Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.
Depression can be long-lasting or recurrent, substantially impairing an individual’s ability to function at work or school or cope with daily life. At its most severe, depression can lead to suicide. When mild, people can be treated without medicines but when depression is moderate or severe they may need medication and professional talking treatments.
Depression is a disorder that can be reliably diagnosed and treated by non-specialists as part of primary health care. Specialist care is needed for a small proportion of individuals with complicated depression or those who do not respond to first-line treatments.
Types of Depression
Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
- Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
- Perinatal depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
- Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
- Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
- Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
Symptoms of Depression
According to the National Institute of Mental Health, symptoms of depression may include the following:
- Difficulty concentrating, remembering details, and making decisions
- Fatigue and decreased energy
- Feelings of guilt, worthlessness, and/or helplessness
- Feelings of hopelessness and/or pessimism
- Insomnia, early-morning wakefulness, or excessive sleeping
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Overeating or appetite loss
- Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
- Persistent sad, anxious, or “empty” feelings
- Thoughts of suicide, suicide attempts
As with any illness, treatment should be tailored to a specific diagnosis. A treatment plan for a diagnosis of depression and an anxiety disorder should be designed to help a person manage and reduce the symptoms of both disorders, often at the same time.
Some people may have a disorder that causes most of the distress, and it is reasonable to address it first. For example, if a person who is highly depressed is unable to begin treatment for an anxiety disorder, which requires high motivation and energy, it may be necessary to treat the depression first. Often, however it is difficult to tell which set of symptoms is predominant, so treatment of both may start at the same time.
Often depression and an anxiety disorder can be treated similarly. In many cases, therapy can be tailored to an individual so that it works to reduce the symptoms of both disorders.
Several forms of psychotherapy are effective. Of these, cognitive-behavioral therapy (CBT) works to replace negative and unproductive thought patterns with more realistic and useful ones. These treatments focus on taking specific steps to overcome anxiety and depression. Treatment often involves facing one’s fears as part of the pathway to recovery. Interpersonal therapy and problem-solving therapy are also effective.
Medications can also be useful. Symptoms of depression and anxiety disorders often occur together, and research shows that both respond to treatment with selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) medications.
Other medications may be used if an SSRI or SNRI does not provide adequate improvement. For people with severe symptoms or functional limitations, psychotherapy and medication treatment may be combined.
Taking Other Steps
- Consider joining a support group.
- Try relaxation techniques, meditation, and breathing exercises.
- Talk with family members and friends and explain how they can be helpful.
- Your therapist may recommend self-help materials.
- Regular exercise can reduce symptoms of depression and anxiety.
Did You Know?
- Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18% of the population. (Source: National Institute of Mental Health)
- Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
- Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry,60(7), July 1999).
- More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses.
- People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.
- Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.
Anxiety and Depression
It’s not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder.