Topic Overview

Is this topic for you?

This topic covers depression in adults. For information on:

• Depression in young people, see the topic Depression in Children and Teens.
• Depression after childbirth, see the topic Postpartum Depression.
• Depression followed by times of high energy, see the topic Bipolar Disorder.
• Depression and suicide, see Depression and Suicide.

What is depression?

Depression is an illness that causes you to feel sad, to lose interest in activities that you've always enjoyed, to withdraw from others, and to have little energy. It's different from normal feelings of sadness, grief, or low energy. Depression can also cause people to feel hopeless about the future and even to think about suicide.

Many people, and sometimes their families, feel embarrassed or ashamed about having depression. Don't let these feelings stand in the way of getting treatment. Remember that depression is a common illness. Depression affects the young and old, men and women, all ethnic groups, and all professions.

If you think you may be depressed, tell your doctor. Treatment can help you enjoy life again. The sooner you get treatment, the sooner you will feel better.

What causes depression?

Depression is a disease. It's not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Most experts believe a combination of family history (your genes) and stressful life events may cause depression. Life events can include:

• Childbirth, a death in the family, work, or relationships.
• Finding out you have a long-term health problem, such as arthritis, heart disease, or cancer.
• Health problems, such as anemia and an underactive thyroid gland (hypothyroidism). Treating the health problem can usually cure the depression.

Just because you have a family member with depression or have stressful life events doesn't mean you'll get depression.

You also may get depressed even if there is no reason you can think of.

What are the symptoms?

The symptoms of depression may be hard to notice at first. They vary among people, and you may confuse them with just feeling "off" or with another health problem.

The two most common symptoms of depression are:

• Feeling sad or hopeless nearly every day for at least 2 weeks.
• Losing interest in or not getting pleasure from most daily activities nearly every day for at least 2 weeks.

A serious symptom of depression is thinking about death or suicide. If you or someone you care about talks about this or feeling hopeless, get help right away.

You also may:

• Lose or gain weight. You also may feel like eating more or less than usual almost every day.
• Sleep too much or not enough almost every day.
• Feel restless and not be able to sit still, or you may sit quietly and feel that moving takes great effort. Others can easily see this behaviour.
• Feel tired or as if you have no energy almost every day.
• Feel unworthy or guilty nearly every day. You may have low self-esteem and worry that people don't like you.
• Find it hard to focus, remember things, or make decisions nearly every day. You may feel anxious about things.

If you have some of these symptoms for at least 2 weeks, talk to your doctor. Treatment may be right for you.

If you think you may have depression, take a short quiz to check your symptoms:

Interactive Tool: Are You Depressed?

How is it treated?

Depression can be treated in various ways. Counselling, psychotherapy, and/or antidepressant medicines are all used. Lifestyle changes, such as getting more exercise, also may help. Your doctor or mental health professional will help you find the best treatment.

If you have mild or moderate depression, your family doctor or a mental health professional, such as a counsellor or psychologist, may treat you. If you have severe depression or if treatment is not helping, you may need to see a psychiatrist. Some people need to be treated in the hospital, especially if they have thoughts of suicide.

Work with your health care team to find the best treatment for you. It may take a few tries, and it can take several weeks for the medicine to start working. Try to be patient and keep following your treatment plan.

Depression can return (relapse). How likely you are to get depression again increases each time you have a bout of depression. Taking your medicines and continuing some types of therapy after you feel better can help keep that from happening. Some people need to take medicine for the rest of their lives. This does not stop them from living full and happy lives.

Let your doctor know if you think you are depressed. Depression is easy to overlook. The earlier you are treated, the more quickly you will get better.

What can you do if a loved one has depression?

If someone you care for is depressed, the best thing you can do is help the person get or stay in treatment. Learn about the disease. Talk to the person and gently encourage him or her to do things and see people. Don't get upset with the person. The behaviour you see is the disease, not the person.

Is suicide a concern?

