Have you ever been sad because you didn’t get that job you wanted or didn’t make the team? Or perhaps you were sad because you had to say goodbye to a friend, or lost a loved one. Sadness is a normal emotion. Everyone feels sad at some point, whether in response to a disappointing situation or a significant loss. While being sad is a common emotion, that sadness often goes away relatively quickly. When does sadness become abnormal, or a possible depressive disorder?

To identify and diagnose mental disorders, health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM includes descriptions, symptoms and criteria that must be met in order to diagnose a disorder. You can read more about the DMS here. The main criteria for depression is that the symptoms must be present for at least two weeks, and affects a person’s daily life. 

Before discussing the symptoms of depression and the types of depression it is important to note the prevalence of depression. According to Psychiatry nearly 30% of adults have been diagnosed with depression sometime in their lives. Women are more likely than men to experience depression, as are younger adults, with symptoms often appearing in late teens and early 20s. However, these statistics do not mean that men, and people of all ages, do not experience depression. Depression can affect people of all walks of life. 

Types of Depressive Disorders

According to the NIMH there are several types of depressive disorders. These include:

• Major depression includes symptoms of depressed mood or loss of interest, most of the time for at least 2 weeks, that interfere with daily activities.
• Persistent depressive disorder (also called dysthymia or dysthymic disorder) consists of less severe symptoms of depression that last much longer, usually for at least 2 years.
• Perinatal depression is depression that occurs during pregnancy or after childbirth. Depression that begins during pregnancy is prenatal depression, and depression that begins after the baby is born is postpartum depression.
• Seasonal affective disorder is depression that comes and goes with the seasons, with symptoms typically starting in the late fall or early winter and going away during the spring and summer.
• Depression with symptoms of psychosis is a severe form of depression in which a person experiences psychosis symptoms, such as delusions (disturbing, false fixed beliefs) or hallucinations (hearing or seeing things others do not hear or see).

Symptoms and Causes

Symptoms of depression can look different in different people, and can vary from mild to severe. If some of the symptoms have been present for two weeks or more, and are affecting a person’s life, the person should seek professional help. Some of the major symptoms and risk factors are listed below, and are from the NIMH and Psychiatry.

• Feelings of hopelessness, irritability, or frustration
• Feelings of worthlessness, or helplessness
• Loss of interest or pleasure in activities
• Fatigue or lack of energy
• Difficulty concentrating, or making decisions
• Changes in appetite or unplanned weight changes
• Physical aches or pains without a clear physical cause 
• Sleeping too little or too much.
• Decreased energy or increased tiredness or fatigue
• Thoughts of death, suicidal ideation, or suicide attempts

While depression can affect anyone, and there is no one specific cause, there are some risk factors to be aware of. These include:

• Biochemical: certain chemicals in the brain may contribute to symptoms of depression
• Genetic: A family history of depression 
• Personality: People who are easily overwhelmed by stress or those with low self-esteem may be more at risk for depression
• Environmental: Prolonged exposure to neglect, violence, poverty, or abuse may be more likely to develop depression

Treatment

The good news is that depression is very treatable! If you are experiencing symptoms of depression contact your health care provider to determine a diagnosis and treatment plan. As with anxiety disorders, the NIMH identifies psychotherapy, medication, or both as treatments for depression. Psychotherapy for individuals with depression focuses on changing patterns of behavior and teaching new ways of thinking. One popular evidence-based approach is cognitive-behavioral therapy. Medication, or anti-depressants, work on changing how the brain produces or uses certain chemicals. Anti-depressants can take up to four to eight weeks to work. It is important to give treatments time to work before concluding that a treatment is not effective. However, if medication or psychotherapy is not working there is another treatment called brain stimulation therapy. Electroconvulsive therapy (ECT) is one of the most widely used brain stimulation therapies. It is often used for severe depression. During ECT the brain is stimulated electrically, and it is performed under anesthesia.

Self-Help

As with anxiety there are some self-help strategies the NIMH recommends that can reduce symptoms. Getting enough quality sleep on a regular basis, exercising, eating a healthy diet, avoiding alcohol, having a routine, and staying engaged and connected can have a positive impact on depression. You can also check out the CDC for additional tips on improving your emotional well-being. 

If you or someone you know needs support, call or text 988.