What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, theDiagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name “borderline personality disorder” is misleading, a more accurate term does not exist yet.

Most people who have BPD suffer from:

• Problems with regulating emotions and thoughts
• Impulsive and reckless behavior
• Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Causes

Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with BPD suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person’s risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

Signs & Symptoms

According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:

• Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
• A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
• Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
• Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days
• Chronic feelings of emptiness and/or boredom
• Inappropriate, intense anger or problems controlling anger
• Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Suicide and Self-harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.

Who Is At Risk?

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.  BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.

Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional’s attention.

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder. According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness. Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia. These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat BPD and other mental disorders.

No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.

Treatments

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

BPD can be treated with psychotherapy, or “talk” therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional’s care, it is essential for the professionals to coordinate with one another on the treatment plan.

The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.

Psychotherapy

Psychotherapy is usually the first treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.

It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain this type of bond with their therapist.

Types of psychotherapy used to treat BPD include the following:Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

1. Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviors.
2. Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.

Therapy can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively.

One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of BPD, relieve symptoms of depression, and improve quality of life. The effectiveness of this type of therapy has not been extensively studied.

Families of people with BPD may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative’s symptoms.

Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with BPD. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in BPD. Studies with other mental disorders suggest that including family members can help in a person’s treatment.

Other types of therapy not listed in this booklet may be helpful for some people with BPD. Therapists often adapt psychotherapy to better meet a person’s needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section onpsychotherapy.

Some symptoms of BPD may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent. People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with BPD had a relapse after remission.

Medications

No medications have been approved by the U.S. Food and Drug Administration to treat BPD. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.

Medications can cause different side effects in different people. People who have BPD should talk with their prescribing doctor about what to expect from a particular medication.

Other Treatments

Omega-3 fatty acids. One study done on 30 women with BPD showed that omega-3 fatty acids may help reduce symptoms of aggression and depression. The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).

With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with BPD to be patient and to receive appropriate support during treatment.

Living With

Some people with BPD experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.

How can I help a friend or relative who has BPD?

If you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.

To help a friend or relative you can:

Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time

• Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing
• With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members, such as DBT-FST.

Never ignore comments about someone’s intent or plan to harm himself or herself or someone else. Report such comments to the person’s therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.

How can I help myself if I have BPD?

Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.

To help yourself:

• Talk to your doctor about treatment options and stick with treatment
• Try to maintain a stable schedule of meals and sleep times
• Engage in mild activity or exercise to help reduce stress
• Set realistic goals for yourself
• Break up large tasks into small ones, set some priorities, and do what you can, as you can
• Try to spend time with other people and confide in a trusted friend or family member
• Tell others about events or situations that may trigger symptoms
• Expect your symptoms to improve gradually, not immediately
• Identify and seek out comforting situations, places, and people
• Continue to educate yourself about this disorder.

Clinical Trials

NIMH supports research studies on mental health and disorders. See also: A Participant’s Guide to Mental Health Clinical Research.

Participate, refer a patient or learn about results of studies inClinicalTrials.gov , the NIH/National Library of Medicine’s registry of federally and privately funded clinical trials for all disease.

Find NIH-funded studies currently recruiting participants with BPD. 

Myth: Hard Work Beats Depression

Depression affects nearly one in six people at some point in their lives, so folk remedies and half-truths about this common illness abound. One such idea: throw yourself into work and you’ll feel better. For a mild case of the blues, this may indeed help, but depression is a different animal. Overworking can actually be a sign of clinical depression, especially in men.

Myth: It’s Not a Real Illness

Depression is a serious medical condition — and the top cause of disability in American adults. But it’s still confused with ordinary sadness. Biological evidence of the illness can be seen in brain scans, which show abnormal activity levels. Key brain chemicals that carry signals between nerves (shown here) also appear to be out of balance in depressed people.

Fact: Men Fly Under the Radar

A depressed man, his loved ones, and even his doctor may not recognize depression. That’s because men are less likely than women to talk about their feelings — and some depressed men don’t appear sad or down. Instead, men may be irritable, angry, or restless. They may even lash out at others. Some men try to cope with depression through reckless behavior, drinking, or drugs.

