Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Clinical depression is more than just feeling sad or going through a rough patch. It is a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families and caregivers. Fortunately, with early detection, diagnosis and treatment consisting of medication, psychotherapy and healthy lifestyle choices, people can feel better and have improved capacity to function and enjoy life.
Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.
An estimated 16 million American adults—almost 7% of the population—had at least one major depressive episode in the past year. People of all ages and all racial, ethnic and socioeconomic backgrounds experience depression, but it affects some groups more than others.
Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks. Common symptoms include:
- Sleep disturbances – too much, too little, or broken sleep
- Change appetite and/or weight
- Difficulty concentrating, remembering, or making decisions
- Decreased energy or fatigue
- Loss of interest or pleasure in hobbies and activities normally enjoyed
- Feelings of guilt, worthlessness, pessimism, helplessness or hopelessness
- Feeling restless, agitated or having trouble sitting still
- Moving or talking more slowly, feeling slowed down
- Thoughts of death or suicide, or suicide attempts
- Persistent sad, anxious, or “empty” mood
- Physical aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not improve with treatment
To be diagnosed with depressive disorder, a person must have experienced a depressive episode with five (5) or more of the above symptoms lasting longer than two weeks. When symptoms present, it is helpful to have an evaluation performed by a physician involving a physical examination, an interview and lab tests. After ruling out any underlying physical illnesses, your provider may refer you to a mental health professional for a thorough mental health evaluation.
Using the Diagnostic and Statistical Manual of Mental Disorders (DSM) a mental health professional is able to evaluate your symptoms, make a diagnosis and provide recommendations for treatment.
Although depressive disorder can be a devastating illness, it often responds well to treatment. The key is to get a depression-specific evaluation, accurate diagnosis and develop an effective treatment plan. Creating a safety plan is critical for individuals who have suicidal thoughts or a history of suicide attempts. After an assessment rules out medical and other possible causes, patient-centered treatment plans include any or a combination of the following:
- Psychotherapy – cognitive behavioral therapy, family-focused therapy, interpersonal therapy and other therapies proven to be effective in treating depression
- Medications – antidepressants, mood stabilizers and antipsychotic medications
- Exercise can help with prevention and mild-to-moderate symptoms.
- Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.
- Light therapy uses a light box to expose a person to full spectrum light in an effort to regulate the hormone melatonin.
- Alternative approaches – acupuncture, meditation, faith and nutrition can be part of a comprehensive treatment plan, but do not have strong scientific backing.
- National Alliance on Mental Illness (nami.org)
- National Institute of Mental Health (nimh.nih.gov)
- Diagnostic Statistic Manual of Mental Disorders: DSM-IV-TR and DSM-4