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Can Cannabis Help Depression?

Overview

Research and anecdotal evidence provide hope that cannabis can be effective in helping patients cope with depression, especially less intoxicating varieties. Cannabis is widely used for its ability to elevate the mood, increase pleasurable sensations, both of which are effects that can help alleviate the symptoms of depression. It also interacts with the body’s endocannabinoid system, which plays an important role in regulating our moods. 

In terms of choosing the right type of cannabis to treat depression, preliminary research indicates that products with a chemical profile that includes CBD and CBG, and terpenes beta-caryophyllene, linalool and limonene are a good starting point.

Medical Research on Depression and Cannabis

While scientific research into the matter is still in its early stages, one can’t deny how popular cannabis is for the treatment of depression. Taking a closer look at the research can give a better understanding of how cannabis treatments might actually impact those with depression — both in the short and long term. 

  • A study published in 2018 found that cannabis users perceived a 50% reduction in depression symptoms, and only two puffs of cannabis smoke were needed to relieve depression. The study found that low-THC/high-CBD cannabis was best for reducing perceived symptoms.

  • A 2016 review of studies covering medical cannabis and mental health found nine studies on using cannabis for depression. Of these, seven showed that cannabis use led to improvements in depression symptoms. Still, the authors noted that these improvements were primarily seen in studies of patients with other medical conditions, so it’s unclear whether these improvements in depression might be related to improvements in other medical conditions.

  • A study published in 2019 surveyed 183 heterosexual couples that use cannabis and found that both men and women were more likely to use cannabis in the morning if they started the day in a worse mood. “Immediately after cannabis use, positive affect increased, and hostile and anxious affect decreased relative to that day’s morning levels,” the study found.

  • A 2002 UK survey of cannabis use found that among the medical cannabis users surveyed, 22% were using it to treat depression, close to the percentage that were using it to treat chronic pain (25%). Another study of medical cannabis patients from 2016 in Washington State found that half of the respondents reported using cannabis for depression. In general, these patients indicated that cannabis helps with their depressive symptoms.

That said, researchers have also found that cannabis use can cause depressive symptoms to worsen over time. One systematic review from 2013 found that “cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders.” In addition, a clinical study published in 2017 found that reducing cannabis use could result in fewer depression symptoms, and recommended that physicians “treating patients with co-occurring cannabis use and problems with anxiety, depression, or sleep quality, should attend to cannabis use reduction as a component of treatment.” 

But not all studies show this correlation. A large Swedish study found that the association between cannabis and depression disappeared when confounding factors were accounted for. An Israeli study found similar results, reporting that this association may be due more to sociodemographic and clinical factors than to cannabis use itself. 

In addition, research suggests that cannabis patients do better than those using opiods when it comes to depression. For those treating both depression and chronic pain, cannabis seems to be the option with fewer depressive side effects.

CBD and Depression 

Research has also shown that CBD products can be a particularly helpful treatment for depression, without the psychoactive effects of THC. 

A study published in 2018 looked at the depression-fighting effects of CBD in rodent subjects and found that a single dose could induce fast and sustained antidepressant-like effects. 

In 2014, a review of studies using animal models found that “CBD exhibited an antianxiety and antidepressant effects in animal models discussed.” That said, this could be related to the serotonin levels in the central nervous system, according to a study carried out using rodents in 2018. 

CBD has also shown promise as a treatment for sleep issues and anxiety, the alleviation of which can help patients better cope with depression.

How Cannabis Works on Depression 

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.

The endocannabinoid system is involved with mood regulation, and scientists believe that the cannabinoid receptors located primarily in the brain, called CB1 receptors, play a big role in the occurrence of depression. 

In addition, animal studies have noted that those with depression demonstrate an impairment in the functioning of the ECS. Studies on rodent subjects, for example, found that blocking activation of the CB1 receptor leads to increased depressive symptoms. 

