Time heals all wounds. You’ve heard that one before, right? How about ‘this too shall pass?’ These are nice sentiments, but sometimes, waiting for things to improve is not the answer. In the case of depression, waiting for things to get better often makes them worse.
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We all have moments or periods when we are sad. Grief is a natural response to loss, and loss can take many forms — a breakup, the death of a loved one, or financial losses. Sometimes you might feel down without quite knowing why and that is okay. Fluctuations in hormone levels and daily stress can impact your mood in ways you might not understand.
However, if those feelings of sadness persist and begin to interfere with your daily functioning, you may have depression. For some people, depression isn’t sadness but rather an emptiness or numbness — a loss of interest or pleasure in activities and daily life.
Depression is not like chickenpox; you don’t develop a fever and an easily identifiable rash. The symptoms of depression are harder to spot, and not everyone develops the same symptoms. For this reason, the American Psychiatric Association specifies a set of diagnostic criteria to help doctors determine whether or not you have depression.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, you need to experience five or more symptoms of depression within a two-week period to be diagnosed with a major depressive episode.
At least one of these symptoms needs to be either a depressed mood or loss of interest or pleasure (anhedonia) in activities that you previously found interesting. The other symptoms include:
Appetite or weight changes
Sleep difficulties (an inability to sleep or sleeping too much)
Psychomotor agitation (purposeless and restless movements)
Psychomotor retardation (difficulty starting or completing daily tasks)
Fatigue or loss of energy
Diminished ability to think or concentrate
Feelings of worthlessness or excessive guilt
Suicidality (persistent thoughts about death or hurting yourself)
Once again, it’s not like chickenpox. There is no single, easily identifiable cause of depression. Rather, it is caused by a complex interplay of biological, physiological, psychological, and social factors.
There is a genetic component to depression, meaning you are more likely to develop depression if a close family member has the condition. However, physiological, psychological, and environmental risk factors also increase the probability of the disease. With each additional risk factor, the likelihood of you developing depression increases.
Some risk factors are modifiable — which means you can change them — and others are not. They include:
Stressful life events such as the loss of a loved one, a natural disaster, or a car accident
A history of trauma — physical, emotional, or sexual abuse — especially during childhood
Being female (females are twice as likely to experience depression than males)
Use of certain prescription medications, such as corticosteroids and beta-blockers
Use of alcohol, nicotine, and recreational drugs
Neurodegenerative diseases such as Alzheimer’s or Parkinson’s
Living with chronic pain
Certain medical conditions such as diabetes, cardiovascular disease, or hypertension
Other mental illnesses
A lack of social support
Excessive screen time
If you think that you have depression, you should seek professional help. Don’t wait for things to get worse or for the symptoms to clear up on their own. (Remember, it’s not chickenpox.)
Studies have found that early intervention and treatment are associated with a better response to treatment and an increased chance of remission. The duration of untreated depression — how long you wait before seeking help — correlates with poor treatment outcomes.¹
While depression can be effectively treated, some people develop treatment-resistant depression, which does not respond well to existing treatment options.
In addition to being disabling, treatment-resistant depression can also be life-threatening. Compared to depression that responds to treatment, treatment-resistant depression is associated with a two- to three-fold increase in the risk of suicide attempts. Compared to the general population, the risk increases 15-fold.
Major depressive disorder is generally treated with medication, psychotherapy, or a combination of the two. In some treatment-resistant cases, neuro-stimulation treatments such as electroconvulsive therapy and vagus nerve stimulation are also used.
Neurotransmitters are chemicals that carry messages between brain cells. Certain neurotransmitters, such as serotonin, dopamine, and norepinephrine, have been associated with depression.
The most commonly prescribed antidepressants — selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and norepinephrine-dopamine reuptake inhibitors (NDRIs) — work by changing the availability of these neurotransmitters in your brain.
Older antidepressants, known as tricyclics and monoamine oxidase inhibitors (MAOIs), are associated with more side effects but are still sometimes prescribed if newer antidepressants are ineffective.
Antidepressants take time to work (up to eight weeks), so don’t be discouraged if you don’t immediately notice a change in your symptoms. Not everyone responds to antidepressants in the same way, and you may need to try more than one type before finding the medication that works well for you.
Psychotherapy is a broad term used for different types of talking therapy. Some of these therapies focus on the past and events that might have contributed to your depression, while others, such as cognitive behavioral therapy, focus on the present.
Cognitive behavioral therapy (CBT), often used to treat depression, helps you recognize and change unhelpful thinking and behavior patterns. This type of therapy aims to equip you with the knowledge and skills to act as your own therapist.
Neuro-stimulation therapies are not often prescribed because they generally need to take place in a hospital setting under anesthesia.
Electroconvulsive therapy (ECT) involves using an electric current to provoke a seizure. It has proved effective in treating treatment-resistant depression, with 30% of patients going into remission after six ECT sessions. The side effects of ECT — which can include disorientation, impaired learning, and retrograde amnesia (memory loss) — usually resolve quickly.
While depression can be treated, it can’t be cured, and many people experience recurrent depressive episodes. Seeking professional help is important. However, there are also lifestyle changes that you can make to improve your mental well-being.
Spending time in nature, exercising regularly, and making social connections (the real kind, not via social media!) have been shown to boost mood and improve mental well-being. Meditation, a healthy diet (think fruit, vegetables, whole grains, and fish), and sufficient sleep will all help to make you more resilient.
While it is possible that a depressive episode will eventually clear up on its own, it isn’t probable. It isn’t worth waiting to find out. Studies have found that the longer depression goes untreated, the worse the prognosis.
So, if you suspect you have depression, make an appointment to see your doctor.
What are the risk factors for depression? | Psych Central
Mental health medications | National Institute of Mental Health
What is cognitive behavioral therapy? | Posttraumatic Stress Disorder
Nurtured by nature | American Psychological Association
How meditation helps with depression | Harvard Health Publishing
Diet and depression | Harvard Health Publishing
Depression and sleep: Understanding the connection | Johns Hopkins Medicine