Myth: Depression Is Just Self-Pity

Our culture admires will power and mental toughness and is quick to label anyone who falls back as a whiner. But people who have clinical depression are not lazy or simply feeling sorry for themselves. Nor can they “will” depression to go away. Depression is a medical illness — a health problem related to changes in the brain. Like other illnesses, it usually improves with appropriate treatment.

Fact: Anyone Can Get Depressed

Poet or linebacker, shy or outgoing, anyone from any ethnic background can develop depression. The illness is twice as common in women as in men, but it may be that women are more likely to seek help. It’s often first noticed in the late teens or 20s, but an episode can develop at any age. Tough personal experiences can trigger depression, or it may develop out of the blue.

Fact: It Can Sneak Up Slowly

Depression can creep up gradually, which makes it harder to identify than a sudden illness. A bad day turns into a rut and you start skipping work, school, or social occasions. One type, called dysthymia, can last for years as a chronic, low-level illness – a malaise that silently undermines your career and relationships. Or depression can become a severe, disabling condition. With treatment, many feel substantial relief in 4-6 weeks.

Myth: Help Means Drugs for Life

Despite the buzz about a “Prozac Nation,” medication is only one of the tools used to lift depression. And asking for help does not mean you’ll be pressured to take prescription drugs. In fact, studies suggest that “talk” therapy works as well as drugs for mild to moderate depression. Even if you do use antidepressants, it probably won’t be for life. Your doctor will help you determine the right time to stop your medication.

Myth: Depressed People Cry a Lot

Not always. Some people don’t cry or even act terribly sad when they’re depressed. Instead they are emotionally “blank” and may feel worthless or useless. Even without dramatic symptoms, untreated depression prevents people from living life to its fullest — and takes a toll on families.

Fact: Family History Is Not Destiny

If depression appears in your family tree, you’re more likely to get it too. But chances are you won’t. People with a family history can watch for early symptoms of depression and take positive action promptly — whether that means reducing stress, getting more exercise, counseling, or other professional treatment.

Myth: Depression Is Part of Aging

Most people navigate the challenges of aging without becoming depressed. But when it does occur, it may be overlooked. Older people may hide their sadness or have different, vague symptoms: food just doesn’t taste good anymore, aches and pains worsen, or sleep patterns change. Medical problems can trigger depression in seniors — and depression can slow recovery from a heart attack or surgery.

Fact: Depression Imitates Dementia

In seniors, depression can be the root cause of memory problems, confusion, and in some cases, delusions. Caregivers and doctors may mistake these problems for signs of dementia, or an age-related decline in memory. Getting treatment lifts the cloud for the majority of older people with depression. Psychotherapy is particularly useful for people who can’t or don’t want to take medication.

Myth: Talking Makes Things Worse

People were once advised not to “dwell on” problems by talking about them. Today, there’s evidence that guided discussions with a professional can make things much better. Different types of psychotherapy help treat depression by addressing negative thought patterns, unconscious feelings, or relationship troubles. The first step is to talk to a mental health professional.

Fact: Positive Thinking May Help

The old advice to “accentuate the positive” has advanced into a practice that can ease depression. It’s called cognitive behavioral therapy (CBT). People learn new ways of thinking and behaving. Negative “self-talk” and behavior is identified and replaced with more upbeat thoughts and a more positive mood. Used alone or with medication, CBT works for many people.

Myth: Teens Are Unhappy by Nature

Although many teens are moody, argumentative, and intrigued by “the dark side,” prolongued sadness or irritability is not normal for teens. When unhappiness lasts more than two weeks, it may be a sign of depression — which develops in about one in 11 teens. Other signs a teen may need help include: being constantly sad or irritable even with friends, taking no pleasure in favorite activities, or a sudden drop in grades.

Fact: Exercise Is Good Medicine

Very good studies now show that regular, moderately intense exercise can improve symptoms of depression and work as well as some medicines for people with mild to moderate depression. Exercising with a group or a good friend adds social support, another mood booster.

Myth: Depression Is Tough to Treat

The reality is most people who take action to lift their depression do get better. In a large study by the National Institute of Mental Health, 70% of people became symptom-free through medications — though not always with the first medicine. Studies show the best treatment is combining medication and talk therapy.

