Abusing drugs can reduce the effectiveness of your treatment, prolong your illness and increase the risk of side effects.

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1 Depression: This brochure can help you learn more about depression. It does not replace regular medical check-ups or your health care provider s advice. Talk with your health care provider about what you should do if you feel depressed.

2 Some people mistakenly believe that depression is a character flaw or a sign of personal weakness. This is NOT true. Everyone occasionally feels sad, but these feelings are usually brief and go away in a few days. Depression can affect anyone. Since many people who suffer from depression do not realize they are depressed or believe they can overcome depression by themselves it is important to seek care if the signs of depression persist. There are many options for treatment that are effective for most individuals. Depression is a serious medical illness (just like diabetes and high blood pressure are medical illnesses) that significantly impairs your thoughts, feelings and ability to function in daily life. If left untreated it can have severe consequences and even be deadly. The cause of depression is unknown, but many doctors believe that depression is related to an imbalance of chemical messengers in the brain. Certain medications and other conditions can cause the same symptoms as depression. A doctor can eliminate other possibilities that may be causing the symptoms by doing a physical exam, interview and lab tests. Since there is no simple test to identify if you are depressed, you need to visit a doctor or mental health specialist. If you have five or more of the following symptoms of depression, one of which must be feeling persistently sad or feeling hopeless or pessimistic, that last for two weeks or more, it is likely that you have major depressive disorder. Feeling persistently sad, anxious or empty Feeling hopeless or pessimistic Feeling guilty, worthless or helpless Irritability, restlessness Loss of interest in activities or hobbies, once pleasurable, including sex Fatigue and decreased energy Difficulty concentrating, remembering details and making decisions Unable to sleep, waking up early or sleeping too much Overeating or not wanting to eat at all Thoughts of suicide, suicide attempts Aches or pains, headaches or cramps or digestive problems that do not ease, even with treatment The signs and severity of the symptoms of depression vary from person to person. Not everyone who is depressed experiences every symptom listed above. A person s diagnosis depends upon the number of symptoms, the severity of the symptoms, and how long the symptoms last. 1

3 A variety of different risk factors can increase your chances of being depressed. Some risk factors are beyond your control. There are others that you can control. Risk Factors you CAN control A risk factor is something that is associated with an increased chance for something to happen. For example, being overweight (the risk factor) may increase a person s chance of developing a disease like diabetes. Abusing alcohol, nicotine or drugs Being physically inactive Having few friends or supportive relationships Certain personality traits Certain medications Abusing drugs can reduce the effectiveness of your treatment, prolong your illness and increase the risk of side effects. Physical activity has been shown to reduce the chance of developing depression, particularly in the elderly. Being isolated can compound your problems. Healthy relationships and a strong social network can give you the support you need. Traits such as chronic worrying and anxiety, compulsive behavior, having unattainable goals, constantly seeking attention from others, excessive dependency on others, preoccupation with uncontrollable thoughts, and being extremely self-critical are risk factors for depression. Talk to your doctor before stopping any medication you think could be affecting your mood. Risk factors you CANNOT control Gender Heredity Stressful Life Events Severe or Chronic Illness Trauma Females are about 70% more likely than males to experience depression, and more than one of every four women will experience depression in her lifetime. You are more likely to suffer from depression if your biological relatives suffered from depression. Catastrophic illness or death of a close family member or friend, divorce, career crisis, moving to a new place, financial problems, military service or any unwelcome change in life patterns can be risk factors for depression. Serious illness, such as cancer, Alzheimer s disease or HIV/AIDS are risk factors for depression. If you had traumatic experiences as a child, you are at a greater risk for depression. 2

4 There are positive steps you can take to lower your risk of depression. Just because you have one or more risk factors for depression this does not mean you will suffer from depression. Reducing risk factors will not only decrease your chances of being depressed, but will also contribute to better overall health and an improved quality of life. Take care of yourself exercise regularly eat a healthy diet get plenty of sleep maintain personal grooming practice relaxation techniques expose yourself to a little sunlight every day Maintain and build healthy relationships talk with a trusted friend or relative confide in a counselor, therapist or clergy member can be helpful participate in activities that you enjoy get together with family and friends regularly Set realistic goals that are not overwhelming simplify your life reduce obligations when possible break big tasks into smaller steps that are achievable give yourself permission to do less when you feel down Structure your time plan your day and activities make a list of tasks set priorities 3

5 Many people are so depressed they can t reach out for help. Some people mistakenly blame depression on personal weakness, a character flaw or not being a real man. A significant proportion of people with depression think they do not need treatment. Many do not seek care because they do not recognize their symptoms as signs of depression. There are also other reasons, some of which are embedded in the beliefs of society, the practices of employers and the absence of education and information about the treatments that are available for depression. Although depression is very common, up to 50% of people with depression do not seek treatment. Between 80-90% of people with depression respond positively to treatment, and almost all gain some relief from their symptoms. But it may take time to find the one that is right for you. There is hope! Below are some of the challenges that make it difficult to seek help. Many people don t think they are depressed Many people are so depressed that they can t reach out for help Not knowing where to find accurate information about depression Many people do not recognize their symptoms as signs of depression Fear of revealing personal problems Fear of stigma or being discriminated against Doubt about whether treatments work Afraid of the side effects of medications Fear of being committed to mental facility and subject to abuse Prohibitive cost of treatment Doubts about the capabilities, knowledge, skills and understanding of health care professionals 4

