The Signs, Symptoms, and Treatments for Depression

While everyone has experienced sadness, not everyone has experienced depression. In fact, if you’ve never been depressed, chances are that you don’t have a real grasp on what living with this complex mental illness is like.
Depression is insidious. It affects not only your mood, but also your ability to feel, think, and function. It blunts sensations of pleasure, closes off connectedness, stifles creativity, and, at its worst, shuts down hope. It also often causes deep emotional pain not only to the person experiencing it, but to that person’s close family and friends.

Depression Statistics: Disturbing Trends, Helpful Treatment
Unfortunately, there are plenty of people who know exactly what it means to be depressed. An estimated 17.3 million, or 7 percent, of adults in the United States had at least one major depressive episode in the past year, according to the National Institute of Mental Health, making it one of the most common mental illnesses in the United States.(1)

What’s more, a recent report from Mental Health America, a nonprofit founded in 1909, offers startling statistics pertaining to one of depression's most disturbing symptoms: thoughts of suicide.

According to its 2020 State of Mental Health in America report, suicidal ideation among adults increased from 3.77 percent in 2012 to 4.19 percent in 2017, the most recent year for which statistics are available.(2) That means more than 10.3 million adults in the United States are affected by negative thoughts or emotions.

There is a bright side. Although there is no one-size-fits-all cure for depression, there are many effective treatment options, one of which is bound to help you heal if you’re struggling with the illness. This cannot be emphasized enough, given that roughly two-thirds of people living with depression do not receive the care they need, according to a report in the journal Neuropsychiatric Disease and Treatment, published online February 22, 2019.(3)

Signs and Symptoms: How to Identify Depression
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If sadness alone isn’t a good gauge of depression, what is? According to the American Psychiatric Association’s current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the diagnostic guide used by most mental health professionals, if you’ve experienced at least five of the following symptoms most of the day, nearly every day, for at least two weeks, you may be diagnosed with major depressive disorder (MDD), also known as clinical depression.(4)

Do you:

• Constantly feel tearful, empty, or worthless?
• Have little interest or pleasure in your work, hobbies, friends, family, and other things you once enjoyed?
• Notice dramatic changes up or down in your appetite or your weight not related to dieting?
• Often feel listless or fatigued for no obvious reason?
• Have trouble concentrating or making decisions?
• Find yourself wringing your hands, pacing, or showing other signs of anxious restlessness — or the opposite, moving or speaking more slowly than usual?
• Struggle with insomnia or sleep too much?
• Have recurrent thoughts of suicide or death?

To be diagnosed with MDD, one of your symptoms must be a persistent low mood or a loss of interest or pleasure, the DSM-5 states. Your symptoms must also not be due to substance abuse or a medical condition, such as thyroid problems, a brain tumor, or a vitamin deficiency. 

Of course, it’s normal to have any or all of these symptoms temporarily (for hours or even days) from time to time. The difference with depression is that the symptoms persist and make it difficult to function normally.

Important: If you suspect you have depression, or if you’re feeling troubled by your symptoms, have suicidal thoughts, just need to talk, want some advice, or need a referral for treatment, call the National Suicide Prevention Lifeline at 800-273-8255 or the National Substance Abuse and Mental Health Services Administration Helpline at 800-662-4357. Both are free and available 24/7, 365 days a year.

What Are the Different Types of Depression?

In addition to MDD there are several other kinds of depression, including:

• Persistent depressive disorder (PDD) Previously known as dysthymia, PDD is diagnosed in people who have at least two of the symptoms of major depression for at least two years at a time. It’s possible to fluctuate between severe and less-severe symptoms, and to have both PDD and MDD at the same time, a condition called double depression.(5) People with PDD are often perceived as cranky, sullen, changeable, or pessimistic rather than being recognized as having a treatable disorder.
• Bipolar disorder, formerly called manic depressive disease, is characterized by moods that cycle between extreme highs (mania) and lows (depression), often with periods of normal mood in between.(6) Bipolar disorder affects 2.8 percent of U.S. adults, or more than 6 million people.(7)
• Seasonal affective disorder (SAD) is depression that occurs at the same time each year, usually beginning in fall and persisting through winter. SAD is associated with changes in sunlight, and is often accompanied by increased sleep, weight gain, and cravings for foods high in carbohydrates.(8)
• Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMDD usually develops a week or two before a woman’s period and passes two or three days after menstruation starts.(9)
• Postpartum (or perinatal) depression (PPD) is diagnosed in mothers who experience symptoms of major depression up to one year after giving birth.(10) PPD is usually related to a combination of factors, including sharp changes in hormone levels following childbirth. Feelings of intense sadness, anxiety, or exhaustion are much stronger, and last longer, than the “baby blues” — the relatively mild symptoms of depression and anxiety that many new mothers experience.

