Depression - overview
Blues; Gloom; Sadness; Melancholy
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.
Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for 2 weeks or more.
If you often feel sad, blue, unhappy, miserable, or down in the dumps, you may have depression. Let's talk about depression, and what you can do to get out of your funk. Depression often runs in families. This may be due to your genes, passed down by your parents and grandparents, the behaviors you learn at home, or both. Even if your genetic makeup makes you more likely to develop depression, a stressful or unhappy life event may triggers the depression. Depression can have many causes, including internal factors like genetics, or negative personality. External factors, substance misuse, or trauma and loss. Common triggers include alcohol or drug use, and medical problems long-term pain, cancer or even sleeping problems. Stressful life events, like getting laid off, abuse at home or on the job, neglect, family problems, death of a loved one, or divorce, can send someone spiraling into depression. There are three main types of depression; major depression, atypical depression and dysthymia. To be diagnosed with major depression, you must demonstrate 5 or more of the primary symptoms for at least two weeks. Atypical depression occurs in about a third of patients with depression, with symptoms including overeating, oversleeping, and feeling like you are weighed down. Dysthymia is a milder form of depression that can last for years if not treated. Other forms include the depression that is part of bipolar disorder, postpartum depression, occurring after a woman gives birth, premenstrual dysphoric disorder, occurring 1 week before a woman's menstrual period and seasonal affective disorder, occurring in both males and females during the fall and winter seasons. No matter what type of depression you have and how severe it is, some self-care steps can help. Get enough sleep if you can, exercise regularly, and follow a healthy, nutritious diet. Avoid alcohol and recreational drugs. Get involved in activities that make you happy and spend time with family and friends. If you are religious, talk to a clergy member. Consider meditation, tai chi, or other relaxation methods. If you are depressed for 2 weeks or longer, contact your doctor or other health professional before your symptoms get worse. Treatment will depend on your symptoms. For mild depression, counseling and self-care may be enough. Either psychotherapy or antidepressant medicines may help, but they are often more effective when combined. Vigorous exercise and light therapy could offer significant benefit alone or in combination. Healthy lifestyle habits can help prevent and treat depression, and reduce the chances of it coming back. Talk therapy and antidepressant medication can also make you less likely to become depressed again. In fact, talk therapy may help you through times of grief, stress, or low mood. In general, staying active, making a difference in the life of others, getting outside and keeping in close contact with other people is important for preventing depression.
Children who are depressed may exhibit symptoms differently than adults. For instance, a depressed child may seem bored and unusually irritable.
The link between heart disease and depression has long been thought of as cause-and-effect. Studies are now showing that depression itself may contribute to heart disease.
A form of depression exclusive to women, premenstrual dysphoric disorder (PMDD) is a syndrome of depressive symptoms brought about by monthly hormonal fluctuation.
Studies show bouts of insomnia may predispose individuals to depressive illness. The correlation between sleep disorders and mood disorders holds true across age and gender lines.
Considerations
Depression can occur in people of all ages:
Symptoms of depression include:
- Agitation, restlessness, irritability, and anger
- Becoming withdrawn or isolated
- Fatigue and lack of energy
- Feeling hopeless, helpless, worthless, guilty, and self-hate
- Loss of interest or pleasure in activities that were once enjoyed including sex
- Sudden change in appetite, often with weight gain or loss
- Thoughts of death or suicide
- Trouble concentrating
- Trouble sleeping or sleeping too much
Remember that children may have different symptoms than adults. Watch for changes in schoolwork, sleep, and behavior. If you wonder whether your child might be depressed, talk with your health care provider. Your provider can help you learn how to help your child with depression.
The main types of depression include:
- Major depression -- It occurs when feelings of sadness, loss, anger, or frustration interfere with daily life for 2 weeks or longer periods of time.
- Persistent depressive disorder -- This is a depressed mood that lasts 2 years. Over that length of time, you may have periods of major depression, with times when your symptoms are milder.
Other common forms of depression include:
- Postpartum depression -- Many women feel somewhat down after having a baby. However, true postpartum depression is more severe and includes the symptoms of major depression.
- Premenstrual dysphoric disorder (PMDD) -- Symptoms of depression occur 1 week before your period and disappear after you menstruate.
- Seasonal affective disorder (SAD) -- This occurs most often during fall and winter, and disappears during spring and summer. It is most likely due to a lack of sunlight.
- Major depression with psychotic features -- This occurs when a person has depression and loss of touch with reality (psychosis).
- Bipolar disorder (formerly called manic depression) -- This occurs when depression alternates with mania. Bipolar disorder has depression as one of its symptoms, but it is a different type of mental illness.
Causes
Depression often runs in families. This may be due to your genes, behaviors you learn at home, or your environment. Depression may be triggered by stressful or unhappy life events. Often, it is a combination of these things.
Many factors can bring on depression, including:
When to Contact a Medical Professional
Contact your provider if:
- You hear voices that are not there.
- You cry often without cause.
- Your depression has affected your work, school, or family life for longer than 2 weeks.
- You have three or more symptoms of depression.
- You think one of your current medicines may be making you feel depressed. Do not change or stop taking any medicines without talking to your provider.
- If you think your child or teen may be depressed.
You should also contact your provider if:
- You think you should cut back on drinking alcohol
- A family member or friend has asked you to cut back on drinking alcohol
- You feel guilty about the amount of alcohol you drink
- You drink alcohol first thing in the morning
If you or someone you know is thinking about suicide, call or text 988 or chat
You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.
If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.
References
Barnhill JW, Wood WC, Yonkers KA, et al. Depressive disorders. In: Barnhill JW, ed. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision (DSM-5-TR). Arlington, VA: American Psychiatric Publishing. 2022:chap 4.
Fava M, Østergaard SD, Cassano P. Mood disorders: depressive disorders (major depressive disorder). In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 29.
Kraus C, Kadriu B, Lanzenberger R, Zarate Jr CA, Kasper S. Prognosis and improved outcomes in major depression: a review. Transl Psychiatry. 2019;9(1):127. PMID: 30944309
Walter HJ, DeMaso DR. Mood disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 39.
Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D; GLAD-PC STEERING GROUP. Guidelines for adolescent depression in primary care (GLAD-PC): part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3). pii: e20174081. PMID: 29483200
Version Info
Last reviewed on: 5/10/2023
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
