Most people have felt sad or depressed at a certain point in their lives. This feeling can be a normal reaction to loss, life’s struggles, or an injured self-esteem.

Clinical depression is a treatable condition which is characterized by feelings of intense sadness — including feeling helpless, hopeless, and worthless — last for many days to weeks and keep you from functioning normally

Major Depression

  • Feeling depressed most of the time for most days of the week.
  • Other Symptoms:
    • Loss of interest or pleasure in activities
    • Weight loss or gain
    • Trouble sleeping or daytime sleepiness
    • Feelings of being “sped up” or “slowed down”
    • Constant tiredness or lack of energy
    • Feelings of worthlessness or guilt
    • Trouble concentrating or making decisions
    • Suicidal thoughts
  • Doctors may make a diagnosis if a person has five or more of these symptoms on most days for 2 weeks or longer. Also , at least one of the symptoms must be a depressed mood or loss of interest in activities.

Persistent Depressive Disorder

  • Depression that lasts for 2 years or longer. It used to be known as dysthymia.
  • Symptoms:
    • Change in your appetite
    • Excessive or lack of sleep
    • Fatigue or Lack of energy
    • Low self-esteem
    • Trouble concentrating or making decisions
    • Feel hopeless

Bipolar Disorder

  • Mood episodes that range from extremes of high energy with an “up” mood to low “depressive” periods.
  • The low phase consists of symptoms of major depression

Seasonal Affective Disorder (SAD)

  • Period of major depression that most often happens during the winter months, when the days grow short and you get less and less sunlight.

Psychotic Depression

  • Presents with symptoms of major depression along with “psychotic” symptoms, such as:
    • Hallucinations (seeing or hearing things that aren’t there)
    • Delusions (false beliefs)
    • Paranoia (wrongly believing that others are trying to harm you)

Postpartum Depression

  • Major depression in the weeks and months after childbirth

Premenstrual Dysphoric Disorder (PMDD)

  • Occurs in women who experience depression and other symptoms at the start of their period
  • Other symptoms:
    • Mood swings
    • Irritability
    • Anxiety
    • Trouble concentrating
    • Fatigue
    • Change in appetite or sleep habits
    • Feelings of being overwhelmed


Physician may do/request:

  • History & Physical Exam
    • Talking with the patient may be the most important diagnostic tool the doctor has.
    • The doctor must hear about specific symptoms of depression by talking with a patient and learning about other things that are relevant to making a depression diagnosis.




  • It is important to keep these points in mind:
    • Only about 30% of people with depression go into full remission after taking their first course of antidepressants. That’s according to a 2006 study funded by the National Institutes of Health. Those who got better were more likely to be taking slightly higher doses for longer periods.
    • Some antidepressants work better for certain individuals than others. It’s not uncommon to try different depression medicines during treatment.
    • Some people need more than one medicine for depression treatment.
    • Antidepressants carry a boxed warning about increased risk compared to placebo for suicidal thinking and behavior in children, adolescents, and young adults 18-24 years old.
    • Consult your doctor for the risks and benefits of treatment and the optimization of the medication that best relieves your symptoms.

Types of Anti-depressants:

  • Selective serotonin reuptake inhibitors (SSRIs)
    • Most common class used for depression. Examples include citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), vortioxetine (Brintellix), and sertraline (Zoloft).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
    • Newer type of antidepressant. Examples include venlafaxine (Effexor), desvenlafaxine (Pristiq and Khedezla), duloxetine (Cymbalta), and, levomilnacipran (Fetzima)
  • Tricyclic antidepressants (TCAs)
    • Among the first medications used to treat depression. Examples are amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil).
  • Monoamine oxidase inhibitors (MAOIs)
    • Among the earliest treatments for depression. Examples are phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAMskin patch).
    • Not prescribed very often because of the risk of dangerous reactions

Other medications:

  • Bupropion (Wellbutrin, Aplenzin
  • Mirtazapine (Remeron)
  • Trazodone (Desyrel)

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