Depression

What is depression?

Depression is more than a feeling of being sad or irritable for a few days. It's a serious mood disorder. As one of the most common mental disorders in the United States, depression can affect how you think, feel, and your everyday life. You may not know why you feel this way, but even basic daily activities such as sleeping, eating, or working may become difficult. Depression often needs long-term treatment but getting help at the earliest sign of a problem can help manage your symptoms.

The most common types of depression are major depression and persistent depressive disorder.

• Major depression symptoms include a depressed mood or a loss of interest. Symptoms affect your daily activities and last for at least two weeks.
• Persistent depressive disorder (also called dysthymia or dysthymic disorder) has less severe depressive symptoms, but they last longer, usually for at least two years.

Other types of depression can include:

• Seasonal affective disorder comes and goes with the seasons. It usually starts in late fall and early winter and goes away during the spring and summer.
• Bipolar disorder is sometimes called manic depression. This mood disorder can cause intense mood swings.
• Depression with symptoms of psychosis is a severe form of depression that also has delusions (false beliefs) or hallucinations (seeing, hearing, or feeling something that isn't there).

There are a variety of things that may cause depression, including genetic, biological, environmental, and psychological factors. Depression can happen at any age and can affect anyone, but it's more common in women. This is often due to the physical and hormonal changes that women have during menstruation, pregnancy, the postpartum period, and menopause. Other mental disorders or chronic medical conditions such as diabetes, cancer, or heart disease may occur with depression. This may make the chronic condition or depression worse.

In some cases, there is no clear cause for depression.

You may be at a higher risk of depression if you have a close relative who has it or another mental health disorder. Going through trauma or stressful life events may raise your risk even more.

Depression doesn't look the same on everyone. The type and number of symptoms of depression can vary and don't always appear like sadness. Depression may affect you differently based on your:

• Age. The symptoms of depression may be different in a child, who may appear more irritable than sad. Teens may act out or have excessive sleepiness. The symptoms for an older adult may not be as obvious as other age groups.
• Sex. Men often show symptoms and coping behaviors differently than women. Rather than sad, men may appear angry or irritable.
• Medical conditions. Some medicines and medical conditions may cause symptoms that look like depression. Chronic conditions may make depression worse.

Symptoms of depression are ongoing and affect your day-to-day life. They can include:

• Feeling sad or "empty"
• Losing interest in favorite activities
• Overeating, or not wanting to eat at all
• Sleeping too much, or not enough
• Feeling very tired
• Feeling hopeless, irritable, anxious, or guilty
• Having aches and pains, headaches, cramps, or digestive problems
• Having thoughts of death or suicide
• Changing moods or behaviors
• Increasing use of alcohol or drugs
• Isolating from family and friends

If you think you have depression, talk to your health care provider or a mental health provider. To be diagnosed with depression, your provider may use many tools:

• A medical history will include asking about your symptoms and family history. To be diagnosed with depression, your symptoms must occur most of the day, nearly every day, for at least two weeks. One of the symptoms must be a depressed mood or a loss of interest in most activities.
• Medical tests may be done to rule out other medical conditions. Certain medicines and medical conditions (such as viruses or thyroid disorders) may cause symptoms like depression.
• A physical exam to make sure another issue isn't causing your symptoms.
• A mental health evaluation by your provider or a mental health provider.

Depression may need long-term treatment. Most treatments include medicines and/or psychotherapy (talk therapy):

• Medicines such as antidepressants may help control your symptoms. You may need to try several medicines to find which works best for you. Medicine may take time to work and can have side effects. Don't stop taking your medicine without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicine.
• Psychotherapy (talk therapy) under the care of a mental health provider can help you recognize and change troubling emotions, thoughts, and behaviors. This may be done one-on-one or in a group setting. It can give you and your family support, education, skills, and coping strategies.
• Light therapy has been shown to be effective for seasonal affective disorder (SAD).
• Other treatments options may be considered if treatment isn't working or if depression is severe. These may include:
  • Electroconvulsive therapy (ECT) is a brain stimulation procedure that uses a mild electric current when you are under general anesthesia. ECT is most often used for severe depression that is not getting better with other treatments.
  • Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation procedure that uses magnetic waves to relieve depression. It's not as powerful as ECT, but with rTMS, you don't need anesthesia. It also has a low risk of negative effects on your memory and thinking.

