Depression (major depressive disorder) is a common and serious mental disorderthat negatively affects how you feel, think, act, and perceive the world.
Nearly three in ten adults (29%) have been diagnosed with depression at some point in their lives and about 18% are currently experiencing depression, according to a 2023 national survey. Women are more likely than men and younger adults are more likely than older adults to experience depression. While depression can occur at any time and at any age, on average it can first appear during one’s late teens to mid-20s.
Symptoms of depression symptoms can vary from mild to severe and can appear differently in each person. These symptoms can include:
- Feeling sad, irritable, empty and/or hopeless.
- Losinginterest or pleasure in activities you once enjoyed.
- A significant changein appetite (eating much less or more than usual) and/orweight (notable loss or gain unrelated to dieting).
- Sleeping too little or too much.
- Decreased energy or increased tiredness or fatigue
- Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech that are severe enough to be observable by others.
- Feeling worthless or excessively guilty.
- Difficulty thinking orconcentrating, forgetfulness, and/or difficulty making minor decisions.
- Thoughts of death, suicidal ideation,or suicide attempts.
It is normal to experience moments of sadness or feeling “down in the dumps” or the blues as part of the human experience. However, a diagnosis of depression requires that the above symptoms occur for most of the day, nearly every day, for more than two weeks, along with a clear change in day-to-day functioning (e.g., in work/school performance, personal relationships, and hobbies). Fortunately, depression is very treatable.
Risk Factors for Depression
Depression can affect anyone—even those who seemingly have it all. Several factors can play a role in depression. Several factors can play a role in depression:
- Biochemical: Differences in certain chemicals in the brain (such as the neurotransmiters serotonin, dopamine and norepinephrine) may contribute to symptoms of depression.
- Genetic: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.
- Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic maybe more likely to experience depression.
- Environmental: Continuous exposure to violence, neglect, abuse or poverty can also pose risks for developing depression.
Depression is among the most treatable of mental disorders. Between 70% and 90% percent of people with depression eventually respond well to treatment.
To diagnose depression, a healthcare professional will conduct a thorough diagnostic evaluation that includes a comprehensive interview to discuss your symptoms in addition to your personal, medical and family histories. Moreover, a physical examination should be performed to screen for underlying medical conditions that may mimic depression — such as hormonal imbalances, vitamin deficiencies, neurological problems and drug or alcohol use. Laboratory and imaging tests may also be included in the evaluation as part of the medical screening. The evaluating medical professional will take all of these factors into account as they formulate a diagnosis and recommend an individualized treatment plan.
Medication
Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants may be recommended. These medications are not sedatives, “uppers” or tranquilizers. They are not addictive.
Antidepressants may produce some improvement within the first week or two of use yet full benefits may not be seen for two to three months. If a personfeels little or no improvement after several weeks, theirpsychiatrist/healthcare professional may recommendadjustingthe dose, adding a new medication, or switching to an alternateantidepressant. In some situations, other classes of psychiatricmedications, such as mood stabilizers, may be helpful. It is important to let your healthcare professionalknow if you have concerns about your mediation(s) or experience any side effects of the medication.
Psychiatrists usually recommend that patients continue to take medication for six or more months after the depressive symptoms have improved. For certain people at risk — for example, those who have experienced multiple episodes of depression in the past, or those with a strong family history of depression — longer-term maintenance treatment may be suggested to decrease the risk of future episodes.
Psychotherapy
Psychotherapy, or “talk therapy,” is also often recommended.Cognitive behavioral therapy (CBT), one of the most common forms of psychotherapy,has been found to be effective in treating depression. CBT focuseson recognizing andcorrecting unhealthy thinking patterns with the goal of changing thoughts and behaviors to respond to challenges in a more positive manner. It may be used alone or in combination with antidepressant medication.
Psychotherapy may involve one or more people. For example, family or couples therapy can help address issues within these close relationships. Group therapy brings together, in a therapeutic environment, a cohort of people who are similarly experiencing depression, providing an opportunity for mutual learning and support.
Depending on the severity of the depression, treatment with psychotherapy can last a few weeks or longer. Significant improvement can aften be made in 10 to 15 sessions.
Electroconvulsive Therapy (ECT)
ECT is a medical treatment that is generallyreserved for those with severedepressive episodeswho have not responded to other treatments.ECT has been used since the 1940s, and many years of research have led to major improvements and the recognition of its effectiveness as a mainstream rather than a "last resort" treatment.ECT is a procedure performed under anesthesia during which the brain is stimulated electrically to induce a brief seizure. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant.
Self-help and Coping
There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.
Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, a first step is to see your family physician or psychiatrist. Talk about your concerns and request a thorough evaluation.
The tabs below provide brief descriptions of six conditions related to depression: perinataldepression (previously postpartum depression), seasonal depression (also called seasonal affective disorder), bipolar disorders, persistent depressive disorder,premenstrual dysphoric disorder, and disruptive mood dysregulation disorder.
While having a baby ican be exciting and joyous for many women, it can also be a difficult and distressing experience for some.Perinataldepression refers to depression occurring during pregnancy or after childbirth.The use of the term perinatalrecognizes that depression associated with having a baby often begins during pregnancy.
