Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being. People with depressed mood can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable or restless. They may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present.
Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder, but it may also be a normal reaction to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments.
Clinical depression is more than just the "blues," being "down in the dumps," or experiencing temporary feelings of sadness we all have from time to time in our lives. It is a serious condition that affects a person's mind and body. It impacts all aspects of everyday life including eating, sleeping, working, relationships, and how a person thinks about himself/herself. People who are clinically depressed cannot simply will themselves to feel better or just "snap out of it." If they do not receive appropriate treatment their symptoms can continue for weeks, months, or years.
The good news is that very effective treatments are available to help those who are depressed. However, only about one-third of those who are depressed actually receive treatment. This is unfortunate since upwards of 80-90% of those who do seek treatment can feel better within just a few weeks. Many people do not seek treatment for depression for a variety of reasons. Some believe that depression is the result of a personal weakness or character flaw. This is simply not true. Like diabetes, heart disease, or any other medical condition, clinical depression is an illness that should be treated by a mental health professional or physician. Another reason why many people do not seek help for depression is that they simply do not recognize the signs or symptoms that something may be wrong.
Depression affects approximately 19 million Americans, or 9.5% of the population in any given one-year period. At some point in their lives, 10%-25% of women and 5%-12% of men will likely become clinically depressed. In fact, it affects so many people that it is often referred to as the "common cold" of mental illness. It is estimated that depression exacts an economic cost of over $30 billion each year, but the cost of human suffering cannot be measured. Depression not only causes suffering to those who are depressed, but it also causes great difficulty for their family and friends who often do not know how to help.
Types of Depression
Major Depressive Disorder
This illness impairs a person's ability to work, sleep, eat, and function as he or she normally would. It keeps people from enjoying activities that were once pleasurable, and causes them to think about themselves and the world in negative ways. Major depression is often disabling and may occur several times in a person's lifetime.
A milder yet more enduring type of major depression. People with dysthymia may appear to be chronically mildly depressed to the point that it seems to be a part of their personality. When a person finally seeks treatment for dysthymia, it is not uncommon that he/she has struggled with this condition for a number of years.
Also known as manic-depression or manic-depressive disorder. This condition is characterized by mood that alternates between periods of depression and periods of elation and excitable behavior known as mania (see symptoms below). For people who have bipolar disorder, the depressions can be severe and the mania can seriously impair one's normal judgment. When manic, a person is prone towards reckless and inappropriate behavior such as engaging in wild spending sprees or having promiscuous sex. He or she may not be able to realize the harm of his/her behavior and may even lose touch with reality.
A milder yet more enduring type of bipolar disorder. A person's mood alternates between a less severe mania (known as hypomania) and a less severe depression.
Mood Disorder Due to a General Medical Condition
Depression may be caused or precipitated by a known or unknown physical medical condition such as hypothyroidism.
Substance-Induced Mood Disorder
Depression may be caused or precipitated by the use or abuse of substances such as drugs, alcohol, medications, or toxins.
Seasonal Affective Disorder (SAD)
This condition affects people during specific times or seasons of the year. During the winter months individuals feel depressed and lethargic, but during other months their moods may be normal.
A rare form of depression occurring in women within approximately one week to six months after giving birth to a child.
Premenstrual Dysphoric Disorder
This is an uncommon type of depression affecting a small percentage of menstruating women. It is a cyclical condition in which women may feel depressed and irritable for one or two weeks before their menstrual period each month.
Symptoms of Depression
People who are depressed or manic may not experience all of the following symptoms. Some will have many symptoms, others will have just a few. The severity of the symptoms may also be different for every person and even vary over time. If you are experiencing some of these symptoms or if you have questions about whether you may be depressed or manic, you should consult with your physician or a qualified mental health professional. If you or someone you know is considering suicide, or has made plans to do so, you should seek the help of a mental health professional or physician immediately.
