While everyone has experienced sadness, not everyone has experienced depression. If you’ve never been depressed, chances are you don’t have a real grasp of what living with this complex mental illness is like.
Depression is insidious. It affects not only your mood, but also your ability to feel, think, and function. It blunts sensations of pleasure, closes off connectedness, stifles creativity, and, at its worst, shuts down hope. It also often causes deep emotional pain not only to the person experiencing it, but to that person’s close family and friends.
“It’s not what people think, an act of laziness or a lack of will for change,” says E. Mollie Kashuk, a 21-year-old college senior in Claremont, California. “Instead, it’s genuinely believing that change is not possible for you. It’s genuinely believing that you’re stuck in an overwhelming darkness that will never go away.”
Common Questions & Answers
Depression Statistics: Disturbing Trends, Helpful Treatment
What’s more, a recent report from Mental Health America, a nonprofit founded in 1909, offers startling statistics pertaining to one of depression's most disturbing symptoms: thoughts of suicide.
Signs and Symptoms: How to Identify Depression
- Constantly feel tearful, empty, or worthless?
- Have little interest or pleasure in your work, hobbies, friends, family, and other things you once enjoyed?
- Notice dramatic changes up or down in your appetite or your weight not related to dieting?
- Often feel listless or fatigued for no obvious reason?
- Have trouble concentrating or making decisions?
- Find yourself wringing your hands, pacing, or showing other signs of anxious restlessness — or the opposite, moving or speaking more slowly than usual?
- Struggle with insomnia or sleep too much?
- Have recurrent thoughts of suicide or death?
To be diagnosed with MDD, one of your symptoms must be a persistent low mood or a loss of interest or pleasure, the DSM-5 states. Your symptoms must also not be due to substance abuse or a medical condition, such as thyroid problems, a brain tumor, or a nutritional deficiency.
Of course, it’s normal to have any or all of these symptoms temporarily (for hours or even days) from time to time. The difference with depression is that the symptoms persist and make it difficult to function normally.
If you suspect you may be depressed, the best first step is to reach out to your primary care doctor, a psychiatrist, or a psychotherapist. If you’re reluctant to consult a professional, type “depression” or “clinical depression” into Google on your cellphone or computer and you’ll find links to a clinically validated depression test known as the PHQ-9 patient health questionnaire?(PDF). Although designed to be administered by a healthcare professional, this test is short and straightforward. Take it and you can immediately see if your score indicates you may have depression.
Important: If you suspect you have depression, or if you’re feeling troubled by your symptoms, have suicidal thoughts, just need to talk, want some advice, or need a referral for treatment, call the Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) at the three-digit code 988, or the National Substance Abuse and Mental Health Services Administration Helpline at 800-662-HELP (4357). Both are free and available 24/7, 365 days a year.
What Are the Different Types of Depression?
In addition to MDD there are several other kinds of depression, including:
- Persistent depressive disorder (PDD) Previously known as dysthymia, PDD is diagnosed in people who have at least two of the symptoms of major depression for at least two years at a time. It’s possible to fluctuate between severe and less-severe symptoms, and to have both PDD and MDD at the same time, a condition called double depression.People with PDD are often perceived as cranky, sullen, changeable, or pessimistic rather than being recognized as having a treatable disorder.
- Bipolar disorder, formerly called manic depressive disease, is characterized by moods that cycle between extreme highs (mania) and lows (depression), often with periods of normal mood in between.Bipolar disorder affects 2.8 percent of U.S. adults.
- Seasonal affective disorder (SAD) is depression that occurs at the same time each year, usually beginning in fall and persisting through winter. SAD is associated with changes in sunlight, and is often accompanied by increased sleep, weight gain, and cravings for foods high in carbohydrates.
- Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMDD usually develops a week or two before a woman’s period and passes two or three days after menstruation starts.
