Chronic Myofascial Pain

What is chronic myofascial pain?

Most people have muscle pain from time to time. But chronic myofascial pain is a kind of ongoing or longer-lasting pain that can affect the connective tissue (fascia) of a muscle or group of muscles. With myofascial pain, there are areas called trigger points. Trigger points are usually in fascia or in a tight muscle.

Myofascial pain often goes away with treatment.

What causes chronic myofascial pain?

Experts don't know exactly what causes chronic myofascial pain. It may start after:

Strain or injury to the muscles, ligaments, or tendons.
Using a muscle after you haven't used it for a while, such as after a stroke or after having a broken bone.

What are the symptoms?

The main symptom of chronic myofascial pain is ongoing or longer-lasting muscle pain, in areas such as the low back, neck, shoulders, and chest. You might feel the pain or the pain may get worse when you press on a trigger point. The muscle may be swollen or hard—you may hear it called a "taut band" of muscle or "knot" in the muscle. Symptoms of myofascial pain may include:

A muscle that is sensitive or tender when touched.
Muscle pain that happens with pressure on a trigger point.
Pain that feels like aching, burning, stinging, or stabbing.
Reduced range of motion in the affected area.
A feeling of weakness in the affected muscle.

People with chronic myofascial pain may have other health problems, such as tension headaches, depression, sleep problems, and fatigue. These problems are common in people who have chronic pain.

How is chronic myofascial pain diagnosed?

To diagnose chronic myofascial pain, your doctor will ask if you have had a recent injury, where the pain is, how long you have had the pain, what makes it better or worse, and if you have any other symptoms.

The doctor will also give you a physical examination. He or she will press on different areas to see if the pressure causes pain.

You may have tests to see if some other condition is causing your pain.

How is it treated?

Talk to your doctor about the best way to treat your pain. The main treatment may include any of the following:

Cognitive-behavioural therapy (CBT). Cognitive-behavioural therapy can teach you how to change your negative thoughts about pain. This can also help you be more active.
Cooling spray. This involves using a cooling spray (such as Biofreeze) directly on the skin from the trigger point to the painful area and then gently stretching the muscle. This may be repeated several times.
Hypnosis. Hypnosis may help you relax and reduce your pain.
Massage therapy.
Physiotherapy, which may include stretching and strengthening exercises. It may also include counselling about how to change the things that make the pain worse. For example, you may learn how to adjust your workstation, improve your posture, or change your sleep position to avoid muscle tension.
Trigger point shots (injections). A doctor inserts a needle into the trigger point and injects medicine such as a local anesthetic.
Transcutaneous electrical nerve stimulation (TENS).
Ultrasound.

Your doctor may also recommend non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. These medicines may help with your symptoms. Be safe with medicines. Read and follow all instructions on the label.

Sometimes doctors prescribe certain antidepressants or muscle relaxants that help relax muscles and relieve sleep problems related to myofascial pain.

Rhabdomyolysis

What is rhabdomyolysis?

Rhabdomyolysis (say "rab-doh-my-AH-luh-suss") is a rare but serious muscle problem. When you have it, your muscle cells break down, or dissolve. The contents of those cells leak into the blood. When it's in the blood, that material can travel to various parts of the body and cause problems.

If left untreated, this condition can be life-threatening. But when it's treated right away, most people make a full recovery.

What causes rhabdomyolysis?

Rhabdomyolysis can be caused by a variety of problems, such as:

Severe muscle injury.This might be caused by prolonged pressure on muscle tissue, heat exhaustion, extreme physical exertion, seizures, or electrical burns.
Medicines.Medicines that can cause this problem include:
- Statins. These are medicines used to treat high cholesterol.
- Salicylate. This is a form of aspirin that is found in Pepto-Bismol. It's also in some medicines used to reduce fever, pain, and inflammation such as in arthritis.
- Gemfibrozil. This is a medicine used to treat high cholesterol.
- Corticosteroids. This is a group of medicines used to treat or prevent inflammation.
- Phenytoin. This is used to prevent and control seizures.
Toxins.Toxins are substances that are poisonous, such as alcohol, cocaine, hornet stings, snakebite, and carbon monoxide.
Certain infections. This includes salmonella, the flu, Legionnaires' disease, and some blood infections.

What are the symptoms?

