This is also very common. Data from the Centers for Disease Control and Prevention estimates that 18.5% of U.S. adults experienced symptoms of depression during any two weeks in 2019.
Although depression and grief share some common characteristics, depression is different from grief after the loss of a loved one or grief after a traumatic life event. Depression usually involves self-loathing or loss of self-esteem, whereas sadness usually does not.
In grief, positive emotions and happy memories of the deceased are often accompanied by emotional pain. In major depression, feelings of sadness are persistent.
People experience depression in different ways. It can interfere with your daily routine, resulting in lost time and reduced productivity. It can also affect relationships and some chronic health conditions.
Depression can cause worsening of conditions, including:
- arthritis
- asthma
- Cardiovascular diseases
- cancer
- diabetes
- obesity
It's important to realize that feeling down at times is a normal part of life. Sad and disturbing events happen to everyone. But if you often feel depressed or hopeless, you may be dealing with depression.
Depression is considered a serious illness and can get worse without proper treatment.
depressive symptoms
Depression is more than just a persistent feeling of sadness or "blueness."
Major depression can cause a variety of symptoms. Some affect you emotionally, some affect you physically. Symptoms may also persist or come back.
General signs and symptoms
Not everyone with depression experiences the same symptoms. Symptoms vary in severity, frequency, and duration.
You may have depression if you experience some of the following symptoms of depression almost every day for at least two weeks:
- Feeling sad, anxious, or "empty"
- Feeling hopeless, worthless and pessimistic
- crying a lot
- feel troubled, irritated or angry
- Loss of interest in hobbies and interests you once enjoyed
- decreased energy or fatigue
- Difficulty concentrating, remembering, or making decisions
- move or speak slower
- Trouble sleeping, waking up early, or oversleeping
- Changes in appetite or weight
- Chronic body pain that has no clear cause and does not improve with treatment (headaches, aches, digestive problems, cramps)
- Thoughts of death, suicide, self-harm, or suicide attempts
Symptoms of depression may differ among men, women, teenagers, and children.
Men may experience symptoms related to:
- Emotions, such as anger, aggression, irritability, anxiety, or restlessness
- Emotional health, such as feeling empty, sad, or hopeless
- Behaviors such as loss of interest, no longer finding enjoyment in favorite activities, getting tired easily, having suicidal thoughts, using alcohol, drugs, or engaging in high-risk activities
- Sexual interest, such as decreased sexual desire or lack of sexual performance
- Cognitive abilities, such as difficulty concentrating, completing tasks, or responding slowly during conversations
- Sleep patterns, such as insomnia, restless sleep, excessive sleepiness, or staying awake all night
- Physical health, such as fatigue, pain, headaches, or digestive problems
Women may experience symptoms related to:
- Mood, such as irritability
- Emotional health, such as feeling sad or empty, anxious, or hopeless
- Behaviors, such as losing interest in activities, withdrawing from social activities, or having suicidal thoughts
- Cognitive abilities, such as thinking or speaking more slowly
- Sleep patterns, such as difficulty sleeping through the night, waking up early, or sleeping too much
- Physical health, such as decreased energy, more fatigue, changes in appetite, weight changes, increased pain, headaches, or cramps
Children may experience symptoms related to:
- Emotions, such as irritability, anger, rapid mood changes, or crying
- Emotional health, such as feelings of inadequacy (e.g., "I can't do anything right") or despair, crying, or intense sadness
- Behaviors such as getting into trouble or refusing to go to school, avoiding friends or siblings, having thoughts of death or suicide, or self-harm
- Cognitive abilities, such as difficulty concentrating, decreased academic performance, or changes in grades
- Sleep patterns, such as difficulty falling asleep or sleeping too much
- Physical health, such as energy loss, digestive problems, changes in appetite, or weight loss or gain
causes of depression
There are many possible causes of depression. They can range from biological to environmental.
Common reasons include:
- Brain Chemistry. People with depression may have chemical imbalances in the parts of the brain that regulate mood, thoughts, sleep, appetite and behavior.
- Hormone levels. Changes in the female hormones estrogen and progesterone during different periods of the menstrual cycle, postpartum, perimenopause or menopause may increase a person's risk of depression.
- family history. If you have a family history of depression or other mood disorders, you are at higher risk of developing depression.
- Early childhood trauma. There are certain events that can affect how your body responds to fearful and stressful situations.
- Brain structure. If the frontal lobe of the brain is less active, the risk of depression is greater. However, scientists don't know whether this happens before or after symptoms of depression appear.