- Postpartum (or perinatal) depression (PPD) is diagnosed in mothers who experience symptoms of major depression shortly after giving birth.PPD is usually related to a combination of factors, including sharp changes in hormone levels following childbirth. Feelings of intense sadness, anxiety, or exhaustion are much stronger, and last longer, than the “baby blues” — the relatively mild symptoms of depression and anxiety that many new mothers experience in the first few days after childbirth.
Depression: Recognizing Unusual Symptoms
What Causes Depression?
Among the potential contributors to depression are:
- Genetics Many studies suggest that depression can spring from a genetic predisposition, including one international study involving more than 807,000 people, published in the February 2019 issue of the journal Nature Neuroscience, that linked 269 genes to depression.Genes alone are not believed to write your destiny, however. Scientists think that while some genes may increase risk, other factors are needed to trigger symptoms.
- Neurotransmitters The long-held idea that depression is caused by low levels of certain neurotransmitters (chemical messengers that communicate between neurons) has been debunked. But it’s clear that neurotransmitters play a role, at least for some people. Experts’ current belief is that the relationship between depression and neurotransmitters is complex and may be related to nerve cell connections, nerve cell growth, or the functioning of nerve circuits.
- Inflammation Multiple studies indicate that disease-related or stress-related inflammation may create chemical changes in the brain that can trigger or worsen depression in certain people and influence how a person responds to drug therapy.
- Hardship There’s growing evidence, according to the World Health Organization, that psychological and social factors like a history of abuse, poor health and nutrition, unemployment, social isolation or loneliness, low socioeconomic status, or stressful life events (divorce or money worries, for example) can play a decisive role in the onset of depression.For example, adults with MDD have double the rate of childhood trauma compared with people without MDD, a study published May 3, 2016, in the journal Translational Psychiatry showed.
- Traumatic brain injury (TBI) Another all-too-common cause of depression is TBI. In 2019, more than 223,000 people were hospitalized for TBIs (aka concussions) following a bump or blow to the head from things like falls, assaults, car accidents, and workplace and sports-related injuries, according to the Centers for Disease Control and Prevention.And more than half of those patients will meet the criteria for major depression three months after their injury, suggests a study published November 30, 2017, in the journal Brain Injury.
Depression and Gender: Is It Different in Men and Women?
Depression Treatment: Lifestyle Changes, Talk Therapy, Antidepressants
Lifestyle Changes for Depression
Lifestyle changes, such as making art, journaling, exercising more, and practicing yoga or mindfulness, can also alleviate depression and the stress that can heighten it. Alternative treatments like massage, acupuncture, and light therapy may also help.
Diet changes, too, can uplift your mood by reducing inflammation and helping to ensure your brain gets the nutrients it needs to function at its best.
Which Types of Talk Therapy Work Best for Depression?
- Behavioral activation therapy The aim of this type of therapy is to reverse the downward spiral of depression by encouraging you to seek out experiences and activities that give you joy.
- Cognitive behavioral therapy (CBT) CBT focuses on changing specific negative thought patterns so that you are able to better respond to challenging and stressful situations.
- Interpersonal therapy This very structured, time-limited form of therapy focuses on identifying and improving problematic personal relationships and circumstances directly related to your current depressive mood.
- Problem-solving therapy This therapy is a form of CBT that teaches take-charge skills that help you solve real-life problems and stressors, big and small, that contribute to depression.
- Self-management/self-control therapy This type of behavioral therapy trains you to lessen your negative reactions to events and reduce your self-punishing behaviors and thoughts.
What Are the Different Antidepressants and How Do They Work?
- SSRI (selective serotonin reuptake inhibitor) This category of drug includes fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) and targets serotonin, a neurotransmitter that helps control mood, appetite, and sleep.
- SNRI (serotonin and norepinephrine reuptake inhibitor) SNRIs include drugs like duloxetine (Cymbalta), desvenlafaxine (Pristiq), and venlafaxine (Effexor XR), which block the reabsorption of both serotonin and another neurotransmitter, norepinephrine.
- NDRI (norepinephrine–dopamine reuptake inhibitor) This class of medications includes bupropion.
