What Is Depression?
Most people feel sad or depressed at times. It’s a normal reaction to loss or life's challenges. But when intense sadness -- including feeling helpless, hopeless, and worthless -- lasts for many days to weeks and keeps you from living your life, it may be something more than sadness. You could have clinical depression, a treatable medical condition.
According to the DSM-5, a manual doctors use to diagnose mental disorders, you have depression when you have five or more of these symptoms for at least 2 weeks:
- Your mood is depressed for most of the day, especially in the morning.
- You feel tired or have a lack of energy almost every day.
- You feel worthless or guilty almost every day.
- You feel hopeless or pessimistic.
- You have a hard time focusing, remembering details, and making decisions.
- You can’t sleep, or you sleep too much, almost every day.
- You have almost no interest or pleasure in many activities nearly every day.
- You think often about death or suicide (not just a fear of death).
- You feel restless or slowed down.
- You’ve lost or gained weight.
You may also:
- Feel cranky and restless
- Lose pleasure in life
- Overeat or stop feeling hungry
- Have aches, pains, headaches, cramps, or digestive problems that don’t go away or get better with treatment
- Have sad, anxious, or "empty" feelings
While these symptoms are common, not everyone with depression will have the same ones. How severe they are, how often they happen, and how long they last can vary.
Your symptoms may also happen in patterns. For example, depression may come with a change in seasons (a condition formerly called seasonal affective disorder).
It's not uncommon for people with depression to have physical signs of the condition. They may include joint pain, back pain, digestive problems, sleep trouble, and appetite changes. You might have slowed speech and movements, too. The reason is that brain chemicals linked to depression, specifically serotonin and norepinephrine, play a role in both mood and pain.
Depression in Children
Childhood depression is different from the normal "blues" and everyday emotions most kids feel. If your child is sad, it doesn’t necessarily mean they have depression. It's when the sadness stays day after day that depression may be an issue. Disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life may also be signs of a problem.
Depression in Teens
A lot of teens feel unhappy or moody. When the sadness lasts for more than 2 weeks and a teen has other symptoms of depression, there may be a problem. Watch for withdrawal from friends and family, a drop in their performance at school, or use of alcohol or drugs. Talk to your doctor and find out if your teen may be depressed. There is effective treatment that can help teens move beyond depression as they grow older.
Doctors haven’t pinpointed exact causes for depression. They think it may be a combination of things, including:
- Brain structure. People with depression seem to have physical differences in their brains from people who don’t have depression.
- Brain chemistry. Chemicals in your brain called neurotransmitters play a part in your mood. When you have depression, it could be because these chemicals aren’t working the way they should.
- Hormones. Your hormone levels change because of pregnancy, postpartum issues, thyroid problems, menopause, or other reasons. That can set off depression symptoms.
- Genetics. Researchers haven’t yet found the genes that might be responsible for depression, but you’re more likely to have depression if someone you’re related to has it.
Types of Depression
There are a few types of depressive disorders that doctors can diagnose, including:
- Unipolar major depression
- Persistent depressive disorder, also called dysthymia, when depression lasts for at least 2 years
- Disruptive mood dysregulation disorder, when children and teens get very cranky, angry, and often have intense outbursts that are more severe than a child’s typical reaction
- Premenstrual dysphoric disorder, when a woman has severe mood problems before her period, more intense than typical premenstrual syndrome (PMS)
- Substance-induced mood disorder (SIMD), when symptoms happen while you’re taking a drug or drinking alcohol or after you stop
- Depressive disorder due to another medical condition
- Other depressive disorders, such as minor depression
Your depression may have other specific features, such as:
- Anxious distress. You worry a lot about things that might happen or about losing control.
- Mixed features. You have both depression and mania -- periods of high energy, talking too much, and high self-esteem.
- Atypical features. You can feel good after happy events, but you also feel hungrier, need to sleep a lot, and are sensitive to rejection.
- Psychotic features. You believe things that aren’t true, or see and hear things that aren’t there.
- Catatonia. You can’t move your body normally. You might be still and unresponsive or have uncontrollable movements.
- Peripartum depression. Your symptoms begin during pregnancy or after giving birth.
- Seasonal pattern. Your symptoms get worse with changes in the seasons, especially the colder, darker months.
What Illnesses Happen With Depression?
It’s common for people to have other medical or mental health problems along with depression, such as anxiety, obsessive compulsive disorder, panic disorder, phobias, substance use disorders, and eating disorders. If you or a loved one has symptoms of depression or another mental illness, talk to your doctor. Treatments can help.
Depression and Suicide
Anybody who thinks or talks about harming themselves should be taken very seriously. Do not hesitate to call your local suicide hotline right away. Call 800-SUICIDE (800-784-2433); 800-273-TALK (800-273-8255); or, for the hotline for the hearing impaired, call 800-799-4889. Or contact a mental health professional ASAP. If you intend or have a plan to commit suicide, go to the emergency room right away.
Warning signs include:
- Thoughts or talk of death or suicide
- Thoughts or talk of self-harm or harm to others
- Aggressive behavior or impulsiveness
Watch for these signs if your child or teen starts taking antidepressants. In some cases, people under 25 may have more suicidal thoughts in the first weeks of taking these medicines or when they take a different dose.
In order to diagnose you with depression, your doctor will use several methods, including:
- Physical exam. Your doctor will check on your overall health to see if you might be dealing with another condition.
- Lab tests. For example, you may have bloodwork done to check on certain hormone levels.
- Psychiatric evaluation. Your doctor will be interested in your mental health and will ask about your thoughts, feelings, and behavior patterns. You may also fill out a questionnaire.
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The American Psychiatric Association lists the criteria for depression in this manual. Your doctor may check your symptoms against it to see if you fit the standard.
If you or someone you know has symptoms of the condition, talk to your doctor. They can evaluate you and offer you treatment or refer you to a mental health professional.
The type of treatment your doctor recommends will depend on your symptoms and how severe they are. You may need one or more of the following:
- Medication. Antidepressant medications (in combination with therapy) are effective for most people with depression. There are many types of antidepressants. You may have to try several kinds before you find the one that works best for you. You may need a combination of two. Or your doctor may also prescribe another type of medication to help your antidepressant work best, such as a mood stabilizer, antipsychotic, anti-anxiety medication, or stimulant medication.
- Psychotherapy. Talking to a mental health professional on a regular basis about your depression and other issues can help treat the symptoms. Different methods are available, including cognitive behavioral therapy (CBT) and talk therapy.
- Hospital or residential treatment. If your depression is severe enough that you’re having trouble taking care of yourself or may harm yourself or others, you may need psychiatric treatment in a hospital or residential facility.
- Electroconvulsive therapy (ECT). This brain stimulation therapy passes electric currents through your brain to help your neurotransmitters work better. Typically, you wouldn’t use this therapy unless antidepressants aren’t working or you can’t take them for other health reasons.
- Transcranial magnetic stimulation (TMS). Your doctor typically suggests this only after antidepressants haven’t worked. This treatment uses a coil to send magnetic pulses through your brain to help stimulate nerve cells that regulate mood.