Depression

Depression: Causes, Symptoms, & Treatments 

More than 264 million people suffer from depression worldwide. 

Research shows that depression can lead to other health conditions (including mental health conditions). Since there are so many types of depression, ranging in severity from mild-to-moderate depression to severe mood disorders, the symptoms of depression can vary greatly — as can depression’s causes and treatments. Finding treatment can feel like a never-ending rat race. Read on if you want to know where to find help and start feeling better. 

From behavioral therapy to antidepressants, naturopathic treatments, emergency care, and everything in between, we’ve got you covered. 

What Is Depression? 

Depression is a common mood disorder (and one of the most common mental disorders). It’s also known as major depressive disorder (MDD) and clinical depression. According to the National Institute of Mental Health, depression can cause “severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.” 

As these symptoms are common and most people experience them from time to time, the NIMH dictates that a person must have mild-to-moderate symptoms present for two weeks to be diagnosed with atypical depression. There are many types of depression, so research shows that symptoms can vary from person to person. 

Depression often makes people feel like they’re ‘empty’ or ‘hollow’ inside or can cause extreme symptoms and signs such as thoughts of suicide, harming others, or even suicidal ideation. 

If you or someone you know is experiencing thoughts of self-harm, harming others, or thoughts of death and suicide, contact the National Suicide Prevention Lifeline immediately at 1-800-273-8255. 

Depression Causes: Who Is at Risk for Depression? 

According to the National Institute of Mental Health, a little more than 7% of all adults in the U.S. had at least one depressive episode in 2017. Women have the highest risk of a major depressive episode (at 13.1%), and only about 5.3% of men experience a major depressive episode. People between the ages of 18 and 25 and mixed-race people are at the highest risk for a major depressive episode for age and race demographics.  

Depression can rear its head at just about any age, but most people start experiencing feelings or symptoms during late adolescence and early adulthood. In fact, depression might have something to do with high reports of quarter-life crises. 

As parents report children experiencing anxiety at earlier and earlier ages, doctors believe that other mental disorders might affect a person’s likelihood of developing depression later in life, too. 

Research shows that both environment and genetics play equally important roles in mental health; those who have the highest risk for depression — from mild-to-moderate depression to atypical depression — have experienced trauma and have a history of depression in their family. In fact, depression can be caused by one or more of the following factors:

• Biology
• Genetics
• Environment
• Psychology
• Predisposition to mood disorders

Many people who suffer from debilitating depression also experience symptoms of other major disorders, such as anxiety, bipolar disorder, and obsessive-compulsive disorder (OCD).

Other medical ailments and illnesses can also trigger depression. These include:

• Autoimmune diseases (such as Parkinson’s disease)
• Cancer
• Chronic pain
• Diabetes
• Frontal lobe damage
• Heart Disease
• Substance abuse, including alcohol addiction and drug addiction 

Doctors suspect that a variety of factors might link these medical illnesses to depression. Many patients might experience several mood disorders from the trauma of the illness itself, while many of the medications associated with these illnesses also include mental disorders such as depression.

The most common causes of depression include:

• Family history of medical disorders
• Life changes
• Medical illnesses
• Side effects from medications
• Substance abuse
• Traumatic stress

Some people who struggle with depression are only affected during certain seasons when there are fewer hours of daylight (see types of depression).

RELATED ARTICLE: Seasonal Depression

Family History of Medical Disorders

Family history is an important factor in the diagnosis of major depressive disorders. According to Stanford Medicine, “Heritability is probably 40-to-50%, and might be higher for severe depression.” Since environment and lifestyle play a large role in familial settings (and genetics). It’s possible that depression could be caused equally by genetics and childhood settings. 

Environment/Life Changes

Most researchers agree that environments play a huge role in the probability that a person will develop depression at some point in life. Stress factors and major life changes are also the main causes of major depressive disorders and put a person at a higher risk for depression. Poor habits, self-deprecating thoughts, and abusive tendencies can all be learned in childhood and repeated throughout adulthood. For example, if someone was sexually abused during their childhood, they could suffer from post-traumatic stress disorder (PTSD), which can then lead to them also suffering from depression. 

Many women suffer from Postpartum depression after the birth of a child as their hormone levels change and begin to regulate to what they once were pre-pregnancy. Postpartum depression is a serious mental health condition that many women are uncomfortable talking about. They often experience feelings of grief once their baby is born, like they've lost something even though they're holding their brand-new baby in their arms. This can be difficult to discuss with friends or even a partner, especially if those people haven't been through pregnancy. 