Many people who have depression have thoughts of death or thoughts of suicide, and depression can lead to suicide. Learn the warning signs of suicide, which include talking a lot about death, giving things away, or using a lot of alcohol or drugs or both. If you see these signs in yourself or a loved one, get help.

Call 911 or check your local phone book or provincial website for resources on getting help in your area if you (or someone you care about who has depression):

• Plan to harm yourself or others.
• Talk, write, read, or draw about death, including writing suicide notes and talking about items that can harm you, such as pills, guns, or knives.
• Buy guns or bullets, stockpile medicines, or take other action to prepare for a suicide attempt. You may have a new interest in guns or other weapons.
• Hear or see things that aren't real.
• Think or speak in a bizarre way that is not like your usual behaviour.

If a suicide threat seems real, call 911, a suicide hotline, or the police. Stay with the person, or ask someone you trust to stay with the person, until the crisis has passed. Don't argue or challenge the person. Tell the person you don't want him or her to die.

Frequently Asked Questions

Cause

Depression is a disease. It is not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Most experts believe a combination of family history (your genes) and stressful life events may cause depression.

• Genes: Your chance of having a bout of depression is greater if other family members have had depression. You may have inherited a trait that makes you more likely to get depressed. If this is true for you, a stressful life event is more likely to trigger depression.
• Life events: Stressful life events can trigger depression. For example, you could become depressed if you have:
  • Lost a loved one.
  • Had a baby (depression after childbirth).
  • Recently divorced.
  • Been diagnosed with a long-term (chronic) disease such as diabetes or heart disease.

Sometimes even happy life events, such as a marriage or promotion, can trigger depression because of the stress that comes with change.

Just because you have a family member with depression or have stressful life events doesn't mean you'll get depression. You also may get depression without going through a stressful event.

Other causes

Health problems also can cause depression. For example, both anemia and an underactive thyroid gland (hypothyroidism) can lead to depression. Treating the health problem usually cures the depression.

Certain medicines, such as steroids or narcotics, can cause depression. If you stop using the medicine, the depression may go away.

• For more information on events that could trigger depression, see the What Increases Your Risk section.
• Read more about postpartum depression or depression, anxiety, and other health problems.

Symptoms

The symptoms of depression may be hard to notice at first. They can be different from person to person, and you may confuse them with just feeling "off" or "down." You also may confuse the symptoms with another health problem.

The two most common symptoms of depression are:

• Feeling sad or hopeless nearly every day.
• Losing interest in or not getting pleasure from most daily activities, and you feel this way nearly every day.

A serious symptom of depression is thinking about death and suicide. If you or someone you care about talks about suicide or feeling hopeless, get help right away.

You also may:

• Lose or gain weight. You may also feel like eating more or less than usual almost every day.
• Sleep too much or not enough almost every day.
• Feel restless and not be able to sit still, or you may sit quietly and feel that moving takes great effort. Others can easily see this behaviour.
• Feel tired or as if you have no energy almost every day.
• Feel unworthy or guilty nearly every day. You may have low self-esteem and worry that people don't like you.
• Find it hard to focus, remember things, or make decisions nearly every day. You may feel anxious or worried about things.

Are you depressed?

If you have at least five of the above symptoms for 2 weeks or longer, and one of the symptoms is either sadness or loss of interest, you may have depression and may need treatment. If you have 2 to 4 symptoms for a period of at least 2 years (1 year for a child), you may have a long-term form of depression called dysthymic disorder (dysthymia).

Even if you have fewer symptoms, you may still be depressed and may benefit from treatment. No matter how many symptoms you have, it's important to see your doctor. The sooner you get treatment, the better your chance for a quick and full recovery.

It's possible to have periods of both energy and elation (mania) and depression. This may be bipolar disorder. If this happens to you, tell your doctor. The treatments for depression and bipolar disorder are different. For more information, see the topic Bipolar Disorder.

If you think you may have depression, take a short quiz to check your symptoms:

Interactive Tool: Are You Depressed?

One Woman's Story: "I woke up every day with suicide on my mind, and I went to bed with suicide on my mind."—Martha Read more about Martha and her symptoms.

