Let's Talk About Depression

How are you feeling today? If you’ve found yourself reading this, probably pretty crappy. Maybe you’ve been feeling listless and down for a lot longer than you expected, and it’s making you worry that you might have depression. Maybe you’ve just received a diagnosis of clinical depression and you’re looking for answers. We get it. So many contributors to HealthCentral have felt just like you do now. But we won’t let depression swallow you up. We also won’t bombard you with a bunch of false promises and inaccurate information (that’s what your Facebook feed is for). Here, we share the reality of coping with depression, as well as expert advice from top doctors, the most successful treatments, and mood-lifting lifestyle changes.

什么是抑郁症，真的吗？

It’s normal to experience sadness. (Whodidn’tcry when Simba couldn’t wake up Mufasa?) But unlike typical sadness or grief, time can’t and won’t heal重度抑郁症（MDD），期限为临床抑郁症，其中大部分人只是所谓的“洼地”。这是一种常见的精神健康状况昭示着像一个不必要的房客，并拒绝离开。这个扩展的悲伤和空虚的时期自带的其他症状群，如疲劳，睡眠困难，萎缩食欲，暴饮暴食，突然哭了法术，有时自杀的念头。症状范围的严重程度和必须持续两周以上，以接收MDD诊断，虽然它比一个小插曲罕见只能维持这么短的时间。大多数人有六个月的症状到一年，有时，他们可以持续数年。

Without treatment, depression won’t fade away on its own. Even if you do white-knuckle it through your first episode of depression,你的另一复发的机会is more than 50 percent. If you’ve had two episodes, that chance shoots up to80％。Meaning, you’re going to want to deal with this sooner rather than later.

One hallmark of depression is an inability to experience pleasure, which is literally no fun. Losing interest in things you once enjoyed often means that your capacity to function at work and home takes a dive. In fact, depression is one of the leading causes of disability in the U.S., as 7.2% of Americans—17.7 million people—experience Major Depressive Disorder, each year.

Other Types of Depression

我们谈到MDD（又名抑郁症），但there are other types of depression。They include:

• 持续的抑郁症。这是抑郁症的一种慢性形式，旧称精神抑郁症。Sometimes people call it “high functioning” or “smiling” depression. While symptoms aren’t as severe as MDD, they last for two years orlonger。People with PDD might feel like they’ve always been depressed. (In cases of “double depression”人们自己平时慢性抑郁症的状态中体验MDD的严重发作。）
• Seasonal Affective Disorder (SAD).arou季节性抑郁症状开始和结束nd the same times every year. Most people get depressed in cold, dark winter, but some people’s mood plummets in summer.
• 经前烦躁症（PMDD）。在这里，抑郁症状绑在月经周期的黄体期，开始一周左右的时间段之前，只是你的时间后结束。虽然许多症状镜的PMS-irritability,high anxiety，frequent crying—they’re much more severe. They打断your ability to work, destroy personal relationships, and can lead to thoughts of self-harm and suicide. This condition was added in 2013 as a form of depression to the DSM-5, the official guide of mental disorders.
• Peripartum Depression.这种疾病的新妈妈通常开发生下几周内抑郁症和精神病，甚至症状。它曾经被称为postpartum depression许多人仍沿用互换。（在某些情况下，症状在怀孕期间开始;其他时间，当宝宝几个月老故名变化。）
• 围绝经期抑郁。在中年（具体而言，多年领导到绝经），人们遇到这种疾病具有典型的抑郁症状加perimenopause symptomslike hot flashes and night sweats.
• Substance/Medication-Induced Depressive Disorder.Substance abuse (alcohol, opiates, sedatives, amphetamines, cocaine, hallucinogens,etc.) or taking some medications, likecorticosteroidsorstatins，can trigger the symptoms of depression. If substance use (or withdrawal from using) is causing your symptoms, you may have this version of depression.
• Disruptive Mood Regulation Disorder.一个孩子这个少年障碍is性情乖戾的andbad-tempered大多数时候。They have severe, explosive outbursts with parents, teachers, and peers several times a week. Their overreactions are extreme and inconsistent with their developmental level.

萧条打击的人在32中位数年龄，但要记住，抑郁症可发生在任何人，在任何年龄，任何种族，性别或政治倾向是很重要的。每六个成年人一出将在其人生的某个时间出现抑郁症。幸运的是，抑郁症是可以治疗的。这就是为什么，在症状第一次暗示，它做一个心理健康专家预约，谁可以帮助确定是否有抑郁症是很重要的，如果是的话，哪种类型，以及最重要的是，它的治疗是适合您。

What Causes Depression?