Symptoms may range in intensity; one person may experience extremely intense symptoms while another person’s symptoms could be mild or moderate.

Medical Illnesses

Three physical factors related to mental illness are the highest causes of medically-induced depression:

• Sickness behavior syndrome (the breakdown of the immune system)
• Psychological trauma
• Medication side-effects

The immune and digestive systems are connected to the causes of depression. When the immune system is attacked, or gut health is suboptimal, the risk of atypical depression is much higher. 

Side Effects From Medications

Some medications tote side effects that include depression. Just some of these medications include:

• Acne medications
• Anti-seizure drugs
• Anxiety medications
• Anticholinergic drugs
• Allergy medications
• Acid reflux medications
• Antibiotics
• Antidepressants
• Autoimmune disorder medications
• Benzodiazepines
• Beta-Blockers
• Cholesterol medications
• Corticosteroids
• Epilepsy medications
• H2 Blockers
• Hormone replacements
• Pain relievers
• Stimulants
• Thyroid medications

Traumatic Stress

One of the most common causes of depression is traumatic stress and post-traumatic stress disorder (PTSD). Some of the defining factors that may lead to major depression include a death in the family, divorce, financial problems, and violence (physical, mental, or sexual). Stress and trauma may also lead to suicidal ideas and thoughts of self-harm.

Substance Abuse

Substance abuse can also increase the risk of depression in adults and adolescents.

According to the Substance Abuse and Mental Health and Mental Health Services Administration, “In 2013, 1.4% of adolescents had co-occurring MDE and substance use disorder (SUD); 3.2% of adults had co-occurring AMI and SUD; 1% of adults had co-occurring SMI and SUD.”

Symptoms of depression can range from mild to moderate, depending on these causes. The longer a person takes to seek help, the more intense some symptoms will begin to feel. 

Depression Symptoms and Signs 

Depression is diagnosed using a long list of symptoms and signs. The symptoms of depression are so varied (and depend on the type of depression) that it’s impossible to self-diagnose a major depressive disorder. Depressed people often feel like they’re ‘empty’ or ‘hollow’ or no longer enjoy things that once sparked joy. 

The symptoms of depression can be mild to moderate to extreme. Mild-to-moderate depression is often accompanied by feelings of sadness, anxiety, or changes in mood. People who experience this type of depression don’t always need to make big changes to feel better. Often, simple lifestyle changes might have the greatest effect.

Mental health research shows that people with more severe depression (including feelings of hopelessness, thoughts of death and suicide, and physical symptoms) often need psychological and medical help. 

The symptoms of depression can be broken down into three categories:

• Mental (mood, emotional, behavioral changes)
• Physical and cognitive 
• Emergency warning signs

Mood, Emotional, and Behavioral Changes 

• Loss of interest in activities and friends
• Sudden changes in mood
• Feeling sad, anxious, hopeless, and/or lost
• Sudden feelings of anger or irritability

Physical and Cognitive Symptoms

• Headaches
• Loss of vision/poor vision
• Digestive issues
• Body aches and pains/chronic pain
• Inability to concentrate or sit still
• Sleep disorders (sleeping too little or too much; disrupted sleep patterns and disorders, such as sleep paralysis)
• Changes in appetite (loss or gain)
• Changes in body weight and appearance
• Slowed movements 

Emergency Warning Signs

• Thoughts of death and suicide
• Suicidal ideation
• Thoughts of self-harm or harming others

If you or someone you know is experiencing thoughts of self-harm, harming others, or thoughts of death and suicide, contact the National Suicide Prevention Lifeline immediately at 1-800-273-8255. 

Diagnosing Depression 

Diagnosing depression can be as tricky as the disorder itself. Since there are so many types of depression and symptoms can vary greatly from person to person, there’s no cookie-cutter test to diagnose it. 

Most doctors ask a series of questions or request patients to fill out a questionnaire. Combined with a patient’s medical history, family history, and lifestyle factors, doctors can make an accurate assessment and corresponding treatment program. For these reasons, it’s not advised to perform a self-diagnosis while not under the treatment of a medical doctor.

Your doctor may ask you questions about your:

• Medical history
• Family medical history
• Mental history
• Trauma and stress factors
• Symptoms
• Mood changes
• Sleep patterns
• Energy levels
• Diet and exercise fluctuations
• Thought patterns and ideations
• Medication history

Misdiagnosis (and self-misdiagnosis) often happens when the doctor or patient doesn’t consider possible medical problems, such as medication side effects or thyroid problems. Sometimes depression can even be triggered by seemingly innocent factors such as vitamin deficiencies or seasonal affective disorder. 