- TCA (tricyclic antidepressant) TCAs include such drugs as imipramine (Tofranil) and nortriptyline (Pamelor). These drugs were among the earliest antidepressants to come on the market. These days, doctors generally only turn to them when treatment with SSRIs, SNRIs, and NDRIs has failed.
- MAOI (monoamine oxidase inhibitor) MAOIs, including phenelzine (Nardil) and isocarboxazid (Marplan), were the first antidepressants developed. They’re rarely used today, in part because people who take them require careful monitoring to prevent negative interactions with certain foods and other medications.
All antidepressants can have side effects, but some may be more problematic than others. You may need to try several different medications, or a combination, guided by your doctor, before you find what works best for you.
Have You Ever Experienced Antidepressant Withdrawal?
Should You Worry About Antidepressant Withdrawal?
More to the point, while you should slowly stop your antidepressant with the help of your doctor, antidepressants do not cause dependence and withdrawal like other substances. Unlike substances that are known to cause addiction, such as alcohol, opioids, and barbiturates, people don't crave antidepressants. You don’t get “high” from them, and they aren’t intentionally or compulsively overused. Serious reactions like the seizures and agitation that can follow sudden withdrawal from addictive substances are “unheard of when these antidepressants are tapered gradually,” note the authors of the Psychiatric Times report.
What Is Treatment Resistant Depression, and Is There Any Help for It?
- Esketamine A nasal spray marketed under the name Spravato, esketamine won FDA approval on March 5, 2019, as a new treatment for TRD.It is derived from ketamine, a veterinary anesthetic best known as the street drug “Special K.” Because of safety concerns, Spravato must be administered in a medical office and should be taken along with an oral antidepressant.
- Electroconvulsive therapy (ECT) ECT is the modern-day version of electroshock therapy. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. According to the APA, ECT rapidly provides substantial improvement in approximately 80 percent of patients with severe, uncomplicated major depression. Like any medical procedure, ECT is associated with side effects — most commonly, issues with memory. In most cases, this is short-term; however, some people can experience permanent gaps in memory. Nevertheless, current ECT has far fewer side effects than electroshock therapy of the past.
- Transcranial magnetic stimulation (TMS) TMS uses rapidly alternating magnetic fields to change activity in specific areas of the brain. Although researchers don’t fully understand how exactly TMS affects the brain, it appears to influence how the brain is operating and, in turn, improve mood and decrease depressive symptoms.
- Vagus nerve stimulation This therapy involves implanting a tiny device in the chest that provides regular mild electrical pulses to the longest of the nerves that arise from the brain. A study published on August 21, 2018, in the Journal of Clinical Psychiatry involving nearly 600 patients with TRD found that vagus nerve stimulation significantly improved quality of life for many patients.
- Psychedelic drugs While not yet FDA approved, microdosing with psychedelic drugs to produce a more positive mood in people with chronic depression is the focus of a flurry of research worldwide, including at the Johns Hopkins Center for Psychedelic and Consciousness Research. The possibilities appear vast and promising. For example, one of the latest Johns Hopkins studies, published March 1, 2019, in the?American Journal of Drug and Alcohol Abuse, found that a synthetic form of a psychedelic derived from the venom of certain toads provided fast-acting relief from depression and anxiety.According to a July 2022 position statement from the APA, there’s not enough evidence yet to endorse the use of psychedelics for the treatment of any mental health condition except during approved investigational studies, and more research is needed in this field.
What’s the Difference Between Grief and Depression?
Given that the primary symptom associated with depression is sadness, it can be easy to think of grief or bereavement as depression. But grief is a natural response to specific experiences, such as the end of a relationship or the death of a loved one. While you might feel regret or remorse, and you might withdraw from usual activities if you are experiencing grief, you’re unlikely to feel the overwhelming sense of worthlessness, thoughts of self-harm or suicide, and other symptoms of depression. Another important difference is that in grief, painful feelings usually come in waves and are often mixed with positive memories.
