Depression

Depression is a common mental health condition that affects millions of people worldwide, causing persistent sadness and changes in how you think, sleep, eat, and function in daily life. While it’s more than just feeling down, effective treatments are available that can help people recover and return to normal activities.

Table of contents

• What is Depression
• Types of Depression
• Who is Affected by Depression
• Signs and Symptoms
• What Causes Depression
• Treatment Options
• Self-Help and Coping Strategies
• When and How to Seek Help

What is Depression

Depression is a mood disorder (a condition that affects your emotional state) that causes a persistent feeling of sadness and loss of interest in things and activities you once enjoyed^[5]. It can also cause difficulty with thinking, memory, eating, and sleeping^[5].

Depression is different from regular mood changes and feelings about everyday life. It’s normal to feel sad about or grieve over difficult life situations, such as losing your job or a divorce. But depression is different in that it persists practically every day for at least two weeks and involves other symptoms than sadness alone^[5].

Depression isn’t a weakness or a character flaw. It’s not about being in a bad mood, and people who experience depression can’t just snap out of it^[2]. Depression is a common, serious, and treatable condition^[2].

Some symptoms of depression, such as fatigue, can be mistaken for a physical illness^[14]. Depression is a medical condition and not “laziness” or a temporary response to normal grief and discouragement^[15].

Types of Depression

There are several types of depressive disorders, each with different characteristics and symptoms^[5].

Clinical depression (also called major depressive disorder) is the most severe type of depression and one of the most common forms. A diagnosis of major depressive disorder means you’ve felt sad, low, or worthless most days for at least two weeks while also having other symptoms such as sleep problems, loss of interest in activities, or change in appetite^[5].

Persistent depressive disorder is mild or moderate depression that lasts for at least two years. The symptoms are less severe than major depressive disorder^[5]. Healthcare providers used to call this condition dysthymia^[5].

Disruptive mood dysregulation disorder causes chronic, intense irritability and frequent anger outbursts in children. Symptoms usually begin by the age of 10^[5].

Premenstrual dysphoric disorder involves premenstrual syndrome (PMS) symptoms along with mood symptoms, such as extreme irritability, anxiety, or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life^[5].

Depressive disorder due to another medical condition occurs when many medical conditions create changes in your body that cause depression. Examples include low thyroid function, heart disease, Parkinson’s disease, and cancer. If you’re able to treat the underlying condition, the depression usually improves as well^[5].

There are also specific forms of major depressive disorder. Seasonal affective disorder (seasonal depression) is a form of major depressive disorder that typically arises during the fall and winter and goes away during the spring and summer^[5]. This type of depression, which usually occurs in the fall, may be caused by decreased sunlight as the days shorten^[4].

Prenatal depression is depression that happens during pregnancy. Postpartum depression is depression that develops within four weeks of delivering a baby^[5]. Worldwide, more than 10% of pregnant women and women who have just given birth experience depression^[3].

Who is Affected by Depression

Depression can affect anyone at any age and of any race or ethnic group^[5]. Globally, an estimated 5.7% of adults suffer from depression^[3]. In the United States, more than 5 percent, or 15 million Americans, suffer from depression^[4]. Major depression affects more than 8% (21 million) of American adults each year^[7].

Depression is about 1.5 times more common among women than among men^[3]. More women are affected by depression than men, though the reasons for this are still unclear. They may include the hormonal changes women go through during menstruation, pregnancy, childbirth, and menopause. Other reasons may include the stress caused by the multiple responsibilities that women have^[7].

Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression^[2]. Young people are also affected, with 15% of youth (3.7 million) ages 12-17 experiencing major depression^[7].

In 2021, an estimated 727,000 people lost their lives to suicide. Suicide is the third leading cause of death in 15–29-year-olds^[3].

Signs and Symptoms

During a depressive episode (a period when depression symptoms occur), a person experiences a depressed mood (feeling sad, irritable, empty). They may feel a loss of pleasure or interest in activities^[3].

A depressive episode is different from regular mood fluctuations. They last most of the day, nearly every day, for at least two weeks^[3]. A major depressive episode is defined as experiencing five or more of the following symptoms every day (or most days) for two weeks or more^[15]:

• Ongoing sad, anxious, or empty feelings^[4]
• A loss of interest in activities that normally are pleasurable, including sex^[4]
• Depressed or irritable mood^[15]
• Sleep problems (insomnia, early morning wakening, or oversleeping)^[4]
• Appetite and weight changes (either loss or gain)^[4]
• A loss of energy and a sense of fatigue, or being “slowed down”^[4]
• Feelings of guilt, worthlessness, and helplessness^[4]
• Feelings of hopelessness and pessimism^[4]
• Difficulty in concentrating, remembering, and making decisions^[4]
• Irritability^[4]
• Thoughts of death or suicide, or suicide attempts^[4]
• Ongoing body aches and pains or problems with digestion that are not caused by physical disease^[4]
• Agitation or severe anxiety/panic attacks^[15]

Depression can cause difficulties in all aspects of life, including in the community and at home, work, and school^[3]. A depressive episode can be categorized as mild, moderate, or severe depending on the number and severity of symptoms^[3].