Similar results have been found in human testing as well. Rimonabant, for example, is a drug that was marketed in Europe as an appetite suppressant. It works by blocking CB1 receptor activity — because those receptors are associated with hunger response, scientists hoped they could reduce appetite by blocking this receptor. Unfortunately, the drug had to be pulled from the market because many of the patients using it developed depressive and anxiety symptoms. Thus, blocking CB1 in both animals and humans seems to produce the same mood altering effect — increased depression. 

Researchers have also examined whether stimulating CB1 might produce antidepressant like properties. One study on rodent subjects found that low doses of a CB1-activating substance did increase antidepressant activity and serotonin responses in similar ranges to an SSRI antidepressant. However, the same study found that high doses had an opposite effect. The authors of this study say it confirms that CB1 should be a target for developing new antidepressants, and that cannabinoids from cannabis might be a helpful treatment. 

Still, given the complex, dose-dependant relationship between CB1 activation and depression, much more research is needed to confirm the theory that cannabis can help treat depression.

Using Cannabis for Your Depression 

Given the research above, there is a good chance that using cannabinoids to activate your endocannabinoid system can help to temporarily alleviate depression symptoms. High-CBD options may be particularly helpful for this, but both THC and CBD seem to offer short-term boosts in positivity and relief from depression symptoms. Still, it is important to note that research suggests these effects are dose dependent. Low doses of THC may improve depression while high doses may exacerbate it.

In addition, some research points to the possibility that long-term use of cannabis can lead to worsening symptoms of depression. While these results were inconsistent between studies, and may be related to other factors, rather than cannabis directly, it is too early to say with confidence that cannabis use won’t lead to these worsening depression symptoms. 

Still, if you have other medical conditions related to your depression, cannabis may be a better treatment option than alternatives. Chronic pain patients, for example, can expect to have better outcomes in terms of depression using cannabis rather than opiods. 

If you have depression and want to treat it with cannabis, the best first step is to consult a medical doctor with a specialization in cannabinoid medicine to find out if it is the right option for you.

Deciding which strain of marijuana to use can be more complicated than you may think, and can require some trial and error. If you do decide to use medical cannabis to treat depression, take some time to work out which cannabis strain works best for you.

One important factor when it comes to cannabis treatment is the chemical profile you choose. There are thousands of cannabis varieties, commonly referred to as strains, each with its own unique chemical profile. There is indeed a lack of research for specific types of cannabis and depression, but cannabis compounds that show particular potential for depression are the cannabinoids CBD and CBG, and the terpenes beta caryophyllene, limonene, and linalool. So looking for less intoxicating cannabis strains that have low or medium levels of THC, and high levels of these compounds would be a good place to start.  

Side Effects

While cannabis may be helpful, it does have some side effects which may be of particular interest to people coping with depression. In particular, THC has been known to trigger anxiety and paranoia in some users, which can aggravate depression. Cannabis can also cause temporary cognitive impairment, respiratory issues like chronic bronchitis, or cardiovascular issues like temporarily increased heart rate and blood pressure.

In addition, cannabis can be habit forming, and patients must make sure to use it responsibly.

Cannabis Side Effects

About Depression Overview

Overview

Clinical depression, also called Major Depressive Disorder, is a common and disabling condition that affects how you feel, the way you think, and how you act and practically every other aspect of your life.  

Many people think that depression is another word for feeling sad or low, but clinical depression goes beyond mere sadness. It’s important to know that depression isn’t something that you can just “snap out of” or cure just by wanting to hard enough, although it can be treated. 

There are several different types of clinical depression:

  • Persistent depressive disorder, or dysthymia, is a type of depression that lasts for more than two years, although sometimes you might feel that your symptoms are less severe. 
  • Postpartum depression (PPD) is a major depressive attack experienced by women after giving birth. People with PPD feel far more sad, anxious, and exhausted than women with regular “baby blues,” and unlike the “baby blues,” PPD may not clear up on its own.
  • Psychotic depression is a form of depression that comes together with psychotic symptoms like delusions or hallucinations. 
  • Seasonal affective disorder (SAD) is a type of depression that affects you only during part of the year. Most people with SAD only feel symptoms in the winter, due to a lack of sunlight. 

