Depression Self-Test

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Most Common Types of Depression

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.

Depression by the Numbers

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.

Types of Depression

There are other types of depression. Some of these can develop under special conditions.2

Persistent Depressive Disorder (PDD)

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

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

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.

Seasonal Affective Disorder (SAD)

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

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.

Video: What is Depression?

00:07 Depression is the leading cause of disability in the world. 00:11 In the United States, 00:12 close to 10% of adults struggle with depression. 00:15 But because it's a mental illness, 00:17 it can be a lot harder to understand than, say, high cholesterol. 00:21 One major source of confusion is the difference between having depression 00:25 and just feeling depressed. 00:27 Almost everyone feels down from time to time. 00:31 Getting a bad grade, 00:32 losing a job, 00:33 having an argument, 00:34 even a rainy day can bring on feelings of sadness. 00:38 Sometimes there's no trigger at all. 00:39 It just pops up out of the blue. 00:42 Then circumstances change, 00:43 and those sad feelings disappear. 00:46 Clinical depression is different. 00:48 It's a medical disorder, 00:49 and it won't go away just because you want it to. 00:52 It lingers for at least two consecutive weeks, 00:55 and significantly interferes with one's ability to work, 00:58 play, 00:59 or love. 01:00 Depression can have a lot of different symptoms: 01:03 a low mood, 01:04 loss of interest in things you'd normally enjoy, 01:06 changes in appetite, 01:08 feeling worthless or excessively guilty, 01:10 sleeping either too much or too little, 01:13 poor concentration, 01:15 restlessness or slowness, 01:17 loss of energy, 01:18 or recurrent thoughts of suicide. 01:21 If you have at least five of those symptoms, 01:23 according to psychiatric guidelines, 01:25 you qualify for a diagnosis of depression. 01:28 And it's not just behavioral symptoms. 01:31 Depression has physical manifestations inside the brain. 01:35 First of all, 01:36 there are changes that could be seen with the naked eye 01:39 and X-ray vision. 01:40 These include smaller frontal lobes and hippocampal volumes. 01:44 On a more microscale, 01:46 depression is associated with a few things: 01:49 the abnormal transmission or depletion of certain neurotransmitters, 01:53 especially serotonin, norepinephrine, and dopamine, 01:56 blunted circadian rhythms, 01:58 or specific changes in the REM and slow-wave parts of your sleep cycle, 02:03 and hormone abnormalities, 02:05 such as high cortisol and deregulation of thyroid hormones. 02:10 But neuroscientists still don't have a complete picture 02:12 of what causes depression. 02:15 It seems to have to do with a complex interaction between genes and environment, 02:20 but we don't have a diagnostic tool 02:21 that can accurately predict where or when it will show up. 02:26 And because depression symptoms are intangible, 02:28 it's hard to know who might look fine but is actually struggling. 02:32 According to the National Institute of Mental Health, 02:34 it takes the average person suffering with a mental illness 02:37 over ten years to ask for help. 02:41 But there are very effective treatments. 02:43 Medications and therapy complement each other to boost brain chemicals. 02:47 In extreme cases, electroconvulsive therapy, 02:50 which is like a controlled seizure in the patient's brain, 02:53 is also very helpful. 02:55 Other promising treatments, 02:56 like transcranial magnetic stimulation, 02:59 are being investigated, too. 03:01 So, if you know someone struggling with depression, 03:04 encourage them, gently, to seek out some of these options. 03:08 You might even offer to help with specific tasks, 03:11 like looking up therapists in the area, 03:13 or making a list of questions to ask a doctor. 03:16 To someone with depression, 03:17 these first steps can seem insurmountable. 03:20 If they feel guilty or ashamed, 03:23 point out that depression is a medical condition, 03:25 just like asthma or diabetes. 03:27 It's not a weakness or a personality trait, 03:30 and they shouldn't expect themselves to just get over it 03:33 anymore than they could will themselves to get over a broken arm. 03:36 If you haven't experienced depression yourself, 03:39 avoid comparing it to times you've felt down. 03:42 Comparing what they're experiencing to normal, temporary feelings of sadness 03:46 can make them feel guilty for struggling. 03:49 Even just talking about depression openly can help. 03:52 For example, research shows that asking someone about suicidal thoughts 03:57 actually reduces their suicide risk. 03:59 Open conversations about mental illness help erode stigma 04:03 and make it easier for people to ask for help. 04:06 And the more patients seek treatment, 04:08 the more scientists will learn about depression, 04:10 and the better the treatments will get.

