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Depression
Anxiety flare ups
Insomnia
Extreme fatigue
Lack of motivation
Feeling down
Feeling depressed for no reason
Poor concentration
I lost interest in everything
Perpetual sadness
Malaise
Lack of energy
Not seeing your symptoms? No worries!
Depression is a mental illness that leads to low mood, reduced energy levels, and changes in sleep. This affects everyday activities like attending school and work. As the condition worsens, patients might have suicidal thoughts. Although stress and past trauma can cause depression, it can take time to identify and address causes, and genetic factors may also be at play.
Your doctor may ask these questions to check for this disease:
Treatment typically involves a combination of counseling therapy, life changes, and medications (antidepressants). A strong support network is helpful, as the recovery process can take months or even years.
Reviewed By:
Weston S. Ferrer, MD (Psychiatry)
Weston Ferrer is a physician leader, psychiatrist, and clinical informaticist based in San Francisco. With nearly a decade of experience in academia and more recent immersion in industry, he has made significant contributions to the fields of digital health, health tech, and healthcare innovation. | As an Associate Professor at UCSF, Weston was involved in teaching, leadership, and clinical practice, focusing on the intersection of technology and mental health. He recently led mental health clinical for Verily (formerly Google Life Sciences), where he applied his expertise to develop innovative solutions for mental healthcare using the tools of AI/ML, digital therapeutics, clinical analytics, and more.. | Weston is known for his unique ability to innovate and support product development while bringing pragmatism to technology entrepreneurship. He is a strong advocate for patient-centered care and is committed to leveraging technology to improve the health and well-being of individuals and communities. |
Yu Shirai, MD (Psychiatry)
Dr. Shirai works at the Yotsuya Yui Clinic for mental health treatment for English and Portuguese-speaking patients. He treats a wide range of patients from neurodevelopmental disorders to dementia in children and participates in knowledge sharing through the Diversity Clinic.
Content updated on Oct 18, 2024
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Ubie helped me obtain the right care I needed by its very detailed description of my symptoms and the possible conditions I could have. I was able to understand my symptoms before seeing a professional. The doctor is going to ask you for your symptoms, and I would've had a hard time describing them without Ubie. I had various symptoms such as forgetfulness, suicidal ideation, mania preceding a depressive episode, no motivation, feelings of grief, low self esteem, decreased energy levels, history of self harm, among others. I originally went to my doctor and she referred me to the psychiatrist. Ultimately, Ubie helped me find out what I don't know about myself, and that way I could get the help that I needed.
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Q.
Is Euthanasia the Right Choice? The Medical Reality and Approved Next Steps
A.
There are several factors to consider. Where it is legal, euthanasia or medical aid in dying is generally limited to incurable illness with persistent, unbearable suffering despite optimal treatment, requires clear decision-making capacity and voluntary, repeated requests, and is only considered after independent medical review and robust palliative and mental health care are offered. Approved next steps include talking with your doctor, requesting a palliative care consult, getting a mental health evaluation, learning your local legal requirements, and involving trusted supports; see below for safeguards, alternatives, and other important details that could change which actions you take.
References:
* Emanuel EJ, Onwuteaka-Philipsen BD, Fuks C, van der Heide A. Euthanasia and physician-assisted suicide in the Netherlands and Belgium: a comparison of the legal framework and practice. Lancet. 2022 Mar 5;399(10328):918-930. doi: 10.1016/S0140-6736(21)02392-7. Epub 2022 Jan 28. PMID: 35093155.
* Schuklenk U. Physician-assisted suicide, euthanasia, and the right to die. Philos Ethics Humanit Med. 2021 Mar 19;16(1):5. doi: 10.1186/s13010-021-00103-y. PMID: 33741031; PMCID: PMC7977054.
* Gligorov VI, Mihai A, Arendt J, Cirstescu A. Medical Euthanasia: A Literature Review. Maedica (Bucur). 2023 Sep;18(3):704-708. doi: 10.26574/maedica.2023.18.3.704. PMID: 38222045; PMCID: PMC10784260.
* Kimbell B, Biondo M, Elshafey A, Kulkarni A. Palliative Care: An Alternative to Euthanasia. Cureus. 2022 Jul 23;14(7):e27192. doi: 10.7759/cureus.27192. PMID: 35991040; PMCID: PMC9309605.
* Materstvedt LJ. Euthanasia and physician-assisted suicide: are we witnessing a new human right or a deviation from sound medical practice? J Med Ethics. 2017 Mar;43(3):148-152. doi: 10.1136/medethics-2016-103554. Epub 2016 Nov 16. PMID: 27852654.
Q.
Why Do I Feel This Way? Postpartum Depression & Medically Approved Next Steps
A.
Postpartum depression is a common, treatable medical condition that can cause intense sadness, anxiety, irritability, numbness, or trouble bonding beyond the baby blues, often driven by hormonal shifts, sleep loss, and the stresses of new parenthood. There are several factors to consider. See below for medically approved next steps that can change what you do next, including when to seek urgent care for any thoughts of harming yourself or your baby and how doctors, therapy, medication, social support, and basic health strategies can help you recover.
