Depression

What Is Depression?

Depression is a mental health condition that many factors, including genetics, life events, and hormones, can cause. It is characterized by feelings of prolonged sadness, low mood, or despair. Depression can affect almost every aspect of your life, including your work, school performance, and personal relationships.

What Are The Types Of Depression?

There are several different types of depression that doctors can diagnose. Clinical depression or major depressive disorder is what most people think of when they think of depression, but there are many other types, as well.

Clinical Depression (Major Depressive Disorder)

Clinical depression, also known as major depressive disorder (MDD), is the most well-known and common type of depression. MDD is a severe mood disorder marked by a persistent depressed mood and a loss of interest in normal activities. Clinical depression can affect your mental and physical health and cause:

• Feelings of hopelessness and sadness
• Sleep disruptions
• Change in appetite
• Pain
• Trouble concentrating

To be diagnosed with MDD, your symptoms must be present for at least two weeks.

Major depressive disorder is a chronic condition but occurs in episodes that may come and go. MDD is usually classified as being mild, moderate, or severe. If it’s severe, a person may experience suicidal thoughts and behaviors.

Persistent Depressive Disorder (PDD)

Persistent depressive disorder, formerly known as dysthymia, is a chronic, long-lasting depression that is mild to moderate.

People with persistent depressive disorder may experience symptoms similar to other types of depression.

The main difference between PDD and other types of depression is the duration. With PDD, the symptoms occur almost every day and persist for two years or longer. A person can experience PDD and major depressive disorder at the same time.

Disruptive Mood Dysregulation Disorder (DMDD)

Disruptive mood dysregulation disorder is a newer diagnosis in psychiatry. DMDD is a condition diagnosed in children and adolescents ages 6-18. Adolescents with DMDD cannot regulate their emotions and often display reactions disproportionate to the situation. This disorder is characterized by frequent, severe temper outbursts and irritability greater in scale than would be considered a typical temper tantrum or response for children of that age.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder interferes with daily life and involves severe emotional and physical symptoms that start 7 to 10 days before menstrual periods. PMDD affects up to 8% of women or those assigned female at birth (AFAB) during reproductive age. PMDD symptoms include:

• Moodiness and irritability
• Anxiety
• Sadness or crying
• Forgetfulness
• Headache
• Back pain
• Heart palpitations
• Thoughts of suicide

The symptoms usually go away on their own a few days after menstruation starts but return the next month.

Depressive Disorder Due To Another Medical Condition

Some medical conditions, especially ones that are severe or chronic, can cause depression. Depressive disorder due to another medical condition is directly caused by a medical condition like Huntington’s disease, multiple sclerosis, stroke, or cancer. The symptoms are the same as for major depressive disorder.

Often, the symptoms of this form of depression improve when the underlying medical condition is treated. A person may need other treatments, such as therapy or medication.

Seasonal Affective Disorder (Seasonal Depression)

Seasonal affective disorder (SAD) is a mood disorder that occurs with the changing of the seasons. Symptoms typically start in the fall or winter and end in the spring for most people with SAD; however, it can develop in the spring or early summer and resolve in the fall for others. It is believed that the decrease in sunlight and shorter days trigger a change in certain neurotransmitters in the brain responsible for moods, leading to symptoms of depression.

The symptoms of SAD are the same as major depressive disorder and include sadness, sleep changes, social withdrawal, and excessive fatigue.

Prenatal Depression And Postpartum Depression

Prenatal and postpartum depression is depression that occurs during and after pregnancy. It is thought that hormonal shifts cause prenatal and postpartum depression. Symptoms include:

• Sadness
• Irritability
• Excessive worry
• Trouble concentrating
• Sleeping and eating change
• A loss of interest in normal activities
• Fatigue

In some cases, the depressive symptoms can be severe enough to cause the mother to harm herself or her baby.

Atypical Depression

Atypical depression, which is now classified as major depressive disorder with atypical features, has most of the same symptoms as clinical depression. However, in MDD with atypical features, a person’s mood can temporarily improve in response to positive events.

The symptoms of MDD are similar to those of clinical depression. However, the symptoms usually occur at an earlier age in MDD with atypical features, so a person may be diagnosed earlier, often during the teenage years.

How Is Depression Different From Sadness Or Grief?

A person might use the term “depressed” to describe how they feel after watching something sad on the news. However, being unhappy isn’t the same as depression. Depression is more than just a case of “the blues.”

Sadness is a normal human emotion that everyone experiences occasionally. It is a natural reaction to difficult life situations. Like other emotions, sadness quickly passes.

In this way, sadness differs from depression. Although sadness is a symptom of depression, the emotion is persistent in depression. Depression isn’t something you can “snap out” of. It is an illness that doesn’t go away without treatment. Also, suicidal thoughts are not present when a person is sad, but they are often a part of depression.

