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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Everyone experiences feelings of sadness from time to time. Even prolonged periods of sadness are a normal part of the human experience, often occurring after serious life events like the death of a loved one or a divorce.
What makes major depressive disorder (depression) different from typical episodes of sadness is that it affects almost all aspects of your life.
Depression not only changes the way you feel, but also the way you think, the way you act, and the way your body works.
How depression feels
A good way to think of depression is to consider having a big wet blanket thrown over your head. Suddenly you can’t see or act the way you used to. It’s harder to move around. Things you used to enjoy, like playing sports or even just watching them on TV, suddenly seem impossible.
You try to go about your daily routine, but you’re constantly distracted by the weight of the blanket, constantly tripping over it. You start to feel exhausted from the burden of it. You begin to lose all hope that you’ll ever find your way out from under it. And you begin thinking how much easier it would be if you just laid down.
Symptoms of depression
The symptoms of depression are pervasive. They tend to persist for most of the day, every day. And they last two weeks or longer.
People with depression typically experience several of the following symptoms (Chand, 2021):
- Feeling sad, empty, or hopeless
- Losing interest in most of the activities that you used to enjoy
- Feeling irritable, angry, or easily frustrated
- Insomnia (difficulty falling or staying asleep) or hypersomnia (sleeping too much)
- Feeling like you have no energy or are tired all the time
- Significant changes in appetite
- Rapid weight loss or weight gain
- Feeling worthless or guilty
- Having trouble thinking, concentrating, or making decisions
- Acting fidgety—wringing hands, bouncing feet, pacing
- Moving or talking more slowly than usual
- Thinking a lot about death or commiting suicide
Depression presents differently in different people. In some people, depression can feel like it’s causing physical symptoms. In others, it can feel like an absence of feelings.
Depression can also present differently in people of different ages, particularly in seniors and children (Fiske, 2009; Selph, 2019). Some of these associated symptoms include:
- Stomach upset (cramping, diarrhea, nausea, loss of appetite)
- Achy joints
- Excessive worry about physical health
- Difficulty remembering things
- Personality changes
- Feeling “nothing”
- Feeling like you don’t care about anything
- Loss of sexual appetite or desire
The symptoms of depression are severe enough to cause significant distress. They impair your ability to function normally at home, work, or school (Chand, 2021).
How to recognize depression in others
It is not at all uncommon for someone to be clinically depressed without realizing it. People often need to be encouraged to seek the help they need.
Outward signs of depression that friends and family can look out for include (Chand, 2021):
- Teariness and depressed facial expressions
- Withdrawal from friends and family
- Failing to meet obligations at home, work, or school
- Giving up on hobbies or activities that used to be fun
- Talking slowly, pausing before answering, speaking softly, or using few words
- Sleeping too much during the day or waking too often during the night
- Substance use or abuse
- Repeated absences from work or school
- Getting into trouble at work or school
- Complaining of body aches and pains
- Getting easily frustrated or irritated by minor inconveniences
- Angry outbursts
- Trouble keeping up with self-care (showering, brushing hair, changing clothes)
Risk factors for depression
Major depression is a serious and common form of mental illness, with major depressive episodes affecting nearly 8% of adults and nearly 16% of adolescents in the United States each year (SAMHSA, 2020). There is no single cause of depression. It can happen to anyone at any age.
Depression typically develops in people with a combination of biological and environmental risk factors. Many people have risk factors for depression, but never develop the condition (Assari, 2016).
The first onset of depression is often triggered by a stressful life event or another form of acute psychological stress (Assari, 2016).
Factors that increase the likelihood of experiencing major depression include the following (Lyness, 2021):
- Genetics—Depression is more common in people who have a blood relative with a history of depression, bipolar disorder, or substance abuse. People with a first-degree family member (parent or sibling) with major depression are two to four times more likely than members of the general population to be diagnosed with depression (Chand, 2021).
- Environment—Depression is more common in people who have experienced traumatic or stressful life events, such as physical or sexual abuse, neglect, or exposure to violence or poverty. People with early childhood trauma are at particular risk, due to the way trauma affects a developing brain (Chand, 2021).
- Addiction—People who struggle with substance use disorders are at increased risk of developing what is known as comorbid depression, in which their addiction becomes intertwined with their depression (Lyness, 2021).
- Medical conditions—Chronic health issues like diabetes, obesity, and heart disease increase the risk of depression. As does chronic pain and other disabling health conditions (Chand, 2021).
