Everything You Need to Know About Depression (Major Depressive Disorder)

 Depression can be temporary or long-term. You may find help with mediation or different therapies, such as cognitive behavior therapy. It’s important to seek professional help if you’re feeling major depression.

Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities.

It’s also fairly common. Data from the Centers for Disease Control and Prevention (CDC)Trusted Source estimates that 18.5 percent of American adults had symptoms of depression in any given 2-week period in 2019.

Though depression and grief share some features, depression is different from grief felt after losing a loved one or sadness felt after a traumatic life event. Depression usually involves self-loathing or a loss of self-esteem, while grief typically does not.

In grief, positive emotions and happy memories of the deceased typically accompany feelings of emotional pain. In major depressive disorder, the feelings of sadness are constant.

People experience depression in different ways. It may interfere with your daily work, resulting in lost time and lower productivity. It can also influence relationships and some chronic health conditions.

Conditions that can get worse due to depression include:

• arthritis
• asthma
• cardiovascular disease
• cancer
• diabetes
• obesity
• It’s important to realize that feeling down at times is a normal part of life. Sad and upsetting events happen to everyone. But if you’re feeling down or hopeless on a regular basis, you could be dealing with depression.

  Depression is considered a serious medical condition that can get worse without proper treatment.

  Depression can be more than a constant state of sadness or feeling “blue.”

  Major depression can cause a variety of symptoms. Some affect your mood and others affect your body. Symptoms may also be ongoing or come and go.

  General signs and symptoms

  Not everyone with depression will experience the same symptoms. Symptoms can vary in severity, how often they happen, and how long they last.

  If you experience some of the following signs and symptomsTrusted Source of depression nearly every day for at least 2 weeks, you may be living with depression:

  • feeling sad, anxious, or “empty”
  • feeling hopeless, worthless, and pessimistic
  • crying a lot
  • feeling bothered, annoyed, or angry
  • loss of interest in hobbies and interests you once enjoyed
  • decreased energy or fatigue
  • difficulty concentrating, remembering, or making decisions
  • moving or talking more slowly
  • difficulty sleeping, early morning awakening, or oversleeping
  • appetite or weight changes
  • chronic physical pain with no clear cause that does not get better with treatment (headaches, aches or pains, digestive problems, cramps)
  • thoughts of death, suicide, self-harm, or suicide attempts

  The symptoms of depression can be experienced differently among males, females, teens, and children.

  Males may experience symptoms related to their:

  • mood, such as anger, aggressiveness, irritability, anxiousness, or restlessness
  • emotional well-being, such as feeling empty, sad, or hopeless
  • behavior, such as loss of interest, no longer finding pleasure in favorite activities, feeling tired easily, thoughts of suicide, drinking excessively, using drugs, or engaging in high-risk activities
  • sexual interest, such as reduced sexual desire or lack of sexual performance
  • cognitive abilities, such as inability to concentrate, difficulty completing tasks, or delayed responses during conversations
  • sleep patterns, such as insomnia, restless sleep, excessive sleepiness, or not sleeping through the night
  • physical well-being, such as fatigue, pains, headache, or digestive problems

  Females may experience symptoms related to their:

  • mood, such as irritability
  • emotional well-being, such as feeling sad or empty, anxious, or hopeless
  • behavior, such as loss of interest in activities, withdrawing from social engagements, or thoughts of suicide
  • cognitive abilities, such as thinking or talking more slowly
  • sleep patterns, such as difficulty sleeping through the night, waking early, or sleeping too much
  • physical well-being, such as decreased energy, greater fatigue, changes in appetite, weight changes, aches, pain, headaches, or increased cramps

  Children may experience symptomsTrusted Source related to their:

  • mood, such as irritability, anger, rapid shifts in mood, or crying
  • emotional well-being, such as feelings of incompetence (e.g., “I can’t do anything right”) or despair, crying, or intense sadness
  • behavior, such as getting into trouble at school or refusing to go to school, avoiding friends or siblings, thoughts of death or suicide, or self-harm
  • cognitive abilities, such as difficulty concentrating, decline in school performance, or changes in grades
  • sleep patterns, such as difficulty sleeping or sleeping too much
  • physical well-being, such as loss of energy, digestive problems, changes in appetite, or weight loss or gain. 
  • Depression causes

    There are several possible causes of depression. They can range from biological to circumstantial.

    Common causes include:

    • Brain chemistry. There may be a chemical imbalance in parts of the brain that manage mood, thoughts, sleep, appetite, and behavior in people who have depression.
    • Hormone levels. Changes in female hormones estrogen and progesterone during different periods of time like during the menstrual cycle, postpartum period, perimenopause, or menopause may all raise a person’s risk for depression.
    • Family history. You’re at a higher risk for developing depression if you have a family history of depression or another mood disorder.
    • Early childhood trauma. Some events affect the way your body reacts to fear and stressful situations.
    • Brain structure. There’s a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms.
    • Medical conditions. Certain conditions mayTrusted Source put you at higher risk, such as chronic illness, insomnia, chronic pain, Parkinson’s disease, stroke, heart attack, and cancer.
    • Substance use. A history of substance or alcohol misuse can affect your risk.
    • Pain. People who feel emotional or chronic physical pain for long periods of time are significantly more likelyTrusted Source to develop depression.