You’re not going to like this answer, but no one knows for sure. That said, for the past few decades, the prevailing theory is that depressed people have an imbalance in their brain chemistry—more specifically, low levels ofneurotransmitters像去甲肾上腺素，肾上腺素和多巴胺，这有助于调节人的情绪，睡眠和新陈代谢。现在我们知道这是一个有点复杂多了。

某些情况下，把人放在抑郁症的风险较高，包括童年创伤，其他类型的精神疾病和慢性疼痛，或抑郁家族史的，但任何人都可以变得沮丧。

科学家通过几十年的研究通报认为，以下因素也你成为抑郁的风险，但他们不能证明因果关系。尽管如此，他们可以在抑郁症巨资发展发挥，所以要知道他们是非常重要的：

• Genetics.Research shows that具有一级亲属患有抑郁症(a parent, sibling, or child) makes you two-to-three times more likely to have depression tendencies.
• Traumatic life events from childhood,such as abuse or neglect.
• 环境压力，就像一个爱的人的死亡，杂乱离婚，或财务问题。
• Some medical conditions（例如，甲状腺功能低下，慢性疼痛）。每学，这些物理条件和抑郁症之间的关系是双向的，所以有鸡还是先有蛋的事怎么回事，因为他们互相喂对方。
• 某些药物，including some sedatives and blood pressure pills.
• Hormonal changes,像那些前来分娩和更年期。
• Gut bacteria.已经有一link在微生物和肠脑轴之间建立的，但它只是刚刚开始进行研究。

我有抑郁症的症状？

想知道你的感情是否有资格获得临床抑郁症？那些有经验的MDD或更多的以下症状五期间相同的两个星期内，以及至少一个必须抑郁情绪或快感的损失。这些症状会感到痛苦或影响日常运作。

1. Youfeel down大多数时候。
2. 你喜欢做的不再是东西给你带来快乐。
3. Significantweight loss (without dieting)or体重增加感觉还是一贯多少那么饿了或饿了than usual.
4. Having a很难入睡和保持睡眠或睡过头。
5. 思想的糖蜜般放缓，成为一个沙发土豆，或在床上消磨时间。（这应该是察觉别人，不烦躁不安或slothiness的只是主观感受。）
6. So. So. Tired. You’reso exhaustedyou can’t even.
7. Feeling worthless a lot of the time, even if you haven’t done anything wrong.
8. 作为超distracted, indecisive,and unable to concentrate.
9. 复发thoughts of death or suicide(with or without a specific plan to actually do it). If you need help for yourself or someone else, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

怎么做医生诊断抑郁症？

When you’re having a depressive episode, it might feel like you’re destined to feel terrible forever. That’s not true. It’s just what your depressed brain wants you to think. The hardest step is ignoring that feeling and making an appointment with a doctor and/or mental health professional, such as a psychologist or psychiatrist. A mental health professional is the only expert that can help you figure out if you are depressed.

Unfortunately, there’s no easy blood test that can determine if you have depression, though that would make diagnosis a lot easier. (Get on it, science!) TheDSM-5帮助医生做出与常见的症状有针对性的列表中调用。-期间快感两周内一个必须心情郁闷或损失 - 被诊断为抑郁症，患者必须经历五个以上的上述症状（见“我有抑郁症的症状是什么？”）。

Even if your symptoms match up to MDD, though, your doctor should rule out any underlying medical causes first. Some conditions, such as thyroid disease and vitamin deficiency, can mimic symptoms of depression. Next, consider any medications you’re currently taking.
If this sounds like you or someone you know, make an appointment with a mental health professional. Now. Don't wait! What's the worst thing that can happen? If you feel better by the time the appointment rolls around, you can always cancel it. If you don’t, you’ve saved yourself precious time (and unnecessary pain) by taking steps to managing your mental health.

What Are the Best Treatments for Depression?

不管你为什么要郁闷了，它获得治疗是很重要的条件开始侵蚀你的生活质量了。研究和调查表明，大多数成年人在美国谁抑郁症筛查阳性得不到治疗。不要成为其中之一。

随着科学家不断地散了理论有关的根本原因抑郁症，研究表明，最有效的治疗是心理治疗，药物治疗和改变生活方式的混合。这可能需要一个（令人沮丧长），而在不同的人不同的找到合适的配方-antidepressants工作，以便找到合适人选往往需要一些试验和错误。此外，心理健康专业人士与您合作会在你身边。他们不会放弃，你也不应该。一些可用的治疗方案是：

心理治疗

这并不意味着你会发现自己斜躺在沙发上，抱怨你和母亲的关系（尽管它可能）。精神病医生，心理学家，治疗师，或许可临床社会工作者可以使用多种技术来帮助改变消极思想，信仰或加剧你的忧郁，让你的世界似乎无望的行为。治疗的类型包括psychodynamic therapy，Cognitive Behavioral Therapy (CBT)，and人际关系治疗。

