What is depression?
Depression is a complex mood disorder characterized by persistent feelings of sadness and a loss of interest. Often referred to as major depressive disorder or clinical depression, it can significantly impact thoughts, emotions, and behaviors, leading to both psychological and physical challenges. Individuals with depression may find everyday tasks overwhelming and, in severe cases, experience feelings of hopelessness or despair.
Unlike temporary feelings of sadness, depression is not a sign of personal weakness and cannot be resolved through sheer willpower. Effective management often requires a comprehensive approach involving long-term treatment. With the right combination of therapy, medication, or both, many individuals achieve meaningful improvement and regain a sense of well-being.
What causes depression?
Researchers are still studying what causes depression, but several factors seem to contribute. Changes in brain chemistry are thought to play a big role. Depression also often runs in families, suggesting a genetic link. Stressful life events or certain illnesses can sometimes trigger it. However, depression can also develop without an obvious reason, making it a complex condition to understand.
What are symptoms of depression?
While depression may present as a single episode in some individuals, it often recurs throughout a person’s life. During these episodes, symptoms persist for most of the day, nearly every day, and may include the following:
- Persistent feelings of sadness, emptiness, or hopelessness
- Irritability, frustration, or angry outbursts over seemingly minor issues
- Loss of interest or enjoyment in activities once found pleasurable, including hobbies, sports, or intimacy
- Disrupted sleep patterns, such as difficulty falling asleep, staying asleep, or oversleeping
- Persistent fatigue and low energy, making even small tasks feel overwhelming
- Changes in appetite, resulting in weight loss or gain due to eating significantly less or more than usual
- Heightened anxiety, restlessness, or an inability to stay calm
- Noticeable slowing of thoughts, speech, or physical movements
- Overwhelming feelings of guilt, worthlessness, or self-blame, often tied to past mistakes
- Difficulty with focus, decision-making, and memory recall
- Recurrent thoughts of death, suicidal ideation, or attempts to end one’s life
- Physical symptoms without an apparent cause, such as chronic pain or headaches
For many, these symptoms interfere with daily responsibilities, relationships, or social interactions, significantly impacting quality of life. In some cases, individuals may experience an ongoing sense of unhappiness without a clear understanding of its origin.
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What are depression symptoms in children and teenagers?
While depression in children and teenagers shares many symptoms with adults, there are some distinct differences based on age and developmental stage.
In younger children, signs of depression may include:
- Persistent sadness or tearfulness
- Irritability or frequent mood swings
- Increased clinginess or fear of separation
- Excessive worry or anxiety
- Physical complaints, such as unexplained aches and pains
- Reluctance to attend school or a sudden drop in school participation
- Loss of appetite or noticeable weight loss
For teenagers, symptoms of depression may present as:
- Ongoing feelings of sadness or hopelessness
- Irritability, anger, or frequent frustration
- Negative self-perception or feelings of worthlessness
- Struggles with academic performance or increased school absences
- A sense of being misunderstood or heightened emotional sensitivity
- Experimentation with alcohol or recreational drugs
- Changes in eating or sleeping habits, such as excessive eating or oversleeping
- Self-harming behaviors or thoughts of self-harm
- Withdrawal from social activities and a lack of interest in previously enjoyed hobbies
Recognizing these signs early in children and teens is crucial, as depression can affect their emotional development, academic progress, and relationships with family and peers.
What are depression symptoms in older adults?
Depression is not a natural part of aging and should always be taken seriously. Sadly, it often goes unnoticed and untreated in older adults, who may also hesitate to seek help. In this age group, the symptoms of depression can be less obvious or present differently, including:
- Memory issues or noticeable changes in personality
- Persistent physical pain or discomfort without a clear medical cause
- Fatigue, changes in appetite, difficulty sleeping, or loss of interest in intimacy not linked to a health condition or medication
- A preference for staying home, avoiding social interactions, or a lack of enthusiasm for trying new activities
- Thoughts of suicide or feelings of hopelessness, which are particularly concerning in older men
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How is depression diagnosed?
Depression is typically diagnosed through a thorough evaluation conducted by a healthcare provider. This process often involves several steps to ensure an accurate diagnosis and to rule out other possible causes of symptoms.
A physical examination is usually the first step, where your doctor may inquire about your overall health and medical history. This helps identify whether any underlying physical conditions might be contributing to the symptoms of depression. Laboratory tests, such as a complete blood count or thyroid function test, may also be ordered to rule out conditions that can mimic or exacerbate depressive symptoms.
