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Understanding
Psychosis
What is psychosis?
Psychosis refers to a collection of symptoms that affect
the mind, where there has been some loss of contact with
reality. During an episode of psychosis, a person’s
thoughts and perceptions are disrupted and they may
have difficulty recognizing what is real and what is not.
Who develops psychosis?
It is difficult to know the number of people who experience
psychosis. Studies estimate that between 15 and 100
people out of 100,000 develop psychosis each year.
Psychosis often begins in young adulthood when a person
is in their late teens to mid-20s. However, people can
experience a psychotic episode at younger and older ages
and as a part of many disorders and illnesses. For
instance, older adults with neurological disorders may be
at higher risk for psychosis.
What are the signs and symptoms of
psychosis?
|
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What are the signs and symptoms of
psychosis?
People with psychosis typically experience delusions
(false beliefs, for example, that people on television are
sending them special messages or that others are trying
to hurt them) and hallucinations (seeing or hearing things
that others do not, such as hearing voices telling them to
do something or criticizing them). Other symptoms can
include incoherent or nonsense speech and behavior that
is inappropriate for the situation.
However, a person will often show changes in their
behavior before psychosis develops. Behavioral warning
signs for psychosis include:
• Suspiciousness, paranoid ideas, or uneasiness
with others
• Trouble thinking clearly and logically
• Withdrawing socially and spending a lot more time alone
• Unusual or overly intense ideas, strange feelings, or a
lack of feelings
• Decline in self-care or personal hygiene
• Disruption of sleep, including difficulty falling asleep
and reduced sleep time
|
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|
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lack of feelings
• Decline in self-care or personal hygiene
• Disruption of sleep, including difficulty falling asleep
and reduced sleep time
• Difficulty telling reality from fantasy
• Confused speech or trouble communicating
• Sudden drop in grades or job performance
Alongside these symptoms, a person with psychosis may
also experience more general changes in behavior that
include:
• Emotional disruption
• Anxiety
• Lack of motivation
• Difficulty functioning overall
In some cases, a person experiencing a psychotic episode
may behave in confusing and unpredictable ways and
may harm themselves or become threatening or violent
toward others. The risk of violence and suicide decreases
with treatment for psychosis, so it is important to seek
help. If you find that you are experiencing these changes
in behavior or notice them in a friend or family member
and they begin to intensify or do not go away, reach out to
a health care provider.
|
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The National Institute of Mental Health (NIMH) has
information on ways to get help and find a health
care provider or access treatment at www.nimh.nih.
gov/findhelp.
If you or someone you know is struggling or having
thoughts of suicide, call or text the 988 Suicide &
Crisis Lifeline at 988 or chat at 988lifeline.org. In
life-threatening situations, call 911.
What causes psychosis?
There is no one cause of psychosis. Psychosis appears to
result from a complex combination of genetic risk,
differences in brain development, and exposure to
stressors or trauma. Psychosis may be a symptom of a
mental illness, such as schizophrenia, bipolar disorder, or
severe depression. However, a person can experience
psychosis and never be diagnosed with schizophrenia or
any other disorder.
|
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For older adults, psychosis symptoms can be part of a
physical or mental illness that emerges later in life.
Psychosis can also be a symptom of some diseases of
older age, including Parkinson’s disease, Alzheimer’s
disease, and related dementias.
Other possible causes of psychosis include sleep
deprivation, certain prescription medications, and the
misuse of alcohol or drugs. A mental illness, such as
schizophrenia, is typically diagnosed by excluding these
other causes.
A qualified mental health professional (such as a
psychologist, psychiatrist, or social worker) can provide
a thorough assessment and accurate diagnosis. Find tips
to help prepare for and get the most out of your visit at
www.nimh.nih.gov/talkingtips. For additional resources,
including questions to ask your health care provider,
visit the Agency for Healthcare Research and Quality at
www.ahrq.gov/questions.
How is psychosis treated?
|
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How is psychosis treated?
Studies have shown that it is common for a person to have
psychotic symptoms for more than a year before receiving
treatment. Reducing this duration of untreated psychosis
is critical because early treatment often means better
recovery. A qualified psychologist, psychiatrist, or social
worker can make a diagnosis and help develop a
treatment plan.
Treatment of psychosis usually includes antipsychotic
medication. There are several different types of
antipsychotic medications, and they have different side
effects, so it is important to work with a health care
provider to determine the medication that is most
effective with the fewest side effects.
|
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Treatment also often includes other elements. There is
substantial research support for coordinated specialty
care, which is a multi-element, recovery-oriented team
approach to treating psychosis that promotes easy access
to care and shared decision-making among specialists,
the person experiencing psychosis, and family members.
People experience better outcomes from coordinated
specialty care if they begin treatment as soon as possible
after psychotic symptoms emerge.
Coordinated specialty care is now the standard of care for
early psychosis, according to “The American Psychiatric
Association Practice Guideline for the Treatment of
Patients With Schizophrenia.”
NIMH research on coordinated specialty care
|
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The Recovery After an Initial Schizophrenia Episode (RAISE)
research project, supported by NIMH, established
coordinated specialty care as an effective treatment for
early psychosis and identified important elements for
helping people lead productive, independent lives. Learn
more about the RAISE studies at www.nimh.nih.gov/raise.
NIMH continues to prioritize research on and expansion of
treatments for early psychosis with the launch of the Early
Psychosis Intervention Network (EPINET) in 2019. Through
EPINET, NIMH funded awards to establish a national data
coordinating center and regional scientific hubs connected
to more than 100 coordinated specialty care programs that
provide early psychosis treatment in 17 states. The EPINET
website provides resources for researchers, health care
providers, administrators, and people experiencing
psychosis and their families. The website is found at
https://nationalepinet.org.
|
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Coordinated specialty care consists of multiple components:
• Individual or group psychotherapy is tailored to a person’s
recovery goals. Cognitive and behavioral therapies
focus on developing the knowledge and skills necessary
to build resilience and cope with aspects of psychosis
while maintaining and achieving personal goals.
• Family support and education programs teach
family members about psychosis as well as coping,
communication, and problem-solving skills. Family
members who are informed and involved are more
prepared to help loved ones through the recovery process.
• Medication management (also called pharmacotherapy)
means tailoring medication to a person’s specific needs
by selecting the appropriate type and dose of medication
to help reduce psychosis symptoms. Like all medications,
antipsychotic medications have risks and benefits. People
should talk with a health care provider about side effects,
|
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medication costs, and dosage preferences (daily pill or
monthly injection).
• Supported employment and education services focus
on return to work or school, using the support of a coach
to help people achieve their goals.
• Case management provides opportunities for people
with psychosis to work with a case manager to address
practical problems and improve access to needed
support services.
Learn more about the components of coordinated
specialty care at www.nimh.nih.gov/raise.
People with psychosis should be involved in their
treatment planning and consulted in making decisions
about their care. Their needs and goals should drive the
treatment programs, which will help them stay engaged
throughout the recovery process.
|
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It is important to find a mental health professional who is
trained in psychosis treatment and who makes the person
feel comfortable. With early diagnosis and appropriate
treatment, it is possible to recover from psychosis. Some
people who receive early treatment never have another
psychotic episode. For other people, recovery means the
ability to lead a fulfilling and productive life, even if
psychotic symptoms sometimes return.
Clinical trials studying psychosis and related disorders
NIMH supports a wide range of research, including clinical
trials that look at new ways to prevent, detect, or treat
diseases and conditions, such as psychosis. The goal of a
clinical trial is to determine if a new test or treatment works
and is safe. Although people may benefit from being part of
a clinical trial, they should know that the primary purpose
of a clinical trial is to gain new scientific knowledge so that
others can be better helped in the future.
|
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Researchers at NIMH and around the country conduct
clinical trials with people experiencing psychosis and
healthy volunteers. Talk to a health care provider about
clinical trials, their benefits and risks, and whether one is
right for you. For more information and to find a clinical
trial, visit www.nimh.nih.gov/clinicaltrials.