Symptoms can vary

Symptoms can be mild, moderate, or severe:

• In mild depression, you have few symptoms. They affect your life, but you can deal with them with treatment.
• In moderate depression, you have more symptoms, and they are beginning to change your life.
• In severe depression, the symptoms change your life and affect your job or career and your relationships.

Depression can affect your physical health. You may have headaches or other aches and pains or have digestive problems such as constipation or diarrhea. You may have trouble having sex or may lose interest in it. If you notice any of these changes, talk to your doctor. Your doctor may be able to help.

Depression, PMS, and childbirth

Many women have mood changes before menstruation. This may be a sign of premenstrual syndrome (PMS). But if your premenstrual mood changes and other PMS symptoms are making daily life hard or harming your relationships, you may have a type of depression known as premenstrual dysphoric disorder (PMDD). To learn more about this, see the topic Premenstrual Syndrome (PMS).

Women also may feel sad after having a baby. But if you feel very sad after you've had your baby, see your doctor. You may have postpartum depression. For more information, see the topic Postpartum Depression.

Symptoms in older adults

Symptoms of depression may be different for older adults. Depression can make older adults confused or forgetful or cause them to stop seeing friends and doing things. It can be confused with problems like dementia.

Symptoms in children and teens

Symptoms of depression in children and teens can be different from adult symptoms. These symptoms include doing poorly in school, having temper tantrums, and becoming sexually active. For more information, see the topic Depression in Children and Teens.

Warning signs of suicide

Thoughts of suicide are common in people who have depression. Most people do not act on these thoughts, but they must be taken seriously.

Call 911 or check your local phone book or provincial website for resources on getting help in your area if you (or someone you care about who has depression):

• Plan to harm yourself or others.
• Talk, write, read, or draw about death, including writing suicide notes and talking about items that can harm you, such as pills, guns, or knives.
• Buy guns or bullets, stockpile medicines, or take other action to prepare for a suicide attempt. You may have a new interest in guns or other weapons.
• Hear or see things that aren't real.
• Think or speak in a bizarre way that is not like your usual behaviour.

Learn about depression and suicide and the warning signs of suicide, such as giving away things or suddenly using lots of alcohol or drugs or both.

Warning signs of suicide in children and teens may include running away from home or doing risky or dangerous things, such as driving drunk or abusing drugs. If you see warning signs in yourself or a loved one, get help.

What Happens

Depression is different for everyone.

For some people, a bout of depression begins with symptoms of anxiety (such as worrying a lot), sadness, or lack of energy. This may go on for days or months before you or others think you are depressed. And other people may feel depressed suddenly. This may happen after a big change in life, such as the loss of a loved one or a serious accident.

It's possible to have periods of both energy and elation (mania) and depression. This may be bipolar disorder. If this happens to you, tell your doctor. The treatments for depression and bipolar disorder are different. For more information, see the topic Bipolar Disorder.

How long does depression last?

If you don't get treated, depression may last from months to a year or longer. A small number of people feel depressed for most of their lives and always need treatment.

Depression can return, which is called a relapse. At least half of the people who have depression once get it again.¹ How likely you are to get depression again increases each time you have a bout of depression. You can make having another bout of depression less likely by following your treatment plan and using your medicines.

Depression and other health concerns

Depression is linked with many health concerns. These include other diseases, drug or alcohol use, and pregnancy.

If you have depression and another health concern, you need to deal with both of them. Read about:

• Depression, anxiety, and other health problems.
• Depression and problems with drugs or alcohol.
• Depression and aging.
• Depression and post-traumatic stress disorder (PTSD).
• Depression and suicide.
• Depression during pregnancy and after having a baby (postpartum depression).

  Depression: Managing Postpartum Depression

What Increases Your Risk?

Experts don't know why some people get depression and others don't. But certain things make you likely to get depression. These are called risk factors.

Important risk factors for depression include:

• Having a father, mother, brother, or sister who has had depression.
• Having had depression before.
• Having post-traumatic stress disorder (PTSD).
• One-time stressful events, such as the death of a loved one, losing your independence or your job, or having a serious accident.