- Sadness, anxiety, or "empty" feelings
- Decreased energy, fatigue, being "slowed down"
- Loss of interest or pleasure in activities that were once enjoyed, including sex
- Insomnia, oversleeping, or waking much earlier than usual
- Loss of weight or appetite, or overeating and weight gain
- Feelings of hopelessness and pessimism
- Feelings of helplessness, guilt, and worthlessness
- Thoughts of death or suicide, or suicide attempts
- Difficulty concentrating, making decisions, or remembering
- Restlessness, irritability or excessive crying
- Chronic aches and pains or physical problems that do not respond to treatment
Symptoms of Mania
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
Most people have felt sad or depressed at times. Feeling depressed can be a normal reaction to loss, life's struggles, or an injured self-esteem.
But when feelings of intense sadness -- including feeling helpless, hopeless, and worthless -- last for many days to weeks and keep you from functioning normally, your depression may be something more than sadness. It may very well be clinical depression -- a treatable medical condition.
How Do I Know If I Have Depression?
According to the DSM-5, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following symptoms at the same time:
- A depressed mood during most of the day, particularly in the morning
- Fatigue or loss of energy almost every day
- Feelings of worthlessness or guilt almost every day
- Impaired concentration, indecisiveness
- Insomnia (an inability to sleep) or hypersomnia (excessive sleeping) almost every day
- Markedly diminished interest or pleasure in almost all activities nearly every day
- Recurring thoughts of death or suicide (not just fearing death)
- A sense of restlessness or being slowed down
- Significant weight loss or weight gain
A key sign of depression is either depressed mood or loss of interest in activities you once enjoyed. For a diagnosis of depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. In addition, the depressive symptoms need to cause clinically significant distress or impairment. They cannot be due to the direct effects of a substance, for example, a drug or medication. Nor can they be the result of a medical condition such as hypothyroidism.
Symptoms of Depression
According to the National Institute of Mental Health, people with depressive illnesses don't all experience the same symptoms. How severe they are, how frequent, and how long they last will vary depending on the individual and his or her particular illness. Here are common symptoms people with depression experience:
- Difficulty concentrating, remembering details, and making decisions
- Fatigue and decreased energy
- Feelings of guilt, worthlessness, and/or helplessness
- Feelings of hopelessness and/or pessimism
- Insomnia, early morning wakefulness, or excessive sleeping
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Loss of pleasure in life
- Overeating or appetite loss
- Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
- Persistent sad, anxious, or "empty" feelings
- Thoughts of suicide or suicide attempts
Symptoms of Depression continued...
While these are common symptoms of depression, they may also occur in patterns. For example, a person may experience depression with mania or hypomania -- a condition sometimes called manic depression or bipolar disorder. Or the symptoms may be seasonal as in the case of seasonal affective disorder.
There are several types of manic depression. People with bipolar II disorder have at least one episode of major depression and at least one hypomanic -- mild elation or high -- episode. People with bipolar I disorder have a history of at least one manic -- extreme elation or high -- episode, with or without past major depressive episodes. A patient with unipolar depression has major depression only and has never had a full hypomanic or manic episode. A new category, though, in the DSM-5 allows for the presence of some symptoms of mania or hypomania during a full depressive episode in someone who technically hasn't met the full criteria for bipolar disorder. That suggests the line between unipolar and bipolar disorder can sometimes be blurry..
Is Childhood Depression Common?
Childhood depression is different from the normal "blues" and everyday emotions that occur as a child develops. If your child is sad, this does not necessarily mean he or she has significant depression. It's when the sadness becomes persistent -- day after day -- that depression may be an issue. Or, if your child has disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life, it may indicate that he or she has a depressive illness.
Depression in Teens
It is common for teens to occasionally feel unhappy. However, when the unhappiness lasts for more than two weeks and the teen experiences other symptoms of depression, then he or she may be suffering from adolescent depression. Because as many as one in every 33 children and one in eight adolescents suffer with depression, talk to your doctor and find out if your teen may be depressed. There is effective treatment available to help teens move beyond depression as they grow older.
How Common Is Depression?
It is estimated that, by the year 2020, major depression will be second only to ischemic heart disease in terms of the leading causes of disability in the world. But people with depression sometimes fail to realize (or accept) that there is a physical cause to their depressed moods. As a result, they may search endlessly for external causes.
How Common Is Depression? continued...