How can I find help?
NIMH does not endorse specific psychosis clinics or
evaluate individual practitioners’ professional qualifications
or competencies. However, several organizations are
available to assist in finding a treatment program in your
area. The following is not a comprehensive list of all
programs, and a program’s inclusion on the list does
not constitute an endorsement by NIMH.
• Early Assessment and Support Alliance (EASA):
EASA offers a National Early Psychosis Directory
that lists early psychosis programs across the
United States. The directory is available at
www.easacommunity.org/national-directory.php.
|
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For more information about EASA, visit
www.easacommunity.org.
• Early Psychosis Intervention Network (EPINET):
EPINET’s Early Psychosis Intervention Network Clinics
provide treatment and services to individuals with
early psychosis across 17 states. The list of states with
early psychosis clinics is found at
https://nationalepinet.org/epinet-clinics.
For more information about EPINET, visit
https://nationalepinet.org.
• National Alliance on Mental Illness (NAMI): The NAMI
HelpLine can connect you with the NAMI office in your
state and help you find programs close to home.
Find ways to get help at www.nami.org/help.
Also, you can talk with someone at the NAMI HelpLine,
Monday–Friday, 10:00 a.m.–10:00 p.m. ET, by:
■ Calling 1-800-950-NAMI (6264)
■ Texting “HelpLine” to 62640
■ Emailing [email protected]
For more information about NAMI, visit www.nami.org.
• Psychosis-Risk and Early Psychosis Program
|
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■ Calling 1-800-950-NAMI (6264)
■ Texting “HelpLine” to 62640
■ Emailing [email protected]
For more information about NAMI, visit www.nami.org.
• Psychosis-Risk and Early Psychosis Program
Network (PEPPNET): PEPPNET supports an Early
Psychosis Program Directory that provides services to
people at risk for or experiencing early psychosis. The
directory is available at https://med.stanford.edu/
peppnet/interactivedirectory.html.
For more information about PEPPNET, visit
https://med.stanford.edu/peppnet.
• Substance Abuse and Mental Health Services
Administration (SAMHSA): SAMHSA has an
Early Serious Mental Illness Treatment Locator
for finding mental health treatment facilities and
programs. Find a facility in your state at
www.samhsa.gov/esmi-treatment-locator.
For more information about SAMHSA, visit
www.samhsa.gov.
For more information
MedlinePlus (National Library
of Medicine)
https://medlineplus.gov
(en español: https://medlineplus.gov/
spanish)
|
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For more information
MedlinePlus (National Library
of Medicine)
https://medlineplus.gov
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spanish)
ClinicalTrials.gov
www.clinicaltrials.gov
(en español: https://salud.nih.gov/
investigacion-clinica)
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|
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Attention-Deficit/
Hyperactivity Disorder:
What You Need to Know
What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder marked by persistent
symptoms of inattention, hyperactivity, and impulsivity. Some people mostly have symptoms of
inattention. Others mostly have symptoms of hyperactivity and impulsivity. Some people have both
types of symptoms.
Symptoms begin in childhood and can interfere with daily life, including social relationships and
school or work performance. ADHD is well-known among children and teens, but many adults also
have the disorder. Effective treatments are available to manage symptoms.
What are the symptoms of ADHD?
People with ADHD may experience an ongoing pattern of:
► Inattention: Difficulty paying attention
► Hyperactivity: Showing too much energy or moving and talking too much
► Impulsivity: Acting without thinking or having difficulty with self-control
|
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|
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► Inattention: Difficulty paying attention
► Hyperactivity: Showing too much energy or moving and talking too much
► Impulsivity: Acting without thinking or having difficulty with self-control
Signs of inattention can include frequent difficulty with:
► Paying attention to details, leading to careless mistakes at school, work, or during other activities
► Concentrating on tasks or activities, for instance, while having conversations, taking tests,
completing assignments, or reading papers
► Listening when spoken to directly
► Following instructions or finishing tasks at school, work, or home
► Organizing tasks and activities, managing time, and meeting deadlines
► Completing tasks that require sustained attention, such as homework, large projects, and
complicated forms
► Losing things, such as backpacks, books, keys, wallets, and phones
► Getting easily distracted by unrelated thoughts or stimuli
|
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complicated forms
► Losing things, such as backpacks, books, keys, wallets, and phones
► Getting easily distracted by unrelated thoughts or stimuli
► Forgetting about daily activities, such as chores, errands, and events, or other important things, like
assignments, appointments, and phone calls
Signs of hyperactivity and impulsivity can include often:
► Fidgeting, tapping hands or feet, or squirming while seated
► Moving around when expected to remain seated, such as in the classroom or office, or feeling
restless in these situations
► Running, climbing, or moving around at times when it is not appropriate
► Being constantly “on the go” and acting as if driven by a motor
► Being unable to quietly play or take part in hobbies and activities
► Talking excessively
► Answering questions before they are fully asked or finishing other people’s sentences
► Struggling to wait or be patient, such as when playing a game or waiting in line
|
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► Talking excessively
► Answering questions before they are fully asked or finishing other people’s sentences
► Struggling to wait or be patient, such as when playing a game or waiting in line
► Interrupting or intruding on others, for example, in conversations, games, or meetings
What causes ADHD?
Researchers are not sure what causes ADHD, although many studies suggest that genes play a large
role. Like many other disorders, ADHD probably results from a combination of factors.
In addition to genetics, researchers are looking at differences in brain development and neurobiology
among people with ADHD compared to those without the disorder. They are also studying
environmental factors that might increase the risk of developing ADHD, including brain injuries,
nutrition, and social environments.
How is ADHD diagnosed?
Based on their specific symptoms, a person can be diagnosed with one of three types of ADHD:
|
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How is ADHD diagnosed?
Based on their specific symptoms, a person can be diagnosed with one of three types of ADHD:
► Inattentive: Mostly symptoms of inattention but not hyperactivity or impulsivity
► Hyperactive-impulsive: Mostly symptoms of hyperactivity and impulsivity but not inattention
► Combined: Symptoms of both inattention and hyperactivity and impulsivity
ADHD symptoms must begin in childhood (before age 12). Symptoms often continue into the teen
years and adulthood. The criterion for a diagnosis differs slightly based on age.
► Children up to 16 years must show at least six symptoms of inattention, hyperactivity and
impulsivity, or both.
► Adults and youth over 16 years must show at least five symptoms of inattention, hyperactivity
and impulsivity, or both.
To be diagnosed with ADHD, a person’s symptoms must also:
► Occur for at least 6 months
► Be present in two or more settings (for example, at home, at work, in school, or with friends)
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To be diagnosed with ADHD, a person’s symptoms must also:
► Occur for at least 6 months
► Be present in two or more settings (for example, at home, at work, in school, or with friends)
► Interfere with or impair social, school, or work functioning
Stress, sleep disorders, anxiety, depression, and other physical conditions or illnesses can cause
similar symptoms to those of ADHD. A health care provider needs to do a thorough evaluation to
determine the cause of symptoms, make a diagnosis, and identify effective treatments.
Primary care providers sometimes diagnose and treat ADHD, or they may refer the person to a mental
health professional. During an evaluation, a provider usually:
► Examines the person’s mental health and medical history, including their mood and past or current
health conditions.
|
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► Examines the person’s mental health and medical history, including their mood and past or current
health conditions.
► Looks at the person’s current or, if an adult, childhood behavior and school experiences. To obtain
this information, the provider may ask for permission to talk with family, friends, partners, teachers,
and others who know the person well and have seen them in different settings to learn about
behaviors and experiences at home, school, or elsewhere.