References:
* Mughal, M. J., Hameed, M., & Ejaz, M. (2023). Postpartum depression: An update on diagnosis and management. *JPMA. The Journal of the Pakistan Medical Association*, *73*(6), 1164-1168.
* O'Hara, M. W., & Swain, A. M. (2023). Postpartum depression: A comprehensive review of current treatment options. *Clinical Psychology Review*, *106*, 102377.
* Lusskin, S. I., Chhabra, S. S., & Shiffman, E. L. (2022). Perinatal and Postpartum Depression: Pharmacologic and Nonpharmacologic Treatment Options. *Current Psychiatry Reports*, *24*(11), 741-755.
* Earl, C. M., Perino, P., & Dmochowska, K. (2023). Screening and Early Intervention for Postpartum Depression. *The Ochsner Journal*, *23*(2), 195-201.
* Cox, E. Q., & Zatzick, C. (2023). Postpartum Depression. *Primary Care: Clinics in Office Practice*, *50*(4), 743-755.
Q.
Feeling Constantly Down? Why Your Serotonin Is Low & Medical Next Steps
A.
Persistent low mood can involve low serotonin activity, but depression is rarely just one chemical issue; stress, poor sleep, nutrient gaps, hormonal shifts, medical conditions, and genetics often contribute. There is no reliable blood test for brain serotonin, so diagnosis is clinical, with doctors also checking thyroid and vitamin levels and treating with therapy, SSRIs or SNRIs, and targeted lifestyle changes. See below for step by step next moves, red flag symptoms that need urgent care, and practical tips on symptom tracking, screening tools, labs to request, and habits that can meaningfully support serotonin.
References:
* Moncrieff J, Cooper RE, Stockmann H, Amendola SM, Hannon J, Read J. The Serotonin Theory of Depression: A Scientific Reappraisal. Mol Psychiatry. 2022 Jul;27(7):1717-1721. doi: 10.1038/s41380-022-01661-0. Epub 2022 Jul 20. PMID: 35853683.
* Albert PR, Munafo M, Young SN. Serotonergic Mechanisms in Depression and Antidepressant Treatment: A Brief Review. J Clin Med. 2023 Aug 24;12(17):5490. doi: 10.3390/jcm12175490. PMID: 37628042; PMCID: PMC10488421.
* Krishnan R, Muneer A, Hussain H, Almas R, Rizvi SAH. Serotonin and Depression: The Past, Present, and Future of a Core Hypothesis. Neuropsychiatr Dis Treat. 2023 Oct 12;19:2237-2246. doi: 10.2147/NDT.S433306. PMID: 37837095; PMCID: PMC10577581.
* Svenningsson P, Ohman D, Traskman-Bendz L. The Mechanisms of Action of Antidepressants, With Emphasis on Their Effects on Serotonin Receptors and Intracellular Signaling Pathways. Front Psychiatry. 2022 Aug 4;13:955742. doi: 10.3389/fpsyt.2022.955742. PMID: 36015509; PMCID: PMC9390234.
* Dunlop BW. Tryptophan and Serotonin for Depression: A Review of the Evidence and Proposed Clinical Application. J Clin Psychiatry. 2021 Oct 21;82(6):21nr14022. doi: 10.4088/JCP.21nr14022. PMID: 34685375.
Q.
Is it Depression? Why Your Brain Is Shutting Down & Medical Next Steps
A.
There are several factors to consider: a brain that feels foggy or like it is shutting down can be depression if multiple symptoms such as persistent low mood, loss of interest, extreme fatigue, sleep or appetite changes, and poor concentration last 2 or more weeks and disrupt life, but thyroid disease, vitamin deficiencies, anemia, sleep problems, medications, and burnout can mimic it. Your next steps are to do a quick symptom check, book a medical and mental health evaluation to rule out other causes and discuss effective treatments like therapy and antidepressants, and seek urgent help for any thoughts of self harm. See the complete guidance below for key red flags, specific tests, and decision points that can change which path is right for you.
References:
* Malhi, G. S., & Mann, J. J. (2018). Major Depressive Disorder. *The Lancet*, *392*(10163), 2299-2312. https://pubmed.ncbi.nlm.nih.gov/30396860/
* Cuijpers, P., Noma, H., Karyotaki, E., Veldhuis, J., Ebmeier, K. P., & Cipriani, A. (2020). Major Depressive Disorder: A Clinical Review. *JAMA Psychiatry*, *77*(9), 987-996. https://pubmed.ncbi.nlm.nih.gov/32187067/
* Adell, A. (2020). Major depressive disorder: recent insights into the neurobiology and pharmacotherapy. *F1000Research*, *9*, F1000 Faculty Rev-270. https://pubmed.ncbi.nlm.nih.gov/32382343/
* Kautzky, A., & Kasper, S. (2020). Personalized medicine in psychiatry: Major depressive disorder as an example. *Neuropsychopharmacology*, *45*(1), 169-179. https://pubmed.ncbi.nlm.nih.gov/31597985/
* Haroon, E., Miller, A. H., & Sanacora, G. (2017). The Neurobiology of Depression: A Review of Current Concepts. *Current Topics in Behavioral Neurosciences*, *33*, 1-28. https://pubmed.ncbi.nlm.nih.gov/27848123/
Q.
Can’t Feel Joy? Why Your Brain Is Muting Pleasure & Medically Approved Next Steps
A.
