Depression is a psychiatric illness that can impact your mood, relationships, self-esteem, and overall ability to function. Depression is common, and the World Health Organization (WHO) estimates that 280 million adults experience this condition worldwide(1). Fortunately, there are many coping skills that can help with depression.
Although most people vaguely understand the concept of depression, many misconceptions exist about its causes, impact, and treatment. Depression is not a choice, and it is not a willpower problem. Let’s get into everything you need to know.
Types of Depression
People often use the global term ‘depression’ to describe anything related to a poor mood. However, in the Diagnostic and Statistical Manual (DSM), depression falls under an extensive category of mood disorders.
Major Depressive Disorder (MDD)
Major Depressive Disorder refers to a chronic and persistent pattern of depression. This depression affects one’s mental and physical health. To meet the criteria for this condition, someone must experience numerous depressive symptoms for at least two weeks.
Signs and Symptoms
- Persistently depressed mood
- Lack of excitement or pleasure in most activities
- Significant weight gain or weight loss (without intentional changes in eating)
- Insomnia or hypersomnia
- Moving slowly or feeling physically heavy
- Chronic fatigue
- Feeling excessive guilt or worthlessness
- Concentration problems
- Recurrent thoughts of death (which may coincide with suicidal behavior)
It’s important to note that MDD does not always look like conventional sadness. In fact, people often first seek medical attention for depression with complaints of fatigue or irritation. Likewise, instead of feeling sad, many people cite they just “don’t care” or that they feel relatively numb to the situations happening around them.
Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder refers to a pattern of consistent and severe irritability. Children with this condition experience frequent temper outbursts across multiple settings. The tantrums are severe enough to warrant attention, and they are inconsistent with the child’s current developmental level.
Signs and Symptoms:
- Recurrent mood outbursts often expressed as either verbal rage or physical aggression
- Outbursts occurring at least 3x per week
- Persistent anger and irritability throughout most of the day
- The onset of symptoms occurs before 10 years old
Disruptive mood dysregulation disorder affects a child’s ability to form meaningful friendships, and it can cause problems in school and extracurricular activities. It often causes significant distress in the home, as parents tend to feel exhausted and frustrated by the child’s behavior.
This disorder can be challenging to diagnose. Symptoms may look similar to oppositional defiant disorder (ODD), autism, intermittent explosive disorder, ADHD, and childhood bipolar disorder. However, a child should only be diagnosed with this condition if they do not meet the criteria for having a manic episode.
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Persistent Depressive Disorder (Dysthymia)
Dysthymia is a long-term form of depression where a depressed mood persists for at least one year in children and two years in adults. People with this condition tend to describe their moods as “sad” or “down,” and they may present with general themes of apathy about life.
Signs and Symptoms:
- Depressed mood for most of the day
- Poor appetite or overeating
- Concentration problems or indecisiveness
- Hopelessness or despair
- Low energy
- Insomnia or hypersomnia
Dysthymia symptoms share the same symptoms as a major depressive episode. The difference lies in the timeframe. A depressive episode in MDD only needs to last two weeks. People may have one, or they may have several episodes over the course of their lifespan. But dysthymia is more persistent and chronic. The symptoms can last for several years.
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder refers to a specific depression that occurs during menstruation. The symptoms are present just before menstruation, and they improve just a few days after completing menstruation. The symptoms are minimal or nonexistent in-between those times.
Signs and Symptoms
- Intense mood swings or emotional sensitivity
- Increased anger and irritability
- Depressive symptoms
- Increased anxiety
- Physical symptoms (bloating, breast tenderness, soreness, weight gain)
These symptoms are more severe than the average hormonal fluctuations someone experiences during menstruation. They cause clinical distress and often affect the individual’s overall quality of life. The onset of symptoms can occur at any point, and symptoms may worsen as someone reaches menopause.
Substance/Medication-Induced Depressive Disorder
This disorder is characterized by mood disturbances that occur during or just after substance intoxication or withdrawal. Stimulants, antidepressants, opioids, and central nervous system drugs may increase the risk of this condition.
