Many people think that being depressed simply means feeling really, really sad. But you don’t have to be teary to be depressed. All of the behaviors mentioned above — and a myriad of others that affect how you think, feel, behave, and express yourself — can be signs of depression.
One of those symptoms needs to be persistent feelings of sadness or emptiness, or a loss of interest in activities you used to enjoy, such as work, hobbies, seeing friends — even food and sex. According to the American Psychiatric Association’s current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you also need to experience at least four of the following symptoms (or three if you have both of the symptoms above):
Significant changes in appetite — weight loss or gain not related to dietingDifficulty sleeping (insomnia) or oversleeping (hypersomnia)Increased restlessness — or the opposite, moving more slowlyFatigue, tiredness, or loss of energy that makes even simple tasks, such as dressing or washing, difficultFeeling worthless or inappropriately guilty, such as constantly thinking about past mistakesDifficulty thinking clearly, concentrating, or making decisionsRecurrent thoughts of death or suicide (without or without a specific plan), or a suicide attempt
It’s important to note that to count toward a diagnosis of major depressive disorder, a symptom must cause significant distress or make everyday tasks much harder than usual. So, for example, if you normally have trouble falling asleep, insomnia wouldn’t count as a symptom of major depression for you.
When Is It Not Major Depressive Disorder?
PDD symptoms are similar to MDD symptoms — sleep problems, low energy, low self-esteem, difficulty concentrating, appetite changes, and feelings of hopelessness — but they’re milder and they’re chronic: You can generally function, just not at your best. To meet the criteria for PDD, your mood needs to be low and you must have at least two other symptoms for two years or more. “Patients and healthcare providers need to be aware of the risk of depression that comes with all kinds of common prescription drugs — many of which are also available over the counter,” notes Dima Mazen Qato, PharmD, PhD, the lead author of the study. (Dr. Qato is also the Hygeia Centennial Chair and an associate professor in the Titus Family Department of Clinical Pharmacy at the University of Southern California Leonard D. Schaeffer Center for Health Policy and Economics in Los Angeles.) “Many may be surprised to learn that their medication, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms and may lead to a depression diagnosis,” says Qato.
Teaching hospitals and universities with training programs in psychiatry and psychology, which often offer low-cost psychotherapy provided by trainees supervised by senior staffThe Medicine Assistance Tool from the Pharmaceutical Research and Manufacturers of America, which connects to a database of hundreds of public and private programs that provide eligible patients with prescription drugs at a discount or for freeRetailers, including Walmart, Walgreens, and Rite Aid, selling several frequently prescribed generic drugs for as little as $4
After having a good medical workup to rule out any underlying causes, a person diagnosed with major depression can be treated a number of ways. The most frequently used approaches are either medication, which is thought to lessen symptoms by acting on neurotransmitters, or chemical messengers in the brain; psychotherapy aimed at altering thought patterns that negatively affect mood; or a combination of the two. Studies suggest that typically a combination of psychotherapy and medication is more effective than either method alone. The reason isn’t clear. Perhaps medication eases symptoms so that patients are more open to psychotherapy. Or maybe psychotherapy increases the odds that patients will stick to their medication schedule. It could even be that having two clinicians, one who prescribes medication and one who provides talk therapy, enhances the effectiveness of both treatments. “Antidepressants can be an effective tool to treat major depression, but this does not necessarily mean that antidepressants should always be the first line of treatment,” says Andrea Cipriani, MD, PhD, lead author of the study and a professor in the department of psychiatry at the University of Oxford in England. “Medication should always be considered alongside other options, such as psychological therapies, where these are available. Patients should be aware of the potential benefits from antidepressants and always speak to the doctors about the most suitable treatment for them individually,” says Dr. Cipriani.
Which Types of Psychotherapy Work Best?
Cognitive Behavioral Therapy Often referred to simply as CBT, this is a systematic approach aimed at identifying and altering negative thought patterns.Interpersonal Therapy This approach focuses on increasing happiness by improving how you interact with others.Psychodynamic Therapy This approach aims to reduce the negative influence of past life events and traumas by providing insight into how those events affect your current behavior.
Options for Treatment-Resistant Depression
Electroconvulsive Therapy Also known as shock treatment, this option involves using short electrical impulses to cause seizures that are thought to repair faulty wiring in the brain. It is done under anesthesia.Repetitive Transcranial Magnetic Stimulation Done while the patient is awake and alert, this treatment uses a magnet instead of an electrical current to stimulate brain regions linked to mood.