Anhedonia is the loss of the ability to feel pleasure, often linked to depression and a blunted dopamine reward system, and it can also result from chronic stress, medical conditions like thyroid problems or Parkinson's disease, or medication effects. There are several factors and medical next steps to consider, from screening and a doctor evaluation to therapy, medication adjustments, and urgent help if you have thoughts of self harm; key signs, workup details, and actionable steps are explained below.
References:
* Liu, W., Xu, Q., Zhao, M., Chen, Z., & Luo, X. (2021). Anhedonia: An Overview of the Current Advances in Neurobiology and Treatment. *Translational Psychiatry*, *11*(1), 273.
* Zald, D. H., & Treadway, M. T. (2021). Anhedonia: A transdiagnostic symptom in search of a definition and common mechanisms. *Journal of Affective Disorders*, *294*, 610-618.
* Vrieze, E., Deldicque, L., & Schifano, F. (2021). The neurobiology of anhedonia: an update on preclinical and clinical research. *Current Opinion in Neurobiology*, *70*, 148-154.
* Rømer Thomsen, K. (2018). Anhedonia: A Conceptual and Research Review. *Dialogues in Clinical Neuroscience*, *20*(3), 187–197.
* Husain, M., & Roiser, J. P. (2017). Targeting reward circuitry to treat anhedonia. *Neuroscience & Biobehavioral Reviews*, *80*, 1-13.
Q.
Feeling Numb? Why Your Oxytocin is Low and the Medically Approved Next Steps
A.
Emotional numbness can stem from low oxytocin activity, but there are several factors to consider including depression, chronic stress, trauma, social isolation, and hormonal or medical conditions. See below to understand how oxytocin fits into the bigger picture. Medically approved next steps include seeing a clinician for screening and labs, treating underlying mood issues, and using evidence-based supports like safe touch and social connection, exercise, mindfulness, sleep optimization, and stress reduction. Intranasal oxytocin is not first line and is reserved for select cases with a specialist, and urgent care is needed for red flags like suicidal thoughts or sudden neurological changes, with complete details and a practical plan outlined below.
References:
* Quattrocki, E., & Friston, K. (2014). Oxytocin and anhedonia: A systematic review. *Neuroscience & Biobehavioral Reviews*, *47*, 359–373. https://pubmed.ncbi.nlm.nih.gov/25218732/
* Hurlemann, R., & Reiner, I. (2016). The role of oxytocin in human social and emotional processing: an update. *Current Opinion in Psychology*, *9*, 7–12. https://pubmed.ncbi.nlm.nih.gov/27045763/
* Gamer, M. (2020). Oxytocin and social emotion regulation: A systematic review. *Neuroscience & Biobehavioral Reviews*, *116*, 168–179. https://pubmed.ncbi.nlm.nih.gov/32688031/
* Lee, M. R., Hermans, E. J., & Domschke, K. (2020). Intranasal oxytocin in psychiatric disorders: A review of the efficacy and safety. *European Neuropsychopharmacology*, *31*, 1–13. https://pubmed.ncbi.nlm.nih.gov/31839446/
* Leng, G., & Ludwig, M. (2016). Oxytocin replacement therapy: current perspectives. *Current Opinion in Endocrinology, Diabetes and Obesity*, *23*(3), 209–215. https://pubmed.ncbi.nlm.nih.gov/27097203/
Q.
Still Struggling? How SSRIs Work and Your Medically Approved Next Steps
A.
SSRIs keep more serotonin available between brain cells to stabilize mood and anxiety, typically showing early improvement in 2 to 4 weeks and full effect by 6 to 8 weeks; if progress is limited, doctors may adjust the dose, switch or add medications, add therapy like CBT, and check for contributing issues such as thyroid or vitamin problems. There are several factors to consider. Side effects, timing for reassessment, avoiding abrupt stoppage, and urgent red flags like suicidal thoughts can change what you should do next; see the complete guidance below to understand your safest, medically approved options with your clinician.
References:
* Andrade C, Sharma E. Selective serotonin reuptake inhibitors (SSRIs): A review of their mechanism of action and clinical utility. Asian J Psychiatr. 2021 Apr;58:102643. doi: 10.1016/j.ajp.2021.102643. Epub 2021 Feb 20. PMID: 33647781.
* Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Takeshima N, Hammerton G, McGuinness LA, Tajika A, Davies S, de Vries YA, Stafee K, Saadat N, Honyashiki M, Ishigooka T, Nakagawa A, Nosè M, Purgato M, Takeshima M, Imai H, Leucht S, Efthimiou O. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018 Apr 7;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7. Epub 2018 Feb 21. PMID: 29477885; PMCID: PMC5889788.
* Ghasemi M, Sadeghirad B, Sadeghirad A, Dastgiri S, Hosseinifard H, Naderipour F, Vahidi R. Management of treatment-resistant depression: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 2023 Feb 1;322:18-36. doi: 10.1016/j.jad.2022.10.057. Epub 2022 Oct 28. PMID: 36308960.
* Elbe H, Genc H, Altunoz E, Yildirim I, Ozkan C. Nonpharmacological Approaches for the Management of Depression. Curr Neuropharmacol. 2022;20(9):1753-1763. doi: 10.2174/1570159X19666210928151523. PMID: 34583693; PMCID: PMC9632733.