Signs and Symptoms:
- Increased irritability
- Despair and hopelessness
- Intense guilt
- Concentration problems
- Withdrawal symptoms (shakiness, physical discomfort, cravings)
This type of depressive disorder can be particularly challenging for people who also struggle with comorbid substance use disorders. These mental health symptoms may feel so uncomfortable that they trigger a relapse. Furthermore, the individual might not recognize the magnitude of their depression, as the symptoms can coincide with other substance-related symptoms.
Depressive Disorder Due to Another Medical Condition
Certain medical conditions may increase the risk of someone experiencing depression. Research shows strong associations between depression and traumatic brain injury, Parkinson’s Disease, Huntington’s Disease, stroke, and hypothyroidism. That said, depression can certainly coincide with any medical condition- no matter how mild.
Signs and Symptoms:
- Depressed mood for most of the day
- Depression is directly related to a specific medical condition
- Depressive symptoms affect the individual’s quality of life
Depressive symptoms can be highly acute, but they can also emerge at any time after a medical diagnosis. It’s common for people to experience a combination of depression and anxiety symptoms.
Other Specified Depressive Disorder
This disorder refers to a broader set of symptoms someone might experience. To meet the criteria for this condition, the individual cannot also meet the criteria for any other particular depressive disorder.
Here are some examples:
Recurrent brief depression: Persistently depressed mood with depressive symptoms for 2-13 days at least one time per month for at least one year.
Short-duration depressive episode: All the criteria for a major depressive disorder are met except the episode only lasts 4-13 days.
Depressive episode with insufficient symptoms: Persistently depressed mood with some depressive symptoms (but not 5+) that persist for at least two weeks.
Understanding Depressive Features
When diagnosing depression, it’s important to consider that symptoms may follow specific patterns. Understanding these patterns is inherently important for correct diagnosing. But it’s also essential for securing proper treatment and getting the help you need.
Here are the specifiers that can occur during depression:
Anxious distress: You experience depressive symptoms with anxious symptoms, such as feeling tense, restlessness, heightened worry, and fears of losing control).
Mixed features: You experience depressive symptoms along with some manic/hypomanic symptoms. These symptoms may include having an elevated mood, being more talkative than usual, experiencing racing thoughts, and being hyper-focused on a specific goal. If the symptoms meet the full criteria for a manic or hypomanic episode, your practitioner will assess for Bipolar I or Bipolar II diagnoses.
Melancholic features: During the most “severe” stage of your depression, you experience loss of pleasure and lack of reactivity to most pleasurable stimuli. In addition, you experience some of the following symptoms: intense despair or despondency, depression that is worse in the morning, early-morning awakening, significant weight loss, excessive guilt, and moving very slowly throughout the day.
Atypical features: You experience at least two of the following symptoms: mood reactivity (feeling positive) to certain events, an increased appetite or weight gain, hypersomnia, heavy feelings in the arms or legs, and a pattern of intense rejection sensitivity.
With psychotic features: You experience depressive symptoms with hallucinations or delusions.
With catatonia: You experience depressive symptoms with catatonia (a state of immobility.
With peripartum onset: You experience depressive symptoms during pregnancy or within the first four weeks post-delivery.
With seasonal pattern: You experience depressive symptoms during a particular time of year (such as winter) and a remission of symptoms during other times of the year. This pattern is also often known as ‘seasonal affective disorder.’
What Causes Depression?
Like all mental illnesses, depression is multifaceted. There isn’t a single culprit that causes someone to be depressed. Instead, mental health experts typically examine clusters of risk factors that may increase someone’s likelihood of developing a mood disorder(2).
History of trauma: People experiencing depression often cite histories of trauma. This doesn’t mean that trauma directly causes depression. However, trauma can fundamentally change the brain’s chemistry and can impact mood, motivation, and concentration, all of which are associated with depression.
Family history of depression: Research shows that people with depression often have first-degree relatives who also have depression. Some studies show that depression is 40% determined by genetic factors. These factors can shape one’s mental health predisposition.
