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National Institute of Mental Health (NIMH)

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Signs, Symptoms, and Treatment of Depression

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Depression is a serious medical illness. It's more than just a feeling of being sad or "blue" for a few days. If you are one of the more than 19 million teens and adults in the United States who have depression, the feelings do not go away. They persist and interfere with your everyday life. Symptoms can include:

Feeling sad or "empty"

Loss of interest in favorite activities

Overeating, or not wanting to eat at all

Not being able to sleep, or sleeping too much

Feeling very tired

Feeling hopeless, irritable, anxious, or guilty

Aches or pains, headaches, cramps, or digestive problems

Thoughts of death or suicide

Depression is a disorder of the brain. There are a variety of causes, including genetic, biological, environmental, and psychological factors. Depression can happen at any age, but it often begins in teens and young adults. It is much more common in women. Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder.

There are effective treatments for depression, including antidepressants, talk therapy, or both.

NIH: National Institute of Mental Health

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Depression is a serious medical illness. It affects almost 7 percent of U.S. adults. It causes feelings of sadness, hopelessness, and frustration that do not go away. Learn about treatments.

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Overview

What is depression? A Mayo Clinic expert explains.

Learn more about depression from Craig Sawchuk, Ph.D., L.P., clinical psychologist at Mayo Clinic.

Hi, I'm Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I'm here to talk with you about depression. Whether you're looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.

What is depression?

Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.

What causes depression?

While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.

The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.

To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.

Help is available. You don't have to deal with depression by yourself. Take the next step and reach out. If you're hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn't easy and you're not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.
Depression care at Mayo Clinic
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Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, tearfulness, emptiness or hopelessness

Angry outbursts, irritability or frustration, even over small matters

Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

Sleep disturbances, including insomnia or sleeping too much

Tiredness and lack of energy, so even small tasks take extra effort

Reduced appetite and weight loss or increased cravings for food and weight gain

Anxiety, agitation or restlessness

Slowed thinking, speaking or body movements

Feelings of worthlessness or guilt, fixating on past failures or self-blame

Trouble thinking, concentrating, making decisions and remembering things

Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.

In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties or personality changes

Physical aches or pain

Fatigue, loss of appetite, sleep problems or loss of interest in sex - not caused by a medical condition or medication

Often wanting to stay at home, rather than going out to socialize or doing new things

Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

Call your doctor or mental health professional.

Contact a suicide hotline.

In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

U.S. veterans or service members who are in crisis can call 988 and then press "1" for the Veterans Crisis Line. Or text 838255. Or chat online.

The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

Reach out to a close friend or loved one.

Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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Causes

It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

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

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.

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 lesbian, gay, bisexual or transgender, 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)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

Excess weight or obesity, which can lead to heart disease and diabetes

Pain or physical illness

Alcohol or drug misuse

Anxiety, panic disorder or social phobia

Family conflicts, relationship difficulties, and work or school problems

Social isolation

Suicidal feelings, suicide attempts or suicide

Self-mutilation, such as cutting

Premature death from medical conditions

Prevention

There's no sure way to prevent depression. However, these strategies may help.

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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Depression (major depressive disorder) - Symptoms and causes

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Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily functioning.

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What Is Depression? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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Learn how to recognize the warning signs and symptoms of clinical depression and what to do to treat it with and without medication.

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Common reasons people avoid treatment and expert advice on how to get past them.
From the WebMD Archives

Are you struggling with depression? Are you getting treatment for it? If not, you're not alone. About two-thirds of people with major depression never seek appropriate treatment, and the consequences can be devastating: personal suffering, missed work, broken marriages, health problems and, in the worst cases, death.

The World Health Organization ranks depression as one of the world's most disabling diseases. Yet with treatment, 70% of people with clinical depression can improve, often in a matter of weeks.

