Depression is one of the most common and most powerful mental health conditions a person can endure. Depression can emerge in many unique ways depending on the person, their specific depressive disorder, and the intensity of their symptoms. Fortunately, mental health experts can successfully diagnose and treat a range of depressive disorders to restore the health and well-being people desire.
Due to a number of biological and environmental causes, nearly 20 million, including more than 17 million adults and more than 2 million adolescents, reported experiencing depressive episodes in 2017 alone, according to the National Institute of Mental Health (NIMH).1 Therapy, medication, and lifestyle changes may all play a role in effectively treating and managing depression.
Types of Depression
Rather than only being one condition, depression is actually a constellation of depressive disorders. Though these conditions differ, they share commonalities like a mood that is sad, empty, or irritable paired with behavior and thinking changes that serve to reduce a person’s ability to function at their expected level.2
The main differences among depressive disorders are how long they last, the timing of the symptoms, and the events or situations that trigger the symptoms to emerge. Depressive disorders include eight separate conditions and include:
1. Major Depressive Disorder
Major depressive disorder (MDD) is the condition many picture when they think of depression. MDD will affect a person’s mood and happiness, but it has the power to disrupt a person’s energy, sleep, and diet. MDD can negatively influence the attention levels, concentration, decision-making, and self-esteem of anyone with the condition.
A person may have only a single episode of major depression with a few mild symptoms. Another person could have recurrent MDD with severe symptoms that trigger feelings of worthlessness, guilt, and suicidal thoughts. During a year, about 7% of the U.S. population will have major depressive disorder. 2
2. Persistent Depressive Disorder (Dysthymia)
People with persistent depressive disorder will feel periods of depression lasting for two years or longer. Since symptoms of persistent depressive disorder are so long in duration, a person can struggle to remember a time when they were not depressed.
While other depressive disorders have a way of remitting and returning, the trademark of persistent depressive disorder is the disorder’s consistency. If signs of persistent depressive disorder do alleviate, they may only do so for less than two months before returning. The disorder, formerly called dysthymia, affects about 0.5% of people in the U.S. each year. 2
3. Premenstrual Dysphoric Disorder
The hormonal changes linked to menstruation create an expected shift in mood and energy, but premenstrual dysphoric disorder marks an extreme shift in irritability and anxiety brought on by the menstrual cycle. The symptoms typically build during the days leading up to menstruation and will then alleviate a few days after menstruation begins. Premenstrual dysphoric disorder will create a negative effect on the person’s school, work, or social life due to the intensity of symptoms. Premenstrual dysphoric disorder affects as many as 5.8% of menstruating women each year.2
4. Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder (DMDD) is a condition marked by high levels of irritability. People with DMDD will have frequent outbursts and tantrums that may occur at home, work, school, or in the community. In between the outbursts, they will display a chronically irritable mood.
An essential aspect of DMDD is the timing of the symptoms as mental health professionals cannot give the diagnosis to anyone under six and older than 18. Experts believe that between 2% and 5% of people under 18 will have DMDD each year.2
Other Common Depressive Disorders
The above conditions will be the most frequently encountered depressive disorders, but there are others. Some other depressive disorders include:2
- Substance/ medication-induced depressive disorder: occurs when the use of drugs, alcohol, or medications cause depressive symptoms to emerge
- Depressive disorder due to another medical condition: a group of depressive symptoms triggered by a medical condition, physical health change, or an event like a stroke
- Other specified depressive disorder & unspecified depressive disorder: when depressive symptoms appear but do not fit into other categories, one of these diagnoses could be appropriate
Depression in Different Populations
Depression and depressive disorders do not discriminate. Instead, they adversely influence people regardless of their age, gender, and ethnicity. According to the NIMH, the groups with the highest rates of depression in the United States are:1
- Multiracial people. Interestingly, people who report belonging to two or more races/ ethnic groups reported some of the highest levels of depression, regardless of age.
- Native Americans. Whether they are adolescents or adults, American Indians and Alaska Natives have rates of depression that are higher than all other ethnic groups.
- Young people. People ages 12 to 17 and 18 to 25 have rates of depression that nearly double the levels of older adults.
- Females, especially adolescent females. Adolescent females have rates of depression higher than any other group. About one in every five adolescent females experienced at least one depressive episode in 2017, according to NIMH.
- Asian adults and black adolescents have some of the lowest rates of depression.
There are many possible options to explain the rates of depression for various ages, races, and sexes. In the end, no person or group of people is immune to the impacts of depression.