It’s estimated that more than 250 million people around the world suffer from depression, and that 1 out of every 6 people will have a depressive episode at some point in their lives. Generally, most people who feel depressed have their first experience of depression some time between their late teens and their mid-20s. 

Anyone can experience depression, but it affects women more than men. According to some studies, 1 out of every 3 women will feel depression at some point. 

Symptoms

Symptoms

When you have depression, you’ll feel some or all of these symptoms every day, and for most of the day. It’s important to know that a person who has depression can have several episodes of depression. During an episode of depression, you’ll feel more severe symptoms, but in between episodes, the symptoms may still be present though milder or barely noticeable.

Symptoms of depression can include:

  • Feeling sad and tearful
  • Feeling anxious and restless
  • Feeling empty, worthless, and without hope
  • Irritability and getting angry over small things
  • No longer taking pleasure in the things you used to enjoy
  • Moving, talking, and thinking more slowly than usual
  • Sleep issues, whether it’s sleeping too much or having trouble sleeping
  • Tiredness and lack of energy, even when you’ve been sleeping a lot
  • Weight loss and a lack of appetite
  • Having trouble concentrating, focusing on your work, or making decisions
  • Memory problems 
  • Thinking about death or suicide, or a suicide attempt

You might also feel physical symptoms when you have depression, like joint pain, back pain, and digestive issues. 

Note: Depression is not the same as the grief you feel after a bereavement, losing your job, or ending a relationship, even though people might say that they feel depressed. If you’re feeling grief, your sadness and painful feelings generally come in waves, mixed together with happy memories and positive thoughts. With grief, you also don’t usually feel a lack of self-esteem, which tends to accompany depression. 

However, grief can trigger and overlap with depression, which makes it important to pay attention to your symptoms and to go to the doctor if you or someone you’re close to feels that your sadness is leading to depression. 

Children and teenagers could show slightly different symptoms, including:

  • Refusing to go to school and/or performing badly at school
  • Losing or not gaining weight
  • Being irritable, clingy, and anxious
  • Complaining of general aches and pains
  • Eating or sleeping too much or not enough 
  • Drug or alcohol abuse
  • Self-harm
  • Avoiding socializing and other normal activities

Depression is often missed in older adults because the symptoms can be less obvious. Symptoms of depression in elderly people include:

  • Personality changes
  • Difficulty remembering things
  • Excessive tiredness
  • Loss of appetite
  • Insomnia and generally having trouble sleeping
  • Losing interest in sex
  • Becoming reclusive and avoiding socializing or going out of the house
  • Suicidal thoughts

When to see a doctor

When to see a doctor

Feeling sad and low is a normal part of life, so it can be difficult to know when to see a doctor. What’s more, someone with depression might not realize that their feelings of sadness, anger, or low self-worth aren’t reasonable, making it important for friends and family to pick up on these symptoms. Generally, you should go to the doctor if you feel at least 5 of the symptoms listed above, and they last for 2 weeks or more. If you feel the urge to commit suicide, you should seek help immediately.

Diagnosis

Diagnosis

To diagnose depression, your doctor will generally talk to you about your symptoms, and carry out tests to rule out any other causes or underlying physical issues. You can expect to undergo:

  • A physical examination, to check that you don’t have any underlying physical problem
  • Blood tests, to check for other conditions that may also present with similar symptoms such as thyroid issues, or vitamin deficiencies. 

Assessments—questionnaires that may check if you are experiencing symptoms as per above that may indicate depression or anxiety.

Causes

Causes

It’s almost impossible to pinpoint specific causes of depression. It can affect anyone and at any time, but there are certain risk factors that make it more likely that you’ll experience it. 

