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This is the first credible website I used to find out the types of depression people can have and what it is.

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Introduction

Do you feel sad, empty, and hopeless most of the day, nearly every day? Have you lost interest or pleasure in your hobbies or being with friends and family? Are you having trouble sleeping, eating, and functioning? If you have felt this way for at least 2 weeks, you may have depression, a serious but treatable mood disorder.

What is depression?

Everyone feels sad or low sometimes, but these feelings usually pass with a little time. Depression-also called "clinical depression" or a "depressive disorder"-is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, symptoms must be present most of the day, nearly every day for at least 2 weeks.

What are the different types of depression?

Two of the most common forms of depression are:

Major depression-having symptoms of depression most of the day, nearly every day for at least 2 weeks that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person's lifetime, but more often, a person has several episodes.

Persistent depressive disorder (dysthymia)-having symptoms of depression that last for at least 2 years. A person diagnosed with this form of depression may have episodes of major depression along with periods of less severe symptoms.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

Perinatal Depression: Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression).

Seasonal Affective Disorder (SAD): SAD is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer.

Psychotic Depression: This type of depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

Other examples of depressive disorders include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder. Depression can also be one phase of bipolar disorder (formerly called manic-depression). But a person with bipolar disorder also experiences extreme high-euphoric or irritable -moods called "mania" or a less severe form called "hypomania."

You can learn more about these disorders on the National Institute of Mental Health (NIMH)'s website (www.nimh.nih.gov).

What causes depression?

Scientists at NIMH and across the country are studying the causes of depression. Research suggests that a combination of genetic, biological, environmental, and psychological factors play a role in depression.

Depression can occur along with other serious illnesses, such as diabetes, cancer, heart disease, and Parkinson's disease. Depression can make these conditions worse and vice versa. Sometimes medications taken for these illnesses may cause side effects that contribute to depression symptoms. For more information on ongoing research on depression, visit www.nimh.nih.gov.

What are the signs and symptoms of depression?

Sadness is only one small part of depression and some people with depression may not feel sadness at all. Different people have different symptoms. Some symptoms of depression include:

Persistent sad, anxious, or "empty" mood

Feelings of hopelessness or pessimism

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in hobbies or activities

Decreased energy, fatigue, or being "slowed down"

Difficulty concentrating, remembering, or making decisions

Difficulty sleeping, early-morning awakening, or oversleeping

Appetite and/or weight changes

Thoughts of death or suicide or suicide attempts

Restlessness or irritability

Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Does depression look the same in everyone?

No. Depression affects different people in different ways. For example:

Women have depression more often than men. Biological, lifecycle, and hormonal factors that are unique to women may be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.

Men with depression are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognize their depression and fail to seek help.

Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.

Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.

Older children and teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse.

How is depression treated?

The first step in getting the right treatment is to visit a health care provider or mental health professional, such as a psychiatrist or psychologist. Your health care provider can do an exam, interview, and lab tests to rule out other health conditions that may have the same symptoms as depression. Once diagnosed, depression can be treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, brain stimulation therapy may be another treatment option to explore.

Medications

Medications called antidepressants can work well to treat depression. They can take 2 to 4 weeks to work. Antidepressants can have side effects, but many side effects may lessen over time. Talk to your health care provider about any side effects that you have. Do not stop taking your antidepressant without first talking to your health care provider.

Please Note: Although antidepressants can be effective for many people, they may present serious risks to some, especially children, teens, and young adults. Antidepressants may cause some people, especially those who become agitated when they first start taking the medication and before it begins to work, to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start taking them. For most people, though, the risks of untreated depression far outweigh those of antidepressant medications when they are used under a doctor's careful supervision.

Information about medications changes frequently. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, or newly approved medications.

Psychotherapy

Psychotherapy helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to depression. Therapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse.

Brain Stimulation Therapies

Electroconvulsive therapy (ECT) and other brain stimulation therapies may be an option for people with severe depression who do not respond to antidepressant medications. ECT is the best studied brain stimulation therapy and has the longest history of use. Other stimulation therapies discussed here are newer, and in some cases still experimental methods. For more information on these treatment options, visit www.nimh.nih.gov/health. To find clinical trials, visit www.clinicaltrials.gov.

How can I help myself if I am depressed?