Other risk factors include:

• Long-term (chronic) stressful situations, such as living in poverty, having marriage or family problems, or helping someone who has a long-term medical problem.
• Physical or sexual abuse in childhood or in a relationship, such as domestic abuse or violence.
• Getting older.

Medical risk factors

Medical problems also may cause depression or make it worse. These problems include:

• Abusing drugs or alcohol.
• Having a long-term (chronic) health problem, such as coronary artery disease, diabetes, cancer, or chronic pain. Read more about depression and chronic illness.
• Having a mental health problem or behaviour disorder, such as post-traumatic stress disorder (PTSD), dementia, anxiety disorder, or an eating disorder.
• Having had a recent serious illness or surgery.
• Having a health problem such as anemia or an underactive thyroid gland (hypothyroidism). Treating the health problem usually cures the depression.
• Using certain medicines, such as steroids or narcotics. If you stop using the medicine, the depression will probably go away.

Other risk factors for women

Women may have other risk factors. These include:

• Menopause.
• Pregnancy or recent childbirth. For more information on depression after childbirth, see the topic Postpartum Depression.
• Use of birth control pills (oral contraceptives).
• A history of premenstrual dysphoric disorder (severe premenstrual syndrome).

When to Call a Doctor

Call 911, your provincial health information line, or other emergency services right away if:

• You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • You have decided how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.
• You feel you cannot stop from hurting yourself or someone else.

Call a doctor right away if:

• You hear voices.
• You have been thinking about death or suicide a lot, but you do not have a suicide plan.
• You are worried that your feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

• You have symptoms of depression, such as:
  • Feeling sad or hopeless.
  • Not enjoying anything.
  • Having trouble with sleep.
  • Feeling guilty.
  • Feeling anxious or worried.
• You have been treated for depression for more than 3 weeks, but you aren't getting better.

If you have not been diagnosed with depression, but you think you may be depressed, use the Feeling Depressed topic to check your symptoms.

Who to see

There any many types of professionals who treat depression and many types of treatments. A good place to start is with your family doctor or general practitioner. If treatment by your doctor does not help you, you may be referred to a specialist such as a psychiatrist.

Whomever you see, it is important that this person has experience treating people with depression and is trained in proven therapies. It is also important that you establish a good long-term relationship. If you don't feel comfortable with one doctor or therapist, try another one.

Treatment such as professional counselling or therapy can be provided by:

• Psychiatrists (who can also diagnose and prescribe medicines).
• Psychologists.

Other health professionals who also may be trained in treating depression include:

• Social workers.
• Mental health counsellors.
• Psychiatric nurses.

Examinations and Tests

Depression may be diagnosed when you talk to your doctor about feeling sad or when your doctor asks you questions and discovers that you are feeling sad. You may be seeing your doctor because you feel sad or because you have another health problem or concern.

If your doctor thinks you are depressed, he or she will ask you questions about your health and feelings. This is called a mental health assessment. Your doctor also may:

• Do a physical examination.
• Do tests to make certain your depression is not caused by a disease such as an underactive thyroid (hypothyroidism) or vitamin B12 deficiency anemia.
• Ask you about suicide.

Depending on your history and risk factors, your doctor may order other tests.

If you are depressed, your doctor may treat you or refer you for therapy to treat your symptoms.

Tell your doctor

Always tell your doctor if you feel sad or have other symptoms of depression. Many times, people are embarrassed by these feelings and say nothing. Depression can be treated, and the sooner you get treatment, the better your chance for a quick and full recovery.

It's possible to have periods of both energy and elation (mania) and depression. This may be bipolar disorder. If this happens to you, tell your doctor. The treatments for depression and bipolar disorder are different. For more information, see the topic Bipolar Disorder.

If you have depression only during certain seasons of the year, such as the fall and winter months, tell your doctor. You may have seasonal affective disorder. For more information, see the topic Seasonal Affective Disorder (SAD).

