It's normal to feel down once in a while, but if you're sad most of the time and it affects your daily life, you may have clinical depression. It's a condition you can treat with medicine, talking to a therapist, and changes to your lifestyle.
Whatever the cause, your first step is to let your doctor know how you're feeling. They may refer you to a mental health specialist to help figure out the type of depression you have. This diagnosis is important in deciding the right treatment for you.
You may hear your doctor call this "major depressive disorder." You might have this type if you feel depressed most of the time for most days of the week.
Some other symptoms you might have are:
- Loss of interest or pleasure in your activities
- Weight loss or gain
- Trouble getting to sleep or feeling sleepy during the day
- Feeling restless and agitated, or else very sluggish and slowed down physically or mentally
- Being tired and without energy
- Feeling worthless or guilty
- Trouble concentrating or making decisions
- Thoughts of suicide
Your doctor might diagnose you with major depression if you have five or more of these symptoms on most days for 2 weeks or longer. At least one of the symptoms must be a depressed mood or loss of interest in activities.
Major depression looks differently in different people. Depending on how your depression makes you feel, it could be:
Anxious distress. You feel tense and restless most days. You have trouble concentrating because you’re worried that something awful could happen, and you feel like you might lose control of yourself.
Melancholy. You feel intensely sad and lose interest in the activities you used to enjoy. You feel bad even when good things happen. You might also:
- Feel particularly down in the mornings
- Lose weight
- Sleep poorly
- Have suicidal thoughts
If you have melancholic depression, your symptoms might be worst in the mornings when you first wake up. Consider having someone help you with your first tasks of the day. Make sure to eat regularly even if you don’t feel hungry.
Agitated. You feel uneasy most of the time. You may also:
- Talk a lot
- Move for no reason, like fidgeting with your hands and pacing around the room
- Act impulsively
Talk therapy can help. You'll meet with a mental health specialist who will help you find ways to manage your depression. Medications called antidepressants can also be useful.
When therapy and medication aren't working, other options your doctor may suggest are:
- Electroconvulsive therapy (ECT)
- Transcranial magnetic stimulation (TMS)
- Vagus Nerve Stimulation (VNS)
ECT uses electrical pulses, TMS uses a special kind of magnet, and VNS uses an implanted device. All are design to stimulate certain areas of brain activity. This helps the parts of your brain that control your mood work better.
Persistent Depressive Disorder
If you have depression that lasts for 2 years or longer, it's called persistent depressive disorder. This term is used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.
You may have symptoms such as:
- Change in your appetite (not eating enough or overeating)
- Sleeping too much or too little
- Lack of energy, or fatigue
- Low self-esteem
- Trouble concentrating or making decisions
- Feeling hopeless
You may be treated with psychotherapy, medication, or a combination of the two.
When you're in the low phase, you'll have the symptoms of major depression.
Medication can help bring your mood swings under control. Whether you're in a high or a low period, your doctor may suggest a mood stabilizer, such as lithium.
The FDA has approved three medicines to treat the depressed phase:
Doctors sometimes prescribe other drugs "off label" for bipolar depression, such as the anticonvulsant lamotrigine or the atypical antipsychotic Vraylar.
Traditional antidepressants are not always recommended as first-line treatments for bipolar depression because there's no proof from studies that these drugs are more helpful than a placebo (a sugar pill) in treating depression in people with bipolar disorder. Also, for a small percentage of people with bipolar disorder, some traditional antidepressants may increase the risk of causing a "high" phase of illness, or speeding up the frequency of having more episodes over time.
Psychotherapy can also help support you and your family.
Seasonal Affective Disorder (SAD)
Seasonal affective disorder is a period of major depression that most often happens during the winter months, when the days grow short and you get less and less sunlight. It typically goes away in the spring and summer.
If you have SAD, antidepressants can help. So can light therapy. You'll need to sit in front of a special bright light box for about 15-30 minutes each day.
People with psychotic depression have the symptoms of major depression along with "psychotic" symptoms, such as:
- Hallucinations (seeing or hearing things that aren't there)
- Delusions (false beliefs)
- Paranoia (wrongly believing that others are trying to harm you)
A combination of antidepressant and antipsychotic drugs can treat psychotic depression. ECT may also be an option.
Peripartum (Postpartum) Depression
Women who have major depression in the weeks and months after childbirth may have peripartum depression. Approximately 1 in 10 men also experience depression in the peripartum period. Antidepressant drugs can help similarly to treating major depression that is unrelated to childbirth.
Premenstrual Dysphoric Disorder (PMDD)
Women with PMDD have depression and other symptoms at the start of their period.
Besides feeling depressed, you may also have:
- Mood swings
- Trouble concentrating
- Change in appetite or sleep habits
- Feelings of being overwhelmed
Antidepressant medication or sometimes oral contraceptives can treat PMDD.
This isn't a technical term in psychiatry. But you can have a depressed mood when you're having trouble managing a stressful event in your life, such as a death in your family, a divorce, or losing your job. Your doctor may call this "stress response syndrome."
Psychotherapy can often help you get through a period of depression that's related to a stressful situation.
This type is different from the persistent sadness of typical depression. It is considered to be a "specifier" that describes a pattern of depressive symptoms. If you have atypical depression, a positive event can temporarily improve your mood.
Other symptoms of atypical depression include:
- Increased appetite
- Sleeping more than usual
- Feeling of heaviness in your arms and legs
- Oversensitive to criticism
Antidepressants can help. Your doctor may suggest a type called an SSRI (selective serotonin reuptake inhibitor) as the first-line treatment.
They may also sometimes recommend an older type of antidepressant called an MAOI (monoamine oxidase inhibitor), which is a class of antidepressants that has been well-studied in treating atypical depression.
Treatment Resistant Depression
About 1/3 of people treated for depression try several treatment methods without success. If that’s you, you might have treatment resistant depression. There are many reasons your depression might be treatment resistant. For example, you might have other conditions that make your depression difficult to treat.
If you’re diagnosed with treatment resistant depression, your doctor might recommend some less conventional treatment options. Electroconvulsive therapy (ECT) is sometimes helpful in this situation.