How is Depression Different from Being Sad?

Sadness

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

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.

Internal Struggle

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.

Behavior Changes

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.

Symptoms of Depression

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

Feeling irritable

Feeling guilty

Feeling worthless

Feeling helpless

Losing interest or pleasure in things that used to be enjoyable

Loss of energy

Feeling tired all the time

Oversleeping

Appetite changes

Weight changes

Finding it hard to concentrate

Memory problems

Moving more slowly

Talking more slowly

Feeling restless

Feeling like you cannot sit still

Problems making decisions

Sleeping problems

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

Suicide attempts

Men and Depression

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

Risk Factors for Depression

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:

  • Trauma
  • Stress
  • History of depression
  • Family history of depression
  • Major life changes

Rates of Depression

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:

Rates of Depression
  • From 2013 to 2016, about 8% of adults reported depressive symptoms that lasted two weeks or longer.
  • The lowest rates of depression were found among non-Hispanic Asian adults.
  • Depression decreased as family income levels increased.
  • Approximately 80% of Americans with depression reported some difficulties with home, work, or social activities due to their depressive symptoms.

Men, Women, and Depression

Women were twice as likely to have depression as men.6 This ratio was true across all age groups.7 Postpartum depression carries a significant suicide rate. About 20% of deaths after childbirth deliveries are from maternal suicide due to depression.8

Veterans and Depression

As of 2008, the U.S. Department of Veteran Affairs reports:9

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.

Children and Depression

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:

  • During an episode of depression, teens are at a greater risk for suicide (their leading cause of death).
  • Untreated major depression can lead to serious alcohol or drug addictions.
  • Untreated major depression can cause teens to isolate themselves from friends and activities.

While younger children and teens may show the same symptoms as adults due to depression, they may also:

  • Show antisocial behavior
  • Become clingy
  • Have nightmares
  • Show boredom

Talk to a doctor if these symptoms:

  • Last for more than two months
  • Do not respond to efforts to help
  • Seem to affect many areas of the child’s life

Diagnosing Adult Depression

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.

Physical Exam

Doctors may perform a physical exam and ask questions to screen for depression. For some people, depression may be from a health problem.

Lab Tests

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.

Psychiatric Exaluation

Therapists will be brought in to ask about symptoms, thoughts, feelings, and behaviors. Sometimes a written questionnaire is used to help answer these questions.

Could Depression be Part of Another Mental Health Problem?

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:

Bipolar Disorders

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.

Premenstrual Disorders

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. 

Other Depression Disorders

Depression can be caused by using recreational drugs, some prescribed medications, or alcohol.

Treating Depression

Treatment for depression typically includes therapy from a health professional and medication. Most people with depression feel better with medication, therapy, or both.

Medications for Depression Treatment

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.

SSRIs

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:

Celexa

Lexapro

Prozac

Paxil

Zoloft

Viibryd

SNRIs

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:

Cymbalta

Effexor XR

Other Antidepressants

These medications are not typical antidepressants, but can be used to treat depression.14 Some examples are:

Wellbutrin XL

Remeron

Trintellix

Tricyclic Antidepressants

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:

Tofranil

Pamelor

Surmontil

Norpramin

Vivactil

MAOIs

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:

Parnate

Nardil

Marplan

Emsam - a newer MAOI skin patch that may cause fewer side effects than other MAOIs

Other Medications

Other medications can help an antidepressant work better. Doctors may do one or more of the following:

  • Combine two antidepressants
  • Add mood-stabilizing drugs
  • Add an antipsychotic drug
  • Add anti-anxiety medication
  • Add stimulant medications

Add-On Antipsychotic Drugs

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:

Abilify

Seroquel XR

Symbyax

Rexulti

How to Find the Right Medication

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.

Medication Risks

Withdrawal from Stopping or Reducing Dosages

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.

Pregnancy and Nursing

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.

Suicide Risks and Antidepressants

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.

Antidepressant Side Effects and How to Deal With Them

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:

  • Depression symptoms may quickly return.
  • May have withdrawal-like symptoms.

Doing so in consultation with a doctor is the best option in all cases

Psychotherapy Treatment for Depression

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.

Cognitive-Behavioral Therapy (CBT)

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.

Interpersonal Therapy (IPT)

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.

Behavioral Activation Therapy (BA)

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.

Acceptance and Commitment Therapy (ACT)

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.

Problem-Solving Therapy (PST)

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.

Short-Term Psychodynamic Psychotherapy (STPP)

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.