Symptoms of Depression
- A depressed mood with feelings of sadness, hopelessness, emptiness, or irritability
- Decreased pleasure and interest in previously enjoyed activities
- A noteworthy weight change or a significant change in appetite
- Sleeping too much or too little throughout the day
- Feeling or looking very sped up or slowed down in behaviors
- Loss of energy
- Feeling worthless or very guilty
- Thinking about death, dying, or suicide
Not only does a person need to display these symptoms, but they need to do so for most days during a two-week period. Additionally, these depressive qualities need to drastically impact the person’s daily functioning at home, work, or school to qualify as depression.2
The above symptoms are common during periods of depression, but other people will note specific versions of depression that may include: 2
- Psychotic features: At times, people will experience depression so intense that it creates psychotic symptoms. When these present, the person may hallucinate, leading them to hear, see, smell, or feel things that are not there, or they could have delusional thinking with odd or bizarre beliefs.
- Peripartum onset: Women may experience depressive symptoms during pregnancy or in the weeks that follow. This depression with peripartum onset may be dangerous as the woman could develop extreme anxiety or psychotic symptoms like hallucinations.
- Seasonal pattern: When people experience depressive symptoms linked to seasonal changes, they could have depression with seasonal pattern. They may see symptoms worsen in the winter before alleviating in the spring. This form of depression is sometimes referred to as seasonal affective disorder.
What Depression Looks Like
Many aspects of depression are individualized, so two people with the condition may show unique signs. Depending on factors like age and sex, depression could look very different.
The stereotypical view of a person weeping on their couch as they lay in their bathrobe may be true for some, but other people may express their depression through powerful bouts of irritability and anger. Children and adolescents are more likely to display an irritable mood rather than a depressed one.
Regardless of age, men are more likely to experience and complain about physical symptoms of depression than women. They will complain of: 5
- Heart problems
- Chest pain
- Digestive health issues
Because the depression presents differently, people may resort to different techniques to try and resolve these symptoms.
Treatment of Depression
Effective treatments for depression including professional services like psychotherapy and medication management. Some people will also find success with lifestyle adjustments like changes in their exercise, diet, and sleep. Not every treatment option will be an appropriate match for every person with depression, so treatment must be tailored to each individual for the best results.
Therapy is at the frontline of treatment for depression. This treatment commonly involves the person with depression attending sessions with a talk therapist in an individual, group, or family setting with the appointments taking place in an office, the home, or in the community. People with severe depression may require treatment in an inpatient or residential treatment center.
Therapy for depression occurs at a range of intensities and frequencies. Some people can benefit from one therapy session each month while others will require the attention of several hours of therapy each day to manage the signs and symptoms of depressive disorders.
Common Types of Therapies for Depression
Professionals can use a multitude of therapeutic orientations to target the depressive symptoms including:3
- Cognitive-Behavioral Therapy (CBT): a therapeutic style that hopes to challenge depression by adjusting negative thinking patterns, identifying what contributes to depression, and modifying behaviors to engage in more positive, healthy activities.
- Interpersonal Therapy (IPT): a type of therapy that investigates the impact of relationships on depression. By understanding how significant relationship changes affect mood, IPT helps people make their current relationships more positive and shift their view of past relationships.
- Problem-Solving Therapy (PST): a short-term treatment option ideal for older adults with depression. PST works to identify problems and resolve them using a specific step-by-step process so that the individual can arrive at a practical solution.
Some therapists may opt for only one therapeutic approach while others may choose to combine aspects of various therapies based on their education and experience. Therapy is not a “one-size-fits-all” process, so people in treatment should consider exploring several treatment styles until they find a style that seems beneficial.
Intended Therapy Outcome & Timeline
When therapy is working well, it will quickly and effectively reduce the depression symptoms of the individual in treatment. Depending on the level of depression, complete remission of symptoms is possible, but others may only hope to decrease the harmful aspects of their ongoing symptoms.
About 40% of people will see recovery begin within three months of symptom onset while 80% of people will see recovery within a year. Like other conditions, starting treatment for depression quickly can result in better outcomes. The presence of other mental health conditions like personality disorders and anxiety can slow the progression of treatment. 2
Medication is another standard treatment option for depression. Medication management can be used alone or in combination with other treatments like therapy to complement its effectiveness.
Depending on the state where treatment occurs, people can receive medication for depression from professionals including:
- Primary care physicians
- Psychologists (limited number of states)
- Nurse practitioners
- Other medical doctors
Medication management for depression usually requires some level of trial and error to find the wanted effects. Many types of antidepressant medications exist like:
- Selective serotonin reuptake inhibitors (SSRIs): newer drugs with fewer side effects for most people that help the brain absorb more serotonin.4 Examples include Celexa, Lexapro, Prozac, and Paxil.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): a group of antidepressants that interact with both serotonin and norepinephrine in the brain. Examples include Cymbalta, Effexor, Pristiq, and Fetzima.