Early symptoms are often hard to notice. Symptoms include:

Weak muscles.
Pain.
Stiffness.
Fever.
Nausea.
Dark-coloured urine.

How is rhabdomyolysis diagnosed?

Your doctor will ask questions about your symptoms and past health and do a physical examination. The diagnosis is confirmed with blood and urine tests.

How is it treated?

Most people need to be treated in the hospital. If possible, the doctor will stop the cause of muscle cell death. The doctor will take steps to protect your organs. You may have to stop taking certain medicines if they are the cause of the problem.

You will also get treatment to help the kidneys remove the toxins from your blood. This includes getting plenty of fluids. You may get fluids through a vein (by IV). If your kidneys are badly damaged, you may also need dialysis.

How can you prevent it from coming back?

Follow your doctor's advice to stop taking any medicines that may have helped cause the problem.
Fluids help your kidneys filter out substances that can cause problems. Make sure you're getting enough fluids, especially:
- After strenuous exercise.
- After any condition that may have damaged your skeletal muscles. These are muscles that help you move, walk, and lift.

If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.

Degenerative Disc Disease

What is degenerative disc disease?

Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).

The changes in the discs can result in back or neck pain and/or:

Osteoarthritis, the breakdown of the tissue (cartilage) that protects and cushions joints.
Herniated disc, an abnormal bulge or breaking open of a spinal disc.
Spinal stenosis, the narrowing of the spinal canal, the open space in the spine that holds the spinal cord.

These conditions may put pressure on the spinal cord and nerves, leading to pain and possibly affecting nerve function.

What causes degenerative disc disease?

As we age, our spinal discs break down, or degenerate, which may result in degenerative disc disease in some people. These age-related changes include:

The loss of fluid in your discs. This reduces the ability of the discs to act as shock absorbers and makes them less flexible. Loss of fluid also makes the disc thinner and narrows the distance between the vertebrae.
Tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jelly-like material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments.

These changes are more likely to occur in people who smoke cigarettes and those who do heavy physical work (such as repeated heavy lifting). People who are obese are also more likely to have symptoms of degenerative disc disease.

A sudden (acute) injury leading to a herniated disc (such as a fall) may also begin the degeneration process.

As the space between the vertebrae gets smaller, there is less padding between them, and the spine becomes less stable. The body reacts to this by constructing bony growths called bone spurs (osteophytes). Bone spurs can put pressure on the spinal nerve roots or spinal cord, resulting in pain and affecting nerve function.

What are the symptoms?

Degenerative disc disease may result in back or neck pain, but this varies from person to person. Many people have no pain, while others with the same amount of disc damage have severe pain that limits their activities. Where the pain occurs depends on the location of the affected disc. An affected disc in the neck area may result in neck or arm pain, while an affected disc in the lower back may result in pain in the back, buttock, or leg. The pain often gets worse with movements such as bending over, reaching up, or twisting.

The pain may start after a major injury (such as from a car crash), a minor injury (such as a fall from a low height), or a normal motion (such as bending over to pick something up). It may also start gradually for no known reason and get worse over time.

In some cases, you may have numbness or tingling in your leg or arm.

How is degenerative disc disease diagnosed?

Degenerative disc disease is diagnosed with a medical history and physical examination. Your doctor will ask about your symptoms, injuries or illnesses, any previous treatment, and habits and activities that may be causing pain in the neck, arms, back, buttock, or leg. During the physical examination, he or she will:

Check the affected area's range of motion and for pain caused by movement.
Look for areas of tenderness and any nerve-related changes, such as numbness, tingling, or weakness in the affected area, or changes in reflexes.
Check for other conditions, such as fractures, tumours, and infection.

If your examination reveals no signs of a serious condition, imaging tests, such as an X-ray, are unlikely to help the diagnosis. Imaging tests may be considered when your symptoms develop after an injury, nerve damage is suspected, or your medical history suggests conditions that could affect your spine, such as bone disease, tumours, or infection.

How is it treated?

To relieve pain, put ice or heat (whichever feels better) on the affected area. Ask your doctor if you can take acetaminophen (such as Tylenol) or non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen. Your doctor can prescribe stronger medicines if needed. Be safe with medicines. Read and follow all instructions on the label.

