The Many Faces of Depression and How to Recognize Them
If you aren’t suffering from depression, the odds are good that you know someone who is. According to the World Health Organization (WHO), 300 million people worldwide have this debilitating condition. Major depressive disorder, a serious mental illness characterized by feelings of sadness, hopelessness, loss of interest in formerly pleasurable activities, anger, and frustration, affects close to 6.7% of the adult population in the United States. In severe cases, depression can lead to suicidal thoughts. Joint findings from WHO and the Centers for Disease Control and Prevention (CDC) put the number of people who die from depression-related suicides each year at 800,000.
If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the National Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK (8255) or via their site here. This national network of local crisis centers provides free, confidential counseling for those in suicidal crisis or emotional distress as well as the loved ones of people who are experiencing suicidal ideation or have committed suicide. También disponible en español.
While everyone feels sad, overwhelmed, or irritable from time to time, those feelings typically pass. For individuals with depression, however, negative feelings linger. Experts consider this chronic illness to be a significant public-health issue. Not only are people with depression more likely to die from suicide, but they also face an elevated risk of health conditions such as heart disease.
While the statistics surrounding depression sound grim, the good news is that the vast majority of people with depression who seek treatment find relief. The first step in getting help is admitting that you need it.
What Causes Depression?
Depression has no single cause. Researchers have identified a variety of factors that can trigger its onset, including the loss of a loved one, a serious illness such as cancer, social isolation, and life stresses such as divorce or financial troubles. It's also entirely possible for depression to arise without any distinguishable external cause.
The following risk factors, according to experts in the field, may make a person more prone to develop depression:
- Genetics: Mood disorders like depression often run in families.
- Childhood trauma: This can create lasting changes to brain pathways for processing fear and stress.
- Substance abuse: An estimated 30% of people who drink or use drugs in problematic ways are dealing with depression, necessitating a dual treatment approach.
- Anxiety: Individuals diagnosed with anxiety are at high risk of developing depression, and vice versa. Nearly half of those with depression also have anxiety.
- Other medical conditions: It appears that sleep disorders, chronic pain, and attention deficit hyperactivity disorder (ADHD) can also make someone more likely to develop depression.
Scientists have found certain changes in the brains of those with depression, specifically, the frontal lobe becomes less active, but it's not clear whether those changes cause depression or arise because of it.
Recognizing Signs of Depression
A common condition, depression results in physical and emotional problems that affect the way individuals feel, think, and act.
You’ve probably heard the expression that depression has many faces. With that in mind, it's important to understand that the myriad symptoms of depression can vary significantly from person to person. If you're wondering whether you or a family member might be struggling with depression, consider whether you're experiencing any of the following in your daily life:
- Sad, empty, anxious, or hopeless feelings
- Outbursts of anger or frustration
- Lack of interest in activities you previously enjoyed
- Unexplained physical problems, such as back pain or headaches
- Exhaustion, trouble sleeping, or a habit of sleeping too much
- Increase or decrease in appetite
- Problems with concentration, decision-making, or memory
- Thoughts of suicide
5 Common Types of Depression
Most of us have days when we feel mopey, blue, or out of sorts. However, if you’re experiencing persistent or severe depression, you should consider seeking medical attention. A doctor or therapist can help you determine whether you’re suffering from a temporary condition or a more severe form of clinical depression that requires treatment.
Here are some of the most common types of depression along with their distinguishing traits.
- Major depression: Also called major depressive disorder, this is likely the type of depression you think of when a friend or loved one says they're depressed. Patients with this condition often experience feelings of worthlessness, trouble sleeping, and a loss of interest in daily activities. In some cases, patients with major depression have thoughts of suicide, so exploring depression treatment options is crucial.
- Persistent depressive disorder: It's possible to experience clinical depression arising from known or unknown causes for a short period of time, or more chronically. In order to be diagnosed with persistent depressive disorder, also known as dysthymia, a person must be experiencing a depressed mood for a duration of 2 years or longer. The severity of symptoms may fluctuate over that time, but they must be consistently present.