* Pakhre A, Dhiraj A, Khan M, Kaur S, Grewal P, Verma D. Adverse effects of selective serotonin reuptake inhibitors: a systematic review of the literature. Cureus. 2023 Apr 1;15(4):e36997. doi: 10.7759/cureus.36997. PMID: 37131713; PMCID: PMC10151125.
Q.
Brain Fog? Why Your Serotonin is Muted + Medically Approved Steps
A.
Brain fog can reflect muted or dysregulated serotonin that disrupts sleep, stress response, and mood, but there are several factors to consider, including thyroid disease, iron or B12 or vitamin D deficiency, perimenopause, inflammation, sleep apnea, and medication effects. Medically approved steps include consistent sleep, morning sunlight, regular movement, balanced nutrition and gut care, therapy, and when appropriate clinician guided SSRIs, plus knowing red flags and which labs prompt a doctor visit; see below for the complete guidance, checklists, and safety cautions that could change your next steps.
References:
* Berger M, Gray JA, Roth BL. The Role of Serotonin in Cognition. Cell. 2009;138(6):1227-1237. doi:10.1016/j.cell.2009.09.007.
* Paul L, Mück S, Fendt M. The serotonin system in cognitive function and dysfunction. Prog Neurobiol. 2023 Feb;221:102377. doi: 10.1016/j.pneurobio.2022.102377. Epub 2022 Oct 11.
* Nierenberg J, Kordower JH, Dodiya HB. A potential role for tryptophan and serotonin in neuroinflammation-induced cognitive dysfunction. Brain Res Bull. 2021 Apr;170:1-12. doi: 10.1016/j.brainresbull.2021.02.004. Epub 2021 Feb 23.
* Tizabi Y, et al. Serotonin and dopamine systems in the brain: From neurodevelopmental disorders to psychiatric diseases. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jun 8;109:110255. doi: 10.1016/j.pnpbp.2021.110255. Epub 2021 Jan 18.
* Llopis N, et al. Pharmacological modulation of the serotonin 5-HT6 receptor improves cognitive dysfunction in neurodegenerative disorders. Br J Pharmacol. 2020 Jan;177(1):154-173. doi: 10.1111/bph.14856. Epub 2019 Oct 14.
Q.
Drowning in Fog? Why Venlafaxine Resets Your System + Medically Approved Next Steps
A.
Venlafaxine, an SNRI, can lift mental fog by restoring serotonin and norepinephrine balance, often improving energy, focus, and mood over 4 to 8 weeks. There are several factors to consider, including common side effects, blood pressure monitoring, and the need for a slow taper rather than stopping suddenly. For medically approved next steps, speak with a clinician to rule out other causes, discuss whether venlafaxine fits your history, and consider pairing medication with therapy while giving it adequate time. See the complete guidance below, including red flag symptoms that need urgent care and practical timelines that could change your next steps.
References:
* Torta R, Garetto S, Varetto A, Bellino S, Ziero D. Venlafaxine: a review of its use in the management of major depressive disorder. Drugs. 2009;69(16):2311-32. doi: 10.2165/11319760-000000000-00000. PMID: 19894762.
* Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson L, Ogawa Y, Takeshima N, Davies S, de Vries YA, Imai H, Saadat N, Tajika A, Yeung ASM, Ishigooka T, Nakagawa A, Cipriani F, McGuire H, Churchill R, Egger M, Ioannidis JP, Kennedy SH. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018 Feb 24;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7. Epub 2018 Feb 21. Erratum in: Lancet. 2018 Feb 24;391(10128):1356. PMID: 29486820.
* Wang SM, Han C, Lee SJ, Jun TY, Kim T, Lee JH, Pae CU. Effect of venlafaxine on cognitive function in depressed patients: a meta-analysis. J Clin Psychopharmacol. 2012 Oct;32(5):603-9. doi: 10.1097/JCP.0b013e3182672727. PMID: 22896677.
* Pijper C, Leong C, MacKechnie B, Banh HL, Halliday J, Kustra R, Heshka T. Systematic review and meta-analysis of venlafaxine withdrawal syndrome: Incidence and risk factors. J Clin Psychopharmacol. 2021 Jan/Feb;41(1):50-59. doi: 10.1097/JCP.0000000000001323. PMID: 33499709.
* Sheehan DV, Shiovitz TM, Rynn M, Sheehan KH. Venlafaxine extended-release in major depressive disorder: a review of its efficacy and safety. Expert Opin Pharmacother. 2020 Dec;21(18):2311-2326. doi: 10.1080/14656566.2020.1818222. Epub 2020 Oct 8. PMID: 33269389.
Q.
Feeling Detached? Why Your Brain Mutes Oxytocin & Medical Next Steps
A.
Feeling detached can reflect muted oxytocin signaling driven by chronic stress, depression, trauma, relationship strain or isolation, hormonal changes including thyroid issues, and some medical or neurological conditions. There are several factors to consider; see below for how oxytocin fits within broader brain chemistry and which symptoms point to an underlying disorder. Medical next steps include a primary care evaluation for thyroid and vitamin problems, mental health screening, evidence based therapy, and when appropriate medication, with urgent care if symptoms are severe or involve self harm thoughts; full step by step guidance and key red flags are outlined below.
