What is depression?
Depression is a common yet complex mental health condition affecting more than 16 million adults and 3 million adolescents in the US each year. People with depression feel sad, empty, or hopeless much of the time. It’s more than a case of the blues; depression looms like a storm cloud that won’t let sunshine peak through. It saps the joy of being with friends and family. People can lose interest in hobbies, sex, and other pleasurable activities, and they may have trouble eating or sleeping.
Some cases of depression have a genetic component, but lots of factors beyond an inherited tendency can spur and aggravate depression symptoms, including various environmental factors.
Sometimes people don’t acknowledge or recognize depression in themselves or others, so they fail to seek help from a health care professional. But without treatment, depression can linger for weeks or months–sometimes years–and can lead to worsening symptoms. Depression can wreck lives, friendships, and marriages and pose problems at school or work. Some people may turn to alcohol or drugs to ease their pain or consider some form of self-harm or suicide as an escape.
If you’re feeling depressed or suspect a loved one is struggling with depression, it’s important to reach out for help as soon as possible. Most cases, even severe depression, can be successfully treated.
Types of depression
Major depressive disorder or major depression is another name for classic depression, the type that thrusts people into a dark mood. To be diagnosed with major depression, you must have symptoms that interfere with daily life nearly every day for at least two weeks.
Persistent depressive disorder is a common, long-lasting form of depression characterized by low mood. People have symptoms for two years or more, but they aren’t as disruptive as in major depression.
Premenstrual dysphoric disorder or PMDD is a severe form of premenstrual syndrome (PMS) that can trigger severe depression in the week before a woman’s monthly period begins.
Medication- or alcohol-induced depression is a mood change caused by the use or abuse or alcohol, certain medications, and illicit drugs. Also called substance-induced depression, symptoms may occur when someone stops taking certain medicines or drugs too.
Depression due to an illness can occur alongside heart disease, cancer, multiple sclerosis, and HIV/AIDS. It’s normal for these diagnoses to be emotional, but if mood changes linger for more than a couple of weeks, you might have depression. Thyroid problems as well as other mental illnesses, such as anxiety and schizophrenia, can also lead to feelings of depression.
Disruptive mood dysregulation disorder is a childhood condition that results in irritable and angry mood; frequent, severe temper tantrums; and an inability to function in school. Kids with DMDD are at risk for developing anxiety disorders and depression in adulthood.
Bipolar depression, also known as manic-depressive illness, is characterized by unusually wide swings in mood and energy, including periods of depression.
Seasonal affective disorder or SAD is also known as seasonal depression. This type of recurring depression commonly strikes in a seasonal pattern, usually during the fall or winter, and disappears in the spring or summer.
What causes depression?
The exact causes of depression are unclear. Experts think there may be multiple factors involved. Many times, it’s the intermingling of two or more of these factors that bring on depression or make it worse. Depression causes include:
Your genes. Depression can be hereditary. Certain gene mutations may impede the ability of nerve cells in the brain to communicate effectively.
Changes in brain chemistry. Depression is often described as a chemical imbalance in the brain, but it’s not quite as simple as being too low or too high in one chemical or another. There are many ways brain chemistry is linked to depression. For example, women are more likely than men to develop depression, perhaps due to fluctuating hormone levels. Overproduction of the stress hormone cortisol has also been linked to depression. In addition, there’s a connection between serotonin and depression. Some depressed people have reduced transmission of this important chemical messenger in the brain.
Personality. A person’s temperament and upbringing are among the psychological and social factors that may influence how he or she reacts to stressful situations and views the world. As a result, some people may be more vulnerable to depression.
Environment. Stressful life events, such as a childhood trauma, relationship conflicts, and loss, may alter brain function in ways that make a person susceptible to depression.
Medications. Certain medicines are tied to depression. The list includes heart drugs such as beta-blockers and calcium-channel blockers; cholesterol-lowering statins; female hormones; anticonvulsants; opioids; and corticosteroids.
