Everyone feels sad at times. Sometimes, when people say “I’m depressed,” what they actually mean is that they are feeling sad or blue. There are major differences between feeling sad and having depression.
Major depression disorder (MDD) is one of the most common mental health disorders in the United States. In some cases, MDD can be seriously disabling and interfere with or limit the ability to function in daily life.
Clinical depression is a common, serious mood disorder. It affects how people feel, think, and deal with daily life. Among other symptoms, depression can affect sleep, eating habits, and work-life. Depression is usually diagnosed as clinical depression; these symptoms occur for at least two weeks.
The 2017 National Survey on Drug Use and Health (NSDUH) looked at people over the age of 18 in the United States who had a major depressive episode.1 The survey found:
About 17.3 million adults had at least one major depressive episode.
More females experienced a major depressive episode than males.
The age group of individuals age 18 to 25 had the highest reporting of a major depressive episode.
Adults identifying as two races or more reported the highest rates of major depressive episodes.
PDD is a depression condition that continues for two years or longer. Those with PDD can experience major depression, along with times of less severe symptoms.
Postpartum depression happens after giving birth when some women get the “baby blues.” Postpartum depression involves longer-lasting major depression during pregnancy or after delivery. This involves feeling mildly depressed, exhausted, and anxious. These symptoms usually go away within two weeks after giving birth.
Postpartum depression makes it hard for new mothers to care for themselves and their new babies. It can cause bonding issues between mother and child because the mother is too depressed to connect with her baby.
Psychotic depression occurs when a person has severe depression, along with a form of psychosis. Symptoms of psychosis can include delusions or hallucinations. The psychotic symptoms have a depressive tone, such as delusions of poverty, guilt, or illness.
SAD happens in the winter months. Days are shorter and there is less sunlight. SAD symptoms include isolation, sleeping more and weight gain. SAD often goes away during spring and summer but winter can bring another bout of seasonal affective disorder.
Bipolar disorder differs from depression. It is included as a type of depression because its low moods meet the guidelines for major depression. People with bipolar disorder also have extremely high moods called mania or less severe high moods called hypomania.
Sadness is a common emotion that is likely experienced by everyone at some point in their lives. Sadness can stem from hurtful situations or difficult experiences. These feelings are the result of an event, or they are triggered by something. Unlike depression, sadness can go away when circumstances change or when adjustments have been made. Usually, when individuals can adjust, recover from loss, or get over disappointment, the sadness fades.
Depression is a mental health disorder that can affect emotions, behaviors, and interactions. Feeling depressed for more than two weeks is not a normal way of life. Those with depressive symptoms can feel sad about everything. Feeling depressed does not mean one simply cannot handle difficult situations. Most times, depression happens without triggers – it is not necessarily triggered by loss or change.
Individuals might look fine to outsiders and be in denial about their own state of health. However, those with depression still struggle internally. Depression affects all parts of life. Everything is less enjoyable and less interesting. Those with depression can feel less important, lovable, and worthwhile. A person with depression sometimes withdraws to minimize the pain that interactions may cause.
Depression drains away energy, making the person feel tired all the time. There is a loss of motivation. It might be difficult to experience joy or pleasure. There is little or no excitement or anticipation. It is a struggle to feel satisfied or connected to others. It is not easy to see hope or meaning in life. Negative emotions and reactions are always near the surface. It is much easier to be impatient or to become angry. Frustration and breakdowns happen more easily. It takes longer to recover from anything.
Most people with a form of clinical depression need formal treatment to break the cycle.
Depression is usually recognized via long-term (2 consecutive weeks or more) symptoms.3 Symptoms of depression include:
Feeling sad, anxious, or "hollow"
Feeling hopeless or having a gloomy outlook
Losing interest or pleasure in things that used to be enjoyable
Loss of energy
Feeling tired all the time
Finding it hard to concentrate
Moving more slowly
Talking more slowly
Feeling like you cannot sit still
Problems making decisions
Finding it hard to awaken
Unexplained aches, pains, headaches, or cramps that treatment does not help
Digestive problems without a physical cause that treatment does not help
Thoughts of death/suicide
Men and women can experience depression differently.4 This could be from biological sex differences like hormonal imbalances. Signs of depression in men include:
Spending lots of time "escaping," for example, spending many hours at work or playing sports
Physical signs, such as headaches, stomach aches, or aches and pains with no clear causes
Alcohol or drug abuse
Controlling, violent, or abusive behavior
Irritability or quick to anger
Risky behavior, such as drinking and driving
Depression is caused by a mix of heredity, physical, and mental factors. Environment also plays a role. Depression can set in at any age; however, it is most common in adults. Depression looks different in children and teens. Rather than a sad mood, children and teens become highly irritable.