A psychiatric evaluation is another essential component. A mental health professional will discuss your symptoms, thoughts, emotions, and behavior patterns in detail. They may also provide questionnaires to gather additional insights and better understand your mental health.
Finally, the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are often used. This manual, published by the American Psychiatric Association, provides standardized guidelines to help mental health professionals identify and classify depression based on specific symptoms and their duration.
How is depression treated?
Most people with depression find relief through a combination of medications and psychotherapy. While primary care physicians can prescribe medications to help alleviate symptoms, many individuals benefit from additional support from mental health professionals such as psychiatrists or psychologists. In cases of severe depression, residential care or structured outpatient treatment programs may be necessary until symptoms are better managed.
Medications for depression
A variety of antidepressants are available to treat depression, and choosing the right one depends on individual needs and medical history. Below are the main categories of antidepressants:
- Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are often the first line of treatment because they are generally safe and cause fewer side effects compared to older antidepressants. Common SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and vilazodone (Viibryd).
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): These medications target both serotonin and norepinephrine levels in the brain. Examples include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), and levomilnacipran (Fetzima).
- Atypical Antidepressants: These medications do not fit into the other categories but are effective in treating depression. Examples include bupropion (Wellbutrin), mirtazapine (Remeron), trazodone, nefazodone, and vortioxetine (Trintellix).
- Tricyclic Antidepressants: While effective, these drugs, including amitriptyline, nortriptyline (Pamelor), and imipramine (Tofranil), often cause more severe side effects and are usually reserved for cases where newer antidepressants like SSRIs have not worked.
- Monoamine Oxidase Inhibitors (MAOIs): MAOIs, such as phenelzine (Nardil) and tranylcypromine (Parnate), are generally used when other treatments have failed due to their significant side effects and strict dietary restrictions. Selegiline (Emsam), a patch version of an MAOI, may have fewer side effects.
- Other Medications: In some cases, additional medications are prescribed alongside antidepressants to enhance their effectiveness. These may include mood stabilizers, antipsychotics, anti-anxiety drugs, or stimulants, depending on the individual’s symptoms and needs.
Finding the right treatment often involves some trial and error, but with careful monitoring and adjustments, most individuals experience significant improvement in their symptoms. Always discuss potential side effects and treatment options thoroughly with your doctor.
Therapy for depression
Psychotherapy, also known as talk therapy, is a cornerstone of depression treatment and is highly effective for many individuals. This approach involves working with a mental health professional to address the thoughts, emotions, and behaviors contributing to depression. Therapy not only helps alleviate symptoms but also provides tools to manage stress and build resilience. Several types of psychotherapy have proven to be effective in treating depression, including:
- Cognitive Behavioral Therapy (CBT): One of the most commonly used approaches, CBT helps individuals identify and challenge negative thought patterns that fuel depression. By replacing these patterns with healthier, more constructive ways of thinking, individuals can improve their mood and outlook.
- Interpersonal Therapy (IPT): IPT focuses on improving relationships and communication skills, as well as addressing interpersonal conflicts or life transitions that may contribute to depression.
- Psychodynamic Therapy: This approach explores underlying emotional conflicts, unconscious patterns, and past experiences that may be influencing current feelings of depression.
- Behavioral Activation Therapy: This method encourages individuals to engage in meaningful and enjoyable activities to counteract the cycle of avoidance and withdrawal often seen in depression.
- Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder, DBT is also effective for depression, particularly when combined with emotional regulation and mindfulness strategies.
- Problem-Solving Therapy: This short-term therapy focuses on developing practical solutions to specific problems that may be contributing to depressive symptoms.
For many people, a combination of therapy and medication yields the best results. While medication addresses the biological aspects of depression, therapy tackles the psychological and social dimensions. This integrated approach helps individuals build lasting coping strategies and prevent relapse.
Alternate therapeutic options for depression
Therapy for depression isn’t limited to traditional face-to-face sessions in a therapist’s office. Alternative formats are available and can be effective for some individuals. These include therapy delivered through online platforms, computer programs, video sessions, or self-help workbooks. Depending on the format, these programs may be guided by a therapist, partially guided, or completely independent. Before choosing an alternative therapy format, it’s important to discuss your options with a mental health professional. They can recommend trusted programs or resources tailored to your needs.
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View Article References
- Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry, 12(2), 92–98.