What is depression?
Major depressive disorder also called clinical depression, or usually just depression, is a mood disorder. It causes depressive episodes, which are periods where you feel lasting feelings of sadness, numbness, and a loss of interest in your life.
Everyone can feel sad and disinterested at times, but the difference with depression is the severity of the symptoms and how long they last. Depressive episodes can last for weeks to months and can make it difficult to live your daily life. Depression is not usually something you can snap yourself out of. Neither is it self-indulgent, a sign of weakness, or something to be ignored. Depression is a serious illness that requires treatment.
It is also common and widespread. The World Health Organization (WHO) says depression is one of the leading causes of disability worldwide and estimates that over 264 million people suffer from it. In the US, around 7% of adults have depression (over 17 million US adults).
The symptoms of depression are diverse and vary by person. Your experience of depression may be similar to someone else’s or very different.
Depression usually causes depressive episodes. During these episodes you can feel any of the below:
- Sad, unhappy, or dejected
- Numb, with little or no emotion
- Disinterested in activities you usually enjoy
- Fatigued – having low energy levels
- A loss of interest in sex
- Less time and care spent on your personal hygiene
- Feelings of worthlessness and guilt
- Problems sleeping or sleeping more
- Eating less or eating more, which can lead to weight loss or gains
- Problems thinking, concentrating, and making decisions
- Slowed speech and movements that are noticeable to other people
- Increased irritability or anger
- Restless activity, like pacing and hand wringing
- Social isolation
- Thoughts of suicide or attempts to commit suicide
One diagnosis of major depressive disorder is to have a depressive episode in which you have at least five of these symptoms, every day. These can last as long as two weeks. Definitions of depression can vary by medical practitioner.
Depressive episodes can last from weeks to months. Between episodes, your depression may recede or disappear entirely, but episodes often reoccur. You may experience depressive episodes over months and years, particularly if your depression isn’t treated.
Symptoms of depression in men
Research has shown that men can experience different symptoms of depression than women. These can include higher rates of:
- Anger and aggression
- Abuse of alcohol and drugs
- An increase in risk-taking behaviors, like gambling and having unsafe sex
- Social isolation
- Working obsessively
- Becoming controlling and abusive in relationships
Some of these symptoms aren’t amongst the usual list of depression symptoms, but in many men, they are thought to be caused by depression. When focusing on more traditional measures and symptoms of depression, women are more likely to be depressed. But when the above symptoms are included, the rates of depression become equal in men and women.
Symptoms of depression in women
With traditional measures, depression is almost twice as common in women as in men. This could be due to biological differences, or it may be due to social expectations on how the sexes should behave. It may be more acceptable for men and women to exhibit different symptoms of depression.
Women are more likely to experience symptoms like:
- Irritability and mood swings
- Dwelling on negative thoughts
Postpartum depression symptoms
Postpartum depression, sometimes called postnatal depression, is a form of depression that comes on after the birth of a child. It usually happens between a few days to a month after birth, and can last for months or even years. Postpartum depression is more common in women but can affect men too.
The symptoms of postpartum depression are similar to major depressive disorder, such as sadness, fatigue, and changes in eating and sleeping. There are additional symptoms related to the baby though, including:
- Problems bonding with the baby
- Not feeling able to take care of the baby
- Feeling scared of the baby
- Worry about harming the baby or the partner
It’s not known for sure what causes postpartum depression. Rather than having a single cause, it’s likely brought on by a mix of factors, like intense emotions, hormonal changes, sleep deprivation, and the increased demands of taking care of a baby.
Symptoms of depression in teens
Depression can be common in teens and is often overlooked. School demands and expectations, physical changes, peer pressure, and social media use can all contribute to depression in teenagers. Symptoms in teens can include:
- Problems concentrating on schoolwork
- Isolation from friends and family
- Feelings of worthlessness, helplessness, and guilt
Symptoms of depression in children
Depression tends to be associated with adults and teenagers, but younger children can develop it too. Depression can be more difficult to identify in children as they may not be able to express their feelings in words. Look out for changes in behavior, including:
- Crying more often
- Being more clingy
- Vocal and emotional outbursts
- Defiant behavior
- Low energy levels
Severe depression symptoms
Some depressive episodes can be more severe than others. Symptoms of severe depression include:
- Feelings of hopelessness and despair
- An inability to live your daily life, take care of yourself and fulfill your responsibilities
- Excessive sleeping or an inability to sleep (insomnia)
- Social isolation
- In rare cases, psychosis – such as hallucinations and delusions
- Thoughts of suicide or suicide attempts
When to see a doctor
If you think you’re depressed, you should talk to your doctor. They can make a professional diagnosis, or they can refer you to a healthcare professional who can help.