In the U.S., about 14.8 million adults suffer from major depression, according to the National Institute of Mental Health. The suicide risk in people with this type of depression is the highest rate for any psychiatric condition. For people between the ages of 10 and 24, suicide is the third leading cause of death. Unfortunately, most people with clinical depression never seek treatment. Left undiagnosed and untreated, depression can worsen, lasting for years and causing untold suffering, and possibly suicide.
What Are the Warning Signs of Suicide?
Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 800-SUICIDE (800-784-2433) or 800-273-TALK (800-273-8255) -- or the deaf hotline at 1-800-4889. Or contact a mental health professional immediately.
Warning signs of suicide include:
- Thoughts or talk of death or suicide
- Thoughts or talk of self-harm or harm to others
- Aggressive behavior or impulsiveness
Previous suicide attempts increase the risk for future suicide attempts and completed suicide. All mention of suicide or violence must be taken seriously. If you intend or have a plan to commit suicide, go to the emergency room for immediate evaluation and treatment.
Are There Different Types of Depression?
There are a number of different types of depression including:
- Major depression
- Chronic depression (dysthymia)
- Bipolar depression
- Seasonal depression (SAD or seasonal affective disorder)
- Psychotic depression
- Postpartum depression
- Substance-induced mood disorder (SIMD)
Are There Other Types of Depression?
Other types of depression that can occur include:
- Double depression -- a condition that happens when a person with chronic depression (dysthymia) experiences an episode of major depression.
- Treatment-resistant depression -- a condition that doesn't respond to treatment with antidepressants, and may be longstanding or chronic. For chronic treatment-resistant depression, electroconvulsive therapy (ECT) is sometimes the treatment of choice depending on the nature and severity of symptoms.
- Masked depression -- a depression that is hidden behind physical complaints for which no organic cause can be found.
What Illnesses Occur With Depression?
Depression commonly occurs with other illnesses such as anxiety,obsessive compulsive disorder, panic disorder, phobias, and eating disorders. If you or a loved one has symptoms of depression or another mental illness, talk to your doctor. Treatments are available to lift the depression and other mental illnesses.
Can Depression Have Physical Symptoms?
Because certain brain chemicals or neurotransmitters, specifically serotonin and norepinephrine, influence both mood and pain, it's not uncommon for depressed individuals to have physical symptoms. These symptoms may include joint pain, back pain, gastrointestinal problems, sleep disturbances, and appetite changes. The symptoms may also be accompanied by slowed speech and movements. Many people go from doctor to doctor seeking treatment for their physical symptoms when, in fact, they are clinically depressed.
Where Can I Get Help for Depression?
If you or someone you know is experiencing symptoms of depression, seek care from your healthcare provider. He or she will evaluate your symptoms and provide treatment or refer you to a mental health professional.
Depression is a real illness that impacts the brain. Anyone suffering from depression will tell you, it’s not imaginary or “all in your head.” Depression is more than just feeling “down.” It is a serious illness caused by changes in brain chemistry. Research tells us that other factors contribute to the onset of depression, including genetics, changes in hormone levels, certain medical conditions, stress, grief or difficult life circumstances. Any of these factors alone or in combination can precipitate changes in brain chemistry that lead to depression’s many symptoms.
Depression is a serious condition. It’s also, unfortunately, a common one. The World Health Organization characterizes depression as one of the most disabling disorders in the world, affecting roughly one in five women and one in ten men at some point in their lifetime. It is estimated that 21% of women and 12% of men in the U.S will experience an episode of depression at some point in their lifetime.
Depression does not discriminate. Men and women of every age, educational level, and social and economic background suffer from depression. There is no area of life that does not suffer when depression is present. Marriage, parenting, friendships, careers, finances – every aspect of daily living is compromised by this disease. Once an episode of depression occurs, it is also quite likely that it will recur. And the impact of depression can be even more severe when it occurs in combination with other medical illnesses such as diabetes, stroke, or cardiovascular disease, or with related disorders such as anxiety or substance abuse.
The problems caused by depression are made worse by the fact that most people suffering from the disease are never diagnosed, let alone treated. The good news is that when depression is promptly identified and treated, its symptoms are manageable and there are many effective strategies for living with the disease. Depression and bipolar disorder are both treated most effectively in their earliest stages when symptoms are less severe.