Resources We Love
Favorite Organizations for Depression
American Psychiatric Association (APA)
The APA offers a wealth of information and resources for people who have depression. We love that you can easily locate a doctor who specializes in treating your condition on their Find a Psychiatrist page.
National Institute of Mental Health (NIMH)
The NIMH is the largest research organization in the world committed to understanding the treatment and prevention of mental disorders. Their site offers information about depression and also lets you search for clinical trials in your area.
Favorite Online Support Networks
Anxiety and Depression Association of America (ADAA)
If you’re looking for support, the ADAA can help you find it. Search for a support group near you or start your own.
Depression and Bipolar Support Alliance (DBSA)
This organization provides hope, support, and inspiration to those battling depression and bipolar disorder. DBSA chapters offer support groups around the country. Most are volunteer-run and allow participants to meet with others who might have similar struggles.
Families for Depression Awareness
Families need support, too. This organization caters to family members, friends, and caregivers of those who have depression. Their free webinars cover ways to spot depression and intervene with those who are affected.
Favorite Apps, Products, and Gadgets
7 Cups App
If you’re feeling sad, lonely, or stressed, the 7 Cups app could provide you with online therapy and emotional support, allowing you to speak to someone 24/7 in a confidential setting.
This app offers activities and games to overcome negative thoughts. You’ll receive a “happiness score” that you can improve each time you play. It’s based on effective, evidence-based psychological strategies. The company says 86 percent of those who use the app report feeling better about their lives after just two months.
Bright Light Therapy Lamp
If you have seasonal affective disorder (SAD), bright light therapy may improve your symptoms. We like the Verilux HappyLight Lucent 10,000 Lux LED Bright White Light Therapy Lamp. It’s compact and portable, so you can use it on the go. And it received an average of 4.6 stars on Amazon reviews. The cost is around $45.
Favorite Annual Meetings
American Psychiatric Association (APA) Annual Meeting
The APA’s annual conference covers some of the biggest research breakthroughs in the field of psychiatry, including those related to depression.
Anxiety and Depression Association of America (ADAA) Conference
The ADAA sponsors an annual conference that brings together clinicians and researchers from across the United States and the world. The focus of the meeting is to highlight improved treatments and new data on anxiety, depression, and related disorders.
Sierra Tucson, located in Tucson, Arizona, is a recognized retreat and rehab center for those battling addiction and certain mental health concerns like depression. We like that their comprehensive program is based on individual needs and proven treatment modalities. They also work with insurance companies to try to keep your costs down.
Editorial Sources and Fact-Checking
- Major Depression. National Institute of Mental Health. January 2022.
- The State of Mental Health in America 2022. Mental Health America. 2022.
- Bailey RK, Mokonogho, J, Kumar A. Racial and Ethnic Differences in Depression: Current Perspectives. Neuropsychiatric Disease and Treatment. February 22, 2019.
- What Is Depression? American Psychiatric Association. October 2020.
- Persistent Depressive Disorder (PDD). Cleveland Clinic. March 8, 2021.
- What Are Bipolar Disorders? American Psychiatric Association. January 2021.
- Bipolar Disorder. National Institute of Mental Health.
- Seasonal Affective Disorder (SAD). Mayo Clinic. December 14, 2021.
- Premenstrual Dysphoric Disorder (PMDD). U.S. Department of Health and Human Services. February 22, 2021.
- Postpartum Depression. American College of Obstetricians and Gynecologists. December 2021.
- Krakowski M, Nolan K. Depressive Symptoms Associated With Aggression. Psychiatric Times. February 27, 2017.
- Salcedo B. The Comorbidity of Anxiety and Depression. National Alliance on Mental Illness. January 19, 2018.
- Tjornehoj T. The Relationship Between Anxiety and Depression. Hartgrove Behavioral Health System.
- Trivedi MH. The Link Between Depression and Physical Symptoms. Primary Care Companion to the Journal of Clinical Psychiatry. February 2004.
- Hardeveld F, Spijker J, De Graaf R, et al. Recurrence of Major Depressive Disorder and Its Predictors in the General Population: Results From the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Psychological Medicine. October 31, 2012.
