Depression is a mental health condition that entails persistent feelings of sadness, apathy, hopelessness, loss of energy, and/or lack of interest in life.
Mild versions of these feelings are normal parts of day-to-day life. It's common, and even healthy, to feel sad or hopeless in reaction to stressful life events, the state of the world around you, or just to go through a period where things feel off.
But when these emotions become especially frequent, intense, or long-lasting, they can interfere with daily life activities.
Prevalence of depression
Major depressive disorder, also called major depression, is the most common diagnosis, which affects around 21 million adults in the United States each year - that's roughly 8.4% of all the adults - and nearly 280 million people globally. The COVID-19 pandemic has shifted these numbers up considerably with a 25% increase in anxiety and depression worldwide. Some sources estimate that up to 15% of the adult population internationally will experience clinical depression at some point in their lives.
The Depression and Bipolar Support Alliance notes that women are twice as likely to be diagnosed than men, and the symptoms between genders differ. Many women experience postpartum depression or episodes of depression during pregnancy.
A wide range of risk factors play a role in depression, including genetic predisposition, psychological stress, environmental, and psychological factors. A person's family history and genetics, chronic stress, history of trauma, gender, nutrition, unresolved grief or loss, personality traits, and use of medication and substances may all contribute to an increased risk for depression. It is important to consider these factors when seeking treatment and support from a mental health care provider.
If you're struggling with a mood disorder or mental health condition, you may find it difficult to seek help. Data from the ADAA shows that nearly 40% of all individuals with severe depression did not contact a mental health care provider to receive treatment.
Symptoms of depression
The severe symptoms of depression can vary and may sometimes seem to contradict each other. Common symptoms in men tend toward anger, irritability, and fatigue, while women's symptoms are more related to feelings of guilt, worthlessness and sadness. Likewise, there are some differences in symptoms between adults and children. Generally, some of the most common emotional and physical symptoms include:
- Persistent intense sadness or feelings of hopelessness: These feelings might occur without an obvious cause and may not improve when external circumstances improve.
- Lack of energy: Those struggling with depressed mood may find it difficult to get out of bed and complete daily activities.
- Irritability or restlessness: Some presentations of depression may include excessive or agitated activity, rather than (or alternating with) a lack of energy.
- Difficultly concentrating: You might feel a general sense of mental fogginess, and/or find it harder to focus and think things through.
- Loss of interest in pleasurable activities: Experiencing apathy is common when the things that usually bring you joy (social activities, hobbies, sex) may seem dull and uninteresting.
- Changes in sleeping or eating habits: Feelings of sadness and negative emotions can cause you to sleep or eat too much or too little, often resulting in rapid weight gain or significant weight loss.
- Thoughts of suicide or death: These feelings of worthlessness and negative thoughts may be persistent, involuntary, and disruptive to your daily life.
It is important to rule out other mental disorders or medical illnesses and diseases, like hypothyroid problems, diabetes, anemia or other chemical imbalance when looking for a diagnosis.
Different types of depression
Several different conditions fall under the umbrella of mood disorders. The diagnosis of depression comes from a medical health care provider after the completion of a physical and mental evaluation. With prolonged and severe symptoms, the most common forms are:
- Major Depressive Disorder: This is the most usual form of depression. Those struggling with major depression experience several of the above symptoms most days, to a degree that clearly affects their day-to-day lives. These symptoms persist for at least two weeks and are generally not related to specific life stressors (loss of a job, death of a loved one, etc.).
- Persistent Depressive Disorder: People with this form of depression experience milder versions of the same symptoms described above. These indications are still present most of the time, but they are less severe symptoms and those people struggling with chronic depression may be able to hide these symptoms from most people in their lives.
- Premenstrual Dysphoric Disorder: Also known as PMDD, this form of depression is an extension of PMS. Its occurrence is linked to a woman's menstrual cycle and usually involves the onset of depressive symptoms about seven to 10 days before the start of a menstrual period.
- Substance-Induced Depressive Disorder: Here, depressive symptoms are connected to the patient's substance use disorder or abuse of alcohol or other substances.
- Depressive Disorder due to Another Medical Condition: Certain medical conditions can cause depressive symptoms. In this type, the medical condition physiologically affects the individual's brain chemistry to cause the symptoms; it is not a psychological response to being sick.
- Seasonal Affective Disorder (SAD): Often equated to the 'winter blues,' SAD is a more severe with increased symptoms that can resemble those of Major Depressive Disorder. Typically triggered by a lack of sunlight or changes in seasons, SAD tends to occur during the winter months and is often treated with light therapy.
