U.S. DepartMeNt of HealtH & HUMaN ServIceS

National Institutes of Health 

NIH publication No. 08-3561

revised 2008
Contents 

What is depression? 2 

What are the different forms of depression? 3 

What are the symptoms of depression? 4 

What illnesses often co-exist with depression? 5 

What causes depression? 6 

How do women experience depression? 7 

How do men experience depression? 7 

How do older adults experience depression? 8 

How do children and adolescents experience depression? 9 

How is depression detected and treated? 10 

How can I help a friend or relative who is depressed? 18 

How can I help myself if I am depressed? 19 

Where can I go for help? 20 

What if I or someone I know is in crisis? 21 

Citations 22 
What Is Depression? 

Everyone occasionally feels blue or sad, but these feelings 

are usually fleeting and pass within a couple of days.When 

a person has a depressive disorder, it interferes with daily 

life, normal functioning, and causes pain for both the person 

with the disorder and those who care about him or her. 

Depression is a common but serious illness, and most who 

experience it need treatment to get better. 

Many people with a depressive illness never seek treatment. But the vast majority, even those with the most 

severe depression, can get better with treatment. Intensive 

research into the illness has resulted in the development of 

medications, psychotherapies, and other methods to treat 

people with this disabling disorder. 

Depression is a common but serious illness. 

Most who experience depression 

 need treatment to get better. 

2 

Depression 

National Institute of Mental Health 
What are the different forms of depression? 

There are several forms of depressive disorders. The most 

common are major depressive disorder and dysthymic 

disorder. 

Major depressive disorder, also called major depression, 

is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and 

enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. 

An episode of major depression may occur only once in 

a person’s lifetime, but more often, it recurs throughout a 

person’s life. 

Dysthymic disorder, also called dysthymia, is characterized by long-term (two years or longer) but less severe 

symptoms that may not disable a person but can prevent 

one from functioning normally or feeling well. People with 

dysthymia may also experience one or more episodes of 

major depression during their lifetimes. 

Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may 

develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms 

of depression. They include: 

Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such 

as a break with reality, hallucinations, and delusions. 

Postpartum depression, which is diagnosed if a new mother 

develops a major depressive episode within one month after 

delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.1 

Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter 

months, when there is less natural sunlight. The depression 

generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with 

SAD do not respond to light therapy alone. Antidepressant 

medication and psychotherapy can reduce SAD symptoms, 

either alone or in combination with light therapy.2 

Bipolar disorder, also 

called manic-depressive 

illness, is not as common 

as major depression 

or dysthymia. Bipolar 

disorder is characterized by cycling mood 

changes—from extreme 

highs (e.g., mania) to 

extreme lows (e.g., 

depression). More information about bipolar 

disorder is available at 

http://www.nimh.nih. 

gov/healthinformation/ 

bipolarmenu.cfm. 

3 
4 

What are the symptoms of depression? 

People with depressive illnesses do not all experience the 

same symptoms.The severity, frequency and duration of 

symptoms will vary depending on the individual and his or 

her particular illness. 

symptoms 

Persistent sad, anxious or “empty” feelings 

Feelings of hopelessness and/or pessimism 

Feelings of guilt, worthlessness and/or helplessness 

Irritability, restlessness 

Loss of interest in activities or hobbies once 

pleasurable, including sex
 

Fatigue and decreased energy
 

Difficulty concentrating, remembering details 


and making decisions 

Insomnia, early-morning wakefulness, 

or excessive sleeping 

Overeating, or appetite loss 

Thoughts of suicide, suicide attempts 

Persistent aches or pains, headaches, cramps 

or digestive problems that do not ease even
 

with treatment
 

Depression 

National Institute of Mental Health 
What illnesses often co-exist with depression? 

Depression often co-exists with other illnesses. Such illnesses may precede the depression, cause it, and/or be a 

consequence of it. It is likely that the mechanics behind 

the intersection of depression and other illnesses differ 

for every person and situation. Regardless, these other cooccurring illnesses need to be diagnosed and treated. 

Anxiety disorders, such as post-traumatic stress disorder 

(PTSD), obsessive-compulsive disorder, panic disorder, 

social phobia and generalized anxiety disorder, often 

accompany depression.3,4 People experiencing PTSD are 

especially prone to having co-occurring depression. PTSD is 

a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a 

natural disaster, an accident, terrorism or military combat. 