New Treatments for MDD
Recent research has shown that ketamine, primarily used as a tranquilizer in veterinary medicine and often abused as a recreational club drug called Special K, can rapidly lift people out of depression and keep even chronically suicidal patients feeling well for days or even weeks. Hallucinogenic mushrooms, LSD, and other psychedelics are emerging as another potential new treatment option for depression. In 2019, John Hopkins Medicine in Bethesda, Maryland, launched the Center for Psychedelic and Consciousness Research, a first-of-its-kind initiative studying compounds like psilocybin (the active ingredient in hallucinogenic mushrooms) and their effect on a range of mental health problems, including treatment-resistant depression. Seek out friends and family. It may not come as a surprise that loneliness increases the risk of depression. “The importance of social support is not talked about nearly enough,” says Dr. Landau.
A Silver Lining
Al Levin, an assistant elementary school educator in St. Paul, Minnesota, was in a hopeless, dark place in the fall of 2013 when a second bout of paralyzing depression hit him. “Suddenly, I was unable to stop crying for 30 minutes at a time,” recalls the father of four, who is now in his fifties. “I could not sleep. I could not eat. I could not summon the will to do much of anything. I was in such a dire situation, I was searching the internet for which method of suicide would work best.” That’s when he knew he needed help, which he got through a partial hospitalization program that provided not just medication and psychotherapy but also taught him coping skills to help prevent a recurrence. These days, Levin is energized by a newfound passion: working toward minimizing or even eliminating the stigma around mental health through his podcast, The Depression Files. “Going through major depressive episodes has changed me in positive ways,” Levin says. “I definitely had some awful stereotypes in my mind about people with mental illness. When I thought of depression, I thought of disheveled people who just didn’t want to fix themselves. I now know how debilitating it can be and how much it can impact the whole being of anyone at any time. It’s been a humbling experience, for which I am definitely grateful.”
Call your doctor.Call 911 for service or go to the nearest emergency room.Talk to a trained counselor at the toll-free 24-hour Suicide and Crisis Lifeline by dialing the three-digit code 988.Avoid leaving a suicidal person alone.
For more information, resources, and research on depression, go to MentalHealth.gov, the National Institute of Mental Health website, or the National Library of Medicine’s MedlinePlus. The APA is a great resource for anyone battling MDD. You can easily locate a doctor in your area on their Find a Psychiatrist page. National Institute of Mental Health (NIMH) Want up-to-date information about MDD? The NIMH offers free, easy-to-read publications about various mental health conditions, which can be found in the Health Topics section of their website. They also offer brochures and fact sheets for select materials, and some are written in Spanish. Mental Health America (MHA) The MHA offers tons of information about various types of depression. Consider taking their depression test to see if your symptoms indicate that you have risk factors depression.
Favorite Online Support Networks
24-Hour Suicide and Crisis Lifeline Don’t take matters into your own hands. Instead, talk to trained counselors who are available 24 hours a day at the Suicide and Crisis Lifeline. Support is free and confidential. The number to call: 988. Anxiety and Depression Association of America (ADAA) Sometimes, connecting with others can help you work through your bad days. If you’re looking for support, the ADAA can help. Search for a support group near you or start your own.
Favorite Advocacy Groups
MentalHealth.gov: Conversations in Your Community Community conversation events, which take place across the country, give people a chance to learn more about mental health issues. You can help start a conversation in your own community by using the tools provided on MentalHealth.gov.
Favorite App
Catch It Looking for ways to manage your lows? Enter some information about your current mood, and this app will prompt you to look at the situation in a different way by using CBT techniques. The idea is to “catch it, check it, and change it.” You can even store your entries, so you can go back later and look at your mood patterns.
Favorite Annual Meetings
ADAA Conference This annual conference, which brings together clinicians and researchers from around the world, highlights improved treatments for anxiety, depression, and related disorders.
Favorite Retreat
The Meadows Treatment Center This treatment center in Wickenburg, Arizona, offers help for patients with a variety of mental health and addiction disorders. Their clinicians and therapists specialize in treating not only the symptoms of depression but also the underlying causes. They’ve been around for more than 45 years and use a holistic approach to healing. Additional reporting by Pamela Kaufman.
