Everything You Need to Know About Depression (Major Depressive Disorder)

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Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities.

It’s also fairly common. Data from the Centers for Disease Control and Prevention estimates that 18.5 percent of American adults had symptoms of depression in any given 2-week period in 2019.

Though depression and grief share some features, depression is different from grief felt after losing a loved one or sadness felt after a traumatic life event. Depression usually involves self-loathing or a loss of self-esteem, while grief typically does not.

In grief, positive emotions and happy memories of the deceased typically accompany feelings of emotional pain. In major depressive disorder, the feelings of sadness are constant.

Almost two-thirds of that $3.3 trillion cost – 64% – is paid for by American tax dollars, and that amount is growing. A study by the American Journal of Public Health predicts that taxpayers will shoulder 67.3% of the burden of healthcare costs by the year 2024, Physicians for a National Health Program

People experience depression in different ways. It may interfere with your daily work, resulting in lost time and lower productivity. It can also influence relationships and some chronic health conditions.

Conditions that can get worse due to depression include:

It’s important to realize that feeling down at times is a normal part of life. Sad and upsetting events happen to everyone. But if you’re feeling down or hopeless on a regular basis, you could be dealing with depression.

Depression is considered a serious medical condition that can get worse without proper treatment.

Depression can be more than a constant state of sadness or feeling “blue.”

Major depression can cause a variety of symptoms. Some affect your mood and others affect your body. Symptoms may also be ongoing or come and go.

General signs and symptoms

Not everyone with depression will experience the same symptoms. Symptoms can vary in severity, how often they happen, and how long they last.

If you experience some of the following signs and symptoms of depression nearly every day for at least 2 weeks, you may be living with depression:

feeling sad, anxious, or “empty”
feeling hopeless, worthless, and pessimistic
crying a lot
feeling bothered, annoyed, or angry
loss of interest in hobbies and interests you once enjoyed
decreased energy or fatigue
difficulty concentrating, remembering, or making decisions
moving or talking more slowly
difficulty sleeping, early morning awakening, or oversleeping
appetite or weight changes
chronic physical pain with no clear cause that does not get better with treatment (headaches, aches or pains, digestive problems, cramps)
thoughts of death, suicide, self-harm, or suicide attempts

The symptoms of depression can be experienced differently among males, females, teens, and children.

Males may experience symptoms related to their:

mood, such as anger, aggressiveness, irritability, anxiousness, or restlessness
emotional well-being, such as feeling empty, sad, or hopeless
behavior, such as loss of interest, no longer finding pleasure in favorite activities, feeling tired easily, thoughts of suicide, drinking excessively, using drugs, or engaging in high-risk activities
sexual interest, such as reduced sexual desire or lack of sexual performance
cognitive abilities, such as inability to concentrate, difficulty completing tasks, or delayed responses during conversations
sleep patterns, such as insomnia, restless sleep, excessive sleepiness, or not sleeping through the night
physical well-being, such as fatigue, pains, headache, or digestive problems

Females may experience symptoms related to their:

mood, such as irritability
emotional well-being, such as feeling sad or empty, anxious, or hopeless
behavior, such as loss of interest in activities, withdrawing from social engagements, or thoughts of suicide
cognitive abilities, such as thinking or talking more slowly
sleep patterns, such as difficulty sleeping through the night, waking early, or sleeping too much
physical well-being, such as decreased energy, greater fatigue, changes in appetite, weight changes, aches, pain, headaches, or increased cramps

Children may experience symptoms related to their:

mood, such as irritability, anger, rapid shifts in mood, or crying
emotional well-being, such as feelings of incompetence (e.g., “I can’t do anything right”) or despair, crying, or intense sadness
behavior, such as getting into trouble at school or refusing to go to school, avoiding friends or siblings, thoughts of death or suicide, or self-harm
cognitive abilities, such as difficulty concentrating, decline in school performance, or changes in grades
sleep patterns, such as difficulty sleeping or sleeping too much
physical well-being, such as loss of energy, digestive problems, changes in appetite, or weight loss or gain

There are several possible causes of depression. They can range from biological to circumstantial.