Treatment Overview

Depression can be treated in various ways. Counselling, psychotherapy, and antidepressant medicines may all be used. Lifestyle changes, such as getting more exercise, also may help.

Your doctor or mental health professional will help you find the best treatment. For severe depression, a very small number of people may need to stay in a hospital for a short time, especially if they are thinking about suicide.

Work with your health care team to find the best treatment for you. To get the most benefit, be sure you find a therapist who has experience treating people who have depression and who is trained in proven therapies, and use your medicines as your doctor directs.

• If your depression is mild, you may need only therapy.
• If you have moderate to severe symptoms, your doctor probably will suggest medicine and/or therapy.
• If you are using medicine, your doctor may have you try different medicines or a combination of medicines.
• You may need to go to the hospital if you show warning signs of suicide, such as having thoughts about harming yourself or another person, not being able to tell the difference between what is real and what is not (psychosis), or using a lot of alcohol or drugs.

If you don't get treated, depression may last from months to a year or longer. A small number of people feel depressed for most of their lives and always need treatment.

For more information, see the Therapy and Medications sections of this topic.

Lifestyle decisions

You can help yourself by getting support from family and friends, eating a balanced diet, avoiding alcohol, staying active, and getting enough sleep.

If you need help deciding whether to talk to your doctor about depression, see some common reasons people don't get help and how to overcome them.

For more information on making changes in your lifestyle to help with depression, see the Living With Depression section of this topic.

Other treatment

Other treatments for depression include electroconvulsive therapy (ECT) and alternative or complementary treatment. ECT involves an electric stimulation to the brain. Alternative treatments include the herb St. John's wort and omega-3 fatty acids. For more information on these treatments, see the Other Treatment section of this topic.

One Man's Story: "...[T]his was the first time I was willing to do anything to recover. It's changed my whole life."—Stan Read more about Stan's struggle with depression.

Prevention

There is little research on whether you can prevent a first bout of depression. But several studies suggest that exercise may help prevent a first bout of depression.^{2, 3} Exercise also may help prevent depression from coming back (relapse) and may improve symptoms of mild depression.^{2, 3}

If you worry about getting depression, talk to your doctor. Regular screening for depression helps find depression early, and early treatment may help you get better faster.

You also may be able to prevent depression by avoiding alcohol and drugs. Alcohol and drugs can trigger depression. And using them is often a sign that you have depression.

Preventing depression from coming back

You may be able to prevent a relapse or keep your symptoms from getting worse if you:

• Take your medicine as prescribed. Depression often returns if you stop taking your medicine or don't take it as your doctor advises.
• Continue to take your medicine after your symptoms improve. Taking your medicine for at least 6 months after you feel better can help keep you from getting depressed again. If this is not the first time you have been depressed, your doctor may want you to take medicine even longer. You may benefit from long-term treatment with antidepressants.
• Continue cognitive-behavioural therapy after your symptoms improve. Research shows that those who continued this type of therapy had less chance of relapse.⁴
• Eat a balanced diet.
• Get regular exercise.
• Get treatment right away if you notice that symptoms of depression are coming back or getting worse.
• Have healthy sleep patterns.
• Avoid drugs and alcohol.

Therapy

Counselling and psychotherapy are important parts of treatment for depression. You will work with a mental health professional such as a psychologist, mental health counsellor, clinical social worker, or psychiatrist. Together, you will develop an action plan to treat your depression.

The first step is finding a therapist you trust and feel comfortable with. The therapist also should have experience treating people who have depression and should be trained in proven therapies. These therapies include:⁵

• Cognitive-behavioural therapy (CBT), which teaches you how to change the ways you think and behave. This can help you stop thinking bad thoughts about yourself and your life. You can take part in CBT with a therapist or in a group setting. Also see:

  Depression: Using Positive Thinking.

  Positive Thinking: Stopping Unwanted Thoughts.

• Interpersonal therapy, which looks at your social and personal relationships and related problems.