WHAT CAUSES DEPRESSION?
Although scientists agree that depression is a brain disorder, the debate continues about exact causes. Many factors may contribute to the onset of depression, including genetic characteristics, changes in hormone levels, certain medical illnesses, stress, grief, or substance abuse. Any of these factors alone or in combination can bring about the specific changes in brain chemistry that lead to the many symptoms of depression, bipolar disorder and related conditions.
WHAT ARE THE SYMPTOMS OF DEPRESSION?
Depression commonly affects your thoughts, your emotions, your behaviors and your overall physical health. Here are some of the most common symptoms that point to the presence of depression:
- Angry outbursts
- Loss of interest in friends, family and favorite activities, including sex
- Trouble concentrating
- Trouble making decisions
- Trouble remembering
- Thoughts of harming yourself
- Delusions and/or hallucinations can also occur in cases of severe depression
- Withdrawing from people
- Substance abuse
- Missing work, school or other commitments
- Attempts to harm yourself
- Tiredness or lack of energy
- Unexplained aches and pains
- Changes in appetite
- Weight loss
- Weight gain
- Changes in sleep – sleeping too little or too much
- Sexual problems
Of course, all of us can expect to experience one or more of these symptoms on occasion. An occurrence of any one of these symptoms on its own does not constitute depression. When healthcare professionals suspect depression, they commonly look for clusters of these symptoms occurring regularly for two weeks or longer, and impacting functional aspects of the person’s life.
COULD YOU BE SUFFERING FROM DEPRESSION?
Together with a healthcare provider, you can find out whether what you are experiencing is depression or bipolar disorder, and chart a course to feeling and functioning better. This website provides tips and tools for starting that conversation with your primary care physician or nurse practitioner, or with a community health professional.
Prior to engaging your doctor or healthcare provider, you may find it helpful to know more about how depression and bipolar disorder are diagnosed. Experts commonly employ a series of questions called a screening tool to identify depression. To walk yourself through the same questions, click on Are you depressed?. Once you have completed the questionnaire, you can share your answers with a professional to determine the best course of action.
HOW IS DEPRESSION TREATED?
There are several strategies for treating depression. Depending upon each individual’s characteristics and symptoms, healthcare professionals may employ one or more types of psychotherapy that rely upon a sequence of interpersonal treatment sessions with a trained professional. In addition, clinicians may suggest that a patient try one of a number of different medications. Lifestyle changes, including improvements in sleeping and eating habits, physical activity and stress reduction have also proven very helpful in managing symptoms.
What is depression?
Major depression is a mood state that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health. Depression is a life-long condition in which periods of wellness alternate with recurrences of illness.
Each year depression affects 5-8 percent of adults in the United States. This means that about 25 million Americans will have an episode of major depression this year alone, but only one-half receive treatment. Without treatment, the frequency and severity of these symptoms tend to increase over time. All age groups and all racial, ethnic and socioeconomic groups can experience depression.
Some individuals may only have one episode of depression in a lifetime, but often people have recurrent episodes. More than one-half of people who experience a first episode of depression will have at least one other episode during his/her lifetime. Some people may have several episodes in the course of a year, and others may have ongoing symptoms. If untreated, episodes commonly last anywhere from a few months to many years.
Major depression is also known as clinical depression, major depressive illness, major affective disorder and unipolar mood disorder. It involves some combination of the following symptoms: depressed mood (sadness), poor concentration, insomnia, fatigue, appetite disturbances, excessive guilt and thoughts of suicide. Left untreated, depression can lead to serious impairment in daily functioning and even suicide, which is the 10th leading cause of death in the U.S. Researchers believe that more than one-half of people who die by suicide are experiencing depression. Depression is a leading cause of disability worldwide and represents a global public health challenge. According to the World Health Organization, it is the fourth-leading contributor to Global Burden of Disease, and by 2020, depression is projected to be the second-leading cause. Devastating as this disease may be, it is treatable in most people. The availability of effective treatments and a better understanding of the biological basis for depression may lessen the barriers that can prevent early detection, accurate diagnosis and the decision to seek medical treatment.
Who's at risk?
All age groups and all racial, ethnic and socioeconomic groups can experience depression.