- Postpartum depression: A type of depression affecting women who have just given birth, postpartum depression is characterized by intense feelings of depression, anxiety, and exhaustion. It's quite common for new mothers to experience some anxiety and depression after giving birth, but in most cases, that resolves within about two weeks. Despite its name, postpartum depression may arise during pregnancy or after giving birth. Mothers experiencing postpartum depression may struggle to care for themselves or their infants.
- Seasonal affective disorder (SAD): This type of depression tends to impact patients during the cold-weather months and is believed to result from a reduced exposure to sunlight. SAD symptoms, which include social withdrawal, fatigue, and weight gain, typically improve in the spring and summer but return when the days grow shorter and colder.
- Psychotic depression: This serious condition refers to a combination of serious depression and some type of psychosis, such as hallucinations (seeing or hearing things that others cannot) or delusions (upsetting and rigid false beliefs), and feelings of paranoia. In most cases, psychosis symptoms center on a theme such as persecution, guilt, or illness. According to the American Psychiatric Association, early, well-coordinated treatment is vital to securing good outcomes for individuals experiencing psychosis.
A few other types of depressive disorders recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).
Though it was formerly called manic depression, and does include episodes of extremely low moods that meet the criteria for major depression, bipolar disorder is a separate disorder and requires its own distinct treatment approaches. The key difference between bipolar disorder and depression is that the former features periods of extremely elevated moods—usually either euphoria or intense irritability—called mania or less intense versions of the same called hypomania.
How Many People Experience Depression?
Depression is one of the most common mental health disorders, both in the United States as well as worldwide. Statistics show rates of depression are rising, particularly among adolescents.
Data shared by the National Institutes of Health (NIH) shows that in 2016, 16.2 million adults over the age of 18 had experienced at least one major depressive episode. The number of adolescents with depression has climbed more steeply than that in any other age group. In 2016, that number reached 3.1 million—19.4% of girls and 6.4% percent of boys.
In fact, unlike many other health conditions, the risk of depression actually drops as you age. Adults between 18 and 25 face the highest risk of depression (10.9%) while older adults who've reached the age of 50 and beyond face the lowest risk (4.8%).
Across all age groups, women in the United States are substantially more likely to experience depression than men—8.5% compared to 4.8%.
Race plays a role in depression risk too. Adults who identify with two or more racial or ethnic groups have the highest risk of depression at 10.5%.
Having had a prior depressive episode also increases the likelihood you'll experience another. Researchers from Pro Persona at the Institute for Mental Health Care in the Netherlands found that more than 13% of individuals who recover from an episode of major depression will experience another within five years. When they extended the time frame to 10 years, that rises to 23%, and for 20 years, to 42%.
Though depression is highly treatable, the Pro Persona researchers found that less than 50% of those with this condition receive adequate care. In some countries, a mere 10% receive the treatment they need. A variety of factors contribute to this problem, including a lack of knowledgable health care professionals, misdiagnosis, and social stigma.
Seeking Help for Depression
Multiple treatments exist to help depression patients reduce symptoms and improve quality of life. Statistics show that between 80% and 90% of individuals with depression who seek treatment will find an option that works for them. However, finding the right one can be a complicated process, and individuals often have to try different options to achieve positive results.
Lifestyle Changes and Alternative Treatments
Many patients also rely on lifestyle adjustments to ease their depression symptoms. Some popular alternative treatments that can complement traditional approaches to treating depression include:
- Prioritizing physical activity, such as yoga
- Committing to a regular meditation practice
- Using acupuncture to alleviate physical and mental distress
- Building a supportive social network
- Caring for your physical self by, for example, eating a nutrient-rich diet
There are also a number of herbal supplements, such as St. John's wort, that have been shown to effectively address symptoms of depression. Since supplements can interact with other medications, be sure to speak with your doctor about any possible interactions.
