategies, self-control therapy, or social learning activities.

Interpersonal Therapy

This is talking therapy aimed at helping people cope with life’s changes and losses. Therapists help you to develop skills to understand the effects of change and grief. They also help you to develop healthy patterns to deal with change and loss.

Marital Therapy, Family Therapy, and Group Therapy

These are all forms of talking therapy that help people deal with specific life situations they may want help with.

Electroconvulsive Therapy (ECT) in depression

ECT is electroconvulsive therapy, often called ‘shock treatment’. This is a form of treatment where a small electric current is delivered to the brain causing a small seizure. Patients are asleep during the treatment procedure and are given a muscle relaxant. The seizure lasts approximately 30 seconds and after 10 to 15 minutes the patient wakes up. A course of ECT is usually given three times weekly, with many people receiving 6 to 12 treatments overall. A positive response to treatment usually begins between 10 to 14 days.

ECT has received a lot of negative press primarily because of how it was used in the early years after it was discovered. A lot of misinformation about ECT continues to be found in the literature and on various websites.

ECT has a higher rate of success for severe depression than any other form of treatment. As a result, it can be an excellent choice of treatment in patients with severe major depression, who have not responded to medication. It is also sometimes used for patients in whom a rapid response is needed, who are pregnant, or in people wanting ECT because they have had previous success with it.

The American Psychiatric Association task force studying ECT considered it the treatment of choice for severe major depressive disorder when it is coupled with psychotic features, catatonic stupor, severe suicidal symptoms, or refusal to eat due to severe depression.

The most common side effects of ECT are short-term confusion and memory loss for a brief period before and after ECT. These problems are generally clear in a few weeks. Some patients report permanent memory loss for some events, which have occurred for a few months prior to, during, and for a few months after treatment.

Patients who have been treated with ECT often experience a relapse of their depression within six months of treatments. As a result, it is important for patients to receive medication treatment or maintenance electroconvulsive therapy (ECT) to decrease the chances of relapse. Some patients receive maintenance ECT every four to six weeks.

Psychotherapy for Depression 101

Apart from pharmaceuticals, one of the more popular treatments for depression is going to counseling or therapy. Therapy, like all things, is not always successful for everyone. However, it has helped countless individuals and should at the very least be considered an option.

There are several different methods of therapy:

• Psychoanalysis looks into a person’s unconscious thoughts and past experiences in order to understand and change their behavior. They also spend a lot of time exploring feelings.
• Behavior therapy, on the other hand, focuses exclusively on someone’s behavior, without seeking to understand the thoughts and feelings behind their behavior.
• Finally, interpersonal psychotherapy is a mix of the two: there is some exploration of feelings and thoughts, along with problem-solving and behavior changing. This is done through talk therapy.

For those suffering from depression, psychotherapy can supplement any antidepressants you are on, and may actually end up replacing them. However, choosing a type of therapy may be difficult. And once you decide on that, you must find a therapist you are comfortable with and is well trained. It is essential that you trust this individual.

Because therapy often uncovers difficult issues (for example, past abuse/trauma or unusual feelings or thoughts), it can be detrimental. Therapists shouldn’t be aggressive with their clients, nor should they force their own ideas or values on someone.

It can also be helpful for those struggling with depression to read more about it: learn about how depression affects them, read self-help books aimed to bring healing, and seek out stories of other individuals who have suffered from depression but were able to manage it and pursue healing.

Depression Treatment Techniques Used in Cognitive Therapy

Cognitive Therapy is used to change negative ideas and behaviors into positive ones. By working as a team, the therapist and patient examine the patient’s thoughts and actions. They analyze the truth or reality of those thoughts. Actions are tested to see if they were the best choice in the circumstances or there were other, perhaps better, possibilities.

Cognitive Therapy uses a number of techniques. One of these is reconstruction. The therapist-patient team reconstructs the stages of the patient’s depression. When did it first begin? What were the circumstances at the time? Is the depression constant or does it come and go?

The goal of reconstruction is to focus the patient on details. As the number of details increases, patterns begin to form. Patients begin to see that it is their interpretation of events or situations that are the problem and not the situations themselves.

A second technique is a behavioral activation. Depressed people don’t behave in the positive ways they once did. They may no longer spend time on hobbies, visit friends, or go to the gym. This technique asks the patient to list their positive behaviors prior to the depression. Then, from time to time, the patient is encouraged to “do” one of these behaviors such as visit a friend.

In the beginning, patients visit in a robotic manner. They don’t gain any satisfaction or pleasure. However, the actual fact of doing the visiting reminds the brain that once this behavior was done. Somehow, this reminder encourages the patient to do it again. The more it is repeated, the more pleasurable it becomes.

Another technique is neutralizing automatic thoughts. Most of us have such thoughts. They can be thought of as the “tape” or CD that plays in our heads. A depressed person’s tape is usually filled with invalid negative thoughts. These thoughts play over and over, reinforcing themselves. They become so automatic that the patient does not stop to think about their validity or truth.

Cognitive Therapy analyzes these thoughts one by one. The patient begins to see their invalidity. Then, even if the thoughts play, their strength is much reduced.

A fourth technique involves making time for cognition or thought. For many people, life is a series of “stimulus-response”. That is, something happens to a person and he or she reacts. There is no conscious thought involved. Patients are taught to slow things down and make time for thought.

Taking time to think opens up an entire world of possibilities. Suddenly, things are not as “black and white” as they once appeared. Did the event that just happens really happen the way I think it did? Perhaps something I took as fact was really just an idea or an opinion? After such a review, it becomes clear that there is usually more than one reaction option.

Through the use of such techniques, Cognitive Therapy creates a personal “toolbox”. In this toolbox are techniques for evaluation, analysis, and decision-making. Cognitive Therapy believes that these tools will enable the patient to make the right choices more often.

Herbal Therapies of depression

St John’s Wart is a well-known herbal therapy used to treat mild to moderate depression.

It is important not to combine this medication with other antidepressants as it can cause some serious drug interactions resulting in heart arrhythmias. Prescription medications have many more research studies done with them and may be a better choice.

These and other herbal medications often have drug interactions with prescription drugs so should never be taken without checking their safety with your present medication therapy.