Brain chemistry. There may be a chemical imbalance in parts of the brain that manage mood, thoughts, sleep, appetite, and behavior in people who have depression.
Hormone levels. Changes in female hormones estrogen and progesterone during different periods of time like during the menstrual cycle, postpartum period, perimenopause, or menopause may all raise a person’s risk for depression.
Family history. You’re at a higher risk for developing depression if you have a family history of depression or another mood disorder.
Early childhood trauma. Some events affect the way your body reacts to fear and stressful situations.
Brain structure. There’s a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms.
Medical conditions. Certain conditions may put you at higher risk, such as chronic illness, insomnia, chronic pain, Parkinson’s disease, stroke, heart attack, and cancer.
Substance use. A history of substance or alcohol misuse can affect your risk.
Pain. People who feel emotional or chronic physical pain for long periods of time are significantly more likely to develop depression.

Risk factors

Risk factors for depression can be biochemical, medical, social, genetic, or circumstantial. Common risk factors include:

Sex. The prevalence of major depression is twice as high in females as in males.
Genetics. You have an increased risk of depression if you have a family history of it.
Socioeconomic status. Socioeconomic status, including financial problems and perceived low social status, can increase your risk of depression.
Certain medications. Certain drugs including some types of hormonal birth control, corticosteroids, and beta-blockersmay be associated with an increased risk of depression.
Vitamin D deficiency.Studies have linked depressive symptoms to low levels of vitamin D.
Gender identity. The risk of depression for transgender people is nearly 4-fold that of cisgender people, according to a 2018 study.
Substance misuse. About 21 percent of people who have a substance use disorder also experience depression.
Medical illnesses. Depression is associated with other chronic medical illnesses. People with heart disease are about twice as likely to have depression as people who don’t, while up to 1 in 4 people with cancer may also experience depression.

Medications

Your healthcare professional may prescribe:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most commonly prescribed antidepressant medications and tend to have few side effects. They treat depression by increasing the availability of the neurotransmitter serotonin in your brain.

SSRIs should not be taken with certain drugs including monoamine oxidase inhibitors (MAOIs) and in some cases thioridazine or Orap (pimozide).

People who are pregnant should talk to their healthcare professionals about the risks of taking SSRIs during pregnancy. You should also use caution if you have narrow-angle glaucoma.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs treat depression by increasing the amount of the neurotransmitters serotonin and norepinephrine in your brain.

SNRIs should not be taken with MAOIs. You should use caution if you have liver or kidney problems, or narrow-angle glaucoma.

Examples of SNRIs include desvenlafaxine (Pristiq, Khedezla), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), and venlafaxine (Effexor XR).

Tricyclic and tetracyclic antidepressants

Tricyclic antidepressants (TCAs) and tetracyclic antidepressants (TECAs) treat depression by increasing the amount of the neurotransmitters serotonin and norepinephrine in your brain.

TCAs can cause more side effects than SSRIs or SNRIs. Do not take TCAs or TECAs with MAOIs. Use with caution if you have narrow-angle glaucoma.

Examples of tricyclic antidepressants include amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), desipramine (Norpramin), nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).

Atypical antidepressants

Noradrenaline and dopamine reuptake inhibitors (NDRIs)

These drugs can treat depression by increasing the levels of dopamine and noradrenaline in your brain.

Monoamine oxidase inhibitors (MAOIs)

MAOIs treat depression by increasing the levels of norepinephrine, serotonin, dopamine, and tyramine in your brain.

Due to side effects and safety concerns , MAOIs are not the first choice for treating mental health disorders. They are typically used only if other medications are unsuccessful at treating depression.

Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate).

N-methyl D-aspartate (NMDA) antagonists

N-methyl-D-aspartate (NDMA) antagonists treat depression by increasing levels of glutamate in the brain. Glutamate is a neurotransmitter believed to be involved in depression.

NMDA antagonists are used only in patients who have not had success with other antidepressant treatments.

The FDA has approved one NDMA medication, esketamine (Spravato), for the treatment of depression.

Esketamine is a nasal spray that is only available through a restricted program called Spravato REMS.