If you develop health problems such as osteoarthritis, a herniated disc, or spinal stenosis, you may need other treatments. These include physiotherapy and exercises for strengthening and stretching the back. In some cases, surgery may be recommended. Surgery usually involves removing the damaged disc. In some cases, the bone is then permanently joined (fused) to protect the spinal cord. In rare cases, an artificial disc may be used to replace the disc that is removed.

Spinal Osteoarthritis (Degenerative Arthritis of the Spine)

What Is Osteoarthritis?

Osteoarthritis is also known as degenerative joint disease. It is a condition in which the protective cartilage that cushions the tops of bones degenerates, or wears down. This causes swelling and pain. It may also cause the development of osteophytes, or bone spurs.

What Is Osteoarthritis of the Spine?

Osteoarthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and lower back.

Sometimes, osteoarthritis produces spurs that put pressure on the nerves leaving the spinal column. This can cause weakness and pain in the arms or legs.

Who Gets Osteoarthritis of the Spine?

In general, osteoarthritis happens as people get older. Younger people may get it from one of several different causes:

injury or trauma to a joint
a genetic defect involving cartilage

For people younger than age 45, osteoarthritis is more common among men. After age 45, osteoarthritis is more common among women. Osteoarthritis occurs more often among people who are overweight. It also occurs more frequently in those who have jobs or do sports that put repetitive stress on certain joints.

What Are the Symptoms of Osteoarthritis of the Spine?

Osteoarthritis of the spine may cause stiffness or pain in the neck or back. It may also cause weakness or numbness in the legs or arms if it is severe enough to affect spinal nerves or the spinal cord itself. Usually, the back discomfort is relieved when the person is lying down.

Some people experience little interference with the activities of their lives. Others become more severely disabled. In addition to the physical effects, a person with osteoarthritis might also experience social and emotional problems. For instance, a person with osteoarthritis that hinders daily activities and job performance might feel depressed or helpless.

How Is Osteoarthritis of the Spine Diagnosed?

The best way to confirm a diagnosis of osteoarthritis is by X-ray. The doctor will take a medical history and perform a physical exam to see if the person has pain, tenderness, loss of motion involving the neck or lower back, or if symptoms are suggestive, signs of nerve involvement such as weakness, reflex changes, or loss of sensation.

The doctor may order certain tests to aid in the diagnosis of osteoarthritis of the spine. These tests include:

X-rays to look for bone damage, bone spurs, and loss of cartilage or disc; however, X-rays are not able to show early damage to cartilage.
Blood tests to exclude other diseases
Magnetic resonance imaging (MRI) to show possible damage to discs or narrowing of areas where spinal nerves exit

How Is Osteoarthritis of the Spine Treated?

In most cases, treatment of spinal osteoarthritis is geared toward relieving the symptoms of pain and increasing a person's ability to function. The goal is to have a healthy lifestyle.

Initial treatment may include losing weight if needed and then, for everyone, maintaining a healthy weight. It may also include exercise. Besides helping with weight management, exercise can also help:

increase flexibility
improve attitude and mood
strengthen the heart
improve blood flow
make it easier to do daily tasks

Some of the exercises associated with osteoarthritis treatment include swimming, walking, and water aerobics. Exercise may be broken down into the following categories:

Strengthening exercises. These exercises seek to make muscles that support the joints stronger. They work through resistance with the use of weights or rubber bands.
Aerobic exercises. These are exercises that make the heart and circulatory system stronger.
Range-of-motion exercises. These exercises increase the body’s flexibility.

Including rest periods in the overall treatment plan is necessary. But bed rest, splints, bracing, or traction for long periods of time is not recommended.

There are non-drug treatments available for osteoarthritis, including:

massage
acupuncture
heat or cold compresses, which refers to placing ice or heated compresses onto the affected joint (check with your doctor about which option, or which combination of heat and cold options, is best for you.)
transcutaneous electrical nerve stimulation (TENS) using a small device that emits electrical pulses onto the affected area
nutritional supplements

Pain medications may also be used to treat osteoarthritis. Over-the-counter products include acetaminophen (Tylenol).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are also available over-the-counter in certain strengths. Examples include aspirin, naproxen sodium (Aleve), and ibuprofen (Motrin or Advil). NSAIDs may have serious side effects. Those include heart attack, stroke, stomach irritation and bleeding, and less frequently, kidney damage.

Topical ointments and creams are also available to treat pain. They are applied to the skin in the area that hurts, but generally, these are not effective. Examples of topical drugs include Ben-Gay and Aspercreme.