► Uses standardized behavior rating scales or ADHD symptom checklists to determine whether the
person meets the criteria for a diagnosis of ADHD.
► Administers psychological tests that look at cognitive skills, such as working memory, executive
|
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person meets the criteria for a diagnosis of ADHD.
► Administers psychological tests that look at cognitive skills, such as working memory, executive
functioning (abilities such as planning and decision-making), visual and spatial abilities, or
reasoning. Such tests can help identify psychological or cognitive (thinking-related) strengths and
challenges and identify or rule out possible learning disabilities.
Does ADHD look the same in everyone?
Anyone can have ADHD. However, boys and men tend to display more hyperactive and impulsive
symptoms, while girls and women are more likely to be diagnosed with inattentive ADHD.
ADHD can also be diagnosed at any age, although symptoms must have begun in childhood (before
age 12). Adults with ADHD often have a history of problems with school, work, and relationships.
ADHD symptoms may change as a person gets older.
|
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ADHD symptoms may change as a person gets older.
► Children show hyperactivity and impulsivity as the most common symptoms. As academic and
social demands increase, symptoms of inattention often become more prominent and begin to
interfere with academic performance and peer relationships.
► Adolescents usually show less hyperactivity and may appear as restless or fidgeting. Symptoms of
inattention and impulsivity typically continue and may cause academic, organizational, or relationship
challenges. Teens with ADHD are more likely to engage in impulsive, risky behaviors, such as
substance use and unsafe sexual activity.
► Adults, including older adults, can show inattention, restlessness, and impulsivity, although, in
some people, those symptoms become less severe and less impairing. They may also be irritable,
have a low tolerance for frustration and stress, or experience frequent or intense mood changes.
|
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some people, those symptoms become less severe and less impairing. They may also be irritable,
have a low tolerance for frustration and stress, or experience frequent or intense mood changes.
Some adults may not have been diagnosed with ADHD when younger because their teachers or
family did not recognize the disorder, they had a mild form of the disorder, or they managed well until
experiencing the demands of adulthood. But it is never too late to seek a diagnosis and treatment for
ADHD and other mental health conditions that may co-occur with it. Effective treatment can make
day-to-day life easier for people with ADHD and their families.
How is ADHD treated?
Although there is no cure for ADHD, current treatments may help reduce symptoms and improve
functioning. Common treatments for ADHD are medication, psychotherapy, and other behavioral
interventions. For children, treatment often includes parent education and school-based programs.
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Researchers are studying new treatments for people with ADHD, such as cognitive training and
neurofeedback. These options are usually explored only after medication and psychotherapy have
already been tried. For many people, treatment involves a combination of elements.
Medication
Stimulants are the most common type of medication used to treat ADHD, and research shows them to
be highly effective. They work by increasing levels of brain chemicals involved in thinking and attention.
Like all medications, stimulants can have side effects and must be prescribed and monitored by a
health care provider. Tell the provider about other medications you or your child are taking.
Medications for common health problems, such as diabetes, anxiety, and depression, can interact
with stimulants, in which case, a provider can suggest other medication options.
|
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Health care providers sometimes prescribe nonstimulant medications like antidepressants to treat
ADHD. However, the U.S. Food and Drug Administration (FDA) has not approved these medications
specifically for ADHD. Sometimes, a person must try several different medications or dosages before
finding the one that works for them.
NIMH has information on stimulants and other mental health medications at www.nimh.nih.gov/
medications. You can learn more about specific medications, including the latest approvals, side
effects, warnings, and patient information, on the FDA website at www.fda.gov/drugsatfda.
Psychotherapy and behavioral interventions
Psychological interventions for ADHD can take many forms and be combined with medication and
other elements for parents, families, and teachers. Adding therapy to an ADHD treatment plan can
help some people better cope with daily challenges, gain confidence, or manage impulsive and risky
behaviors.
|
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Therapy is especially helpful if ADHD co-occurs with other mental disorders, such as anxiety,
depression, conduct problems, or substance use disorders. You can learn about other mental
disorders at www.nimh.nih.gov/health.
Several psychosocial interventions have been shown to help manage symptoms and improve
functioning.
► Behavioral therapy helps a person change their behavior. It might involve practical assistance, such
as organizing tasks or completing schoolwork, learning social skills, or monitoring one’s behavior.
► Cognitive behavioral therapy helps a person become aware of attention and concentration
challenges and work on skills to improve focus and organization and complete daily tasks (for
instance, by breaking large tasks into smaller, more manageable steps).
► Family and marital therapy helps family members learn to handle disruptive behaviors, encourage
behavior changes, and improve interactions with children and partners.
|
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► Family and marital therapy helps family members learn to handle disruptive behaviors, encourage
behavior changes, and improve interactions with children and partners.
Some people find it helpful to get support from a professional life coach or ADHD coach who can
teach them skills to improve daily functioning.
For more information on psychotherapy, including what to look for in a therapist and how to find one,
visit www.nimh.nih.gov/psychotherapies.
Parent education and support
Therapy for children and teens requires parents to play an active role. Treatment sessions with the
child alone are more likely to be effective for treating symptoms of anxiety or depression that may
co-occur with ADHD than for managing core symptoms of the disorder.
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Mental health professionals can educate parents about the disorder and how it affects a family. They
also can help parents develop new skills, attitudes, and ways of relating to their child. Examples
include parenting skills training, stress management techniques for parents, and support groups that
help parents and families connect with others who have similar concerns.
School-based programs
Many children and teens with ADHD benefit from school-based behavioral interventions and
academic accommodations. Interventions include behavior management plans or classroom-taught
organizational and study skills. Accommodations include preferential seating in the classroom,
reduced classwork, and extended time on tests and exams. Schools may provide accommodations
through what is called a 504 Plan or, for children who qualify for special education services, an
Individualized Education Plan (IEP).
|
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To learn more about special education services and the Individuals with Disabilities Education Act,
visit https://idea.ed.gov.
Cognitive training
Cognitive training approaches involve repeatedly using a program or activity over several
weeks to improve specific functions, such as memory or attention. Exercises are tailored to the
person’s ongoing performance.
Cognitive training is shown to modestly improve the tasks being practiced. For instance, research shows
the training can help memory, attention, inhibition, planning, and cognitive flexibility in people with
ADHD. However, these improvements don’t usually translate to changes in core ADHD symptoms of
impulsivity and hyperactivity.
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Neurofeedback
Neurofeedback is a noninvasive technique in which an electronic device monitors and records a
person’s brain activity, providing them with immediate feedback to support self-regulation. The
device measures brain activity through such means as EEG or fMRI scans and feeds the information
back to the person, usually in the form of a computer screen or visual cue. Through this feedback,
people learn to self-regulate their brain activity to directly alter the associated behavior. The
assumption is that, with repeated, real-time information, people can change their internal brain
activity, with observable effects on behavior and cognition.
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For people with ADHD, neurofeedback is used to train and improve specific cognitive functions.
Although it is shown to help reduce some ADHD symptoms, the effects of neurofeedback remain
lower than those seen from medication and psychotherapy. Additional research is needed to refine
the treatment and determine for whom it works and under what conditions.
Complementary health approaches
Some people may explore complementary health approaches to manage symptoms of ADHD. These
can include natural products, vitamins and supplements, diet changes, and acupuncture. Others find
it helpful to make lifestyle changes, like adding more physical exercise to their daily schedule.
Unlike psychotherapy and medication that are scientifically shown to improve ADHD symptoms,
complementary health approaches generally have not been found to treat ADHD effectively and do
not qualify as evidence-supported interventions.
|
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For more information, visit the National Center for Complementary and Integrative Health at
www.nccih.nih.gov/health/attention-deficit-hyperactivity-disorder-at-a-glance.