  • Biochemistry and other biological differences. Research has discovered that people who have depression have differences in the chemicals in the brain that are in control of your mood. 
  • Genetics and heredity. Depression tends to run in the family. If you have a family member(s) who have had depression, alcoholism, bipolar disorder, or have a history of suicide attempts, you’re more likely to experience depression yourself. 
  • Hormones. Changes in your hormones, like those felt after giving birth, after menopause, or due to thyroid issues, can bring on an episode of depression.
  • Personality. People who are pessimistic, have trouble coping with stress, have low self-esteem, and/or are highly dependent or self-critical are more likely to become depressed. 
  • Environment. People who live with violence, abuse, neglect, or in severe poverty are more likely to develop depression.
  • Trauma. Traumatic incidents like a bereavement, abuse, losing your job, or serious financial troubles can trigger depression.
  • A separate mental health disorder. This includes eating disorders, anxiety disorders, or post-traumatic stress disorder (PTSD).
  • Some medications. Medications like blood pressure pills and sleeping pills, can sometimes cause depression. 
  • Alcohol and drug abuse. People who abuse alcohol and drugs frequently also suffer from depression.
  • Serious chronic illness. Cancer, heart disease, chronic pain, or strokes can lead to depression.
  • Struggling with being lesbian, gay, bi-sexual, transgender, or intersex. Lack of support and compassion can lead members of the LGBTQ community to depression.

Treatment

Treatment

The good news is that depression is one of the most treatable mental health disorders. Some 80-90% of people with depression respond well to treatment, and almost everyone feels some level of relief from their symptoms. Treatment for depression includes medication, psychotherapy and brain stimulation therapies, and self-help through lifestyle changes. 

Medication

Generally, your doctor will prescribe you antidepressants. There are a few different types of antidepressants, including SSRIs like Prozac, SNRIs like Cymbalta, and other medications like Wellbutrin. These medications have fewer side effects, so they are the first ones that your doctor will suggest. 

If these medications don’t work, your doctor may prescribe atypical antipsychotics like Abilify, tricyclic antidepressants like Elavil or Norpramin, or monoamine oxidase inhibitors (MAOIs) like Nardil or Marplan. These medications have more serious side effects, and some MAOIs can even be fatal if you eat certain foods or combine them with certain other medicines. 

It takes time for antidepressants to work, usually between 3 and 6 weeks, and only at the right dose, so it’s important to give them enough time to work. You’ll typically find that symptoms like sleep and appetite issues and difficulty concentrating improve before your mood does. 

Once you’ve found a medication that works for you, it’s best to continue taking it even after your symptoms have improved, like another 6 or 12 months. You should never abruptly stop taking antidepressants, since that can cause serious withdrawal issues. Instead, you need to slowly decrease the dose with the advice of your doctor.

Herbal medicines and supplements 

Some herbal medicines and supplements, like St John’s Wort, omega-3 fatty acids, and S-adenosylmethionine (SAMe) have become popular for treating depression. Although some people find that they’re effective, they haven’t been approved for treatment by the FDA, so it’s important to be very careful when taking them, and to always consult your doctor. St John’s Wort, in particular, can interact badly with certain medications. 

Psychotherapy 

Psychotherapy, or talk therapy, can be effective against depression, either on its own or together with medication. There are a few psychotherapies used for depression, including cognitive behavioral therapy (CBT), interpersonal therapy, and problem-solving therapy. Psychotherapy can be for individuals or in a group, and it can include family therapy and couples therapy. Most people find that psychotherapy improves their depression within 10 to 15 sessions, but it can take much longer. 

ECT and Neuromodulatory therapy

If you’ve had severe depression, and it hasn’t improved with medication or psychotherapy, your doctor might suggest some type of brain stimulation therapy. These include electroconvulsive therapy (ECT), or repetitive transcranial magnetic stimulation (rTMS) or vagus nerve stimulation (VNS). 

ECT is not painful and it is actually quite safe. In fact, you often don’t feel anything. You could expect to get ECT two or three times a week, for up to 4 weeks. It may have some side effects, like memory issues, disorientation, and confusion, but they generally resolve quite quickly. 

Self-help and lifestyle changes

Lifestyle changes play a central and important part in the treatment of depression.  For instance, aerobic exercise alone can increase many of the neurotransmitters such as serotonin that are lacking in sufferers of depression. Stress reduction, relaxation techniques, adequate sleep, healthy diet, engaging in stimulating activities, and having a support network are critical in the treatment of depression.  

