Depression — also known as major depressive disorder (MDD) or clinical depression — affects not only your mood, but also your ability to feel, think, and function. It blunts sensations of pleasure, closes off connectedness, stifles creativity, and, at its worst, shuts down hope. It also often causes deep emotional pain not only to the person experiencing it but to that person’s close family and friends.
In addition to MDD, there are several other kinds of depression, including:
Persistent depressive disorder (PDD), previously known as dysthymia, is diagnosed in people who experience persistent mild to moderate depression for at least two years at a time.
Bipolar disorder, formerly called manic depression, is characterized by moods that cycle between extreme highs (mania) and lows (depression), often with periods of neutral mood in between. Bipolar disorder affects 2.8 percent of U.S. adults.
Seasonal affective disorder (SAD) is depression that occurs at the same time each year, usually beginning in fall and persisting through winter. SAD is associated with changes in daylight hours, and is often accompanied by increased sleep, weight gain, and cravings for foods high in carbohydrates.
Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMDD usually develops a week or two before a woman’s period.
Postpartum (or perinatal) depression (PPD) is diagnosed in women who experience symptoms of major depression shortly after giving birth (or during pregnancy).PPD is usually related to a combination of factors, including sharp changes in hormone levels following childbirth. Feelings of intense sadness, anxiety, or exhaustion are much stronger, and last longer, than the “baby blues” — the relatively mild symptoms of depression and anxiety that many new mothers experience in the first few days after childbirth.
According to the American Psychiatric Association’s (APA) current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic guide used by most mental health professionals, if you’ve experienced at least five of the following symptoms most of the day, nearly every day, for at least two weeks, you may have MDD.
Depressed mood
Loss of interest or pleasure in your work, hobbies, friends, family, and other things you once enjoyed
Tearfulness, emptiness, worthlessness, or guilt
Hopelessness
Dramatic changes in your appetite or your weight not related to dieting
Feelings of listlessness or fatigue for no obvious reason
Trouble concentrating or making decisions
Anxious restlessness that manifests in ways like pacing or wringing your hands — or the opposite — moving or speaking more slowly than usual
One reason depression can be hard to identify is that its signs can vary widely from person to person and sometimes be masked by atypical symptoms. For example, some people who are depressed may show it by acting disgruntled, resentful, or irritable. Aggression — including outright acts of violence — can sometimes be indicative of depression.
Depression masquerading as anger may seem surprising at first, but not when you consider that several underlying factors, including alcohol or substance abuse and childhood trauma, have been linked to both.
Similarly, although it’s not clear why, a person who experiences anxiety is at high risk for developing depression. As many as 60 to 70 percent of people with anxiety will also have depression; the same goes for people with depression having symptoms of anxiety.
Depression may also manifest psychosomatically, meaning that instead of presenting first and foremost as a mood disorder, the dominant symptom may be things like vague aches, headaches, or back pain. Complicating matters is that it’s often hard to know whether depression is causing the physical symptoms or if the physical symptoms are causing depression.
No one knows for sure why some people become depressed and others do not. Depression can occur spontaneously, without any obvious cause. And it’s well documented that once you’ve had one depressive episode, your risk of having another later in life increases.
Psychiatrists today generally look at depression in “bio-psycho-social” terms, meaning that they see it as a complex disorder most likely triggered by overlapping biological, psychological, and social (also referred to as environmental) factors.
Among the potential contributors to depression are:
Genetics Many studies suggest that depression can spring from a genetic predisposition, including one international study involving more than 807,000 people, that linked 269 genes to depression. Scientists think that while some genes may increase risk, other factors are needed to trigger symptoms.
Neurotransmitters The long-held idea that depression is caused by low levels of the neurotransmitter serotonin (a chemical messenger that communicates between neurons) has been debunked, according to one review. But it’s clear that neurotransmitters play a role, at least for some people. Experts’ current belief is that the relationship between depression and neurotransmitters is complex and may be related to nerve cell connections, nerve cell growth, or the functioning of nerve circuits.
Inflammation Research indicates that disease-related or stress-related inflammation may create chemical changes in the brain that can trigger or worsen depression in certain people and influence how a person responds to drug therapy.
