Will you ever experience depression? In all likelihood, the answer is “yes,” even if for only a short period of time.
About one in fifteen Americans struggle with major depressive disorder, according to the Anxiety and Depression Association of America. Prevalence is higher among younger people, women, and people who indicate they come from two or more racial backgrounds.
Depression is a mental health disorder characterized by depressed mood over a long period of time and loss of interest in daily life that causes significant impairment. Symptoms sometimes include changes in appetite or sleeping patterns, low energy level or agitation, difficulty concentrating, and feelings of guilt or lowered self-esteem. Depression is also often associated with suicidal ideation. The onset of depression is typically an interaction between your biology and a wide range of psychological and social factors, like a major setback at work or school, or the loss of a loved one.
“There are many underlying causes to depression and there are many different ways it can show up,” said Dr. Whitley Lassen, Clinical Director of Mental Health Services at K Health, adding, “depression is not just ‘feeling sad.’”
With suicide rates in the U.S. up by 30% from 2000 to 2020, it’s more important now than ever that you be aware of the signs of depression in yourself and those close to you. Here’s what doctors wish you knew about depression and how to treat it.
1. Depression Is Not Just Feeling Sad
It’s a common refrain among those of us going through a difficult time, “I’m depressed.” But are you really?
“A lot of people confuse depression with feeling sad,” said Jamie Ward, LPC, a K Health-affiliated clinician. “Depression isn’t just a feeling. It’s more of a state of being and it has a cluster of associated symptoms.”
When a loved one passes away or an important relationship comes to an end against our will, we often feel grief or deep sadness. Depression occurs when intense negative feelings don’t subside in a reasonable amount of time.
“For an actual diagnosis of depression, you have to experience a low mood for a period of two weeks or more,” said Lassen.
When untreated, depressive episodes can last a long time, generally six-to-eight months on average, and potentially longer. If that doesn’t sound like a very long time, consider how debilitating it can feel when you are at your lowest point; now imagine feeling that for weeks or months, without any break.
“When you’re sad, you generally have that down feeling. You might cry. You might feel lost. We all experience that every once in a while,” said Ward. “Depression is thinking you are worthless, believing you are a burden, like you have no purpose. You might stop eating, stop seeing friends, stop taking care of yourself. Even brushing your teeth can feel like you’re dragging a fifty-pound weight behind you. Sometimes you don’t go to work, or to school, you don’t pay bills, or take care of your kids or your pets. Depression has more consequences and deeper symptoms than just feeling sad.”
2. The Symptoms of Depression Can Vary Widely
One of the frameworks for understanding depression is understanding that “feeling down” is normal for everyone, but what really characterizes depression as an illness is the intensity and duration of the negative emotional state. The predominant symptoms or experience of depression can vary widely though.
“Some people just feel physically tired, like they’re dragging their feet through molasses and they just want to sleep all the time,” said Lassen. “Some people feel like they’re tired but they can’t sleep at all. Some people report that they feel like their thinking has slowed down.”
Some of the symptoms may seem contradictory, or may even be hidden altogether.
“Depression can lead to sleeping too much, not sleeping enough, eating too much, not eating enough,” said Austin Matthews, LCSW, a K Health-affiliated clinician, adding, “We all know people who are internalizers vs externalizers. For people who keep stuff on the inside, they can be like ducks swimming on the surface of a pond: It looks smooth, but underneath the surface, they’re going a million miles an hour.”
It’s also important to note that suicidal thoughts can be a symptom of depression. If you think someone you know is depressed, it may be a difficult conversation to have, but don’t hesitate to ask if they are experiencing suicidal thinking. If you or someone you know is having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to be connected to a trained counselor at a suicide crisis center near you. Resources from American Foundation for Suicide Prevention may also be helpful.
3. There Are Many Kinds of Depression
In addition to major depressive disorder, there are several other kinds of depression that we can experience.
Seasonal depression happens to many of us in the winter months when there is less sunshine and we spend less time outside. Sunshine causes your body to produce vitamin D, which helps regulate the serotonin levels in your body. People who lack enough vitamin D can feel depressed in winter months and develop what we now call “major depressive disorder with a seasonal specifier,” but you might know it as seasonal affective disorder (SAD, for short).
“If you have a seasonal type of depression, then there’s support for getting out in the sun or using a light box as treatment because of the benefits of vitamin D,” said Lassen.
Postpartum depression is experienced by people after giving birth. Most people who give birth experience what’s known as the “baby blues” for a few days after, but it usually subsides. When people experience those feelings for more than a few days and they intensify, then it rises to the level of depression. While giving birth is one of the most joyous things we can experience, post-birth changes in hormones can cause postpartum depression. This kind of depression can lead to very serious symptoms, including having thoughts about harming your baby or harming yourself. A majority of people who experience this kind of depression have already had one or more depressive episodes.
“Depression is definitely impacted by what’s going on in our bodies and in our brains,” said Lassen. “With the ‘baby blues,’ it often goes away on its own, but postpartum depression is more pronounced and, often, more impactful.”
People should also be aware of bi-polar disorder, a mood disorder that has periods of depression as one of its hallmarks. With bi-polar disorder, there are periods of depression followed by periods of having so much energy that you don’t sleep for days, also known as a “manic” episode. For people who experience periods of depression followed by manic episodes, the treatment is very different than for other kinds of depression.
There are other, rarer forms of depression as well, like dysthymia, which is depression that lasts two years or more, premenstrual dysphoric disorder, which is a severe form of premenstrual syndrome, and disruptive mood dysregulation disorder in children, which is when a child exhibits an intense irritability and frequent outbursts.