Home > Conditions > Depression
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Can Cannabis Help Depression?

by Emily Earlenbaugh, PhD

Listen

Overview

Research and anecdotal evidence provide hope that cannabis can be effective in helping patients cope with depression, especially less intoxicating varieties. Cannabis is widely used for its ability to elevate the mood, increase pleasurable sensations, both of which are effects that can help alleviate the symptoms of depression. It also interacts with the body’s endocannabinoid system, which plays an important role in regulating our moods. 

In terms of choosing the right type of cannabis to treat depression, preliminary research indicates that products with a chemical profile that includes CBD and CBG, and terpenes beta-caryophyllene, linalool and limonene are a good starting point.

Medical Research on Depression and Cannabis

While scientific research into the matter is still in its early stages, one can’t deny how popular cannabis is for the treatment of depression. Taking a closer look at the research can give a better understanding of how cannabis treatments might actually impact those with depression — both in the short and long term. 

  • A study published in 2018 found that cannabis users perceived a 50% reduction in depression symptoms, and only two puffs of cannabis smoke were needed to relieve depression. The study found that low-THC/high-CBD cannabis was best for reducing perceived symptoms.

  • A 2016 review of studies covering medical cannabis and mental health found nine studies on using cannabis for depression. Of these, seven showed that cannabis use led to improvements in depression symptoms. Still, the authors noted that these improvements were primarily seen in studies of patients with other medical conditions, so it’s unclear whether these improvements in depression might be related to improvements in other medical conditions.

  • A study published in 2019 surveyed 183 heterosexual couples that use cannabis and found that both men and women were more likely to use cannabis in the morning if they started the day in a worse mood. “Immediately after cannabis use, positive affect increased, and hostile and anxious affect decreased relative to that day’s morning levels,” the study found.

  • A 2002 UK survey of cannabis use found that among the medical cannabis users surveyed, 22% were using it to treat depression, close to the percentage that were using it to treat chronic pain (25%). Another study of medical cannabis patients from 2016 in Washington State found that half of the respondents reported using cannabis for depression. In general, these patients indicated that cannabis helps with their depressive symptoms.

That said, researchers have also found that cannabis use can cause depressive symptoms to worsen over time. One systematic review from 2013 found that “cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders.” In addition, a clinical study published in 2017 found that reducing cannabis use could result in fewer depression symptoms, and recommended that physicians “treating patients with co-occurring cannabis use and problems with anxiety, depression, or sleep quality, should attend to cannabis use reduction as a component of treatment.” 

But not all studies show this correlation. A large Swedish study found that the association between cannabis and depression disappeared when confounding factors were accounted for. An Israeli study found similar results, reporting that this association may be due more to sociodemographic and clinical factors than to cannabis use itself. 

In addition, research suggests that cannabis patients do better than those using opiods when it comes to depression. For those treating both depression and chronic pain, cannabis seems to be the option with fewer depressive side effects.

CBD and Depression 

Research has also shown that CBD products can be a particularly helpful treatment for depression, without the psychoactive effects of THC. 

A study published in 2018 looked at the depression-fighting effects of CBD in rodent subjects and found that a single dose could induce fast and sustained antidepressant-like effects. 

In 2014, a review of studies using animal models found that “CBD exhibited an antianxiety and antidepressant effects in animal models discussed.” That said, this could be related to the serotonin levels in the central nervous system, according to a study carried out using rodents in 2018. 

CBD has also shown promise as a treatment for sleep issues and anxiety, the alleviation of which can help patients better cope with depression.

How Cannabis Works on Depression 

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.

The endocannabinoid system is involved with mood regulation, and scientists believe that the cannabinoid receptors located primarily in the brain, called CB1 receptors, play a big role in the occurrence of depression. 

In addition, animal studies have noted that those with depression demonstrate an impairment in the functioning of the ECS. Studies on rodent subjects, for example, found that blocking activation of the CB1 receptor leads to increased depressive symptoms. 