How can I find help?
If you’re unsure of where to get help, a health care provider is a good place to start. They can refer
you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social
worker, who can help figure out the next steps. Find tips for talking with a health care provider about
your or your child’s mental health at www.nimh.nih.gov/talkingtips.
The Centers for Disease Control and Prevention (CDC) has information about ADHD symptoms, diagnosis,
and treatment, as well as additional resources for families and providers, at www.cdc.gov/adhd.
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The Centers for Disease Control and Prevention (CDC) has information about ADHD symptoms, diagnosis,
and treatment, as well as additional resources for families and providers, at www.cdc.gov/adhd.
The Substance Abuse and Mental Health Services Administration (SAMHSA) also has resources
for finding support at https://findsupport.gov and locating mental health services in your area at
https://findtreatment.gov. For additional resources, visit www.nimh.nih.gov/findhelp.
How can I help myself?
Medication and therapy are the most effective treatments for ADHD. Other strategies may also help
manage symptoms.
► Get regular exercise, especially when feeling hyperactive or restless.
► Eat regular, healthy meals.
► Get plenty of sleep. Try to turn off screens at least 1 hour before bedtime and get between
7–9 hours of sleep every night.
► Stick to a consistent routine.
► Work on time management and organization. Prioritize time-sensitive tasks and write down
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7–9 hours of sleep every night.
► Stick to a consistent routine.
► Work on time management and organization. Prioritize time-sensitive tasks and write down
assignments, messages, appointments, reminders, and important thoughts.
► Take short breaks during tasks that require sustained attention to help maintain focus and prevent
burnout. Break large tasks into smaller, more manageable steps.
► Connect with people and maintain relationships. Schedule activities with friends, particularly
supportive people who understand your challenges with ADHD.
► Take medications as directed. Avoid alcohol, tobacco, and drugs not prescribed for you.
How can I help my child?
► Be patient, flexible, and understanding. ADHD can be frustrating both for people who have it and
the people in their lives. ADHD may make it hard for your child to perform certain tasks or
behaviors. Some children may need to use different strategies to help them succeed.
|
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the people in their lives. ADHD may make it hard for your child to perform certain tasks or
behaviors. Some children may need to use different strategies to help them succeed.
► Use clear, simple, direct language to explain rules and expectations. Reward behaviors that meet
these expectations with positive reinforcement. Provide consistent praise or rewards for acting in a
desired way.
► Offer practical help, such as on tasks like cleaning and organizing, or simply be present and
engaged while your child works, which can give them a sense of accountability and motivation and
help them stay focused and on track.
► Provide opportunities to explore different activities and interests. Help your child discover their
unique talents and build confidence in their abilities.
|
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|
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Reprints
The information in this publication is in the public domain and may be reused or copied without
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 24-MH-8300
2024
[Image OCR Text]
? me
National Institute
: ea NIH)) of Mental Health
[Table Data]
[Table: table_2_1]
| Col0 | propriate
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waiting in line
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[Table: table_8_1]
| Col0 | Col1 |
| --- | --- |
| Clinical trials
Clinical trials are research studies that look at ways to prevent, detect, or treat diseases and
conditions. These studies help show whether a treatment is safe and effective in people. Some
people join clinical trials to help doctors and researchers learn more about a disease and improve
health care. Other people, such as those with health conditions, join to try treatments that aren’t
widely available.
NIMH supports clinical trials across the United States. Talk to a health care provider about clinical
trials and whether one is right for you. For more information, visit www.nimh.nih.gov/clinicaltrials.
For more information
Learn more at www.nimh.nih.gov/health. For information about various health topics, visit the
National Library of Medicine’s MedlinePlus resource at https://medlineplus.gov.
Contact us
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
|
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National Library of Medicine’s MedlinePlus resource at https://medlineplus.gov.
Contact us
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
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NIH Publication No. 24-MH-8300
2024 | |
|
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ADHD in Adults:
4
Things to Know
From the NATIONAL INSTITUTE of MENTAL HEALTH
1 Adults can have ADHD.
Attention-deficit/hyperactivity disorder (ADHD) is
marked by a persistent pattern of inattention and/or
hyperactivity and impulsivity that makes it hard to
function in at least two areas of life, such as at home,
school, or work.
Adults with ADHD may experience the following
types of symptoms:
► Inattention: Difficulty paying attention, staying on
task, or being organized
► Hyperactivity: Excessive activity or restlessness,
even at inappropriate times, and difficulty engaging
in quiet activities
► Impulsivity: Acting without thinking or having
trouble with self-control
Based on their symptoms, a person can be
diagnosed with one of three types of ADHD:
inattentive, hyperactive-impulsive, or combined.
|
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trouble with self-control
Based on their symptoms, a person can be
diagnosed with one of three types of ADHD:
inattentive, hyperactive-impulsive, or combined.
Adults with ADHD often have a history of poor
academic performance, work problems, or strained
relationships. They may find it challenging to stay
organized, stick to a job, keep appointments, perform
daily tasks, or complete large projects. They may be
restless, try to do multiple things at once, or engage
in risky or impulsive behaviors.
ADHD is considered a developmental disorder because symptoms must begin
in childhood—but many adults also have ADHD.
2 ADHD symptoms can cause problems in daily life.
|
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ADHD is considered a developmental disorder because symptoms must begin
in childhood—but many adults also have ADHD.
2 ADHD symptoms can cause problems in daily life.
ADHD symptoms interfere with daily functioning. In
adults, symptoms can lead to:
► Difficulty paying attention and often getting distracted
► Disorganization and procrastination
► Poor time management, planning, or organization
► Trouble remembering daily tasks
► Frequently losing things or being forgetful in activities
► Frequently interrupting others or being very talkative
► Trouble focusing on a large task or multitasking
► Trouble following instructions or finishing projects
► Difficulty sitting still for long periods and often
moving or fidgeting
► Feelings of restlessness and a need for constant
activity or stimulation
► Choosing immediate rewards over future rewards
or consequences
|
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moving or fidgeting
► Feelings of restlessness and a need for constant
activity or stimulation
► Choosing immediate rewards over future rewards
or consequences
Many people show some of these behaviors some of
the time. However, for adults with ADHD, they are
more severe, frequent, and persistent, interfering
with daily life, occurring across multiple situations,
and lasting at least 6 months.
ADHD often co-occurs with other mental disorders
and can make them harder to treat. Sleep problems
are especially prevalent, affecting up to 70% of
adults with ADHD.
Symptoms continue into adulthood for many
people with ADHD, but they may change with age.
For instance, inattentive symptoms often persist
as people get older, whereas hyperactivity and
impulsivity are more likely to decline. Learn
more about symptoms and types of ADHD at
www.nimh.nih.gov/ADHD.
3 ADHD is diagnosed differently in children and adults.
Why wasn’t I diagnosed with
ADHD earlier?
|
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Why wasn’t I diagnosed with
ADHD earlier?
There are many reasons someone may not be
diagnosed with ADHD until adulthood. For instance,
your teachers and parents may not have recognized
the disorder or may have provided supportive
environments that helped you thrive despite it. Or
you may have a milder form of ADHD that could be
managed well until faced with the stresses and
demands of adulthood, especially at work.
ADHD symptoms among girls and women
are especially likely to have been missed in
childhood. Sex differences in diagnosis rates begin
to even out in adulthood.
It is never too late to seek a diagnosis and treatment
for ADHD and any other mental health condition that
may occur with it. Effective treatment can make
day-to-day life easier for many adults and their
families. Find tips for talking with a health care
provider at www.nimh.nih.gov/talkingtips.
|
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] |
You can learn more about getting help at
www.nimh.nih.gov/findhelp. The Substance Abuse
and Mental Health Services Administration (SAMHSA)
provides information about finding support at
https://findsupport.gov and locating mental health
services in your area at https://findtreatment.gov.