Fact: It’s Not Always Depression

Some life events cause sadness or disappointment, but do not become clinical depression. Grief is normal after a death, divorce, loss of a job, or diagnosis with a serious health problem. One clue of a need for treatment: the sadness is constant every day, most of the day. When people are weathering difficult times appropriately, they can usually be distracted or cheered up for short periods of time.

Fact: Hope for Better Days Is Real

In the depths of depression, people may think there’s no hope for a better life. This hopelessness is part of the illness, not a reality. With treatment, positive thinking gradually replaces negative thoughts. Sleep and appetite improve as the depressed mood lifts. And people who’ve seen a counselor for talk therapy are equipped with better coping skills to deal with the stresses in life that can get you down.

 

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Although men, women, and teenagers can experience the same depression symptoms, the illness often has different signs in each of these groups.

Unlike regular feelings of sadness that pass relatively quickly, depression is a clinical illness in which negative emotions last for weeks or longer.

It’s one of the most common mental illnesses people experience, affecting an estimated 350 million people across the globe, according to the World Health Organization.

Depression is treatable, and it’s important to know the signs and symptoms of the illness so that you can get help as soon as possible.

Signs of Depression in Adults

Depression doesn’t affect all people in exactly the same way, but the illness is associated with a number of possible symptoms, which include:

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Persistent feelings of sadness or emptiness
Frequently feeling irritated, anxious, frustrated, or angry
Feeling hopeless, worthless, helpless, or guilty
Fatigue and decreased energy
Changes in appetite and eating habits
Inability to concentrate, remember details, or make decisions
Sleep disturbances, such as sleeping more than usual or insomnia
Loss of interest in activities or hobbies that were once enjoyable
Unexplained body aches or pains, headaches, cramps, or digestive problems
Thoughts of death and suicide
Slowed thinking, speaking, or movement
Reckless behavior
Substance abuse
Depression in Men

Although men and women can experience the same symptoms of depression, there are important differences in how often they report specific symptoms, according to a 2013 report in the journal JAMA Psychiatry.

Men with depression are more likely than women to report the following signs of depression:

Anger
Aggression
Drug and alcohol abuse
Risk-taking behavior
Depression in Women

Women are 70 percent more likely than men to experience depression, according to the National Institutes of Health.

Other sources, including the 2013 JAMA Psychiatry report, state that women are twice as likely to be diagnosed with depression.

Women with depression are more likely to report the following symptoms:

Stress
Withdrawal
Irritability
Sleep problems
Loss of interest
Teen Depression

Teenagers experience the same symptoms of depression as adults, but these changes in mood and behavior are sometimes mistaken as a normal part of puberty or adolescence.

Other signs of depression in teenagers can include:
Obsession with death, such as poems and drawings that refer to death
Criminal behavior, such as shoplifting
Withdrawal from family and friends
Sudden sensitivity to criticism
Drop in grades or school attendance
Risky behavior, such as unsafe sex and reckless driving
Drinking alcohol or using drugs
Irrational or bizarre behavior
Sudden, dramatic changes in personality or appearance
Giving away belongings
Complications of Depression

Experiencing and surviving an episode of major depression puts you at risk for more episodes in the future.

Half of people who recover from their first episode of depression will eventually have one or more additional episodes later in their life.

Additionally, 80 percent of people who have experienced two episodes will go on to have additional episodes, according to a 2007 report in Clinical Psychology Review.

Up to two-thirds of all suicides are associated with clinical depression, according to the health information resource A.D.A.M.

Depression can negatively affect your personal relationships and work life.

It may also raise your risk of developing heart disease or obesity, having a heart attack, or experiencing a sharp decline in mental function in old age.

Depression Tests and Diagnosis

There are a number of online tools and self-tests to determine whether you may be depressed and need to seek help, but only your doctor can diagnose clinical depression.

Before diagnosing major depression — the most common type of depression — your doctor will conduct exams and tests to rule out other problems that could be causing your symptoms, such as thyroid issues, brain tumors, sleep apnea, or vitamin deficiencies.

These efforts may include a physical examination and blood tests, as well as a discussion about your medications, some of which may cause depressive symptoms.

Your doctor will also ask in-depth questions about your mood and feelings, and may ask you to fill out a questionnaire.

