What is Depression?

It is normal for everyone to feel down or sad sometimes. These feelings can occur after having a bad day at work, having an argument with a loved one, or getting a bad grade on an exam. In most cases, these feelings do not last, and a person’s mood improves within a few days. But a person with depression has symptoms that interfere with his or her daily life for at least two weeks.

Depression is a common and serious mental disorder. It can affect people in different ways. It can change how a person feels, thinks, acts, and handles daily activities, such as sleeping, eating, and working. People with depression may feel sad, hopeless, angry, irritable, and tired. They may have physical symptoms such as stomachaches, headaches, migraines, and muscle pains. They may have suicidal thoughts and suicide attempts.

Depression is sometimes called major depressive disorder or clinical depression. A person may experience depression only once in their lifetime; however, it often reoccurs. The following common and related disorders share symptoms with depression:

Persistent depressive disorder (also called dysthymia) involves depressive symptoms that last for at least two years.
Adjustment disorder causes many of the symptoms seen in depression, but occurs after a person goes through a stressful time in life, such as the death of a loved one, divorce or relationship problems, illnesses, unexpected catastrophes, or worries about money.
Postpartum depression occurs in some women after childbirth and may make it difficult for new mothers to take care of themselves and their babies.
Psychotic depression occurs in some people with depression, causing them to believe things that are not real (delusions) and hear or see things that others cannot (hallucinations).
Seasonal affective disorder involves onset of depression during winter, when there is less natural sunlight, and generally lifts during spring and summer.
Bipolar disorder involves shifts in a person’s mood, alternating between depression and mania—feeling extremely “up,” elated, and energized.

Signs and Symptoms

A person with depression may not realize it. The symptoms vary from person to person. Without proper treatment, the symptoms may get worse.

A person with depression will have some of the following symptoms for at least two weeks, as well as significant impact on their daily life functions::

Sadness, anxiety, or feeling “empty” of any mood
Feelings of hopelessness
Feelings of pessimism, expecting only bad things to occur
Loss of interest or pleasure in previously enjoyed hobbies and activities
Neglecting care of oneself, such as not bathing, grooming, or eating
Fatigue or decreased energy level, moving or speaking slowly
Irritability
Feelings of guilt, worthlessness, or helplessness
Restlessness or having trouble sitting still
Difficulty concentrating, remembering, or making decisions
Difficulty following through with tasks, being unable to perform well at work, or ineffective parenting
Increase in pain sensitivity
Difficulty sleeping, waking very early in the morning, or sleeping more than usual
Increased or decreased appetite, large changes in the body weight
Aches or pains, headaches, cramps, or digestive problems without a clear physical cause or that do not ease even with targeted treatment
Thoughts of death or suicide, or suicide attempts

Not everyone who is depressed has all symptoms. The severity and frequency of symptoms and how long they last will vary depending on the person. A person who has had depression has an increased risk of having depression again. Some people may go many years without symptoms. The longer a person who has had depression goes without depressive symptoms, the lower the risk that the symptoms will come back.

Risk and Protective Factors

Depression is one of the most common mental disorders. About 7% of the United States population has depression in any given year. Females are almost three times more likely than males to have depression.

The symptoms can be different in young people than in adults. For example, children and adolescents with depression have more irritability than sadness. Likewise, older adults with depression are less likely to complain of depressed mood and more often talk about loss of energy, loss of interest, and physical symptoms.

The first episode of depression usually occurs between ages 18–29, but depression can start at any age. Alcohol use and other substance use disorders often co-occur with depression.

Research suggests that depression is caused by a combination of factors, including genetic, biological, environmental, and psychological factors.

Specific risk factors for depression include:

Having depression in the past
Having a family member who has had depression or substance use disorders
Major life changes such as death of a loved one, divorce, or losing a job
Experiencing a trauma or stressful life event in childhood, or recently as an adult
Certain physical illnesses and medications

Depression can co-occur with other serious medical illnesses, such as diabetes, heart disease, cancer, and Parkinson’s disease. In these cases, depression often worsens the symptoms and outcome of the medical illness. Medications taken for physical illnesses sometimes can cause side effects that contribute to depression. Recognizing the symptoms of depression, and seeking treatment and supports early, can prevent depression or shorten its duration. A doctor experienced in treating depression can help find the best treatment.

Suicide is a major health concern for persons with depression and is preventable. People of all genders, ages, and ethnicities can be at risk for suicide. If you are having suicidal thoughts or are worried that someone you know might be suicidal, please contact the Suicide Prevention Lifeline(link is external), 1-800-273-TALK (8255).

Protective Factors

Some activities and ways of thinking can help people avoid depression. These include:

Physical activity
Recognizing and being thankful for aspects of one’s life
Supportive social and family interactions
Recognizing a purpose to one’s life
Spiritual involvement
Being connected within a community
Involvement in activities that the person sees as meaningful

Evidence-based Treatment

Even in the most severe cases, depression can be treated effectively. The earlier treatment starts, the sooner the symptoms will improve. The treatment plan should consider each person’s needs and choices. A person should consult a healthcare professional when choosing the right treatment and consider his or her own gender, race, ethnicity, language, and culture.

Depression is usually treated with medications, psychotherapy, sometimes called “talk therapy”, or a combination of the two. There is no “one-size-fits-all” treatment for depression. It may take some trial and error to find the treatment that works best. The effectiveness of treatment should be monitored. The treatment approach should be changed if symptoms have not improved after one month. If depression symptoms are severe, inpatient or partial hospitalization may be needed until the symptoms improve.

There is a trend toward treating depression in a primary care setting. Using this integrated approach, the primary care doctor provides medications for depression. Behavioral health providers provide psychotherapy either on site or in partnership the doctor. Learn more about integrated health care.