ADHD can be diagnosed in childhood or adulthood.
However, adults must have shown symptoms much
earlier, starting before age 12.
The main difference between diagnosing ADHD
in children and adults is the number of symptoms.
Adults or adolescents over 16 years must show
five (instead of six) symptoms of inattention or
hyperactivity and impulsivity.
How can a provider know if I showed
ADHD symptoms as a child?
Diagnosing ADHD in adulthood is complicated
by the need to show symptoms before age 12.
For this reason, a diagnosis relies heavily on past
reports of behavior.
|
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Diagnosing ADHD in adulthood is complicated
by the need to show symptoms before age 12.
For this reason, a diagnosis relies heavily on past
reports of behavior.
To help diagnose ADHD, a primary care provider or
mental health professional may ask to talk to people
who know you well, such as a partner, family members,
and friends, to learn about your behavior in different
situations and during childhood. They may look at
school reports or other childhood records.
A provider will also talk to you and may ask you to
do the following:
► Complete clinical interviews, behavior rating
scales, or symptom checklists to determine
whether you meet the criteria for a diagnosis
of ADHD.
► Take psychological tests that look at cognitive
processes, such as memory, planning, decision-
making, reasoning, and thinking, to identify strengths
and challenges and possible learning disabilities.
|
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► Report on your mood and current and past
medical conditions to rule out alternative
diagnoses and establish an overall treatment plan.
4 Treatment is available for adults with ADHD.
Some adults may find it helpful to get support from a
life coach or ADHD coach who can teach them
executive function skills to improve daily functioning.
Others try lifestyle changes, like adding more
physical exercise to their daily schedule.
People whose ADHD symptoms cause impairment
at work may qualify for reasonable accommodations
under the Americans with Disabilities Act (ADA). You
can learn more about the ADA at www.ada.gov.
Treatment for ADHD can reduce symptoms and
improve functioning. The most common treatments
for ADHD in adults are:
► Medication, usually stimulant medications
► Psychotherapy, like behavioral and cognitive
behavioral therapy
|
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► Medication, usually stimulant medications
► Psychotherapy, like behavioral and cognitive
behavioral therapy
Effective treatment often involves a combination
of elements. Sometimes, people must try several
treatments before finding the one that works
for them.
NIMH has information on stimulants and
other mental health medications at
www.nimh.nih.gov/medications. You can
learn about psychotherapy, including what
to look for in a therapist and how to find one,
at www.nimh.nih.gov/psychotherapies.
Find additional resources
The following organizations have more information on ADHD:
► Attention Deficit Disorder Association:
Offers an array of resources to find help, including virtual support groups and a professional
directory, at https://add.org
► Children and Adults with Attention-Deficit/Hyperactivity Disorder:
Hosts a National Resource Center with information, links, and resources at
https://chadd.org/nrc
|
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► Children and Adults with Attention-Deficit/Hyperactivity Disorder:
Hosts a National Resource Center with information, links, and resources at
https://chadd.org/nrc
► Centers for Disease Control and Prevention:
Provides information and resources on ADHD symptoms, diagnosis, and treatment options at
www.cdc.gov/adhd
Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s
inclusion does not constitute an endorsement by NIMH.
What are clinical trials and why are they important?
Clinical trials are research studies that look
at ways to prevent, detect, or treat diseases
and conditions.
Other people, such as those with health
conditions, join to try treatments that aren’t
widely available.
These studies help show whether a treatment
is safe and effective in people. Some people
join clinical trials to help doctors and researchers
learn more about a disease and improve
health care.
|
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] |
NIMH supports clinical trials across the
United States. Talk to a health care provider
about clinical trials and whether one is right
for you. For more information, visit
www.nimh.nih.gov/clinicaltrials.
For more information
Reprints
Learn more at www.nimh.nih.gov/
health. For information about various
health topics, visit the National Library
of Medicine’s MedlinePlus resource at
https://medlineplus.gov.
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and Communications
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content at www.nimh.nih.gov/copyright.
|
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NIH Publication No. 24-MH-3573
2024
Follow us on
social media @NIMHgov
|
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Obsessive-
Compulsive
Disorder:
When Unwanted Thoughts or
Repetitive Behaviors Take Over
What is OCD?
Obsessive-compulsive disorder (OCD) is a long-lasting disorder in which a
person experiences uncontrollable and recurring thoughts (obsessions),
engages in repetitive behaviors (compulsions), or both. People with OCD have
time-consuming symptoms that can cause significant distress or interfere with
daily life. However, treatment is available to help people manage their
symptoms and improve their quality of life.
What are the signs and symptoms of OCD?
People with OCD may have obsessions, compulsions, or both. Obsessions are
repeated thoughts, urges, or mental images that are intrusive, unwanted, and
make most people anxious. Common obsessions include:
|
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● Fear of germs or contamination
● Fear of forgetting, losing, or misplacing something
● Fear of losing control over one’s behavior
● Aggressive thoughts toward others or oneself
● Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
● Desire to have things symmetrical or in perfect order
Compulsions are repetitive behaviors a person feels the urge to do, often in
response to an obsession. Common compulsions include:
● Excessive cleaning or handwashing
● Ordering or arranging items in a particular, precise way
● Repeatedly checking things, such as that the door is locked or the oven is off
● Compulsive counting
● Praying or repeating words silently
OCD symptoms may begin anytime but usually start between late childhood
and young adulthood. Most people with OCD are diagnosed as young adults.
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OCD symptoms may begin anytime but usually start between late childhood
and young adulthood. Most people with OCD are diagnosed as young adults.
The symptoms of OCD may start slowly and can go away for a while or worsen
as time passes. During times of stress, the symptoms often get worse. A
person’s obsessions and compulsions also may change over time.
People with OCD might avoid situations that trigger their symptoms or use
drugs or alcohol to cope. Many adults with OCD recognize that their compulsive
behaviors do not make sense. However, children may not realize that their
behavior is out of the ordinary and often fear that something terrible will happen
if they do not perform certain compulsive rituals. Parents or teachers typically
recognize OCD symptoms in children.
Recognizing OCD: How to know if your symptoms are OCD
|
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Everyone rethinks or double-checks things sometimes. Not all repeated
thoughts are obsessions, and not all rituals or habits are compulsions.
However, people with OCD generally:
● Can’t control their obsessions or compulsions, even when they know
they’re excessive.
● Spend more than 1 hour a day on their obsessions or compulsions.
● Don’t get pleasure from their compulsions but may feel temporary
relief from their anxiety.
● Experience significant problems in daily life due to these thoughts
or behaviors.
Some people with OCD also have a tic disorder involving repetitive movements
or sounds. Motor tics are sudden, brief, repetitive movements, such as eye
blinking and other eye movements, facial grimacing, shoulder shrugging,
and head or shoulder jerking. Vocal tics include things like repetitive throat-
clearing, sniffing, or grunting sounds. It is common for people with OCD to
also have a diagnosed mood disorder or anxiety disorder.
|
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If you think you or your child may have OCD, talk to a health care provider. If left
untreated, OCD symptoms can become severe and interfere with daily life.
What are the risk factors for OCD?
Although the exact causes of OCD are unknown, various risk factors increase
the chances of developing the disorder.
● Genetics: Studies have shown that having a first-degree relative (parent or
sibling) with OCD is associated with an increased chance of developing the
disorder. Scientists have not identified any one gene or set of genes that
definitively leads to OCD, but studies exploring the connection between
genetics and OCD are ongoing.
|
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● Biology: Brain imaging studies have shown that people with OCD often have
differences in the frontal cortex and subcortical structures of the brain, areas
of the brain that impact the ability to control behavior and emotional
responses. Researchers also have found that several brain areas, brain
networks, and biological processes play a key role in obsessive thoughts,
compulsive behavior, and associated fear and anxiety. Research is underway
to better understand the connection between OCD symptoms and parts of
the brain. This knowledge can help researchers develop and adapt
treatments targeted to specific brain locations.