In middle-age and older adults, depression can follow the development of a serious illness. Older people with cancer, diabetes, and heart disease are at risk for depression. If depression came first, it often worsens after sickness. In some cases, medications taken for physical illnesses can have side effects that lead to depression.
Other risk factors include:
The National Center for Health Statistics published a report about depression among Americans ages 20 and older.5 Their key findings about the rates of depression included:
Approximately 1 in 3 veterans visiting medical clinics had some depression symptoms. 1 in 5 veterans had serious symptoms that required more tests for major depression. 1 in 8 veterans had major depression needing psychotherapy or antidepressant treatment.
It is estimated that approximately 10% to 15% of children and teens are depressed.10 About 1 in 4 adolescents experience major depression at some point during high school. The average age of a teen experiencing depression is 14 years old.
The consequences of teen depression are serious:
While younger children and teens may show the same symptoms as adults due to depression, they may also:
Talk to a doctor if these symptoms:
If you or a loved one is feeling depressed for two weeks or more, see your doctor. An evaluation will be done to see if it is depression or possibly something else.
Doctors may perform a physical exam and ask questions to screen for depression. For some people, depression may be from a health problem.
Doctors may order a blood test called a complete blood count (CBC) or a thyroid test. Again, the doctor is looking for any physical issues that could lead to depressive symptoms.
Therapists will be brought in to ask about symptoms, thoughts, feelings, and behaviors. Sometimes a written questionnaire is used to help answer these questions.
Sometimes depression is a symptom of another mental health disorder. It is important to determine whether this is the case, provide an accurate diagnosis, and follow up with the best treatment plan. These mental health disorders can include:
Mild to severe bipolar mood disorders include high and low mood swings. The low mood swings look like depression. It is often difficult to determine if someone has bipolar disorder or depression.
This type of depression is related to hormonal changes in the body. These changes usually begin a week before a woman begins menstruation. Symptoms usually ease with a few days and go away after the completion of the cycle.
Depression can be caused by using recreational drugs, some prescribed medications, or alcohol.
Treatment for depression typically includes therapy from a health professional and medication. Most people with depression feel better with medication, therapy, or both.
Antidepressants are drugs used to treat depression and depressive symptoms. These medications can help the way the brain metabolizes chemicals that control mood or stress.11 There are many types of antidepressants. Doctors and patients should review all possible side effects and weigh the risks before prescribing any medications.
Doctors often begin treatment by prescribing an SSRI.12 These medicines are considered safer than other depression drugs. SSRIs also cause less side effects than other antidepressants. SSRIs your doctor may prescribe are:
Another group of drugs, called SNRIs, can help with depression as well.13 SNRIs are also used to treat nerve pain and anxiety. SNRIs include:
These medications are not typical antidepressants, but can be used to treat depression.14 Some examples are:
These types of antidepressants can work well.15 They are also known to cause more serious side effects. Usually, these medications are prescribed if an SSRI does not work well. Some examples are:
MAOIs are often prescribed when other drugs have not worked well in relieving depression.16 They can cause serious side effects. Individuals taking MAOIs must restrict their diets. Certain wines, cheeses, and pickles can trigger dangerous or fatal reactions while on MAOIs. Negative interactions with other medicines and herbal supplements are also a risk. Some examples of MAOIs include:
Emsam - a newer MAOI skin patch that may cause fewer side effects than other MAOIs
Other medications can help an antidepressant work better. Doctors may do one or more of the following:
Doctors may prescribe an atypical antipsychotic. This would be an add-on to make the antidepressant more effective. The FDA has approved these atypical antipsychotics for the add-on treatment of depression:
When trying to find the best medications to treat depression, asking for recommendations from family and friends who have had positive results from an antidepressant might be a helpful place to start. The drug that did well for them may be successful in other cases. Don’t get discouraged if the first drugs do not provide optimal results. Several prescriptions, or a combination of several medications, might need to be tried before results are seen.