Psychotherapy

Several types of psychotherapy can help people with depression. Psychotherapy teaches strategies and tools to help a person with depression deal with their symptoms and the related unhealthy thoughts and actions. Psychotherapy can be offered one-on-one or in a group therapy setting. Psychotherapy alone is sometimes the best treatment. Other times, psychotherapy is combined with medications.

Evidence-based approaches for treating depression include:

Cognitive behavioral therapy helps a person explores how their thoughts and beliefs influence their mood and actions. He or she learns to identify distorted or unhelpful thinking, change inaccurate beliefs, and change behaviors that affect their well-being. This form of therapy reduces current symptoms of depression and reduces the risk of future episodes of depression.

In interpersonal therapy, a person is asked to look closely at how their interactions with others may contribute to depression. The person explores their experiences with loss, isolation, stress, grief, or times when many changes are occurring in the person’s life. By identifying what factors may trigger depressive symptoms, the person can learn skills and tools to manage their depression.

For more information on psychotherapy, visit Psychotherapies from NIMH or access the NIMH publication Depression: What You Need to Know.

Medications

Antidepressants are medicines that are prescribed for depression. Each type of antidepressant works in a slightly different way by changing the chemicals in the brain. Common antidepressants include:

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin norepinephrine reuptake inhibitors (SNRIs)
Bupropion
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)

People with depression often need to try more than one medication before finding the right one to improve their depressive symptoms and limit unpleasant side effects.

After starting an antidepressant, it may take up to eight weeks before a person feels relief from most of their depressive symptoms. Symptoms such as problems with sleep, appetite, and concentration often get better more quickly. If a person starts having side effects using a medication and the side effects do not go away over time, he or she should schedule a consultation with a prescriber. It is important to consult with a prescriber before stopping an antidepressant. Stopping these medications abruptly can cause serious health problems.It is important to know the benefits and risks of taking a medication. A doctor should closely monitor anyone who has recently started taking an antidepressant. In some cases, children, teenagers, and young adults (under age 25) may have more suicidal thoughts or actions when taking antidepressants. This is more likely in the first few weeks after starting a medication, or when the dose is changed. Women who are pregnant, planning to become pregnant, or breastfeeding should talk to their prescriber about possible health risks to the woman and her unborn or nursing child.

For basic information about medications, visit Mental Health Medications at NIMH. Up-to-date information on medications, side effects, and warnings is available from the Food and Drug Administration (FDA).

Other Treatment Options

Electroconvulsive therapy (ECT) may be effective for people who have tried psychotherapies and medications and have not been able to control or reduce their depression symptoms. ECT involves sending electric stimulations to the brain. It is not painful. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the brief treatment session, the patient is awake and alert. The treatment consists of a series of sessions. Advances in ECT devices and methods have made modern ECT safe and effective for most people.

Other brain stimulation therapies arise as new techniques emerge to help people whose depressive symptoms are not addressed by psychotherapies and medications. These treatments include:

Repetitive transcranial magnetic stimulation (rTMS)
Vagus nerve stimulation (VNS)

Other types of brain stimulation treatments are under research. Learn more about these therapies at Brain Stimulation Therapies from NIMH.

Light therapy, also called phototherapy, is used to treat seasonal affective disorder. Scientists think this disorder occurs in some people when short days and long nights disrupt the body’s daily rhythms. This seasonal change affects the hormone melatonin. During light therapy, a person sits in front of a “light box” for periods of time, usually in the morning. The box emits full-spectrum light, which seems to help reset the body’s daily rhythms.

Behavioral Health Advance Directive

A person with depression is encouraged to create a behavioral health advance directive, stating:

Where they wish to receive care
What treatments they want
Who can make legal healthcare decisions for them, if they cannot do so due to their illness

Advance directive laws vary across states. Learn more about advance directives for behavioral health.

Complementary Therapies and Activities

Complementary therapies and activities can help people with mental disorders improve their well-being and are meant to be used along with evidence-based treatments.

A person with depression should create a self-care plan. The plan includes some of the following activities and approaches that can help improve symptoms:

Be active and exercise regularly
Make time to talk and interact with friends and family
Ask for help and let people
Do activities that were fun before the depressive symptoms started
Realize that depression improves over time, not immediately
Postpone making important life decisions until symptoms improve, or discuss a major decision with family and friends who can see things more objectively

St. John’s wort (Hypericum perforatum) has some benefit for reducing mild to moderate depression in some people. But there is some concern that St. John’s wort interacts with other medications and reduces their intended effects.

Vitamin B supplements may be helpful for people with depression when used with standard care.

Mind and body practices, when used along with standard treatment for depression, help some people. For example, music therapy may improve mood. Relaxation training is better than no treatment in reducing symptoms of depression, but not as helpful as standard psychotherapies or medications.

Yoga and meditation are sometimes recommended to supplement the effects of standard treatments.

Other natural products sold as dietary supplements, such as SAMe (S-adenosyl-L-methionine) and valerian, are being studied but have not yet been proven safe and effective for routine use. FDA has not approved these or any other over-the-counter herbal products or supplements for treating depression. For more information on herbal and other complementary approaches and current research, visit the National Center for Complementary and Integrative Health.

Recovery and Social Support Services and Activities

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:

Overcoming or managing one’s condition(s) or symptoms
Having a stable and safe place to live
Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
Having relationships and social networks that provide support, friendship, love, and hope

Recovery helps a person develop resilience, increasing the ability to cope with adversity and adapt to challenges or change.

Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with behavioral health conditions. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills.

Resources for people with depressive disorders and their families include:

Sources: https://www.samhsa.gov/treatment/mental-disorders/depression