Your doctor may also recommend prescription drugs to treat symptoms, as there are no medications that reverse the process. These may include prescription painkillers, mild narcotics, or injections of corticosteroids around the spinal column called epidural steroid injections. It is important to understand that these injections do not correct the underlying problem and are sometimes used without clear indication of long-term benefit. Oral steroids are not commonly used.

Most cases of spinal osteoarthritis can be treated without surgery, but surgery is sometimes performed. Spinal osteoarthritis is one of the causes of spinal stenosis, or narrowing of the spinal canal. In cases where bladder and bowel function is impaired, where the nervous system is damaged, or when walking becomes very difficult, surgery will likely be recommended.

Anxiety Disorders

What are anxiety disorders?

Anxiety disorders are mental illnesses. The different types of anxiety disorders include:

Phobias

A phobia is an intense fear around a specific thing like an object, animal, or situation. Most of us are scared of something, but these feelings don’t disrupt our lives. With phobias, people change the way they live in order to avoid the feared object or situation.

Panic disorder

Panic disorder involves repeated and unexpected panic attacks. A panic attack is a feeling of sudden and intense fear that lasts for a short period of time. It causes a lot of physical feelings like a racing heart, shortness of breath, or nausea. Panic attacks can be a normal reaction to a stressful situation, or a part of other anxiety disorders. With panic disorder, panic attacks seem to happen for no reason. People who experience panic disorder fear more panic attacks and may worry that something bad will happen as a result of the panic attack. Some people change their routine to avoid triggering more panic attacks.

Agoraphobia

Agoraphobia is fear of being in a situation where a person can’t escape or find help if they experience a panic attack or other feelings of anxiety. A person with agoraphobia may avoid public places or even avoid leaving their homes.

Social anxiety disorder

Social anxiety disorder involves intense fear of being embarrassed or evaluated negatively by others. As a result, people avoid social situations. This is more than shyness. It can have a big impact on work or school performance and relationships.

Generalized anxiety disorder

Generalized anxiety disorder is excessive worry around a number of everyday problems for more than six months. This anxiety is often far greater than expected—for example, intense anxiety over a minor concern. Many people experience physical symptoms too, including muscle tension and sleep problems.

Other mental illnesses

Some mental illnesses are no longer classified as anxiety disorders, though anxiety or fear is a major part of the illnesses.

Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder is made up of unwanted thoughts, images, or urges that cause anxiety (obsessions) or repeated actions meant to reduce that anxiety (compulsions). Obsessions or compulsions usually take a lot of time and cause a lot of distress.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder can occur after a very scary or traumatic event, such as abuse, an accident, or a natural disaster. Symptoms of PTSD include reliving the event through nightmares or flashbacks, avoiding reminders of the traumatic event, and feeling unsafe in the world, even when a person isn’t in danger.

Who do they affect?

Anxiety disorders can affect anyone at any age, and they are the most common mental health problem. Sometimes, anxiety disorders are triggered by a specific event or stressful life experience. Anxiety disorders may be more likely to occur when we have certain ways of looking at things (like believing that everything must be perfect) or learn unhelpful coping strategies from others. But sometimes there just doesn’t seem to be a reason.

What can I do about them?

Many people who experience an anxiety disorder think that they should just be able to ‘get over it’ on their own. Others may need time to recognize how deeply anxiety affects their life. However, anxiety disorders are real illnesses that affect a person’s well-being. It’s important to talk to a doctor about mental health concerns. Some physical health conditions cause symptoms of anxiety. A doctor will look at all possible causes of anxiety.

Normal, expected anxiety is part of being human. Treatment should look at reducing unhelpful coping strategies and building healthy behaviours that help you better manage anxiety.

Each anxiety disorder has its own specific treatments and goals, but most include some combination of the following strategies:

Counselling

An effective form of counselling for anxiety is cognitive-behavioural therapy (or ‘CBT’). CBT teaches you how your thoughts, feelings, and behaviours work together. A goal of CBT is to identify and change the unhelpful patterns of thinking that feed anxious thoughts. CBT can help you identify problem behaviours and replace them with helpful strategies. It’s often the first treatment to try for mild or moderate problems with anxiety.

Medication

Some people also find antianxiety or antidepressant medication helpful. Medication can help with the physical feelings of anxiety. It may also make anxious thoughts less frequent or intense, so it can be easier to learn helpful coping strategies. Some people take medication until their anxiety is controlled enough to try therapies like CBT.