Depression is a serious condition and shouldn’t be taken lightly. You shouldn’t expect it to resolve without treatment, and it’s not something you should ignore or try to ‘push through’ by yourself. The sooner you talk to a doctor, the faster you can get yourself on the road to recovery.
If it helps, you can talk to friends and family too, but make sure you see your doctor.
When to get emergency help
If you’re having suicidal thoughts, thoughts of harming yourself or others, or otherwise think you need emergency help, call 911. If you can, try and get a family member or a friend to stay with you until emergency help arrives.
Causes of depression
Depression is a complex condition and the medical and scientific communities don’t fully understand why some people develop it and others don’t.
Research has revealed a wide range of factors that may cause or contribute to the development of depression. However, it’s important to note that these can affect people differently:
- Genetics. Depression runs in families, suggesting it’s inherited, and certain genes have been associated with depression. Your genes won’t give you depression, but they may make you more likely to develop it.
- Brain biochemistry. Differences in people’s brains may make them more likely to develop depression. Low levels, or imbalances, of natural chemicals in your brain called neurotransmitters have been associated with depression.
- Hormone changes. Changes in hormone levels have been associated with depression. Particularly hormone changes after childbirth.
- Personality. Certain personality traits may make depression more likely. These can include low self-esteem, pessimism, being self-critical, and being easily overwhelmed by stress.
- Life events. What happens in your life can interact with the above to bring on depression. Sudden traumatic events, spikes in stress, or persistent problems may trigger depression. Abuse, violence, neglect, poverty, death and illness, isolation, and unemployment are all possible triggers.
Is depression genetic?
Depression is known to run in families. If a parent or sibling has had depression, you’re around three times more likely to develop it too. This suggests that depression is partly genetic, that you can inherit a greater risk of developing depression.
Research has shown that certain genes increase your risk of depression. A study of 135,000 people with depression, found 44 genes that are associated with it. If you have copies of these genes, you’re more likely to develop depression.
It’s important to recognize that depression isn’t just genetic and that these genes don’t predict it 100%. Your genetics may make you more likely to develop depression, but this isn’t 100% guaranteed. And you may not have family members who have had depression, or you may not be genetically at risk, but you could still develop it. In one piece of research, scientists estimated 37% of depression cases involved genetics, but 63% didn’t.
For some people, depressive episodes can be triggered by emotional, psychological, or physical incidents in their life. Understanding if certain circumstances trigger your depression can help you manage it, particularly if you can avoid triggers or prepare yourself to deal with them.
What triggers depression will vary by person, but common triggers include:
- Workplace stress
- Relationship problems
- Family difficulties
- Worry over finances
- Sudden stressful events that happen to you or loved ones, like job losses, illnesses, deaths, or divorce
- Difficult life transitions
- Self-image issues
- Sexual problems
- Poor diet, bad sleep, and lack of exercise
- Other health conditions that affect your daily life
- Low levels of sunlight
Risk factors for depression
Some people are more likely to develop depression than others. Your genetics, lifestyle, events in your life, can all increase your risk of becoming depressed. These include:
- Having close family members with depression or a genetic predisposition to depression
- Major life events, like deaths, sudden illnesses, unemployment, relationship changes, or the birth of children
- Prolonged stress, like workplace stress or worrying about health, relationships, or money
- Having poor coping strategies
- Sleeping badly, not eating a healthy diet, and not exercising regularly
- Illnesses, particularly long-lasting (chronic) illnesses that can affect the quality of your life, including diabetes, chronic obstructive pulmonary disease (COPD), chronic pain conditions, HIV/AIDS, and cancer
- Having previously had depression or other mental health disorders like anxiety
- Some prescription drugs, including corticosteroids, some beta-blockers, and any medications that affect your brain chemistry (including antidepressants)
- Drinking alcohol and taking recreational drugs
- Having had a previous head injury
Complications of depression
Depression is a serious condition that can cause a host of physical, emotional, and behavioral effects on your life. Each case of depression is unique, so you won’t necessarily develop all or any of the complications below, but the following are common:
- Social isolation and the breakdown of friendships
- Relationship difficulties
- Conflict with family and friends
- Declines in work and school performance
- Problems meeting other responsibilities
- Weight gain and obesity
- Alcohol and drug abuse
- Insomnia – not being able to fall or stay asleep
- A reduced sex drive (libido) and other sexual issues, like erectile dysfunction
- An increased risk of suicide
- An increased risk of death from a variety of other illnesses, including heart disease
If you think you have depression, you should get yourself assessed by a doctor or other mental health professional. The first step in getting treated is getting a diagnosis.
