Depression Archive

Stress can raise your risk of developing a substance use disorder. Here's how to get help when you need it.

In recent months, Americans' collective stress level has risen in response to the pandemic and economic fallout. Many people are looking for ways to help themselves feel better. Unfortunately, stress can trigger a number of unhealthy coping strategies — drinking alcohol to excess, bingeing on junk food, engaging in drug use, or other harmful behaviors. If you've ever had a substance use disorder, a bout of significant stress may even put your recovery at risk.

This is likely due to the shift the human brain makes in times of trauma. Instead of focusing on long-term goals, your brain zeroes in on short-term objectives.

Before taking pills for a temporary situation, consider the risks.

You might think that using an antidepressant temporarily could help you weather a challenging time, such as a period of grief, extreme stress, or serious illness. But you shouldn't just jump into taking an antidepressant, cautions Dr. Jane Erb, psychiatric director of the Behavioral Health Integration in Primary Care Program at Harvard-affiliated Brigham and Women's Hospital.

"There's no evidence that taking an antidepressant in the short term will help or that it will prevent longer-term consequences of stress, such as post-traumatic stress disorder," she says.

No single treatment—whether it's an antidepressant drug or a style of talk therapy—can ease depression in every case. However, research suggests you will improve your chances of getting relief if you combine drugs and therapy. One report that pooled findings from 25 studies found that adding psychotherapy to drug treatment was more helpful than medication alone in treating major depression. Earlier research suggested that one reason therapy and medication may complement each other is that they have different effects on the brain.

In addition to relieving depression, combination therapy may help ward off recurrences. A classic three-year study reported in JAMA tracked recurrences of major depression in about 200 people ages 60 or older. Of those who received monthly interpersonal therapy and who also took an antidepressant medication, 80% avoided a recurrence. In contrast, the same could be said for only 57% of those who received the drug alone, 36% of those given just interpersonal therapy, and a mere 10% in the placebo group.

Memory slips are aggravating, frustrating, and sometimes worrisome. When they happen more than they should, they can trigger fears of looming dementia or Alzheimer’s disease. But there are some treatable causes of forgetfulness.

Sharing your life experiences and wisdom with the younger generation can benefit both them and you.

Did you have someone in your life you looked up to? A role model who offered guidance and advice during your formative childhood years or early in your career? These mentors helped shape the person you became. Now is an ideal time to return the favor and become a mentor for a younger person.

"Many older adults have valuable insight and experience that can benefit the next generation as well as improve their own well-being in the process," says Dr. Shannon Scott-Vernaglia, director of pediatric residency training with Harvard-affiliated Massachusetts General Hospital, who leads the hospital's mentorship program. "Mentorship can be a wonderful gift for everyone involved."

There is evidence that antidepressants are not effective in older people with dementia. Emerging research suggests that nondrug, psychosocial interventions are the most effective treatments for depression or anxiety in older adults with cognitive impairment.

Shifts in the levels of female hormones can cause temporary mood changes, including symptoms of depression.

The years leading up to menopause and the transition itself can bring changes to your body. But they can also have an effect on your mind, specifically your mental health.

The incidence of depression doubles during this time. Women who have struggled in the past with depression or anxiety might also see a resurgence in symptoms.

Ask the doctors

Q. Every winter I experience mood changes. How do I know if it's seasonal affective disorder?

A. Seasonal affective disorder (SAD) is a type of depression that typically affects individuals during the winter months. Some experts believe it's triggered by a reduction in natural light, which starts in the fall and continues until the spring. Tracking your mood changes can help your doctor determine if you have the condition. People formally diagnosed with SAD experience episodes of major depression that occur in the fall and winter for at least two years. During these episodes, people may feel hopeless or worthless, have sleep problems, or experience changes in appetite or weight. They may also be irritable or anxious and lose interest in favorite activities.

It's not clear that supplements are effective, but some evidence is encouraging.

Some people are wary of taking antidepressants to treat their mild or moderate depression. They may not want to deal with the hassle of prescriptions, the costs, the potential side effects (such as sexual dysfunction), or the worry that medication treatment could mean an endless commitment.

There are many medications that can be used to treat mood disorders. But finding the right one can be a lengthy process, and the choice can be more complicated than you might imagine. Just because a particular drug worked for a friend doesn't mean it will work for you. Psychiatrists and doctors who prescribe antidepressants choose a particular drug and dosage based on many factors, including the following:

• Diagnosis. Certain drugs are a better choice for specific symptoms and types of depression. For example, an antidepressant that makes you sleepy may be better when insomnia is an issue. The severity of your illness or the presence of anxiety, obsessions, or compulsions may also dictate the choice of one drug over another.
• Side effects. You may first want to choose a drug based on which side effect you most want to avoid. Medications vary in the likelihood they will cause such problems as sexual effects, weight gain, or sedation.
• Age. As you age, your body tends to break down drugs more slowly. Thus, older people may need a lower dose. For children, only a few medications have been studied carefully.
• Health. If you have certain health problems, it's best to avoid certain drugs. For example, your doctor will want to consider factors such as heart disease or neurological illnesses when recommending a drug. For this reason, it's important to discuss medical problems with a primary care doctor or psychiatrist before starting an antidepressant.
• Medications, supplements, and diet. When combined with certain drugs or substances, antidepressants may not work as well, or they may have worrisome or dangerous side effects. For example, combining an SSRI or another antidepressant with the herbal remedy St. John's wort can boost serotonin to dangerous and, in rare cases, fatal levels. Mixing St. John's wort with other drugs—including certain drugs to control HIV infection, cancer medications, and birth control pills—might lower their effectiveness. Women receiving tamoxifen for breast cancer should take an antidepressant that does not interfere with tamoxifen's effectiveness. Eating certain foods, such as aged cheeses and cured meats, while taking an MAOI can cause a dangerous rise in blood pressure.
• Alcohol or drugs. Alcohol and other substances can cause depression and make antidepressants less effective. Doctors often treat alcohol or drug addiction first if they believe either is causing the depression. In many instances, simultaneous treatment for addiction and depression is warranted.
• Personal and family mental health and medication history. If you or a member of your family has had a good response to a medication in the past, that information may guide your choice. Depending on the nature and course of your depression (for example, if your depression is long-lasting or difficult to treat), you may need a higher dose or a combination of drugs. This may also be true if an antidepressant has stopped working for you, which may occur after you've used it for some time or after you've stopped and restarted treatment with it.
• Cost. Since all antidepressants are roughly equivalent in their effectiveness, you won't lose anything by trying a generic version first.
• Your preference. Once you have learned as much as you can about the treatment options, your doctor will want to know what approach makes most sense given your lifestyle, your interests, and your judgment.

To learn more strategies for battling depression, check out Understanding Depression, a Special Health Report from Harvard Medical School.