Similar results have been found in human testing as well. Rimonabant, for example, is a drug that was marketed in Europe as an appetite suppressant. It works by blocking CB1 receptor activity — because those receptors are associated with hunger response, scientists hoped they could reduce appetite by blocking this receptor. Unfortunately, the drug had to be pulled from the market because many of the patients using it developed depressive and anxiety symptoms. Thus, blocking CB1 in both animals and humans seems to produce the same mood altering effect — increased depression. 

Researchers have also examined whether stimulating CB1 might produce antidepressant like properties. One study on rodent subjects found that low doses of a CB1-activating substance did increase antidepressant activity and serotonin responses in similar ranges to an SSRI antidepressant. However, the same study found that high doses had an opposite effect. The authors of this study say it confirms that CB1 should be a target for developing new antidepressants, and that cannabinoids from cannabis might be a helpful treatment. 

Still, given the complex, dose-dependant relationship between CB1 activation and depression, much more research is needed to confirm the theory that cannabis can help treat depression.

Using Cannabis for Your Depression 

Given the research above, there is a good chance that using cannabinoids to activate your endocannabinoid system can help to temporarily alleviate depression symptoms. High-CBD options may be particularly helpful for this, but both THC and CBD seem to offer short-term boosts in positivity and relief from depression symptoms. Still, it is important to note that research suggests these effects are dose dependent. Low doses of THC may improve depression while high doses may exacerbate it.

In addition, some research points to the possibility that long-term use of cannabis can lead to worsening symptoms of depression. While these results were inconsistent between studies, and may be related to other factors, rather than cannabis directly, it is too early to say with confidence that cannabis use won’t lead to these worsening depression symptoms. 

Still, if you have other medical conditions related to your depression, cannabis may be a better treatment option than alternatives. Chronic pain patients, for example, can expect to have better outcomes in terms of depression using cannabis rather than opiods. 

If you have depression and want to treat it with cannabis, the best first step is to consult a medical doctor with a specialization in cannabinoid medicine to find out if it is the right option for you.

Deciding which strain of marijuana to use can be more complicated than you may think, and can require some trial and error. If you do decide to use medical cannabis to treat depression, take some time to work out which cannabis strain works best for you.

One important factor when it comes to cannabis treatment is the chemical profile you choose. There are thousands of cannabis varieties, commonly referred to as strains, each with its own unique chemical profile. There is indeed a lack of research for specific types of cannabis and depression, but cannabis compounds that show particular potential for depression are the cannabinoids CBD and CBG, and the terpenes beta caryophyllene, limonene, and linalool. So looking for less intoxicating cannabis strains that have low or medium levels of THC, and high levels of these compounds would be a good place to start.  

Side Effects

While cannabis may be helpful, it does have some side effects which may be of particular interest to people coping with depression. In particular, THC has been known to trigger anxiety and paranoia in some users, which can aggravate depression. Cannabis can also cause temporary cognitive impairment, respiratory issues like chronic bronchitis, or cardiovascular issues like temporarily increased heart rate and blood pressure.

In addition, cannabis can be habit forming, and patients must make sure to use it responsibly.

Cannabis Side Effects

About Depression

Overview

Clinical depression, also called Major Depressive Disorder, is a common and disabling condition that affects how you feel, the way you think, and how you act and practically every other aspect of your life.  

Many people think that depression is another word for feeling sad or low, but clinical depression goes beyond mere sadness. It’s important to know that depression isn’t something that you can just “snap out of” or cure just by wanting to hard enough, although it can be treated. 

There are several different types of clinical depression:

  • Persistent depressive disorder, or dysthymia, is a type of depression that lasts for more than two years, although sometimes you might feel that your symptoms are less severe. 
  • Postpartum depression (PPD) is a major depressive attack experienced by women after giving birth. People with PPD feel far more sad, anxious, and exhausted than women with regular “baby blues,” and unlike the “baby blues,” PPD may not clear up on its own.
  • Psychotic depression is a form of depression that comes together with psychotic symptoms like delusions or hallucinations. 
  • Seasonal affective disorder (SAD) is a type of depression that affects you only during part of the year. Most people with SAD only feel symptoms in the winter, due to a lack of sunlight. 