One reason depression can be hard to identify is that its signs can vary widely from person to person and sometimes be masked by atypical symptoms. For example, some people who are depressed may show it by acting disgruntled, resentful, or irritable. In fact, aggression — including outright acts of violence — can be indicative of “hidden” depression, according to a February 28, 2017, report in Psychiatric Times.(11) Depression masquerading as anger may seem surprising at first, but not when you consider that several underlying factors, including alcohol or substance abuse and childhood trauma, have been linked to both.

Similarly, although it’s not clear why, a person who experiences anxiety is at high risk for developing depression, and vice versa. The National Alliance on Mental Illness reports that as many as 60 percent of people with anxiety will also have symptoms of depression; the same goes for people with depression having symptoms of anxiety.(12) Some researchers even suspect that depression and anxiety are, in fact, inexorably intertwined expressions of the same underlying psychological disorder.(13)

Depression may also manifest psychosomatically, meaning that instead of presenting first and foremost as a mood disorder, the dominant symptom may be things like vague aches, dizziness, headaches, digestive problems, or back pain, according to the Journal of Clinical Psychiatry.(14) Complicating matters is that it’s often hard to know whether depression is causing the physical symptoms, or if the physical symptoms are causing depression.

What Causes Depression?

No one knows for sure why some people become depressed and others do not. As with other brain diseases, such as Alzheimer’s, the precise cause remains elusive. Depression can occur spontaneously, without any obvious cause. And it’s well documented that once you’ve had one depressive episode your risk of having another later in life increases. For example, a study in Psychological Medicine found that more than 13 percent of people who recover from their first episode of major depression go on to have another episode within five years; 23 percent within 10 years; and 42 percent within 20 years.(15)

Psychiatrists today generally look at depression in “bio-psycho-social” terms, meaning that they see it as a complex disorder most likely triggered by overlapping biological, psychological, and social (also referred to as environmental) factors.(16)

Among the potential contributors to depression are:

• Genetics Many studies suggest that depression can spring from a genetic predisposition, including one international study involving more than 2 million people, published in the February 2019 issue of the journal Nature Neuroscience, that linked 269 genes to depression.(17) Genes alone are not believed to write your destiny, however. Scientists think that while some genes may increase risk, other factors are needed to trigger symptoms.
• Neurotransmitters The long-held idea that depression is caused by low levels of certain neurotransmitters (chemicals messengers that communicate between neurons) has been debunked. And yet it’s clear that neurotransmitters do play a role. The new thinking is that depression can sometimes be activated by nerve cell connections in the brain, nerve cell growth, or when the functioning of nerve circuits goes awry.(18)
• Inflammation Multiple studies indicate that disease-related or stress-related inflammation may create chemical changes in the brain that can trigger or worsen depression in certain people and influence how a person responds to drug therapy.(19)
• Hardship There’s growing evidence, according to the World Health Organization, that psychological and social factors like a history of abuse, poor health and nutrition, unemployment, social isolation or loneliness, low socioeconomic status, or stressful life events (divorce or money worries, for example) can play a decisive role in the onset of depression.(20) For example, adults with MDD have double the rate of childhood trauma compared with people without MDD, a study published May 3, 2016, in the journal Translational Psychiatry found.(21)
• Traumatic brain injury (TBI) Another all-too-common cause of depression is traumatic brain injury (TBI). Close to three million people each year are treated in U.S. emergency rooms for TBIs (aka concussions) following a bump or blow to the head from things like falls, assaults, car accidents, and workplace and sports-related injuries, according to the Centers for Disease Control and Prevention.(22) And more than half of those patients will meet the criteria for major depression three months after their injury, suggests a study published November 30, 2017, in the journal Brain Injury.(23)

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Depression and Gender: Is It Different in Men and Women?

When it comes to depression, there is a distinct gender gap. Depression is nearly twice as common in women as in men, according to data from the National Center for Health Statistics.(24) Hormonal and other biological factors play a role in this disparity. After all, only women can have premenstrual or postpartum depression. The same is true of antenatal (or prenatal) depression — depression during pregnancy — which the American College of Obstetricians and Gynecologists estimates affect anywhere from 14 to 23 percent of pregnant women.(25)

But women also have higher rates of seasonal affective disorder, depressive symptoms in bipolar disorder, and persistent depressive disorder, note Harvard Health experts.(26) The reasons for this are cause for speculation. Some researchers believe that environmental factors, such as the different stressors and expectations that society places on women, are an important factor. Others theorize that men and women actually have depression at similar rates, but that women are more likely to talk about their feelings and seek help.
 
Depression Treatment: Lifestyle Changes, Talk Therapy, Antidepressants

If you suspect that depression is interfering with your life, talking about what you’re experiencing and discussing treatment options with a medical professional is essential. As actress Taraji P. Henson, who describes her depression as “suffocating” darkness, recently explained in an interview with Self magazine, “When you’re quiet, things aren’t fixed. It gets worse.”(27)

The good news is that there’s abundant evidence that people with depression who seek treatment will find significant relief from lifestyle changes, talk therapy (psychotherapy), medication, or a combination of all efforts, according to the Anxiety and Depression Association of America.(28)
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Lifestyle Changes for Depression
Lifestyle changes, such as making art, journaling, exercising more, and practicing yoga or mindfulness, can also alleviate depression and the stress that can heighten it. Alternative treatments like massage, acupuncture, and light therapy may also help.