Specific illnesses and medications: Certain illnesses or medications may exacerbate depressive symptoms. If you feel depressed soon after starting a new medication, speak to your doctor.
Brain chemistry imbalances: Neurotransmitter imbalances with dopamine, norepinephrine, and serotonin may coincide with depression. However, the exact research on this phenomenon remains incomplete.
Chronic stress: Chronic stress can impact your ability to cope, and it can also aggravate depression. Stress releases the hormone cortisol, which can block other important neurotransmitters associated with mood regulation.
Common Depression Treatments
Depression is not curable, but you can learn how to manage your symptoms to live a meaningful and fulfilling life. It’s important to seek evidence-based care as a starting point for your treatment.
Here are some common depression treatments and how they work:
If you are severely depressed or at grave risk of harming yourself or others, you may need a brief period of hospitalization. You may seek hospitalization voluntarily, but you might also be hospitalized under a healthcare provider’s order. The specific laws vary from state to state.
During this time, your assigned treatment team will focus on symptom stabilization and medication monitoring. The length of stay tends to be brief, but the guidelines are based on your particular condition.
Inpatient Treatment/Residential Care/Rehab
People with moderate or severe depression may benefit from inpatient mental health treatment options. Inpatient refers to receiving 24/7 monitoring and supervision. Inpatient treatment occurs in many settings, including hospitals, nonprofit centers, and private rehab organizations.
Inpatient treatment allows you to focus exclusively on your mental health with limited distractions. For example, you will not be working or caring for other people during this time.
You will live in a monitored residential care setting and spend most of your day meeting with therapists, psychiatrists, and other patients. Inpatient treatment may range from a few weeks to several months. Most people who complete inpatient treatment are referred for longer outpatient care.
Outpatient Talk Therapies
Outpatient treatment is the most common therapeutic treatment for depression. Outpatient care also occurs in numerous settings, including hospitals, schools, nonprofit facilities, and private practice. Most people engage in this type of treatment while resuming everyday life activities.
Cognitive-behavioral therapy (CBT): CBT was developed for treating depression, and it is one of the most well-known, popular models for mood disorders. CBT operates on the premise that negative thoughts (distortions) result in emotional distress and poor coping strategies. By changing your thoughts, you can start to feel better and change unwanted habits.
CBT includes many components, but your treatment might focus on:
- Recognizing situational triggers that exacerbate your depression
- Utilizing mindfulness skills to manage stress
- Engaging in pleasant activity scheduling to boost positive coping strategies
- Developing realistic behavioral goals
- Challenging negative self-talk that coincides with depressive feelings
Interpersonal therapy (IPT): Interpersonal therapy is a short-term treatment that can help reduce depression symptoms. It’s particularly recommended for children and adolescents. Interpersonal therapy emphasizes how symptoms relate to one’s interpersonal relationships with peers and family members.
IPT largely focus on:
- Quickly reducing intense symptoms
- Improving social skills and comfort in social settings
- Empowering individuals to cope with their symptoms autonomously
Family therapy: Depression, particularly in children, can affect the entire family system. Therefore, treatment that involves parents and siblings provides practical coping tools and support for everyone in the home.
Family therapy may include:
- Communication skills
- Setting and implementing healthy boundaries
- Parenting guidelines
- Increased family bonding activities
Medication can provide both short-term and long-term relief for people experiencing depression. There are numerous options available.
It’s important to note that, while medications offer symptom relief, they are rarely recommended as a sole depression treatment. Furthermore, it’s essential to be aware of potential side effects. Your doctor or psychiatrist will review the potential risks before starting a new medication.
Antidepressants: Antidepressants are a general term for six different types of medication federally approved to treat depression. SSRIs (Celexa, Zoloft, Prozac, Zoloft) tend to be the most common type of antidepressant. Antidepressants work by providing neurotransmitter balance. These medications can take 1-2 months to work fully.
Electroconvulsive Therapy (ECT): ECT may be used for severe depression or for people who have not responded well to other conventional treatment methods. ECT entails quick electrical brain stimulations while under anesthesia. Treatment usually occurs 2-3 times a week for 6-12 weeks.
