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NIH MedlinePlus the Magazine, Trusted Health Information from the National Institutes of Health


"Depression Can Disguise Itself…"—But There Is Help

Mayada Akil, M.D.

Mayada Akil, M.D., directs the Mood and Anxiety Disorders Clinic at Georgetown University.
Photo: Courtesy Mayada Akil

Depression is a common but serious medical illness. It's more than just a feeling of being "down in the dumps" or "blue" for a few days. Depression, in all its forms, affects as many as 20 million Americans. Most who experience it need treatment to get better. Although help is available, many depressed people never seek it.

Mayada Akil, M.D., is a professor of Psychiatry at Georgetown University, in Washington, DC, and a Senior Advisor to the Director of the National Institute of Mental Health (NIMH), part of the National Institutes of Health, in Bethesda, Md. She spoke with NIH MedlinePlus Magazine Coordinator Christopher Klose about the need to recognize and be treated for depression. The disorder affects over 20 million Americans.

What are the signs of depression?

Sadness or inability to enjoy things are hallmarks of depression. It also affects sleep, appetite, and concentration. But depression can disguise itself. It is common for people to go to their healthcare providers complaining of insomnia, fatigue, and various aches and pains. These are very real symptoms but the underlying cause can be depression.

What is depression and how does it affect us?

Depression is a brain disorder that shows itself in both psychological and physiological ways. It affects our emotions, thinking, and behavior. It impacts our relationships, at home and at work, our happiness, well being, and health. It is a major cause of disability, and the increased risk of suicide, of course, is a big concern.

"I can remember it started with a loss of interest in basically everything that I like doing. I just didn't feel like doing anything. I just felt like giving up. Sometimes I didn't even want to get out of bed."

–Rene R., retired police officer

"You don't have any interest in thinking about the future, because you don't feel that there is going to be any future."

–Shawn C., competitive diver

"Your tendency is just to wait it out, you know, let it get better. You don't want to go to the doctor. You don't want to admit to how bad you're really feeling."

–Paul Gottlieb, publisher

What's the difference between feeling "blue" and being depressed?

Everyone feels "blue" or down in the dumps at times. That's normal. Clinical depression is marked by longer duration, severity, and it affects function. It is important to learn more about depression if you suspect that you or a loved one may have it.

How can someone learn about depression?

A good place to start is the National Institute of Mental Health. I give my patients very informative, easy-to-read pamphlets on depression from NIMH. They have an excellent Web site (, with information in English and Spanish.

What should people with depression do?

Seek treatment. Don't wait. Depression is very treatable. So often, people blame themselves for feeling the way they do. And they worry about the social stigma attached to depression. Studies show that people wait far too long before seeking help; an average of eight years! Seeking treatment can prevent a great deal of unnecessary suffering and disability.

What should people tell their doctors?

People need to talk to their primary healthcare providers about all their symptoms, physical and emotional. They need to make sure that the provider takes the time to listen. Sometimes there are medical conditions that cause depression, such as hypothyroidism, and those should be ruled out. If depression is diagnosed, the healthcare provider may choose to treat the patient or send the patient to a specialist, depending on the situation.

Are you hopeful that a cure for depression may be found some day?

I am very hopeful that there will be breakthroughs in the treatment of depression in my lifetime. Many of the medicines we've been using were discovered to be effective for depression by chance. Now we're seeking new, more targeted treatments thanks to research into what happens in the brains of people with depression. Some of these treatments are showing great promise. I am also excited about research that will help us select the right treatment for each individual. This is an exciting time in brain research, and it can only benefit our patients.

Read More "Depression" Articles

"Depression Can Disguise Itself…" —But There Is Help / Working It Out / Do You Have Major Depression? / When Medication Is Prescribed

Fall 2009 Issue: Volume 4 Number 4 Pages 16 - 17