Symptoms Of Depression

Depression symptoms typically occur almost every day and last for most of the day. The symptoms are typically severe enough to cause problems in daily life, such as school, social activities, relationships with others, or work. Not everyone with depression will experience all of the symptoms. Common signs of depression include:

• Persistent feelings of sadness
• Feelings of hopelessness or emptiness
• Feelings of deep guilt or worthlessness
• Irritability or anger outbursts
• Fatigue and lack of energy
• Loss of interest in most activities, such as hobbies or sex
• Appetite loss or overeating
• Insomnia
• Trouble remembering details, making decisions, and concentrating
• Physical complaints such as stomach pain or headaches
• Sexual dysfunction

Sometimes, people with severe depression have frequent thoughts about death or suicide. If you are having these recurrent thoughts, call 988 (in the U.S.) to reach the Suicide & Crisis Lifeline. The 988 Lifeline has trained crisis counselors. Services are confidential and free and available 24 hours a day, seven days a week.

If you believe that you might attempt suicide or have made an attempt, contact 911 (in the U.S.) or go to your nearest emergency room right away.

Risk Factors For Depression

Multiple factors can increase your risk of being depressed. Knowing what can increase the risk of depression will help you get treatment if you need it. Common risk factors include:

• Trauma
• Stressful life events or major life changes, such as a divorce
• Substance abuse
• Serious or chronic illness, like stroke and Parkinson’s disease
• Genetics
• Chronic pain

Being a female or assigned female at birth increases the risk for depression. There could be several reasons for this, including hormonal differences, social factors, and coping mechanisms. A 2020 study published in the journal Frontiers in Genetics found that there are gender-specific genes associated with depression, which may play a role. Women may also be more likely than men to seek help for depressive symptoms than men.

What Causes Depression?

There is no singular cause of depression. Instead, depression is a complex disease caused by a diverse range of things and it is not always preventable. Some types of depression are triggered by events in your life, like pregnancy, while others are caused by medical conditions or chemical imbalances in your brain. Hormones also play a role in several types of depression, including postpartum and premenstrual dysphoric disorder.

The causes of depression are not always known. Some people have a family history of depression and may develop the disease for no known reason other than a family history.

Who Does Depression Affect?

Depression can affect anyone, including adults and children, from any age range, ethnicity, and cultural background. However, some groups are distinctively affected by depression.

• There are higher rates of depression among those in the LGBTQI+ community.
• Women and those assigned female at birth are more likely to be diagnosed with depression than men.
•  In non-White individuals, the symptoms of depression are usually more debilitating and severe.

How Common Is Depression?

Depression is one of the most common mental health disorders in the United States. About 1 in 5 adults in the U.S. has received a diagnosis of depression in their lifetime, according to the Centers for Disease Control and Prevention (CDC). The prevalence of major depression is 10.3% among females and just over 6.2% among males.

How Is Depression Diagnosed?

Either a mental health professional, such as a psychiatrist or your primary care physician, can diagnose depression based on your symptoms.

To assess for symptoms, your doctor will likely give you a depression test. To be diagnosed with depression, your symptoms will need to meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

In addition to a psychological evaluation, your physician may also order the following:

• Lab tests: These may help rule out other conditions that could be causing the depressive symptoms, such as thyroid issues.
• Physical exam: Your doctor may conduct a physical test to check your lungs, heart, and other bodily systems. They may also ask questions about your physical health. This is to figure out if the depressive symptoms are related to an underlying condition.

After the assessment, your doctor will discuss your symptoms with you and go over the most appropriate treatment options.

How Is Depression Treated?

There are many treatment options available for depression. According to the American Psychiatric Association, between 70 to 90% of people with depression get relief from symptoms with treatment, which may include medication, therapy, and other therapies.

Medication

Antidepressants are the most commonly prescribed medications for depression. They cause changes in the brain that improve depressive symptoms. Here are some of the most common antidepressant types:

• Norepinephrine-dopamine reuptake inhibitors (NDRIs): These are a newer class of antidepressants that have fewer side effects compared to other classes. Notably, NDRIs don’t have the sexual dysfunction side effects that other antidepressants have, but only one NDRI is currently approved for depression: bupropion (Wellbutrin).
• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are the most commonly prescribed medications for depression in the United States. SSRIs target serotonin, a neurotransmitter involved in mood, sleep, and appetite. Common SSRIs include:
  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Sertraline (Zoloft)
  • Luoxetine (Prozac)
• Serotonin And Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs work by increasing the levels of both norepinephrineand serotonin, which are neurotransmitters that affect thoughts, moods, and feelings. Common SNDRIs include desvenlafaxine (Pristiq), venlafaxine (Effexor XR), and duloxetine (Cymbalta).
• Monoamine Oxidase Inhibitors (MAOIs): MAOIs were the first antidepressants developed. Today, they are one of the least commonly prescribed antidepressants due to the increased risk of side effects, interactions with certain foods, and the need for close monitoring. However, these drugs are more effective than other antidepressants for atypical depression. It’s been found that people with this type of depression respond best to MAOIs. Common MAOIs include isocarboxazid (Marplan) and phenelzine (Nardil).