- Medical conditions. Certain conditions may put you at higher risk, such as chronic illness, insomnia, chronic pain, Parkinson's disease, stroke, heart disease, and cancer.
- Substance use. A history of drug or alcohol abuse may affect your risk.
- pain. People who experience prolonged emotional or chronic physical pain are significantly more likely to develop depression.
risk factors
Risk factors for depression may be biochemical, medical, social, genetic, or environmental. Common risk factors include:
- gender. Major depression is twice as common in women as in men.
- Genetics. If you have a family history of depression, your risk of developing it is increased.
- socioeconomic status. Socioeconomic status, including financial problems and low social status, may increase your risk of depression.
- Certain medications. Certain medications, including certain types of hormonal contraceptives, corticosteroids, and beta-blockers, may increase the risk of depression.
- Vitamin D deficiency. Research has linked symptoms of depression to low vitamin D levels.
- Gender identity. According to a 2018 study, transgender people are almost four times more likely to suffer from depression than cisgender people.
- Substance abuse. About 21% of people with substance use disorders also suffer from depression.
- Medical illness. Depression is associated with other chronic illnesses. People with heart disease are about twice as likely to be depressed as people without heart disease, and up to a quarter of cancer patients may also be depressed.
depression treatment
You may be able to successfully control your symptoms with one type of treatment, or you may find that a combination of treatments works best.
It's common to combine medication with lifestyle therapies, including the following:
drug
Your healthcare professional may prescribe:
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are the most commonly used antidepressant medications and have few side effects. They treat depression by increasing the availability of the neurotransmitter serotonin in the brain.
SSRIs should not be taken with certain drugs, including monoamine oxidase inhibitors (MAOIs), and in some cases with thioridazine or Orap (pimozide).
Pregnant women should discuss the risks of taking SSRIs during pregnancy with their healthcare professional. You should also use caution if you have narrow-angle glaucoma.
Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil, Paxil XR, Pexeva), and sertraline (Zoloft).
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs treat depression by increasing levels of the neurotransmitters serotonin and norepinephrine in the brain.
SNRIs should not be taken with MAOIs. Use with caution if you have liver or kidney problems, or narrow-angle glaucoma.
Examples of SNRIs include desvenlafaxine (Pristiq, Khedezla), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), and venlafaxine (Effexor XR).
Tricyclic and tetracyclic antidepressants
Tricyclic antidepressants (TCA) and tetracyclic antidepressants (TECA) treat depression by increasing the levels of the neurotransmitters serotonin and norepinephrine in the brain.
TCAs cause more side effects than SSRIs or SNRIs. Do not take TCA or TECA with MAOIs. Use caution if you have narrow-angle glaucoma.
Examples of tricyclic antidepressants include amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), desipramine (Norpramin), nortriptyline (Pamelor, Aventyl) and protriptyline (Vivactil).
atypical antidepressants
Norepinephrine and dopamine reuptake inhibitors (NDRI)
These drugs treat depression by increasing levels of dopamine and norepinephrine in the brain.
Examples of NDRIs include bupropion (Wellbutrin).
Monoamine oxidase inhibitors (MAOIs)
MAOIs treat depression by increasing levels of norepinephrine, serotonin, dopamine, and tyramine in the brain.
MAOIs are not the first choice for treating mental health disorders due to side effects and safety concerns. They are usually only used when other medications have failed to treat depression.
Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate).
N-methyl D-aspartate (NMDA) antagonist
N-methyl-D-aspartate (NMDA) antagonists treat depression by increasing glutamate levels in the brain. Glutamic acid is a neurotransmitter thought to be involved in depression.
NMDA antagonists are reserved for patients who have not been successful with other antidepressant treatments.
The FDA has approved an NMDA drug, esketamine (Spravato), for the treatment of depression.
Esketamine is a nasal spray that is only available through a restricted program called Spravato REMS.
After taking the medication, patients may experience fatigue and schizophrenia (difficulty concentrating, judging, and thinking). Therefore, esketamine is used in medical settings where health care professionals can monitor sedation and dissociation.
Each medication used to treat depression has benefits and potential risks.
psychotherapy
Talking to a therapist can help you learn skills to cope with negative emotions. You may also benefit from family or group therapy sessions.
Psychotherapy, also known as "talk therapy," is when a person talks with a trained therapist to identify and learn to cope with the factors contributing to their mental health condition, such as depression.
Psychotherapy has been shown to be an effective treatment for improving symptoms in people with depression and other mental illnesses.