It’s estimated that more than 250 million people around the world suffer from depression, and that 1 out of every 6 people will have a depressive episode at some point in their lives. Generally, most people who feel depressed have their first experience of depression some time between their late teens and their mid-20s. 

Anyone can experience depression, but it affects women more than men. According to some studies, 1 out of every 3 women will feel depression at some point. 

Symptoms

When you have depression, you’ll feel some or all of these symptoms every day, and for most of the day. It’s important to know that a person who has depression can have several episodes of depression. During an episode of depression, you’ll feel more severe symptoms, but in between episodes, the symptoms may still be present though milder or barely noticeable.

Symptoms of depression can include:

  • Feeling sad and tearful
  • Feeling anxious and restless
  • Feeling empty, worthless, and without hope
  • Irritability and getting angry over small things
  • No longer taking pleasure in the things you used to enjoy
  • Moving, talking, and thinking more slowly than usual
  • Sleep issues, whether it’s sleeping too much or having trouble sleeping
  • Tiredness and lack of energy, even when you’ve been sleeping a lot
  • Weight loss and a lack of appetite
  • Having trouble concentrating, focusing on your work, or making decisions
  • Memory problems 
  • Thinking about death or suicide, or a suicide attempt

You might also feel physical symptoms when you have depression, like joint pain, back pain, and digestive issues. 

Note: Depression is not the same as the grief you feel after a bereavement, losing your job, or ending a relationship, even though people might say that they feel depressed. If you’re feeling grief, your sadness and painful feelings generally come in waves, mixed together with happy memories and positive thoughts. With grief, you also don’t usually feel a lack of self-esteem, which tends to accompany depression. 

However, grief can trigger and overlap with depression, which makes it important to pay attention to your symptoms and to go to the doctor if you or someone you’re close to feels that your sadness is leading to depression. 

Children and teenagers could show slightly different symptoms, including:

  • Refusing to go to school and/or performing badly at school
  • Losing or not gaining weight
  • Being irritable, clingy, and anxious
  • Complaining of general aches and pains
  • Eating or sleeping too much or not enough 
  • Drug or alcohol abuse
  • Self-harm
  • Avoiding socializing and other normal activities

Depression is often missed in older adults because the symptoms can be less obvious. Symptoms of depression in elderly people include:

  • Personality changes
  • Difficulty remembering things
  • Excessive tiredness
  • Loss of appetite
  • Insomnia and generally having trouble sleeping
  • Losing interest in sex
  • Becoming reclusive and avoiding socializing or going out of the house
  • Suicidal thoughts

When to see a doctor

Feeling sad and low is a normal part of life, so it can be difficult to know when to see a doctor. What’s more, someone with depression might not realize that their feelings of sadness, anger, or low self-worth aren’t reasonable, making it important for friends and family to pick up on these symptoms. Generally, you should go to the doctor if you feel at least 5 of the symptoms listed above, and they last for 2 weeks or more. If you feel the urge to commit suicide, you should seek help immediately.

Diagnosis

To diagnose depression, your doctor will generally talk to you about your symptoms, and carry out tests to rule out any other causes or underlying physical issues. You can expect to undergo:

  • A physical examination, to check that you don’t have any underlying physical problem
  • Blood tests, to check for other conditions that may also present with similar symptoms such as thyroid issues, or vitamin deficiencies. 

Assessments—questionnaires that may check if you are experiencing symptoms as per above that may indicate depression or anxiety.

Causes

It’s almost impossible to pinpoint specific causes of depression. It can affect anyone and at any time, but there are certain risk factors that make it more likely that you’ll experience it. 