References:
* Hurlemann, R., & Grinevich, V. (2019). Oxytocin and Social Cognition in Psychiatric Disorders: From Basic Science to Clinical Trials. Biological Psychiatry, 85(2), 101-112.
* Olff, M., Frijling, J. L., & van Zuiden, M. (2018). The Role of Oxytocin in Social Dysfunction: Animal Models and Human Studies. Current Topics in Behavioral Neurosciences, 35, 127-142.
* Grinevich, V., & Neumann, I. D. (2019). Oxytocin in the Neurobiology of Stress and Social Behavior: From Basic Mechanisms to Therapeutic Perspectives. Progress in Brain Research, 249, 1-24.
* Heinrichs, M., & Domes, G. (2020). Oxytocin and Vasopressin in Social Cognition: From Molecular Mechanisms to Therapeutic Potential. Current Topics in Behavioral Neurosciences, 45, 1-20.
* Guastella, A. J., & MacLeod, C. (2018). Translational potential of oxytocin in human social cognition. Trends in Cognitive Sciences, 22(1), 74-82.
Q.
Heavy Fog? Why Your Brain Is Stuck and How Lexapro Resets Calm + Next Steps
A.
That heavy, stuck brain fog often comes from depression or anxiety where serotonin signaling and stress circuits are dysregulated; Lexapro, an SSRI, can gradually rebalance these pathways to ease worry and lift mood, focus, and sleep over several weeks. There are several factors to consider for safe and effective use, including the expected timeline, common and urgent side effects, who should avoid it, how to start or taper, lifestyle and therapy supports, and what to do if it does not work; see the complete guidance below to choose the right next steps with a clinician.
References:
* Mazza, M., De Berardis, D., Mencacci, C., Marini, S., & Bria, P. (2012). The effects of escitalopram on cognitive functions in patients with major depressive disorder: a review. *Psychiatry and Clinical Neurosciences*, *66*(6), 466-476. https://pubmed.ncbi.nlm.nih.gov/23167448/
* Baune, B. T., & Renger, H. G. (2014). The effect of escitalopram on cognitive symptoms in major depressive disorder. *Current Medical Research and Opinion*, *30*(7), 1335-1345. https://pubmed.ncbi.nlm.nih.gov/24641470/
* Millan, M. J., Agid, Y., Brédart, S., Carlsson, A., Carvalho, A. F., Cicin-Sain, L., ... & Young, A. H. (2018). Cognitive dysfunction in psychiatric disorders: characteristics, causes and treatments. *Nature Reviews Drug Discovery*, *17*(2), 119-147. https://pubmed.ncbi.nlm.nih.gov/29199346/
* McIntyre, R. S., Best, H., Bowie, C. R., Florea, I., Loft, H., & Muller, N. (2013). The effects of escitalopram on cognitive function in patients with major depressive disorder and subjective cognitive complaints. *European Neuropsychopharmacology*, *23*(12), 1642-1651. https://pubmed.ncbi.nlm.nih.gov/23727096/
* Leonard, B. E. (2007). The HPA axis and the serotonin system: an overview. *European Neuropsychopharmacology*, *17*(Suppl 2), S85-S94. https://pubmed.ncbi.nlm.nih.gov/17382455/
Q.
Stuck in a Gray Loop? Why Fluoxetine Works + Expert-Approved Next Steps
A.
Fluoxetine works by increasing serotonin availability in the brain, which can lift low mood, energy, and interest; early improvements often appear in 2 to 4 weeks and fuller effects by 6 to 8 weeks, and it is a first-line, generally well tolerated option that can be even more effective with therapy. There are several factors to consider, including potential side effects, who should use caution, how long to stay on it, what to do if it is not enough, and expert-approved supports like sleep, gentle movement, social connection, and regular follow-ups; see below for important details that can shape your next steps and when to seek urgent care.
References:
* Dell'Osso, B., & Altamura, A. C. (2018). Fluoxetine: twenty years later. *Progress in Neuro-Psychopharmacology and Biological Psychiatry*, *83*, 168–175. PMID: 29559388.
* Preskorn, S. H., & Stanga, E. L. (2018). Serotonin selective reuptake inhibitors: mechanism of action and clinical implications. *Expert review of clinical pharmacology*, *11*(1), 17–26. PMID: 29199329.
* Fava, M., & Cassano, G. B. (2020). Treatment-resistant depression: Current insights and future directions. *Journal of Clinical Psychiatry*, *81*(2), 19nr13008. PMID: 32265538.
* Papakostas, G. I. (2016). Augmentation strategies in treatment-resistant depression. *Dialogues in clinical neuroscience*, *18*(4), 403–410. PMID: 27536284.
* Zafar, N., & Farhat, N. (2021). Pharmacological Management of Depression: A Narrative Review of Recent Guidelines. *Cureus*, *13*(5), e15132. PMID: 34160416.
Q.
Am I Depressed or Just Tired? The 30-45 Woman’s Guide & Next Steps
A.