- Other mental health conditions—People who struggle with other mental health problems, like anxiety disorders or personality disorders, have an increased risk of depression (Lyness, 2021).
- Personality—People with certain personality traits, like neuroticism, low self-esteem, and pessimism are more vulnerable to depression than others (Chand, 2021).
- Hormones—Fluctuating hormone levels, which are common during and after pregnancy and menopause, increase the risk of depression (Bains, 2020).
Depression is a treatable condition. Even severe and chronic cases can be effectively treated with the right combination of therapies. Unfortunately, not all therapies work for all people (Bains, 2020).
The brain is incredibly complex, as are the multiple causes of depression. It can therefore take some time and some trial and error to find the most effective treatment plan for you and your unique brain.
In most cases, treatment involves a combination of psychotherapy (work with a psychologist or other therapist) and medication. However, there are a number of emerging treatment options that may provide an alternative to traditional antidepressant medications. Treatment options include (Bains, 2020):
- Therapy—Psychotherapy, or talk therapy, is used to treat mild to severe depression. Working with a mental health professional, like a psychologist or licenced mental health counselor, you work to identify negative thought patterns and other issues that may be contributing to your depression. Cognitive behavioral therapy (CBT) is a type of therapy commonly used for depression that helps you modify both your thinking and behavior.
- Medications—Antidepressants are often used to treat moderate to severe depression. There are a variety of antidepressant medications available, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, and tricyclic antidepressants.
- Inpatient programs—People struggling with severe depression, or depression combined with substance use disorders or suicidal thoughts often benefit from inpatient, residential treatment programs. These intensive programs offer multiple forms of therapy in a safe environment free from the pressures of normal life. People typically spend anywhere from one week to three months at these facilities working to better their mental health.
- More aggressive treatment options—For people who don’t respond to other forms of therapy, there are more aggressive options such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), which can be used to stimulate the chemicals and cells in your brain.
- Alternative treatments—Newer treatment options like the nasal spray Spravato (esketamine) are sometimes used in conjunction with other therapies to treat people who haven’t responded well to medication and psychotherapy.
How to get help
If you think you may have depression, the sooner you reach out for help the better. There are several places you can turn for professional help. But don’t forget about your friends and family.
Informing a trusted friend or family member about your concern for your mental health and your desire to seek help is a valuable first step. Letting someone in can help you feel less alone and help keep you accountable. Your loved ones can help you take the next step and make sure you follow through with your appointments and treatment plan.
Other steps you can take to find help include:
- Your doctor—Your family doctor is a great resource who may be familiar with mental health professionals in your area.
- Your insurance company—Health insurance companies typically have a list of in-network mental health providers, including psychiatrists, psychologists, and therapists. Call the number on your insurance card or check their website.
- SAMHSA—The Substance Abuse and Mental Health Services Administration (SAMHSA) has a searchable directory of treatment providers in your area.
You don’t have to suffer in silence
Depression feels awful, but it is treatable. Finding the best treatment for you can take some trial and error, but is absolutely worth the effort. It’s often a matter of finding the right medication, therapist, and treatment option for you.
If you or someone you love is experiencing suicidal thoughts, call 911 or The National Suicide Prevention Lifeline to get 24/7 crisis support.
- Assari, S., & Lankarani, M. M. (2016). Stressful Life Events and Risk of Depression 25 Years Later: Race and Gender Differences. Frontiers in public health, 4(49). Retrieved April 12, 2021 from https://pubmed.ncbi.nlm.nih.gov/27047914/
- Bains N, Abdijadid S. (2021). Major Depressive Disorder. In: StatPearls [Internet]. StatPearls Publishing. Retrieved Apr 12, 2021 https://www.ncbi.nlm.nih.gov/books/NBK559078/
- Chand S.P., Arif H. Depression. (2021) In: StatPearls [Internet]. StatPearls Publishing. Retrieved Apr 15, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK430847/
- Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual review of clinical psychology, 5, 363–389. Retrieved April 15, 2021 from https://pubmed.ncbi.nlm.nih.gov/19327033/
- Lyness, J. M. (2021). Beyond the Basics: Depression in Adults. Uptodate. Retrieved April 12, 2021 from https://www.uptodate.com/contents/depression-in-adults-beyond-the-basics
- Selph, S. S., & McDonagh, M. S. (2019). Depression in Children and Adolescents: Evaluation and Treatment. American family physician, 100(10), 609–617. Retrieved April 15 2021, from https://pubmed.ncbi.nlm.nih.gov/31730312/
- Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved April 12, 2021 from https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.