Some therapists use acceptance and commitment therapy (ACT). In ACT, you work with a therapist to learn to accept your negative feelings but not let them run your life. You learn to make choices and act based on your personal values, not negative feelings.

Mindfulness strategies are another type of therapy. They seek to focus your attention on what is happening at the moment without trying to change it. These strategies teach you to let go of past regrets and not worry about the future. They may help with depression in some people.

Learn about:

Stress Management: Doing Meditation.

Other treatments you may have heard of include problem-solving therapy, which looks at your current problems and helps you solve them, and family therapy, which brings you and your family together to discuss your relationships and depression. Experts don't know how well these therapies work for depression.⁵

When you hear "counselling" or "therapy," you may think of lying on a couch and talking about your childhood. But most of these treatments do not look for hidden memories. They deal with how you think about things and how you act each day.

One Woman's Story: "I walked into the therapist's office crying, mute. I felt as if no one heard me." —Debbie Read more about how therapy helped Debbie.

How long will you need counselling or therapy?

How long your treatment lasts depends on how severe your depression is and how well you respond to treatment. Short-term counselling or therapy usually lasts from 10 to 20 weeks, and you usually see your mental health professional once a week. But you may need to meet with your health professional more often or for a longer time.

Medicines

Antidepressant medicines may improve or completely relieve the symptoms of depression. If you are mildly depressed, you may not have to take them, but most people with moderate or severe depression need medicine.

Antidepressant medicines work in different ways. No antidepressant works better than another, but different ones work better or worse for different people. The side effects of antidepressant medicines are different and may lead you to choose one instead of another.

You may have to try different medicines or take more than one to help your symptoms. Most people find a medicine that works within a few tries. Other people take longer to find the right one and may need to take the antidepressant and another type of medicine, such as an antiseizure, mood stabilizer, antipsychotic, or antianxiety medicine.

Together you and your doctor will decide if you need medicine, what things you'll need to think about if you need medicine, and which medicine is right for you.

Depression: Should I Take an Antidepressant?

Antidepressant medicines include:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
• Tricyclic and tetracyclic antidepressants, such as doxepin (Sinequan) and nortriptyline (Aventyl, Norventyl).
• Other antidepressants, such as bupropion (Wellbutrin XL, Wellbutrin SR), mirtazapine (Remeron), and trazodone, and venlafaxine (Effexor XR).
• Monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate (Nardil) and selegiline.

One Woman's Story "It took about a year for me to not feel depressed at all."—Sherri Read more about how medicine helped Sherri.

How long will you need medicines?

If you take antidepressants, you should take them for at least 6 months after you begin to feel better. This can help prevent you from feeling depressed again (relapse). If this is not the first time you have been depressed, your doctor may want you to take these medicines even longer.

You may start to feel better within 1 to 3 weeks after starting your antidepressant medicine. But it can take as many as 6 to 8 weeks to see a great deal of improvement. If you have questions or concerns about your medicines, or if you do not notice that you feel better by 3 weeks, talk to your doctor.

Some people need to remain on medicine for several months to years. Others will need medicine long-term. This is more likely if you have had several bouts of depression that you had to treat in the hospital or that led you to attempt suicide.

Don't quit taking your medicines without talking to your doctor. If you quit suddenly, it can cause dizziness, anxiety, fatigue, and headache. If you and your doctor decide you can quit using medicine, gradually reduce the dose over several weeks.

Depression: Should I Stop Taking My Antidepressant?

Side effects and safety

Antidepressant medicines have side effects. You may notice the side effects before you notice that the medicine is helping you. Side effects vary depending on the medicine you take.

• Common side effects include diarrhea, headaches, loss of sexual desire, not feeling like eating, having an upset stomach, and feeling on edge.
• Most side effects are mild and will go away after you take the medicine for a few weeks.
• Call your doctor right away and stop taking the medicine if you have serious side effects such as chest pain, hives, shortness of breath, trouble swallowing, or swelling of your lips.
• If your side effects are less serious but bother you, talk with your doctor about how to deal with the side effects or to see whether you should try another antidepressant medicine.