Most cases of depression can't be prevented, but healthy lifestyle changes can have long-term benefits for your mental health. These can include:

• Getting regular exercise
• Having a consistent sleep schedule
• Controlling stress

If you, or someone you love is depressed, see your provider or a mental health provider. It's important to get treatment at the earliest sign of a problem.

If you or someone you know has thoughts of hurting themselves or attempting suicide, get help right away. If it is an emergency, dial 911.

NIH: National Institute of Mental Health

Diabetes Type 2

What is type 2 diabetes?

Type 2 diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your main source of energy. It comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. If you have diabetes, your body doesn't make enough insulin or doesn't use insulin well. The glucose then stays in your blood and not enough goes into your cells.

Over time, having too much glucose in your blood can cause health problems. But you can take steps to manage your diabetes and try to prevent these health problems.

Type 2 diabetes may be caused by a combination of factors:

• Being overweight or having obesity
• Not being physically active
• Genetics and family history

Type 2 diabetes usually starts with insulin resistance. This is a condition in which your cells don't respond normally to insulin. As a result, your body needs more insulin to help the glucose enter your cells. At first, your body makes more insulin to try to get cells to respond. But over time, your body can't make enough insulin, and your blood glucose levels rise.

You are at higher risk of developing type 2 diabetes if you:

• Are over age 45. Children, teenagers, and younger adults can get type 2 diabetes, but it is more common in middle-aged and older people.
• Have prediabetes, which means that your blood glucose is high for you but not high enough to be called diabetes
• Had diabetes in pregnancy or gave birth to a baby weighing 9 pounds or more.
• Have a family history of diabetes
• Are overweight or have obesity
• Are Black or African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander
• Are not physically active
• Have other conditions such as high blood pressure, heart disease, stroke, polycystic ovary syndrome (PCOS), or depression
• Have low HDL (good) cholesterol and high triglycerides
• Have acanthosis nigricans - dark, thick, and velvety skin around your neck or armpits

Many people with type 2 diabetes have no symptoms at all. If you do have them, the symptoms develop slowly over several years. They might be so mild that you do not notice them. The symptoms can include:

• Increased thirst and urination
• Increased hunger
• Feeling tired
• Blurred vision
• Numbness or tingling in the feet or hands
• Sores that do not heal
• Unexplained weight loss

Your provider will use blood tests to diagnose type 2 diabetes. The blood tests include:

• A1C test, which measures your average blood glucose level over the past 3 months.
• Fasting plasma glucose (FPG) test, which measures your current blood glucose level. You need to fast (not eat or drink anything except water) for at least 8 hours before the test.
• Random plasma glucose (RPG) test, which measures your current blood glucose level. This test is used when you have diabetes symptoms and the provider does not want to wait for you to fast before having the test.

Treatment for type 2 diabetes involves managing your blood glucose levels. Many people are able to do this by living a healthy lifestyle. Some people may also need to take medicine:

• A healthy lifestyle includes following a healthy eating plan and getting regular physical activity. You need to learn how to balance what you eat and drink with physical activity and diabetes medicine, if you take any.
• Medicines for diabetes include oral medicines, insulin, and other injectable medicines. Over time, some people will need to take more than one type of medicine to control their diabetes.
• You will need to check your blood glucose regularly. Your provider will tell you how often you need to do it.
• It's also important to keep your blood pressure and cholesterol levels close to the targets your provider sets for you. Make sure to get your screening tests regularly.