Hardship There’s evidence that psychological and social factors like a history of abuse, poor health and nutrition, unemployment, social isolation or loneliness, low socioeconomic status, or stressful life events (divorce or money worries, for example) can play a decisive role in the onset of depression.
Traumatic Brain Injury (TBI) Another all-too-common cause of depression is TBIs. In 2021, more than 214,000 people were hospitalized for TBIs, such as a concussion, following a bump or blow to the head from things like falls, assaults, car accidents, and workplace and sports-related injuries. One study found that people who’d experienced a TBI were 11 times more likely to meet the criteria for depression one year after the injury.
To be diagnosed with MDD, one of your symptoms must be a persistent low mood or a loss of interest or pleasure, the DSM-5 states. Children and teens may have irritability rather than sadness. Your symptoms must also not be due to another medical condition, such as thyroid problems or a virus.
Of course, it’s normal to have any or all of these symptoms temporarily from time to time. The difference with depression is that the symptoms persist and make it difficult to function normally.
If you suspect you may be depressed, the best first step is to reach out to your primary care doctor, a psychiatrist, or a psychotherapist. Also, know that depression screenings may now be a part of routine checkups. As of June 2023, the U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers screen all adults for depression, including pregnant and postpartum women and older adults.
It may also be helpful to take an online, clinically validated depression test known as the PHQ-9 patient health questionnaire. This test is short and straightforward, and it may help you get a better idea of whether you may be experiencing depression.
If you suspect that depression is interfering with your life, talking about what you’re experiencing and discussing treatment options with a medical professional is essential. There’s abundant evidence that people with depression who seek treatment will find significant relief from talk therapy (psychotherapy), medication, lifestyle changes, or a combination.
Talk Therapy for Depression
Several types of psychotherapy have been found to be effective treatments for depression:
Behavioral Activation Therapy The aim of this type of therapy is to reverse the downward spiral of depression by encouraging you to seek out experiences and activities that give you joy.
Cognitive Behavioral Therapy (CBT) CBT focuses on changing specific negative thought patterns so that you can better respond to challenging and stressful situations.
Interpersonal Therapy This very structured, time-limited form of therapy focuses on identifying and improving problematic personal relationships and circumstances directly related to your current depressive mood.
Problem-Solving Therapy This therapy is a form of CBT that teaches take-charge skills that help you solve real-life problems and stressors, big and small, that contribute to depression.
Self-Management or Self-Control Therapy This type of behavioral therapy trains you to lessen your negative reactions to events and reduce your self-punishing behaviors and thoughts.
Medication for Depression
Antidepressant medications cause changes in brain chemistry that affect how neurons communicate. Exactly how this improves mood remains somewhat of a mystery, but the fact that they do often work is well-established. If you’re thinking about trying antidepressants, talk to your doctor about whether these treatments could be right for you.
Selective Serotonin Reuptake Inhibitors (SSRIs) This category of drug includes fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) and targets serotonin, a neurotransmitter that helps control mood, appetite, and sleep.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) SNRIs include drugs like duloxetine (Cymbalta), desvenlafaxine (Pristiq), and venlafaxine (Effexor XR), which block the reabsorption of both serotonin and another neurotransmitter, norepinephrine.
Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs) This class of medications includes bupropion.
Tricyclic or Tetracyclic Antidepressants (TCAs) TCAs include such drugs as imipramine (Tofranil) and nortriptyline (Pamelor). These drugs were among the earliest antidepressants to come on the market. These days, doctors generally only turn to them when treatment with SSRIs, SNRIs, and NDRIs has failed.
Monoamine Oxidase Inhibitors (MAOIs) MAOIs, including phenelzine (Nardil) and isocarboxazid (Marplan), were the first antidepressants developed. They’re rarely used today, in part because people who take them require careful monitoring to prevent negative interactions with certain foods and other medications.
N-Methyl D-Aspartate (NMDA) Receptor Antagonists NDMAs help maintain the balance of glutamate and gamma-aminobutyric acid (GABA) in the body. They can help people whose symptoms haven’t been relieved by standard treatments and often work more rapidly than other antidepressants. They include drugs like esketamine (Spravato) and dextromethorphan-bupropion (Auvelity).