So what keeps us from seeking help? "It's hard to find out from folks why they are not coming [for treatment], because if they are not coming, they can't tell us," says Kate Muller, PsyD. "But when they do finally get to our offices, they can certainly speak about the things that might have kept them from coming initially."

Major Depression: Reasons Why People Avoid Treatment

If you feel depressed and are trying to deal with it on your own, see if any of these reasons ring true to you. If they do, then follow the experts' advice to get the help you need.

If I give it time, I'll snap out of it. Although a case of the blues passes with time, clinical depression may linger indefinitely if not treated, says Erik Nelson, MD. People can't just snap out of being depressed. Sometimes depression has a biological cause. And like other medical conditions, it often requires treatment to control or heal it.

Waiting for depression to simply pass can be harmful for a number of reasons. For one, depression that goes untreated may become more severe, Nelson says. The longer the delay in treatment, the more difficult it may be to control, and the more likely it is to recur when treatment is stopped. There also is growing evidence that untreated depression can contribute to or worsen other medical problems. " Heart disease is the one that has been most linked to depression, but research also suggests a link between depression and metabolic issues such as obesity, diabetes, and diseases such as Alzheimer's and cancer," Nelson says.

Continued

Expert advice: Don't allow depression to linger. Speak to your doctor. If you find it difficult to seek treatment for a mental disorder, remember that treatment for it may help prevent serious health conditions like heart disease.

I don't want to take antidepressants. "Sometimes I think what keeps people from coming in to see us is that they're afraid they'll have to take a pill," Muller says. "They think, 'I don't want to take a pill for the rest of my life.'"

Although antidepressants are effective against depression, treatment for depression doesn't always involve medication. "We have psychotherapies these days that are as effective, so if you are depressed, medication may not be the only option," Muller says.

"Cognitive-behavioral therapy is a form of talk therapy that focuses on the here and now -- helping you look at your emotions, thoughts, and behaviors to try to improve your quality of life and reduce your depression," she says. "We know that it may work as well as medications in the short term, but may also last longer."

Expert advice: See a therapist (psychologist, psychiatrist, or social worker) as well as your regular doctor. If you do need a medication, it most likely won't be for life. Learn all you can and don't rely on stories you have heard from others who have taken antidepressants, Muller says. Every person reacts a little differently to them.

I don't feel sad all the time. Why do I need treatment for depression? You don't need to feel sad or cry all day to be clinically depressed. Often people with depression see their primary care doctors for problems such as muscle pain, sleeping problems, or fatigue, not knowing those are signs of depression, Nelson says. Sometimes these symptoms accompany sadness; other times they don't.

"There is also so-called 'masked depression' -- when, for whatever reason, people don't feel in touch with a sense of sadness or abnormal mood," he says. "They may be more likely to report something like apathy, blunted mood, or not feeling like themselves."

Continued

In these cases, a doctor may diagnose depression based on other symptoms, particularly decreased interest in or loss of pleasure from favorite activities.

Expert advice: If you are having symptoms such as fatigue, muscle pain, or loss of interest in activities you love, don't rule out depression as a cause. See your doctor.

I'm embarrassed to talk to my doctor about it. "The shame of having a mental health problem keeps folks from seeking help or even talking about suffering from depression," says Bob Livingstone, author of The Body Mind Soul Solution: Healing Emotional Pain Through Exercise. But depression is nothing to be ashamed of. It is a medical condition, much like diabetes or high cholesterol, which requires treatment.

It is also a very common condition. Depressive disorders affect nearly 19 million people in the U.S. every year -- regardless of gender, age, race, religion, sexuality, income, or education. So there's a good chance your doctor won't hear anything from you that she hasn't heard many times before.

Expert advice: Remember that virtually everyone experiences depression at some point, and your doctor will not repeat anything that you share during an office visit. Still, if speaking to your own doctor is embarrassing, find out if your health insurance has someone you can speak with first by phone. If you don't have insurance coverage for mental health, check out mental health services in your community.

