Everything You Need to Know About Depression (Major Depressive Disorder)

• Everything You Need to Know About Depression (Major Depressive Disorder)
• Symptoms
• Causes
• Treatment
• Natural remedies and lifestyle tips
• Test
• Types
• And anxiety
• And OCD
• With psychosis
• Pregnancy
• And alcohol
• Prevention
• Outlook

What is depression?

Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities.

It’s also fairly common. Data from the Centers for Disease Control and PreventionTrusted Source estimates that 18.5 percent of American adults had symptoms of depression in any given 2-week period in 2019.

Though depression and grief share some features, depression is different from grief felt after losing a loved one or sadness felt after a traumatic life event. Depression usually involves self-loathing or a loss of self-esteem, while grief typically does not.

In grief, positive emotions and happy memories of the deceased typically accompany feelings of emotional pain. In major depressive disorder, the feelings of sadness are constant.

People experience depression in different ways. It may interfere with your daily work, resulting in lost time and lower productivity. It can also influence relationships and some chronic health conditions.

Conditions that can get worse due to depression include:

• arthritis
• asthma
• cardiovascular disease
• cancer
• diabetes
• obesity

It’s important to realize that feeling down at times is a normal part of life. Sad and upsetting events happen to everyone. But if you’re feeling down or hopeless on a regular basis, you could be dealing with depression.

Depression is considered a serious medical condition that can get worse without proper treatment.

Depression symptoms

Depression can be more than a constant state of sadness or feeling “blue.”

Major depression can cause a variety of symptoms. Some affect your mood and others affect your body. Symptoms may also be ongoing or come and go.

General signs and symptoms

Not everyone with depression will experience the same symptoms. Symptoms can vary in severity, how often they happen, and how long they last.

If you experience some of the following signs and symptomsTrusted Source of depression nearly every day for at least 2 weeks, you may be living with depression:

• feeling sad, anxious, or “empty”
• feeling hopeless, worthless, and pessimistic
• crying a lot
• feeling bothered, annoyed, or angry
• loss of interest in hobbies and interests you once enjoyed
• decreased energy or fatigue
• difficulty concentrating, remembering, or making decisions
• moving or talking more slowly
• difficulty sleeping, early morning awakening, or oversleeping
• appetite or weight changes
• chronic physical pain with no clear cause that does not get better with treatment (headaches, aches or pains, digestive problems, cramps)
• thoughts of death, suicide, self-harm, or suicide attempts

The symptoms of depression can be experienced differently among males, females, teens, and children.

Males may experience symptoms related to their:

• mood, such as anger, aggressiveness, irritability, anxiousness, or restlessness
• emotional well-being, such as feeling empty, sad, or hopeless
• behavior, such as loss of interest, no longer finding pleasure in favorite activities, feeling tired easily, thoughts of suicide, drinking excessively, using drugs, or engaging in high-risk activities
• sexual interest, such as reduced sexual desire or lack of sexual performance
• cognitive abilities, such as inability to concentrate, difficulty completing tasks, or delayed responses during conversations
• sleep patterns, such as insomnia, restless sleep, excessive sleepiness, or not sleeping through the night
• physical well-being, such as fatigue, pains, headache, or digestive problems

Females may experience symptoms related to their:

• mood, such as irritability
• emotional well-being, such as feeling sad or empty, anxious, or hopeless
• behavior, such as loss of interest in activities, withdrawing from social engagements, or thoughts of suicide
• cognitive abilities, such as thinking or talking more slowly
• sleep patterns, such as difficulty sleeping through the night, waking early, or sleeping too much
• physical well-being, such as decreased energy, greater fatigue, changes in appetite, weight changes, aches, pain, headaches, or increased cramps

Children may experience symptomsTrusted Source related to their:

• mood, such as irritability, anger, rapid shifts in mood, or crying
• emotional well-being, such as feelings of incompetence (e.g., “I can’t do anything right”) or despair, crying, or intense sadness
• behavior, such as getting into trouble at school or refusing to go to school, avoiding friends or siblings, thoughts of death or suicide, or self-harm
• cognitive abilities, such as difficulty concentrating, decline in school performance, or changes in grades
• sleep patterns, such as difficulty sleeping or sleeping too much
• physical well-being, such as loss of energy, digestive problems, changes in appetite, or weight loss or gain

Depression causes

There are several possible causes of depression. They can range from biological to circumstantial.