● Temperament: Some research has found that people who exhibit more
reserved behaviors, experience negative emotions, and show symptoms of
anxiety and depression as children are more likely to develop OCD.
|
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reserved behaviors, experience negative emotions, and show symptoms of
anxiety and depression as children are more likely to develop OCD.
● Childhood trauma: Some studies have reported an association between
childhood trauma and obsessive-compulsive symptoms. More research is
needed to understand this relationship.
Children who suddenly develop OCD symptoms or experience a worsening of
OCD symptoms after a streptococcal infection may be diagnosed with Pediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections
(PANDAS). You can learn more about PANDAS at www.nimh.nih.gov/pandas.
How is OCD diagnosed?
Diagnosing OCD can be difficult because symptoms such as worry, anxiety, and
low mood—which are often people’s most distressing concerns—can be similar
to those of other mental illnesses. Also, people with OCD may not tell their
health care provider about their obsessions and compulsions out of fear of
judgment.
|
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If you are experiencing symptoms, the first thing you should do is speak with a
health care provider. They will examine you and ask about your health history to
ensure other illnesses or conditions are not causing your symptoms. A health
care provider may refer you to a mental health professional for further
evaluation or treatment.
How is OCD treated?
Treatment helps many people, even those with the most severe forms of OCD.
Mental health professionals treat OCD with medications, psychotherapy, or a
combination of treatments. A mental health professional can help you decide
which treatment option is best for you and explain the benefits and risks of
each.
Following your treatment plan is important because psychotherapy and
medication can take some time to work. Although there is no cure for OCD,
treatments help people manage their symptoms, engage in day-to-day
activities, and lead full, active lives.
|
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Find tips for talking with a health care provider to improve your care and get
the most out of your visit at www.nimh.nih.gov/talkingtips.
Psychotherapy
Psychotherapy can be an effective treatment for adults and children with OCD.
Research shows that certain types of psychotherapy, including cognitive
behavioral therapy and other related therapies, can be as effective as
medication for many people. For others, psychotherapy may be most effective
when combined with medication.
|
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● Cognitive behavioral therapy (CBT): CBT is a type of talk therapy that helps
people recognize harmful or untrue ways of thinking so they can more clearly
view and respond to challenging situations. CBT helps people learn to
question these negative thoughts, determine how they impact their feelings
and actions, and change self-defeating behavior patterns. CBT has been well
studied and is considered the “gold standard” of psychotherapy for many
people. CBT works best when customized to treat the unique characteristics
of specific mental disorders, including OCD.
|
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● Exposure and response prevention therapy (ERP): Research shows that ERP,
a specific type of CBT, effectively reduces compulsive behaviors, even for
people who do not respond well to medication. With ERP, people spend time
in a safe environment that gradually exposes them to situations that trigger
their obsession (such as touching dirty objects) and prevent them from
engaging in their typical compulsive behavior (such as handwashing).
Although this approach may initially cause anxiety, creating a risk of dropping
out of treatment prematurely, compulsions decrease for most people as they
continue treatment.
Children with OCD may need additional help from family members and health
care providers to recognize and manage their OCD symptoms. Mental health
professionals can work with young children to identify strategies for managing
stress and increasing support so they can control their OCD symptoms.
|
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You can learn more about psychotherapies, including CBT, at www.nimh.nih.
gov/psychotherapies.
Medication
Health care providers may prescribe medication to help treat OCD. The most
common medications prescribed for OCD are antidepressants that target serotonin,
a chemical transmitter in the brain involved in depression and OCD. The largest
category of antidepressants is called selective serotonin reuptake inhibitors.
|
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] |
Antidepressant treatment can take 8–12 weeks before symptoms begin to
improve, and treatment for OCD may require higher doses than are typically
used to treat depression. For some people, these medications may cause side
effects such as headaches, nausea, or difficulty sleeping. Most people with
OCD find that medication, often in combination with psychotherapy, can help
them manage their symptoms.
Your health care provider can adjust medication doses over time to minimize
side effects or withdrawal symptoms. Do not stop taking your medication
without first talking to your health care provider. They can work with you to
monitor your health and adjust your treatment plan safely and effectively.
The most up-to-date information on medications, side effects, and warnings
is available on the U.S. Food and Drug Administration (FDA) website at
www.fda.gov/drugsatfda.
Other treatments
|
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] |
The most up-to-date information on medications, side effects, and warnings
is available on the U.S. Food and Drug Administration (FDA) website at
www.fda.gov/drugsatfda.
Other treatments
In 2018, the FDA approved using a deep form of repetitive transcranial magnetic
stimulation (rTMS)—along with medication, psychotherapy, or a combination
of both—to treat people with severe OCD who did not respond to other
treatments. In 2022, this approval was extended to standard TMS devices.
Most commonly used to treat depression, rTMS is a noninvasive therapy that
uses a magnet to deliver repeated low-intensity pulses to stimulate a particular
part of the brain. Unlike most treatments, rTMS can target specific brain areas
associated with OCD.
|
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Deep brain stimulation (DBS) is a surgical procedure that uses electricity to
directly stimulate sites in the brain. Health care providers may use DBS to treat
people with severe OCD when other treatments have not worked. However, this
therapy is considered experimental.
Although DBS has received FDA approval to treat certain neurological disorders
such as Parkinson’s disease, its effectiveness for treating mental disorders
is still being actively researched. The FDA has approved using DBS to treat
severe cases of OCD under a Humanitarian Device Exemption. This exemption
allows the use of a medical device, such as DBS, for rare diseases or conditions
that affect a relatively small number of people, making it challenging to gather
enough evidence to establish the device’s effectiveness.
|
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You can learn more about brain stimulation therapies, including rTMS and DBS,
at www.nimh.nih.gov/braintherapies. Visit www.fda.gov/medical-devices for
the latest information and guidance on brain stimulation devices.
Effective strategies for managing stress and anxiety
You can do several things to manage the stress and anxiety associated
with OCD.
● Create a consistent sleep schedule.
● Make regular exercise a part of your routine.
● Eat a healthy, balanced diet.
● Seek support from trusted family and friends.
How can I find help?
If you’re unsure where to get help, a health care provider is an excellent place
to start. They can refer you to a qualified mental health professional who has
experience treating OCD and can evaluate your symptoms.
|
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You can learn more about getting help and finding a health care provider on
the NIMH website at www.nimh.nih.gov/findhelp. The Substance Abuse and
Mental Health Services Administration (SAMHSA) has an online tool at https://
findtreatment.gov to help you find mental health services in your area.
If you or someone you know is struggling or having thoughts of suicide, call
or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org.
In life-threatening situations, call 911.
What are clinical trials and why are they important?
Clinical trials are research studies that look at new ways to prevent, detect, or
treat diseases and conditions. These studies help researchers determine if a
new treatment is safe and effective in people. The main purpose of a clinical
trial is to gain new scientific knowledge so that others may be better helped in
the future.
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People volunteer for clinical trials for many reasons. Some people join clinical
trials to help doctors and researchers learn more about a disease and improve
health care. Other people, such as those with health conditions, join to try new
or advanced treatments that aren’t widely available.
NIMH supports clinical trials at the National Institutes of Health campus in
Bethesda, Maryland, and across the United States. Talk to a health care provider
about clinical trials, their benefits and risks, and whether one is right for you. For
more information, visit www.nimh.nih.gov/clinicaltrials.
Reprints
The information in this publication is in the public domain and may be reused
or copied without permission. However, you may not reuse or copy the images.