As you continue treatment, you may start to feel better gradually. Remember that if you are taking an antidepressant, it may take 2 to 4 weeks to start working. Try to do things that you used to enjoy. Go easy on yourself. Other things that may help include:

Trying to be active and exercise

Breaking up large tasks into small ones, set priorities, and do what you can as you can

Spending time with other people and confide in a trusted friend or relative

Postponing important life decisions until you feel better. Discuss decisions with others who know you well

Avoiding self-medication with alcohol or with drugs not prescribed for you

How can I help a loved one who is depressed?

If you know someone who has depression, first help him or her see a health care provider or mental health professional. You can also:

Offer support, understanding, patience, and encouragement

Never ignore comments about suicide, and report them to your loved one's health care provider or therapist

Invite him or her out for walks, outings, and other activities

Help him or her adhere to the treatment plan, such as setting reminders to take prescribed medications

Help him or her by ensuring that he or she has transportation to therapy appointments

Remind him or her that, with time and treatment, the depression will lift

Where can I go for help?

If you are unsure where to go for help, ask your health provider or check out the NIMH Help for Mental Illnesses webpage at www.nimh.nih.gov/findhelp. Another Federal health agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), maintains an online Behavioral Health Treatment Services Locator athttps://findtreatment.samhsa.gov/. You can also check online for mental health professionals; contact your community health center, local mental health association, or insurance plan to find a mental health professional. Hospital doctors can help in an emergency.

If you or someone you know is in crisis, get help quickly.

Call your or your loved one's health professional.

Call 911 for emergency services.

Go to the nearest hospital emergency room.

Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TYY: 1-800-799-4TTY (4889).

Reprints

This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. We encourage you to reproduce it and use it in your efforts to improve public health. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:

NIMH does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes.

NIMH does not provide specific medical advice or treatment recommendations or referrals; our materials may not be used in a manner that has the appearance of providing such information.

NIMH requests that non-Federal organizations not alter our publications in ways that will jeopardize the integrity and "brand" when using the publication.

The addition of non-Federal Government logos and website links may not have the appearance of NIMH endorsement of any specific commercial products or services, or medical treatments or services.

Images used in publications are of models and are used for illustrative purposes only. Use of some images is restricted.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Resource Center at 1-866-615-6464 or e-mail nimhinfo@nih.gov.

For More Information

For more information on conditions that affect mental health, resources, and research, go to MentalHealth.gov at www.mentalhealth.gov, or the NIMH website at www.nimh.nih.gov. In addition, the National Library of Medicine's MedlinePlus service (www.nlm.nih.gov/medlineplus/) has information on a wide variety of health topics, including conditions that affect mental health.

National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: www.nimh.nih.gov

U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. 19-MH-8079
Revised 2016

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Do you feel sad, empty, and hopeless most of the day, nearly every day? Have you lost interest or pleasure in your hobbies or being with friends and family? Are you having trouble sleeping, eating, and functioning? If you have felt this way for at least 2 weeks, you may have depression, a serious but treatable mood disorder.

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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?

Depression, also known as major depressive disorder, is a mood disorder that makes you feel constant sadness or lack of interest in life.

Most people feel sad or depressed at times. It's a normal reaction to loss or life's challenges. But when intense sadness -- including feeling helpless, hopeless, and worthless -- lasts for many days to weeks and keeps you from living your life, it may be something more than sadness. You could have clinical depression, a treatable medical condition.

Depression Symptoms

According to the DSM-5, a manual doctors use to diagnose mental disorders, you have depression when you have five or more of these symptoms for at least 2 weeks:

Your mood is depressed for most of the day, especially in the morning

You feel tired or have a lack of energy almost every day.

You feel worthless or guilty almost every day.

You have a hard time focusing, remembering details, and making decisions.

You can't sleep, or you sleep too much, almost every day.

You have almost no interest or pleasure in many activities nearly every day.

You think often about death or suicide (not just a fear of death).

You feel restless or slowed down.

You've lost or gained weight.

Continued

You may also:

Feel cranky and restless

Lose pleasure in life

Overeat or stop feeling hungry

Have aches, pains, headaches, cramps, or digestive problems that don't go away or get better with treatment

Have sad, anxious, or "empty" feelings

While these symptoms are common, not everyone with depression will have the same ones. How severe they are, how often they happen, and how long they last can vary.

