Depression

Many people feel sadness or mild depression in certain situations and circumstances. For a diagnosis of major depressive disorder to be made, a qualified health professional must:

• evaluate the symptoms and course of the illness over a period of at least two weeks
• rule out causes by other medical conditions, other psychiatric disorders, substance use, and grief in response to a significant loss

Symptoms of depression include:

• feelings of sadness, loneliness, or emptiness that last most of the day for several days on end
• loss of interest or pleasure in activities that used to be enjoyable (anhedonia)
• tiredness and chronic low energy
• difficulty thinking clearly, concentrating, making decisions or remembering
• feelings of worthlessness and guilt
• feelings of irritability, frustration or anger that are out of proportion with the circumstances
• restlessness and agitation
• sleep disturbances, including sleeping too much and sleeping too little (insomnia)
• change of appetite, most often leading to loss of weight, though some people may have increased appetite and weight gain
• Recurrent thoughts of death or suicide, as well as suicide attempts or plans

Major depression belongs to the category of mental health conditions known as mood disorders. These disorders affect a person’s mood, causing it to be consistently lower (depression and related disorders), or sometimes lower and sometimes higher (bipolar and related disorders). In children and adolescents, the mood may be irritable rather than sad.

Types of Mood Disorders

Major Depressive Disorder – what most people think of as clinical depression (see above).

Persistent Depressive Disorder (formerly “dysthymia”) – continuous long-term depression that lasts for two years or longer.

Seasonal Affective Disorder (SAD) – a period of major depression that usually occurs during winter months when days are shorter. SAD is a potential feature of major depressive disorder and is not considered a separate diagnosis.

Postpartum Depression (PPD) – an episode of major depression that occurs in some women following childbirth.  About half of all cases of PPD actually begin before childbirth. Like SAD, PPD is a feature of major depressive disorder.

Bipolar Disorder (formerly “manic depression”) – a serious disorder involving major mood swings that include emotional highs (mania or hypomania) and lows (depression). Although people diagnosed with bipolar disorder may at times experience severe depression, the treatment for bipolar is very different from that for major depressive disorder.

“Situational” Depression – not a formal diagnosis, feature or disorder, but commonly used to describe the depressed mood or sadness many people feel when dealing with a stressful life event, such as a death in the family, divorce, or sudden unemployment.

Depression and depression-like symptoms can also be caused by or linked to substance use or withdrawal, menstruation in women, use of some medications, or the physical effects of a medical condition.

Major depression and related disorders are frequently seen with other mental health conditions, known as co-occurring disorders. The most frequent are: anxiety disorders, substance use disorders, eating disorders and medical illnesses such as cancer, diabetes and Alzheimer’s syndrome.

True depression is a medical condition and a person who has it cannot get better by simply “snapping out of it” or by having a better attitude. Depression can occur at any age. It is most common in adults aged 25-44, with a median age of onset of 32. Major depression is a serious mental health problem that has the potential to be a disabling condition. It also carries a higher risk of suicide. The good news is that there are many effective treatments that offer a range of options to the person affected.

Major depression usually occurs in episodes which can last for 3-12 months. Many people experience several episodes before they seek help. Early intervention results in better outcomes and a lessened chance of developing a lifelong disability. For this reason it is better to seek treatment as soon as the first symptoms appear.

Depression is most often treated with psychotherapy or medication, frequently together. Other treatments, such as Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) may be helpful for some people who do not respond to more typical treatments. Although people diagnosed with bipolar disorder may at times experience severe depression, the treatment for bipolar is very different from that for major depressive disorder. The following treatments and supportive services may be helpful to a person with major depression:

Treatments
Cognitive Behavior Therapy
Dialectical Behavior Therapy
Electroconvulsive Therapy (ECT)
Light Therapy (for SAD)
Medication
Transcranial Magnetic Stimulation (TMS)

Complementary and Supportive Services
Medication Management/Monitoring
Mindfulness Meditation
Peer Support
Psychoeducation
Psychosocial Rehabilitation
Self-management Strategies
Supported Employment
Supported Education
Supportive Housing

Our Directory of Family-Endorsed Providers features private practitioners and organizations offering treatment and supportive services for people living with depression. Please consult our Family-Endorsed Providers page for more information on these providers and how to initiate a referral for services.

It can be deeply distressing to watch a loved one in depression, especially if that person is a child, teen or young adult. Our culture tends to think of childhood and adolescence as happy, carefree times of life, free of worry from the problems of the world. This makes it easy for families, as well as educators and other professionals, to overlook the signs of depression in a young person. It is also possible to confuse signs of depression in young people, as their mood may seem more irritable than sad.

Depression carries an increased risk of suicide. Family and friends should be aware of the risk factors and warning signs, and never dismiss or ignore a depressed person’s thoughts or words on the subject of suicide.

Symptoms of depression can resemble those of a substance use problem, and in fact the two are often linked. Knowing the symptoms and signs of both and understanding how they interact as co-occurring disorders can aid treatment, care, and recovery.

Severe depression has the potential to be a disabling condition. However, most cases of depression occur in episodes lasting 2-3 months. Many people with depression lead happy, active, fulfilling lives in the periods between episodes. Medication, psychotherapy and healthy self-care practices can lessen the impact and severity of episodes when they do occur.

Many notable and famous people have led highly productive, celebrated lives while living with depression, as featured in our post on Living Well With Depression.