Nutritional therapy using amino acids is an especially exciting approach to depression treatment. "Supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders. Based on emerging scientific evidence, this form of nutritional supplement treatment may be appropriate for controlling major depression," explained an article written by two scientists at the Global Neuroscience Initiative Foundation in Los Angeles.
The amino acid L-tyrosine, for instance, supports the synthesis of the neurotransmitters epinephrine, norepinephrine, and dopamine, which can result in decreased depression symptoms.
In addition to lifestyle changes, individuals with depression may experience significant benefits from therapy. Interpersonal and problem-solving approaches can be helpful, but the strongest evidence to date supports an approach called cognitive-behavioral therapy (CBT).
A wealth of research indicates that CBT, a form of psychological treatment, can bring about significant improvements in terms of both functioning and quality of life for people with depression and other mental health issues.
The goal of CBT is to alleviate depression symptoms by modifying behaviors, thoughts, and feelings and breaking larger problems down into smaller ones that can be easily managed. Some of the core principles of this therapy approach include the idea that depression and other psychological problems arise because of unhelpful ways of thinking and behaviors. By changing those thought and behavior patterns, people can experience significant and measurable relief.
In a sense, CBT practitioners teach people how to be their own therapist by helping them build more effective coping skills. The focus in each session is on the current realities of a person's life, rather than historical events that may have contributed to the difficulty they are experiencing. Some information about a person's history will, of course, be necessary, but the overall emphasis is on learning how to effectively interact with emotions and challenges that arise in daily life.
If lifestyle changes or therapy cannot resolve symptoms of depression, medications can be a useful additional treatment option. The CDC estimates that 13% of Americans age 12 and older take antidepressant medication, an increase of 65% from 1999 to 2014.
When delving into the world of pharmaceutical treatments for depression, you'll encounter what at first may appear to be a bewildering array of acronyms: SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), NDRIs (norepinephrine–dopamine reuptake inhibitors), TCAs (tricyclic antidepressants), and MAOIs (monoamine oxidase inhibitors). Each string of letters refers to a category of drugs that have been grouped together due to the similar way in which they impact the neurotransmitters in your brain.
SSRIs, the most commonly prescribed class of antidepressants, work by boosting serotonin levels. Individuals with depression often display strikingly low levels of this important neurotransmitter, which impacts mood, sleep, and appetite. You may be familiar with brand names within this drug class such as Prozac, Celexa, and Zoloft. By stopping the reabsorption of serotonin, these drugs make more of the substance available in the brain.
Antidepressants usually take between 2 weeks to 2 months to produce noticeable changes, and they often come with side effects. Working with a skilled professional will be key to determining which antidepressant (if any) offers relief for you.
Options for Treatment-Resistant Depression
For individuals with severe, persistent depression that does not respond to other treatments, doctors may recommend more invasive options such as electroconvulsive therapy (ECT).
While many understandably have negative associations based on the primitive versions of electroshock therapy administered beginning in the 1940s, ECT treatments have evolved drastically. Today, patients can typically resume normal activities in about an hour after the procedure concludes.
Ketamine, a drug initially intended for use primarily as an animal tranquilizer that became popular on the black market for its ability to create a detached, dream-like state, can bring remarkably rapid relief for individuals suffering intransigent depression. Clinical trials have shown highly promising results. In 2019, the U.S. Food and Drug Administration (FDA) approved the use of Spravato, a drug based on ketamine, to treat depression via a nasal spray. Given its potential for abuse, it's only available in controlled clinical settings.
Dealing with Depression? You're Not Alone
Whether you're dealing with depression yourself, or supporting a child, parent, spouse, or friend, remember that support is always available to you.
An abundance of reliable, up-to-date information can be found on websites run by organizations like the National Institute of Mental Health (NIMH), while grassroots groups like the National Alliance on Mental Illness (NAMI) can help connect you with support groups in your area. Many also find comfort from personal essays that describe another person's lived experience with depression.
Depression can make you feel helpless and alone, but even taking small steps, like chatting with a trained counselor from your own home, can show you that's not the case.