  • Biochemistry and other biological differences. Research has discovered that people who have depression have differences in the chemicals in the brain that are in control of your mood. 
  • Genetics and heredity. Depression tends to run in the family. If you have a family member(s) who have had depression, alcoholism, bipolar disorder, or have a history of suicide attempts, you’re more likely to experience depression yourself. 
  • Hormones. Changes in your hormones, like those felt after giving birth, after menopause, or due to thyroid issues, can bring on an episode of depression.
  • Personality. People who are pessimistic, have trouble coping with stress, have low self-esteem, and/or are highly dependent or self-critical are more likely to become depressed. 
  • Environment. People who live with violence, abuse, neglect, or in severe poverty are more likely to develop depression.
  • Trauma. Traumatic incidents like a bereavement, abuse, losing your job, or serious financial troubles can trigger depression.
  • A separate mental health disorder. This includes eating disorders, anxiety disorders, or post-traumatic stress disorder (PTSD).
  • Some medications. Medications like blood pressure pills and sleeping pills, can sometimes cause depression. 
  • Alcohol and drug abuse. People who abuse alcohol and drugs frequently also suffer from depression.
  • Serious chronic illness. Cancer, heart disease, chronic pain, or strokes can lead to depression.
  • Struggling with being lesbian, gay, bi-sexual, transgender, or intersex. Lack of support and compassion can lead members of the LGBTQ community to depression.

Treatment

The good news is that depression is one of the most treatable mental health disorders. Some 80-90% of people with depression respond well to treatment, and almost everyone feels some level of relief from their symptoms. Treatment for depression includes medication, psychotherapy and brain stimulation therapies, and self-help through lifestyle changes. 

Medication

Generally, your doctor will prescribe you antidepressants. There are a few different types of antidepressants, including SSRIs like Prozac, SNRIs like Cymbalta, and other medications like Wellbutrin. These medications have fewer side effects, so they are the first ones that your doctor will suggest. 

If these medications don’t work, your doctor may prescribe atypical antipsychotics like Abilify, tricyclic antidepressants like Elavil or Norpramin, or monoamine oxidase inhibitors (MAOIs) like Nardil or Marplan. These medications have more serious side effects, and some MAOIs can even be fatal if you eat certain foods or combine them with certain other medicines. 

It takes time for antidepressants to work, usually between 3 and 6 weeks, and only at the right dose, so it’s important to give them enough time to work. You’ll typically find that symptoms like sleep and appetite issues and difficulty concentrating improve before your mood does. 

Once you’ve found a medication that works for you, it’s best to continue taking it even after your symptoms have improved, like another 6 or 12 months. You should never abruptly stop taking antidepressants, since that can cause serious withdrawal issues. Instead, you need to slowly decrease the dose with the advice of your doctor.

Herbal medicines and supplements 

Some herbal medicines and supplements, like St John’s Wort, omega-3 fatty acids, and S-adenosylmethionine (SAMe) have become popular for treating depression. Although some people find that they’re effective, they haven’t been approved for treatment by the FDA, so it’s important to be very careful when taking them, and to always consult your doctor. St John’s Wort, in particular, can interact badly with certain medications. 

Psychotherapy 

Psychotherapy, or talk therapy, can be effective against depression, either on its own or together with medication. There are a few psychotherapies used for depression, including cognitive behavioral therapy (CBT), interpersonal therapy, and problem-solving therapy. Psychotherapy can be for individuals or in a group, and it can include family therapy and couples therapy. Most people find that psychotherapy improves their depression within 10 to 15 sessions, but it can take much longer. 

ECT and Neuromodulatory therapy

If you’ve had severe depression, and it hasn’t improved with medication or psychotherapy, your doctor might suggest some type of brain stimulation therapy. These include electroconvulsive therapy (ECT), or repetitive transcranial magnetic stimulation (rTMS) or vagus nerve stimulation (VNS). 

ECT is not painful and it is actually quite safe. In fact, you often don’t feel anything. You could expect to get ECT two or three times a week, for up to 4 weeks. It may have some side effects, like memory issues, disorientation, and confusion, but they generally resolve quite quickly. 

Self-help and lifestyle changes

Lifestyle changes play a central and important part in the treatment of depression.  For instance, aerobic exercise alone can increase many of the neurotransmitters such as serotonin that are lacking in sufferers of depression. Stress reduction, relaxation techniques, adequate sleep, healthy diet, engaging in stimulating activities, and having a support network are critical in the treatment of depression.  

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