- Pies RW. Debunking the Two Chemical Imbalance Myths, Again. Psychiatric Times. August 2, 2019.
- Howard DM, Adams MJ, McIntosh AM, et al. Genome-Wide Meta-Analysis of Depression Identifies 102 Independent Variants and Highlights the Importance of the Prefrontal Brain Regions. Nature Neuroscience. February 4, 2019.
- What Causes Depression? Harvard Medical School. January 10, 2022.
- Pariante CM. Why Are Depressed Patients Inflamed? A New Path to Personalized Treatment in Psychiatry. Psychiatric Times. May 31, 2018.
- Social Determinants of Mental Health. World Health Organization. 2014.
- Williams LM, Debattista C, Duchemin A-M, et al. Childhood Trauma Predicts Antidepressant Response in Adults With Major Depression: Data From the Randomized International Study to Predict Optimized Treatment for Depression. Translational Psychiatry. May 3, 2016.
- TBI Data. Centers for Disease Control and Prevention. March 21, 2022.
- Singh R, Mason S, Lecky F, Dawson J. Prevalence of Depression After TBI in a Prospective Cohort: The SHEFBIT Study. Brain Injury. November 30, 2017.
- Brody DJ, Pratt LA, Hughes JP. Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016. Centers for Disease Control and Prevention. February 2018.
- Screening for Perinatal Depression. American College of Obstetricians and Gynecologists. November 2018.
- Taraji P. Henson on Living With Depression and Anxiety. Self. December 3, 2019.
- Salcedo B. Depression Treatment — It Works. Anxiety and Depression Association of America. May 29, 2018.
- Francis HM, Stevenson RJ, Chambers JR, et al. A Brief Diet Intervention Can Reduce Symptoms of Depression in Young Adults — a Randomized Controlled Trial. PLoS One. October 9, 2019.
- Treatment Target: Depression. Society of Clinical Psychology.
- Questions and Answers About the NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study — All Medication Levels. National Institute of Mental Health. November 2006.
- Depression Medicines. U.S. Food and Drug Administration. September 2019.
- Wang P, Si T. Use of Antipsychotics in the Treatment of Depressive Disorders. Shanghai Archives of Psychiatry. June 25, 2013.
- Pies RW, Osser DN. Sorting Out the Antidepressant “Withdrawal” Controversy. Psychiatric Times. March 11, 2019.
- Jha MK, Rush AJ, Trivedi MH. When Discontinuing SSRI Antidepressants Is a Challenge: Management Tips. American Journal of Psychiatry. December 1, 2018.
- Bergfeld IO, Mantione M, Figee M, et al. Treatment-Resistant Depression and Suicidality. Journal of Affective Disorders. August 1, 2018.
- FDA Approves New Nasal Spray Medication for Treatment-Resistant Depression; Available Only at a Certified Doctor’s Office or Clinic. U.S. Food and Drug Administration. March 5, 2019.
- What Is Electroconvulsive Therapy (ECT)? American Psychiatric Association. July 2019.
- Transcranial Magnetic Stimulation. Mayo Clinic. November 27, 2018.
- Conway CR, Kumar A, Xiong W, et al. Chronic Vagus Nerve Stimulation Significantly Improves Quality of Life in Treatment-Resistant Major Depression. Journal of Clinical Psychiatry. 2018.
- Davis AK, So S, Lancelotta R, et al. 5-Methoxy-N,N-Dimethyltryptamine (5-MeO-DMT) Used in a Naturalistic Group Setting Is Associated With Unintended Improvements in Depression and Anxiety. American Journal of Drug and Alcohol Abuse. March 1, 2019.
- Position Statement on the Use of Psychedelic and Empathogenic Agents for Mental Health Conditions. American Psychiatric Association. July 2022.
- Kavan MG, Barone EJ. Grief and Major Depression — Controversy Over Changes in DSM-5 Diagnostic Criteria. American Family Physician. November 15, 2014.