Depression

Clinical depression, or major depressive disorder (MDD), is marked by one or both of the following core symptoms: a persistent depressed mood, which includes feelings of sadness, emptiness, or hopelessness, and a significant loss of interest or pleasure in most activities. Individuals with MDD often experience other symptoms such as irritability, feelings of guilt or worthlessness, changes in sleep or appetite, fatigue, difficulty concentrating, and recurrent thoughts of death or suicide. In some cultural contexts, depression might also manifest through physical symptoms like pain or fatigue. Children and teenagers can exhibit different symptoms, including increased irritability and emotional outbursts. If you or someone you know is experiencing suicidal thoughts, it is crucial to seek support. You can reach out to the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741-741 for help.

Causes

Depression is a complex mental health disorder with several possible causes, often resulting from a combination of factors:

• Brain structure and function

• Genetic predisposition or family history

• Personality traits

• Environmental influences

Depression can affect individuals of any age, including children and older adults, though it typically begins in adulthood. Those with a personal or family history of MDD may be at higher risk. Additionally, certain life experiences such as relationship difficulties, social isolation, job stress, financial challenges, experiences of abuse, racial trauma, medical conditions, and substance abuse can increase the likelihood of developing depression.

Symptoms

Individuals experiencing clinical depression typically display at least one of two primary symptoms:

• A persistently depressed mood, characterized by sadness, hopelessness, or emptiness.

• A noticeable loss of interest or pleasure in nearly all activities.

Beyond these, people with Major Depressive Disorder may experience:

• Irritability or increased agitation

• Overwhelming feelings of guilt or worthlessness

• Sleep disturbances

• Changes in appetite

• Persistent fatigue or low energy

• Difficulty focusing or making decisions

• A sense of restlessness or moving slowly

• Recurrent thoughts about death or suicide

In some cultures, depression might present through physical symptoms like headaches or weakness. Children and adolescents might show different symptoms, such as increased irritability or emotional outbursts. Remember, support is available through the National Suicide Prevention Lifeline at 1-800-273-8255 or by texting HOME to 741-741.

Diagnosis

Diagnosing Major Depressive Disorder requires the presence of at least five depression symptoms, which must occur nearly every day, for at least two weeks, causing disruption to daily life. It's important that these symptoms are not caused by substance use, medication, or another medical condition, and are not better explained by another mental health disorder. Discuss any concerns with your healthcare provider, especially if symptoms persist for more than a few weeks. Mental Health America offers a free online depression screening tool to help determine if you should seek a professional evaluation. During a consultation, your healthcare provider may ask about your symptoms and recommend a physical exam or blood tests to rule out physical conditions like thyroid issues or anemia.

Treatments

There are effective treatment options for depression, primarily psychotherapy and medications. Psychotherapy can be beneficial alone or alongside medication, helping patients understand their thoughts and behaviors while learning coping strategies. Types of therapy such as Cognitive-behavioral therapy (CBT), Interpersonal therapy (IPT), Psychodynamic therapy, and Supportive therapy have proven effective in treating MDD. Complementary treatments like bright light therapy, yoga, and music therapy may also support recovery. In cases where standard treatments do not work, brain stimulation therapies like transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) may be considered.

Medications

Various medications effectively treat depression, including:

• Selective Serotonin Reuptake Inhibitors (SSRIs)

• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

• Atypical Antidepressants

Antidepressants typically require continuous daily use for 1 to 2 months before significant improvement is noticed. If no improvement occurs, your healthcare provider might adjust your dosage or suggest a different antidepressant, as responses vary. Sometimes, an additional medication like atypical antipsychotics, mood stabilizers, or thyroid hormone might be recommended to enhance the effectiveness of antidepressants. If first-choice medications are ineffective, older antidepressants, such as Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs), may be explored. Ketamine and its derivative, Esketamine (Spravato), provide rapid relief from MDD symptoms under clinical supervision when traditional treatments have failed.