What You Need To Know About Depression

What is depression?

The National Institute of Mental Health (NIMH) reports that depression is one of the most common mental disorders affecting people in the United States.

In 2019, an estimated 19.4 million adults and 3.8 million aged 11-17 (15.7% of the population for that age bracket) experienced one or more major depressive episodes. Women are about twice as likely as men to be diagnosed with depression.

The World Health Organization(WHO) reports that depression is the leading cause of disability worldwide.

Depression is often associated with feelings of sadness, emptiness, or hopelessness. While it is normal to experience moments of sadness and upset when we face personal struggles, clinical depression goes deeper than these fleeting emotions.

Depression has a significant impact on your daily life and can often result in the inability to perform everyday tasks or activities you used to enjoy.

To be diagnosed with depression, you must display at least five of the clinical symptoms associated with depression. The symptoms must be experienced daily, for the majority of the day, and persist for at least two weeks.

Depression is a mental illness that tends to require professional medical support. With the right support, you can access effective treatments to help you manage and often recover from symptoms of depression so you can improve your quality of life. There is no single cause linked to depression, but rather a range of factors can contribute to you developing the illness.

Other related conditions

Symptoms

Depression comes with a range of symptoms that vary from person to person. Some of the most common symptoms include:

  • Feeling sad, empty, or hopeless 

  • Inability to enjoy yourself, including things that used to bring you pleasure

  • Changes in appetite 

  • Weight loss or weight gain

  • Difficulty sleeping or excessive sleeping

  • Increased fatigue

  • Feeling heavy or restless

  • Poor concentration, focus, and decision-making skills

  • Feeling worthless 

  • Excessive guilt 

  • Irritability and angry outbursts over small issues

  • Suicidal thoughts

Symptoms of depression can often be severe and disrupt your day-to-day activities, including school, work, and relationships with others.

If you have depression, you may know something is wrong, but you feel you can resolve it on your own. The reality is that most people wait too long before seeking help when dealing with depression.

If you notice you have any symptoms of depression, it is important to seek professional help as soon as possible. Early intervention can help you to manage symptoms and recovery faster.

Depression in the brain

Researchers are still trying to fully understand how depression works and what it is caused by. Many complicated processes happen in the brain that are linked to depression.

Chemical imbalances in the brain have typically been at the forefront of mental illness discussions. Still, the answer is not as simple as having too much or too little of a particular chemical substance.

The brain is a complex organ that we are still seeking to understand. While chemical imbalances of dopamine, norepinephrine, and serotonin play a role in the development of depression, millions of chemical reactions make up the elaborate system responsible for your mood and how you experience life on a day-to-day basis.

These complexities remain the subject of research to better understand how they work and why people with similar symptoms may react differently to the same treatments.

Research shows that some individuals suffering from depression have a smaller hippocampus¹. One common theory is that there is a link between reduced neuron production in the hippocampus and lower moods.

Antidepressant medication may support this theory, as these medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters), which can cause you to notice changes in your mood within a few weeks to a month.

These delayed results are thought to be due to mood only improving after the nerves grow and form new connections, a process that takes weeks¹. If this theory is correct, there is potential for researchers to combine medications that stimulate nerve growth and boost the chemical messengers in the brain to provide faster results than current treatments to help people recover from depression.

Learn more about what depression does to your brain.

  1. What causes depression? | Harvard Health Publishing

Causes

There is no single cause of depression. Instead, depression can be caused by a combination of biological and environmental factors that vary from person to person. However, there is a range of risk factors associated with depression, including (but not limited to):

Family history of depression

If you have a first-degree family member who is or has been diagnosed with major depression, you have an elevated risk of developing the condition yourself.

Environmental factors

If you have experienced trauma, you have an increased risk of developing depression.

Changes in hormone levels

Hormonal changes can cause or trigger depression. In women, these changes often occur due to thyroid issues during pregnancy or in the weeks after delivery or as a result of menopause, polycystic ovarian syndrome (PCOS), or other hormonal conditions.

Drug or alcohol use

People who have a mental illness can often use alcohol or drugs to help them cope with their symptoms. However, substance abuse often leads to you feeling worse.

A nationwide study in the US involving 43,093 participants revealed that over 20% of¹ adults² who reported that they had an alcohol addiction also experienced a major depressive episode. The study found that participants who sought treatment for alcohol abuse were 40%¹ more likely to suffer from at least one mood disorder than the general US population.