Patience is key! Some medications need a few weeks or longer to take full effect. It may also take several weeks for the side effects to wind down as bodies metabolize medications at different speeds. Heredity can play a part in how antidepressants affect the body. Genetic blood or swab tests can help doctors determine how individuals might respond to certain antidepressants. Keep in mind, other factors besides genes can affect responses to medication. This should be discussed with a doctor.
Antidepressants are not necessarily addictive, but some can cause physical dependence. It is important to talk to a doctor before stopping an antidepressant. Withdrawal symptoms can occur after a change in dosage or stoppage of treatment. Depressive symptoms can also worsen during the withdrawal process. This should be done under a physician’s supervision to minimize risks and complications. Dosage should be reduced gradually and safely.
Women who are breastfeeding should use caution when taking antidepressants. Some antidepressants can cause health risks for nursing children. Doctors should be informed immediately of pregnancy or if a patient is planning to become pregnant.
Most antidepressants are considered safe. Despite this, the Food and Drug Administration (FDA) requires all antidepressants to carry a warning.17 This warns about increased suicide risks in younger people on antidepressants. In some cases, people below the age of 25 may have increased suicidal thoughts or behaviors when taking antidepressants. People of all ages should watch for worsening depression or unusual behavior. If suicidal thoughts happen, get emergency help or talk to a doctor.
Antidepressants are more likely to reduce the risk of suicide for the long-term by improving mood and stopping depressive symptoms. Like any other drug, doctors and patients must balance the benefits against the risks.
Antidepressants can have side effects. Signs and symptoms such as weight gain, nausea, or trouble sleeping can happen almost immediately. Many people see these side effects improve after a few weeks. For others, antidepressants cause side effects that do not ease. First, individuals should talk to a doctor or mental health professional about any side effects once they appear. Blood tests can help adjust dosages to decrease side effects. If certain side effects are especially difficult to handle, individuals may be tempted to stop taking or reduce the amount of the antidepressant on their own. Either action can cause great harm:
Doing so in consultation with a doctor is the best option in all cases
Psychotherapy can help improve depression. It can also help uncover the mental roots of depression. The following treatments can be helpful options. Each type can take from 10 to 20 visits.
Work with patients to identify negative thoughts that make them feel depressed. They help patients exchange those negative thoughts with more realistic ones that support health, happiness, and life goals. CBT does not focus on the past. Rather, it focuses on the feelings, thoughts, and behaviors currently being experienced. CBT can be held in an individual or group setting.
IPT looks at a patient’s personal relationships and how they can be improved. Stable, strong, and solid social support is essential to one’s healthy well-being. If a relationship suffers, individuals can be impacted by the negativity, which can be unhealthy. IPT aims to improve relationship skills. It works on effective communication, how to express emotions, and how to be properly assertive at work and with loved ones. IPT can be held in an individual or group setting.
BA helps change behaviors that can help change moods. Many will learn to be aware of when they start to get depressed. Then, they will get into activities that they value or enjoy. Doing so helps combat isolation, sluggishness, and lack of interest depression can cause. Patients could spend time with loved ones or take an exercise class. They can do whatever interests them or makes them feel valued. BA therapy is practical and helps patients identify and achieve their goals.
ACT helps patients focus on the present. ACT aims to direct thinking away from the past or future. It also helps individuals see and accept negative thoughts and feelings, so they do not get caught up in them. ACT focuses on identifying what is most meaningful and important in their lives. Once this is understood, they can act on it to build a full, rewarding, and rich life.
PST teaches patients how to cope with daily life stresses and problems. With depression, individuals may feel threatened by daily problems or stresses. They might also believe they cannot solve these problems. A PST therapist helps analyze problems and find solutions that may work. The patient and therapist work together to carry out solutions and evaluate the results.
STPP focuses on relationships, unconscious thoughts, and feelings. STPP aims to reduce symptoms and to make patients vulnerable to depression. It also focuses on making patients stronger.