Medication

Your depression might require more than coaching.Doctors may prescribe medication includingantidepressants，情绪稳定和/或antipsychotic pillsin order to decrease the symptoms of depression. These include:

• SSRIs的（选择性血清素再摄取抑制剂）like Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) andSNRIs (serotonin and norepinephrine reuptake inhibitors)like Cymbalta (duloxetine) and Effexor XR (venlafaxine) make neuro-transmitters serotonin and norepinephrine already existing in the brain more available.
• TCAs (tricyclic antidepressants)like Tofranil (imipramine) and Norpramin (desipramine) andMAOIs (monoamine oxidase inhibitors)like Emsam (selegiline) and Marplan (isocarboxazid) are first-generation antidepressants that work similarly on neuro-transmitters, but they’re used less often because of unpleasant side effects.
• Doctors may also use非典型抗抑郁药如耐烟盼或安非他酮(安非他酮)或Remeron (mirtazapine) that affect serotonin, norepinephrine, and dopamine levels in ways unique from other anti-depression drugs. Or they may add非典型抗精神病药物，又名第二代抗精神病药等思瑞康（喹硫平），或阿立（阿立哌唑）。他们是“非典型”的，因为它们会影响多巴胺等神经递质没有身体的副作用，如抽搐和震颤，即第一代抗精神病药物可引起。

Brain Stimulation

对于treatment-resistant depression不得到耗尽心理治疗和多类抗抑郁药（SSRIs类药物等，并TCAS）后更好，有更多的铁杆选择。严重的抑郁症可以保证电惊厥疗法（ECT），which you might remember from飞越疯人院。不要害怕现代ECT是安全的，在麻醉下进行的，并且比你在电影里看到更积极。

There is alsorepetitive transcranial magnetic stimulation (rTMS)其中一些文档称之为“ECT精简版”。对于严重的抑郁症，一些人收到迷走神经刺激（VNS），外科植入物的作品有点像一个心脏起搏器，发送电脉冲到大脑。

Other Treatment Approaches

这些可能包括：

• 对于严重的，treatment-resistant depression，美国FDA最近批准esketamine，喷鼻剂基础上，党的药物/麻醉剂氯胺酮。Experts say it works by kicking up production of谷氨酸，a neurotransmitter that helps prompt the brain to form new neural connections.
• 在悲伤季节性抑郁症（SAD）can be alleviated with melatonin-regulating光疗。
• Postpartum depression may be treated withBrexanolone(Zulresso), an IV version of the body’s own neurosteroid allopregnanolone.
• Research shows thatlifestyle changeslike incorporating行使and mindfulness可以放大用药和治疗的结果。即使他们并非万无一失心情升降机，它绝不会伤害到建立有利于健康的程序。

Where Can I Find Depression-Related Communities?

The thing about depression is that it makes you want to roll yourself into a blanket burrito and never come out. But shutting out the world can make an already-bad situation worse by giving you free reign to neglect your needs, ruminate over your perceived flaws, and destroy any chance of forward momentum. Along with therapy and medication, finding supportive people—and connecting with them online and in real life—is a key part of taking care of yourself. Here's where to start.

顶部凹陷Instagrammers和博客

• Tonya Ingram,@tonyainstagram，tonyaingram.com

遵循这是因为：She has one hell of a way with words—after all, she is a poet and author. She also battles some pretty heavy stuff like depression, lives as a “lupus legend” (her words—we love) and is currently waiting on the sidelines for a kidney transplant. She takes it all day by day and shares how she gets out of bed, looks herself in the mirror, and figures out how to simply... survive.

• 斯科特Ste。Marie的，@depressiontoexpression，depressiontoexpression.com

遵循这是因为：Immediately, he sounds like someone you want to be friends with, someone whose vibe you want to channel. A former Twitter employee and now public speaker, Scott isn’t going to guide you on some path to a complete cure—nor is he going to sugarcoat the realities of living with depression. In order to overcome your demons, Scott believes you have to come to terms with the fact that sometimes life sucks, and that’s okay.

• Kevin Hines,@kevinhinesstory，kevinhinesstory.com

遵循这是因为：你知道的说：“那些杀不死你只让你更加坚强”？凯文·海因斯是活生生的证据。他是唯一的人永远生存在金门大桥自杀未遂。经过海狮让他漂浮，他是重生的人谁现在致力于他的生活，以确保您在这里的明天，这就是为什么他经常使用＃标签#beheretomorrow。

• 萝拉，吉娜和诺拉塔什和妮可ARGIRIS，@mytherapistsays，mytherapistsays.ca

遵循这是因为：有时来了深刻的暗洞的唯一出路是欢笑的通用语言。这些女孩（主要是家庭或像家人一样）创建表示真正的考验和生活在今天的社会化媒体出没的世界的苦难无尽的热闹模因。这一切的呢？所以，你知道，就像他们所说的那样，“你永远不会孤独，从来没有为batshit像你想象的。”

• 伤心女孩俱乐部，@sadgirlsclub

遵循这是因为：这不是你的鼓舞人心的报价和点头值得模因典型的卷轴 - 尽管，那些在洒了。大多数情况下，这种饲料经营的颜色的女性（包括创始人@elyse.fox)—gives you actual advice on how to cope with depression, especially in modern-day situations, like discussing mental health at work (hashtagawkward）。This feed gives you the ammo you need to shut down stigma.