I'm afraid of having to talk about painful subjects in therapy. "Depressed people avoid treatment for fear of having to undergo a probing examination of their psychological pain," says Joe Wegmann, a licensed clinical social worker in Metairie, La.

"They have a fear of opening it all up -- 'I don't want to go there,'" Kate Muller says. Unfortunately, in some cases, getting into painful discussions is necessary for healing, she says. "But in other cases, it doesn't have to be as deep or scary as you might think. A good therapist understands what is like for someone to open up to a stranger and will guide you through that process. He won't push you to open up too quickly or at a level you are not comfortable with."

Expert advice: Find a therapist you feel comfortable with and ask him as many questions as he asks you, Muller says. Find out what therapy will be like. Although painful discussions may be necessary in time, your therapist cannot force you. What you reveal is up to you.

WebMD Feature Reviewed by Joseph Goldberg, MD on September 14, 2012

Sources

SOURCES:

University of Michigan Depression Center: "Major Depressive Disorder."

Robert Wood Johnson University Hospital: "Major Depression."

Duke University Student Health Center: "Depression."

Kate Muller, PsyD, associate director, Center for Integrative Psychotherapy, PC, Allentown, Pa.

Erik Nelson, MD, adjunct associate professor of psychiatry, University of Cincinnati.

Bob Livingstone, psychotherapist, San Francisco area; author, The Body Mind Soul Solution: Healing Emotional Pain Through Exercise.

Joe Wegmann, PD, LCSW, Metairie, La.

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Depression: Why Aren't You Getting Treatment?

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Common reasons people avoid treatment and expert advice on how to get past them. From the WebMD Archives Are you struggling with depression? Are you getting treatment for it? If not, you're not alone. About two-thirds of people with major depression never seek appropriate treatment, and the consequences can be devastating: personal suffering, missed work, broken marriages, health problems and, in the worst cases, death.

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National Institute of Mental Health (NIMH)

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Learn about depression, including types, signs and symptoms, risk factors, treatments and therapies, and things you can do to help during treatment.

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"Really, depression? I had no idea..."

These are common responses I get when I mention depression has been part of my life.

I hear the same reactions when we lose someone to suicide: "Can you believe it? I never even suspected he was struggling."

When the truth emerges about people who struggle with mental illness, others are usually shocked. However, I've come to expect the disbelief and surprise. After all, as someone who hid depression and anxiety from the world for years, I know firsthand how hard we often work hard to hide mental illness from others. I wipe away my tears before walking out the door of my home and I try to keep my head lifted high in public. I wear a superhero mask and put on Emmy-worthy performances day in and day out. Though every person has unique reasons for sharing or not sharing struggles with depression, here are the top six reasons I don't tell others I'm depressed:

This is sad but true. I remember the first time someone shared with me her struggle with depression, and I bumbled through an awkward response of: "I'm sorry... I um, I have to go." At the time, I didn't understand depression and knew very little about it. I had no clue how to engage in a conversation in something I didn't understand. It made me uncomfortable.

Since then I have gained plenty of firsthand experience about depression and have a much more caring, empathetic response. I've also experienced those bumbling, awkward responses from the other side of the conversation. I've been the one to witness others stammer and blush and suddenly forget how to talk when depression comes up. Though the awkwardness doesn't bother me much anymore, I do think twice about how someone will respond before mentioning depression.

2. I don't want to come across as "needy."

Unfortunately, the stereotypical "depressed person" is weak, needy and perhaps clingy. In an effort to avoid this stereotype at all costs, we keep our struggles to ourselves. We strive to keep up our reputations as strong, independent individuals. Isn't this the American ideal?

Yet herein lies the misconception that strong means not needing others - and furthermore, that neediness is equal to needing help. For a long time, I avoided talking about depression because I believed needing help made me less-than and weak, in the end only to discover true courage is practicing vulnerability and asking for help.

