Depression

Overview

Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities.

People experience depression in different ways. It may interfere with your daily work, resulting in lost time and lower productivity. It can also influence relationships and some chronic health conditions.

Conditions that can get worse due to depression include:

• arthritis
• asthma
• cardiovascular disease
• cancer
• diabetes
• obesity

It’s important to realize that feeling down at times is a normal part of life. Sad and upsetting events happen to everyone. But, if you’re feeling down or hopeless on a regular basis, you could be dealing with depression.

Depression is considered a serious medical condition that can get worse without proper treatment. Those who seek treatment often see improvements in symptoms in just a few weeks.

Symptoms

Depression can be more than a constant state of sadness or feeling “blue.”

Major depression can cause a variety of symptoms. Some affect your mood, and others affect your body. Symptoms may also be ongoing, or come and go.

The symptoms of depression can be experienced differently among men, women, and children differently.

Men may experience symptoms related to their:

• mood, such as anger, aggressiveness, irritability, anxiousness, restlessness
• emotional well-being, such as feeling empty, sad, hopeless
• behavior, such as loss of interest, no longer finding pleasure in favorite activities, feeling tired easily, thoughts of suicide, drinking excessively, using drugs, engaging in high-risk activities
• sexual interest, such as reduced sexual desire, lack of sexual performance
• cognitive abilities, such as inability to concentrate, difficulty completing tasks, delayed responses during conversations
• sleep patterns, such as insomnia, restless sleep, excessive sleepiness, not sleeping through the night
• physical well-being, such as fatigue, pains, headache, digestive problems

Women may experience symptoms related to their:

• mood, such as irritability
• emotional well-being, such as feeling sad or empty, anxious or hopeless
• behavior, such as loss of interest in activities, withdrawing from social engagements, thoughts of suicide
• cognitive abilities, such as thinking or talking more slowly
• sleep patterns, such as difficulty sleeping through the night, waking early, sleeping too much
• physical well-being, such as decreased energy, greater fatigue, changes in appetite, weight changes, aches, pain, headaches, increased cramps

Children may experience symptoms related to their:

• mood, such as irritability, anger, mood swings, crying
• emotional well-being, such as feelings of incompetence (e.g. “I can’t do anything right”) or despair, crying, intense sadness
• behavior, such as getting into trouble at school or refusing to go to school, avoiding friends or siblings, thoughts of death or suicide
• cognitive abilities, such as difficulty concentrating, decline in school performance, changes in grades
• sleep patterns, such as difficulty sleeping or sleeping too much
• physical well-being, such as loss of energy, digestive problems, changes in appetite, weight loss or gain

The symptoms can extend beyond your mind.

These seven physical symptoms of depression prove that depression isn’t just all in your head.

Causes

There are several possible causes of depression. They can range from biological to circumstantial.

Common causes include:

• Family history. You’re at a higher risk for developing depression if you have a family historyof depression or another mood disorder.
• Early childhood trauma. Some events affect the way your body reacts to fear and stressful situations.
• Brain structure. There’s a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms.
• Medical conditions. Certain conditions may put you at higher risk, such as chronic illness, insomnia, chronic pain, or attention-deficit hyperactivity disorder (ADHD). 
• Drug use. A history of drug or alcohol misuse can affect your risk.

About 21 percent of people who have a substance use problem also experience depression. In addition to these causes, other risk factors for depression include:

• low self-esteem or being self-critical
• personal history of mental illness
• certain medications
• stressful events, such as loss of a loved one, economic problems, or a divorce

Many factors can influence feelings of depression, as well as who develops the condition and who doesn’t.

The causes of depression are often tied to other elements of your health.

However, in many cases, healthcare providers are unable to determine what’s causing depression.

Depression test

There isn’t a single test to diagnose depression. But your healthcare provider can make a diagnosis based on your symptoms and a psychological evaluation.

In most cases, they’ll ask a series of questions about your:

• moods
• appetite
• sleep pattern
• activity level
• thoughts

Because depression can be linked to other health problems, your healthcare provider may also conduct a physical examination and order blood work. Sometimes thyroid problems or a vitamin D deficiency can trigger symptoms of depression.

Don’t ignore symptoms of depression. If your mood doesn’t improve or gets worse, seek medical help. Depression is a serious mental health illness with the potential for complications.

If left untreated, complications can include:

• weight gain or loss
• physical pain
• substance use problems
• panic attacks
• relationship problems
• social isolation
• thoughts of suicide
• self-harm

Type of depression

When people think about depression, they often divide it into one of two things—either clinical depression which requires treatment or “regular” depression that pretty much anyone can go through. As a condition, depression can be a difficult concept to grasp since we refer to it as both the symptom of a condition and a condition itself.

From a medical standpoint, depression is defined​ as a mood disorder that causes a persistent feeling of depressed mood or sadness and the often profound loss of interest in things that usually bring you pleasure.

Depression affects how you feel, think, and behave and can interfere with your ability to function and carry on with daily life. There are many different causes of depression, some of which we don’t fully understand. Seven of the more common types of depression include the following.

