Diagnosing And Treating Depression

Over 40 million adults deal with anxiety or depression. That's almost 18% of the US population¹ and just the number who are professionally diagnosed. Psychologists believe that millions more are living their lives with an undiagnosed mental illness.

Many people assume that long periods of sadness are just a phase, so they are reluctant to seek help. Others are simply so overwhelmed by the idea of seeing a mental health professional that they just can't bring themselves to make the appointment.

The pandemic has only worsened depression in the US; a JAMA study found a three-fold increase² since the beginning of March 2020.

When does depression begin?

Children as young as three have been diagnosed with depression³, and diagnoses among adolescents and teens are on the rise. Extreme irritability is how the disease manifests itself in children, instead of the low mood and sadness that identifies adult depression. Many adults who suffer from depression had anxiety as children and teens, but even so, most are only diagnosed once they reach adulthood.

What causes depression?

Any number of internal and external factors can trigger depression, but some people are biologically more susceptible than others.

Depression is almost always the result of a combination of life events that seem to snowball out of control. For example, if you went through a break-up or divorce and lost your support group, you may then become isolated. Isolation and boredom may cause you to start drinking more than usual. Your health suffers as a result because the excess alcohol is causing your liver to become stressed. You then find yourself lonely, sad, and sick. This scenario is an example of how depression can develop and worsen as stressors pile up and increase in severity.

Depression is a disease with no easy answers. It's not quantifiable like diabetes or heart disease, and there is no cause-and-effect for diagnosis.

External factors

Some medications can trigger symptoms of depression, although the symptoms go away when you stop taking the medication. If you are taking any of the medications below, there is a possibility that depression may develop.

• Barbiturates

• Corticosteroids

• Benzodiazepines

• Opioids

Mental health professionals and cardiologists have discredited any theories that certain blood pressure medications can lead to depression.

Internal triggers

The most common reasons people get depressed are a combination of factors—biological, social, and psychological. The biology of depression primarily includes hormonal changes, immune system suppression, abnormalities in brain activity, inflammation, nutritional deficiencies, and even shrinking brain cells. 

In the past, neurological chemical imbalances got the blame for depression, but it is now thought to be quite a lot more complex than that.

On the psychological level, factors that lead to depression can be experiences like past trauma, low self-esteem, loneliness, substance abuse, and lifestyle choices. Traumatic life events include the loss of a job, a divorce, or the death of a family member or close friend. Even the loss of a beloved pet can trigger these symptoms, but only in rare cases does situational sadness turn into clinical depression.

What are the symptoms of depression?

Depression is a complicated disease. There is no one-size-fits-all box that identifies symptoms, the type of depression, or the treatment required. Rather, the markers and therapies are unique to each individual. However, there are some common denominators that suggest a diagnosis of depression is likely.

Loss of energy and interest

Finding the energy to get out of bed in the morning is exhausting, and your daily routine is overwhelming. Constant feelings of fatigue, sluggishness, and overall tiredness are classic symptoms of depression. You never feel refreshed in the morning, no matter how many hours you slept.

Along with this constant tiredness is a loss of interest in the daily activities that you used to enjoy—hobbies, social or athletic activities, and sex. Why? Because depression can cause an inability to feel joy.

Insomnia

While it's true that depression is mentally and physically draining, you may also feel exhausted in the mornings because you're not getting enough sleep. Or, it might take hours to finally fall asleep. Once you do get to sleep, oversleeping is common, as you are unlikely to be getting quality rest.

Feeling hopeless

Feeling that you live in a world where nothing will ever get better so there's no point in even trying is another marker for depression. No matter how well your life is going, you have a bleak outlook and feelings of impending doom. You might cheer up for short periods of time, but in general, you feel helpless and hopeless.

Anger and irritability

Everybody has days when the world is on your last nerve, but depression takes that irritability to new levels. Persistent feelings of anger combined with a really short temper and intolerance for just about everything might sound like the opposite of what you've heard about depression.

You might believe it causes a lack of emotional response, however, the contrary is typically the case. When you're depressed, anger can even turn into rage. In severe cases, this can result in violence.

Problems with concentration

Another sign of depression is persistent brain fog. Many sufferers start by seeking treatment for attention issues because they have difficulty focusing. You might also struggle to make decisions, and the relative importance of the decisions doesn’t matter. Choosing a toothpaste brand can be as hard as making a career change.  

Your memory also takes a hit when you're depressed. If you decided on the toothpaste, later on, you might not even remember you bought it.

Weight loss or gain

Depression takes many forms, and some people lose their appetite. Others are always hungry and eat all the time. Any significant change in weight—5% in a month is considered significant—is a sign of depression.

Self-loathing

When being your own worst critic turns into a constant recitation of your faults and mistakes, that is a sign that you are depressed. Feeling guilty without knowing why and being convinced that you are worthless accompanies this internal criticism.

In severe cases, you might take self-loathing a step further and engage in reckless behavior—things like driving dangerously, substance abuse, or compulsive gambling. The most overwhelming sense of self-loathing often leads to suicidal thoughts.

Random aches and pains

If you're suddenly bombarded with vague aches and pains, depression might be the culprit. Your body responds to the chemical changes in your brain when you are depressed, so stress headaches, stomach pains, stomach cramps, and muscle aches are another signal that it's time to seek help.