Neuroactive Steroids Neuroactive steroids are believed to work by affecting GABA levels. They often work more rapidly than other antidepressants. They include drugs like brexanolone (Zulresso) and zuranolone (Zurzuvae), which are both FDA-approved to treat postpartum depression.
Serotonin Receptor Agonists This new class of antidepressants is thought to work by affecting certain serotonin receptors in the brain that help regulate mood and emotions. This class includes the drug gepirone ER (Exxua).
All antidepressants can have side effects, but some may be more problematic than others. You may need to try several different medications, or a combination, guided by your doctor, before you find what works best for you. Some of the most common side effects of antidepressants include:
Nausea
Headache
Drowsiness
Diarrhea
Upset stomach
Dry mouth
Weight gain
Sexual problems
In addition, it may take some patience before you see results. The full benefits of the drugs may not be realized until you’ve taken them for as long as three months.
Sometimes, other medications may be added to your regimen, depending on the form of depression, the severity of your symptoms, and your response to other therapies. These might include a mood stabilizer, such as lithium (sold under several brand names) or valproic acid (Depakene, Depakote).
If your depression isn’t improving enough with standard treatments, or if symptoms of psychosis (having delusions or seeing or hearing voices that are not real, for example) are present, a doctor may prescribe an antipsychotic medication.
Some experts believe that using an antipsychotic in combination with an antidepressant may be more effective for depressive disorders than antidepressants alone. Antipsychotics that are approved for use in combination with an antidepressant include brexpiprazole (Rexulti), aripiprazole (Abilify), cariprazine (Vraylar), quetiapine (Seroquel XR), and fluoxetine and olanzapine combination (Symbyax).
Should You Worry About Antidepressant Withdrawal?
In general, going off antidepressants is safe as long as you taper off slowly with the help of your doctor. Antidepressant discontinuation syndrome (ADS), can occur if you abruptly stop taking medication rather than tapering off. ADS is marked by a wide range of responses, including but not limited to flu-like symptoms, insomnia, worsening mood, and nausea.
One study concluded that about 15 percent of patients discontinuing antidepressants will have symptoms; only around 2 percent will have severe symptoms.
What Is Treatment Resistant Depression and Is There Any Help for It?
If you’ve tried at least two different antidepressants and your depression hasn’t improved, you may be diagnosed with treatment-resistant depression (TRD). TRD is a serious condition that has been highly associated with suicidal ideation and suicide attempts. Thirty percent of people with treatment-resistant depression attempt suicide in their lifetime, double the rate of their treatment-responsive peers (15 percent).
It is not, however, a hopeless condition. A number of treatment approaches for TRD are available, including:
Esketamine (Spravato) A nasal spray, Spravato won FDA approval on March 5, 2019, as a new treatment for TRD. It is derived from ketamine, a veterinary anesthetic best known as the street drug “Special K.” Because of safety concerns, Spravato must be administered in a medical office and can be taken on its own or in combination with an oral antidepressant.
Electroconvulsive Therapy (ECT) ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia. ECT rapidly provides substantial improvement in approximately 80 percent of patients with severe, uncomplicated major depression. Like any medical procedure, ECT is associated with side effects — most commonly, issues with memory. In most cases, this is short-term; however, some people can experience permanent gaps in memory.
Transcranial Magnetic Stimulation (TMS) TMS uses rapidly alternating magnetic fields to change activity in specific areas of the brain. Although researchers don’t fully understand how exactly TMS affects the brain, it appears to influence how the brain is operating and, in turn, improve mood and decrease depressive symptoms.
Vagus Nerve Stimulation This therapy involves implanting a tiny device in the chest that provides regular mild electrical pulses to the longest of the nerves that arise from the brain. Vagus nerve stimulation has been found to significantly improve quality of life for many patients.
Psychedelic Drugs While not yet FDA approved, microdosing with psychedelic drugs to produce a more positive mood in people with chronic depression is the focus of a flurry of research worldwide. Evidence has yet to endorse the use of psychedelics for the treatment of any mental health condition except during approved investigational studies, and more research is needed in this field.
There’s no surefire way to prevent depression. But these steps could help.
If you suspect you have depression, get professional help early on to keep it from getting worse.
Lean on your family or friends for support.