History of other mental health disorders

Having a history of mental health disorders such as social anxiety, panic disorder, and anxiety disorder can increase your risk of developing depression.

If you notice that you are showing symptoms of another mental illness, or you have already been diagnosed with one, it is important to seek the right treatment as soon as possible. Your healthcare professional can work with you to create a treatment plan suited to your individual condition and circumstances.

Serious or chronic illness

Serious and chronic illnesses can impact the body in a major way, including the brain, which may trigger a depressive episode.

While it is common to experience stress and anxiety when dealing with a serious illness, it’s important to speak to your doctor if these feelings persist. Your doctor will review your medical history and may have you undergo tests to check for any underlying physical causes of depression.

Certain medications

Certain medications³ can trigger changes in your mood. Speak to your doctor if you have started a new medication and notice any sudden changes in how you are feeling.

Diagnosis

Depression can be hard to diagnose since it manifests in different ways that can differ from person to person.

Your doctor may have you undergo tests and exams to rule out any other physical issues that may be causing symptoms similar to depression. They will typically start by asking questions regarding your general health, physical activity, mood, and mental health problems.

You will also be asked about your personal and social history, including any life events and stressors affecting the way you feel.  Your doctor may also conduct a physical examination or order bloodwork to check your thyroid or other hormones.

Although standardized questionnaires are sometimes used, there is no “test” to confirm whether you have depression.

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to confirm whether you are presenting with a cluster of symptoms that fit the criteria for a clinical diagnosis of depression.

To qualify for a diagnosis, you need to have at least five of the nine common symptoms, which must be present for most of the day on a daily or near-daily basis for at least two weeks.

Understand more about how depression is diagnosed, and the doctors and mental health professionals you'll likely see.

  1. Depression & Substance Abuse | American Addiction Center

  2. 2018 NSDUH Detailed Tables | Substance Abuse and Mental Health Services Administration

  3. General Medical Drugs Associated with Depression (2008)

Treatments

Depression is a very common mental illness with a high recovery rate. Many treatment options are available and ongoing research into depression could also lead to new treatments becoming available in the near future.

Medication

Since your brain chemistry can be a contributing factor to depression, your doctor may prescribe antidepressants to help adjust your individual brain chemistry.

Types of antidepressant medication include:

  • Selective serotonin reuptake inhibitors (SSRIs) inhibit the uptake of at least one neurotransmitter, ensuring more are available in the brain. 

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) work like SSRIs but hinder serotonin and norepinephrine reuptake.

  • Monoamine oxidase inhibitors (MAOIs) – MAOIs reduce the activity of the enzyme MAO, which results in higher levels of norepinephrine, serotonin, and dopamine in the brain. The availability of more neurotransmitters in the brain helps in mood regulation.

Antidepressants may deliver some improvements in your symptoms in less than two weeks, but it can take up to two-three months to experience the full benefits.

If you don't notice any significant improvement after this period, you should talk to your doctor about your dosage and possibly changing medications.

Other medications can help in some situations, including:

  • Anxiolytics

  • Antipsychotics

  • Mood stabilizers

If you are taking an antidepressant medication, it is important that you do not suddenly stop taking it. Stopping the medication should be done gradually, usually over a four-week period or longer. Otherwise, you may experience a range of withdrawal symptoms which can include dizziness, sudden changes in mood and anxiety levels, or a sense of being physically unwell.

Psychotherapy

Another common way of treating depression is psychotherapy, which can help to treat mild depression. This involves you having a conversation with a mental healthcare professional. However, moderate to severe depression often requires a combination of antidepressant medications and psychotherapy.

Types of psychotherapy for depression include:

Cognitive behavioral therapy (CBT)

CBT is one of the most well-known types of therapy and has been proven to be effective in treating depression. It helps you recognize negative or distorted thought patterns to help you change your thoughts and behaviors and positively respond to challenging situations.

Interpersonal therapy (IPT)

IPT is available both as individual and group therapy. Group therapy brings individuals with similar illnesses together in a supportive environment and helps you understand how others cope with similar situations. Treatment can take weeks, and you can expect to see significant improvements in 10-15 sessions.

Electroconvulsive therapy (ECT)

ECT is a medical treatment reserved for severe major depression that does not respond well to other treatments. The procedure uses a controlled electric current to induce a seizure in the brain while you are under anesthesia. You will often receive two-three stimulations per week for a total of 6-12 treatments.

This treatment has been used since the 1940s, and continuous improvements have resulted in a safe and effective mainstream treatment, rather than being seen as a last-resort option.