People with PTSD often re-live the traumatic event in flashbacks, memories or nightmares. Other symptoms include 

irritability, anger outbursts, intense guilt, and avoidance of 

thinking or talking about the traumatic ordeal. In a National 

Institute of Mental Health (NIMH)-funded study, researchers 

found that more than 40 percent of people with PTSD also 

had depression at one-month and four-month intervals after 

the traumatic event.5 

Alcohol and other substance abuse or dependence may also 

co-occur with depression. In fact, research has indicated that 

the co-existence of mood disorders and substance abuse is 

pervasive among the U.S. population.6 

Depression also often co-exists with other serious medical 

illnesses such as heart disease, stroke, cancer, hiv/AiDS, 

diabetes, and Parkinson’s disease. Studies have shown that 

people who have depression in addition to another serious 

medical illness tend to have more severe symptoms of both 

depression and the medical illness, more difficulty adapting 

to their medical condition, and more medical costs than those 

who do not have co-existing depression.7 Research has yielded 

increasing evidence that treating the depression can also help 

improve the outcome of treating the co-occurring illness.8 

5 
What causes depression? 

There is no single known cause of depression. Rather, it 

likely results from a combination of genetic, biochemical, 

environmental, and psychological factors. 

Research indicates that depressive illnesses are disorders 

of the brain. Brain-imaging technologies, such as magnetic 

resonance imaging (MRI), have shown that the brains of 

people who have depression look different than those of 

people without depression.The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important 

neurotransmitters—chemicals that brain cells use to communicate—appear to be out of balance. But these images 

do not reveal why the depression has occurred. 

Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people 

without family histories of depression as well.9 Genetics 

research indicates that risk for depression results from the 

influence of multiple genes acting together with environmental or other factors.10 

In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive 

episode. Subsequent depressive episodes may occur with 

or without an obvious trigger. 

Research indicates that depressive illnesses 

are disorders of the brain. 

6 

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How do women experience depression? 

Depression is more common among women than among men. 

Biological, life cycle, hormonal and psychosocial factors unique 

to women may be linked to women’s higher depression rate. 

Researchers have shown that hormones directly affect brain chemistry that controls emotions and mood. For example, women are 

particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of 

caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the “baby blues,” but some will 

develop postpartum depression, a much more serious condition 

that requires active treatment and emotional support for the new 

mother. Some studies suggest that women who experience postpartum depression often have had prior depressive episodes. 

Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric 

disorder (PMDD), a condition resulting from the hormonal changes 

that typically occur around ovulation and before menstruation 

begins. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how 

the cyclical rise and fall of estrogen and other hormones may affect 

the brain chemistry that is associated with depressive illness.11 

Finally, many women face the additional stresses of work and home 

responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women 

faced with enormous challenges develop depression, while others 

with similar challenges do not. 

How do men experience depression? 

Men often experience depression differently than women and may 

have different ways of coping with the symptoms. Men are more 

likely to acknowledge having fatigue, irritability, loss of interest 

in once-pleasurable activities, and sleep disturbances, whereas 

women are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt.12,13 

Men are more likely than women to turn to alcohol or drugs when 

they are depressed, or become frustrated, discouraged, irritable, 

angry and sometimes abusive. Some men throw themselves into 

their work to avoid talking about their depression with family or 

friends, or engage in reckless, risky behavior. And even though 

more women attempt suicide, many more men die by suicide in 

the United States.14 

7 
How do older adults experience depression? 

Depression is not a normal part of aging, and studies show that 

most seniors feel satisfied with their lives, despite increased 

physical ailments. However, when older adults do have depression, it may be overlooked because seniors may show different, 

less obvious symptoms, and may be less inclined to experience 

or acknowledge feelings of sadness or grief.15 

In addition, older adults may have more medical conditions 

such as heart disease, stroke or cancer, which may cause 

depressive symptoms, or they may be taking medications with 

side effects that contribute to depression. Some older adults 

may experience what some doctors call vascular depression, 

also called arteriosclerotic depression or subcortical ischemic 

depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming 

constricted. Such hardening of vessels prevents normal blood 

flow to the body’s organs, including the brain. Those with 

vascular depression may have, or be at risk for, a co-existing 

cardiovascular illness or stroke.16 

Although many people assume that the highest rates of suicide are among the young, older white males age 85 and older 