Common causes include:

• Brain chemistry. There may be a chemical imbalance in parts of the brain that manage mood, thoughts, sleep, appetite, and behavior in people who have depression.
• Hormone levels. Changes in female hormones estrogen and progesterone during different periods of time like during the menstrual cycle, postpartum period, perimenopause, or menopause may all raise a person’s risk for depression.
• Family history. You’re at a higher risk for developing depression if you have a family history of depression or another mood disorder.
• Early childhood trauma. Some events affect the way your body reacts to fear and stressful situations.
• Brain structure. There’s a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms.
• Medical conditions. Certain conditions mayTrusted Source put you at higher risk, such as chronic illness, insomnia, chronic pain, Parkinson’s disease, stroke, heart attack, and cancer.
• Substance use. A history of substance or alcohol misuse can affect your risk.
• Pain. People who feel emotional or chronic physical pain for long periods of time are significantly more likelyTrusted Source to develop depression.

Risk factors

Risk factors for depression can be biochemical, medical, social, genetic, or circumstantial. Common risk factors include:

• Sex. The prevalence of major depression is twice as high in femalesTrusted Source as in males.
• Genetics. You have an increased riskTrusted Source of depression if you have a family history of it.
• Socioeconomic status. Socioeconomic status, including financial problems and perceived low social status, can increaseTrusted Source your risk of depression.
• Certain medications. Certain drugs including some types of hormonal birth control, corticosteroids, and beta-blockers may be associatedTrusted Source with an increased risk of depression.
• Vitamin D deficiency. StudiesTrusted Source have linked depressive symptoms to low levels of vitamin D.
• Gender identity. The risk of depression for transgender people is nearly 4-fold that of cisgender people, according to a 2018 study.
• Substance misuse. About 21 percent of people who have a substance use disorder also experience depression.
• Medical illnesses. Depression is associated with other chronic medical illnesses. People with heart disease are about twice as likelyTrusted Source to have depression as people who don’t, while up to 1 in 4 peopleTrusted Source with cancer may also experience depression.

The causes of depression are often tied to other elements of your health.

Treatment for depression

You may successfully manage symptoms with one form of treatment, or you may find that a combination of treatments works best.

It’s common to combine medical treatments and lifestyle therapies, including the following:

Medications

Your healthcare professional may prescribe:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most commonly prescribed antidepressant medications and tend to have few side effects. They treat depression by increasing the availability of the neurotransmitter serotonin in your brain.

SSRIs should not be takenTrusted Source with certain drugs including monoamine oxidase inhibitors (MAOIs) and in some cases thioridazine or Orap (pimozide).

People who are pregnant should talk to their healthcare professionals about the risks of taking SSRIs during pregnancy. You should also use cautionTrusted Source if you have narrow-angle glaucoma.

Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil, Paxil XR, Pexeva), and sertraline (Zoloft).

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs treat depression by increasing the amount of the neurotransmitters serotonin and norepinephrine in your brain.

SNRIs should not be taken with MAOIs. You should use caution if you have liver or kidney problems, or narrow-angle glaucoma.

Examples of SNRIs include desvenlafaxine (Pristiq, Khedezla), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), and venlafaxine (Effexor XR).

Tricyclic and tetracyclic antidepressants

Tricyclic antidepressants (TCAs) and tetracyclic antidepressants (TECAs) treat depression by increasing the amount of the neurotransmitters serotonin and norepinephrine in your brain.

TCAs can cause more side effects than SSRIs or SNRIs. Do not take TCAs or TECAs with MAOIs. Use with caution if you have narrow-angle glaucoma.

Examples of tricyclic antidepressants include amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil), desipramine (Norpramin), nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).