Hospital or in-patient treatment

In-patient treatment may be considered if your depression has worsened to the point where you are no longer eating or drinking or are experiencing suicidal thoughts.

Your feelings of depression may become unbearable, and thoughts of death may present a way to escape the suffering. If your suicidal thoughts intensify, they can result in self-harm or doing something that you will regret later, so it is important that you receive treatment immediately.

Emergency help

You should consider emergency help for depression if you experience severe manifestations of anything that threatens your well-being, such as homicidal, suicidal, or self-harm thoughts.

Lifestyle and self-care

Lifestyle changes could help to reduce symptoms of depression and improve your mental health. Some positive changes and lifestyle habits for better self-care include:

  • Exercise

  • Eating a healthy diet

  • Reducing or avoiding smoking

  • Reducing or avoiding alcohol and drug use

  • Improve sleep habits

  • Reaching out to family and friends

  • Rediscovering activities you used to enjoy

Other changes that can be helpful include:

Cut back on social media time

While social media keeps us connected to friends, family, and colleagues, it can become addictive and, even worse, contribute to low self-esteem and depression¹. You can limit the amount of time you spend on social media by deleting social apps from your smartphone or deactivating your accounts for a while to take a social media hiatus.

Minimize your daily choices

Every day, there are so many choices we have to make, from which outfit to wear or which route to take on your daily commute to what to eat and what to watch on TV. Unfortunately, too many choices and decisions can lead to increased stress.

Consider reducing the number of decisions you make in a week to reduce stress and anxiety. You can also learn to speed up your decision-making to cut down the amount of time you would otherwise spend worrying about your decisions.

Plan for triggers

Certain events, such as the anniversary of a death or divorce, can trigger depression. But since they can be unavoidable in life, it is important to plan for them so you can manage these triggers when they arise. For example, you can schedule an appointment with your mental health professional ahead of time when you know one of these events is coming up.

Coping mechanisms and lifestyle changes

Getting a good night's sleep² helps you to maintain positive mental health. Our brains thrive on consistency and routine, so it's recommended that you set yourself specific times to sleep and wake up while minimizing daytime naps.

Avoid or limit alcohol

While alcohol can provide short-term relief from symptoms of depression, there are always aftereffects. Alcohol affects your sleep, leaving you restless the following day. Taking alcohol with antidepressants can also worsen depression symptoms. It is therefore recommended that you either limit or altogether avoid alcohol.

Practice meditation

Practicing meditation brings a sense of relaxation and tranquility to your mind, lowering stress and calming anxiety. Meditation can include breathing techniques, guided meditations, such as via an app, or a gentle walk in nature, feeling completely present.

Make sure to focus your attention on the meditation, avoid distractions, and relax your breathing. Even if you only meditate for a short time, it helps to clear your mind and regulate your emotions, which is a key component to reducing symptoms of depression.

Discover 10 coping strategies that can help you deal with depression.

Doctors & specialists

General practitioners tend to be your first contact if you have depression. Your GP can screen for depression, may prescribe antidepressants, and they can refer you to a counselor, therapist, social worker, psychologist, or psychiatrist.

Psychiatrists

A psychiatrist is a medical professional trained to evaluate, diagnose, and treat mental health conditions, including depression. Psychiatrists are experts in diagnosing and treating all types of mental disorders since they undergo both a medical degree and additional specialized mental health training.

Psychiatrists can prescribe drugs such as antidepressants. However, they do not often provide counseling or psychotherapy services, but rather they tend to refer you to therapists.

Psychiatrists can provide you with continuous care and treatment, or they may see you just once or a few times, then give advice to your GP, who becomes your primary healthcare provider.

Learn more about how to get help with mental health issues.


Clinical trials for depression

Actively recruiting
A Prospective, Multi-center, Randomized Controlled Blinded Trial Demonstrating the Safety and Effectiveness of VNS Therapy® System as Adjunctive Therapy Versus a No Stimulation Control in Subjects With Treatment-Resistant Depression
AL, CA, FL, GA and 25 more locations (US)
Actively recruiting
sA Study of Seltorexant Compared to Quetiapine XR as Adjunctive Therapy to Antidepressants in Adult and Elderly Participants With Major Depressive Disorder With Insomnia Symptoms Who Have Responded Inadequately to Antidepressant Therapy
AustraliaUnited States
Actively recruiting
Esketamine Nasal Spray alone for treatment-resistant depression
AL, AR, CA, CT and 18 more locations (US)