4. Depression Can Be Deadly
In America, about 1.7% of deaths are by suicide, according to the Centers for Disease Control and Prevention. For people who have ever been treated for depression in an outpatient setting, that number is 2%, according to the U.S. Department of Health and Human Services. For people who have ever been treated for depression in an inpatient setting, the number increases further to 4%. And for those people who have suicidal thoughts accompany their depression, the rate is 6%.
That’s why it’s so important to treat depression and to ask those around you – and yourself – if they are experiencing suicidal thoughts.
“We have to talk to people,” said Matthews. “We have to ask them questions, which can be really difficult, because when you love someone you want to be delicate, but it shouldn’t get in the way of asking someone if they are alright.”
It’s important if someone is depressed to ask about suicidal thinking. Having suicidal thoughts isn’t normal and if someone has them, they are at serious risk. If you or someone you know is having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to be connected to a trained counselor at a suicide crisis center near you. Resources from American Foundation for Suicide Prevention may also be helpful.
5. Depression Is Very Treatable
There are many treatments for depression, but medication plus therapy is the most effective treatment. Separately, both are still effective. Medication can help alleviate the most acute symptoms of depression when you are experiencing them. It’s convenient, easy, and safe. Therapy can also alleviate symptoms and is effective at teaching skills to help deal with depressed feelings, even after you have stopped medication and ended therapy. Therapy is less convenient and more effective, but, unlike medication, can continue working even after ending treatment.
“Medication and therapy have been proven to be the most effective when they’re together,” said Ward.
For some cases of depression, there are other treatments that are effective, like electro-convulsive therapy, where electric shocks are administered, or TMS (trans-cranial magnetic stimulation), a therapy similar to ECT. There are also newer options, like ketamine, a drug used as an anesthetic. New research shows it to be effective in treating depression and suicidal ideation.
There are also less intrusive interventions that can be effective when depression is caught early, like behavioral activation, which is another way of saying that depression can be positively impacted when individuals can find ways to keep behaving in ways that used to bring them pleasure.
“If you find a friend isolating or if you’re isolating, consider returning to an old routine,” said Matthews. “If you’re a person who plays tennis twice a week and you find yourself not going anymore, you should think about that.”
Spending time in nature, out in the sunlight, and with people with whom you have close, positive relationships are also things that can help alleviate the symptoms of depression.
“There’s this sense that I hear often that depression is something you can just snap out of,” said Lassen. “That’s not the case. If someone had depression and could just snap their fingers and not have it anymore, they would. It does take a lot of effort and work in therapy, in lifestyle changes, or in medications to recover from depression.”
6. The Earlier You Treat Depression, the Better
Like cancer and some other diseases, the disease of depression is better treated when it’s treated earlier. There are several reasons.
One indication that you might experience depression is if you’ve experienced depression in the past. A single episode of depression means a 50% likelihood of a second episode within five years; for people who experience two depressive episodes, the likelihood of having another within five years rises to 70%. But if depression is detected early and successful interventions are made, then it reduces the likelihood for future depressive episodes. That means that catching depression early, particularly in adolescents, can prevent a lifetime of depressive episodes.
While most symptoms of depression can resolve without treatment, untreated depressive episodes can last nearly a year. The disease can be so debilitating for some, that a year of feeling so low isn’t acceptable. That’s another reason why it’s important to recognize depression early and treat it: to reduce needless suffering.
7. Depression Medication Is Safe
There’s a very damaging stigma in society with taking medication for depression. But the truth is, depression medications are safe and effective. Dozens of studies show that selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are extremely effective in treating depression and anxiety. According to K Health clinical data, 88% of patients on SSRIs and SNRIs for depression feel less depressed in 12 weeks. These data are consistent with results from other clinical practices.
“The conversation around whether you should or should not have medicine to treat this disease is rooted in stigma,” said Matthews. “We would never tell a cancer patient they shouldn’t get chemotherapy because of the stigma. There’s no shame in taking it to get better and depression meds are the same way.”
Some people may worry that taking depression medications long term can “mess you up,” according to Ward, “but as long as you are seeing a prescriber who gives you the meds and who is monitoring your progress and can make sure you’re taking it as prescribed, there is little danger.”
8. Depression and Suicide in Teens Is Rising
The pressures of the pandemic have been a contributing factor, but other societal changes have also played a roll.
“Things are very different for kids today,” said Ward, who began her career working with adolescents. “With social media, there’s pressure that wasn’t there before.”
Teens can be dramatic sometimes, but you have to look at each situation and understand why. For instance, some teens will harm themselves, a very concerning behavior.
“Parents say, ‘it’s just for attention,’ and I respond, ‘what’s wrong with seeking attention from your parents?’” said Ward.
It’s called “non-suicidal self-injury” and can take the form of cutting, burning, or other wreckless behavior, like driving too fast or aggressively.
“It’s a way for them to feel something other than the negative emotions they may be experiencing,” said Ward. “They don’t want to kill themselves – they want to feel something else.”
Yet, when teens engage in this behavior, it’s very important to get them assessed at a mental health hospital, psychiatrist, or pediatrician to screen for suicidal thoughts. It can be easier for teens to talk to people outside of their parents about difficult topics.
“There is a myth that if you talk about suicide with a teenager, it will give them that idea,” said Ward. “But talking about it just takes away the stigma and allows a safe space to tell their thoughts.”
But parents need to be proactive when their teenage children experience depression. Parents often need to be part of the socio-emotional learning involved in recovering from depression.
“It’s a family process,” said Matthews. “If you think you can just stick your kid in therapy and they will get better, it’s not likely to work. Therapy and meds might help, but people get their behavior from somewhere, and we model our emotional behavior after our parents and caretakers. Families have to be involved in the process.”