It’s important to remember that not everyone who is depressed is suicidal. You can still seek help even if you haven’t demonstrated any specific suicidal or self-harm behaviors, or even if your symptoms aren’t as severe or persistent as the symptoms noted above^[15].

What Causes Depression

Experts believe that there are many factors that cause depression^[4]. The exact cause of depression is unknown. It may be caused by a combination of genetic, biological, environmental, and psychological factors^[6].

Chemical and nerve cell disturbances within the brain, sometimes genetically inherited, play an important role in depression^[4]. People with depression may have too little or too much of certain brain chemicals called “neurotransmitters.” Changes in these brain chemicals may cause or contribute to depression^[7].

A family history of depression increases the risk of developing the illness. Some studies also suggest that a combination of genes and environmental factors work together to increase risk for depression^[6]. First-degree relatives of depressed individuals are about 3 times as likely to develop depression as the general population; however, depression can occur in people without family histories of depression^[6].

Other factors that can contribute to depression include:

• Losing a relationship or a loved one^[4]
• Stressful life events^[4]
• Experiencing traumatic or stressful events, such as physical or sexual abuse or financial problems^[6]
• Going through a major life change, even if it was planned^[6]
• Having another medical illness^[4]
• Drinking too much alcohol or abusing drugs^[4]
• Side effects of some medications^[6]

People with negative thinking patterns and low self-esteem are more likely to develop clinical depression^[7]. Depression is more likely to occur along with certain illnesses, such as heart disease, cancer, Parkinson’s disease, diabetes, Alzheimer’s disease, and hormonal disorders^[7].

Treatment Options

Without treatment, depression can get worse and last longer. In severe cases, it can lead to self-harm or death by suicide. The good news is that treatments can be very effective in improving symptoms^[5]. Depression is treatable — usually with talk therapy, medication, or both^[5].

Different types of depression require different treatment^[14]. Treatment for depression should start with seeing your doctor. Your doctor may ask you to fill out a screening questionnaire or conduct some tests to rule out other conditions^[14].

Treatment for Mild Depression

Mild symptoms may be relieved by learning about the condition, lifestyle changes (such as regular physical exercise), and psychological therapy provided by a mental health professional or via online programs^[14].

If you have less severe (mild) depression, your doctor may suggest waiting a short time to see if it gets better by itself. In this case, you’ll be seen again after 2 to 4 weeks to monitor your progress. This is known as watchful waiting^[13].

Treatment for Moderate to Severe Depression

For moderate to more severe depression, medical treatments are likely to be required, in combination with other treatments^[14]. If you have more severe depression, which includes moderate or severe depression, antidepressants and talking therapy may be recommended^[13].

A doctor may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. A combination of an antidepressant and therapy usually works better than having just one of these treatments^[13]. The combination of medication and psychotherapy is preferred for severe depression^[12].

Antidepressant Medications

Antidepressants are medicines that treat the symptoms of depression. There are many different types of antidepressant. They have to be prescribed by a doctor, usually for depression that’s moderate or severe^[13].

Second-generation antidepressants (including drugs called selective serotonin reuptake inhibitors, or SSRIs) are first-line therapy for depression^[12]. There are many antidepressant medications that work to restore the balance and effectiveness of chemicals and nerve cells in the brain. These medications help people feel and function better. Some of the newer antidepressants have fewer side effects than older kinds, and they can begin to work after two or three weeks of use^[4].

Treatment history, comorbidities, costs, and risk of adverse effects should be considered when choosing an antidepressant medication^[12]. Although many patients use antidepressants indefinitely, few studies have examined safety and effectiveness beyond two years^[12].

Medications may take up to six weeks to be effective, so be patient^[14]. People with seasonal affective disorder are treated with light therapy^[4].

Talking Therapies (Psychotherapy)

Psychotherapy (also called talking therapy) is a series of private talks with a psychiatrist or mental health professional where a person discusses the feelings, thoughts, and behaviors that are causing problems^[4]. Psychotherapy is a first-line treatment for depression^[12].

Cognitive behavioral therapy (often called “CBT” for short) is often used to treat depression^[13]. CBT aims to help you understand your thoughts and behavior, and how they affect you. It recognizes that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel, and behave in the present^[13]. It teaches you how to overcome negative thoughts^[13].