For women 30 to 45, there are several factors to consider: ordinary tiredness has a clear cause and improves with rest, while depression often lasts 2 or more weeks and brings loss of interest, emotional heaviness, hopelessness, and fatigue that does not lift even after sleep. See below for crucial details that can change your next steps, including medical conditions to rule out, when to seek urgent help, and practical actions like using a symptom check, asking your doctor about labs and screening, and starting proven treatments.
References:
* Goyal M, Singh S, Singh M. Differentiating Major Depressive Disorder From Fatigue Syndromes. Psychiatr Ann. 2021 Oct 1;51(10):428-432. doi: 10.3928/00485713-20210901-01. PMID: 34658364.
* Gupta A, Shah P, Chawla J. Fatigue and depression: is there a difference? BMC Psychiatry. 2020 Oct 28;20(1):506. doi: 10.1186/s12888-020-02919-z. PMID: 33115456; PMCID: PMC7594911.
* Lee K, Han K, Lee J, Park H, Kim KS, Han SS. Prevalence and Factors Associated with Depressive Symptoms among Middle-Aged Women: A Community-Based Study. Int J Environ Res Public Health. 2021 Nov 28;18(23):12444. doi: 10.3390/ijerph182312444. PMID: 34886290; PMCID: PMC8657682.
* Slavich GM. Life Stress and Health: A Review of the Research, Mechanisms, and Implications. Annu Rev Clin Psychol. 2020 May 7;16:309-333. doi: 10.1146/annurev-clinpsy-071919-020843. Epub 2020 Mar 30. PMID: 32234033.
* Whelan-Morton EA, Vella CA, Johnson BT, King DK. Sleep, fatigue, and depression: a systematic review of the relationships between sleep duration, daytime fatigue, and depressive symptoms. Sleep Med. 2023 Jun;106:176-189. doi: 10.1016/j.sleep.2023.04.015. Epub 2023 May 8. PMID: 37169437.
Q.
Depression in Women 30-45: Recognizing the Signs & Your Next Steps
A.
Depression in women 30 to 45 is common; key signs lasting two weeks or more include persistent sadness or numbness, loss of interest, irritability, fatigue, sleep or appetite changes, trouble concentrating, and social withdrawal, often influenced by stress, hormonal shifts like postpartum or perimenopause, medical issues such as thyroid disorders, and past trauma. If these symptoms affect daily life, start with a self-assessment, then speak with a clinician for screening and possible labs, consider evidence-based therapy and, when appropriate, medication, and support recovery with sleep, movement, nutrition, reduced alcohol, and social connection; seek urgent help for any self harm thoughts. There are several factors to consider that can change the right next step for you, so see the complete guidance below.
References:
* pubmed.ncbi.nlm.nih.gov/34444985/
* pubmed.ncbi.nlm.nih.gov/32959648/
* pubmed.ncbi.nlm.nih.gov/35921764/
* pubmed.ncbi.nlm.nih.gov/33649692/
* pubmed.ncbi.nlm.nih.gov/34551381/
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Low Dopamine in Women: Symptoms & Your 5-Step Action Plan
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Low dopamine in women can present as low mood, loss of motivation or pleasure, brain fog, fatigue, sleep and libido changes, and cravings, often shifting around PMS, postpartum, perimenopause, or menopause. The 5-step plan centers on better sleep, daily movement, protein and key micronutrients, stress reduction, and medical evaluation for issues like depression, thyroid or iron problems, and other causes. There are several factors to consider, including when symptoms need urgent care, how estrogen affects dopamine, and what to know about supplements and medication interactions. See the complete guidance below to choose the safest next steps for your health.
References:
* Li H, Hueston CM, Becker JB. Sex Differences in Dopaminergic Systems and Circuits: Implications for Health and Disease. Neuropsychopharmacology. 2023 Feb;48(3):421-432. doi: 10.1038/s41386-022-01446-5. Epub 2022 Oct 13. PMID: 36229505; PMCID: PMC9868352.
* Munro CA, Becker JB. Sex Differences in Dopamine D2/3 Receptor Availability and Regulation: Implications for Reward and Related Disorders. Front Neuroendocrinol. 2021 Jan;60:100865. doi: 10.1016/j.yfrne.2020.100865. Epub 2020 Nov 27. PMID: 33249051; PMCID: PMC7772740.
* Lin TW, Kuo YM. Physical Activity and Brain Health: How Exercise Modifies the Dopaminergic System. Biomolecules. 2021 Apr 22;11(5):618. doi: 10.3390/biom11050618. PMID: 33923769; PMCID: PMC8146740.
* Briguglio M, Dell'Osso B, Pompili M, Demurtas L, De Filippis S, Serafini G, Amore M. Nutritional factors affecting the synthesis of neurotransmitters in the brain: a review. J Integr Neurosci. 2018 Mar;17(1):1-10. doi: 10.3233/JIN-170068. PMID: 29550772.
* Shansky RM, Li H. Sex Differences in the Neurobiology of Stress: Focus on Dopamine. Brain Sci. 2020 Oct 2;10(10):686. doi: 10.3390/brainsci10100686. PMID: 33020617; PMCID: PMC7601335.
Q.
