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JAMA Patient Page
June 18, 2003


JAMA. 2003;289(23):3198. doi:10.1001/jama.289.23.3198

A person who feels sad all the time, has unexplained crying spells, or loses interest in usual activities may have major depression, a serious medical illness that should be distinguished from normal temporary feelings of sadness after a loss, such as the death of a relative or friend. Major depression affects 14 million persons in the United States each year. The June 18, 2003, issue of JAMA is a theme issue devoted to articles about depression.

Symptoms of major depression

Having at least 5 of these symptoms occurring nearly every day for at least 2 weeks:

  • Feeling sad or empty

  • Decreased interest or pleasure in activities

  • Appetite change with weight loss or weight gain

  • Decreased or increased sleeping

  • Fatigue or loss of energy

  • Feeling worthless or guilty

  • Being either agitated or slowed down

  • Difficulty thinking or concentrating

  • Recurrent thoughts of death or suicide

Other types of depression

  • Bipolar disorder (previously called manic-depressive disorder)—occurrence of episodes of major depression and episodes of abnormally elevated mood called mania (severe) or hypomania (less severe)

  • Dysthymia—mild depression symptoms lasting for at least 2 years

  • Postpartum depression—depression occurring after the birth of a baby

  • Seasonal affective disorder—major depression occurring regularly in seasons with low sunlight

Treatments for depression

  • Medications
    Several types of antidepressant medications have been shown to be effective for depression, but they must be taken for several weeks before they begin to work.

  • Psychotherapy
    Several kinds of "talking therapies" have also been shown to be effective for depression. They involve evaluating and changing the thoughts, attitudes, and relationship problems that are associated with depression.

  • Bright light
    Daily exposure to bright light can be helpful for seasonal depression.

  • Electroconvulsive therapy
    A series of treatments involving passage of electric current through the brain while the patient is asleep from an anesthetic medication can often relieve even severe depression. These treatments are usually given about 3 times per week for several weeks.

Anyone who is experiencing symptoms of depression should be evaluated by a doctor. Although individuals with depression often feel that nothing can help them, effective treatments are available. Evaluation and treatment are particularly important to prevent suicide. Suicide usually stems from depression.

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on postpartum depression was published in the February 13, 2002, issue; one on electroconvulsive therapy was published in the March 14, 2001, issue; one on adolescent suicide was published in the December 26, 2001, issue; and one on psychiatric illness in older adults was published in the June 7, 2000, issue.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.

Sources: American Psychiatric Association, National Institute of Mental Health, Depression and Bipolar Support Alliance, National Mental Health Association