Perinataldepression is a serious, but treatable medical illness involving feelings of extreme sadness, indifference and/or anxiety, as well as changes in energy, sleep, and appetite. It carries risks for the mother and child. An estimated one in seven women experiences peripartum depression.An estimated one in seven women experiences perinatal depression.
Seasonal affective disorder* is a form of depression also known as SAD, seasonal depression or winter depression. In theDiagnostic Manual of Mental Disorders, 5th Edition, Text Revision(DSM-5-TR), this disorder is identified as a type of depression – major depressive disorder with seasonal pattern.
People with SAD experience mood changes and symptoms similar to depression.The symptoms usually occur during the fall and winter months when there is less sunlight and usually improve with the arrival of spring. The most difficult months for people with SAD in the United States tend to be January and February. While it is much less common, some people experience SAD in the summer.
SAD is more than just “winter blues.” The symptoms can be distressing and overwhelming and can interfere with daily functioning. However, it can be treated. About 5 percent of adults in the U.S. experience SAD and it typically lasts about 40 percent of the year. It is more common among women than men.
Bipolar disorder is a brain disorderthat is associated withchanges in a person’s mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes. These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well. When treated, people with bipolar disorder can lead full and productive lives.
People without bipolar disorder experience mood fluctuations as well. However, these mood changes typically last hours rather than days. Also, these changes are not usually accompanied by the extreme degree of behavior change or difficulty with daily routines and social interactions that people with bipolar disorder demonstrate during mood episodes. Bipolar disorder can disrupt a person’s relationships with loved ones and cause difficulty in working or going to school.
Bipolar disorder is a category that includes three different diagnoses: bipolar I, bipolar II, and cyclothymic disorder.
A person with persistent depressive disorderhas a depressed mood for most of the day, for more days than not, for at least two years. In children and adolescents, the mood can be irritable or depressed, and must continue for at least one year.
In addition to depressed mood, symptoms include:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
Persistent depressive disorder often begins in childhood, adolescence, or early adulthood and affects an estimated 0.5% of adults in the United States every year. Individuals with persistent depressive disorder often describe their mood as sad or “down in the dumps.” Because these symptoms have become a part of the individual’s day-to-day experience, they may not seek help, just assuming that “I’ve always been this way.”
The symptoms cause significant distress or difficulty in work, social activities, or other important areas of functioning. While the impact of persistent depressive disorder on work, relationships and daily life can vary widely, its effects can be as great as or greater than those of major depressive disorder.
A major depressive episode may precede the onset of persistent depressive disorder but may also arise during (and be superimposed on) a previous diagnosis of persistent depressive disorder.
Premenstrual dysphoric disorder (PMDD) was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Premenstrual dysphoric disorder is estimated to affect between 1.8% to 5.8% of menstruating women every year. A woman with PMDD has severe symptoms of depression, irritability, and tension about a week before menstruation begins.
Common symptoms include mood swings, irritability or anger, depressed mood, and marked anxiety or tension. Other symptoms may include decreased interest in usual activities, difficulty concentrating, lack of energy or easy fatigue, changes in appetite with specific food cravings (specifically for sweets and other carbohydrates), trouble sleeping or sleeping too much, or a sense of being overwhelmed or out of control. Physical symptoms may include breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.These symptoms begin a week to 10 days before the start of menstruation and improve or stop around the onset of menses. The symptoms lead to significant distress and problems with regular functioning or social interactions.For a diagnosis of PMDD, symptoms must have occurred in most of the menstrual cycles during the past year and must have an adverse effect on work or social functioning.
PMDD can be treated with antidepressants, birth control pills, or nutritional supplements. Diet and lifestyle changes, such as reducing caffeine and alcohol, getting enough sleep and exercise, and practicing relaxations techniques, can also help.
Premenstrual syndrome (PMS) is similar to PMDD in that symptoms occur seven to 10 days before a woman’s period begins. However, PMS involves fewer and less severe symptoms than PMDD.
Disruptive mood dysregulation disorder is a mood condition that is diagnosedin children and youth ages 6 to 18. It involves a chronic and severe irritability resulting in severe and frequent temper outbursts. The temper outbursts can appear asverbal or physical aggression, are significantly out of proportion to the situation, and are not consistent with the child’s developmental age. They episodes must occur frequently (three or more times per week on average) and typically in response to frustration. In between the outbursts, the child’s mood is persistently irritable or angry most of the day, nearly every day. This mood is noticeable by others, such as parents, teachers, and peers.
For a diagnosis of disruptive mood dysregulation disorder to be made, symptoms must begin before the age of 10 and be present for at least one year in at least two settings (such as at home, at school, with peers). Disruptive mood dysregulation disorder is much more common in males than females. It may occur along with other disorders, including major depressive, attention-deficit/hyperactivity, anxiety, and conduct disorders.
Disruptive mood dysregulation disorder can have a significant impact on the child’s ability to function. Chronic, severe irritability and temper outbursts can disrupt family life, cause difficulties in shcool, and make it difficult for the child/youth to make or keep friendships.
Treatment typically involvespsychotherapy(cognitive behavior therapy) and/or medications.
Depression Is Different From Sadness or Grief/Bereavement
The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”
But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:
- In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.
- In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
- In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.
Grief and depression can co-exist. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.Distinguishing between grief and depression is important and can assist people in getting the help, support or treatment they need.
Physician Review
Chinenye Onyemaechi, M.D.
April 2024
