Depression
Depression goes beyond feeling sad. It can drain your energy, flatten interest in things you used to enjoy, disrupt sleep and appetite, and make everyday tasks feel heavy.
Major depression looks different from person to person. Some people feel persistently low or empty, others feel irritable or numb. Concentration, motivation, and hope itself can wear thin. It is one of the most common mental health conditions, and it often recurs, which is why ongoing care matters as much as the first visit.
Evaluation means understanding your history, your symptoms, and what you have already tried. SSRIs, the most commonly prescribed antidepressants, increase the availability of serotonin in the brain. The current understanding goes deeper than the old chemical imbalance idea: depression wears down the mood circuits until they lose flexibility, and these medications help those circuits recover and respond again, which is why they take weeks to reach full effect. Treatment is tailored to the individual and may include medication, therapy, or a combination, with progress monitored closely.
Research and further reading
A few key papers behind how this condition is understood and treated today. Links open the abstract on PubMed, a free public database from the U.S. National Library of Medicine.
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Cipriani et al. · The Lancet · 2018
In 522 trials involving more than 116,000 adults, all 21 antidepressants were more effective than placebo on average, but their effectiveness and tolerability differed.
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Malhi et al. · The Lancet · 2018
This broad clinical review explains that major depression can present in many ways, often recurs, and usually requires treatment tailored to the individual.
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Rush et al. · The American Journal of Psychiatry · 2006
Many patients improved after trying additional treatment steps, but the chance of remission decreased and relapse risk increased when several treatments were needed.
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Gibbons et al. · Archives of General Psychiatry · 2012
Using patient level data from many trials, fluoxetine and venlafaxine improved depression more than placebo in adults, young people, and older adults.
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Antidepressant drug effects and depression severity: a patient-level meta-analysis
Fournier et al. · JAMA · 2010
The advantage of antidepressants over placebo grew with depression severity and was substantial for very severe depression, while it was small for mild or moderate symptoms.
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Nelson et al. · The American Journal of Psychiatry · 2009
Across placebo controlled trials, adding an atypical antipsychotic helped more patients reach response and remission when their antidepressant alone had not done enough. The benefit had to be weighed against a higher burden of side effects.
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Crossley et al. · The Journal of Clinical Psychiatry · 2007
Two combined analyses of randomized trials found lithium significantly more effective than placebo as an add on to antidepressants for depression. Evidence that lithium speeds up the onset of benefit was more modest.
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