Depression is one of the most common mental health issues in the world, affecting more than 264 million people globally.
Yet, data from the American Public Health Association shows that up to 70% of people worldwide don’t seek help for mental health conditions due to stigma, lack of information, and lack of access to treatment.
What is depression?
Depression, also known as major depressive disorder (MDD) or clinical depression, is a medical condition that’s different from feelings of sadness.
If you’re sad, there is usually a cause, such as grief or a bad day at work. These feelings are mainly related to the specific situation that caused them, and should be resolved in time. You’ll often be able to make yourself feel better — perhaps by talking about your feelings with a friend or blowing off steam through an activity you enjoy.
But if you’re depressed, you’ll likely experience a gradual onset of symptoms, such as a lack of interest in activities you once enjoyed, changes in sleep and appetite, and difficulty thinking and concentrating.
These symptoms will generally have a significant negative impact on daily life for at least two weeks. While depression can be triggered by a variety of specific situations, it’s commonly caused by genetic factors.
“Often when someone is depressed, they have a history of depression, bipolar, or a mood disorder in the family,” says Sheila Josephson, Ph.D., a psychotherapist and clinical social worker.
Quiz: Do you have depression?
Methodology: This quiz is based on the DSM-5 criteria for major depressive disorder, as well as the patient health questionnaire (PHQ-9) that medical professionals use to screen patients with depressive symptoms.
Editor’s note: The results of this quiz should not be read as a diagnosis. To truly diagnose depression, a doctor must also determine whether depressive feelings could be caused by normal bereavement or loss, another mental or physical disorder, and medication or other drugs.
Signs of depression
Typically, the major symptoms of depression are:
- A constantly low mood
- Loss of enjoyment or interest in activities
- Change in appetite
- Insomnia, restless sleeping, or oversleeping
- Fatigue and tiredness
- Feelings of worthlessness or guilt
- Difficulty in concentrating, making decisions, or memory
- Thoughts of suicide
Depression can have physical symptoms, too, such as fatigue or unexplained body aches and pains. This can often imitate other illnesses, like thyroid conditions or a Vitamin D deficiency.
If you’re experiencing any of these symptoms, reach out to a care provider — whether a primary care doctor or a mental health specialist. Then, you’ll undergo a more thorough evaluation before a diagnosis of depression is given.
“That should include a physical exam and often some lab work,” says Beth Salcedo, MD, former president at The Anxiety and Depression Association of America. “It would involve a lengthy discussion of symptoms and past medical and mental health history, along with family history.”
How to deal with depression
If you think you might have depression, it’s important to seek help from a licensed health professional. A therapist, counselor, or your primary care doctor is a perfect place to start.
For those unable to access these medical practitioners or experiencing milder symptoms, online therapy platforms like BetterHelp or TalkSpace offer an alternative solution.
If you need immediate help or have had thoughts of harming yourself or others, Samaritans have a globally accessible suicide prevention hotline in 38 countries.
And if you’re worried about a friend or family member, Josephson recommends talking to them in a non-judgemental way about different options for care.
“When you have that conversation, don’t place blame: be positive, and remind them how much you care for them,” she says.
Along with therapy and medication, there are a few common lifestyle changes that anyone can use to improve their mental health and help relieve depressive symptoms:
Good nutrition is vital for keeping your body chemically and hormonally balanced.
Make sure you avoid or limit sugar and caffeine consumption, which can cause abrupt mood swings. Instead, incorporate more fruits and vegetables into your diet, along with oily fish and lean protein.
If you’re looking for an eating plan to try, the Mediterranean diet is touted by dietitians and may have mental health benefits.
Avoid alcohol and drugs
For those experiencing depression, it’s common to turn to alcohol and drugs for relief. However, alcohol is a depressant, which will ultimately exacerbate depressive symptoms.
Many drugs also increase the risk of psychosis or depression through their interaction with the nervous system.
Exercise releases neurotransmitters and hormones like endorphins, dopamine, norepinephrine, and serotonin, which boost and enhance your mood.
A 2016 meta-study of over one million people found that exercise significantly improves mental health — dividing the sample into three sections, the least fit group were 75% more likely to have depression than the fittest group.
And it doesn’t need to be traditional exercise like running. A 2019 meta-study on dance movement therapy (DMT) found that it was an effective remedy for depression in adults, for its combined exercise and social benefits.
Get enough sleep
There is a strong correlation between sleeping troubles and depression, and insomnia is closely related to depression.
Good sleep hygiene, such as not looking at phone, TV, or laptop screens an hour before bed — and instead creating a relaxing evening routine — can help improve sleep quality.
For example, a 2008 review noted multiple studies that found treating sleep and insomnia correlated significantly with improved depressive symptoms.
Meditation has been proven to significantly improve the symptoms of stress, anxiety and depression.
For example, a 2014 meta-review at Johns Hopkins University School of Medicine found 30 to 40 minutes of daily meditation in an eight-week mindfulness meditation program improved those with mild depressive symptoms.
Starting with 5 or 10 minutes of mindfulness meditation can be an important way to strengthen mental health — and here’s a guide for how to meditate on your own.
Psychotherapy is a common treatment for depression. According to Salcedo, types of therapy for depression usually include:
- Cognitive Behavioral Therapy (CBT)
- Acceptance and Commitment Therapy
- Interpersonal Psychotherapy for Depression
CBT is one of the most effective talk therapies. It helps patients relearn the way they think by challenging negative thoughts, particularly when it comes to feelings of self-worth: the therapy follows the theory that if negative thinking is corrected and replaced with positive thinking, the symptoms of depression will be lessened.
A 2018 paper referred to CBT as the “gold standard of psychotherapy” — as it is currently the most widely studied and proven type of therapy. In fact, one 2009 study found that cognitive therapies could be as effective as medication, and even have longer-lasting effects.
However, therapies for depression are not one-size-fits-all, and a combination of multiple types of treatment will likely be needed.
“Which is most effective depends on many factors, including the availability of therapies and compliance on the part of the patient,” says Salcedo. “All have shown themselves to be highly effective though, and sometimes in combination.”
Medication can also be an effective treatment for depression, usually in addition to therapy. That’s because depression is thought to be caused by a chemical imbalance in the body, and antidepressants help to combat this imbalance.
According to Salcedo the most commonly prescribed antidepressants are called SSRIs, or selective serotonin reuptake inhibitors.
Examples of SSRIs include:
Medication is used to help patients get the most out of their therapy, says Salcedo, particularly when their symptoms are severe and debilitating.
Studies have found that SSRIs, along with SSNRIs, a similar class of medication, are the most effective antidepressants. In fact, between 40 to 60% of people who took these medications experienced improvement in moderate to severe depressive symptoms.
Antidepressants are typically taken for one or two years, depending on the severity of symptoms. Josephson notes that those who commit to their prescribed medication and therapy can expect positive results, but that if patients come off their medication too early, depressive episodes can become a recurrent problem.
The bottom line
If you think you may be depressed, it’s important to talk it over with a doctor. Only a licensed health professional can determine whether you have depression and get you the help that you need.
While difficult to manage, depression is treatable. Overall, a combination of therapy, medication, and lifestyle changes can help those with depression to recover and avoid future relapses.