Is It Depression? Risk Factors, Symptoms and Treatment

According to the National Association on Mental Illness (NAMI), 17 million U.S. adults—more than 7% of the population—experience depression. People from every walk of life and all racial, ethnic and socioeconomic backgrounds are afflicted.

And yet, despite the prevalence, this mental health condition is often stigmatized and misunderstood. Loved ones might suggest that a person with depression "snap out of it" or "think more positively," implying that the medical condition can be overcome with the right attitude or effort. This approach can actually harm more than help people who struggle with a major depressive disorder by reinforcing feelings of worthlessness, emptiness or despondency.

What Is Depression?

Although "feeling depressed" has become something of a catchall phrase in popular culture—to describe everything from having a bad day to suffering deep despair—clinical depression is defined as a mental health spectrum disorder. This means depressive disorders can range from mild to severe.

Sometimes classified as mood disorders, major depressive disorders negatively impact how a person thinks and feels and behaves. Major depressive disorders can even affect how well a person feels physically. People in the midst of a depressive episode often describe the experience as having a low mood or lacking interest in things that they would normally enjoy. Such a depressed mood can put an enormous strain on relationships and make it difficult to function at work or school. The cumulative effect? Feeling overwhelmed and unable to cope with life in general.

What Are the Symptoms of Depression?

Depressive symptoms can change over time and can be different for different people. Symptoms can also be affected by co-occurring disorders such as anxiety, substance use disorder or other medical issues. Severe depression can cause significant distress or impairment in social, occupational or other important areas of life. Generally, depression symptoms include:

• Changes in appetite
• Changes in sleep patterns
• Inability to make decisions or a lack of concentration
• Fatigue or sluggishness
• Poor grooming
• Agitation
• Lack of interest in activities
• Decreased libido
• Hopelessness
• Physical aches and pains
• Sense of worthlessness or excessive, inappropriate or delusional guilt
• Suicidal thoughts or contemplation of self-harm

Depressive symptoms typically persist most of the day and last for at least a two-week period. Bereavement or sadness over the death of a loved one is not considered a major depressive disorder. If you are experiencing a number of these symptoms, be sure to consult a medical professional to receive an accurate diagnosis and rule out other possible medical conditions such as hypothyroidism, which can cause similar reactions.

What Causes Depression?

Depression is a complex mental health disorder caused by a combination of contributing factors. Common risk factors to consider include:

• Brain chemistry - The brain contains neurotransmitters, which are chemicals that relay messages from neuron to neuron. Low levels of two chemicals, serotonin and dopamine, are often associated with depression.
• Genetics - If depression runs in your family, you may be at a higher risk for major depressive disorder.
• Environment - Exposure to trauma, violence, neglect, abuse, poverty or other stressful life circumstances can lead to depressive disorders.

What Is the Treatment for Depression?

The most-effective psychiatric and mental health care takes an individualized and tailored approach to meeting the unique needs of each person. Many evidence-based depression treatments and therapies are available on an outpatient basis—and the good news is that treatment works. The mode of treatment depends on the type and severity of depression, and the existence of other mental health or medical conditions. For most people, a combination of medication (prescribed by a psychiatrist) and talk therapy provides the best results.

Antidepressant medications are designed to reduce or control depressive symptoms. It's important to understand, however, that antidepressants work differently from person to person. A medication that helps to relieve symptoms for one individual may have little or no effect for someone else. Another important note about antidepressant medications: Symptoms are not alleviated overnight. Some people find relief within two to four weeks of starting a medication. For others, it can take 60 to 90 days to experience the full antidepressant effects of a medication.

Close consultation with a mental health professional is needed to determine whether medication dosage should be adjusted or a new medication is needed. Waiting for an antidepressant medication to take effect can be difficult, but the results can be life-changing. Here are the types of medications most commonly used to treat clinical depression or major depressive episodes.

Selective serotonin reuptake inhibitors (SSRIs) – These are the most commonly prescribed antidepressants. They affect serotonin, a brain chemical. SSRI drugs (with brand names) include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil, Pexeva, Brisdelle)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) – These medications increase serotonin and norepinephrine. SNRI drugs (with brand names) include:

• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)

Norepinephrine-dopamine reuptake inhibitors (NDRIs) – These medications increase dopamine and norepinephrine. Bupropion (Wellbutrin) is a popular NDRI medication that's been around a long time and tends to cause fewer side effects than other antidepressants. Other medications include Mirtazapine (Remeron), second-generation antipsychotics (SGAs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

Brain-stimulating therapies are also used to relieve major depression but typically only after other therapies have been tried without success. Talk therapy and group therapy, also known as psychotherapy, are proven effective in relieving depressive symptoms. Most therapists are trained to provide more than one kind of psychotherapy. These can include:

• Cognitive Behavioral Therapy - Focuses on identifying thought patterns that lead to self-destructive actions and modifying these patterns to strengthen coping skills
• Motivational Enhancement and Interviewing - A collaborative, goal-oriented approach that helps clients identify "what's in it for me" with regard to working through challenges and difficulties
• Dialectical Behavior Therapy - Emphasizes validation, acceptance and mindfulness to encourage emotional regulation and problem-solving in promoting behavioral change
• Acceptance and Commitment Therapy - Employs mindfulness and behavior therapy to increase the ability to engage in values-based behaviors while experiencing difficult emotions or thoughts

With any behavioral health concern, self-care is an important aspect of the healing process. Getting exercise, eating healthy foods and staying socially engaged (not isolating) are healthy self-care practices.

How Long Is Treatment for Major Depression?

Treatment length depends on a number of different factors including the severity of depressive symptoms, medications used and responsiveness to therapy. While mental health care professionals work with patients to get the best results in the shortest amount of time, depression is a complex condition. Results shouldn't be expected within a few days.

Why Are Depression Symptoms Worse in the Morning?

People with depression tend to have disrupted circadian rhythms The body's natural circadian rhythm regulates sleep, energy, mood, thinking and other brain functions. In the early-morning hours, the brain may still be sending the signal to sleep when it's time to awaken. The resulting sense of lethargy and sluggishness can worsen or intensify feeling depressed.

How Effective Is Depression Treatment?

Considerable scientific evidence substantiates the effectiveness of depression treatment. Remember, however, that no single treatment program or approach works for everyone. Consult with your health care provider to discuss and determine depression treatment options to best meet your situation.

Where to Get Treatment for Depression

Some people start by consulting with their family physician. Others schedule an assessment with a mental health professional such as a psychologist. Today telehealth options make accessing "face-to-face" mental health services even easier. Medications can be prescribed by your primary care physician or by a psychiatrist. Outpatient care may not be the best option for people experiencing severe depression or suicidal thoughts. In those cases, hospitalization may be necessary.