Patients may experience tiredness and dissociation (difficulty with attention, judgment, and thinking) after taking the medication. For this reason, esketamine is administered in a healthcare setting where a healthcare professional can monitor for sedation and dissociation.

Psychotherapy

Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.

Psychotherapy, also known as “talk therapy,” is when a person speaks to a trained therapist to identify and learn to cope with the factors that contribute to their mental health condition, such as depression.

Psychotherapy has been shown to be an effective treatment in improving symptoms in people with depression and other psychiatric disorders.

Psychotherapy is often used alongside pharmaceutical treatment. There are many different types of psychotherapy, and some people respond better to one type than another.

Cognitive behavioral therapy (CBT)

In cognitive behavioral therapy (CBT), a therapist will work with you to uncover unhealthy patterns of thought and identify how they may be causing harmful behaviors, reactions, and beliefs about yourself.

Your therapist might assign you “homework” where you practice replacing negative thoughts with more positive thoughts.

Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT) is similar to CBT, but puts a specific emphasis on validation, or accepting uncomfortable thoughts, feelings, and behaviors, instead of fighting them.

The theory is that by coming to terms with your harmful thoughts or emotions, you can accept that change is possible and make a recovery plan.

Psychodynamic therapy

Psychodynamic therapy is a form of talk therapy designed to help you better understand and cope with your day-to-day life. Psychodynamic therapy is based on the idea that your present-day reality is shaped by your unconscious, childhood experiences.

In this form of therapy, your therapist will help you reflect and examine your childhood and experiences to help you understand and cope with your life.

Looking for ways to support your mental health and well-being? Try Austra Health’s FindCare tool to connect with mental health professionals nearby or virtually so you can get the care you need.

Light therapy

Exposure to doses of white light can help regulate your mood and improve symptoms of depression. Light therapy is commonly used in seasonal affective disorder, which is now called major depressive disorder with seasonal pattern.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) uses electrical currents to induce a seizure, and has been shown to help people with clinical depression. It’s used in people with severe depression or depression that is resistant to other treatments or antidepressant medications.

During an ECT procedure, you’ll receive an anesthetic agent which will put you to sleep for approximately 5 to 10 minutes.

Your healthcare professional will place cardiac monitoring pads on your chest and four electrodes on specific areas of your head. They will then deliver short electrical pulses for a few seconds. You will neither convulse nor feel the electrical current and will awaken about 5 to 10 minutes after treatment.

Side effects include headaches, nausea, muscle aches and soreness, and confusion or disorientation.

Patients may also develop memory problems, but these usually reside in the weeks and months after treatment

Alternative therapies

Ask your doctor about alternative therapies for depression. Many people choose to use alternative therapies alongside traditional psychotherapy and medication. Some examples include:

Meditation. Stress, anxiety, and anger are triggers of depression, but meditation can help change the way your brain responds to these emotions. Studies show that meditation practices can help improve symptoms of depression and lower your chances of a depression relapse.

Acupuncture.Acupuncture is a form of traditional Chinese medicine that may help ease some symptoms of depression. During acupuncture, a practitioner uses needles to stimulate certain areas in the body in order to treat a range of conditions. Research suggests that acupuncture may help clinical treatments work better and may be as effective as counseling.

Exercise

Aim for 30 minutes of physical activity 3 to 5 days a week. Exercise can increase your body’s production of endorphins, which are hormones that improve your mood.

Avoid alcohol and substance use

Drinking alcohol or misusing substances may make you feel better for a little bit. But in the long run, these substances can make depression and anxiety symptoms worse.

Learn how to set limits

Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.

Take care of yourself

You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.

Sometimes depression doesn’t respond to medication. Your healthcare professional may recommend other treatment options if your symptoms don’t improve.

Supplements

Several types of supplements may have some positive effect on depression symptoms.

S-adenosyl-L-methionine (SAMe)

Some research suggests this compound may ease symptoms of depression. The effects were best seen in people taking SSRIs. However, the results of this research is not conclusive and more research is needed.

5-hydroxytryptophan (5-HTP)

5-HTP may raise serotonin levels in the brain, which could ease symptoms. Your body makes this chemical when you consume tryptophan, a building block of protein. However, more studies are needed.