Atypical antidepressants
Noradrenaline and dopamine reuptake inhibitors (NDRIs)

These drugs can treat depression by increasing the levels of dopamine and noradrenaline in your brain.

Examples of NDRIs include bupropion (Wellbutrin).

Monoamine oxidase inhibitors (MAOIs)

MAOIs treat depression by increasing the levelsTrusted Source of norepinephrine, serotonin, dopamine, and tyramine in your brain.

Due to side effects and safety concernsTrusted Source, MAOIs are not the first choice for treating mental health disorders. They are typically used only if other medications are unsuccessful at treating depression.

Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate).

N-methyl D-aspartate (NMDA) antagonists

N-methyl-D-aspartate (NDMA) antagonists treat depressionTrusted Source by increasing levels of glutamate in the brain. Glutamate is a neurotransmitter believed to be involved in depression.

NMDA antagonists are used only in patients who have not had success with other antidepressant treatments.

The FDA has approved one NDMA medication, esketamineTrusted Source (Spravato), for the treatment of depression.

Esketamine is a nasal spray that is only available through a restricted program called Spravato REMS.

Patients may experience tiredness and dissociation (difficulty with attention, judgment, and thinking) after taking the medication. For this reason, esketamine is administered in a healthcare setting where a healthcare professional can monitor for sedation and dissociation.

Each type of medication that’s used to treat depression has benefits and potential risks.

Psychotherapy

Speaking with a theapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.

Psychotherapy, also known as “talk therapy,” is when a person speaks to a trained therapist to identify and learn to cope with the factors that contribute to their mental health condition, such as depression.

Psychotherapy has been shownTrusted Source to be an effective treatment in improving symptoms in people with depression and other psychiatric disorders.

Psychotherapy is often used alongside pharmaceutical treatment. There are many different types of psychotherapy, and some people respond better to one type than another.

Cognitive behavioral therapy (CBT)

In cognitive behavioral therapy (CBT), a therapist will work with you to uncover unhealthy patterns of thought and identify how they may be causing harmful behaviors, reactions, and beliefs about yourself.

Your therapist might assign you “homework” where you practice replacing negative thoughts with more positive thoughts.

Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT) is similar to CBT, but puts a specific emphasis on validation, or accepting uncomfortable thoughts, feelings, and behaviors, instead of fighting them.

The theory is that by coming to terms with your harmful thoughts or emotions, you can accept that change is possible and make a recovery plan.

Psychodynamic therapy

Psychodynamic therapy is a form of talk therapy designed to help you better understand and cope with your day-to-day life. Psychodynamic therapy is based on the ideaTrusted Source that your present-day reality is shaped by your unconscious, childhood experiences.

In this form of therapy, your therapist will help you reflect and examine your childhood and experiences to help you understand and cope with your life.

Looking for ways to support your mental health and well-being? Try Healthline’s FindCare tool to connect with mental health professionals nearby or virtually so you can get the care you need.

Light therapy

Exposure to doses of white light can help regulate your mood and improve symptoms of depression. Light therapy is commonly used in seasonal affective disorder, which is now called major depressive disorder with seasonal pattern.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) uses electrical currents to induce a seizure, and has been shown to help people with clinical depression. It’s used in people with severe depression or depression that is resistant to other treatments or antidepressant medications.

During an ECT procedure, you’ll receive an anesthetic agent which will put you to sleep for approximately 5 to 10 minutes.

Your healthcare professional will place cardiac monitoring pads on your chest and four electrodes on specific areas of your head. They will then deliver short electrical pulses for a few seconds. You will neither convulse nor feel the electrical current and will awaken about 5 to 10 minutes after treatment.

Side effects include headaches, nausea, muscle aches and soreness, and confusion or disorientation.