Support groups

Support groups—in person or online—may be a good place to share your experiences, learn from others, and connect with people who understand.

Self-help strategies

Many different skills can help people manage anxiety, such as stress management, problem-solving, and relaxation. Mindfulness—developing awareness of the present moment without judgement—may also help. Practices that support wellness, such as eating well, exercising, having fun, and connecting with others, are also important.

How can I help a loved one?

Supporting a loved one who is experiencing an anxiety disorder can be difficult. You may not understand why your loved one feels or acts a certain way. Some people who experience an anxiety disorder feel like they have to do things a certain way or avoid things or situations, and this can create frustration or conflict with others. You may feel pressured to take part in these behaviours or adjust your own behaviours to protect or avoid upsetting a loved one. Support can be a delicate balance, but you should expect recovery—in time.

Here are some general tips.

Remind yourself that the illness is the problem—anger, frustration, or behaviours related to anxiety are nobody’s fault.
Be patient—learning and practicing new coping strategies takes time.
If your loved one is learning new skills, offer to help them practice.
Listen and offer support, but avoid pushing unwanted advice.
Set boundaries and seek support for yourself, if needed.
If other family members are affected by a loved one’s anxiety disorder, consider seeking family counselling.

Currently I Suffer From

Panic disorder

Social anxiety disorder

Generalized anxiety disorder

Obsessive-compulsive disorder (OCD)

Depression (major depressive disorder)

Overview

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, tearfulness, emptiness or hopelessness
Angry outbursts, irritability or frustration, even over small matters
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
Sleep disturbances, including insomnia or sleeping too much
Tiredness and lack of energy, so even small tasks take extra effort
Reduced appetite and weight loss or increased cravings for food and weight gain
Anxiety, agitation or restlessness
Slowed thinking, speaking or body movements
Feelings of worthlessness or guilt, fixating on past failures or self-blame
Trouble thinking, concentrating, making decisions and remembering things
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties or personality changes
Physical aches or pain
Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
Often wanting to stay at home, rather than going out to socialize or doing new things
Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Causes

It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
Abuse of alcohol or recreational drugs
Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

Excess weight or obesity, which can lead to heart disease and diabetes
Pain or physical illness
Alcohol or drug misuse
Anxiety, panic disorder or social phobia
Family conflicts, relationship difficulties, and work or school problems
Social isolation
Suicidal feelings, suicide attempts or suicide
Self-mutilation, such as cutting
Premature death from medical conditions

Prevention

There's no sure way to prevent depression. However, these strategies may help.

Take steps to control stress, to increase your resilience and boost your self-esteem.
Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
Get treatment at the earliest sign of a problem to help prevent depression from worsening.
Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

Diagnosis

Your doctor may determine a diagnosis of depression based on:

Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.
Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it's functioning properly.
Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.
DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Types of depression

Symptoms caused by major depression can vary from person to person. To clarify the type of depression you have, your doctor may add one or more specifiers. A specifier means that you have depression with specific features, such as:

Anxious distress — depression with unusual restlessness or worry about possible events or loss of control
Mixed features — simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy
Melancholic features — severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or sluggishness
Atypical features — depression that includes the ability to temporarily be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in the arms or legs
Psychotic features — depression accompanied by delusions or hallucinations, which may involve personal inadequacy or other negative themes
Catatonia — depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture
Peripartum onset — depression that occurs during pregnancy or in the weeks or months after delivery (postpartum)
Seasonal pattern — depression related to changes in seasons and reduced exposure to sunlight

Other disorders that cause depression symptoms

Several other disorders, such as those below, include depression as a symptom. It's important to get an accurate diagnosis, so you can get appropriate treatment.

Bipolar I and II disorders. These mood disorders include mood swings that range from highs (mania) to lows (depression). It's sometimes difficult to distinguish between bipolar disorder and depression.
Cyclothymic disorder. Cyclothymic (sy-kloe-THIE-mik) disorder involves highs and lows that are milder than those of bipolar disorder.
Disruptive mood dysregulation disorder. This mood disorder in children includes chronic and severe irritability and anger with frequent extreme temper outbursts. This disorder typically develops into depressive disorder or anxiety disorder during the teen years or adulthood.
Persistent depressive disorder. Sometimes called dysthymia (dis-THIE-me-uh), this is a less severe but more chronic form of depression. While it's usually not disabling, persistent depressive disorder can prevent you from functioning normally in your daily routine and from living life to its fullest.
Premenstrual dysphoric disorder. This involves depression symptoms associated with hormone changes that begin a week before and improve within a few days after the onset of your period, and are minimal or gone after completion of your period.
Other depression disorders. This includes depression that's caused by the use of recreational drugs, some prescribed medications or another medical condition.