Please cite the National Institute of Mental Health as the source. Read our
copyright policy to learn more about our guidelines for reusing NIMH content at
www.nimh.nih.gov/copyright.
Where can I learn more?
|
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Where can I learn more?
NIMH website
www.nimh.nih.gov
www.nimh.nih.gov/espanol (en español)
MedlinePlus (National Library of Medicine)
https://medlineplus.gov
https://medlineplus.gov/spanish (en español)
ClinicalTrials.gov
www.clinicaltrials.gov
https://salud.nih.gov/investigacion-clinica (en español)
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
6001 Executive Boulevard, MSC 9663
Bethesda, MD 20892-9663
Toll-free: 1-866-615-6464
Email: [email protected]
Website: www.nimh.nih.gov
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 23-MH-4676
Revised 2023
|
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PDF file: PANICDISORDER.pdf (content extraction failed)
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PDF file: PHOBIAS.pdf (content extraction failed)
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Depression
National Institute
of Mental Health
What is depression?
Everyone feels sad or low sometimes, but these feelings usually pass. Depression (also
called major depression, major depressive disorder, or clinical depression) is different.
It can cause severe symptoms that affect how a person feels, thinks, and handles daily
activities, such as sleeping, eating, or working.
Depression can affect anyone regardless of age, sex, race or ethnicity, income, culture,
or education. Research suggests that genetic, biological, environmental, and
psychological factors play a role in the disorder.
Women are diagnosed with depression more often than men, but men can also be
depressed. Because men may be less likely to recognize, talk about, and seek help for
their negative feelings, they are at greater risk of their depression symptoms being
undiagnosed and undertreated.
|
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In addition, depression can co-occur with other mental disorders or chronic illnesses,
such as diabetes, cancer, heart disease, and chronic pain. Depression can make these
conditions worse and vice versa. Sometimes, medications taken for an illness cause
side effects that contribute to depression symptoms as well.
What are the different types of depression?
There are two common types of depression.
● Major depression includes symptoms of depressed mood or loss of interest, most of
the time for at least 2 weeks, that interfere with daily activities.
● Persistent depressive disorder (also called dysthymia or dysthymic disorder) consists
of less severe depression symptoms that last much longer, usually for at least 2 years.
Other types of depression include the following.
● Seasonal affective disorder comes and goes with the seasons, with symptoms
|
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Other types of depression include the following.
● Seasonal affective disorder comes and goes with the seasons, with symptoms
typically starting in the late fall and early winter and going away during the spring and
summer. For more information, visit www.nimh.nih.gov/SAD.
● Depression with symptoms of psychosis is a severe form of depression in which a
person experiences psychosis symptoms, such as delusions or hallucinations. For
more information, visit www.nimh.nih.gov/psychosis.
● Bipolar disorder involves depressive episodes, as well as manic episodes (or less
severe hypomanic episodes) with unusually elevated mood, greater irritability, or
increased activity level. For more information, visit www.nimh.nih.gov/bipolardisorder.
|
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Additional types of depression can occur at specific points in a woman’s life.
Pregnancy, the postpartum period, the menstrual cycle, and menopause are
associated with physical and hormonal changes that can bring on a depressive
episode in some people.
● Premenstrual dysphoric disorder is a more severe form of premenstrual
syndrome, or PMS, that occurs in the weeks before menstruation.
● Perinatal depression occurs during pregnancy or after childbirth. It is more than
the “baby blues” many new moms experience after giving birth. For more
information, visit www.nimh.nih.gov/perinataldepression.
● Perimenopausal depression affects some women during the transition to
menopause. Women may experience feelings of intense irritability, anxiety,
sadness, or loss of enjoyment.
What are the signs and symptoms of depression?
|
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menopause. Women may experience feelings of intense irritability, anxiety,
sadness, or loss of enjoyment.
What are the signs and symptoms of depression?
Common signs and symptoms of depression include:
● Persistent sad, anxious, or “empty” mood
● Feelings of hopelessness or pessimism
● Feelings of irritability, frustration‚ or restlessness
● Feelings of guilt, worthlessness, or helplessness
● Loss of interest or pleasure in hobbies and activities
● Fatigue, lack of energy, or feeling slowed down
● Difficulty concentrating, remembering, or making decisions
● Difficulty sleeping, waking too early in the morning, or oversleeping
● Changes in appetite or unplanned weight changes
● Physical aches or pains, headaches, cramps, or digestive problems without a clear
physical cause that do not go away with treatment
● Thoughts of death or suicide or suicide attempts
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physical cause that do not go away with treatment
● Thoughts of death or suicide or suicide attempts
Depression can also involve other changes in mood or behavior that include:
● Increased anger or irritability
● Feeling restless or on edge
● Becoming withdrawn, negative, or detached
● Increased engagement in high-risk activities
● Greater impulsivity
● Increased use of alcohol or drugs
● Isolating from family and friends
● Inability to meet responsibilities or ignoring other important roles
● Problems with sexual desire and performance
Not everyone who is depressed shows all these symptoms. Some people experience only
a few symptoms, while others experience many. Depression symptoms interfere with
day-to-day functioning and cause significant distress for the person experiencing them.
|
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If you show signs or symptoms of depression and they persist or do not go away, talk to
a health care provider. If you see signs of depression in someone you know, encourage
them to seek help from a mental health professional.
If you or someone you know is struggling or having thoughts of suicide, call or text
the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life-
threatening situations, call 911.
How is depression diagnosed?
To be diagnosed with depression, a person must have symptoms most of the day,
nearly every day, for at least 2 weeks. One of the symptoms must be a depressed
mood or a loss of interest or pleasure in most activities. Children and adolescents may
be irritable rather than sad.
Although several persistent symptoms, in addition to low mood, are required for a depression
diagnosis, people with only a few symptoms may benefit from treatment. The severity
and frequency of symptoms and how long they last vary depending on the person.
|
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If you think you may have depression, talk to a health care provider, such as a primary
care doctor, psychologist, or psychiatrist. During the visit, the provider may ask when
your symptoms began, how long they have lasted, how often they occur, and if they
keep you from going out or doing your usual activities. It may help to take some notes
about your symptoms before the visit.
Certain medications and medical conditions, such as viruses or thyroid disorders, can
cause the same symptoms as depression. A provider can rule out these possibilities by
doing a physical exam, interview, and lab tests.
Does depression look the same in everyone?
Depression can affect people differently depending on their age.
● Children may be anxious or cranky, pretend to be sick, refuse to go to school, cling to
a parent, or worry that a parent may die.
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Depression can affect people differently depending on their age.
● Children may be anxious or cranky, pretend to be sick, refuse to go to school, cling to
a parent, or worry that a parent may die.
● Older children and teens may get into trouble at school, sulk, be easily frustrated‚
feel restless, or have low self-esteem. They may have other disorders, such as
anxiety, an eating disorder, attention-deficit/hyperactivity disorder, or substance use
disorder. Older children and teens are also more likely to experience excessive
sleepiness (called hypersomnia) and increased appetite (called hyperphagia).
● Young adults are more likely to be irritable, complain of weight gain and hypersomnia,
and have a negative view of life and the future. They often have other disorders, such as
generalized anxiety disorder, social phobia, panic disorder, or substance use disorder.
● Middle-aged adults may have more depressive episodes, decreased libido, middle-
|
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|
131754f2-c5e1-4957-9370-9194f3659a93
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● Middle-aged adults may have more depressive episodes, decreased libido, middle-
of-the-night insomnia, or early morning waking. They often report stomach problems,
such as diarrhea or constipation.
● Older adults often feel sadness, grief, or other less obvious symptoms. They may
report a lack of emotions rather than a depressed mood. Older adults are also more
likely to have other medical conditions or pain that can cause or contribute to
depression. Memory and thinking problems (called pseudodementia) may be
prominent in severe cases.