In depression, negative thought patterns such as self-doubt and feelings of guilt often make the problem worse. Cognitive behavioral therapy aims to break these patterns bit by bit, so that people feel better about themselves. The first step is for them to form a clear idea of their own thoughts, attitudes, and behavioral patterns so that they can recognize and change false and distressing beliefs^[11].

Other types of talking therapies include:

• Interpersonal therapy, which focuses on your relationships with others and problems you may be having in your relationships, such as difficulties with communication or coping with bereavement^[13]
• Behavioral activation, which focuses on identifying links between your activities and your mood, rather than focusing on thoughts and feelings^[13]
• Individual problem-solving, which focuses on identifying problems and developing plans to solve them^[13]
• Psychodynamic psychotherapy, which looks at how past experiences affect current thoughts and feelings^[13]

If you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses, and other professionals. These teams often provide intensive specialist talking treatments as well as prescribed medicine^[13].

Hospital Treatment

In the most severe cases of depression, when the person cannot function and safety is an issue, a brief hospital stay may be necessary^[4].

Self-Help and Coping Strategies

Education, lifestyle changes, social support, and psychological therapy are important treatments for depression^[14]. There are many things that people with depression can do to help themselves^[14].

Stay Connected

Don’t withdraw from life. Socializing can improve your mood. Keeping in touch with friends and family means you have someone to talk to when you feel low^[16]. Don’t avoid talking to other people. Some people can lose their confidence in going out, driving, or traveling. If this starts to happen, facing up to these situations will help them become easier^[16].

Be More Active

Take up some form of exercise. There’s evidence that exercise can help lift your mood^[16]. There’s evidence that exercise can help depression, and it’s one of the main treatments for mild depression^[13]. If you haven’t exercised for a while, start gently by walking for 20 minutes every day^[16].

Eat a Healthy Diet

Some people don’t feel like eating when they’re depressed and are at risk of becoming underweight. Others find comfort in food and can put on excess weight^[16]. Try to carry on cooking and eating regular meals^[16].

Maintain a Routine

When people feel down, they can get into poor sleep patterns, staying up late and sleeping during the day. Try to get up at your normal time and stick to your routine as much as possible^[16]. Not having a routine can affect your eating^[16].

Avoid Alcohol

For some people, alcohol can become a problem. You may drink more than usual as a way of coping with or hiding your emotions, or just to fill time. But alcohol won’t help you solve your problems and could also make you feel more depressed^[16].

Practice Daily Coping Skills

Some positive coping skills can be useful. All of the following techniques are supported by scientific research and are frequently recommended as important parts of treatment even for patients who continue to take antidepressant medications^[15]. It’s important to know you probably won’t be motivated to do any of them at first because depression frequently saps motivation. In other words, know that it’s normal to feel unmotivated until you’re halfway done^[15].

Helpful daily practices include:

• Find small ways to be of service to others. Find personal meaning by serving something larger than yourself^[15]
• Set workable goals that give you a sense of accomplishment. A goal is workable if it’s something you can control, manageable, realistic for you, and measurable^[15]
• Schedule pleasant activities or events. Don’t wait for yourself to be “in the mood”^[15]
• Practice gratitude — take time to notice what went well today, not just what went wrong^[15]
• Stay in the present. This practice is sometimes called mindfulness^[15]

When and How to Seek Help

Seeking medical help as soon as you have symptoms is essential^[5]. People with depression can find it difficult to take the first step in seeking support. They may need to get help with the support of family members, friends, or a health professional^[14].

If you feel depressed, see your doctor. Don’t delay. Seek support early to try to avoid symptoms becoming worse^[14]. Professional help is very important^[14]. Get help if you’re still feeling down or depressed after a couple of weeks^[16].

While most individuals with depression have a full remission of the disorder with effective treatment, only about a third (35%) of those suffering from severe depression seek treatment from a mental health professional^[7]. People often resist treatment because they believe depression isn’t serious, that they can treat it themselves, or that it is a personal weakness rather than a serious medical condition^[7].

In high-income countries, only about one third of people with depression receive mental health treatment. Barriers to effective care include a lack of investment in mental health care, lack of trained health-care providers, and social stigma associated with mental disorders^[3].

If you start to feel that your life isn’t worth living or about harming yourself, get help straight away. You can contact emergency services, call a crisis helpline, call your doctor and ask for an emergency appointment, or go to an emergency department^[16].

Take the time to find the treatment that’s right for you^[14]. It can take time and patience to find a treatment that works^[14]. The sooner a person with depression seeks support, the sooner they can recover^[14].