Patients may also develop memory problems, but these usually reside in the weeks and months after treatment

Alternative therapies

Ask your doctor about alternative therapies for depression. Many people choose to use alternative therapies alongside traditional psychotherapy and medication. Some examples include:

• Meditation. Stress, anxiety, and anger are triggers of depression, but meditation can help change the way your brain responds to these emotions. StudiesTrusted Source show that meditation practices can help improve symptoms of depression and lower your chances of a depression relapse.
• Acupuncture. Acupuncture is a form of traditional Chinese medicine that may help ease some symptoms of depression. During acupuncture, a practitioner uses needles to stimulate certain areas in the body in order to treat a range of conditions. ResearchTrusted Source suggests that acupuncture may help clinical treatments work better and may be as effective as counseling.

Natural remedies and lifestyle tips
Exercise

Aim for 30 minutes of physical activity 3 to 5 days a week. Exercise can increase your body’s production of endorphins, which are hormones that improve your mood.

Avoid alcohol and substance use

Drinking alcohol or misusing substances may make you feel better for a little bit. But in the long run, these substances can make depression and anxiety symptoms worse.

Learn how to set limits

Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.

Take care of yourself

You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.

Sometimes depression doesn’t respond to medication. Your healthcare professional may recommend other treatment options if your symptoms don’t improve.

These options include electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS) to treat depression and improve your mood.

Supplements

Several types of supplements may have some positive effect on depression symptoms.

S-adenosyl-L-methionine (SAMe)

Some researchTrusted Source suggests this compound may ease symptoms of depression. The effects were best seen in people taking SSRIs. However, the results of this research is not conclusive and more research is needed.

5-hydroxytryptophan (5-HTP)

5-HTP may raiseTrusted Source serotonin levels in the brain, which could ease symptoms. Your body makes this chemical when you consume tryptophan, a building block of protein. However, more studies are needed.

Omega-3 fatty acids

These essential fats are important to neurological development and brain health. Adding omega-3 supplements to your diet may helpTrusted Source reduce depression symptoms. However, there is some conflicting evidence and more research is needed.

Always talk to your doctor before taking supplements, as they may interact with other medications or have negative effects.

Vitamins

Vitamins are important to many bodily functions. Research suggests two vitamins are especially useful for easing symptoms of depression:

• Vitamin B: B-12 and B-6 are vital to brain health. When your vitamin B levels are low, your risk for developing depression may beTrusted Source higher.
• Vitamin D: Sometimes called the sunshine vitamin, vitamin D is important for brain, heart, and bone health. There may beTrusted Source a link between vitamin D deficiency and depression, but more research is needed.

Many herbs, supplements, and vitamins claim to help ease symptoms of depression, but most haven’t shown themselves to be effective in clinical research.

Learn about herbs, vitamins, and supplements that have shown some promise, and ask your healthcare professional if any are right for you.

Depression test

There isn’t a single test to diagnose depression. But your healthcare provider can make a diagnosis based on your symptoms and a psychological evaluation.

In most cases, they’ll ask a series of questions about your:

• moods
• appetite
• sleep pattern
• activity level
• thoughts

Because depression can be linked to other health problems, your healthcare professional may also conduct a physical examination and order blood work. Sometimes thyroid problems or a vitamin D deficiency can trigger symptoms of depression.

It’s important not to ignore symptoms of depression. If your mood doesn’t improve or gets worse, seek medical help. Depression is a serious mental health illness with the potential for complications.

If left untreated, complications can includeTrusted Source:

• weight gain or loss
• physical pain
• substance use disorder
• panic attacks
• relationship problems
• social isolation
• thoughts of suicide
• self-harm

Types of depression

Depression can be broken into categories depending on the severity of symptoms. Some people experience mild and temporary episodes, while others experience severe and ongoing depressive episodes.

There are two main types: major depressive disorder and persistent depressive disorder.

Major depressive disorder

Major depressive disorder (MDD) is the more severe form of depression. It’s characterized by persistent feelings of sadness, hopelessness, and worthlessness that don’t go away on their own.