Depression can also look different in men versus women, such as the symptoms they
show and the behaviors they use to cope with them. For instance, men (as well as
women) may show symptoms other than sadness, instead seeming angry or irritable.
|
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] |
For some people, symptoms manifest as physical problems (for example, a racing heart,
tightened chest, chronic headaches, or digestive issues). Many men are more likely to
see a health care provider about these physical symptoms than their emotional ones.
While increased use of alcohol or drugs can be a sign of depression in any person, men
are also more likely to use these substances as a coping strategy.
How is depression treated?
Depression treatment typically involves psychotherapy (in person or virtual), medication,
or both. If these treatments do not reduce symptoms sufficiently, brain stimulation therapy
may be another option.
Choosing the right treatment plan is based on a person’s needs, preferences, and medical
situation and in consultation with a mental health professional or a health care provider.
Finding the best treatment may take trial and error.
|
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For milder forms of depression, psychotherapy is often tried first, with medication added
later if the therapy alone does not produce a good response. People with moderate or
severe depression usually are prescribed medication as part of the initial treatment plan.
Psychotherapy
Psychotherapy (also called talk therapy or counseling) can help people with depression
by teaching them new ways of thinking and behaving and helping them change habits
that contribute to depression. Psychotherapy occurs under the care of a licensed, trained
mental health professional in one-on-one sessions or with others in a group setting.
Psychotherapy can be effective when delivered in person or virtually via telehealth. A
provider may support or supplement therapy using digital or mobile technology, like apps
or other tools.
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Psychotherapy can be effective when delivered in person or virtually via telehealth. A
provider may support or supplement therapy using digital or mobile technology, like apps
or other tools.
Evidence-based therapies to treat depression include cognitive behavioral therapy and
interpersonal therapy. Using other forms of psychotherapy, such as psychodynamic
therapy, for a limited time also may help some people with depression.
● Cognitive behavioral therapy (CBT): With CBT, people learn to challenge and change
unhelpful thoughts and behaviors to improve their depressive and anxious feelings.
Recent advances in CBT include adding mindfulness principles and specializing the
therapy to target specific symptoms like insomnia.
|
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● Interpersonal therapy (IPT): IPT focuses on interpersonal and life events that impact
mood and vice versa. IPT aims to help people improve their communication skills
within relationships, form social support networks, and develop realistic expectations
to better deal with crises or other issues that may be contributing to or worsening
their depression.
For more information on psychotherapy, including what to look for in a therapist and
how to find one, visit www.nimh.nih.gov/psychotherapies.
Medication
Antidepressants are medications commonly used to treat depression. They work by
changing how the brain produces or uses certain chemicals involved in mood or stress.
Antidepressants take time—usually 4−8 weeks—to work, and problems with sleep, appetite,
and concentration often improve before mood lifts. Giving a medication a chance to work
is important before deciding whether it is right for you.
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Treatment-resistant depression occurs when a person doesn’t get better after trying at
least two antidepressants. Esketamine is a medication approved by the U.S. Food and
Drug Administration (FDA) for treatment-resistant depression. Delivered as a nasal
spray in a doctor’s office, clinic, or hospital, the medication acts rapidly, typically within
a couple of hours, to relieve depression symptoms. People will usually continue to take
an antidepressant pill to maintain the improvement in their symptoms.
Another option for treatment-resistant depression is to combine an antidepressant with
a different type of medication that may make it more effective, such as an antipsychotic
or anticonvulsant medication.
All medications can have side effects. Talk to a health care provider before starting or
stopping any medication. For more information, visit www.nimh.nih.gov/medications.
|
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All medications can have side effects. Talk to a health care provider before starting or
stopping any medication. For more information, visit www.nimh.nih.gov/medications.
Note: In some cases, children, teenagers, and young adults under 25 years may
experience an increase in suicidal thoughts or behavior when taking antidepressants,
especially in the first few weeks after starting or when the dose is changed. The FDA
advises that patients of all ages taking antidepressants be watched closely, especially
during the first few weeks of treatment.
Information about medication changes frequently. You can learn more about specific
medications like esketamine, including the latest approvals, side effects, warnings, and
patient information, on the FDA website at www.fda.gov/drugsatfda.
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Brain stimulation therapy
Brain stimulation therapy is an option when other depression treatments have not worked.
The therapy involves activating or inhibiting the brain with electricity or magnetic waves.
Although brain stimulation therapy is less frequently used than psychotherapy and
medication, it can play an important role in treating depression in people who have not
responded to other treatments. The therapy generally is used only after a person has
tried psychotherapy and medication, and those treatments usually continue. Brain
stimulation therapy is sometimes used as an earlier treatment option when severe
depression has become life-threatening, such as when a person has stopped eating or
drinking or is at a high risk of suicide.
|
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The FDA has approved several types of brain stimulation therapy. The most used are
electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS).
Other brain stimulation therapies are newer and, in some cases, still considered
experimental. You can learn more about these therapies at www.nimh.nih.gov/braintherapies.
Natural products
The FDA has not approved any natural products for treating depression. Although
research is ongoing and findings are inconsistent, some people report that natural
products, including vitamin D and the herbal dietary supplement St. John’s wort, helped
their depression symptoms. However, these products can come with risks, including, in
some cases, interactions with prescription medications.
|
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Do not use vitamin D, St. John’s wort, or other dietary supplements or natural products
without first talking to a health care provider. Rigorous studies must test whether these
and other natural products are safe and effective.
How can I take care of myself?
Most people with depression benefit from mental health treatment. Once you begin
treatment, you should gradually start to feel better. Go easy on yourself during this time.
Try to do things you used to enjoy. Even if you don’t feel like doing them, they can improve
your mood.
Other things that may help:
● Try to get physical activity. Just 30 minutes a day of walking can boost your mood.
● Try to maintain a regular bedtime and wake-up time.
● Eat regular, healthy meals.
● Do what you can as you can. Decide what must get done and what can wait.
● Connect with people. Talk to people you trust about how you are feeling.
● Delay making important life decisions until you feel better. Discuss decisions with
|
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people who know you well.
● Avoid using alcohol, nicotine, or drugs, including medications not prescribed for you.
How can I find help for depression?
The National Institute of Mental Health (NIMH) has information on ways to get help,
find a health care provider, and access treatment at www.nimh.nih.gov/findhelp.
You can also find tips to help prepare for and get the most out of your health care
visit at www.nimh.nih.gov/talkingtips.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has an
online tool to find mental health services in your area at https://findtreatment.gov.
How can I help a loved one who is depressed?
If someone you know is depressed, help them see a health care provider or mental health
professional. You also can:
● Offer support, understanding, patience, and encouragement.
● Invite them out for walks, outings, and other activities.
● Help them stick to their treatment plan, such as setting reminders to take
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prescribed medications.
● Make sure they have transportation or access to therapy appointments.
● Remind them that, with time and treatment, their depression can lift.
Clinical trials
Clinical trials are research studies that look at ways to prevent, detect, or treat diseases
and conditions. These studies help show whether a treatment is safe and effective in
people. Some people join clinical trials to help doctors and researchers learn more
about a disease and improve health care. Other people, such as those with health
conditions, join to try treatments that aren’t widely available.
NIMH supports clinical trials across the United States. Talk to a health care provider
about clinical trials and whether one is right for you. For more information, visit
www.nimh.nih.gov/clinicaltrials.
For more information
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
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NIH Publication No. 24-MH-8079
Revised 2024
|
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] |
National Institute
of Mental Health
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 24-MH-8079
Revised 2024
[Table Data]
[Table: table_1_1]
| Col0 | Col1 | Col2 |
| --- | --- | --- |
| Depression
National Institute
of Mental Health | | |
| | | |
|
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|
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