In some cases, such as when there are psychotic symptoms present, an antipsychotic may also be used to treat depression. Research conducted by the Beijing Shijitan Hospital found that using both an antipsychotic and an antidepressant together was often more effective for depressive disorders than antidepressants alone.

Psychotherapy

Talk therapy, or psychotherapy, is an important part of a treatment plan for depression. Cognitive-behavioral therapy (CBT) is one of the most common forms of therapy. It has been scientifically proven effective in treating symptoms of depression.

CBT can help you challenge negative thoughts that contribute to depression and change emotions and behaviors. It can also help you develop coping skills to better manage your symptoms and stress.

Other types of psychotherapy include:

• Dialectical behavioral therapy (DBT): DBT is an evidence-based treatment for depression that emphasizes emotional regulation, finding acceptance, and thinking in new ways to solve problems.
• Interpersonal Therapy: This therapy focuses on improving personal relationships that influence depressive symptoms. Interpersonal therapy is time-limited and structured.
• Mindfulness-Based Cognitive Therapy (MBCT): MBCT combines cognitive therapy with mindfulness meditation to decrease depressive symptoms.
• Behavioral Activation Therapy: With this therapy, you seek activities and experiences that bring you joy. This helps reverse the symptoms of depression.

Remember that your preferences, symptoms, and therapeutic goals should all be taken into consideration and discussed when choosing a therapeutic intervention.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a treatment for severe or treatment-resistant depression. When depressive symptoms don’t respond to medications or other treatments, it’s considered treatment-resistant depression. With ECT, the brain is stimulated with a light electrical current. This causes a brief seizure, which relieves symptoms of depression.

ECT is very effective and safe.However, you do have to undergo general anesthesia for ECT, which is why it’s usually reserved for more severe forms of depression.

Self-Help and Coping Mechanisms

There are some steps you can take to cope with depression. Lifestyle changes can help alleviate depression. Here are some helpful self-help strategies for coping with depression:

• Spend time in nature: Exercising outdoors can have a powerful effect on your mental health. Research indicates that taking nature walks may reduce depressive symptoms in people diagnosed with clinical depression. In another example, exposure to natural sunlight has been found to be helpful for symptom reduction in those experiencing SAD.
• Set small daily goals: With depression, it can be hard to find the motivation needed to accomplish goals. Instead of setting large, overwhelming goals, set small goals you can more easily reach. Examples include taking the trash out, sorting the laundry, or throwing a pile of clothes in the washer. Completing these tasks will help you feel accomplished and more motivated.
• Keep a journal: Journaling can help with many mental health conditions, including depression. In your journal, you can explore emotional triggers, reflect on your progress, or recall your strengths.
• Listen to music: Happy music can improve your mood. Research jointly conducted by the University Clinic Regensburg and the University of Melbourne found that listening to upbeat music can reduce symptoms of depression.
• Try going “sober curious”: The sober curious movement focuses on reducing or giving up alcohol use. This may be a wise decision if you want to reduce the risk of depression since science indicates there is a strong correlation between developing depression and alcohol use disorder, according to a review conducted by researchers at Harvard University.
• Create a relaxing sleep routine: Sleep problems and depression go hand in hand. About 90% of those with depression suffer from a sleep disorder, according to research published by the Yunnan University of Chinese Medicine. A wind-down routine will help you transition from a chaotic day to a calm evening. This will make it easier to fall asleep. A relaxing sleep routine can include things like an adult bedtime story, gentle stretching exercises, or a warm bath.
• Join social media depression groups: These groups can be a great place to share experiences. The sense of anonymity and distance may make online groups less intimidating than in-person support groups.
• Don’t make major life decisions while you’re depressed: Depression can interfere with your judgment and thoughts, so it can be helpful to wait until you feel better to make major decisions about your relationships, career, or other important areas of your life.

The above coping skills will work best for depression when combined with therapy and medications.

Can I Prevent Depression?

It’s not always possible to prevent depression, but there are things you can do to reduce the risk:

• Manage your stress: Life stressors can trigger depression, so it’s important to find ways to manage stress. Don’t use drugs or alcohol to cope with stress.
• Seek social support: Spend time with friends or family members who provide positive support.
• Say no: Set appropriate boundaries with people in your life.
• Practice relaxation techniques: Partaking in yoga and mindful meditation can help treat depression.

You might not be able to always keep from getting depressed — even if you try the things above. However, if you have depression, getting treatment can help keep it from getting worse.

When Should I See My Healthcare Provider About Depression?

Depression is a common mood disorder that’s more than just feeling “sad.” Depression can seriously affect one’s relationships, social life, and work. Fortunately, there are many effective treatments for depression, even when it’s severe. Effective treatment can help you feel better if you are living with the disorder.

If you have symptoms of depression, make an appointment with your doctor or a mental health professional as soon as you can. Talking to your doctor about depression symptoms is the first step toward feeling better.