Mental health research shows that the longer you wait to seek treatment for atypical depression and other mental disorders, the symptoms of depression can worsen over time.

Types of Depression

There are seven major types of depression, including:

• Major depression
• Persistent depressive order
• Situational depression
• Psychotic depression
• Bipolar disorder
• Perinatal depression/postpartum depression
• Seasonal depression

All seven types of depression share similar symptoms and characteristics, but their own characteristics also characterize each type of depression. While almost all types of depression share the symptoms of major depression, differences between disorders often include trigger events, length of depressive episodes, hormonal fluctuations, hallucinations, and manic episodes.

Many of these types of depression are also accompanied by addiction and other mental disorders such as anxiety, eating disorders, such as bulimia or anorexia, and attention deficit hyperactivity disorder (ADHD). 

Major Depression

Major depression is an umbrella term used for extreme and atypical depressive disorders. It’s also called major depressive disorder and is one of the most common types of depression. The symptoms of major depression include:

• Loss of interest in activities and friends
• Changes in mood
• Feelings of sadness, anxiousness, or hopeless
• Headaches
• Loss of vision/poor vision
• Digestive issues
• Chronic pain
• Sleep disorders 
• Changes in appetite 
• Slowed movements 
• Thoughts of death and suicide, self-harm, and/or harming others

Persistent Depressive Disorder

Persistent depressive disorder is a less severe form of major depression. It shares the same signs and symptoms but only lasts up to two years. Many people also report feeling more mild-to-moderate depression symptoms than those with major depression.

Situational Depression

Situational depression also shares similar symptoms to major and persistent depression. Its main defining factor is that it is generally preceded by a major event or trauma, such as an accident, death, abuse, or financial problems. It can last days, weeks, months, or years.

Psychotic Depression

Psychotic depression’s symptoms are similar to major depression, but people with depressive psychosis also experience hallucinations. They often see, hear, smell, feel, and even taste sensations that aren’t real. Psychotic depression is often related to situational depression (patients often report hearing the voices of a recently deceased person or smelling the cologne of an attacker); though, the trauma and the hallucinations aren’t always so closely related.

Bipolar Disorder

Otherwise known as manic depression, bipolar disorder is diagnosed when a patient generally experiences long stretches of depression (thoughts of hopelessness, emptiness, suicidal ideation) followed by manic episodes (high energy, high-risk behaviors, grandiose thoughts, rapid speech and thought patterns, euphoric feelings). 

Perinatal/Postpartum Depression

Perinatal and postpartum depression often go hand-in-hand. Perinatal depression is a condition triggered by pregnancy, where postpartum depression is triggered after birth. Hormonal fluctuations trigger both types of depression during and after pregnancy. Women who experience perinatal and postpartum depression report varying degrees of symptoms. Some women experience ‘feeling blue’ while other women might experience more extreme symptoms, feelings of hopelessness about motherhood, and disinterest in bonding with a child. 

Seasonal Depression 

Some people who struggle with depression are only affected during certain seasons when there are fewer hours of daylight. Known as seasonal affective disorder (SAD) or seasonal mood change, it affects 6% of people in the U.S. residing in the northern part of the country. 14% of people outside of the northern area of the country report suffering from the ‘winter blues,’ which is considered a less extreme version of SAD.

RELATED ARTICLE: Holiday Depression and Stress

Effects of Depression

The symptoms of depression can be debilitating. But just to add insult to injury, research shows that depression itself can be the cause of other health conditions, including:

• Chronic pain
• Substance abuse
• Weight gain and/or loss
• Anxiety
• Panic disorders
• Stroke
• Heart disease
• Self-mutilation

People who experience any symptoms of depression should contact a doctor immediately, as depression can worsen and become the root cause of so many other medical conditions.

Digital Health Clinics That Treat Depression 

Depression Treatments 

The good news is that there are myriad treatments available for depression — and researchers are finding new and better ways to treat it every day through clinical trials. One study claims to even be getting closer to a vaccine for depression. 

Most doctors use a combination of talk therapy and psychotherapy with medication; though, this can vary depending on the diagnosis and severity of symptoms. Most doctors will take into account the types of depression someone is suffering from, and treatment differs from person to person. 