Depression: Dealing With Medicine Side Effects

Antidepressant medicines have helped many people and are considered safe. But like all medicines, they may cause problems in certain people.

People who are taking medicines for other health problems need to know about medicine interactions. Talk with your doctor about the best way to track whether a combination of medicines is harming you. People who are taking a lot of medicines also are more likely to have harmful side effects.

Depression: Should I Take Antidepressants While I'm Pregnant?

Depression: Taking Antidepressants Safely

Living With Depression

When you're going through depression, you can't just shake if off. You might have a couple of good days followed by a bad day or a string of bad days. And you don't know how long it will last. Depression is not like the flu or a sprained ankle, where your doctor can tell you about how long it will take to get better.

When you're getting better, many experts call it recovery. Recovery is finding your path to the life you care about. There are 10 principles of recovery (What is a PDF document?) that can help you recover from depression on your terms. They help you gain self-confidence and respect for yourself.

During your recovery, be patient and kind to yourself. Remember that depression is not your fault and is not something you can overcome with willpower alone. You need treatment for depression, just like for any other illness.

Continuing your treatment, helping yourself, getting support, and having a healthy lifestyle are all part of your recovery. Your symptoms will fade as your treatment starts to work. Don't give up. Focus your energy on getting better. Your mood will improve. It just takes some time.

Your self-care

You can take many steps to help yourself when you feel depressed or are waiting for your medicine to work. These steps also help prevent depression from coming back.

• Be real in what you expect and what you can do. Set goals you can meet. If you have a big task to do, break it up into smaller steps you can handle. Don't take on more than you can handle.
• Don't blame yourself or others for your depression.
• Think about putting off big decisions until your depression has lifted. Wait a bit on making decisions about marriage, divorce, or jobs. Talk it over with friends and loved ones who can help you look at the whole picture.
• Get support from others. Your family can help you get the right treatment and deal with your symptoms. Social support and support groups give you the chance to talk with people who are going through the same things you are.
• Tell people you trust about depression. It is usually better than being alone and keeping it a secret.
• Build your self esteem and try to keep a positive attitude.

  Depression: Using Positive Thinking

  Positive Thinking: Stopping Unwanted Thoughts

• Try to be part of religious, social, holiday, or other activities.
• If you have any other health problems, like diabetes, heart disease, or high blood pressure, continue with your treatment for them. Tell your doctor about all of the medicines you take, with or without a prescription.

You also can help yourself by thinking about what is good in your life. You can:

• Help others who are not as well off as you are.
• Thank people for the small and big things they do for you.
• Be thankful for big things like having a home, family, and friends.
• Be thankful for little things like making people laugh, enjoying a piece of music, or finding warm gloves for the winter.

One Woman's Story: "If you keep your thoughts in, they will never be quiet. It helps my depression to express them."—Cheryl Read more about Cheryl and how she copes with depression.

Remember the basics

• Get regular exercise. People who are fit usually have less anxiety, depression, and stress than people who aren't fit.⁶ Even something as easy as walking can help you feel better. Find a way you can be active.
• Eat a balanced diet. This helps your body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.
• Get enough sleep. A good night's sleep can help mood and stress levels. Avoid sleeping pills unless your doctor prescribes them.
• Deal with stress. Too much stress can help trigger depression. You can do a lot to help relieve stress. For more information, see the topic Stress Management.
• Avoid drinking alcohol or using illegal drugs or medicines that have not been prescribed to you. Having a substance abuse problem makes treating depression harder. Both problems need to be treated.
• Prevent depression from coming back. Take your medicine as your doctor advises. Depression often returns if you stop taking your medicine or don't take it as your doctor advises. For more information, see the Prevention section.

Other Treatment

Other treatments for depression include brain stimulation and treatment with herbs or dietary supplements.

