Major Depression: Seriously Down in the Dumps

If you feel sad or down for most of the day, nearly every day, or you stop getting pleasure from your usual activities, and this has been going on for at least 2 weeks, you may have major depression.

Other symptoms can include:

  • changes in eating or sleeping habits
  • lack of energy
  • feelings of worthlessness or excessive guilt
  • agitation
  • trouble concentrating or making decisions
  • feeling empty or irritable
  • thinking about your own death or suicide

To be considered "major depression" five or more of these symptoms must be present; with fewer, it may be considered "subclinical depression." "Once you've had one episode of major depression, there's a 50 percent chance it'll happen again," says Carol Landau, Ph.D., a clinical professor of psychiatry and medicine at the Alpert Medical School, Brown University.

Talk therapy—such as cognitive behavioral therapy (CBT)—and medications are the primary treatments for major depression. Among the newer types of antidepressants are the selective serotonin reuptake inhibitors (SSRIs such as fluoxetine and sertraline), which increase the availability of the neurotransmitter serotonin in the brain, and the serotinin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine and duloxetine), which enhance norepinephrine and serotonin levels in the brain. The older tricyclic antidepressants (like tofranil and amitriptyline) and MAO inhibitors (like phenelzine and selegiline) are also options, but often have more side effects or dietary restrictions.

With all antidepressants, it can take up to 4 weeks for the full therapeutic effects to kick in. "With regular major depression, two-thirds to three-quarters of people who are treated with either CBT or antidepressants will feel better within 3 to 4 months," says Christopher Beevers, Ph.D., an assistant professor of psychology and director of the mood disorders laboratory at the University of Texas at Austin. With chronic depression, which can persist for years, a combination of antidepressants and CBT has been found to be particularly effective.

For depression of any length, lifestyle can also have an impact. "Managing stress, setting limits, getting enough sleep, and exercising regularly are really important for people with depression," Landau says. "Exercise can be extremely helpful, and there are no side effects."

Publication Review By: the Editorial Staff at

Published: 14 Dec 2010

Last Modified: 11 Sep 2013