    Risk factors

    Risk factors for depression can be biochemical, medical, social, genetic, or circumstantial. Common risk factors include:

    • Sex. The prevalence of major depression is twice as high in femalesTrusted Source as in males.
    • Genetics. You have an increased riskTrusted Source of depression if you have a family history of it.
    • Socioeconomic status. Socioeconomic status, including financial problems and perceived low social status, can increaseTrusted Source your risk of depression.
    • Certain medications. Certain drugs including some types of hormonal birth control, corticosteroids, and beta-blockers may be associatedTrusted Source with an increased risk of depression.
    • Vitamin D deficiency. StudiesTrusted Source have linked depressive symptoms to low levels of vitamin D.
    • Gender identity. The risk of depression for transgender people is nearly 4-fold that of cisgender people, according to a 2018 study.
    • Substance misuse. About 21 percent of people who have a substance use disorder also experience depression.
    • Medical illnesses. Depression is associated with other chronic medical illnesses. People with heart disease are about twice as likelyTrusted Source to have depression as people who don’t, while up to 1 in 4 peopleTrusted Source with cancer may also experience depression.

    Treatment for depression

    You may successfully manage symptoms with one form of treatment, or you may find that a combination of treatments works best.

    It’s common to combine medical treatments and lifestyle therapies, including the following:

    Medications

    Your healthcare professional may prescribe:

    Selective serotonin reuptake inhibitors (SSRIs)

    SSRIs are the most commonly prescribed antidepressant medications and tend to have few side effects. They treat depression by increasing the availability of the neurotransmitter serotonin in your brain.

    SSRIs should not be takenTrusted Source with certain drugs including monoamine oxidase inhibitors (MAOIs) and in some cases thioridazine or Orap (pimozide).

    People who are pregnant should talk to their healthcare professionals about the risks of taking SSRIs during pregnancy. You should also use cautionTrusted Source if you have narrow-angle glaucoma.

    Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil, Paxil XR, Pexeva), and sertraline (Zoloft).

    Serotonin and norepinephrine reuptake inhibitors (SNRIs)

    SNRIs treat depression by increasing the amount of the neurotransmitters serotonin and norepinephrine in your brain.

    SNRIs should not be taken with MAOIs. You should use caution if you have liver or kidney problems, or narrow-angle glaucoma.

    Examples of SNRIs include desvenlafaxine (Pristiq, Khedezla), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), and venlafaxine (Effexor XR).

    Tricyclic and tetracyclic antidepressants

    Tricyclic antidepressants (TCAs) and tetracyclic antidepressants (TECAs) treat depression by increasing the amount of the neurotransmitters serotonin and norepinephrine in your brain.

    TCAs can cause more side effects than SSRIs or SNRIs. Do not take TCAs or TECAs with MAOIs. Use with caution if you have narrow-angle glaucoma.

    Examples of tricyclic antidepressants include amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), desipramine (Norpramin), nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).

    Atypical antidepressants

    Noradrenaline and dopamine reuptake inhibitors (NDRIs)

    These drugs can treat depression by increasing the levels of dopamine and noradrenaline in your brain.

    Examples of NDRIs include bupropion (Wellbutrin).

    Monoamine oxidase inhibitors (MAOIs)

    MAOIs treat depression by increasing the levelsTrusted Source of norepinephrine, serotonin, dopamine, and tyramine in your brain.

    Due to side effects and safety concernsTrusted Source, MAOIs are not the first choice for treating mental health disorders. They are typically used only if other medications are unsuccessful at treating depression.

    Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate).

    N-methyl D-aspartate (NMDA) antagonists

    N-methyl-D-aspartate (NMDA) antagonists treat depressionTrusted Source by increasing levels of glutamate in the brain. Glutamate is a neurotransmitter believed to be involved in depression.

    NMDA antagonists are used only in patients who have not had success with other antidepressant treatments.

    The FDA has approved one NMDA medication, esketamineTrusted Source (Spravato), for the treatment of depression.

    Ketamine is a nasal spray that is only available through a restricted program called Spravato REMS.

    Patients may experience tiredness and dissociation (difficulty with attention, judgment, and thinking) after taking the medication. For this reason, ketamine is administered in a healthcare setting where a healthcare professional can monitor for sedation and dissociation.

    Psychotherapy

    Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.

    Psychotherapy, also known as “talk therapy,” is when a person speaks to a trained therapist to identify and learn to cope with the factors that contribute to their mental health condition, such as depression.

    Psychotherapy has been shownTrusted Source to be an effective treatment in improving symptoms in people with depression and other psychiatric disorders.

    Psychotherapy is often used alongside pharmaceutical treatment. There are many different types of psychotherapy, and some people respond better to one type than another.

    Cognitive behavioral therapy (CBT)

    In cognitive behavioral therapy (CBT), a therapist will work with you to uncover unhealthy patterns of thought and identify how they may be causing harmful behaviors, reactions, and beliefs about yourself.

    Your therapist might assign you “homework” where you practice replacing negative thoughts with more positive thoughts.

    Dialectical behavior therapy (DBT)

    Dialectical behavior therapy (DBT) is similar to CBT, but puts a specific emphasis on validation, or accepting uncomfortable thoughts, feelings, and behaviors, instead of fighting them.

    The theory is that by coming to terms with your harmful thoughts or emotions, you can accept that change is possible and make a recovery plan.

    Psychodynamic therapy

    Psychodynamic therapy is a form of talk therapy designed to help you better understand and cope with your day-to-day life. Psychodynamic therapy is based on the ideaTrusted Source that your present-day reality is shaped by your unconscious, childhood experiences.

    In this form of therapy, your therapist will help you reflect and examine your childhood and experiences to help you understand and cope with your life.