Family Therapy (FT)

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.

Other Therapies for Depression

SAD Light Therapy

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

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.

Electroconvulsive Therapy (ECT)

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

Exercise can also help relieve depression. This can be true because exercise can:

  • Distract from negative thinking
  • Provide opportunities for social contact
  • Provide feelings of being in control over health

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:

  • Aerobic (e.g., jogging , walking)
  • Resistance (e.g., weight lifting)
  • Mindfulness-based exercise (e.g., tai chi or yoga)

Getting Out in Nature

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.

Contact with Animals

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.

Hospital and Residential Treatment for Depression

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.

  • Psychiatric treatment at a hospital can help calm patients and keep them safe.
  • Partial hospitalization programs (PHP), also called day treatment, can also be a good option. Patients attend programming 3 to 5 days a week for about 6 hours each day. They return home at the end of each day. PHPs are a good mix of intensive treatment, outpatient support, and counseling to help get symptoms under control.

Getting the Most Out of Depression Treatment

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.

How to Prevent Relapse from Depression

Depression is treatable, but symptoms can return.23 Research shows that relapse rates for depression for people who have had:

One episode of depression is 50%
50%
Two episodes of depression is 70%
70%
Three or more episodes of depression is 90%
90%

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.

Myths About Depression

Myth #1: You Can Just “Snap Out Of It”

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!

Myth #2: Ignore Depression And It Will Go Away

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.


Resources

  1. Results from the 2017 National Survey on Drug Use and Health: Detailed Tables, SAMHSA, CBHSQ. (2017). Retrieved from
    https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.htm#tab8-56A
  2. Depression Basics. (n.d.). Retrieved from https://www.nimh.nih.gov/health/publications/depression/index.shtml.
  3. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2015). Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S. Government Printing Office.
  4. Men and depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/men-and-depression/index.shtml.
  5. CDC – National Center for Health Statistics – Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016. https://www.cdc.gov/nchs/products/databriefs/db303.htm. February 2018.
  6. Ibid.
  7. Ibid.
  8. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health. 2005;8(2):77-87.
  9. Collaborative Care for Depression in the Primary Care Setting. A Primer on VA’s Translating Initiatives for Depression into Effective Solutions (TIDES) Project. Boston, MA: Center for Information Dissemination and Education Resources; Washington, DC: VA Health Services Research and Development Service, Office of Research and Development, Dept. of Veterans Affairs [2008].
  10. Heller, K. (2018). Depression in Teens and Children. Psych Central. Retrieved on October 21, 2019, from https://psychcentral.com/lib/depression-in-teens-and-children/
  11. Ibid.
  12. Ibid.
  13. Ibid.
  14. Ibid.
  15. Antidepressants. (n.d.). Retrieved from https://livertox.nih.gov/Antidepressants.htm.
  16. Lenzer, J. (2004, September 25). FDA panel urges “black box” warning for antidepressants. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC518888/.
  17. Farah A. The role of L-methylfolate in depressive disorders. CNS Spectr. 2009;14(1 Suppl 2):2-7.
  18. Lucassen PJ, Meerlo P, Naylor AS, van Dam AM, Dayer AG, Fuchs E, et al. Regulation of adult neurogenesis by stress, sleep disruption, exercise and inflammation: implications for depression and antidepressant action. Eur Neuropsychopharmacol. 2010;20(1):1-17.
  19. Pearson, D. G., & Craig, T. (2014, October 21). The great outdoors? Exploring the mental health benefits of natural environments. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204431/.
  20. Crowley-Robinson P., Fenwick D. C., Blackshaw J. K. A long-term study of elderly people in nursing homes with visiting and resident dogs. Applied Animal Behaviour Science. 1996;47(1-2):137-148. doi: 10.1016/0168-1591(95)01017-3.
  21. Tartakovsky, M. (2018). 5 Mistakes People Make When Managing Their Depression. Psych Central. Retrieved on October 23, 2019, from https://psychcentral.com/blog/5-mistakes-people-make-when-managing-their-depression/
  22. Tartakovsky, M. (2018). Top Relapse Triggers for Depression & How to Prevent Them. Psych Central. Retrieved on October 21, 2019, from https://psychcentral.com/lib/top-relapse-triggers-for-depression-how-to-prevent-them/
  23. Tartakovsky, M. (2018). 5 Mistakes People Make When Managing Their Depression. Psych Central. Retrieved on October 23, 2019, from https://psychcentral.com/blog/5-mistakes-people-make-when-managing-their-depression/
  24. Ibid.