What is depression?

Depression is one of the most prevalent mood disorders. It affects how you feel, think and behave. And if left untreated, it can influence your ability to function in school, work or relationships. Depression is more than just feeling sad. Life events may trigger depression, but there is a clinical distinction between temporary negative feelings and diagnosable depression. 

According to the National Institute of Mental Health, an estimated 14.8 million US adults experienced at least one major depressive disorder with severe impairment in 2020. The true number of people with clinical depression may be higher, as 60% of people don't seek medical treatment for depression.

So how do you tell the difference between depression and grief? The topic can quickly become complex, with various nuances that can make it difficult to get help. We'll go through the causes, subsets and treatment options for depression in this all-in-one guide. 

Read more: 5 Best Online Psychiatry Services

What are the causes and risk factors for depression?

There is no single cause of depression. Various risk factors have been identified as contributors to clinical depression. When there are several risk factors, the likelihood of developing depression increases. 

• Genetics: A family history of depression does make a person more likely to develop depression, according to the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. 
  
• Environmental factors: Past trauma or abuse are triggers that can contribute to the development of depression. Major life events and stressors can also serve as triggers for the development of depression. These events can include but are not limited to: loss of a loved one, financial troubles, caregiver burden and interpersonal difficulties. 
  
• Neurotransmitter disruption in the brain: Understanding of the biochemical factor in depression is not fully understood. Experts believe another potential cause of depression is a disruption of neurotransmitters like serotonin, norepinephrine and dopamine in the brain. Neurotransmitters are what the brain's nerve cells use to communicate with each other. Each neurotransmitter carries a different message. Serotonin and dopamine play a role in mood regulation. Norepinephrine is a part of the fight-or-flight response.
  
• Alcohol and drug abuse: One study found that anywhere from 12% to 80% of those with substance issues also have depression. 
  
• Medical conditions: Depression is often comorbid with other medication conditions. Medications or limitations due to the condition can contribute to the development of depression.
  

Additionally, women are more likely to develop depression than men, according to the Centers for Disease Control and Prevention. However, this disparity in depression levels may be partly due to the difference in reporting. A 2021 study concluded that females are more likely to report symptoms of depression than males. A National Health and Nutrition study found that 5.5% of men report symptoms, while 10.4% of women do. Note that this study was based on self-reported data. More research is needed to fully explore the differences. 

There are also racial differences in depression rates. While white Americans tend to report higher initial levels of acute depression than Black Americans, 56% of Black Americans experience chronic depression compared to 38.6% of people who are white. Treatment rates are also lower in BIPOC populations potentially due to stigma and lack of access to treatment. 

In addition to risk factors for depression, some triggers can contribute to a depressive episode. Common triggers for depression include but are not limited to:

• Stressful life events like the loss of a family member, loss of a job or significant relationship changes
  
• A diagnosis of a medical condition
• Previous incomplete treatments for depression 

Read more: 5 Online Therapy Services to Fight Depression and Anxiety

Common signs of depression

Risk factors are just that. Genetic predispositions or having a medical condition doesn't mean you'll experience depression. Quite honestly, it can be hard to differentiate sadness from something more serious. Use these signs and symptoms to help you identify if you may have depression. Note that symptoms will vary and can range from mild to severe. Everyone's experience will differ, there is no one-size-fits-all definition for how depression looks. However, general themes emerge.  

Here are the common signs and symptoms of depression:

• Atypical levels of irritability or anger for you
  
• Difficulty concentrating 
  
• Loss of interest in activities you once enjoyed 
  
• Feelings of sadness or consistent low mood
  
• Sleep troubles -- both insomnia and sleeping too much 
  
• Feelings of fatigue or having no energy
  
• Loss of appetite
  
• Thoughts of self-harm or suicide
  

To be diagnosed with clinical depression, symptoms must persist for at least two weeks and impede your ability to function in your daily life. According to the DSM-5, a major depressive disorder diagnosis comes after five of the nine main clinical symptoms of depression are experienced. The duration of symptoms will vary, from a few weeks, months to even years. 

It's worth noting that the symptoms of depression overlap with other conditions, like vitamin deficiencies or thyroid issues, so it's essential to seek medical treatment to confirm a diagnosis. Depression symptoms can also overlap with other conditions like anemia, infection, sleep disorders, neurological disorders and side effects due to medications.

What are the different types of depression?

There are several subtypes of depression. Which type developed is dependent on the specific experiences and circumstances you experience.  

• Major depressive disorder: MDD is marked by persistent depressed mood, loss of interest in pleasurable activities, difficulty concentrating, lack of energy, appetite changes, sleep disturbances, feelings of guilt or worthlessness, psychomotor agitation or suicidal thoughts. They must be persistent for at least two weeks and impede your ability to function to be considered a major depressive disorder.
  
• Persistent depressive disorder (dysthymia): With this type of depression, less severe symptoms are experienced over longer periods. Generally, a two-year minimum is considered persistent depressive disorder. An estimated 3% of people have dysthymia. 
• Perinatal and postpartum depression: These types of depression coincide with pregnancy and the related hormone changes. Perinatal depression is during pregnancy and postpartum after giving birth. Mothers with perinatal depression experience mood changes and feelings of worry. They may even withdraw from their family and baby. Between 6.5% and 20% of women develop postpartum depression. 
• Seasonal affective disorder: As the name suggests, seasonal affective disorder varies with the seasons. Generally, it's common to experience depression through the fall and winter, when the days are shorter, though it can vary.
• Premenstrual dysphoric disorder: PMDD is a cyclical pattern of mood, behavior and physical indications that happens a week or two before menstruation. It typically goes away once menstruation begins. For most women, symptoms do not interfere with their lives. However, 5% to 8% of women have moderate to severe symptoms that affect their ability to function.
• Psychotic depression: Psychotic depression is a form of major depressive disorder with features like hallucinations, delusions or paranoia. 