actually have the highest suicide rate. Many have a depressive illness that their doctors may not detect, despite the fact 

that these suicide victims often visit their doctors within one 

month of their deaths.17 

The majority of older adults with depression improve when 

they receive treatment with an antidepressant, psychotherapy, 

or a combination of both.18 Research has shown that medication alone and combination treatment are both effective in 

reducing the rate of depressive recurrences in older adults.19 

Psychotherapy alone also can be effective in prolonging periods free of depression, especially for older adults with minor 

depression, and it is particularly useful for those who are 

unable or unwilling to take antidepressant medication.20, 21 

Depression is not a normal part of aging. 

8 

Depression 

National Institute of Mental Health 
How do children and adolescents experience depression? 

Scientists and doctors have begun to take seriously the risk of 

depression in children. Research has shown that childhood 

depression often persists, recurs and continues into adulthood, especially if it goes untreated. The presence of childhood depression also tends to be a predictor of more severe 

illnesses in adulthood.22 

A child with depression may pretend to be sick, refuse to go 

to school, cling to a parent, or worry that a parent may die. 

Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs 

may be viewed as normal mood swings typical of children as 

they move through developmental stages, it may be difficult 

to accurately diagnose a young person with depression. 

Before puberty, boys and girls are equally likely to develop 

depressive disorders. By age 15, however, girls are twice as likely 

as boys to have experienced a major depressive episode.23 

Depression in adolescence comes at a time of great personal 

change—when boys and girls are forming an identity distinct 

from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their 

lives. Depression in adolescence frequently co-occurs with 

other disorders such as anxiety, disruptive behavior, eating 

disorders or substance abuse. It can also lead to increased 

risk for suicide.22,24 

An NIMH-funded clinical trial of 439 adolescents with major 

depression found that a combination of medication and psychotherapy was the most effective treatment option.25 Other 

NIMH-funded researchers are developing and testing ways to 

prevent suicide in children and adolescents, including early 

diagnosis and treatment, and a better understanding of suicidal thinking. 

Childhood depression often persists, recurs, and continues 

into adulthood, especially if left untreated. 

9 
How is depression detected and treated? 

Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the 

likelihood that recurrence can be prevented. 

The first step to getting appropriate treatment is to visit a 

doctor. Certain medications, and some medical conditions 

such as viruses or a thyroid disorder, can cause the same 

symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination,interview and 

lab tests. If the doctor can eliminate a medical condition as a 

cause, he or she should conduct a psychological evaluation 

or refer the patient to a mental health professional. 

The doctor or mental health professional will conduct a 

complete diagnostic evaluation. He or she should discuss 

any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they 

have lasted, their severity, and whether they have occurred 

before and if so, how they were treated. He or she should 

also ask if the patient is using alcohol or drugs, and whether 

the patient is thinking about death or suicide. 

Once diagnosed, a person with depression can be treated 

with a number of methods. The most common treatments 

are medication and psychotherapy. 

10 

Depression 

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Medication 

Antidepressants work to normalize naturally occurring 

brain chemicals called neurotransmitters, notably serotonin 

and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have 

found that these particular chemicals are involved in regu­

lating mood, but they are unsure of the exact ways in which 

they work. 

The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRis). SSRIs include fluoxetine (Prozac), citalopram 

(Celexa), sertraline (Zoloft) and several others. Serotonin 

and norepinephrine reuptake inhibitors (SNRIs) are similar 

to SSRIs and include venlafaxine (Effexor) and duloxetine 

(Cymbalta). SSRIs and SNRIs are more popular than the 

older classes of antidepressants, such as tricyclics—named for 

their chemical structure—and monoamine oxidase inhibitors 

(MAOIs) because they tend to have fewer side effects. How­

ever, medications affect everyone differently—no one-sizefits-all approach to medication exists. Therefore, for some 

people, tricyclics or MAOIs may be the best choice. 

People taking MAOIs must adhere to significant food and medicinal restrictions to avoid potentially serious interactions. 

They must avoid certain foods that contain high levels of the 

chemical tyramine, which is found in many cheeses, wines 

and pickles, and some medications including decongestants. 

MAOIs interact with tyramine in such a way that may cause a 

sharp increase in blood pressure, which could lead to a stroke. 