According to the American Psychiatric Association, you must meet specific criteria to be clinically diagnosed with major depression.
You must have experienced at least five of the following nine symptoms for at least two weeks, and these symptoms must have significantly impaired your ability to function in your daily life:

Feeling sad or having a depressed mood for most of the day
Loss of interest or pleasure in once-enjoyable activities
Unexplained weight loss or gain
Insomnia or sleeping too much
Fatigue or loss of energy
Restlessness or slowed movements, speech, and thoughts
Feelings of worthlessness and guilt
Difficulty thinking, concentrating, or making decisions
Thoughts of death or suicide
Other forms of depression have other specific diagnostic criteria.

Depression Treatment
By Joseph Bennington-Castro Medically Reviewed by Robert Jasmer, MD
Psychotherapy, medication, and brain stimulation therapy can help treat various forms of depression.

Depression is a serious mental illness that can cause real pain to both you and your loved ones, and can even lead to suicide.

In fact, depression is associated with up to two-thirds of all suicide cases, according to the health information resource A.D.A.M.

Despite this alarming statistic, various medications — as well as medication-free treatments — are available to help you overcome depression before such severe complications develop.

Psychotherapy for Depression

Depression is different for everyone, but it typically develops due to a combination of factors.

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Psychotherapy, or talk therapy, is designed to help people identify and effectively deal with the psychological, behavioral, interpersonal, and situational factors related to their depression.

Different types of psychotherapy have different goals, such as helping people:

Identify life problems that contribute to depression or worsen it
Identify negative or distorted thoughts and beliefs that contribute to depression-related feelings, such as hopelessness and helplessness
Develop skills to better cope with stress and solve problems
Explore relationships and experiences to improve their interactions with other people
Create realistic life goals and personal self-care plans
Regain satisfaction and control in life
Understand painful past events
Two of the most common types of psychotherapy are cognitive behavioral therapy (CBT) and interpersonal therapy.

Effective for a wide range of mental illnesses, CBT attempts to help people uncover unhealthy or negative patterns of thoughts and beliefs, and replace those patterns with positive ones.

People undergoing CBT often have “homework” between sessions in which they record their negative thoughts, among other things.

Interpersonal therapy focuses on exploring a person’s relationships, identifying problems in those relationships, and improving interpersonal skills.

It aims to help people discover their negative social patterns, such as isolation and aggression, and develop strategies to better interact with other people.

Psychotherapy alone may be the best option for people with mild to moderate depression, but it may not be enough for people with severe depression, according to the National Institute of Mental Health.

Antidepressants

Antidepressants, first developed in the 1950s, are a class of drugs that moderate certain chemicals in the brain that affect mood and behavior.

About 10 percent of Americans ages 12 and above report taking antidepressants, according to a 2011 report by the National Center for Health Statistics.

There are a range of depression medications available today, including:
SSRIs
SNRIs
MAOIs
Tricyclic antidepressants
Depression and Electroconvulsive Therapy

If psychotherapy and medications don’t work for you, your psychiatrist may recommend that you undergo a brain stimulation therapy.

Once called electroshock therapy, electroconvulsive therapy (ECT) has come a very long way since it was first used in the 1940s.

In ECT, an electrical current is passed through the brain while you’re under anesthesia.

The treatment causes a brief, controlled seizure that affects neurons and brain chemistry. Most people undergo four to six treatments before they see major improvements, according to the National Alliance on Mental Illness.

ECT may cause temporary side effects, including headaches, muscle pain, nausea, confusion, and memory loss.

Transcranial Magnetic Stimulation for Depression

Instead of using an electrical current, transcranial magnetic stimulation (TMS) uses magnetic fields to stimulate neurons and help relieve depressive symptoms.

The treatment, which doesn’t require anesthesia, targets the brain area thought to be involved with regulating moods.

Side effects of TMS may include facial muscle contractions, headaches or light-headedness, and seizures (if you have a history of them).

Vagus Nerve Stimulation for Depression

For chronic depression or depression that doesn’t respond to ECT or TMS, vagus nerve stimulation (VNS) may be an option.

A kind of pacemaker for the brain, this treatment uses an implanted device to stimulate the vagus nerve — which carries messages to the parts of the brain controlling mood and sleep — with electrical signals throughout the day.

Localized side effects are associated with VNS, such as throat issues (swallowing, pain, and coughing), neck pain, and breathing problems while exercising.

