Depression
Depression is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for the people who have it and for their families. Some people have only one episode in a lifetime, but for most people depression recurs. Without treatment, episodes may last a few months to several years.
What is Depression?
The common feature in depressive disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual's capacity to function.
From the DSM-5
What causes Depression?
It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved. Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.
- Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
- Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
- Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
- Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression
Risk Factors
Factors that seem to increase the risk of developing or triggering depression include:
- Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
- Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
- Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
- Being LGBTQ+ or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
- History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
- Abuse of alcohol or recreational drugs
- Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
- Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)
How to Recognize Depression
For most people, anxiety changes how they function day-to-day. People can experience one or more of the following symptoms:
Signs of inattention include:
Know the Facts
Research has found that 32.8 percent of US adults experienced elevated depressive symptoms in 2021, compared to 27.8 percent of adults in the early months of the pandemic in 2020, and 8.5 percent before the pandemic.
The State Of Mental Health In America 2022 reports the following: In 2019, just prior to the COVID-19 pandemic, 19.86% of adults experienced a mental illness, equivalent to nearly 50 million Americans.
Suicidal ideation continues to increase among adults in the U.S. 4.58% of adults report having serious thoughts of suicide, an increase of 664,000 people from last year’s dataset.
A growing percentage of youth in the U.S. live with major depression. 15.08% of youth experienced a major depressive episode in the past year.
Over 2.5 million youth in the U.S. have severe depression, and multiracial youth are at greatest risk.
Over half of adults with a mental illness do not receive treatment, totaling over 27 million adults in the U.S. who are going untreated.
Common forms of Depressive Disorders
Disruptive Mood Dysregulation Disorder
The presentation of children up to 12 years of age with chronic, severe persistent irritability and frequent episodes of extreme behavioral dyscontrol. Children with this symptom pattern typically develop depressive or anxiety disorders as they mature into adolescent and adulthood.
Major Depressive Disorder
Characterized by discrete episodes of at least 2 weeks duration involving clear-cut daily changes in affect, cognition, and daily functions such as eating, sleeping and hygiene. Careful consideration is given to the delineation of normal sadness and grief.
Persistent Depressive Disorder (Dysthymia)
Persistent Depressive Disorder is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years in adults or 1 year in children.
Premenstrual Dysphoric Disorder
Premenstrual Dysphoric Disorder begins sometime following ovulation and remits within a few days of menses and has marked impact on functioning. The essential features are the expression of mood lability, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the premenstrual phase of the cycle.
Treatment Options
Medications and psychotherapy are effective for most people with depression. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you. Many types of antidepressants are available, including those below. Be sure to discuss possible major side effects with your doctor or pharmacist.
Psychotherapy
Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.
Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally, a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you've avoided because of anxiety.
CBT includes exposure therapy, in which you gradually encounter the object or situation that triggers your anxiety so you build confidence that you can manage the situation and anxiety symptoms.
Medications
Your doctor may recommend combining two antidepressants or adding medications such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications also may be added for short-term use.
- Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. These drugs are considered safer and generally cause fewer bothersome side effects than other types of antidepressants.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs).
- Atypical antidepressants. These medications don't fit neatly into any of the other antidepressant categories.
- Other medications. Other medications may be added to an antidepressant to enhance antidepressant effects.
Lifestyle Changes
While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:
From the Mayo Clinic
Take steps to control stress, to increase your resilience and boost your self-esteem.
Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
Get treatment at the earliest sign of a problem to help prevent depression from worsening.
Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.
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