3. I'm afraid there's something wrong with me.

Ashamed. Horrified. Scared. These are the emotions that plagued me in the pits of depression. Because depression is difficult to understand and has no cut-and-dry medical explanation with a formula to get better, it's easy to fall into the lie that depression is an inherent flaw within me.

Depression carries the critical inner voice causing us to doubt our sense of value and our sense of belonging. "A freak. A failure. Of no value," it whispers in my head. With the pressure to conform and my natural aversion to vulnerability constantly weighing on me, of course I choose to keep my depression from others.

4. Some days I can't even admit to myself I'm depressed.

Given the fears discussed above, it's no wonder I try to convince myself I'm not depressed! On my best days in depression and on my worst, there is almost nothing I have wanted more desperately than for depression to be gone. I have wished for a magic cure, I have prayed and begged God to "take it away," and I have spent hours on the internet looking for solutions to this mood disorder.

I have wished depression never existed, and I have wanted to forget about it altogether. I have tried to ignore it, to run from it, to numb myself to it - and on these days of denial, hiding depression from others simply comes as a byproduct of trying to keep it hidden from myself.

5. When I'm with you, I genuinely may be happy.

This may sound odd, but when I greet my friends and see co-workers in the hallway, I genuinely am happy in that moment - happy to see them, happy to know them, happy to spend time with them. In those moments, I am happy. I want to hear about their week and tell them about my day. I smile and crack jokes and do more than my share of laughing because I truly enjoy their company. It simply isn't the right context to mention my depression, especially if I'm not feeling the full weight of it at the moment.

Because most interactions with others happen in these more superficial, 30-second conversations, it makes sense that many would view me as a generally upbeat and happy person. The truth is, in the moments I interact with others I may be genuinely happy, but these moments do not necessarily represent my overall mental and emotional well-being.

6. I don't want unsolicited advice on how to get better.

Well-meaning friends have suggested everything from antidepressants to praying and reading my Bible more. They have told me about their Aunt Milly and what cured her depression and the miraculous recovery of their friend Billy Bob.

For obvious reasons, this can be very annoying to those with depression. Everyone's experience of depression is different, and what helps one person will not necessarily help someone else. It can also be exasperating because it can unintentionally imply that we aren't already trying everything we know to get better. We probably already googled that therapy or pill or herbal supplement you're telling us about, and we probably read about five articles on it while we were busy avoiding people!

Ways to Make the Conversation Easier

Though I've learned to become comfortable talking about depression openly, there are still ways people can make the conversation easier:

1. Create a nonjudgmental attitude/safe atmosphere

2. Focus on listening, not telling

3. Have a genuine desire to learn and understand

4. Use phrases like: "Tell me more about that" or "I'd like to learn more about depression and would love to hear about your experience"

5. Create an environment where others are vulnerable about their struggles as well (a "me too" culture)

6. Cultivate the ability to relate but not compare (for example, "I/someone close to me has walked through depression, and I know it can be really difficult" vs. "My brother was depressed but it wasn't that bad.")

7. After listening, ask "How can I help?" or "What helps on the hard days?"

8. Say "thank you for sharing" or acknowledge in another way how much courage it takes to talk about taboo topics like mental illness.

Perhaps you're familiar with the road of depression, or perhaps you're walking alongside someone with depression. Regardless, I hope this list provides some insight - and please know, we are thankful for you. We are thankful for the conversations about depression, even if they're a little awkward at first! We are thankful for community because even though we don't always like it, we cannot do this alone.

Thanks for letting me tell you I'm depressed.
Follow this journey on Beyond the Smiles. We want to hear your story. Become a Mighty contributor Thinkstock photo via kevinhillillustration. here.

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6 Reasons I Won't Tell You I'm Depressed

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"Really, depression? I had no idea..." These are common responses I get when I mention depression has been part of my life. I hear the same reactions when we lose someone to suicide: "Can you believe it? I never even suspected he was struggling."