Treatment

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Here's a closer look at depression treatment options.

Medications

Many types of antidepressants are available, including those below. Be sure to discuss possible major side effects with your doctor or pharmacist.

Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These drugs are considered safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).
Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
Atypical antidepressants. These medications don't fit neatly into any of the other antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).
Tricyclic antidepressants. These drugs — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and protriptyline (Vivactil) — can be very effective, but tend to cause more-severe side effects than newer antidepressants. So tricyclics generally aren't prescribed unless you've tried an SSRI first without improvement.
Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, typically when other drugs haven't worked, because they can have serious side effects. Using MAOIs requires a strict diet because of dangerous (or even deadly) interactions with foods ― such as certain cheeses, pickles and wines ― and some medications and herbal supplements. Selegiline (Emsam), a newer MAOI that sticks on the skin as a patch, may cause fewer side effects than other MAOIs do. These medications can't be combined with SSRIs.
Other medications. Other medications may be added to an antidepressant to enhance antidepressant effects. Your doctor may recommend combining two antidepressants or adding medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications also may be added for short-term use.

Finding the right medication

If a family member has responded well to an antidepressant, it may be one that could help you. Or you may need to try several medications or a combination of medications before you find one that works. This requires patience, as some medications need several weeks or longer to take full effect and for side effects to ease as your body adjusts.

Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of genetic tests (done by a blood test or cheek swab) may offer clues about how your body may respond to a particular antidepressant. However, other variables besides genetics can affect your response to medication.

Risks of abruptly stopping medication

Don't stop taking an antidepressant without talking to your doctor first. Antidepressants aren't considered addictive, but sometimes physical dependence (which is different from addiction) can occur.

Stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression. Work with your doctor to gradually and safely decrease your dose.

Antidepressants and pregnancy

If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk with your doctor if you become pregnant or you're planning to become pregnant.

Antidepressants and increased suicide risk

Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires all antidepressants to carry a black box warning, the strictest warning for prescriptions. In some cases, children, teenagers and young adults under age 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior, especially when starting a new medication or with a change in dosage. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact a doctor or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

Psychotherapy

Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. Psychotherapy is also known as talk therapy or psychological therapy.

Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy. Your mental health professional may also recommend other types of therapies. Psychotherapy can help you:

Adjust to a crisis or other current difficulty
Identify negative beliefs and behaviors and replace them with healthy, positive ones
Explore relationships and experiences, and develop positive interactions with others
Find better ways to cope and solve problems
Identify issues that contribute to your depression and change behaviors that make it worse
Regain a sense of satisfaction and control in your life and help ease depression symptoms, such as hopelessness and anger
Learn to set realistic goals for your life
Develop the ability to tolerate and accept distress using healthier behaviors

Alternate formats for therapy

Formats for depression therapy as an alternative to face-to-face office sessions are available and may be an effective option for some people. Therapy can be provided, for example, as a computer program, by online sessions, or using videos or workbooks. Programs can be guided by a therapist or be partially or totally independent.

Before you choose one of these options, discuss these formats with your therapist to determine if they may be helpful for you. Also, ask your therapist if he or she can recommend a trusted source or program. Some may not be covered by your insurance and not all developers and online therapists have the proper credentials or training.

Smartphones and tablets that offer mobile health apps, such as support and general education about depression, are not a substitute for seeing your doctor or therapist.

Hospital and residential treatment

In some people, depression is so severe that a hospital stay is needed. This may be necessary if you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves.

Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.

Other treatment options

For some people, other procedures, sometimes called brain stimulation therapies, may be suggested:

Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain to impact the function and effect of neurotransmitters in your brain to relieve depression. ECT is usually used for people who don't get better with medications, can't take antidepressants for health reasons or are at high risk of suicide.
Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven't responded to antidepressants. During TMS, a treatment coil placed against your scalp sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.