Diet changes, too, can uplift your mood by reducing inflammation and helping to ensure your brain gets the nutrients it needs to function at its best.

One randomized controlled study, published October 9, 2019, in the journal PLoS One, found that self-reported symptoms of depression dropped significantly in just three weeks in young adults who changed from a highly processed, high-carbohydrate diet to a Mediterranean diet focused on vegetables, whole grains, lean proteins, unsweetened dairy, nuts and seeds, olive oil, and the spices turmeric and cinnamon. In contrast, the depression scores didn’t budge in a control group of people who didn’t change their diet.(29)

​Which Types of Talk Therapy Work Best for Depression?
The Society of Clinical Psychology rates several types of psychotherapy as highly effective treatments for depression:(30)

• Behavioral activation therapy - The aim of this type of therapy is to reverse the downward spiral of depression by encouraging you to seek out experiences and activities that give you joy.
• Cognitive behavioral therapy (CBT) - CBT focuses on changing specific negative thought patterns so that you are able to better respond to challenging and stressful situations.
• Interpersonal therapy - This very structured, time-limited form of therapy focuses on identifying and improving problematic personal relationships and circumstances directly related to your current depressive mood.
• Problem-solving therapy - This form of therapy teaches take-charge skills that help you solve the real-life problems and stressors, big and small, that contribute to depression. 
• Self-management/self control therapy - This type of therapy trains you to lessen your negative reactions to events and reduce your self-punishing behaviors and thoughts.

 
What’s the Difference Between Grief and Depression?
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Given that the primary symptom associated with depression is sadness, it can be easy to think of grief or bereavement as depression. But grief is a natural response to specific experiences, such as the end of a relationship or the death of a loved one. While you might feel regret or remorse, and you might withdraw from usual activities if you are experiencing grief, you’re unlikely to feel the overwhelming sense of worthlessness, thoughts of self-harm or suicide, and other symptoms of depression. Another important difference is that in grief, painful feelings usually come in waves and are often mixed with positive memories.

In some cases, however, grief and depression do coexist, or grief can trigger depression, according to experts writing in the journal American Family Physician.(31) Having a mental health professional help you distinguish between them can ensure you get the support you need.

If you are experiencing depression and sadness, please email me or call (770) 203-9060 to set up an appointment. Together we will work to fashion an active program of change which lefts you out of the distress you are experiencing and places you on the pathway where you want to be.
 
 
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2.            Reinert M, Nguyen T, Fritze D. The State of Mental Health in America 2020. Mental Health America. 2020.
3.            Bailey RK, Mokonogho, J, Kumar A. Racial and Ethnic Differences in Depression: Current Perspectives. Neuropsychiatric Disease and Treatment. February 22, 2019.
4.            What Is Depression? American Psychiatric Association. January 2017.
5.            Persistent Depressive Disorder. Cleveland Clinic. March 3, 2015.
6.            What Are Bipolar Disorders? American Psychiatric Association. January 2017.
7.            Bipolar Disorder. National Institute of Mental Health. November 2017.
8.            Seasonal Affective Disorder (SAD). Mayo Clinic. October 25, 2017.
9.            Premenstrual Dysphoric Disorder (PMDD). U.S. Department of Health and Human Services Office of Women’s Health. March 16, 2018.
10.         Postpartum Depression. American College of Obstetricians and Gynecologists. November 2019.
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16.         Pies RW. Debunking the Two Chemical Imbalance Myths, Again. Psychiatric Times. August 2, 2019.
17.         Howard D, Adams M, McIntosh A, et al. Genome-Wide Meta-Analysis of Depression Identifies 102 Independent Variants and Highlights the Importance of the Prefrontal Brain Regions. Nature Neuroscience. February 2019.
18.         What Causes Depression. Harvard Health. June 24, 2019.
19.         Pariante CM. Why Are Depressed Patients Inflamed? A New Path to Personalized Treatment in Psychiatry. Psychiatric Times. May 31, 2018.
20.         Social Determinants of Mental Health. World Health Organization. 2014.
21.         Williams LM, Debattista C, Duchemin A-M, et al. Childhood Trauma Predicts Antidepressant Response in Adults With Major Depression: Data From the Randomized International Study to Predict Optimized Treatment for Depression. Translational Psychiatry. May 3, 2016.
22.         TBI-Related Emergency Department Visits, Hospitalizations, and Deaths. Centers for Disease Control and Prevention. March 29, 2019.
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28.         Taraji P. Henson on Living With Depression and Anxiety. Self.com. December 3, 2019.
29.         Salcedo B. Depression Treatment — It Works. Anxiety and Depression Association of America.
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31.         Kavan MG, Barone EJ. Grief and Major Depression — Controversy Over Changes in DSM-5 Diagnostic Criteria. American Family Physician. November 15, 2014.

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