A doctor should give a patient taking an MAOI a complete list 

of prohibited foods, medicines and substances. 

For all classes of antidepressants, patients must take regu­

lar doses for at least three to four weeks before they are 

likely to experience a full therapeutic effect. They should 

continue taking the medication for the time specified by their 

doctor, even if they are feeling better, in order to prevent a 

relapse of the depression. Medication should be stopped only 

under a doctor’s supervision. Some medications need to be 

gradually stopped to give the body time to adjust. Although 

antidepressants are not habit-forming or addictive, abruptly 

ending an antidepressant can cause withdrawal symptoms 

or lead to a relapse. Some individuals, such as those with 

chronic or recurrent depression, may need to stay on the 

medication indefinitely. 11 
In addition, if one medication does not work, patients should 

be open to trying another. NIMH-funded research has shown 

that patients who did not get well after taking a first medication increased their chances of becoming symptom-free after 

they switched to a different medication or added another 

medication to their existing one.26,27 

Sometimes stimulants, anti-anxiety medications, or other 

medications are used in conjunction with an antidepressant, 

especially if the patient has a co-existing mental or physical 

disorder. However, neither anti-anxiety medications nor stimulants are effective against depression when taken alone, and 

both should be taken only under a doctor’s close supervision. 

What are the side effects of antidepressants? 

Antidepressants may cause mild and often temporary side 

effects in some people, but they are usually not long-term. 

However, any unusual reactions or side effects that interfere with normal functioning should be reported to a 

doctor immediately. 

12 

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sIde effects 

The most common side effects associated with 

SSRIs and SNRIs include: 

Headache—usually temporary and will subside. 

Nausea—temporary and usually short-lived. 

Insomnia and nervousness (trouble falling asleep 

or waking often during the night)—may occur during 

the first few weeks but often subside over time or if 

the dose is reduced. 

Agitation (feeling jittery). 

Sexual problems—both men and women can experience sexual problems including reduced sex drive, 

erectile dysfunction, delayed ejaculation, or inability to 

have an orgasm. 

Tricyclic antidepressants also can cause side effects 

including: 

Dry mouth—it is helpful to drink plenty of water, 

chew gum, and clean teeth daily. 

Constipation—it is helpful to eat more bran cereals, 

prunes, fruits, and vegetables. 

Bladder problems—emptying the bladder may be 

difficult, and the urine stream may not be as strong 

as usual. Older men with enlarged prostate conditions 

may be more affected. The doctor should be notified if 

it is painful to urinate. 

Sexual problems—sexual functioning may change, 

and side effects are similar to those from SSRIs. 

Blurred vision—often passes soon and usually will not 

require a new corrective lenses prescription. 

Drowsiness during the day—usually passes soon, 

but driving or operating heavy machinery should be 

avoided while drowsiness occurs. The more sedating 

antidepressants are generally taken at bedtime to 

help sleep and minimize daytime drowsiness. 

Report any 

unusual side 

effects to 

a doctor 

immediately. 

13 
FDA Warning on Antidepressants 

Despite the relative safety and popularity of SSRIs and 

other antidepressants, some studies have suggested that 

they may have unintentional effects on some people, 

especially adolescents and young adults. In 2004, the Food 

and Drug Administration (FDA) conducted a thorough 

review of published and unpublished controlled clinical 

trials of antidepressants that involved nearly 4,400 children 

and adolescents. The review revealed that 4% of those 

taking antidepressants thought about or attempted suicide 

(although no suicides occurred), compared to 2% of those 

receiving placebos. 

This information prompted the FDA, in 2005, to adopt a 

“black box” warning label on all antidepressant medications 

to alert the public about the potential increased risk of 

suicidal thinking or attempts in children and adolescents 

taking antidepressants. In 2007, the FDA proposed that 

makers of all antidepressant medications extend the warning 

to include young adults up through age 24. A “black box” 

warning is the most serious type of warning on prescription 

drug labeling. 

The warning emphasizes that patients of all ages taking 

antidepressants should be closely monitored, especially 

during the initial weeks of treatment. Possible side effects 

to look for are worsening depression, suicidal thinking 

or behavior, or any unusual changes in behavior such as 

sleeplessness, agitation, or withdrawal from normal social 

situations. The warning adds that families and caregivers 

should also be told of the need for close monitoring 

and report any changes to the physician. The latest 

information from the FDA can be found on their Web site 

at www.fda.gov. 