Brain stimulation

Electroconvulsive therapy (ECT) may be used to treat severe depression or depression that does not get better with medicine and counselling or therapy. In ECT, electricity is briefly sent to the brain through electrodes placed on your head. Studies have shown that ECT is an effective short-term treatment for depression.^{3, 7}

Other types of brain stimulation have not been well studied and may be expensive. They usually are considered only if other treatment does not work. They include:

• Deep brain stimulation. A device that uses electricity to stimulate the brain is put in your head. It is used for Parkinson's disease but has not been well studied for depression.
• Vagus nerve stimulation. A generator the size of a pocket watch is placed in your chest. Wires go up from the generator to the vagus nerve in your neck. The generator sends tiny electric shocks through the vagus nerve to the brain.
• Transcranial magnetic stimulation. An electromagnet is placed on your head and sends magnetic pulses that stimulate your brain.

Complementary therapies

Complementary therapies are sometimes used for depression. Always tell your doctor if you are using any of them.

• Massage therapy, yoga, and other relaxation exercises.
• The herb St. John's wort.
• Fish oil containing omega-3 fatty acids.
• SAM-e ( S-adenosylmethionine).

For Family and Friends

If someone you care about is depressed, you may feel helpless. Maybe you're watching a once-active or happy person slide into inactivity or you're seeing a good friend lose interest in favourite activities. The change in your loved one's or friend's behaviour may be so big that you feel you no longer know him or her.

Here are some things you can do to help:

• Help the person get treatment or stay in treatment. This is the best thing you can do.

  Depression: Helping Someone Get Treatment

• Support and encourage the person.

  Depression: Supporting Someone Who Is Depressed

• Learn about depression. Know the facts and myths about it.
• Be aware of your own and other people's negative attitudes (stigma) toward depression. Do what you can to fight stigma and teach people about depression.
• Be aware of other health problems the person may have.
  • Read about depression and post-traumatic stress disorder (PTSD).
  • Read about depression and other health problems.

Help with the basics

You can also help the person have good health habits. Encourage him or her to:

• Limit alcohol and not use drugs. Having a substance abuse problem makes treating depression harder. Both problems need to be treated.
• Be active. People who are fit usually have less anxiety, depression, and stress than people who aren't fit.⁶
• Deal with stress. Too much stress can help trigger depression, but simple things can relieve stress. For more information, see the topic Stress Management.
• Get enough sleep. Sleep can help mood and stress levels.
• Eat a balanced diet. This helps the body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.

One Woman's Story: "Having a friend or loved one to help you can really help."—Susan Read more about Susan's depression.

Depression and suicide

Depression can lead to suicide. Call 911 or check your local phone book or provincial website for resources on getting help in your area if the person:

• Plans to harm himself or herself or others.
• Talks, writes, reads, or draws about death, including writing suicide notes and talking about items that can harm him or her, such as pills, guns, or knives.
• Buys guns or bullets, stockpiles medicines, or takes other action to prepare for a suicide attempt. The person may have a new interest in guns or other weapons.
• Hears or sees things that aren't real.
• Thinks or speaks in a bizarre way that is not usual.

Learn about depression and suicide and the warning signs of suicide, such as giving away things or suddenly using alcohol or drugs.

If a person or family member who is depressed talks about suicide and has a plan and a way to carry it out, follow these guidelines.

• Stay with the person, or ask someone you trust to stay with the person, until the crisis has passed.
• Get professional help.
• Don't argue with the person ("It's not as bad as you think") or challenge him or her ("You're not the type to try suicide").
• Tell the person you don't want him or her to die. Talk about the situation as openly as possible.

Helping yourself

If you are spending a lot of time helping or caring for someone who has depression, find your own support. This can help you deal with the illness. These caregiver tips also can help you.

• Don't help too much. A common mistake caregivers make is providing too much care. Even if they don't say so, people like to help themselves. Take some time off.
• Don't do it alone. Ask others to help you, or join a support group. The more support you have, the more help you can give.
• Get help from a local organization. Your city or province may have programs to help you. Ask at your local health unit or provincial ministry of health services. The Canadian Mental Health Association provides contact information for support organizations nationwide. Go to www.cmha.ca and choose "Support Centre."