1. Major Depressive Disorder (MDD)

When people use the term clinical depression, they are generally referring to major depressive disorder (MDD).1 Major depressive disorder is a mood disorder characterized by a number of key features:

• Depressed mood
• Lack of interest in activities normally enjoyed
• Changes in weight
• Changes in sleep
• Fatigue
• Feelings of worthlessness and guilt
• Difficulty concentrating
• Thoughts of death and suicide

If a person experiences the majority of these symptoms for longer than a two-week period, they will often be diagnosed with MDD.

2. Persistent Depressive Disorder (PDD)

Dysthymia, now known as persistent depressive disorder, refers to a type of chronic depression present for more days than not for at least two years. It can be mild, moderate, or severe.

People might experience brief periods of not feeling depressed, but this relief of symptoms lasts for two months or less. While the symptoms are not as severe as major depressive disorder, they are pervasive and long-lasting.

PDD symptoms include:

• Feelings of sadness
• Loss of interest and pleasure
• Anger and irritability
• Feelings of guilt
• Low self-esteem
• Difficulty falling or staying asleep
• Sleeping too much
• Feelings of hopelessness
• Fatigue and lack of energy
• Changes in appetite
• Trouble concentrating

Treatment for persistent depressive disorder often involves the use of medications and psychotherapy.

According to the National Institute of Mental Health, 1.5% of adults in the United States had persistent depressive disorder in the past year. The disorder affects women (1.9%) more than men (1%), and researchers estimate that around 1.3% of all U.S. adults will have the disorder at some point during their lives.

3. Bipolar Disorder

Bipolar disorder is a mood disorder characterized by periods of abnormally elevated mood known as mania. These periods can be mild (hypomania) or they can be so extreme as to cause marked impairment with a person’s life, require hospitalization, or affect a person’s sense of reality. The vast majority of those with bipolar disorder also have episodes of major depression.

In addition to depressed mood and markedly diminished interest in activities, people with depression often have a range of physical and emotional symptoms which may include:

• Fatigue, insomnia, and lethargy
• Unexplained aches, pains, and psychomotor agitation
• Hopelessness and loss of self-esteem
• Irritability and anxiety
• Indecision and disorganization

The risk of suicide in bipolar illness is about 15 times greater than in the general population. Psychosis (including hallucinations and delusions) can also occur in more extreme cases.

4. Postpartum Depression (PPD)

Pregnancy can bring about significant hormonal shifts that can often affect a woman’s moods. Depression can have its onset during pregnancy or following the birth of a child.

Currently classified as depression with peripartum onset, postpartum depression (PPD) is more than that just the “baby blues.”

Mood changes, anxiety, irritability, and other symptoms are not uncommon after giving birth and often last up to two weeks. PPD symptoms are more severe and longer-lasting.

Such symptoms can include:

• Low mood, feelings of sadness
• Severe mood swings
• Social withdrawal
• Trouble bonding with your baby
• Appetite changes
• Feeling helpless and hopeless
• Loss of interest in things you used to enjoy
• Feeling inadequate or worthless
• Anxiety and panic attacks
• Thoughts of hurting yourself or your baby
• Thoughts of suicide

PPD can range from a persistent lethargy and sadness that requires medical treatment all the way up to postpartum psychosis, a condition in which the mood episode is accompanied by confusion, hallucinations, or delusions.

If left untreated, the condition can last up to a year. Fortunately, research has found that treatments such as antidepressants, counseling, and hormone therapy can be effective.

5. Premenstrual Dysphoric Disorder (PMDD)

Among the most common symptoms of premenstrual syndrome (PMS) are irritability, fatigue, anxiety, moodiness, bloating, increased appetite, food cravings, aches, and breast tenderness.

Premenstrual dysphoric disorder (PMDD) produces similar symptoms, but those related to mood are more pronounced.

PMDD symptoms may include:

• Extreme fatigue
• Feeling sad, hopeless, or self-critical
• Severe feelings of stress or anxiety
• Mood swings, often with bouts of crying
• Irritability
• Inability to concentrate
• Food cravings or binging

6. Seasonal Affective Disorder (SAD)

If you experience depression, sleepiness, and weight gain during the winter months but feel perfectly fine in spring, you may have a condition known as seasonal affective disorder (SAD), currently called major depressive disorder with seasonal pattern.

SAD is believed to be triggered by a disturbance in the normal circadian rhythm of the body.4 Light entering through the eyes influences this rhythm, and any seasonal variation in night/day pattern can cause a disruption leading to depression.

Prevalence rates for SAD can be difficult to pinpoint because the condition often goes undiagnosed and unreported. It is more common in areas further from the equator. For example, estimates suggest that SAD impacts 1% of the population of Florida; that number increases to 9% in Alaska.

SAD is more common in far northern or far southern regions of the planet and can often be treated with light therapy to offset the seasonal loss the daylight.

7. Atypical Depression

Do you experience signs of depression (such as overeating, sleeping too much, or extreme sensitivity to rejection) but find yourself suddenly perking up in face of a positive event?

