Navigating Depression
We all go through periods of sadness as we navigate our lives, but when these emotions begin to interfere with everyday living, it may be a serious mental health condition that requires understanding and medical care.
Depression disorder is one of the most common mental disorders in the United States. Fortunately, with early detection, diagnosis, and a treatment plan consisting of medication, psychotherapy, and healthy lifestyle choices, many people can and do get better.
About 21 million U.S. adults—8.4% of the population—had at least one major depressive episode in 2020. Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Left untreated, symptoms can interrupt lives and relationships.
People of all ages and all racial, ethnic, and economic backgrounds experience depression, but it does affect some groups more than others. Women are diagnosed with depression more often than men. That said, men may be less likely to recognize, talk about, and seek help for their feelings or emotional problems, putting them at greater risk of being undiagnosed or undertreated. Members of the LGBTQIA+ community also have higher rates of depression.
Causes
Depression can be triggered by life events, but it can also occur spontaneously. Here are several factors that can contribute to depression:
Trauma: Experiencing trauma at an early age can cause long-term changes in how our brains respond to fear and stress. These changes may lead to depression.
Genetics: Mood disorders, such as depression, tend to run in families.
Life circumstances: Marital status, relationship changes, financial standing, and where a person lives influence whether a person develops depression.
Other medical conditions: People who have a history of sleep disturbances, medical illness, chronic pain, anxiety, and attention-deficit hyperactivity disorder are more likely to develop depression. Some medical syndromes (like hypothyroidism) can mimic depressive disorder. Some medications can also cause symptoms of depression.
Drug and alcohol misuse: Adults with a substance use disorder are at significantly higher risk for experiencing a major depressive episode. Alcohol can worsen depressive symptoms.
Signs and symptoms
Several persistent symptoms are required for a diagnosis of depression, but people with only a few symptoms may also benefit from treatment. People experiencing some of the following signs and symptoms for at least 2 weeks may be suffering from depression:
Persistent sad, anxious, or “empty” mood
Feelings of hopelessness or pessimism
Feelings of irritability, frustration, or restlessness
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities
Decreased energy, fatigue, or feeling slowed down
Difficulty concentrating, remembering, or making decisions
Changes in sleep habits.
Changes in appetite or unplanned weight changes
Physical pains, headaches, cramps, or other problems without a clear physical cause or treatment
Thoughts of death or suicide or suicide attempts
Not everyone who is depressed experiences every one of these symptoms. In some cases, mental health symptoms appear as physical problems. For example, a racing heart, tightened chest, ongoing headaches, or digestive issues. Men are often more likely to see a healthcare provider about these physical symptoms than their emotional ones.
Treatment
No two people are affected the same way by depression. Therefore, there is no "one-size-fits-all" treatment. Finding the treatment that works best may take trial and error while working closely with a medical provider.
Depression is usually treated with medication, psychotherapy, or a combination of the two. The earlier treatment begins, the more effective it is.
Medications
Antidepressants, as well as mood stabilizers and antipsychotic medications, are used to treat depression. These medicines can help change how the brain produces or uses certain chemicals involved in mood or stress. Antidepressants take time—usually 4–8 weeks—to work fully. Working closely with a healthcare provider will help identify the best combination to improve symptoms and limit side effects.
Sometimes when people feel better, they stop taking their medications, and their depression symptoms return. Do not stop taking any medication before talking to healthcare provider. They can help slowly and safely decrease medications without causing withdrawal symptoms.
Children, teenagers, and adults under 25 years may experience an increase in suicidal thoughts or behavior when taking antidepressants. The FDA advises that patients of all ages taking antidepressants be watched closely, especially during the first few weeks of treatment or dosage changes.
People considering taking an antidepressant who are pregnant, planning to become pregnant, or breastfeeding, should talk to a healthcare provider about potential risks to an unborn or nursing child and how to weigh those risks against the benefits of available treatment options.
Psychotherapy
An open and honest relationship with a therapist can help improve outcomes. Psychotherapy helps people with depressive disorder by teaching new ways of thinking and behaving that help change habits that contribute to depression. A few examples include:
Cognitive behavioral therapy (CBT) helps a patient assess and change negative thinking patterns associated with depression. The goal of this structured therapy is to recognize negative thoughts and to teach coping strategies.
Interpersonal therapy focuses on improving problems in relationships and other changes in life that may be contributing to depressive disorder. Therapists teach individuals to evaluate their interactions and to improve how they relate to others.
Psychodynamic therapy is a treatment approach rooted in recognizing and understanding negative patterns of behavior and feelings that are rooted in past experiences and working to resolve them. Looking at a person’s unconscious processes is another component of this psychotherapy.
Psychoeducation involves teaching individuals about their illness, how to treat it, and how to recognize signs of relapse. This can be especially helpful for family members who want to understand what their loved one is experiencing.
Other treatments
Daily morning light therapy is a common treatment choice for people with seasonal affective disorder. Light therapy devices are much brighter than ordinary indoor lighting and considered safe, except for people with certain eye diseases or taking medications that increase sensitivity to sunlight. As with all interventions, evaluation, treatment, and follow-up by a healthcare provider are strongly recommended.
Self-care
Learning as much as possible about this condition and the many treatment options available is important. It helps the patient identify warning signs and triggers that aggravate depression symptoms. Don’t be afraid to ask friends and family for help—they can help monitor symptoms and behavior. The patient and family members should know how to contact their community’s crisis hotline or emergency walk-in center.
Sharing discoveries with a healthcare provider will help them support recovery—including any reactions to medications, new symptoms, or triggers.
Connecting with others through online message boards, peer-education programs or support groups provide participants an opportunity to share experiences and coping strategies. Support groups may be for the person with the mental health condition, for family/friends, or a combination of both. Mental health professionals lead some support groups, but groups can also be peer-led.
Leading a balanced lifestyle helps manage symptoms of depression. Here are things that can lessen the impact.
Physical activity. Just 30 minutes a day of walking can boost your mood.
Try to maintain a regular bedtime and wake-up time.
Eat well and exercise. Activities like meditation, yoga, or Tai Chi can also relieve stress.
Break large tasks into small ones. Decide what must get done and what can wait.
Try to connect with people. Talk with trusted people about challenges, symptoms, and decisions.
It’s alright to delay important decisions, such as getting married or divorced, or changing jobs until feeling better.
Avoid using alcohol, nicotine, drugs, or unprescribed medications. Using alcohol or drugs may seem to help, but in the long run, using them can hinder recovery and make symptoms worse.
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