How is depression treated? 

There's no cure for depression. It's an ongoing disorder, though treatable, with up to 90% of people eventually responding to treatment. Treatment is an ongoing journey, and remission is the goal. Relapses do happen. 

Feeling comfortable with your treatment plan and feeling empowered to advocate for yourself when things aren't working is essential. Depression treatment is a marathon, not a sprint. You should expect treatment to evolve and change as your life does. Even severe depression is treatable. However, seeking treatment as early as possible will often yield the most effective results. 

Psychotherapy 

Also known as talk therapy, psychotherapy is one of the main treatment options for mild depression. Cognitive behavioral therapy is an effective way to treat depression. CBT is built on the concept that what you feel, think and do depend on each other. By working through CBT, you can begin to recognize negative thinking and change the way you perceive and interpret situations. Cognitive behavioral therapy for depression may happen on an individual basis or may include family members or partners. 

Medication

For moderate or severe depression, medication is used in addition to therapy. Antidepressants are an extremely effective way to manage the symptoms of depression by redirecting how the brain uses essential neurotransmitters like serotonin, dopamine and norepinephrine. The brain uses these chemical messengers to pass signals between nerve cells. When there is an imbalance, the signals can't be passed correctly. Antidepressants increase the amount available in the brain. How this is done varies by medication. 

The most commonly used antidepressants are:

• Selective serotonin reuptake inhibitors
  
• Selective serotonin noradrenaline reuptake inhibitors
  
• Tricyclic antidepressants (least likely to be prescribed)
  

Within six to eight weeks, between 40% and 60% of people with moderate to severe depression notice an improvement after taking antidepressants. 

There are several different medication options available for depression. So you should expect it to take time to find which medication and dosage work best for you. It usually takes four to eight weeks before you fully feel the effects of the antidepressant and symptoms decrease. Remember, it's essential to keep taking your medications until you speak with your doctor. Stopping them without medical recommendations can result in withdrawals and the return of symptoms.

Electroconvulsive therapy

Electroconvulsive therapy is a form of electrical brain stimulation therapy. While it's generally not the first treatment option for depression, it's effective at treating severe major depression that's not responding to therapy and medication, or instances where immediate action is necessary. Advances in ECT devices and practices make it a safe and painless process. 

ECT is a medical procedure performed while the patient is under anesthesia and is often an outpatient procedure. Sessions are typically two to three times each week, for roughly two to four weeks. Side effects associated with ECT are memory loss, confusion and disorientation. In most cases, the side effects are short-term. However, memory problems may linger for the months following the procedure. 

Repetitive transcranial magnetic stimulation

rTMS is another procedure used if the patient doesn't respond to medications. It has become a widely used outpatient brain stimulation treatment. With rTMS, magnets are used to activate specific parts of the brain, which allows rTMS to carry only mild side effects. It's a noninvasive procedure that doesn't require anesthesia as ECT does. 

Tips to manage depression symptoms 

There's no way to prevent or cure depression. However, you can do things in addition to your treatment plan to manage depression symptoms in your daily life. 

• Make time for self-care: Whether it be a bubble bath or meditation, self-care is crucial to managing depression. Find time for things you enjoy and accept when you need to step away from stressful situations. 
  
• Set realistic goals: When living with depression, you must set realistic goals. This will keep things from becoming too overwhelming. Try breaking things down into smaller tasks to ensure you can achieve your goals at the pace you can manage. 
  
• Exercise regularly: Depression can sometimes zap your motivation to do things, especially exercise. However, exercise can increase your energy levels and improve your moods. Rhythmic exercises like walking, swimming and weight training are great options for those with depression. 
  
• Get enough sleep: Sleep problems commonly exacerbate depression and mood symptoms. Having a sleeping disorder doesn't mean you'll have depression. However, establishing good sleep habits ensures your body gets the rest and restoration it needs. 
  
• Eat well: Alcohol, caffeine and fatty foods directly impact how you feel. By being mindful of what you eat, you can reduce foods that impact your mood or brain. 
  
• Ask for and accept help: An integral part of managing depression is recognizing symptoms early on. Asking for help is an important part of this process. Whether asking family members for help or establishing boundaries with friends, it's essential to establish communication about your experiences and needs. 
  

Read more: Best Mental Health Apps 

When to get help for depression

Depression is a common and highly treatable mood disorder -- if you get help. While making lifestyle changes and managing daily symptoms is essential, so is therapy. Therapies like cognitive behavioral therapy can help you identify and target negative thinking so you can ensure it doesn't influence how you perceive and respond to situations. In many cases, medications like antidepressants are also necessary to help stabilize moods and alleviate symptoms by targeting neurotransmitters in the brain.  

Getting help can seem daunting at first, and you may not know where to start. But it doesn't have to be. A great place to start is your primary care doctor, who will be able to recommend psychologists in your insurance network.

Read more: Tips to Find the Right Therapist For You

Online therapy is often more flexible and affordable if traditional in-office therapy isn't the best option for you. However, ensure you choose an option like Cerebral or Talkspace, which allows doctors to prescribe medications. Other options like BetterHelp cannot prescribe medications.

Depression resources

Read more: Talkspace vs. BetterHelp: Which Online Therapy Is Better?

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.