Based on these symptoms, you may be diagnosed with atypical depression (current terminology refers to this as depressive disorder with atypical features), a type of depression that doesn’t follow what was thought to be the “typical” presentation of the disorder. Atypical depression is characterized by a specific set of symptoms related to:

• Excessive eating or weight gain
• Excessive sleep
• Fatigue, weakness, and feeling “weighed down”
• Intense sensitivity to rejection
• Strongly reactive moods

Atypical depression is actually more common than the name might imply. Unlike other forms of depression, people with atypical depression may respond better to a type of antidepressant known as a monoamine oxidase inhibitor (MAOI).

Treatment

Living with depression can be difficult, but treatment can help improve your quality of life. Talk to your healthcare provider about possible options.

You may successfully manage symptoms with one form of treatment, or you may find that a combination of treatments works best.

It’s common to combine medical treatments and lifestyle therapies, including the following:

Medications

Your healthcare provider may prescribe:

• antidepressants
• antianxiety
• antipsychotic medications

Each type of medication that’s used to treat depression has benefits and potential risks.

Psychotherapy

Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.

Light therapy

Exposure to doses of white light can help regulate your mood and improve symptoms of depression. Light therapy is commonly used in seasonal affective disorder, which is now called major depressive disorder with seasonal pattern.

Alternative therapies

Ask your healthcare provider about acupuncture or meditation. Some herbal supplements are also used to treat depression, like St. John’s wort, SAMe, and fish oil.

Talk with your healthcare provider before taking a supplement or combining a supplement with prescription medication because some supplements can react with certain medications. Some supplements may also worsen depression or reduce the effectiveness of medication.

Exercise

Aim for 30 minutes of physical activity 3 to 5 days a week. Exercise can increase your body’s production of endorphins, which are hormones that improve your mood.

Avoid alcohol and drugs

Drinking or misusing drugs may make you feel better for a little bit. But in the long run, these substances can make depression and anxiety symptoms worse.

Learn how to say no

Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.

Take care of yourself

You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.

Sometimes depression doesn’t respond to medication. Your healthcare provider may recommend other treatment options if your symptoms don’t improve.

These include electroconvulsive therapy (ECT), or repetitive transcranial magnetic stimulation (rTMS) to treat depression and improve your mood.

Natural treatment for depression

Traditional depression treatment uses a combination of prescription medication and counseling. But there are also alternative or complementary treatments you can try.

It’s important to remember that many of these natural treatments have few studies showing their effects on depression, good or bad.

Likewise, the U.S. Food and Drug Administration (FDA) doesn’t approve many of the dietary supplements on the market in the United States, so you want to make sure you’re buying products from a trustworthy brand.

Talk to your healthcare provider before adding supplements to your treatment plan.

Supplements

Several types of supplements are thought to have some positive effect on depression symptoms.

St. John’s wort

Studies are mixed, but this natural treatment is used in Europe as an antidepressant medication. In the United States, it hasn’t received the same approval.

S-adenosyl-L-methionine (SAMe)

This compound has shown in limited studies to possibly ease symptoms of depression. The effects were best seen in people taking selective serotonin reuptake inhibitors (SSRIs), a type of traditional antidepressant.

5-hydroxytryptophan (5-HTP)

5-HTP may raise serotonin levels in the brain, which could ease symptoms. Your body makes this chemical when you consume tryptophan, a protein building block.

Omega-3 fatty acids

These essential fats are important to neurological development and brain health. Adding omega-3 supplements to your diet may help reduce depression symptoms.

Essential oils

Essential oils are a popular natural remedy for many conditions, but research into their effects on depression is limited.

People with depression may find symptom relief with the following essential oils:

Wild ginger: Inhaling this strong scent may activate serotonin receptors in your brain. This may slow the release of stress-inducing hormones.

Bergamot: This citrusy essential oil has been shown to reduce anxiety in patients awaiting surgery. The same benefit may help individuals who experience anxiety as a result of depression, but there’s no research to support that claim.

Other oils, such as chamomile or rose oil, may have a calming effect when they’re inhaled. Those oils may be beneficial during short-term use.

Vitamins

Vitamins are important to many bodily functions. Research suggests two vitamins are especially useful for easing symptoms of depression:

Vitamin B: B-12 and B-6 are vital to brain health. When your vitamin B levels are low, your risk for developing depression may be higher.

Vitamin D: Sometimes called the sunshine vitamin because exposure to the sun supplies it to your body, Vitamin D is important for brain, heart, and bone health. People who are depressed are more likely to have low levels of this vitamin.

Many herbs, supplements, and vitamins claim to help ease symptoms of depression, but most haven’t shown themselves to be effective in clinical research.

Learn about herbs, vitamins, and supplements that have shown some promise, and ask your healthcare provider if any are right for you.

Outlook for depression

Depression can be temporary, or it can be a long-term challenge. Treatment doesn’t always make your depression go away completely.

However, treatment often makes symptoms more manageable. Managing symptoms of depression involves finding the right combination of medications and therapies.

If one treatment doesn’t work, talk with your healthcare provider. They can help you create a different treatment plan that may work better in helping you manage your condition.