Psychotherapy is often used along with medication. There are many different types of psychotherapy, and some people respond better to one type than another.
Cognitive behavioral therapy (CBT)
In cognitive behavioral therapy (CBT), a therapist will work with you to uncover unhealthy thought patterns and determine how they lead to harmful behaviors, reactions, and beliefs about yourself.
Your therapist may give you "homework" to practice replacing negative thoughts with more positive ones.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) is similar to CBT but places a strong emphasis on validating, or accepting, uncomfortable thoughts, feelings, and behaviors rather than fighting them.
The theory is that by accepting harmful thoughts or emotions, you can accept that change is possible and develop a recovery plan.
psychodynamic therapy
Psychodynamic therapy is a type of talk therapy designed to help you better understand and cope with daily life. Psychodynamic therapy is based on the idea that your present reality is shaped by your unconscious childhood experiences.
In this form of therapy, your therapist will help you reflect on and examine your childhood and experiences to help you understand and cope with your life.
Phototherapy
Exposure to certain doses of white light can help regulate mood and improve symptoms of depression. Light therapy is often used for seasonal affective disorder, now called seasonal depression.
Consult a health professional before using light therapy. People with bipolar disorder may be at risk for mania when using light therapy.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT), which uses electrical current to induce seizures, has been shown to help people with clinical depression. It is used in people with severe depression or depression that is resistant to other treatments or antidepressant medications.
During the ECT procedure, you will receive an anesthetic that will put you to sleep for about 5 to 10 minutes.
Your healthcare professional will place a heart monitoring pad on your chest and four electrodes on specific areas of your head. They will then emit short electrical pulses for a few seconds. You will not twitch, feel no electricity, and will wake up approximately 5 to 10 minutes after treatment.
Side effects include headache, nausea, muscle pain and soreness, confusion or disorientation.
Patients may also develop memory problems, but these usually appear in the weeks and months after treatment
alternative therapy
Ask your doctor about alternative treatments for depression. Many people choose to use alternative therapies alongside traditional psychotherapy and medication. Some examples include:
meditation. Stress, anxiety and anger are triggers of depression, but meditation can help change the brain's response to these emotions. Research shows that meditation practice can help improve symptoms of depression and reduce the chance of depression returning.
acupuncture. Acupuncture, a form of traditional Chinese medicine, may help relieve some symptoms of depression. During acupuncture, doctors use needles to stimulate certain areas of the body to treat a range of conditions. ResearchTrusted Source suggests acupuncture may help clinical treatments work better and may be as effective as counseling.
Natural Remedies and Lifestyle Tips
exercise
Aim for 30 minutes of physical activity 3 to 5 days per week. Exercise increases the body's production of endorphins, hormones that improve mood.
Avoid alcohol and drugs
Drinking alcohol or abusing drugs may make you feel better. But in the long term, these substances can worsen symptoms of depression and anxiety.
Learn how to set limits
Feeling overwhelmed can exacerbate symptoms of anxiety and depression. Setting boundaries in your professional and personal life can help you feel better.
Take good care of yourself
You can also improve symptoms of depression by taking care of yourself. This includes getting enough sleep, eating healthily, avoiding negative people, and participating in fun activities.
Sometimes depression doesn't respond to medications. If your symptoms don't improve, your healthcare professional may recommend other treatment options.
These options include electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS), which are used to treat depression and improve mood.
supplements
Several types of supplements may have some positive effects on symptoms of depression. Be sure to discuss any new supplements you may be taking with your healthcare team, as some supplements may have significant side effects or interact with medications.
S-adenosyl-L-methionine (SAMe)
Some studies show this compound can relieve symptoms of depression. People taking SSRIs had the most significant effects. However, the results of this study are not conclusive and more research is needed.
5-Hydroxytryptophan (5-HTP)
5-HTP may increase serotonin levels in the brain, thereby relieving symptoms. Your body produces this chemical when you consume tryptophan, a building block of protein. However, more research is needed.
Omega-3 fatty acids
These essential fats are important for neurological development and brain health. Adding omega-3 supplements to your diet may help reduce symptoms of depression. However, there is some conflicting evidence and more research is needed.
Always check with your doctor before taking supplements as they may interact with or have negative side effects with other medications.
vitamins
Vitamins are important for many body functions. Research shows that two vitamins are particularly useful for relieving symptoms of depression:
- B vitamins: B-12 and B-6 are essential for brain health. When your B vitamin levels are low, your risk of depression may be higher.