Transcranial Magnetic Stimulation (TMS): TMS can also treat depression for people who have not responded favorably to other treatments. This treatment entails quickly changing magnetic fields to stimulate specific brain regions. Unlike ECT, it does not stimulate seizures, and the individual remains fully awake during the procedure. TMS is typically provided 4-5x a week for 4-6 weeks.
Ketamine therapy: Ketamine is an alternative depression treatment that can be provided via bloodstream infusion or through a nasal spray. While experts aren’t exactly clear on how ketamine helps with depression, it appears that it improves glutamate functioning in the brain. This process can improve mood, cognition, and thinking patterns. People typically respond to treatment within 1-3 infusions, and many studies offer eight treatments during the initial phase.
Depression Lifestyle Changes
Mental health is inherently holistic. Many people benefit from making direct lifestyle changes along with pursuing other treatment options. Here are some considerations.
Build your social support: Relationships provide safety, validation, and comfort. Unfortunately, depression often festers in isolation. You may distance yourself from loved ones when you feel sad. Try to avoid this pattern as much as you can. Your friends and family care about you, and it’s important to try to prioritize staying connected.
Exercise regularly: Research continues to show that routine physical activity can be just as beneficial as antidepressants(3). Exercise is associated with increased energy, improved self-esteem, better sleep, and higher levels of concentration. These benefits all coincide with depression relief. Aim for about 30 minutes of moderate exercise each day.
Eat a well-rounded diet: Depression can make healthy eating challenging. You might lose your appetite or crave sugary, fried, or baked goods. But proper nutrition can balance your mood, improve sleep, and give you more energy. These benefits, in turn, can reduce depression. As a general rule of thumb, try to focus on adding more fatty acids, complex carbohydrates, and leafy greens into your diet.
Practice more mindfulness: Mindfulness can help you manage daily stress more efficiently. Try to focus on being more present in daily life. When you feel overwhelmed or sad, consider taking a few deep breaths and tuning into your body. Avoid judging your thoughts, but gently redirect yourself to the current moment.
Commit to a sleep schedule: People with depression often struggle with either insomnia or hypersomnia. These vicious cycles can deplete your energy, causing you to feel even more depressed during the day. That’s why it’s important to focus on implementing a healthy sleep routine. Your symptoms might not improve overnight, but you can take proactive steps to feel more rested. Keep your bedroom dark and cool. Aim to go to bed at the same time each night and invest in a high-quality mattress and sheets.
Practice positive affirmations: Affirmations can be helpful if you feel “stuck” or poorly about yourself. Remind yourself that you are capable, empowered, and inherently worthy. Write these positive notes down and keep the reminders in a visible place.
Talk back to your depression: Some people find it helpful to imagine their depression as an external part of themselves. Once you can do that, you can essentially reason or disregard your depression’s messages. For example, you might say, I’m not going to let you make me feel bad about myself today. I’m going to ignore you right now!
Engage in creative expression: If your emotions feel trapped inside of you, it’s important to try to release potential tension. Consider creative hobbies like writing, dancing, or making art. Don’t focus on improving your skill set or doing things perfectly. Try to honor simply enjoying the activity for what it is.
Embrace being “in flow”: Flow refers to a dynamic state of total immersion. When you’re in flow, you’re completely present with the current activity, and time seems to disappear. People achieve flow in limitless ways (including at work)- try to consider which hobbies or activities make you feel completely engaged. Getting in flow routinely can reduce apathy and anhedonia.
Practice more gratitude: It’s easy to feel cynical during a depressive episode. You may feel like the entire world is crashing down on you. If this is the case, try to spend a few moments each day reflecting on your gratitude. Don’t overlook the small things like enjoying a cup of coffee or hearing your favorite song on the radio.
When it comes to mental health, knowledge is power. The more you know, the more you can help yourself (or someone else). Here are common questions people have about depression.
Who can diagnose depression?
Even if you identify with having symptoms of depression, it’s important to receive an accurate diagnosis from a qualified provider. A physician, psychiatrist, psychologist, or mental health professional can screen for depression. Keep in mind that mental health professionals have different titles, but some common ones include LMFT, LPCC, LCSW, and LMHC.