Children, adolescents and 

young adults taking antidepressants 

should be closely monitored. 

14 

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Results of a comprehensive review of pediatric trials 

conducted between 1988 and 2006 suggested that the 

benefits of antidepressant medications likely outweigh their 

risks to children and adolescents with major depression and 

anxiety disorders.28 The study was funded in part by the 

National Institute of Mental Health. 

Also, the FDA issued a warning that combining an SSRI 

or SNRI antidepressant with one of the commonly-used 

“triptan” medications for migraine headache could cause a 

life-threatening “serotonin syndrome,” marked by agitation, 

hallucinations, elevated body temperature, and rapid changes 

in blood pressure. Although most dramatic in the case of the 

MAOIs, newer antidepressants may also be associated with 

potentially dangerous interactions with other medications. 

What about St. John’s wort? 

The extract from St. John’s wort (Hypericum perforatum), 

a bushy, wild-growing plant with yellow flowers, has been 

used for centuries in many folk and herbal remedies. Today 

in Europe, it is used extensively to treat mild to moderate 

depression. In the United States, it is one of the top-selling 

botanical products. 

To address increasing American interests in St. John’s wort, the National Institutes of Health conducted a clinical trial to 

determine the effectiveness of the herb in treating adults who 

have major depression. Involving 340 patients diagnosed with 

major depression, the eight-week trial randomly assigned 

one-third of them to a uniform dose of St. John’s wort, onethird to a commonly prescribed SSRI, and one-third to a 

placebo. The trial found that St. John’s wort was no more 

effective than the placebo in treating major depression.29 

Another study is looking at the effectiveness of St. John’s wort 

for treating mild or minor depression. 

Other research has shown that St. John’s wort can interact 

unfavorably with other medications, including those used 

to control HIV infection. On February 10, 2000, the FDA 

issued a Public Health Advisory letter stating that the herb 

appears to interfere with certain medications used to treat 

heart disease, depression, seizures, certain cancers, and organ 

transplant rejection. The herb also may interfere with the 

effectiveness of oral contraceptives. Because of these potential 

interactions, patients should always consult with their doctors 

before taking any herbal supplement. 15 
Psychotherapy 

Several types of psychotherapy—or “talk therapy”—can help 

people with depression. 

Some regimens are short-term (10 to 20 weeks) and other 

regimens are longer-term, depending on the needs of the individual. Two main types of psychotherapies—cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)—have 

been shown to be effective in treating depression. By teaching 

new ways of thinking and behaving, CBT helps people change 

negative styles of thinking and behaving that may contribute 

to their depression. IPT helps people understand and work 

through troubled personal relationships that may cause their 

depression or make it worse. 

For mild to moderate depression, psychotherapy may be the 

best treatment option. However, for major depression or for 

certain people, psychotherapy may not be enough. Studies 

have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach 

to treating major depression and reducing the likelihood for 

recurrence.25 Similarly, a study examining depression treatment among older adults found that patients who responded 

to initial treatment of medication and IPT were less likely to 

have recurring depression if they continued their combination treatment for at least two years.21 

Electroconvulsive Therapy 

For cases in which medication and/or psychotherapy does 

not help alleviate a person’s treatment-resistant depression, 

electroconvulsive therapy (ECT) may be useful. ECT, formerly known as “shock therapy,” once had a bad reputation. 

But in recent years, it has greatly improved and can provide 

relief for people with severe depression who have not been 

able to feel better with other treatments. 

16 

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Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not 

consciously feel the electrical impulse administered in ECT. 

A patient typically will undergo ECT several times a week, 

and often will need to take an antidepressant or mood stabilizing medication to supplement the ECT treatments and 

prevent relapse. Although some patients will need only a 

few courses of ECT, others may need maintenance ECT, 

usually once a week at first, then gradually decreasing to 

monthly treatments for up to one year. 

ECT may cause some short-term side effects, including 

confusion, disorientation and memory loss. But these side 

effects typically clear soon after treatment. Research has 

indicated that after one year of ECT treatments, patients 

showed no adverse cognitive effects.30 

What efforts are underway to improve treatment? 

Researchers are looking for ways to better understand, 

diagnose and treat depression among all groups of people. 

