Mental Health Conditions: Depression and Anxiety

What Is Depression?

Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be depressed. Symptoms of depression include:¹

• Feeling sad or anxious often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable‚ easily frustrated‚ or restless
• Having trouble falling asleep or staying asleep
• Waking up too early or sleeping too much
• Eating more or less than usual or having no appetite
• Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
• Having trouble concentrating, remembering details, or making decisions
• Feeling tired‚ even after sleeping well
• Feeling guilty, worthless, or helpless
• Thinking about suicide or hurting yourself

The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed‚ talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.

What Causes Depression?

The exact cause of depression is unknown. It may be caused by a combination of genetic, biological, environmental, and psychological factors.² Everyone is different‚ but the following factors may increase a person’s chances of becoming depressed:¹

• Having blood relatives who have had depression
• Experiencing traumatic or stressful events, such as physical or sexual abuse, the death of a loved one, or financial problems   
• Going through a major life change‚ even if it was planned
• Having a medical problem, such as cancer, stroke, or chronic pain
• Taking certain medications. Talk to your doctor if you have questions about whether your medications might be making you feel depressed.
• Using alcohol or drugs

Who Gets Depression?

In general‚ about 1 out of every 6 adults will have depression at some time in their life.³ Depression affects about 16 million American adults every year.⁴ Anyone can get depressed, and depression can happen at any age and in any type of person.

Many people who experience depression also have other mental health conditions.^1,5 Anxiety disorders often go hand in hand with depression. People who have anxiety disorders struggle with intense and uncontrollable feelings of anxiety, fear, worry, and/or panic.¹ These feelings can interfere with daily activities and may last for a long time.

What Is the Link Between Smoking and Mental Health Conditions?

Smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population.⁶ About 3 out of every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions.⁶ Why smokers are more likely than nonsmokers to experience depression, anxiety, and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause‚ smoking is not a treatment for depression or anxiety. Getting help for your depression and anxiety and quitting smoking is the best way to feel better.

What Are the Treatments for Depression?

Many helpful treatments for depression are available. Treatment for depression can help reduce symptoms and shorten how long the depression lasts. Treatment can include getting therapy and/or taking medications. Your doctor or a qualified mental health professional can help you determine what treatment is best for you.

• Therapy. Many people benefit from psychotherapy—also called therapy or counseling.^7,8 Most therapy lasts for a short time and focuses on thoughts‚ feelings‚ and issues that are happening in your life now. In some cases‚ understanding your past can help‚ but finding ways to address what is happening in your life now can help you cope and prepare you for challenges in the future.
  With therapy, you’ll work with your therapist to learn skills to help you cope with life, change behaviors that are causing problems‚ and find solutions. Do not feel shy or embarrassed about talking openly and honestly about your feelings and concerns. This is an important part of getting better.
  Some common goals of therapy include:
  • Getting healthier
  • Quitting smoking and stopping drug and alcohol use
  • Overcoming fears or insecurities
  • Coping with stress
  • Making sense of past painful events
  • Identifying things that worsen your depression
  • Having better relationships with family and friends
  • Understanding why something bothers you and creating a plan to deal with it
• Medication. Many people with depression find that taking prescribed medications called antidepressants can help improve their mood and coping skills. Talk to your doctor about whether they are right for you. If your doctor writes you a prescription for an antidepressant‚ ask exactly how you should take the medication. If you are already using nicotine replacement therapy or another medication to help you quit smoking, be sure to let your doctor know. Several antidepressant medications are available‚ so you and your doctor have options to choose from. Sometimes it takes several tries to find the best medication and the right dose for you, so be patient. Also be aware of the following important information:
  • When taking these medications‚ it is important to follow the instructions on how much to take. Some people start to feel better a few days after starting the medication‚ but it can take up to 4 weeks to feel the most benefit. Antidepressants work well and are safe for most people‚ but it is still important to talk with your doctor if you have side effects. Side effects usually do not get in the way of daily life‚ and they often go away as your body adjusts to the medication.
  • Don't stop taking an antidepressant without first talking to your doctor. Stopping your medicine suddenly can cause symptoms or worsen depression. Work with your doctor to safely adjust how much you take.
  • Some antidepressants may cause risks during pregnancy. Talk with your doctor if you are pregnant or might be pregnant, or if you are planning to become pregnant.  
  • Antidepressants cannot solve all of your problems. If you notice that your mood is getting worse or if you have thoughts about hurting yourself‚ it is important to call your doctor right away.