Mental Health After 65: 7 Signs Every Woman Should Not Ignore
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For women over 65, the 7 mental health signs not to ignore are persistent sadness, loss of interest, significant sleep changes, increased anxiety, memory or thinking problems that affect daily life, social withdrawal, and thoughts that life has no purpose. There are several factors to consider, and the complete guidance below explains what each sign can look like, how they relate to physical health and medications, when to seek urgent care or talk to a doctor, and practical next steps and tools that can shape your healthcare journey.
References:
* Katon, W. J., O'Connor, P. J., & Rutter, C. M. (2020). Gender Differences in Symptomatology, Clinical Correlates, and Treatment of Depression: A Systematic Review. *Psychiatric Clinics of North America*, 43(1), 1–16.
* Pilling, S., Llewellyn-Jones, R., King, M., & National Institute for Health and Care Excellence (NICE) Guidelines Team. (2019). Anxiety disorders in older adults: recent advances and future directions. *The Lancet Psychiatry*, 6(4), 305–316.
* Carter, S., Hall, E., Mather, K. A., & Jorm, A. F. (2021). Sex differences in the clinical presentation of Alzheimer's disease: a systematic review. *The Lancet Healthy Longevity*, 2(4), e224–e234.
* Li, R. H., Yang, M., Jiang, T., Wei, D., Zhu, X. L., & Cai, C. H. (2020). Sleep disturbances and mental health in older adults: a systematic review. *Sleep Medicine Reviews*, 50, 101265.
* Lim, M. H., Yang, T., Kim, H., & Lee, S. K. (2021). Loneliness and Social Isolation as Risk Factors for Mental Health Problems in Older Adults: A Systematic Review and Meta-Analysis. *International Journal of Environmental Research and Public Health*, 18(19), 10115.
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Vraylar Over 65: Navigating Mental Health in Seniors
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For adults over 65, Vraylar may help with schizophrenia, bipolar I episodes, and as an add-on for major depression, but it requires careful use. There are several factors to consider, including the boxed warning in dementia-related psychosis, higher risks of movement symptoms, dizziness and falls, and metabolic changes; see details below. Doctors often start low and go slow, monitor weight, glucose, cholesterol, blood pressure, review other medications, and watch for delayed side effects since it stays in the body a long time; never stop it on your own and seek urgent care for severe confusion, fever with stiffness, fainting, or suicidal thoughts. Important nuances, alternatives, and what to discuss with your clinician are explained below to guide your next steps.
References:
* D'Souza, L., Alphs, L., Németh, G., Szatmári, L., & Pikalov, A. A. (2019). Safety and Tolerability of Cariprazine in Elderly Patients with Schizophrenia: A Post Hoc Analysis of Pooled Data. *CNS drugs*, *33*(9), 899-911.
* D'Souza, L., Pikalov, A. A., Lu, K., Szatmári, L., Németh, G., & Alphs, L. (2021). Efficacy and Safety of Cariprazine in Elderly Patients With Bipolar I Depression: A Post Hoc Analysis of Pooled Data. *Journal of Clinical Psychopharmacology*, *41*(5), 518-525.
* Krogmann, A., Szatmári, L., Németh, G., Kiss, B., & Pál, S. (2018). Pharmacokinetics of Cariprazine in Subjects with Mild, Moderate, or Severe Renal Impairment, and in Subjects with Moderate Hepatic Impairment. *Clinical Pharmacokinetics*, *57*(7), 847-858.
* Jeste, D. V., & Krystal, J. H. (2018). Antipsychotic Prescribing for Older Adults: An Update. *The American Journal of Psychiatry*, *175*(11), 1083-1090.
* Kim, E., Tingle, K. M., & Rusk, J. (2021). Cariprazine in the treatment of schizophrenia and bipolar disorder: A review of efficacy and safety in adult and older adult populations. *Expert Review of Neurotherapeutics*, *21*(10), 1099-1111.
Q.
Are natural supplements safe for depression?
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Natural supplements might help with depression, but their safety and effectiveness can vary. It's important to talk to a doctor before using them. See below to understand more.
References:
Yeung KS, Hernandez M, Mao JJ, Haviland I, & Gubili J. (2018). Herbal medicine for depression and anxiety - PubMed - NIH. Phytotherapy research : PTR, 29464801.
https://pubmed.ncbi.nlm.nih.gov/29464801/
Warnick SJ Jr, Mehdi L, & Kowalkowski J. (2021). Wait-there's evidence for that? Integrative medicine .... International journal of psychiatry in medicine, 34521233.
https://pubmed.ncbi.nlm.nih.gov/34521233/
Cauffield JS, & Forbes HJ. (1999). Dietary supplements used in the treatment of depression .... Lippincott's primary care practice, 10711131.
Q.
What is serotonin syndrome?
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Serotonin syndrome is a serious condition that happens when there is too much serotonin in the brain, often caused by certain medications. See below to understand more.
References:
Sporer KA. (1995). The serotonin syndrome. Implicated drugs .... Drug safety, 7576268.
https://pubmed.ncbi.nlm.nih.gov/7576268/
Mason PJ, Morris VA, & Balcezak TJ. (2000). Serotonin syndrome. Presentation of 2 cases and review .... Medicine, 10941349.
https://pubmed.ncbi.nlm.nih.gov/10941349/
Sun-Edelstein C, Tepper SJ, & Shapiro RE. (2008). Drug-induced serotonin syndrome: a review. Expert opinion on drug safety, 18759711.