Substance abuse. Alcohol and drug use can bring on depression (and people who are depressed often use alcohol and drugs to cope with their depression).
People think of depression as a bad case of the blues. In truth, it’s more complex than that. Depression can alter how people think, feel, and behave, and it can even produce physical symptoms.
Depression can look very different from one person to another. Men are more likely to feel tired, irritable, or angry, and they may abuse alcohol and drugs. Women typically experience feelings of guilt, worthlessness, or sadness.
Older adults are more likely to have a medical condition that triggers or worsens depression, but they may be less likely to talk about feelings of depression. Depression in teenagers may be accompanied by anxiety, eating disorders, or substance abuse. Children with depression may have trouble in school or cling to their parents. Other signs of depression include:
Sadness or emptiness. Everyone has moments or periods of sadness in their lives, especially after a death or tragedy. But when a person feels down most days for at least two weeks, it can be a sign of depression.
Feelings of worthlessness or guilt. People with depression often have a diminished sense of self. They may see themselves as losers. They may have negative thoughts about their life. Or they may inappropriately blame themselves for unfortunate things that happen to them.
Hopelessness or pessimistic thinking. Being overwhelmed with negative thoughts is a hallmark symptom of depression. Pessimistic thinking can give way to feelings of despair that worsen depression.
Loss of interest or pleasure in enjoyable activities. Losing interest or joy in things that make life worth living, like hobbies, friends, work, sex, or food, is a main feature of depression.
Insomnia or oversleeping. People with depression may have trouble falling asleep. Alternately, they may sleep too much rather than engage in activities.
Loss of energy or fatigue. Depression can be exhausting. It can sap a person of the physical or emotional energy to actively engage in life, leading to constant lethargy.
Slowed movements or restlessness. Some people with depression talk and walk more slowly. This is called psychomotor retardation. Less commonly, depression may lead to behaviors that seem more restless in nature, like pacing, fidgeting, or hand gesturing, called psychomotor agitation.
Cognitive problems. Slow or distorted thinking and difficulty concentrating can be signs of depression. Trouble making decisions is another common sign of depression, perhaps because people with depression lack motivation and energy.
Appetite or weight changes. With depression, some people lose interest in food, while others overindulge or seek out comfort in foods high in fat and sugar. Such shifts in appetite can lead to sudden, unintended weight loss or weight gain.
Poor hygiene. People with depression can lose interest in taking care of themselves and may neglect their personal hygiene.
Thoughts of death or suicide or a suicide attempt. People who are depressed may see no way out of their misery other than taking their life. Their thoughts may to turn to self-harm or suicide. Some may verbally express suicidal thoughts or even attempt to commit suicide.
How is depression diagnosed?
A depression diagnosis is typically based on a patient’s personal and family history of depression and reported symptoms. Patients may be asked to take a questionnaire to gauge the severity of their symptoms. A physical exam and lab tests can rule out other medical conditions, such as a thyroid disorder, that can cause the same symptoms as depression.
To be diagnosed with major depression, a person must experience symptoms on most days over at least a two-week period. Sometimes depression persists for two or more years. People can have multiple bouts of depression in their lifetime.
Depression is managed mainly through psychotherapy and medication. The choice of treatment depends on the type of depression and its severity.
Also known as talk therapy or counseling, psychotherapy may be the first line of treatment for people with mild depression. It can be combined with antidepressant medications for moderate to severe cases. There are several types of counseling for depression.
One of the most common forms is called cognitive behavioral therapy. CBT focuses on helping patients identify and change negative thinking and behaviors that cause or worsen their depression. Another type, called interpersonal therapy, seeks to improve a depressed person’s relationships with others.
Several different classes of antidepressant medicines may be used to treat depression by affecting chemical messengers in the brain. Each acts on these brain chemicals slightly differently. They include:
- Selective serotonin reuptake inhibitors (SSRIs). This class of medicines is widely prescribed. It includes fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples include venlafaxine (Effexor) and duloxetine (Cymbalta).
- Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) is the only drug in this class approved by the FDA for treating depression.
- Monoamine oxidase inhibitors (MAOIs). This older class of antidepressants includes phenelzine (Nardil) and tranylcypromine (Parnate).
- Tricyclic antidepressants (TCIs). Examples include amitriptyline (Elavil), imipramine (Tofranil), and nortriptyline (Pamelor).
- Other (atypical) antidepressants. These drugs work on one or more chemical messengers in the brain but don’t fit into other classes of medications. They include trazodone (Oleptro), mirtazapine (Remeron), and vortioxetine (Trintellix).
Electroconvulsive therapy (ECT), also known as shock therapy, may also be used to treat depression. This brain stimulation therapy is reserved for the most severe cases. Electric currents are delivered under general anesthesia to a patient’s brain, inducing a controlled seizure. Doctors believe the seizure changes the brain in a way that can help relieve depression symptoms. Multiple treatments are usually required.
People with seasonal depression may feel better with phototherapy. It involves indirect exposure to bright light from a light therapy box for a short period of time each day.
Can depression be cured or reversed?
While there’s no one-size-fits-all cure for depression, the mood disorder is highly treatable in many cases. The sooner treatment begins, the better the outcome. Likewise, the longer someone suffers from depression, the more difficult it is to manage or reverse. Untreated depression usually doesn’t go away on its own. It can lead to addiction, eating and sleeping problems, relationship difficulties, and suicidal thoughts, and it can pose complications for people with chronic health conditions.
Coping with depression
Changing your lifestyle can have a positive impact on your mood, studies suggest. Here are some strategies for coping with depression and keeping symptoms at bay:
Eat a healthy, balanced diet. Research suggests that healthy food can be medicine for the mind. In a randomized controlled trial published in BMC Medicine, depression sufferers with poor dietary habits were divided into two groups. One group was encouraged to follow a modified Mediterranean diet and the other received social support only. After three months, the healthy-diet group had a much greater reduction in depressive symptoms than their counterparts. The diet emphasized whole grains, fruits and veggies, legumes, low-fat dairy, nuts, lean meat, fish, eggs, and olive oil. It discouraged sweets, refined cereals, fried food, processed meats, and sugary drinks.
Exercise. Moderate exercise is a powerful mood enhancer. It can help people with depression manage their symptoms. And, according to a review in the American Journal of Preventive Medicine, even low levels of exercise can lower the likelihood of being diagnosed with depression later in life. How much exercise is beneficial? Most adults should aim for at least 150 minutes of aerobic exercise a week, plus muscle-strengthening activities two or more days a week. But it’s okay to ease into it. Even a 10-minute walk can help improve your mood.
Sleep. The relationship between sleep and depression is complex. Being depressed can interfere with sleep, and poor sleep can cause or worsen depression. Keeping a regular sleep/wake schedule can help. If you have insomnia at night, avoid afternoon naps. For better shut-eye, sleep in a cool, dark room.
Avoid alcohol. Drinking to improve your mood can actually worsen depression in the long run. Alcohol itself is a depressant. It can also make antidepressant medications less effective.
Get a daily dose of sunshine. Sunlight is a natural mood enhancer. Aim for 15 minutes of sunlight exposure a day. A light therapy box can be an effective substitute.
Connect with other people. Having a social support system of friends and family can help you battle feelings of isolation, which can fuel depression.
Make time for things you enjoy. Being depressed saps your energy. You may not feel like doing fun things. But you may find you feel better when you’re taking trips, participating in a hobby, playing sports, or going out with friends.
Manage stress. Stress can lead to or worsen depression, so it’s important to find ways to release tension and relax. Adopting good sleep habits, reducing caffeine intake, exercising regularly, and having a social support system are just a few of the strategies that may ease physical and psychological stress. Consider adopting a relaxation technique like meditation, deep breathing, yoga, tai chi, progressive muscle relaxation, or visualization.