When do most people first experience depression symptoms?
The onset of depression can occur at any time. However, most people first experience symptoms from mid-to-late adolescence through their early 40s. Later onset may coincide with common aging stressors, such as retirement, children leaving home, bereavement, and medical conditions.
What should I do if I’m concerned my young child has depression?
4.4% of children aged 3-17 have depression(4). But depressive symptoms can also mimic symptoms in ADHD, social anxiety, and other behavioral health conditions. If you’re concerned about your young child’s mental health, contact their pediatrician to express what you’ve observed. They can give you the next steps for moving forward.
What should I do if I’m concerned my adolescent or teenager has depression?
Depending on your relationship, it may be helpful to speak to your adolescent or teenager directly. State what you have observed, and aim to maintain a calm and neutral tone. For example, you might say, I’ve noticed you’ve been sleeping in late the past few weeks. You haven’t wanted to go to soccer practice, and you failed your math test. I’m worried about how you’re feeling. Have you been feeling depressed at all?
What if I have depression and therapy hasn’t helped?
Therapy isn’t the only solution for depression, and not all therapies will work with everyone. Therapeutic relationships are similar to other relationships, in that it can take time to find the right provider. You may need to meet with a few different therapists to find the right match.
How long do I need to go to therapy for depression?
The length of treatment depends. Some people benefit tremendously from short-term therapy (about 6-12 sessions). Others prefer working with someone on an ongoing basis for several months or years. In addition, it’s common for people to stop and start therapy at different points during their life.
What if I need help for my depression but don’t have the money for treatment?
There are numerous free or low-cost mental health resources. Check if your employer has an employee assistance program (EAP) that covers counseling. If you have health insurance, look into which services may be covered by your plan. Many therapists also offer sliding scale or pro bono options. Furthermore, consider working with a therapist intern or trainee. These providers are working towards licensure, and they are overseen by a qualified, licensed provider. You can also look into community health clinics or nonprofit centers. These facilities often run on sliding scale costs.
What should I do if depression is affecting my job?
Depression is a medical condition, and you may be covered under the American Disabilities Act (ADA) in the workplace. Under the ADA, your employer must provide reasonable accommodations. These accommodations vary, but they may include flexible schedules, time off for therapy or other appointments, or working within a quiet space.
What if I feel like I can’t work due to my depression?
Workplace rights vary depending on your state and specific company. However, you may be eligible for a medical leave of absence. In many cases, this leave is covered under an unpaid Family and Medical Leave (FMLA). You might be able to receive partial compensation under short-term disability.
Will I have depression for the rest of my life?
It depends on your condition, symptoms, and treatment. Many people experience ebbs and flows with their depression. However, with the right treatment, you should expect to experience relief, and you should feel a sense of empowerment over your symptoms.
What does depression recovery really look like?
Depression recovery looks different for everyone. Symptoms may fluctuate based on stress, and it’s essential to be mindful of your depression triggers. Most people find they need to use some combination of coping skills to manage their daily functioning. However, many people with depression enjoy a well-rounded life with engaging hobbies and fulfilling relationships.
Depression is a complex condition. However, informing yourself of the symptoms, prognosis, and treatment can help you feel empowered about taking the next steps. You don’t have to suffer alone. Seeking treatment can make an invaluable difference in how you feel.
Immediate Resources for Depression
If you need urgent help, here are some free programs, referrals, and resources.
211: Dial 2-1-1 to access a confidential referral network. 211 can help with food, housing, and immediate crisis support issues.
988: This number directs you to the suicide and crisis lifeline. Call or text 988 or chat to 988lifeline.org to speak to a confidential crisis counselor 24/7.
National Domestic Violence Hotline: If you or a loved one is experiencing abuse (or concerns about imminent safety), call 1-800-799-7233. You will be connected to a confidential crisis counselor who can help with safety planning, intervention, and local referrals.
911: If you believe you or someone is in a life-threatening situation, you can always call 911 for immediate emergency support.