- Tricyclic antidepressants: older antidepressant that are effective but can create more negative side effects than newer medications like SSRIs and SNRIs.4 Examples of generic forms include nortriptyline, amitriptyline, and doxepin.
- Monoamine oxidase inhibitors (MAOIs): another older generation of antidepressant that requires a restricted diet due to dangerous interactions with certain foods and supplements. Examples include Parnate, Nardil, and Marplan.
- Atypical antidepressants: medications that do not fit into other categories. Examples are Wellbutrin, Remeron, and trazodone.
Other medications may be used in combination with these drugs to improve depressive symptoms. Prescribers will likely adjust the doses of these substances throughout treatment to find the best possible results.
Any person using prescribed medications should always use the drug as directed and make their prescriber aware of any health changes like pregnancy. Stopping medications abruptly can result in unwanted effects, so the prescriber will often recommend a weaning schedule to reduce risk 4
Additional Treatments for Depression
People with chronic and severe symptoms of depression may need to explore alternative options to manage their condition. For people in this situation, there are several treatments like: 4
- Electroconvulsive therapy (ECT): If other treatments for depression are unsuccessful, the treatment team may recommend ECT. While under general anesthesia and a muscle relaxant, an electrical current passes through the brain. Though the procedure may sound intimidating, this effective depression treatment produces many benefits for those who have not made progress with therapy or medication.
- Brain stimulation therapies: Options like repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation may help those who have shown limited progress with other therapy and medication options. These treatments are newer than ECT, so they may not be as common in all areas.
People can always take an active role in their depression treatment. There are plenty of ways people can work to improve their depression at-home, and although these may not resolve depression independently, they can add to the benefits of professional strategies. Some lifestyle changes to improve depression include: 3
- Learning more about depression and the nature of the condition
- Increasing exercise and physical activity levels
- Making plans and setting goals
- Spending time with loved ones
- Accepting help and assistance from others
- Setting realistic expectations for self and symptoms
- Being honest and open about the experience of having depression
- Improving your diet by eating healthy foods
- Limiting the use of alcohol and other drugs
- Working to establish a regular sleep routine
Performing these changes will not suddenly eliminate depression, but they could help to limit symptoms and make other treatments more effective. Best of all, these healthy lifestyle changes can be used in conjunction with other professional treatments and carry zero risk of unwanted side effects.
How to Get Help for Depression
When a person can identify the presence of depression, it is time to seek professional treatments. Though it may be tempting to address the situation alone, depression is a serious mental health condition that deserves professional intervention.
Many begin the journey towards depression treatment by speaking to a loved one with personal or professional experience in the field. Other helpful options for beginning mental health treatment include: 3
- Speaking to a primary care doctor
- Calling the local mental health treatment provider
- Most counties have mental health treatment available for their constituents with limited resources
- Phoning a national hotline specializing in depression
- Contacting a religious leader for a referral
- Communicating with the insurance company about covered providers
Waiting may only give time for the symptoms to intensify, so people with depression would do well to seek treatment early.
How to Get Help for a Loved One
Seeing a loved one displaying symptoms of a depressive disorder can be an overwhelming and confusing experience. Wanting to help is a natural response but knowing how is uncertain.
If your loved one has depression, consider: 3
- Offering love, support, patience, and encouragement
- Listening to their situation and provide empathy
- Spending time with the loved one doing activities they enjoy
- Treating statements about death and suicide seriously
- Keeping an optimistic and hopeful style of communication
Remember, above all else, you can help your loved one by promoting the benefits of professional treatment. One may choose to accompany their friend or relative to appointments or simply call and remind them to go. A friend can do much to assist a loved one, but they are not a replacement for treatment.
If a friend seems to be very depressed or considering suicide, loved ones should take immediate action. Calling 9-1-1 can save your loved one’s life and enable the treatment they need.
How to Get Help for a Child
Finding help for a child who is displaying depressive symptoms generally starts with consulting their pediatrician. Your pediatrician can discuss treatment options and make referrals to qualified professionals.
Parents of children and adolescents with depression will have different roles and responsibilities. Depending on the child’s age and symptoms, parents could be an active participant in treatment or could only be responsible for transporting their child to appointments. In any case, parents should work to ensure open communication with treatment providers to support treatment strategies at home.