Natural Remedies for Depression

There are a number of natural remedies, as well as complementary or alternative treatments, that may help treat depression when used in combination with other treatments (including medication).
These remedies include:

Exercise, which releases mood-enhancing hormones
Yoga, meditation, and other mind-body techniques that can lower stress and relieve negative emotions
Massage therapy, which can reduce stress hormones and increase mood-stabilizing brain chemicals (neurotransmitters)
Acupuncture, which may also positively affect neurotransmitters
Certain supplements — including folate, SAMe (S-Adenosyl-L-Methionine), and St. John’s wort — may also help treat depression, but more research is needed to prove their efficacy.

Depression Medications
By Joseph Bennington-Castro Medically Reviewed by Robert Jasmer, MD
Different classes of antidepressants can help treat depression by acting on mood-regulating brain chemicals.

Depression isn’t the same for everyone — multiple types of depression exist, and people experience this treatable illness in varying degrees of severity.

For some people, psychotherapy, lifestyle changes, and natural remedies may be enough to treat their depression.

Many other people, however, also require medications to lift them above the cloud of depression.

According to a 2011 report by the National Center for Health Statistics, about 10 percent of Americans ages 12 and above report taking antidepressants, drugs that work by acting on specific brain chemicals that are involved in regulating your mood.

In addition, antidepressants are the second most commonly prescribed type of drug in the United States, according to the American Psychological Association.

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Numerous depression-fighting medications are available today, so talk to your psychiatrist to learn which treatment may be best for you.

SSRIs

Selective serotonin reuptake inhibitors, or SSRIs, are the most commonly prescribed antidepressants, according to the National Alliance on Mental Illness (NAMI).

These drugs help alleviate depression by making the neurotransmitter serotonin more available to your brain.

According to the National Institute of Mental Health, the most commonly used SSRIs are:

Prozac (fluoxetine)
Zoloft (sertraline)
Lexapro (escitalopram)
Paxil (paroxetine)
Celexa (citalopram)
Common side effects of SSRIs include:

Sexual dysfunction
Gastrointestinal issues, such as nausea, constipation, and diarrhea
Dry mouth
Insomnia
Headache
Nervousness or jitters
Weight gain
Sweating
SNRIs and NDRIs

The second most commonly prescribed class of antidepressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), block the reabsorption of both serotonin and norepinephrine, making them more available to your brain.

Some common SNRIs include:

Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
Fetzima (levomilnacipran)
Savella (milnacipran) is also an SNRI, but it’s used to treat fibromyalgia instead of depression.

These drugs may cause side effects similar to those of SSRIs, as well fatigue and difficulty urinating.

Another popular type of antidepressant that targets norepinephrine is Wellbutrin (bupropion).

This medication affects the neurotransmitter dopamine in addition to norepinephrine, so it’s considered a norepinephrine-dopamine reuptake inhibitor, or NDRI.
Wellbutrin has similar side effects to those of SSRIs and SNRIs, but it’s less likely to cause sexual dysfunction and may increase your risk of seizures.

Tricyclics

Tricyclic antidepressants (tricyclics, or TCAs) are older drugs that work by blocking the reabsorption of serotonin and norepinephrine through a different mechanism than SNRIs.

While effective, these drugs are seldom used today because they can cause a wide range of side effects, some of which may be serious.

But they are sometimes prescribed when other antidepressants are ineffective, according to NAMI.

Examples of tricyclics include:

Elavil (amitriptyline)
Norpramin (desipramine)
Sinequan (doxepin)
Tofranil (imipramine)
Pamelor (nortriptyline)
Avantyl (nortriptyline)
Vivactil (protriptyline)
Some serious potential side effects of tricyclics include:

Blurred vision
Irregular heartbeat
Tremors
Confusion in elderly people
Seizures
MAOIs

The oldest class of antidepressants, monoamine oxidase inhibitors (MAOIs) work by blocking the enzyme monoamine oxidase, which breaks down various neurotransmitters — including serotonin and norepinephrine — in the brain.

Examples of MAOIs include:

Nardil (phenelzine)
Marplan (isocarboxazid)
Parnate (tranylcypromine sulfate)
Emsam (selegiline), a recently developed skin patch that causes fewer side effects than other MAOIs
Like tricyclics, MAOIs are rarely used today because of their potential side effects and interactions.