Your doctor may diagnose you themselves, or they may refer you to a mental health specialist, like a psychiatrist or psychotherapist. Depression is usually diagnosed through talking rather than via any physical tests. You may be asked to describe your symptoms, emotions, and thoughts.
A questionnaire may also be used that’s designed to measure your symptoms. Usually, each symptom is scored, and the total of these scores is used to diagnose you. Examples of these include the Hamilton Depression Rating Scale or the Beck Depression Inventory.
You may have a general medical examination too to rule out other health conditions that could cause similar symptoms.
Types of depression and depressive disorders
The medical and mental health professions recognize different types of depression. So, how many types of depression are there? This often varies by profession and school of thought. Some other types of disorders are sometimes separated from depression, but involve depression or depressive symptoms. These are some of the most commonly recognized:
- Major depression, or major depressive disorder, is what most people refer to when they say depression. It’s a depression that causes periods of serious depressive symptoms called depressive episodes.
- Persistent depression, also called dysthymia or chronic depression, is when a depression lasts for two years or more.
- Melancholic depression is a form of depression that causes more of a loss of pleasure in most or all parts of your life, over feelings of sadness.
- Postpartum depression is a type of depression that mothers and fathers can experience after the birth of a child.
- Major depressive disorder with seasonal pattern, previously called seasonal affective disorder (SAD), is a depression that’s thought to be triggered by low levels of sunlight in the fall and winter.
- Situational depression is a depression brought on by a specific traumatic or otherwise stressful situation.
- Psychotic depression is a form of depression where people also suffer from psychosis. These are periods where people can lose touch with reality, they may experience hallucinations, have delusions, and struggle to tell what’s real or not.
- Bipolar disorder is a mental health disorder that can cause alternating periods of depression and periods of elevated mood and energy.
How to treat depression?
Depression is treatable. As it’s a complex condition brought on by a range of causes, and as it varies from person-to-person, different people will have success with different treatments.
Your options range from medications, psychotherapy, lifestyle changes, to natural remedies. You may find that all of these things help you manage your depression or just some may help.
Antidepressant medications are effective treatments for lots of people with depression. A range of different medicines are available, but they all tend to work in a similar way. They increase substances in your brain called neurotransmitters. These are chemicals produced naturally by your body that help signals pass through your brain.
They can regulate brain function, particularly areas of your brain involved in mood regulation, emotions, thinking, memory, reward, and motivation.
Some common types of antidepressant include:
- Selective serotonin reuptake inhibitors (SSRIs).
These antidepressants slow how quickly your brain breaks down the neurotransmitter serotonin, increasing your serotonin levels. Examples include:
- Celexa (citalopram)
- Prozac (fluoxetine)
- Zoloft (sertraline)
- Selective serotonin and norepinephrine reuptake inhibitors (SNRIs).
These increase levels of both neurotransmitters serotonin and norepinephrine in your brain. Examples include:
- Monoamine oxidase inhibitors (MAOIs).
These antidepressants reduce how quickly your monoamine oxidase enzymes break down neurotransmitters. This causes levels of neurotransmitters like dopamine, norepinephrine, and serotonin to build up in your brain. Examples include:
- Marplan (isocarboxazid)
- Nardil (phenelzine)
- Emsam (selegiline)
- Tricyclic antidepressants.
These are older, and less commonly used antidepressants than the ones above. They also cause levels of serotonin and norepinephrine to increase. Examples include:
- Elavil (amitriptyline)
- Anafranil (clomipramine)
- Norpramin (desipramine)
Antidepressants are prescription medicines. This means you’ll need to have an assessment for your suitability to take them with a doctor or other licensed medical professional. They have to be taken exactly as prescribed, as they can interact with other medications, supplements, and even food.
Like all medications, antidepressants can have side effects. These can be mild, like headaches and feeling sick, to more serious, like sexual problems and more severe depression. Talk to your doctor to find out more about antidepressant side effects.