Quitting smoking will not interfere with your mental health treatment or make your depression worse. In fact, research shows that quitting smoking can actually improve your mental health in the long run.^9,10,11

Depression and Suicide: Getting Help in a Crisis

Some people who are depressed may think about hurting themselves or committing suicide (taking their own life). If you or someone you know is having thoughts about hurting themselves or committing suicide‚ please seek immediate help. The following resources can help:

• Call 1−800−273−TALK (8255) to reach a 24−hour crisis center or dial 911. 1−800−273−TALK is the National Suicide Prevention Lifeline, which provides free‚ confidential help to people in crisis. The Substance Abuse and Mental Health Services Administration runs this lifeline.
• Call your mental health provider.
• Get help from your primary doctor or other health care provider.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader, or someone else in your faith community.

Additional Resources

If you are a smoker and dealing with depression or anxiety, consider the following resources:

• Depression
• MentalHealth.gov
• National Alliance on Mental Illness (NAMI)
• National Institute of Mental Health
  • What Is Depression?
  • What Are Anxiety Disorders?
• Anxiety and Depression Association of America

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Publishing, 2013 [accessed 2015 Nov 17].
2. Belmaker RH, Agam G. Major Depressive Disorder. New England Journal of Medicine 2008;358:355–68 [accessed 2015 Nov 17].
3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 2005;62(6):593-602 [accessed 2015 Nov 17].
4. Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings [PDF - 2.37MB]. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2014 [accessed 2015 Nov 17].
5. Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA, Sampson N, Andrade LH, de Girolamo G, Demyttenaere K, Haro JM, Karam AN, Kostyuchenko S, Kovess V, Lara C, Levinson D, Matschinger H, Nakane Y, Browne MO, Ormel J, Posada-Villa J, Sagar R, Stein DJ. Age Differences in the Prevalence and Co-Morbidity of DSM-IV Major Depressive Episodes: Results From the WHO World Mental Health Survey Initiative. Depression and Anxiety 2010;27(4):351–64 [accessed 2015 Nov 17].
6. Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years with Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62(05):81–7 [accessed 2015 Nov 17].
7. American Psychiatric Association. Practice Guidelines for the Treatment of Patients With Major Depressive Disorder, Third Edition [PDF - 1.64MB]. Arlington, VA: American Psychiatric Publishing, 2010 [accessed 2015 Nov 17].
8. Davidson JRT. Major Depressive Disorder Treatment Guidelines in America and Europe. Journal of Clinical Psychiatry 2010;71(Suppl E1):e04 [accessed 2015 Nov 17].
9. Tidey JW, Miller ME. Smoking Cessation and Reduction in People With Chronic Mental Illness. BMJ 2015; doi:http://dx.doi.org/10.1136/bmj.h4065 [accessed 2015 Nov 17].
10. Evins AE, Cather C, Laffer A. Treatment of Tobacco Use Disorders in Smokers With Serious Mental Illness: Toward Clinical Best Practices. Harvard Review of Psychiatry 2015;23(2):90–8 [accessed 2015 Nov 17].
11. Hitsman B, Moss TG, Montoya ID, George TP. Treatment of Tobacco Dependence in Mental Health and Addictive Disorders. Canadian Journal of Psychiatry 2009;54(6):368–78 [accessed 2015 Nov 17].