Omega-3 fatty acids

These essential fats are important to neurological development and brain health. Adding omega-3 supplements to your diet may help reduce depression symptoms. However, there is some conflicting evidence and more research is needed.

Always talk to your doctor before taking supplements, as they may interact with other medications or have negative effects.

Vitamins

Vitamins are important to many bodily functions. Research suggests two vitamins are especially useful for easing symptoms of depression:

Vitamin B: B-12 and B-6 are vital to brain health. When your vitamin B levels are low, your risk for developing depression may be higher.
Vitamin D: Sometimes called the sunshine vitamin, vitamin D is important for brain, heart, and bone health. There may be a link between vitamin D deficiency and depression, but more research is needed.

Many herbs, supplements, and vitamins claim to help ease symptoms of depression, but most haven’t shown themselves to be effective in clinical research.

There isn’t a single test to diagnose depression. But your healthcare provider can make a diagnosis based on your symptoms and a psychological evaluation.

In most cases, they’ll ask a series of questions about your:

moods
appetite
sleep pattern
activity level
thoughts

Because depression can be linked to other health problems, your healthcare professional may also conduct a physical examination and order blood work. Sometimes thyroid problems or a vitamin D deficiency can trigger symptoms of depression.

It’s important not to ignore symptoms of depression. If your mood doesn’t improve or gets worse, seek medical help. Depression is a serious mental health illness with the potential for complications.

If left untreated, complications can include :

weight gain or loss
physical pain
substance use disorder
panic attacks
relationship problems
social isolation
thoughts of suicide
self-harm

Depression can be broken into categories depending on the severity of symptoms. Some people experience mild and temporary episodes, while others experience severe and ongoing depressive episodes.

There are two main types: major depressive disorder and persistent depressive disorder.

Major depressive disorder

Major depressive disorder (MDD) is the more severe form of depression. It’s characterized by persistent feelings of sadness, hopelessness, and worthlessness that don’t go away on their own.

In order to be diagnosed with clinical depression, you must experience five or more of the following symptoms over a 2-week period:

feeling depressed most of the day
loss of interest in most regular activities
significant weight loss or gain
sleeping a lot or not being able to sleep
slowed thinking or movement
fatigue or low energy most days
feelings of worthlessness or guilt
loss of concentration or indecisiveness
recurring thoughts of death or suicide

There are different subtypes of major depressive disorder, which the American Psychiatric Association refers to as “specifiers.”

atypical features
anxious distress
mixed features
peripartum onset, during pregnancy or right after giving birth
seasonal patterns
melancholic features
psychotic features
catatonia

Persistent depressive disorder

Persistent depressive disorder (PDD) used to be called dysthymia. It’s a milder, but chronic, form of depression.

In order for the diagnosis to be made, symptoms must last for at least 2 years . PDD can affect your life more than major depression because it lasts for a longer period.

It’s common for people with PDD to:

lose interest in normal daily activities
feel hopeless
lack productivity
have low self-esteem

Depression can be treated successfully, but it’s important to stick to your treatment plan.

Living with depression can be difficult, but treatment can help improve your quality of life. Talk to your healthcare professional about possible options.

The Austra Health FindCare tool can provide options in your area if you don’t already have a doctor.

Postpartum depression

Postpartum depression refers to depression that happens after childbirth. It is a common disorder after pregnancy, affecting 1 in 9 new parents .

It’s common for people to experience “baby blues,” or feelings of sadness or emptiness after childbirth. For many people, these symptoms go away in a couple of days.

But if you feel sad, hopeless, or empty for longer than 2 weeks post-childbirth, you may have postpartum depression.

Symptoms of postpartum depression can range from mild to severe and can include :

feeling restless or moody
feeling sad, hopeless, or overwhelmed
having thoughts of hurting the baby or yourself
not having an interest in the baby, feeling disconnected, or as if your baby is someone else’s
having no energy or motivation
eating too little or too much
sleeping too little or too much
having trouble focusing
having memory problems
feeling worthless, guilty, or like a bad parent
withdrawing from activities you once enjoyed
withdrawing from friends and family
having headaches, aches, or stomach issues that don’t go away
feeling empty, unconnected, or as though you might not love or care for the baby