- Vitamin D: Vitamin D, sometimes called the sunshine vitamin, is important for brain, heart and bone health. There may be a link between vitamin D deficiency and depression, but more research is needed.
Many herbs, supplements, and vitamins claim to help relieve symptoms of depression, but most have not been proven effective in clinical studies.
Learn about herbs, vitamins, and supplements that have shown some promise, and ask your health care professional if any are right for you.
depression test
There is no single test that can diagnose depression. But your healthcare provider can make a diagnosis based on your symptoms and psychological evaluation.
In most cases, they will ask a series of questions about you:
- Feeling
- appetite
- sleep mode
- activity level
- idea
Because depression can be related to other health problems, your health care professional may also perform a physical examination and order blood tests. Sometimes thyroid problems or vitamin D deficiency can trigger symptoms of depression.
It is important not to ignore the symptoms of depression. If your mood does not improve or gets worse, seek medical assistance. Depression is a serious mental health disorder that can have complications.
If left untreated, complications may include:
- weight gain or loss
- body pain
- substance use disorder
- panic attack
- relationship issues
- social isolation
- having suicidal thoughts
- self harm
Types of depression
Depression can be divided into several categories based on the severity of symptoms. Some people experience mild and temporary episodes of depression, while others experience severe and persistent episodes of depression.
There are two main types: major depression and persistent depression.
severe depression
Major depressive disorder (MDD) is a more severe form of depression. It is characterized by persistent feelings of sadness, hopelessness, and worthlessness that do not go away on their own.
In order to be diagnosed with clinical depression, you must experience five or more of the following symptoms within a two-week period:
- Feeling depressed most of the day
- Loss of interest in most daily activities
- Significant weight loss or gain
- Sleeping a lot or having trouble falling asleep
- Slowing of thinking or actions
- Feeling tired or low on energy most of the time
- Feelings of worthlessness or guilt
- Inattention or indecisiveness
- Recurrent thoughts of death or suicide
There are different subtypes of major depression, which the American Psychiatric Association calls "specific types."
These include:
- atypical features
- anxious
- Mixed features
- Perinatal, pregnancy, or immediate postpartum onset
- seasonal pattern
- Characteristics of melancholy
- psychopathic traits
- catatonia
persistent depression
Persistent depressive disorder (PDD) used to be called dysthymia. This is a milder but chronic form of depression.
In order to make a diagnosis, symptoms must persist for at least 2 years. PDD affects your life more than major depression because it lasts longer.
People with PDD often:
- Loss of interest in normal daily activities
- feel despair
- lack of productivity
- self-abasement
Depression can be successfully treated, but it's important to stick to your treatment plan.
Read more about why depression treatment is important.
Living with depression can be difficult, but treatment can help improve your quality of life. Discuss possible options with your health care professional.
postpartum depression
Postpartum depression refers to depression that occurs after childbirth. This is a common condition after pregnancy, affecting one in nine new parents.
It's common for people to experience "baby blues," or a feeling of sadness or emptiness after giving birth. For many people, these symptoms disappear within a few days.
But if you feel sad, hopeless, or empty for more than two weeks after giving birth, you may be suffering from postpartum depression.
Symptoms of postpartum depression range from mild to severe and may include:
- Feeling agitated or moody
- Feeling sad, hopeless, or overwhelmed
- Thoughts of harming the baby or yourself
- Not interested in your baby, feeling disconnected, or as if your baby is someone else's
- No energy or motivation
- eating too little or too much
- Sleeping too little or too much
- difficulty concentrating
- Have memory problems
- Feeling worthless, guilty, or like a bad parent
- Quit activities you once enjoyed
- Stay away from friends and family
- Headache, pain, or stomach problems persist
- Feeling empty, disconnected, or like you don't love or care about your baby
Postpartum depression is thought to be triggered by the dramatic hormonal changes that occur after pregnancy.
Bipolar depression occurs in some types of bipolar disorder when a person experiences a depressive episode.
Bipolar disorder is a mental disorder that causes significant changes in mood, energy, concentration, and ability to perform daily tasks.
There are three types of bipolar disorder, all of which include manic episodes, in which you feel extremely "high," elated, or energetic, and depressive episodes, in which you feel "down," Sadness or despair.
If you have bipolar disorder, it can be difficult to recognize the harmful effects of each "mood episode."