You can take steps to help prevent or delay type 2 diabetes by losing weight if you are overweight, eating fewer calories, and being more physically active. If you have a condition which raises your risk for type 2 diabetes, managing that condition may lower your risk of getting type 2 diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Dietary Fiber

Fiber is a substance in plants. Dietary fiber is the kind you eat. It's a type of carbohydrate. You may also see it listed on a food label as soluble fiber or insoluble fiber. Both types have important health benefits.

Good sources of dietary fiber include:

• Whole grains
• Nuts and seeds
• Fruit and vegetables

Dietary fiber adds bulk to your diet and makes you feel full faster, helping you control your weight. It helps digestion and helps prevent constipation. Most Americans don't eat enough dietary fiber. But add it to your diet slowly. Increasing dietary fiber too quickly can lead to gas, bloating, and cramps.

Centers for Disease Control and Prevention

Diets

If you are overweight or have obesity, losing weight can improve your health. It might also help you prevent weight-related diseases, such as heart disease, diabetes, arthritis and some cancers. A healthy diet is an important part of a weight-loss program. It:

• May include fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• May include lean meats, poultry, fish, beans, eggs and nuts
• Goes easy on saturated fats, trans fat, cholesterol, salt (sodium), and added sugars

The key to losing weight is to burn more calories than you eat and drink. A diet can help you to do this through portion control. There are many different types of diets. Some, like the Mediterranean diet, describe a traditional way of eating from a specific region. Others, like the DASH eating plan or a diet to lower cholesterol, were designed for people who have certain health problems. But they may also help you to lose weight. There are also fad or crash diets that severely restrict calories or the types of food you are allowed to eat. They may sound promising, but they rarely lead to permanent weight loss. They also may not provide all of the nutrients your body needs.

In addition to a diet, adding exercise into your daily life can help you to lose weight.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Ectopic Pregnancy

What is an ectopic pregnancy?

The uterus, or womb, is the place where a fetus grows during pregnancy. In an ectopic pregnancy, the fertilized egg grows in the wrong place outside the uterus. It usually occurs in the fallopian tubes. These tubes carry eggs from the ovaries to the uterus. Sometimes, an ectopic pregnancy can occur in the ovaries, abdominal cavity, or the lower part of the uterus (cervix).

Ectopic pregnancies can't end in a healthy pregnancy because the egg cannot grow. If the pregnancy continues, the fallopian tube can burst. This can cause internal bleeding, which can be a life-threatening emergency that needs immediate surgery.

An ectopic pregnancy often happens because there is a problem with your fallopian tubes. But sometimes it's not clear why an ectopic pregnancy happens.

Factors that may increase your risk for an ectopic pregnancy can include:

• Previous ectopic pregnancy
• Prior pelvic, abdominal, or fallopian tube surgery
• Certain sexually transmitted infections (STIs)
• Pelvic inflammatory disease
• Endometriosis
• Becoming pregnant while using an intrauterine device (IUD) for birth control
• Becoming pregnant after a tubal ligation

Other factors that may increase your risk can include:

• Smoking
• Being older than age 35
• Infertility treatments

You may not notice any symptoms at first. Or you may have some of the usual signs of pregnancy such as a missed period, breast tenderness, or nausea.

Early signs of an ectopic pregnancy may be light vaginal bleeding and pelvic pain. Ectopic pregnancy can be a medical emergency. Get medical care right away if you have these signs:

• Abdominal (belly) pain
• Shoulder pain
• Vaginal bleeding
• Feeling dizzy or faint

An ectopic pregnancy can't be diagnosed without blood tests and an ultrasound. Your health care provider will do a pregnancy test to confirm that you're pregnant. They may do a pelvic exam to check for areas of pain, tenderness, or a mass.

An ectopic pregnancy needs treatment to stop any damage to your organs. Your provider will use medicine or surgery to take out the ectopic tissue.

Losing a pregnancy can be devastating. An ectopic pregnancy is like a miscarriage, but it must be treated to prevent problems. People cope with grief in different ways. It may be helpful to discuss your feelings with your provider or a counselor. Many women who have had ectopic pregnancies go on to have healthy pregnancies later.

Dept. of Health and Human Services Office on Women's Health