Your symptoms may also happen in patterns. For example, depression may come with a change in seasons (a condition formerly called seasonal affective disorder).

It's not uncommon for people with depression to have physical signs of the condition. They may include joint pain, back pain, digestive problems, sleep trouble, and appetite changes. You might have slowed speech and movements, too. The reason is that brain chemicals linked to depression, specifically serotonin and norepinephrine, play a role in both mood and pain.

Depression in Children

Childhood depression is different from the normal "blues" and everyday emotions most kids feel. If your child is sad, it doesn't necessarily mean they have depression. It's when the sadness stays day after day that depression may be an issue. Disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life may also be signs of a problem.

Depression in Teens

A lot of teens feel unhappy or moody. When the sadness lasts for more than 2 weeks and a teen has other symptoms of depression, there may be a problem. Talk to your doctor and find out if your teen may be depressed. There is effective treatment that can help teens move beyond depression as they grow older.

Depression Causes

Doctors haven't pinpointed exact causes for depression. They think it may be a combination of things, including:

Brain structure. People with depression seem to have physical differences in their brains from people who don't have depression.

Brain chemistry. Chemicals in your brain called neurotransmitters play a part in your mood. When you have depression, it could be because these chemicals aren't working the way they should.

Hormones. Your hormone levels change because of pregnancy, postpartum issues, thyroid problems, menopause, or other reasons. That can set off depression symptoms.

Genetics. Researchers haven't yet found the genes that might be responsible for depression, but you're more likely to have depression if someone you're related to has it.

Types of Depression

There are a few types of depressive disorders that doctors can diagnose, including:

Unipolar major depression

Persistent depressive disorder, also called dysthymia, when depression lasts for at least 2 years

Disruptive mood dysregulation disorder, when children and teens get very cranky, angry, and often have intense outbursts that are more severe than a child's typical reaction

Premenstrual dysphoric disorder, when a woman has severe mood problems before their period, more intense than typical premenstrual syndrome (PMS)

Substance-induced mood disorder (SIMD), when symptoms happen while you're taking a drug or drinking alcohol or after you stop

Depressive disorder due to another medical condition

Other depressive disorders, such as minor depression

Continued

Your depression may have other specific features, such as:

Anxious distress. You worry a lot about things that might happen or about losing control.

Mixed features. You have both depression and mania -- periods of high energy, talking too much, and high self-esteem.

Atypical features. You can feel good after happy events, but you also feel hungrier, need to sleep a lot, and are sensitive to rejection.

Psychotic features. You believe things that aren't true, or see and hear things that aren't there.

Catatonia. You can't move your body normally. You might be still and unresponsive or have uncontrollable movements.

Peripartum depression. Your symptoms begin during pregnancy or after giving birth.

Seasonal pattern. Your symptoms get worse with changes in the seasons, especially the colder, darker months.

What Illnesses Happen With Depression?

It's common for people to have other medical or mental health problems along with depression, such as anxiety, obsessive compulsive disorder, panic disorder, phobias, substance use disorders, and eating disorders. If you or a loved one has symptoms of depression or another mental illness, talk to your doctor. Treatments can help.

Depression and Suicide

Anybody who thinks or talks about harming themselves should be taken very seriously. Do not hesitate to call your local suicide hotline right away. Call 800-SUICIDE (800-784-2433); 800-273-TALK (800-273-8255); or, for the hotline for the hearing impaired, call 800-799-4889. Or contact a mental health professional ASAP. If you intend or have a plan to commit suicide, go to the emergency room right away.

Warning signs include:

Thoughts or talk of death or suicide

Thoughts or talk of self-harm or harm to others

Aggressive behavior or impulsiveness

Watch for these signs if your child or teen starts taking antidepressants. In some cases, people under 25 may have more suicidal thoughts in the first weeks of taking these medicines or when they take a different dose.

Depression Diagnosis

In order to diagnose you with depression, your doctor will use several methods, including:

Physical exam. Your doctor will check on your overall health to see if you might be dealing with another condition.

Lab tests. For example, you may have bloodwork done to check on certain hormone levels.