Consider long-term treatment to prevent your depressive symptoms from coming back even after you feel better
Try your best to curb stress in your life.
Lifestyle changes, such as exercising more, prioritizing sleep, practicing yoga or mindfulness, making art, or journaling, can also alleviate depression and the stress that can heighten it.
Diet changes, too, can uplift your mood by reducing inflammation and helping to ensure your brain gets the nutrients it needs to function at its best.
One small randomized controlled study found that self-reported symptoms of depression dropped significantly in just three weeks in young adults who changed from a highly processed, high-carbohydrate diet to a Mediterranean diet focused on vegetables, whole grains, lean proteins, unsweetened dairy, nuts and seeds, olive oil, and the spices turmeric and cinnamon. In contrast, the depression scores didn’t budge in a control group of people who didn’t change their diet.
How long depression lasts varies from person to person, but according to the DSM-5, a depressive episode lasts most of the day, nearly every day, for at least two weeks.
Untreated depressive episodes appear to last 6 to 12 months. Depression also tends to be chronic, with episodes happening again in about half of people who’ve experienced one depressive episode, 70 percent of people who’ve had two episodes, and 90 percent of people who’ve had three episodes. But some people never experience another episode after the first one.
Depression can worsen and take a significant toll on your mental and physical health if it’s not properly treated. Potential complications of depression include:
Misuse of alcohol or drugs
Anxiety disorders
Social isolation
Family or relationship difficulties
Work or school issues
Excess weight, which can lead to diabetes or heart disease
Pain
Self-harm or suicide
Early death from other medical conditions
In 2021, an estimated 21 million, or 8.3 percent, of adults in the United States had at least one major depressive episode in the past year, making it one of the most common mental health conditions in the United States.
Although there is no one-size-fits-all cure for depression, there are many effective treatment options, one of which is bound to help you heal if you’re struggling with the condition. This cannot be emphasized enough, given that roughly two-thirds of people living with depression do not receive the care they need.
Research suggests that the following disparities and inequities exist when it comes to depression.
Gender and Depression
When it comes to depression, there is a distinct gender gap. Depression is nearly twice as common in women as in men.
After all, only cisgender women can have premenstrual or postpartum depression. The same is true of antepartum (or perinatal) depression — depression during pregnancy — which is estimated to affect 1 in 10 pregnant women.
People of Color and Depression
Research on depression within communities of color has revealed a number of differences in the symptoms, diagnosis, and treatment between people of color and white communities.
The symptoms of depression may appear different among people of color than in white people. For instance, while white people are more likely to have acute depressive episodes, African Americans are more likely to experience depression that’s chronic, prolonged, and debilitating.
In a study focused primarily on Black and African American mothers, participants were more likely to report self-blame, irritability, difficulty sleeping, and an inability to experience pleasure than some of the hallmark symptoms of depression, such as feelings of hopelessness or sadness.
Importantly, the authors of the study noted, traditional depression screening tools may not capture these symptoms, meaning depression may go undetected in some Black and African American women.
Major depression is one of the most common mental health conditions among Latinx communities. But they’re less likely to receive mental health treatment than other communities. Approximately 33 percent of Latinx adults with a mental health condition like depression receive treatment each year compared with the national average of 43 percent.
When it comes to treatment, Asian American and Pacific Islander (AAPI) communities are the least likely racial group to seek professional mental health services. That’s often due to factors like a lack of accessible resources, language barriers, and cultural stigmas surrounding mental health issues.
When your provider evaluates you for depression, it’s important that they rule out any other potential conditions that could be causing your symptoms. Conditions that may overlap with MDD include:
Substance- or medication-induced depressive disorder
Importantly, some people may have at least one of the above conditions in addition to depression. When a person has multiple mental health conditions at the same time it’s known as psychiatric comorbidity.
Depression is a complex mental health condition that can significantly affect your mood and the way you think, feel, act, and function.
The causes of depression are not fully understood, but research suggests factors like genetics, environment, emotional trauma and hardships, traumatic brain injury, and inflammation may play a role.
Treatment usually centers on talk therapy and antidepressant medications. Lifestyle changes can also help.
If you or a loved one is experiencing significant distress or having thoughts about suicide and need support, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7. If you need immediate help, call 911.