FT is a good option when depression is tied directly to family relationships. FT works on the personal relationships among family members. It also aims to improve communications and end hidden meanings in conversations. FT also examines the parts that family members play regarding depression. Also, education about depression is provided for everyone.
SAD light therapy is a treatment option for those people affected by Seasonal Affective Disorder (SAD). The patient sits in front of a bright light every day. A set period sitting before the light unit helps adjust the body clock. People with SAD may also be treated with antidepressants or therapy if needed.
Folate is a supplement that can be taken to help relieve or treat depression. Vitamin B9 (folate) has been shown to relieve depression in some cases.18 B9 helps bodies better process brain and nerve chemicals. These chemicals regulate moods, sleep, appetite, and other behaviors.
ECT can be used if medications do not work well to treat depression.19 ECT can also be used in some cases of psychotic depression. ECT uses an electric current to cause a brain seizure. The medical community believes that seizures can help the brain rewire itself differently. These changes are hoped to relieve depression symptoms.
ECT is considered mostly safe and effective. ECT is typically performed in a hospital. The person is put to sleep to avoid any pain or panic. Electrodes are placed on the scalp. Some electrodes monitor brain activity. Others deliver the electric current as a small electric current is delivered to the brain, seizure activity results. Drugs are also given to prevent the seizure from spreading throughout the body. A few minutes after the treatment, the person awakes. He or she will have no memory of the session. In a recovery room, the person is monitored.
Exercise can also help relieve depression. This can be true because exercise can:
Exercise lowers stress hormones.20 It also helps brain and nerve chemicals work better. Also, workouts can help promote healthy growth in parts of the brain – just as long-term antidepressant use can.
Exercises that can help relieve depression include:
Getting outdoors can help improve depression symptoms.21 It can also help with lowering stress levels. Visiting a park, beach, or hiking trail regularly could be effective at reducing stress.
Animal contact can help improve moods.22 Without owning a pet, outdoor animal activities are also an option. Visiting a zoo or petting farm, swimming with dolphins, or animal-assisted therapy could work.
For more severe forms of depression, a stay in a treatment center or hospital may be a good choice. These are also good options for those who cannot care for themselves day to day or those feeling suicidal or wanting to harm others.
For recovery from depression, it is critical to follow the treatment plan. Results may vary in the first few weeks, but that is normal. Sticking with your plan and being patient offers the best chance at success. Treatment should never be stopped without consulting a physician. Open lines of communication are important between patients and their therapists and counselors. You should feel you are able to talk freely. You may have to try a few therapists before finding the best fit.
Remain transparent about what does and does not work throughout the treatment plan. Talking to a therapist about how you feel about therapy sessions, regularly revisiting the overall treatment plan, and allowing changes to be made can help improve overall recovery.
Depression is treatable, but symptoms can return.23 Research shows that relapse rates for depression for people who have had:
These numbers reinforce why it is so important to have the right relapse plan in place. A depression relapse prevention plan prevents or limits recurrences.
An effective relapse prevention plan has a continued treatment for symptoms even after they have gone away. And a list of triggers to identify and avoid.
Most people relapse because they stopped following their treatment plan. It is crucial that patients attend all treatment sessions and take medicines on schedule. They should work on recognize when a depression trigger pops up and avoiding these triggers. If they find themselves dwelling on thoughts and failures, they should immediately stop. Using strategies from cognitive behavioral therapy or other therapies can successfully combat negative thoughts.
Take care of oneself is equally as important. Making sure to get enough sleep, proper nutrition, and adequate exercise can help mental and physical health.
If the early signs of a relapse do not go away, reaching out for help before the episode becomes severe is critical. Individuals should seek help from a healthcare professional right away to get evaluated for a relapse.
Depression is a medical condition. Just like other illnesses, such as diabetes or high blood pressure, you cannot treat it by telling yourself to “snap out of it.” 24 Depression is not about any one thing for most people. People with depression try to shame or criticize themselves out of it, which can be harmful. Remind yourself that depression is an illness. Work on your treatment plan instead. Be patient!
Clinical depression does not usually go away on its own. Most people need formal treatment. If you feel depressed for more than two weeks, see a health care professional.