US Pharm. 2021;46(5):15.

Pervasive, With Wide-Ranging Symptoms

Persistent low mood, low energy, and loss of interest in activities and hobbies—these are the hallmark symptoms of depression—a significant and growing public health issue. It is estimated that as many as one in five individuals in the United States will experience a major depressive disorder in their lifetime. Depression is associated with a wide range of psychological, emotional, and even physical symptoms. If left unmanaged, it may cause problems at work and in relationships with others. At its most extreme, depression can lead to suicide—the 10th leading cause of death in the U.S. 

Women at Highest Risk

Depression can occur at any age. It most commonly presents in adults in their 20s and their 50s. A combination of factors increases the risk of developing depression, including genetics, gender, environment, illness, and adverse life events. Women are twice as likely as men to develop depression. The exact pathophysiology of depression is mostly unknown. Still, it is generally accepted that disruptions in the brain’s neurochemistry are at least partly to blame.

Numerous medical conditions can cause or mimic depression symptoms. Neurologic disorders such as epilepsy, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, cerebrovascular disease, and traumatic brain injury have strong associations with depression or depression-like symptoms. Other associated conditions include human immunodeficiency virus  or AIDS, neurosyphilis, cardiomyopathy, ischemic heart disease, heart failure, hypothyroidism, diabetes mellitus, vitamin deficiencies, parathyroid disorders, irritable bowel syndrome, collagen vascular diseases, and chronic liver disorders. For this reason, it is essential that underlying medical conditions be identified and treated first.

Beyond Feeling Sad or Down

To be diagnosed with depression, symptoms must be present for at least 2 weeks, with a clear change from the previous level of functioning. Diagnostic symptoms of depression include the following: persistent sad, anxious, or “empty” mood; feelings of hopelessness or pessimism; irritability; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in hobbies and activities; decreased energy or fatigue; moving or talking more slowly; feeling restless or having trouble sitting still; difficulty concentrating, remembering, or making decisions; difficulty sleeping, early-morning awakening, or oversleeping; appetite and/or weight changes; thoughts of death or suicide, or suicide attempts; and aches or pains, headaches, cramps, or digestive problems without a clear physical cause.

The symptoms of depression may appear differently in men and women. Women with depression are more likely to report physical ailments such as headaches, generalized pain, or gastrointestinal problems. They are also more likely to experience emotional effects such as stress and crying easily. Men with depression are more likely to report aggression, anger, substance-use disorder, and risky behavior.

Depression Is Treatable

Depression is considered one of the more treatable mental disorders. Successful treatment depends on early detection and management. Universal screening for depression in adult patients by their primary care physician is currently recommended by the U.S. Preventive Services Task Force.

Once depression has been diagnosed, physicians choose from several different treatment modalities depending on the severity of symptoms, the duration of symptoms, and the risk of side effects from treatment. Combinations of psychotherapy and drug therapy are used to manage most individuals with major depressive disorder. Antidepressants are the medications used to treat depression. They work by balancing the neurochemicals in the brain that influence mood and emotions.

The goal of therapy with antidepressants should be to minimize adverse effects while improving symptoms. Medication is usually started at a low dose, with gradual increases in dose every 2 to 4 weeks depending on response and side effects.

If you or someone you know is feeling suicidal, seek emergency help immediately by calling 911 or the National Suicide Prevention Lifeline at 800-273-8255.