6 to Get Help There are things you can do to lower the barriers to seeking care for depression. It is difficult for many people so seek care if they feel depressed, especially since they are either so depressed they cannot ask for help or they are not aware they are depressed. It takes courage and often help from a family member or supportive friend to be able to take the first steps. Get the facts about depression depression is not a personal weakness ask your personal doctor for information about depression use credible online sources, such as recognize that depression is a serious medical illness that can be effectively treated Older Adults and Depression Do you feel very tired, helpless and hopeless? Are you sad most of the time and take no pleasure in your family, friends, or hobbies? Are you having trouble working, sleeping, eating, and functioning? Have you felt this way for a long time? If so, you may have depression. National Institute of Mental Health U.S. Department of Health and Human Services National Institutes of Health Get help if your feelings of depression persist tell a family member or friend how you feel if you feel suicidal, call TALK (8255) immediately your doctor can help you by determining if you are depressed and, if necessary, by recommending an appropriate treatment if appropriate, consult a doctor who specializes in treating depression Get information about treatment options several treatment options are available, including antidepressant medications psychotherapy, also known as talk therapy electroconvulsive therapy, and alternative therapies prepare a list of questions to ask your doctor to help you understand the benefits, risks and costs of the different options to treat depression consult with your doctor about which option is best for you 5

7 Not all depression is the same. Different types of depression have different characteristics. Below are some examples of different forms of depression. Major depressive disorder is a disabling form of depression that prevents a person from functioning normally Bi-polar disorder is when a person s mood swings between the highs of mania and the lows of depression Seasonal affective disorder is a type of depression that occurs at a certain time of the year, usually in the winter Post partum disorder is a form of depression that often occurs between 2 weeks and 6 months after childbirth Up to 50% of people who experience depression do not seek treatment. Depression is the leading cause of disability and can be deadly. Between 80-90% of people with depression respond positively to treatment, and almost all gain some relief from their symptoms. Finding the right treatment may take time. Don t give up. There are many options for treating depression. Talk with your doctor about which option is right for your. Types of Treatment Medications Psychotherapy Alternative treatments Electroconvulsive therapy How They Work Antidepressant medications are commonly used to treat depression and primarily work on chemical messengers in the brain. Scientists have found that these messengers are involved in regulating mood, but they are unsure of the exact ways that they work. When the levels of these messengers are low, or not properly balanced, depression may occur. Psychotherapy is sometimes called talk therapy. A licensed mental health professional helps people with depression focus on behaviors, emotions, and thought patterns that contribute to depression. For mild to moderate depression, psychotherapy may be the best option. Alternative treatments can sometimes provide relief that traditional western medicine cannot. Examples include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, herbal remedies, massage, music and dance movement therapy. Electroconvulsive therapy (ECT) is a procedure in which an electric current is used to produce a seizure in the patient. It is believed that ECT results in the release of chemicals in the brain that aid communication between nerves. It is used for severe forms of depression, particularly when antidepressant medications have not worked, and when there is a high risk of suicide. 6

8 Check off items from the list below that you will be able to change or improve. Or you can write in your own action items. Get the facts about depression. Ask your doctor for information about depression. Use credible online information resources, such as Recognize that depression is a serious medical illness and seek care to determine if you need treatment. If you feel suicidal, call TALK (8255) immediately. Get information about treatment options from your doctor. Don t try to medicate yourself with drugs or alcohol. Prepare yourself to meet with your doctor. Make a list of your symptoms, your medical history, all medications and vitamins you are taking, your family history of depression and any significant life events you have experienced Prepare a written list of questions to ask your doctor. Participate in a dialogue with your doctor about which treatment option is best for you. I feel like myself again. Continue taking your prescribed therapy. Continue with your prescribed therapy. Medications take time to work. If you are having side effects, consult your doctor immediately. Maintain and build healthy relationships. Don t become isolated. Get together with family and trusted friends regularly. Take care of yourself and stay physically active. Get as much physical exercise as possible and participate in activities you enjoy. Maintain personal grooming, eat a healthy diet and get plenty of sleep. Simplify your life. Break big tasks into smaller steps that are achievable. Plan your day and make a list of things you want to accomplish. Reduce your obligations when possible. Give yourself permission to do less when you feel down. Other 1. Are the items that you have chosen achievable? Yes No 2. What will you do to make these changes? 3. When will you make these changes? 7 NPC Pfizer Inc. All rights reserved. Printed in USA/January 2014