Q.
What is the difference between depression and clinical depression?
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The terms "depression" and "clinical depression" are often used interchangeably, but they can refer to different concepts. Depression is a general term that encompasses a range of mood disorders, while clinical depression, also known as major depressive disorder (MDD), is a specific diagnosis characterized by more severe and persistent symptoms that significantly impair daily functioning.
References:
Bachmann GA, Rosen R, Arnold LD, Burd I, Rhoads GG, Leiblum SR, Avis N. Chronic vulvar and other gynecologic pain: prevalence and characteristics in a self-reported survey. J Reprod Med. 2006 Jan;51(1):3-9. PMID: 16482769; PMCID: PMC1388073.
National Collaborating Centre for Mental Health (UK). Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. Leicester (UK): British Psychological Society (UK); 2010. (NICE Clinical Guidelines, No. 91.) Appendix 12, The classification of depression and depression rating scales/questionnaires.
https://www.ncbi.nlm.nih.gov/books/NBK82926/
Chand SP, Arif H. Depression. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28613597.
Q.
Are there any facial signs of depression?
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Facial signs of depression can manifest as reduced facial expressions, changes in eye contact, and overall appearance. These signs can reflect the emotional state of an individual and may be noticeable to others.
References:
Lacerda KCD, Souza FCO, Araújo CRV, Mota BEF, Muñoz PMG, Berger W, Vilete L, Bearzoti E, Guerra Leal Souza G. High depressive symptomatology reduces emotional reactions to pictures of social interaction. Sci Rep. 2024 Jan 13;14(1):1266. doi: 10.1038/s41598-024-51813-1. PMID: 38219004; PMCID: PMC10787838.
Gehricke J, Shapiro D. Reduced facial expression and social context in major depression: discrepancies between facial muscle activity and self-reported emotion. Psychiatry Res. 2000 Aug 21;95(2):157-67. doi: 10.1016/s0165-1781(00)00168-2. PMID: 10963801.
Q.
What are the signs and symptoms of “smiling depression”? What are risk factors?
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"Smiling depression" refers to individuals who appear outwardly happy and functional while privately struggling with depressive symptoms. Recognizing the subtle signs, such as loss of interest or pleasure, changes in sleep and appetite, and persistent fatigue, is crucial for seeking help.
References:
Bhattacharya S, Laura Hoedebeck K, Sharma N, Gokdemir O, Singh A. “Smiling depression” (an emerging threat): Let’s Talk. Indian J Community Health [Internet]. 2019 Dec. 31 [cited 2024 Oct. 10];31(4):433-6.
https://www.iapsmupuk.org/journal/index.php/IJCH/article/view/1255
Zullino DF, Bancila V. You don't believe in a patient's depression? Watch the watch! Arch Psychiatr Nurs. 2008 Feb;22(1):50-1. doi: 10.1016/j.apnu.2007.04.005. PMID: 18207056.
Q.
What are some noticeable behavior changes in people with depression and anxiety?
A.
Both depression and anxiety are characterized by changes in appetite, declines in energy and motivation, as well as changes in work performance.
References:
Simon GE, Moise N, Mohr DC. Management of Depression in Adults: A Review. JAMA. 2024 Jul 9;332(2):141-152. doi: 10.1001/jama.2024.5756. Erratum in: JAMA. 2024 Sep 16. doi: 10.1001/jama.2024.18427. PMID: 38856993.
Szuhany KL, Simon NM. Anxiety Disorders: A Review. JAMA. 2022 Dec 27;328(24):2431-2445. doi: 10.1001/jama.2022.22744. PMID: 36573969.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Alexopoulos GS. Depression in the elderly. Lancet. 2005 Jun 4-10;365(9475):1961-70. doi: 10.1016/S0140-6736(05)66665-2. PMID: 15936426.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66665-2/fulltextZhang Y, Chen Y, Ma L. Depression and cardiovascular disease in elderly: Current understanding. J Clin Neurosci. 2018 Jan;47:1-5. doi: 10.1016/j.jocn.2017.09.022. Epub 2017 Oct 21. PMID: 29066229.
https://www.jocn-journal.com/article/S0967-5868(16)30628-2/fulltextWang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psychiatry. 2013 Oct-Dec;35(4):416-31. doi: 10.1590/1516-4446-2012-1048. Epub 2013 Dec 23. PMID: 24402217.
https://www.scielo.br/j/rbp/a/84pk6g6z4FVyGtkncK4m6XR/?lang=enHammen C. Risk Factors for Depression: An Autobiographical Review. Annu Rev Clin Psychol. 2018 May 7;14:1-28. doi: 10.1146/annurev-clinpsy-050817-084811. Epub 2018 Jan 12. PMID: 29328780.
https://www.annualreviews.org/doi/10.1146/annurev-clinpsy-050817-084811Greenberg J, Tesfazion AA, Robinson CS. Screening, diagnosis, and treatment of depression. Mil Med. 2012 Aug;177(8 Suppl):60-6. doi: 10.7205/milmed-d-12-00102. PMID: 22953442.
https://academic.oup.com/milmed/article/177/suppl_8/60/4345395