To understand the widespread impact of depression, consider these statistics compiled by the NIMH in 2017 1
- 8.7% of adult women experienced depressive episodes during the previous year while adolescent females had a depression rate of 20%
- 13.1% of young adults and 13.3% of adolescents displayed depressive symptoms each year
- 8% of American Indians and Alaskan Natives adults had a depressive episode in 2017 with white adults close behind with a depression rate of 7.9%
- Rates of depression decrease with age. 7.7% of people 26 to 49 and 4.7% of people 50 and over reported depressive symptoms
- Nearly two-thirds of adults with depression in the last year reported severe impairment due to the condition
- About 65% of adults with depression received treatments like therapy and medication
- 35% of adults and more than 60% of adolescents with depression received no treatment at all
Living with Depression: Coping & Managing Symptoms
Living with depression is no small task. The best ways to confront the condition and manage symptoms will differ significantly due to each person’s differences, but some suitable choices for all people are: 4
- Working to accept and acknowledge the influence of depression on life, rather than trying to hide the condition
- Seeking professional treatment and consider therapy, medication, and lifestyle changes along the way
- Building an effective treatment team that includes therapists, prescribers, family, and friends
- Avoiding self-medication through substance use, sex, gambling, or other negative coping skills
- Practicing and using patience with coping skills discussed in treatment. Many techniques need time to be effective
- Being kind and patient with yourself. Becoming angry or discouraged only permits depression to grow
Support groups are fantastic ways to extend the benefit of treatment, and they can add a level of social interaction that people cannot otherwise receive. Finding online and in-person options reduces feelings of loneliness and isolation. The National Association for Mental Illness (NAMI) is a good place to start: https://www.nami.org/
Depression vs. Sadness & Other Common Disorders
Because depression affects so many people in so many different ways, it can be challenging to accurately differentiate depression from another mental health condition. At times, it is even difficult to separate depression from normal reactions to everyday life.
Depression vs. Sadness
All people experience sadness, but not all people experience depressive disorders. If someone loses their job, ends a relationship, or loses a loved one, sadness is expected.
Depression is different from sadness because of the difference in intensity, duration of symptoms, and effect on a person’s life. Mental health professionals will work to correctly see the difference and decide if the person is experiencing a mental health condition or typical life. 2
Depression vs. Bipolar Disorder
These two conditions actually share many symptoms. For a person to have bipolar disorder, they must experience depressive episodes.
The difference is that people with bipolar disorder will note periods of high energy, reduced need for sleep, and other symptoms linked to mania or hypomania during periods without depression. People with a depressive disorder will not report these episodes. 2
Depression vs. ADHD
On the surface, it may seem like depression and attention-deficit/ hyperactivity disorder (ADHD) have little in common. In reality, the two share overlapping symptoms like short attention and poor decision-making skills.
People could have ADHD and depression or one could be confused for the other. The overlap and confusion with depression and ADHD are more prevalent in children than in adults. 2
Depression vs. Substance Use Disorders
Substances can produce a multitude of effects during intoxication and withdrawal. Often, these effects could be confused with depression.
During intoxication, drugs that sedate the body could lead to someone being lethargic, having low energy, and sleeping for long hours. During withdrawal, stimulant drugs like methamphetamine can create dysphoria, irritability, increased appetite, and a powerful need for sleep. Though these symptoms present as depression, they are truly the effects of substance use disorders 2
Depression and Co-Occurring Disorders
Depression can also present with a number of mental health conditions like substance use disorders, anxiety disorders, obsessive-compulsive disorder, eating disorders, and borderline personality disorders. Having multiple mental health disorders can complicate treatment and create a poorer prognosis. 2
A thorough evaluation from a mental health professional can work to identify all co-occurring disorders. From there, a comprehensive treatment plan can effectively address all symptoms concurrently for best results.
Depression Tests and Quizzes
People interested in understanding their current condition may look to testing to confirm their diagnosis. They may do this two ways:
Mental Health Evaluation
To offer a diagnosis of depression, mental health experts will usually perform a psychiatric or psychological evaluation to better understand the symptoms, their onset, and their impact on functioning. Professionals will utilize a reference text called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) created by the American Psychiatric Association to compare symptoms to the established criteria for mental health conditions. 4
Evaluation and diagnosis are complicated tasks, so it is possible different professionals will interpret the symptoms differently.
Online Quizzes and Self Diagnosis
Rather than attending a formal evaluation, some people may opt for the convenience of completing an online quiz or researching other tools to diagnose their condition. Though these actions are appealing, they are never recommended.
Without the education and expertise of a mental health expert, there is a strong likelihood of misinterpretation and misdiagnosis. These online tools may be helpful to gain more information about normal functioning, but they cannot replace the knowledge of a trained mental health professional.
For more information about depression, please refer to these organizations: