Depression (also referred to as major depressive disorder or clinical depression) is a serious mood disorder that affects approximately 1.5 percent of the U.S. population age 18 or older in any given year. Symptoms can negatively impact how a person feels and thinks, their ability to function at work or school, and their ability to form and maintain relationships. Symptoms must last for at least two weeks straight, not be attributable to depressing events or circumstances, and include one or more of the following:
- Sadness, emptiness, or hopelessness
- Feelings of worthlessness or guilt
- Irritability, frustration, or anger over even small issues
- Loss of interest in activities once considered pleasurable, such as sex, hobbies, or sports
- Poor sleep—inability to fall asleep or stay asleep, sleeping too much or too little
- Fatigue—having to drag yourself through the day
- Reduced or increased appetite
- Unplanned weight loss or weight gain
- Anxiety, agitation, or restlessness (trouble sitting still)
- Slowed thinking, speaking, or physical movement
- Fixation on perceived failures of the past
- Cognitive impairment—trouble thinking, concentrating, making decisions, or recalling information
- Suicidal thoughts or attempts, or frequent and recurring thoughts of death
- Physical maladies, such as back pain, headaches, cramps, or digestive issues that have no clear physical cause and/or do not respond to treatment
A diagnosis of depression depends on a variety of factors, including the number of symptoms and their severity and duration. However, even if your symptoms do not rise to the level of clinical depression, you may benefit from some form of treatment.
Types of Depression
Depression is often broken down into categories based on specific symptoms and the cause of those symptoms. These categories can be very useful in choosing treatments that are more likely to be effective. Types of depression include the following:
- Persistent depressive disorder (or dysthymia): Alternating periods of major depression and less severe symptoms that last for at least two consecutive years.
- Peripartum or postpartum depression: Major depressive disorder that is clearly associated with the later stages of pregnancy or after delivery and makes it difficult for the new mother to care for herself or her baby.
- Premenstrual dysphoric disorder (PMDD): Depression that occurs at the start of a woman’s period and may respond to antidepressant medications or oral contraceptives.
- Psychotic depression: Major depression accompanied by some form of psychosis (hallucinations, delusions, or paranoia). The psychotic themes are usually depressive, such as delusions over guilt, poverty, illness, or abandonment.
- Seasonal affective disorder (SAD): When the onset of depression generally aligns with the change of seasons (particularly occurring during the winter months), the condition is often categorized as seasonal affective disorder.
- Bipolar depression: When periods of depression alternate with periods of mania or hypomania (elevated energy and mood), the depression may be part of another condition known as bipolar disorder.
- Treatment-resistant depression: When depression fails to respond to most medications, psychotherapies, self-help techniques, and other interventions, it may be classified as treatment-resistant and require other approaches.
Treatments for Depression
Major depressive disorder requires some form of medical intervention, typically combined with psychotherapy and other types of interventions. Treatments for depression can be broken down into the following categories:
- Medication: A wide variety of antidepressants are available, which can be broken down into several different classes:
- Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and escitalopram (Lexapro)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta)
- Norepinephrine-dopamine reuptake inhibitors (NDRIs), which increase levels of dopamine and norepinephrine in the brain, such as bupropion (Wellbutrin)
- Mirtazapine (Remeron)
- Second-generation antipsychotics (SGAs), such as aripiprazole (Abilify) and quetiapine (Seroquel)
- Tricyclic antidepressants (TCAs), including amitriptyline (Elavil), desipramine (Norpramin), and imipramine (Tofranil)
- Monoamine oxidase inhibitors (MAOIs), including phenelzine (Nardil), isocarboxazid (Marplan), and anylcypromine sulfate (Parnate)
- Psychotherapy: Various forms of psychotherapy have proven to be helpful in treating depression, including the following:
- Cognitive behavioral therapy (CBT): Identifies and seeks to modify negative thinking patterns associated with depression.
- Interpersonal therapy (IPT): Focuses on identifying and addressing problems in relationships and life changes that may be contributing to depression.
- Psychodynamic therapy: Focuses on recognizing and addressing negative behavioral patterns that are linked to past experiences and seeking some resolution to these past experiences.
- Brain stimulation: Stimulating the brain or specific nerves with electronic or magnetic energy has shown promise in treating some forms of depression, especially treatment-resistant depression. Brain stimulation therapies include the following:
- Electroconvulsive therapy (ECT)
- Repetitive transcranial magnetic stimulation (rTMS)
- Vagus nerve stimulation (VNS)
- Complementary and Alternative Medicine (CAM): Outside of conventional psychiatry and psychotherapy, you can find complementary and alternative treatments for depression, some of which are supported by research and others which are not. These treatments include the following:
- Herbal remedies such as St. John’s Wort
- Nutritional supplements such as folate (folic acid or vitamin B9)
- Dietary changes, such as eliminating certain foods or food groups that you may be sensitive to
- Physical manipulation, such as acupuncture, chiropractic, massage therapy, or reflexology
- Self-help: Self-help may include changes in diet or lifestyle, exercise, relaxation techniques such as yoga or meditation, or identifying and addressing circumstances that are contributing to depression.
- Support groups: Support groups, such as those sponsored by the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA) provide the means to find support and exchange information among peers.