People with depression may:
- Feeling very sad, hopeless, or empty
- Feeling slowed down or restless
- Trouble falling asleep, waking up too early, or sleeping too much
- increased appetite and weight gain
- Speaks slowly, forgets things, or feels like you have nothing to say
- Difficulty concentrating or making decisions
- Feeling unable to complete basic tasks
- Little interest in activities
- Decreased or absent sexual desire
- Thoughts of death or suicide
Symptoms during a depressive episode last most of the day and may last for days or weeks.
If bipolar disorder is treated, many people experience fewer and fewer symptoms of depression when experiencing a depressive episode.
depression and anxiety
Depression and anxiety can occur in a person at the same time. In fact, research shows that more than 70% of people with depression also have symptoms of anxiety.
Although depression and anxiety are thought to be caused by different causes, they can produce several similar symptoms, which may include:
- irritability
- Difficulty remembering or concentrating
- sleep problems
The two diseases also share some common treatments.
Both anxiety and depression can be treated by:
- therapy, such as cognitive behavioral therapy
- drug
- Alternative therapies, including hypnotherapy
If you think you are experiencing symptoms of one or both of these conditions, make an appointment to speak with your healthcare professional. You can work with them to identify coexisting symptoms of anxiety and depression and how to treat them.
Depression and Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) causes unwanted, repetitive thoughts, urges, and fears (obsessions).
These fears can cause you to repeat behaviors or rituals (compulsions) that you hope will relieve the stress caused by your OCD.
People diagnosed with OCD often find themselves trapped in a cycle of obsessions and compulsions. If you engage in these behaviors, you may feel isolated as a result. This can lead to withdrawal from friends and social situations, increasing the risk of depression.
It is not uncommon for people with OCD to also suffer from depression. Having one anxiety disorder increases the chance of another. Up to 80% of people with obsessive-compulsive disorder also suffer from depression.
This dual diagnosis also causes concern in children. Their compulsive behaviors may start at a young age, which can make them feel unusual. This may cause the child to withdraw from friends and increase the child's chance of developing depression.
Depression accompanies psychosis
Some people diagnosed with major depression may also have symptoms of another mental disorder (called psychosis). When these two conditions occur together, it is called "severe depression with psychotic features" or melancholic psychosis.
Depressive psychosis causes people to see, hear, believe, or smell things that are not true. People with this disorder may also feel sad, hopeless, and irritable.
The combination of these two conditions is particularly dangerous. This is because people with depressive psychosis may develop delusions that lead them to have suicidal thoughts or take unusual risks.
It's not clear what causes either condition or why they occur together, but treatment can be successful in relieving symptoms. Treatment options include medications and electroconvulsive therapy (ECT).
Understanding risk factors and possible causes can help you understand early symptoms.
depression during pregnancy
Pregnancy is often an exciting time for people. However, it is still common for pregnant women to suffer from depression.
Symptoms of depression during pregnancy include:
- Changes in appetite or eating habits
- feel despair
- anxiety
- Loss of interest in activities and things that you once enjoyed
- persistent sadness
- Trouble concentrating or remembering
- Sleep problems, including insomnia or sleeping too much
- Thoughts of death or suicide
Treatment for depression during pregnancy may focus entirely on talk therapy and other natural remedies.
While some women do take antidepressants during pregnancy, it's not clear which medications are safest. Your healthcare provider may encourage you to try other options before your baby is born.
The risk of depression may continue after the baby is born. Postpartum depression, also known as perinatal-onset major depression, is a serious concern for new mothers.
depression and alcohol
Research has established a link between alcohol consumption and depression. People with depression are more likely to abuse alcohol.
Of the 20.2 million U.S. adults who experience a substance use disorder, approximately 50% have a co-occurring mental illness.
Regular drinking can worsen symptoms of depression, and people with depression are more likely to abuse or become dependent on alcohol.
Prevent depression
Depression is generally thought to be unpreventable. It's difficult to identify what causes this condition, which means preventing it is even harder.
But once you've experienced a depressive episode, you may be better able to prevent future episodes by understanding what lifestyle changes and treatments can help.
Techniques that may help include:
- exercise regularly
- enough sleep
- Maintenance treatment
- relieve pressure
- Build strong relationships with others
Other tips and ideas can also help you prevent depression.
The outlook for depression
Depression can be temporary or it can be a long-term challenge. Treatment doesn't always make your depression completely go away.
However, treatment can often make symptoms more manageable. Managing depression symptoms involves finding the right combination of medications and therapies.
If one treatment doesn't work, talk to your health care professional. They can help you develop different treatment plans and better help you manage your condition.
