Understanding Depression

What is depression?

We all go through ups and downs in our mood. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but clinical depression is much more than just sadness.
Some people describe depression as “living in a black hole” or having a feeling of impending doom. However, some depressed people don't feel sad at all — instead, they feel lifeless, empty, and apathetic.

Whatever the symptoms, depression is different from normal sadness in that it engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun. The feelings of helplessness, hopelessness, and worthlessness are intense and unrelenting, with little, if any, relief.

Signs and symptoms of depression

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted — the more likely it is that you’re dealing with depression. When these symptoms are overwhelming and disabling, that's when it's time to seek help.

Common signs and symptoms of depression

• Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
• Loss of interest in daily activities. No interest in or ability to enjoy former hobbies, pastimes, social activities, or sex.
• Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
• Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
• Psychomotor agitation or retardation. Either feeling “keyed up” and restless or sluggish and physically slowed down.
• Loss of energy. Feeling fatigued and physically drained. Even small tasks are exhausting or take longer.
• Self-loathing. Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes.
• Concentration problems. Trouble focusing, making decisions, or remembering things.

Depression and suicide

Depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. 

Thoughts of death or suicide: A serious symptom of depression

A suicidal person may not ask for help, but that doesn't mean that help isn't wanted. Most people who are suicidal don't want to die — they just want to stop hurting. Take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide: it's a cry for help.
If you think a friend or family member is considering suicide, you might be afraid to bring up the subject. But talking openly about suicidal thoughts and feelings can save a life. Speak up if you're concerned and seek professional help immediately! Suicide prevention starts with recognizing the warning signs and taking action.

The faces of depression

Depression often looks different in men and women, and in young people and older adults. An awareness of these differences helps ensure that the problem is recognized and treated.

Depression in teens

While some depressed teens appear sad, others do not. In fact, irritability—rather than depression—is frequently the predominant symptom in depressed adolescents and teens. A depressed teenager may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains are also common symptoms of depression in young people.

Depression in older adults

The difficult changes that many older adults face—such as bereavement, loss of independence, and health problems—can lead to depression, especially in those without a strong support system. However, depression is not a normal part of aging. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression, and so the problem often goes unrecognized. Depression in older adults is associated with poor health, a high mortality rate, and an increased risk of suicide, so diagnosis and treatment are extremely important.

Depression in men

Depression is a loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. This is especially true with men. Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Other signs and symptoms of depression in men include anger, aggression, violence, reckless behavior, and substance abuse. Even though depression rates for women are twice as high as those in men, men are a higher suicide risk, especially older men.

Depression in women

Rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression. As for signs and symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.

Types of depression

Depression comes in many shapes and forms. The different types of depression have unique symptoms, causes, and effects. Knowing what type of depression you have can help you manage your symptoms and get the most effective treatments.

Major depression

Major depression, or clinical depression, is characterized by the inability to enjoy life and experience pleasure. The symptoms are constant, ranging from moderate to severe. Left untreated, major depression typically lasts for about six months. Some people experience just a single depressive episode in their lifetime, but more commonly, major depression is a recurring disorder. However, there are many things you can do to support your mood and reduce the risk of recurrence.

Atypical Depression

Atypical depression is a common subtype of major depression. It features a specific symptom pattern, including a temporary mood lift in response to positive events. You may feel better after receiving good news or while out with friends. However, this boost in mood is fleeting. Other symptoms of atypical depression include weight gain, increased appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection. Atypical depression responds better to some therapies and medications than others, so identifying this subtype can be particularly helpful.

Dysthymia (recurrent, mild depression)

Dysthmia is a type of chronic “low-grade” depression. More days than not, you feel mildly or moderately depressed, although you may have brief periods of normal mood. The symptoms of dysthymia are not as strong as the symptoms of major depression, but they last a long time (at least two years). These chronic symptoms make it very difficult to live life to the fullest or to remember better times. Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.” If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.” However, dysthymia can be treated, even if your symptoms have gone unrecognized or untreated for years.