In order to be diagnosed with clinical depression, you must experience five or more of the following symptoms over a 2-week period:

• feeling depressed most of the day
• loss of interest in most regular activities
• significant weight loss or gain
• sleeping a lot or not being able to sleep
• slowed thinking or movement
• fatigue or low energy most days
• feelings of worthlessness or guilt
• loss of concentration or indecisiveness
• recurring thoughts of death or suicide

There are different subtypes of major depressive disorder, which the American Psychiatric Association refers to as “specifiers.”

These includeTrusted Source:

• atypical features
• anxious distress
• mixed features
• peripartum onset, during pregnancy or right after giving birth
• seasonal patterns
• melancholic features
• psychotic features
• catatonia

Persistent depressive disorder

Persistent depressive disorder (PDD) used to be called dysthymia. It’s a milder, but chronic, form of depression.

In order for the diagnosis to be made, symptoms must last for at least 2 yearsTrusted Source. PDD can affect your life more than major depression because it lasts for a longer period.

It’s common for people with PDD to:

• lose interest in normal daily activities
• feel hopeless
• lack productivity
• have low self-esteem

Depression can be treated successfully, but it’s important to stick to your treatment plan.

Read more about why depression treatment is important.

Living with depression can be difficult, but treatment can help improve your quality of life. Talk to your healthcare professional about possible options.

The Healthline FindCare tool can provide options in your area if you don’t already have a doctor.

Postpartum depression

Postpartum depression refers to depression that happens after childbirth. It is a common disorder after pregnancy, affecting 1 in 9 new parentsTrusted Source.

It’s common for people to experience “baby blues,” or feelings of sadness or emptiness after childbirth. For many people, these symptoms go away in a couple of days.

But if you feel sad, hopeless, or empty for longer than 2 weeks post-childbirth, you may have postpartum depression.

Symptoms of postpartum depression can range from mild to severe and can includeTrusted Source:

• feeling restless or moody
• feeling sad, hopeless, or overwhelmed
• having thoughts of hurting the baby or yourself
• not having an interest in the baby, feeling disconnected, or as if your baby is someone else’s
• having no energy or motivation
• eating too little or too much
• sleeping too little or too much
• having trouble focusing
• having memory problems
• feeling worthless, guilty, or like a bad parent
• withdrawing from activities you once enjoyed
• withdrawing from friends and family
• having headaches, aches, or stomach issues that don’t go away
• feeling empty, unconnected, or as though you might not love or care for the baby

Postpartum depression is thought to be triggered byTrusted Source the dramatic hormonal changes that take place after pregnancy.

Bipolar depression occurs in certain types of bipolar disorder when a person experiences a depressive episode.

Bipolar disorder is a mental disorder that causesTrusted Source distinct changes in mood, energy, concentration, and the ability to carry out your day-to-day tasks.

There are three types of bipolar disorder, all of which include periods known as manic episodes, where you feel extremely “up,” elated, or energized, and depressive episodes where you feel “down,” sad, or hopeless.

If you have bipolar disorder, it can be hard to recognize the harmful effects of each “mood episode.”

People having a depressive episode mayTrusted Source:

• feel very sad, hopeless, or empty
• feel slowed down or restless
• have trouble falling asleep, wake up too early, or sleep too much
• have an increased appetite and weight gain
• talk very slowly, forget things, or feel like they have nothing to say
• have trouble concentrating or making decisions
• feel unable to do basic tasks
• have little interest in activities
• have a decreased or absent sex drive
• have thoughts of death or suicide

Symptoms during a depressive episode last every day for most of the day and can last for several days or weeks.

If bipolar disorder is treated, many will experience fewer and less severe symptoms of depression, if they experience depressive episodes.

These 7 treatments may help ease symptoms of bipolar depression.

Depression and anxiety

Depression and anxiety can occur in a person at the same time. In fact, research has shown that over 70 percentTrusted Source of people with depressive disorders also have symptoms of anxiety.

Though they’re thought to be caused by different things, depression and anxiety can produce several similar symptoms, which can include:

• irritability
• difficulty with memory or concentration
• sleep problems

The two conditions also share some common treatments.