New potential treatments are being tested that give hope to 

those who live with depression that is particularly difficult 

to treat, and researchers are studying the risk factors for 

depression and how it affects the brain. NIMH continues to 

fund cutting-edge research into this debilitating disorder. 

For more information on NIMH-funded research on 

depression, visit http://www.nimh.nih.gov. 

The National Institute of Mental Health 

funds cutting-edge research 

into this debilitating disorder. 

17 
How can I help a friend or relative 

who is depressed? 

If you know someone who is depressed, it affects you too. 

The first and most important thing you can do to help a 

friend or relative who has depression is to help him or her 

get an appropriate diagnosis and treatment. You may need 

to make an appointment on behalf of your friend or relative 

and go with him or her to see the doctor. Encourage him or 

her to stay in treatment, or to seek different treatment if no 

improvement occurs after six to eight weeks. 

help a frIend or relatIve 

Offer emotional support, understanding, patience 

and encouragement. 

Engage your friend or relative in conversation, and 

listen carefully. 

Never disparage feelings your friend or relative 

expresses, but point out realities and offer hope. 

Never ignore comments about suicide, and report 

them to your friend’s or relative’s therapist or doctor. 

Invite your friend or relative out for walks, outings and 

other activities. Keep trying if he or she declines, but 

don’t push him or her to take on too much too soon. 

Although diversions and company are needed, too 

many demands may increase feelings of failure. 

Remind your friend or relative that with time and 

treatment, the depression will lift. 

18 

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How can I help myself if I am depressed? 

If you have depression,you may feel exhausted,helpless and 

hopeless. It may be extremely difficult to take any action 

to help yourself. But it is important to realize that these 

feelings are part of the depression and do not accurately 

reflect actual circumstances. As you begin to recognize your 

depression and begin treatment, negative thinking will fade. 

help yourself 

Engage in mild activity or exercise. Go to a movie, a ballgame, 

or another event or activity that you once enjoyed. Participate 

in religious, social or other activities. 

Set realistic goals for yourself. 

Break up large tasks into small ones, set some priorities 


and do what you can as you can.
 

Try to spend time with other people and confide in a trusted friend 

or relative.Try not to isolate yourself, and let others help you. 

Expect your mood to improve gradually, not immediately.
 

Do not expect to suddenly “snap out of ” your depression.
 

Often during treatment for depression, sleep and appetite 


will begin to improve before your depressed mood lifts.
 

Postpone important decisions, such as getting married 

or divorced or changing jobs, until you feel better. Discuss 

decisions with others who know you well and have a more 

objective view of your situation. 

Remember that positive thinking will replace negative thoughts 

as your depression responds to treatment. 

19 
Where can I go for help? 

If you are unsure where to go for help, ask your family 

doctor. Others who can help are listed below. 

mental health resources 

Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors 

Health maintenance organizations 

Community mental health centers 

Hospital psychiatry departments and outpatient clinics 

Mental health programs at universities 

or medical schools 

State hospital outpatient clinics 

Family services, social agencies or clergy 

Peer support groups 

Private clinics and facilities 

Employee assistance programs 

Local medical and/or psychiatric societies 

You can also check the phone book under “mental health,” 

“health,” “social services,” “hotlines,” or “physicians” for 

phone numbers and addresses. An emergency room 

doctor also can provide temporary help and can tell you 

where and how to get further help. 

20 

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What if I or someone I know is in crisis? 

21 

If you are thinking about harming yourself, 

or know someone who is, tell someone who 

can help immediately. 

Call your doctor. 

Call 911 or go to a hospital emergency room 

to get immediate help or ask a friend or 

family member to help you do these things. 

Call the toll-free, 24-hour hotline of the 

National Suicide Prevention Lifeline at 

1 800-273-TALK (1 800-273-8255); 

TTY: 1 800 799 4TTY (4889) 

to talk to a trained counselor. 

Make sure you or the suicidal person is not 

left alone. 
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3.	 Regier DA, Rae DS, Narrow WE, Kaebler 

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disorders and their comorbidity with mood 

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of Psychiatry, 1998; 155(5): 630-637. 

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23 
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Depression 

National Institute of Mental Health 
U.S. DepartMeNt of HealtH & HUMaN ServIceS 

National Institutes of Health 

NIH publication No. 08 3561 

revised 2008