For example, if you consume a large of amount of the compound tyramine (found in cheese, pickles, and red wine) while taking an MAOI, you could develop hypertensive crisis — a severe spike in blood pressure that can lead to stroke.

You may also experience a severe increase in blood pressure if you take an MAOI with various medications, including certain:

Birth control pills
Prescription pain relievers
Cold and allergy drugs
Herbal supplements
In addition, taking an MAOI along with an SSRI can cause a potentially life-threatening condition called serotonin syndrome.

Other Medications
Various other medications that don’t fit into the classes listed above are also available to treat depression.

These drugs include:

Trazadone
Nefazodone
Remeron (mirtazapine)
Abilify (aripiprazole)
Seroquel (quetiapine
Viibryd (vilazodone)
Brintellix (vortioxetine)

Depression During Pregnancy
By Joseph Bennington-Castro Medically Reviewed by Robert Jasmer, MD
About one-fifth of pregnant women experience antepartum depression (depression during pregnancy).

Depression is a common mental illness in which you feel strong negative emotions — including sadness, loss of interest, and hopelessness — that interfere with daily life for a prolonged period.

There are multiple types of depression, including:

Major depression (severe depressive symptoms last for at least two weeks)
Persistent depressive disorder (low-level depressive symptoms last for at least two years)
Seasonal affective disorder (depression during the winter or fall due to lack of sunlight)
Although a lot of attention has been paid to postpartum depression — depression that occurs after giving birth — it’s also not uncommon for women to experience some form of depression during pregnancy, which is known as antepartum depression.

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In fact, between 14 and 23 percent of pregnant women experience depression at some point during their pregnancy, according to a 2009 report in the journal Obstetrics & Gynecology.

Causes and Risk Factors

Some women who experience antepartum depression have a history of major depression.

Experiencing an episode of major depression puts you at risk for more depressive episodes in the future.

Many women have their first experience of depression while they’re pregnant.

Antepartum depression is generally thought to be caused by a combination of hormonal changes and psychological disturbances associated with pregnancy.

Other physical changes during pregnancy, such as bodily changes and changes in sleep and eating habits, can contribute to the development of antepartum depression.

In addition to having a history of depression, other risk factors for antepartum depression include:
Lack of a partner or social support during pregnancy
Relationship problems
History of abuse or trauma
Stressful life events
Financial stress, including poverty
Substance abuse
Feeling ambivalent toward your pregnancy
Previous pregnancy losses or abortions
Anxiety about the fetus, such as from having pregnancy complications
Unplanned pregnancy
Signs and Symptoms

Depression during pregnancy is defined by the same major depressive symptoms that people experience outside of pregnancy.

These symptoms, which must last for two weeks or longer to constitute depression, include:

Severe, persistent sadness
Difficulty concentrating, remembering, or making decisions
Feeling hopeless, worthless, or guilty
Loss of interest or pleasure in formerly enjoyable hobbies and activities
Fatigue
Disturbed sleep
Irritability
Thoughts of death or suicide
Sudden changes in appetite
Reckless behavior
It’s important to note that many of these symptoms are similar to pregnancy-related changes that many women experience, making it potentially difficult to identify antepartum depression.

Complications of Depression During Pregnancy

Depressed pregnant women are more likely to develop various pregnancy complications — including severe nausea and vomiting, and preeclampsia (high blood pressure during pregnancy) — than nondepressed pregnant women.

Women with antepartum depression are also at higher risk for postpartum depression, which occurs after about 15 percent of births, according to the National Institute of Mental Health.

Left untreated, antepartum depression may harm your infant by increasing your risk of:

Complications with pregnancy or delivery
Delivering a low-birth-weight baby
Prematurely giving birth
Treating Depression During Pregnancy
Antepartum depression can be successfully treated using normal treatments for major depression. These treatments include:

Counseling or therapy, including specific techniques such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy
Support groups
Brain stimulation therapies, including electroconvulsive therapy (ECT), in which a low-level electrical current is passed through the brain
Prescription antidepressants, which can carry risks to both a mother and her child that need to be balanced carefully against the benefits of using these medications
Practicing yoga, eating a balanced diet, and getting regular exercise can also help treat antepartum depression.