Both anxiety and depression can be treated with:

• therapy, like cognitive behavioral therapy
• medication
• alternative therapies, including hypnotherapy

If you think you’re experiencing symptoms of either of these conditions or both of them, make an appointment to talk with your healthcare professional. You can work with them to identify coexisting symptoms of anxiety and depression and how they can be treated.

Depression and obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. It causes unwanted and repeated thoughts, urges, and fears (obsessions).

These fears cause you to act out repeated behaviors or rituals (compulsions) that you hope will ease the stress caused by the obsessions.

People diagnosed with OCD frequently find themselves in a loop of obsessions and compulsions. If you have these behaviors, you may feel isolated because of them. This can lead to withdrawal from friends and social situations, which can increase your risk for depression.

It’s not uncommon for someone with OCD to also have depression. Having one anxiety disorder can increase your odds for having another. Up to 80 percentTrusted Source of people with OCD also have depression episodes.

This dual diagnosis is a concern with children, too. Their compulsive behaviors, which may be first developing at a young age, can make them feel unusual. That can lead to withdrawing from friends and can increase the chance of a child developing depression.

Depression with psychosis

Some individuals who have been diagnosed with major depression may also have symptoms of another mental disorder called psychosis. When the two conditions occur together, it’s known as “major depressive disorder, severe with psychotic features,” or depressive psychosis.

Depressive psychosis causes people to see, hear, believe, or smell things that aren’t real. People with the condition may also experience feelings of sadness, hopelessness, and irritability.

The combination of the two conditions is particularly dangerous. That’s because someone with depressive psychosis may experience delusions that cause them to have thoughts of suicide or to take unusual risks.

It’s unclear what causes these two conditions or why they can occur together, but treatment can successfully ease symptoms. Treatments include medications and electroconvulsive therapy (ECT).

Understanding the risk factors and possible causes can help you be aware of early symptoms.

Read more about depressive psychosis, how it’s treated, and what healthcare professionals understand about why it occurs.

Depression in pregnancy

Pregnancy is often an exciting time for people. However, it can still be common for a pregnant woman to experience depression.

Symptoms of depression during pregnancy include:

• changes in appetite or eating habits
• feeling hopeless
• anxiety
• losing interest in activities and things you previously enjoyed
• persistent sadness
• troubles concentrating or remembering
• sleep problems, including insomnia or sleeping too much
• thoughts of death or suicide

Treatment for depression during pregnancy may focus entirely on talk therapy and other natural treatments.

While some women do take antidepressants during their pregnancy, it’s not clear which ones are the safest. Your healthcare provider may encourage you to try an alternative option until after the birth of your baby.

The risks for depression can continue after the baby arrives. Postpartum depression, which is also called major depressive disorder with peripartum onset, is a serious concern for new mothers.

Recognizing the symptoms may help you spot a problem and seek help before it becomes overwhelming.

Depression and alcohol

Research has established a link between alcohol use and depression. People who have depression are more likely to misuse alcohol.

Out of the 20.2 million U.S. adults who experienced a substance use disorder, about 50 percentTrusted Source had a co-occurring mental illness.

Drinking alcohol frequently can make symptoms of depression worse, and people who have depression are more likely to misuse alcohol or become dependent on it.

Preventing depression

Depression isn’t generally considered to be preventable. It’s hard to recognize what causes it, which means preventing it is more difficult.

But once you’ve experienced a depressive episode, you may be better prepared to prevent a future episode by learning which lifestyle changes and treatments are helpful.

Techniques that may help include:

• regular exercise
• getting plenty of sleep
• maintaining treatments
• reducing stress
• building strong relationships with others

Other techniques and ideas may also help you prevent depression.

Read the full list of 15 ways you may be able to avoid depression.

Outlook for depression

Depression can be temporary, or it can be a long-term challenge. Treatment doesn’t always make your depression go away completely.

However, treatment often makes symptoms more manageable. Managing symptoms of depression involves finding the right combination of medications and therapies.

If one treatment doesn’t work, talk with your healthcare professional. They can help you create a different treatment plan that may work better in helping you manage your condition.