Psychotherapy for depression
Psychotherapies are a range of treatments that involve talking about your depression with an expert psychotherapist. The goal is often to help you better understand your depression, its causes, and triggers, and to help you come to terms with and resolve it. Psychotherapy is often used alongside other treatments, like medication.
Psychotherapy comes in many forms, there are different schools, approaches, and techniques. One approach commonly used for depression is cognitive-behavioral therapy (CBT). With CBT you’re guided to challenge your thoughts and behaviors, and to develop coping strategies. Other approaches include interpersonal psychotherapy (ITP) and mindfulness therapies.
Brain stimulation therapies for depression
Brain stimulation therapies are treatments that use electricity to stimulate and/or inhibit parts of your brain. Electricity can be delivered to your brain using electrodes placed on and around your head, with electrodes inserted into your brain, or by using magnetic fields. This form of stimulation can be effective for severe cases of depression, or when other treatments aren’t working.
The most established technique is electroconvulsive therapy. Others include vagus nerve stimulation (VNS), deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), and magnetic seizure therapy (MST).
Supplements and natural remedies for depression
Supplements and natural remedies help some people manage their depression. Often they aren’t medically proven, so they should be used alongside other treatments, rather than replacing them. You should talk to your doctor about all the supplements you’re taking for depression, as some can interact with other medications, like antidepressants.
Popular natural remedies for depression include:
- St. John’s wort (Hypericum perforatum). An herbaceous plant with yellow flowers that can be taken as a supplement. St. John’s wort is a popular depression remedy in Europe, but it’s not been approved by the FDA to treat depression in the US. It should be taken with caution on the recommendation of your healthcare provider, as it can interact with other medications. It shouldn’t be taken with antidepressants.
- SAMe (short for S-adenosylmethionine). This dietary supplement is taken by some people for depression, although it’s not approved to do so by the FDA. It can cause side effects and it shouldn’t be taken with antidepressants.
- Omega-3 fatty acids. These are fats found in some fish, nuts, and seeds. More research is needed to understand their effect on depression, but they’re considered safe and shouldn’t interact with medications.
- Other supplements commonly taken for depression include saffron extract, a hormone called dehydroepiandrosterone (DHEA), a supplement called 5-hydroxytryptophan (5-HTP), and products that contain ginger, lavender, and camomile.
You should use any nutritional and dietary supplements with caution. They aren’t evaluated and tested by the FDA in the same way medications are, and they can interact with other medications and cause serious side effects.
Lifestyle and home remedies for depression
You can take steps in your life that are proven to reduce your risk of depression and can help treat it.
Diet. Diets high in sugary and processed foods have been associated with a greater risk of depression. Reducing these foods may help alleviate your symptoms. Diet is important for all aspects of your health. Although there’s no single recommended diet for depression, eating plenty of whole foods, fruit, vegetables, and other nutritious foods, may help with your depression.
Exercise. Research has shown that regular exercise can improve your mood, boost your energy levels, and can be effective for people with mild to moderate depression. As with diet, there’s no single recommended form of exercise for depression. Try to find one you like, as you’re more likely to stick with exercise the more you enjoy it.
Give up smoking. Smoking tobacco has been linked to depression. If you quit, you may see an improvement in your condition.
Self-care. Taking time to do the things you enjoy is important. When life gets busy and stressful, pastimes and leisure are often the first things we abandon. But you need to take the time to take care of yourself to protect your mental health. Self-care will look different for different people. It could be reading, playing sports, watching movies, or spending time with your family. Whatever it is for you, make sure you do the things which relax you and bring you joy.
Can depression be cured?
Unfortunately, there is no permanent cure for depression. Some people do overcome their depression with treatment, but as many as 80% of people experience at least one more depressive episode in their lives.
You should view treatment as helping you manage your depression rather than curing it. Treatment can lessen your symptoms, lower your chances of depressive episodes, and help you come out of them faster. Your depression may become less severe over time, and only a few symptoms may persist.
There is always hope that you can put your depression behind you for good, and some people do, but it shouldn’t be an expectation. See your depression as something to manage and to learn to live with effectively.
Where to get support
If you’re struggling with depression, or otherwise need to talk to someone in confidence, you can get free support from:
- The Samaritans: An organization that provides someone to talk to and emotional support. You can call or text them 24 hours a day, 7 days a week on (877) 870-4673
- Lifeline Chat: Part of the National Suicide Prevention Lifeline, you can chat online with someone 24 hours a day, 7 days a week.