It’s also imperative not to treat depression on your own. What helps one person feel better may not work for someone else. A healthcare provider is the only person who can diagnose and treat mental health disorders, such as major depressive disorder. When it comes to patient care, all doctors advise that it’s better to be safe than sorry. 

Therapy/Psychotherapy 

Most people who suffer from depression find relief in the form of psychotherapy and talk therapy. This type of treatment is usually prescribed in tandem with medication, though sometimes doctors may suggest therapy as the only treatment. 

One of the most difficult parts of dealing with depression is untangling the feelings that accompany it. Most doctors recommend talk therapy to help create space between the patient and the disorder (i.e., I am not my depression). Some of the topics of talk therapy may include:

• Relationships
• Boundaries
• Challenges and setbacks
• Exposure therapy 

Some online therapy providers we highly recommend include:

• Talkspace
• Betterhelp
• Brightside
• Lemonaid
• Regain

If one-on-one therapy isn't your thing, you may also want to consider joining an online support group, such as Wisdo. Support groups connect you with a group of people that have or are experiencing similar feelings of depression, giving you the opportunity to know that you're not alone. 

Relationship Coaching

Maintaining relationships can be difficult for people suffering from depression. Many people who suffer from depression feel isolated and alone and also suffer from low self-esteem. Therapists generally help people with these disorders maintain relationships and offer a little perspective to help patients understand the reality of the situation versus any projections created by the mental disorder itself. 

We have done extensive research and reviewed the following therapy providers that specifically cater to people dealing with relationship problems. 

• Talkspace Couples
• Relationship Hero

Setting Boundaries

People with depression, anxiety, and bipolar disorder often find setting boundaries difficult. Many patients are ‘people pleasers’ and generally find false joy in ‘being what others need them to be.’ Situations like this can spiral out of control, as depressed people often overcommit themselves to make others happy and forget to create space for self-care. Therapists can help by building self-confidence and self-worth while putting people-pleasing situations into perspective.

RELATED ARTICLE: Setting Healthy Boundaries

Challenges and Setbacks

Everyone experiences challenges and setbacks in life. But for someone with depression, these setbacks can feel life-shaking. Most therapists offer tips and tricks for dealing with life’s challenges — while helping the patient come to the understanding that things aren’t always as awful as they might seem.

Exposure and Cognitive Behavior Therapy

Exposure and cognitive behavior therapy work hand-in-hand to help people understand the truth in sticky situations and belief systems they might be projecting onto a situation. Exposure therapy encourages patients to put themselves in stressful situations (in real life or fantasy) while using techniques to create space between the situation and its intense emotions. 

Group Therapy

People who suffer from depression almost always say they constantly feel that they’re all alone. Depression can make people feel like they’re the only ones in the world who feel this way — which is why those with major depressive disorders often have feelings of hopelessness and unworthiness. 

Group therapy helps patients understand that they’re not all alone in their feelings and that they’re actually in the majority — not the minority — when it comes to symptoms of hopelessness and despair. 

This type of patient care usually starts by focusing on the problems of the individuals (facilitated by a group leader). After the individual shares a current struggle, the other participants may be asked to share their experiences with similar struggles. 

While group therapy isn’t for everyone, it can be a useful tool. In one study, researchers found that patients who attended group therapy were less likely to drop out of therapy than patients in one-on-one therapy. Group therapy for depression can also combat other types of disorders related to anxiety and self-esteem.

Light Therapy

Light therapy is used specifically to help people with seasonal affective disorder. Patients expose themselves to bright, white light, mimicking the rays of the sun. Research shows that patients with SAD often feel better after only about 30 minutes of light therapy to balance circadian rhythms. 

Medication

Antidepressants and selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat the many forms of depression and mental health disorders, including major depressive disorder, bipolar disorder, anxiety, perinatal and postpartum depression, and psychotic depression (among others).

These types of medications include chemicals that may change the chemical makeup of the brain. Medications work differently on everyone, and many people find they need to try a combination of antidepressants and/or SSRIs and other medications to ease symptoms. 

Medications usually take a week or two to start working, and some take up to a month for patients to see results and feel better. The most common medications used to treat depression include ones on the following list. 