Psychiatric evaluation. Your doctor will be interested in your mental health and will ask about your thoughts, feelings, and behavior patterns. You may also fill out a questionnaire.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The American Psychiatric Association lists the criteria for depression in this manual. Your doctor may check your symptoms against it to see if you fit the standard.

Depression Treatment

If you or someone you know has symptoms of the condition, talk to your doctor. They can evaluate you and offer you treatment or refer you to a mental health professional.

The type of treatment your doctor recommends will depend on your symptoms and how severe they are. You may need one or more of the following:

Medication. Antidepressant medications (in combination with therapy) are effective for most people with depression. There are many different types of antidepressants. You may have to try several kinds before you find the one that works best for you. You may need a combination of two. Or your doctor may also prescribe an additional type of medication to help your antidepressant work best, such as a mood stabilizer, antipsychotic, anti-anxiety medication, or stimulant medication.

Psychotherapy. Talking to a mental health professional on a regular basis about your depression and other issues can help treat the symptoms. Different methods are available, including cognitive behavioral therapy (CBT) and talk therapy.

Hospital or residential treatment. If your depression is severe enough that you're having trouble taking care of yourself or may harm yourself or others, you may need psychiatric treatment in a hospital or residential facility.

Electroconvulsive therapy (ECT). This brain stimulation therapy passes electric currents through your brain to help your neurotransmitters work better. Typically, you wouldn't use this therapy unless antidepressants aren't working or you can't take them for other health reasons.

Transcranial magnetic stimulation (TMS). Your doctor typically suggests this only after antidepressants haven't worked. This treatment uses a coil to send magnetic pulses through your brain to help stimulate nerve cells that regulate mood.

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When Sadness Becomes Clinical Depression: Signs to Look For

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Onset of depression more complex than a brain chemical imbalance

It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It's believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.

Scientists have learned much about the biology of depression, but their understanding of the biology of depression is far from complete. Major advances in the biology of depression include finding links between specific parts of the brain and depression effects, discovering how chemicals called neurotransmitters make communication between brains cells possible, and learning the impact of genetics and lifestyle events on risk and symptoms of depression.

This article will address the how different parts of the brain affect mood.

Brain regions and mood

Popular lore has it that emotions reside in the heart. Science, though, tracks the seat of your emotions to the brain. Certain areas of the brain help regulate mood. Researchers believe that - more important than levels of specific brain chemicals - nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression.

Increasingly sophisticated forms of brain imaging - such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) - permit a much closer look at the working brain than was possible in the past. An fMRI scan, for example, can track changes that take place when a region of the brain responds during various tasks. A PET or SPECT scan can map the brain by measuring the distribution and density of neurotransmitter receptors in certain areas.

Use of this technology has led to a better understanding of which brain regions regulate mood and how other functions, such as memory, may be affected by depression. Areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus (see Figure 1).

Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI study published in The Journal of Neuroscience, investigators studied 24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed. The more bouts of depression a woman had, the smaller the hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe stress can suppress the production of new neurons (nerve cells) in the hippocampus.

Researchers are exploring possible links between sluggish production of new neurons in the hippocampus and low moods. An interesting fact about antidepressants supports this theory. These medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters). Yet people typically don't begin to feel better for several weeks or longer. Experts have long wondered why, if depression were primarily the result of low levels of neurotransmitters, people don't feel better as soon as levels of neurotransmitters increase.

The answer may be that mood only improves as nerves grow and form new connections, a process that takes weeks. In fact, animal studies have shown that antidepressants do spur the growth and enhanced branching of nerve cells in the hippocampus. So, the theory holds, the real value of these medications may be in generating new neurons (a process called neurogenesis), strengthening nerve cell connections, and improving the exchange of information between nerve circuits. If that's the case, depression medications could be developed that specifically promote neurogenesis, with the hope that patients would see quicker results than with current treatments.

Figure 1: Areas of the brain involved with depression

The regions shown here are mirrored in both hemispheres of the brain. Also, these structures are interlocking; the illustration suggests relative position but not precise location.

Amygdala: The amygdala is part of a group of structures deep in the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. Recalling an emotionally charged memory, such as a frightening situation, activates the amygdala. Activity in the amygdala is higher when a person is sad or clinically depressed, and this continues even after recovery from depression. This increase in activity may actually cause the amygdala to enlarge.