It is not uncommon for depressed people to also suffer from co-occurring disorders, like anxiety or bipolar disorder. A medical condition or physical illness like heart disease or cancer can sometimes be an underlying cause as feelings of hopelessness often are part of dealing with major illness.
It's important to understand that depression and anxiety disorders are not the same thing, even though they can share similar symptoms. Anxiety disorders have their own distinct causes and symptoms. Interestingly, many people who experience anxiety have also struggled with a history of depression, although there is no proven link between the two. It's clear, though, that both conditions can be challenging to manage and can greatly affect a person's well-being.
Bipolar disorder, formerly known as manic depression, is also a chronic mood disorder, with periods of low or depressed mood and/or major depression symptoms, but also includes periods of mania. Depression and bipolar disorder are serious mental disorders, though they present with different diagnostic criteria. Medical and mental health professionals have effective treatment plans for both.
Treatments for depression
If you’re experiencing symptoms of depression, you might consider the following courses of action:
- Therapy: Find a therapist or mental health care provider who can help you gain insight into your condition and use proven techniques to improve your symptoms and mood. (See more tips below on selecting a therapist and treatment type.)
- Check-ups: Because depression can be caused by medical illness, it's important to stay up to date with your medical appointments and keep your physical health. Scheduling a check-up with your primary care doctor can help you rule out physical conditions that may contribute to your symptoms or get medical treatment for an underlying cause.
- Antidepressant Medications: Many depressed patients find that medication helps reduce their symptoms. Though most prescription medications come with side effects, a medical professional can help you manage these side effects and find the most effective depression treatment.
- Hotlines: If you're having thoughts of suicide or need immediate support, you can always call the National Suicide Prevention Hotline at 1-800-273-8255. The Substance Abuse and Mental Health Services Administration hotline at 1-800-622-4357 can also help you find resources and treatment options.
Also, studies of people with depression have revealed the benefits of getting enough sleep, maintaining physical activity and performing routine exercise, and eating a well-balanced healthy diet in managing positive mental health.
What to look for in a therapist for depression
Prioritize an approach that appeals to you
Most therapists and mental health care providers are equipped for depression treatment, but their approaches will differ. Use some of the links below to learn more about treatment types for depression or ask the therapist on your initial call what a typical session for depression with them looks like.
- Cognitive Behavioral Therapy (CBT)
- Acceptance and Commitment Therapy (ACT)
- Psychodynamic Therapy
- Interpersonal Psychotherapy
They type of depression may help you decide which type of therapy you would prefer or need. In some cases, these treatment types can be performed in online therapy sessions, so ask your therapist if that is a possibility. In the case of severe depression there are brain stimulation therapies, like electroconvulsive therapy (ECT) and magnetic stimulation, that may be a consideration. Some mental health care providers will treat SAD with light therapy.
Know what questions to ask potential therapists
These questions may prove helpful when interviewing potential therapists:
- What therapy type (possibly one of the examples above) do you use when helping clients manage depression?
- Do you have experience working with clients who have my particular symptoms of depression?
- Do you use mindfulness-based exercises for depression? (This approach may be especially useful for depression because it has been shown to reduce stress).
Assess personal fit
While personality fit is a nuanced factor, it is critical to your success in therapy. Multiple studies have revealed the importance of this factor, often referred to as “therapeutic alliance.”
On your initial phone call with the therapist, ask yourself:
- Could I see myself forming a connection with this therapist?
- Does their approach suit my personality?
- Do I feel like I will be heard and respected by this therapist?
Additionally, consider these factors:
- Some therapists are more reflective and spend most of the session listening and drawing insights about your patterns and coping styles.
- Some mental health care providers are more directive, establishing weekly agendas and assigning tasks to complete between sessions.
- Some use specific techniques or tools (exposure exercises, eye movements, tapping, breath work, guided imagery, art and music, etc.).
- Some use a combination of multiple approaches.
Consider cost, location, and scheduling
Therapy will only work if it works for you. Before making an appointment, ask yourself honestly:
- Can I afford these session fees? The cost of therapy for depression depends on location, practitioner, and whether you're using insurance.
- Can I commit to attending sessions regularly? Remember to account for travel time, and other demands in your schedule.
- Do the therapists' available times work for me? Some therapists offer evening and weekend appointments and online therapy sessions if you have a limited schedule.
New to therapy? Learn about how to find a therapist here.