Selective Serotonin Reuptake Inhibitors (SSRIs)

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

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

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

Tricyclic Antidepressants (TCAs)

• Amitriptyline
• Amoxapine
• Clomipramine (Anafranil)
• Desipramine (Norpramin)
• Doxepin
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)
• Protriptyline
• Trimipramine (Surmontil)

Other Depression Medications 

• 5-HT3 receptor antagonist vortioxetine (Brintellix)
• Bupropion (Wellbutrin)
• Monoamine oxidase inhibitors (MAOIs)
• Olanzapine/fluoxetine (Symbyax)

Common Side Effects of Depression Medications

Research shows the most common side effects of antidepressants and SSRIs include:

• Decreased interest in sex
• Decrease or increase in appetite
• Digestive problems
• Drowsiness
• Dry mouth
• Headache
• Insomnia
• Irritability
• Vertigo
• Weight gain and/or loss

Many people experience one or more of these side effects. Most patients find relief by talking to their doctors and changing medications. It’s common for many patients to try a few different combinations before finding one that works for them.

Depression Medication Warnings

No one should ever stop taking depression medication without the help of a doctor. It’s common for depression to ease or cease and for patients to feel better while on medications, but stopping the medication could cause the depression to return, withdrawal symptoms — or thoughts of self-harm or suicide. 

Children and young adults under the age of 25 should consult with their doctors about possible suicidal thoughts when starting an antidepressant regimen, especially when altering the dosage, stopping, and/or starting a regimen or single medication. Pregnant women or women planning to become pregnant or breastfeed should talk to their mental health professionals or healthcare providers before going on any medication.

Lifestyle Changes

For some people suffering from depression, lifestyle changes can make all the difference. Research shows that those suffering from persistent depressive disorder often feel better without antidepressants by adding a few self-care activities to their routine. Anyone can get a serotonin boost by incorporating daily exercise, social time with friends and family, and healthy meals into their schedules. Similarly, ceasing or cutting back on recreational drugs, alcohol, and nicotine can also help. 

While these tips are ideal for anyone seeking help for mild-to-moderate forms of depression and anxiety, most doctors will advise anyone with major depressive disorders (such as bipolar disorder) to seek more closely-monitored patient care. 

Naturopathic Depression Treatments

Research shows that gut health and brain health may play an important role in overall mental health. Basically, what happens in your digestive system directly affects your brain. 

Many naturopaths advise taking prebiotics and/or probiotics to maintain a healthy balance of good bacteria to reduce anxiety and lower stress. Naturopaths also recommend getting a good dose of gamma-aminobutyric acid (GABA), L-theanine, and magnesium to keep your brain healthy. 

Some clinical trials also show that herbs such as St. John's Wort, Valerian, Folate, and vitamins D and B12 can help regulate anxiety and improve mental health. It’s important to note that these supplements aren’t substitutes for antidepressants and should always be taken under a naturopath and medical doctor's direct supervision. 

Even patients who begin to feel better after starting an herbal regimen should talk to their doctors before going off antidepressants. 

Treatments for Severe Depression 

Sometimes medicine and therapy just aren’t enough to help patients feel better. That’s why there are clinical trials to help people with severe depression (such as bipolar disorder, psychotic depression, and major depression) get the best patient care possible. Some treatments such as brain stimulation therapies and repetitive transcranial magnetic stimulation (rTMS) can help people when other treatments have not.

Brain Stimulation Therapy

Brain stimulation therapy uses electrical currents or magnets to help ease symptoms of depression. 

Electroconvulsive therapy (ECT) is a form of electroshock therapy — but is often confused with a similar therapy used in the mid-20th century. ECT is painless and may offer relief for patients who have already exhausted medication and talk therapy options. ECT is an outpatient treatment that is painless but does come with its own possible side effects, including memory loss and confusion. 

Another type of brain stimulation, repetitive transcranial magnetic stimulation (rTMS), is similar to ECT but uses magnetic coils to stimulate the part of your brain that regulates mood. 

Both types of treatments ideally rewire the brain to alter brain chemistry and function more efficiently. 

Clinical Trials for Depression 

Patients who suffer from depression but haven’t found relief through traditional medicine or therapy often seek out clinical trials to find new and advanced cures — that have yet to be approved by the Federal Drug Administration. 

These trials often come with equally high risks and rewards. Some people find extreme relief in cutting-edge trials, and some experience extreme side effects. Patients simply need to weigh the relief/risk factors before seeking out a clinical trial. 

No matter what your symptoms or family history, there is help for depression. Check out our extensive list of doctors and mental healthcare providers who specialize in varying degrees of depression. From major depressive disorder to anxiety and short-term depression, we’ve got you covered when it comes to finding all the right treatments — right from the comfort of your own home. 

If you or someone you know is experiencing thoughts of self-harm, harming others, or thoughts of death and suicide, contact the National Suicide Prevention Lifeline immediately at 1-800-273-8255.