Basal ganglia (not pictured): The basal ganglia are a related group of structures deep in the brain. They are connected to and interact with structures that are closer to the brain's surface. They may help facilitate movement and may be involved in memorizing, thinking, and emotional processing. Some studies have found shrinkage and other structural changes in the basal ganglia in people with depression.

Hippocampus: The hippocampus plays a key role in processing long-term memory. Interplay between the hippocampus and the amygdala might account for the adage "once bitten, twice shy." It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormones impairs the growth of neurons in this part of the brain.

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What causes depression? - Harvard Health

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Depression has many possible causes, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression.

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I chose this video because it is telling people how depression is different from sadness.

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Lastly, this article explains why women can have more depression than men.

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As noted in a recent blog, women are twice as likely to experience major depression than men. They are also up to three times more apt to suffer from anxiety disorders or to attempt suicide. The reasons for these gender differences are not clear, and some believe such statistics are exaggerated because females are more "sensitive" and therefore more likely to report such symptoms. On the other hand, a variety of observations tend to confirm that these disparities are valid, such as the following half dozen.

1. Hormonal differences are usually cited as the major explanation. Compared to men, women experience much more fluctuation in hormone levels that are associated with symptoms of depression. In addition to premenstrual dysphoric disorder, up to 15% experience postpartum depression. Depression is so common during the menopause, that involutional melancholia was an established psychiatric diagnosis up until 1980. Women are also more apt to suffer from hypothyroidism, which is often associated with depression.

2. Women have a stronger genetic predisposition for depression than men based on identical and fraternal twin studies, as well as documented and detailed family history records.

3. Women tend to be more involved in personal relationships than men and suffer more when they are disrupted. More married women and housewives have increasingly entered the workforce and find it difficult to juggle job and family responsibilities, such as caring for an elderly relative. A major European study covering over 30 countries with a combined population of 514 million people recently reported that depression in middle-aged women had doubled in 40 years because of these pressures. Women between the ages of 25 and 40 were three to four times more likely to become depressed than men.

4. Women live longer than men and extreme old age is often associated with bereavement, loneliness, poor physical health, and other factors that predispose to depression.

5. Women are more likely than men to consult a physician if they do not feel well or have symptoms of depression, and are therefore more likely to be diagnosed. There is also some evidence that both male as well as female physicians are more apt to make a diagnosis of depression in women than men with identical complaints.

6. Seasonal Affective Disorder (SAD syndrome) is four times more common in women than men, and its incidence increases the farther away you live from the Equator. For example, Tromso, a city in Norway 200 miles north of the Arctic Circle, has close to 50 days during the winter when the sun is never seen. This period is referred to as morketi den (murky time) and as one psychiatrist noted, "The whole city slows down, people's concentration and work capacity are reduced and they are always tired. There is a definite increase in depression, particularly in women." Sales of sleeping pills, tranquilizers as well as "pep" pills rise sharply as do accidents. The sun's return after 7 weeks is celebrated as Soldag (Sunday), and the first rays are greeted with tears, prayers and special wishes, children are sent home early from school and everyone stops working.

As will be explained in a subsequent blog, career oriented single working women may be at particularly increased risk not only for anxiety, depression and heart disease, but also breast and ovarian cancer, so stay tuned. Additional information on all the above can be found at www.stress.org.

Paul J. Rosch, MD, FACP

Dr. Paul J. Rosch is current Chairman of the Board of The American Institute of Stress, Clinical Professor of Medicine and Psychiatry at New York Medical College, Honorary Vice President of the International Stress Management Association and has served as Chair of its U.S. branch. You can follow AIS on Twitter, watch AIS videos on You Tube, become a fan of AIS on Facebook and subscribe to one or both free AIS magazines to receive the latest stress information and research from around the globe directly to your inbox.

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Why Do Women Suffer More From Depression And Stress?

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As noted in a recent blog, women are twice as likely to experience major depression than men. They are also up to three times more apt to suffer from anxiety disorders or to attempt suicide. The reasons for these gender differences are

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I chose this video because it gives you the main types of depression and how it can affect people in different ways.

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I chose this article for my counterclaim because it tells people why depressed people dont want to admit their 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."

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."