• Kate Allan,@thelatestkate

遵循这是因为：一个nimals make everything better — especially when they’re paired with a quirky drawing and an all-too-familiar feeling. A wolf that speaks to your soul; a fox that gives you all the feels; and a bird who tells it like it is. Run by artist, author, and anxious human Kate, this page (and the cute animals that live there) is a feel-good must-follow.

• 哀伤的鬼俱乐部，@theofficialsadghostclub，thesadghostclub.com

遵循这是因为：Nathan, Lize, and Helen are besties—or, ghosties, as they refer to themselves—who came together to share life with mental illness from behind the computer screen. These ghosts don’t sugarcoat things, but they’re also not gloom and doom. You’ll be hooked on their graphics and positive (but not overly earnest) messages.

顶级抑郁症相关的播客

• The Hilarious World of Depression。Stand-up comedy meets a psych appointment when actors and comedians struggling with depression tell their (surprisingly funny) mental health stories to “professionally depressed” host John Moe.
• Terrible, Thanks for Asking。一个uthor Nora McInerny, who has dealt with depression, isn’t afraid to ask the awkward questions, as real listeners share their own tales of coping with grief, despair, and anxiety.
• Jen Gotch is OK...Sometimes。Ladyboss CEO and ban.do founder Jen Gotch gets vulnerable and real every week, sharing her struggles with mental health.
• 快乐与格蕾琴·鲁宾。这是毫不奇怪，笔者The New York TimesbestsellerThe Happiness Projecthas tons of suggestions to help you emerge from your sad cave, build positive habits, and create a happier outlook. Her slightly skeptical sister Elizabeth Craft keeps all that sunshine in check.
• 一个nthologies of Hope。You’re here, and you’re reading this, so that in itself proves that you haven’t given up hope. But it’s not just that youare在这里，它是why你在这里。该播客下潜更深成“为什么”，并试图把那个你的脑海里，而不是其他垃圾试图拉你下来。主持人里克Osowski，谁作战了抑郁症，带来了各种各样的客人进折谈谈自己的原因。

Top Depression Support Groups and Non-Profits

• 一个nxiety and Depression Association of America(ADAA). This nonprofit is dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders. Come here for new research, monthly webinars from mental health experts, educational infographics and stats, and a Find-a-Therapist database you can search by disorder. You can always find (free) support on the ADAA Online Peer-to-Peer Support Group orsupport groupiOS应用程序的iPhone。
• National Alliance on Mental Illness(NAMI)。这个非营利组织心理健康宣传组织p offering free education and support programs such as NAMI Peer-to-Peer (eight free sessions for adults with specific mental health conditions). You can also connect with other folks who have depression on this org’s online message boards and viaNAMI连接(use the site to find a weekly or monthly recovery group near you).
• Reddit, r/depression。Reddit is the hideously under-designed social website for anonymous users with a bad rep for attracting “incels” and “neckbeards.” The self-proclaimed “Front Page of the Internet” has memes, conspiracy theories, and thousands of communities called subreddits—and some of them are quite lovely. For example, the r/depression subreddit is over a decade old with more than half a million subscribers. In here, the vibe is all about empathy, support, and helpful feedback. (Arecent studyeven found that visiting the subreddit caused a “positive emotion change” in users.)
• Talkspace。More like “safe space.” It’s online, it’s private, and it’s “open” 24/7. Over 1 million people use Talkspace to get matched up with one of their 5,000+ licensed therapists and then message them...as much and as often as they’d like. There are different packages depending on your needs, but the instant feedback and comfort is pretty much priceless.
• Sad Girls Club。This is a nonprofit, an online community, and an Instagram handle (see above) focused on the millennial and Gen Z experience of mental illness (depression, anxiety, or something undiagnosed all count). They host meetups IRL where you can connect with similar people and try a cool twist on art therapy like a poetry slam or embroidery class.
• To Write Love on Her Arms (TWLOHA)。这不只是一个非营利性的 - 这是一个运动。在网上，在人的事件，通过社交媒体和博客，TWLOHA创造了希望和治疗通过抑郁，成瘾，自伤和自杀的地方。谁参加他们的活动，并加入这个社区有人说，他们已经感到转化。值得一试，啊？