Seasonal affective disorder (SAD)

There’s a reason why so many movies and books portray rainy days and stormy weather as gloomy. Some people get depressed in the fall or winter, when overcast days are frequent and sunlight is limited. This type of depression is called seasonal affective disorder (SAD). Seasonal affective disorder is more common in northern climates and in younger people. Like depression, seasonal affective disorder is treatable. Light therapy, a treatment that involves exposure to bright artificial light, often helps relieve symptoms.

Depression causes and risk factors

Some illnesses have a specific medical cause, making treatment straightforward. If you have diabetes, you take insulin. If you have appendicitis, you have surgery. But depression is more complicated. Depression is not just the result of a chemical imbalance in the brain, and is not simply cured with medication. Experts believe that depression is caused by a combination of biological, psychological, and social factors. In other words, your lifestyle choices, relationships, and coping skills matter just as much — if not more so — than genetics. However, certain risk factors make you more vulnerable to depression.

Causes and risk factors for depression

The road to depression recovery

Just as the symptoms and causes of depression are different in different people, so are the ways to feel better. What works for one person might not work for another, and no one treatment is appropriate in all cases. If you recognize the signs of depression in yourself or a loved one, take some time to explore the many treatment options. In most cases, the best approach involves a combination of self-help strategies, lifestyle changes, and professional help.

Ask for help and support

If even the thought of tackling your depression seems overwhelming, don’t panic. Feeling helpless and hopeless is a symptom of depression—not the reality of your situation. It does not mean that you’re weak or you can’t change! The key to depression recovery is to start small and ask for help. Having a strong support system in place will speed your recovery. Isolation fuels depression, so reach out to others, even when you feel like being alone. Let your family and friends know what you’re going through and how they can support you.

Make healthy lifestyle changes

Lifestyle changes are not always easy to make, but they can have a big impact on depression. Take a good look at your own lifestyle. What changes could you make to support depression recovery?  Self-help strategies that can be very effective include:

• Cultivating supportive relationships
• Getting regular exercise and sleep
• Eating a healthy, mood-boosting diet
• Managing stress
• Practicing relaxation techniques
• Challenging negative thought patterns

Seek professional help

If positive lifestyle changes and support from family and friends aren’t enough, seek help from a mental health professional. There are many effective treatments for depression, including therapy, medication, and alternative treatments. Learning about your options will help you decide what measures are most likely to work best for your particular situation and needs.

Effective treatment for depression often includes some form of therapy. Therapy gives you tools to treat depression from a variety of angles. What’s more, what you learn in therapy gives you skills and insight to prevent depression from coming back.

Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.

Related links for depression

Signs and symptoms of depression

Signs and Symptoms of Mood Disorders – Lists the common signs and symptoms of depression and bipolar disorder. (Depression and Bipolar Support Alliance)

Stories of Depression: Does This Sound Like You? - Read personal stories of depression, review the signs and symptoms, and learn how to get help. (National Institute of Mental Health)

What Does Depression Feel Like? – Provides a list of signs and symptoms and ways you might feel if you're depressed. (Wings of Madness)

When Depression Hurts – Article on the painful physical symptoms of depression, including what causes them and how treatment can help. (Psychology Today)

Male Depression: Don't Ignore the Symptoms – Learn about the distinct symptoms of depression in men and the dangers of leaving them untreated. (Mayo Clinic)

Types of depression

The Different Faces of Depression – Discussion of the different subtypes of depression, including atypical depression, melancholic depression, and psychotic depression. (Psychology Today)

Atypical Depression: What's in a Name? - Article on the symptoms, diagnosis, and treatment of atypical depression. (American Psychiatric Association)

Dysthymia: Psychotherapists and patients confront the high cost of “low-grade” depression – In-depth look at the causes, effects, and treatment of dysthymic disorder. (Harvard Health Publications)

Seasonal Affective Disorder: Winter Depression – Guide to seasonal affective disorder and its symptoms, causes, and treatment. (Northern County Psychiatric Associates)

Depression causes and risk factors

What Causes Depression? - Article describes the many causes of depression and gives advice on taking back control of your life. (Psychology Today)

Co-occurring Disorders and Depression – How medical disorders can affect depression and vice versa (Mental Health America)

Joanna Saisan, MSW, Melinda Smith, M.A., Robert Segal, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last modified in June 2009