What are the most common types of depression?

If you have been experiencing any of the above symptoms for more than two weeks, it's time to see your doctor to determine if you have depression. Psychiatrists and psychologists have identified six common types of depression, but only four apply to both men and women.

Major depression

A consistent dark mood and loss of interest in activities are the hallmarks of major depression, which is clinically classified as major depressive disorder (MDD). The symptoms—weight changes, lack of motivation and focus, insomnia, and feeling worthless—are all-consuming and relentless, to the point that people with MDD often contemplate suicide.

As with any depressive disorder, every person's experience is different. Some people only have one MDD episode in their life, while others live with routine recurrences. Treatment for MDD focuses on psychotherapy (dialectical behavioral therapy is currently the most favored option)  with medication. Cognitive behavioral therapy (CBT) is another popular psychotherapy approach. Electroconvulsive therapy (ECT) is still used for the most severe cases of MDD, those that do not respond to medications or psychotherapy.

People with MDD do experience periods when the disease appears to be in remission, but when left untreated, episodes can last from six months to two years.

Learn more about major depression.

Persistent depressive disorder

Persistent depressive disorder (PDD), or dysthymia, is similar to MDD but with less severe symptoms. PDD is just that—persistent—and lasts for at least two years. PDD can be as simple as just having the blues more often than not, but people with this type of depression usually manage to function well enough to mask the disease. Symptom onset includes changes in appetite and sleep patterns, low energy, and general malaise.

This is also called "atypical" depression because people with PDD can get a mood lift from positive life events, being with friends, and getting good news. Women are more than four times more likely than men to develop PDD.

Bipolar disorder

Bipolar disorder is a form of depression⁴. The manic phase, where people are euphoric, have high energy, and display grandiosity, is inevitably followed by a crash into MDD. In the manic stage, people with bipolar disorder show reckless behavioral symptoms—spending sprees, substance abuse, and physical endangerment or risk-taking. Episodes last from hours to weeks, and people with bipolar disorder can sometimes have mania and depression episodes back to back.

Mood stabilizers are usually prescribed for people with bipolar disorder, along with psychotherapy and antidepressants. It's not uncommon for bipolar disorder to coexist with eating disorders, ADHD, and anxiety. These conditions indicate that bipolar disorder could be caused biologically.

Seasonal affective disorder

Although seasonal affective disorder (SAD) is not as challenging as the other types of depression, it is just as real and just as debilitating. SAD is a year-round disorder, although most people experience it during the fall and winter months when there are shorter days and less sunlight.

Serotonin (a brain chemical that works as a natural mood lifter) and melatonin (a mood lifter and sleep inducer) levels drop off during the winter, leaving people with SAD with mild depression and the inability to sleep.

Light therapy has been shown to combat SAD, as do medication and talk therapy.

Perinatal depression

Also known as postpartum depression, this type of depression is exclusive to women. Childbirth is the trigger, although symptoms may not appear for months. Once the symptoms do show up, they mimic the traditional markers for depression, especially the impending sense of doom and uncontrollable crying.

Many women who have perinatal depression—up to one in seven—feel that if they verbalize their fears, they will be considered inadequate as mothers. Medication and talk therapy are the typical treatments for perinatal depression.

What You Need To Know About Postpartum Depression

Premenstrual dysphoric disorder

This disorder is often referred to as PMS, which is a term everybody has heard of, but it is a more severe form of PMS. A woman in her childbearing years is in constant hormonal flux, and the estrogen that is released after ovulation can sometimes lead to common depression symptoms—appetite changes, sadness, insomnia, and irritability.

Symptoms tend to disappear when menstruation begins, until the next month when symptoms often return. Severe premenstrual dysphoric disorder is treated with antidepressants like Prozac or Zoloft.

Which type of depression do I have?

Only a doctor can definitively diagnose the type and severity of your depression. Realizing why you are depressed is a good way to pinpoint the type of depression you are experiencing. Ask yourself these questions to work out why you feel depressed:

• Are you in a bad relationship, a dead-end job, or dealing with physical health issues?

• Are your mood swings extreme, to the point where you can't control your behavior when you're feeling good?

• Have you always struggled with exhaustion and sadness? 

Once you have been diagnosed, understanding the underlying cause of your depression may help you manage it. Changing your situation can sometimes make a significant difference. If you're new somewhere and lonely, it is often natural to feel some symptoms of depression. In this case, you can find new interests and friends, so it is possible to remove the underlying cause.

This is not to say that treating depression is as simple as taking on a new hobby, but you do have some control over your circumstances.

The lowdown

Medication and therapy can be lifesaving for people with depression. If you or a loved one are dealing with the disease, there are things you can do between episodes that will mitigate symptoms going forward.

• Exercise: increases endorphins and neurotrophins, proteins that promote the growth and function of brain cells

• Set realistic goals: run one errand, don't stress yourself by running five

• Find a confidant: having someone to talk to will help you feel less alone

• Don't put too much pressure on yourself: your mood will improve eventually, but it won’t always happen on your timetable

• Don't make important life decisions until you are feeling better

When you see your doctor, it is important that you are open and honest about your symptoms. You can't get an accurate diagnosis, or the correct medication unless you share all the specifics of your depression.

Don't worry about their response or reactions; your doctor's only concern is helping you get better.