WHAT IS MAJOR DEPRESSION?

The opposite of depression is not happiness but vitality – the ability to experience a full range of emotions, including happiness, excitement, sadness, and grief. Depression is not an emotion itself; it’s the loss of feelings, a big heavy blanket that insulates you from the world yet hurts at the same time. It’s not sadness or grief; it’s an illness. Richard O’Connor, Ph.D., Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You

In major depression, the most prominent symptom is a severe and persistent low mood, profound sadness, or a sense of despair. The mood can sometimes appear as irritability. Or the person suffering from major depression may not be able to enjoy activities that are usually enjoyable.

Major depression is more than just a passing blue mood, a “bad day,” or temporary sadness. The symptoms of major depression are defined as lasting at least two weeks, but usually, they go on much longer — months or even years.

A variety of symptoms usually accompany the low mood, and the symptoms can vary significantly among different people.

Dysthymia is a mild but long-lasting form of depression. It’s also called persistent depressive disorder. People with this condition may also have bouts of major depression at times.

Many people with depression also have anxiety. They may worry more than average about their physical or mental health. They may have excessive conflict in their relationships and may function poorly at work. Sexual functioning may be a problem. People with depression are at more risk for abusing alcohol or other substances.

Depression probably involves changes in the areas of the brain that control mood. Nerve cells may function poorly in specific brain regions, and communication between nerve cells or nerve circuits can make it harder for a person to regulate mood.

Hormone changes may also negatively affect mood in women and result in premenstrual syndrome (PMS) or a condition similar to it, premenstrual dysphoric disorder, or PMDD.

An individual’s life experience affects these biological processes. And genetic makeup influences how vulnerable a person is to getting this illness.

A stressful life event or chronic stress can trigger an episode of depression. However, in many cases, depression does not appear to be related to a specific event.

A major depressive episode may occur just once in a person’s life or may return repeatedly. People who have many episodes of major depression may also have periods of persistent but milder depressed mood.

During a major depressive episode, thinking can get out of step with reality. The person has “psychotic symptoms” such as false beliefs (delusions) or false perceptions (hallucinations).

Others who have episodes of major depression also have episodes of relatively high energy or irritability, which is often diagnosed as bipolar disorder. They may sleep far less than normal and may dream up grand plans that could never be carried out. The severe form of this is called “mania” or a manic episode. Psychotic symptoms also occur in mania. If a person has milder symptoms of mania and does not lose touch with reality, it is called “hypomania” or a hypomanic episode.

A major depressive episode may occur within the first two to three months after giving birth to a baby. In that case, it may be called major depressive disorder with peripartum onset. Most people refer to it as postpartum depression.

Depression that occurs mainly during the winter months is usually called seasonal affective disorder, or “SAD.” It also may be called major depressive disorder with seasonal pattern.

Episodes of depression can occur at any age. Depression is diagnosed in women twice as often as in men. People who have a family member with major depression are more likely to develop depression or drinking problems.

SYMPTOMS OF MAJOR DEPRESSION

A depressed person may gain or lose weight, eat more or less than usual, have difficulty concentrating, and have trouble sleeping or sleeping more than usual. He or she may feel tired and have no energy for work or play. Small burdens or obstacles may appear impossible to manage. The person can appear slowed down or agitated and restless. The symptoms can be quite noticeable to others.

A particularly painful symptom of this illness is an unshakable feeling of worthlessness and guilt. The person may feel guilty about a specific life experience or general guilt unrelated to anything in particular.

If pain and self-criticism become great enough, they can lead to feelings of hopelessness, self-destructive behavior, or thoughts of death and suicide. The vast majority of people who suffer severe depression do not attempt or commit suicide, but they are more likely to do so than people who are not depressed.

Symptoms of major depression include:

• distinctly depressed or irritable mood
• loss of interest or pleasure
• decreased or increased weight or appetite
• decreased or increased sleep
• appearing slowed or agitated
• fatigue and loss of energy
• feeling worthless or guilty
• poor concentration or indecisiveness
• thoughts of death, suicide attempts, or plans.

A primary care physician or a mental health professional can usually diagnose depression by asking questions about medical history and symptoms. By definition, major depression is diagnosed when a person has many of the symptoms listed above for at least two weeks.

Many people with depression do not seek evaluation or treatment because of society’s attitudes about depression. The person may feel the depression is their fault or may worry about what others will think. Also, the depression itself may distort a person’s ability to recognize the problem. Therefore, family members or friends may need to encourage the depression sufferer to seek help.

There are no specific tests for depression. However, it is crucial to be evaluated by a primary care physician to make sure a medical condition or medication is not causing symptoms.

HOW COMMON IS DEPRESSION IN THE UNITED STATES?

The percentage of U.S. adults who report having been diagnosed with depression at some point in their lifetime has reached 29% in 2024, nearly ten percentage points higher than in 2015. The percentage of Americans who currently have or are being treated for depression has also increased to 17.8%, up about seven points over the same period. Both rates are the highest recorded by Gallup since it began measuring depression using the current form of data collection in 2015.

EXPECTATION DURATION OF MAJOR DEPRESSION

On average, untreated episodes last six to twelve months. However, episodes of major depression can last any length of time. And symptoms can vary in intensity during an episode.

If depression is not treated, it can become chronic (long-lasting). Treatment can shorten the length and severity of a depressive episode. Between 70% and 90% percent of people with depression eventually respond well to treatment.

TREATING MAJOR DEPRESSION

PSYCHOTHERAPY

Psychotherapy is often referred to as “talk therapy.” There are various approaches to psychotherapy. Many therapists specialize in a particular type of therapy to treat depression. Still, they sometimes pull from multiple approaches to create a more individualized therapy based on your specific treatment needs.

Since many types of psychotherapy are available, one study set out to discover which ones are most effective for depression. Researchers found that all of the following provide good results.

–Interpersonal Therapy

Interpersonal therapy is based on the idea that depression can be related to our relationships. Therefore, this therapy aims to help you improve your relationship skills, such as becoming a better communicator and learning how to resolve conflict. Interpersonal therapy sessions are relatively short in duration, usually lasting between 12 and 16 weeks.

–Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of talk therapy designed to help you change any negative thoughts or behavior patterns that may be contributing to or worsening your depression. This therapy is also generally short-term and focuses on your current problems and learning new coping skills.

–Social Skills Training

Social skills training teaches you how to interact with others more effectively to have healthy relationships. The goal is to improve your communication skills and learn how to build a strong social network with others, such as by creating relationships based on honesty and respect.

–Psychodynamic Therapy

Psychodynamic therapy is the type of therapy often portrayed in movies or pop culture. During these therapy sessions, you learn how your depression may be related to past experiences, unresolved conflicts, or unhealed wounds. The therapist will help you address these issues so you can move forward in your life.

–Supportive Counseling

Supportive counseling is less structured than some of the other therapies and mainly involves listening to you share whatever is on your mind. You are invited to talk about any issues you want, and the therapist will work with you to show understanding and support.

–Behavioral Activation

Behavioral activation teaches you how to set goals and include more pleasant activities in your lifestyle. The goal of this therapy is to avoid isolation and increase the positive interactions you have with your environment. By getting active and engaging in more pleasurable activities, your symptoms of depression may be reduced.

–Problem-Solving Therapy

Problem-solving therapy aims to define your most pressing issues and then guides you to devise multiple ways to overcome them. The therapist helps you evaluate your options and choose the best solution for you.

–Family or Couples Therapy

Family or couples therapy may be considered when depression affects others in the household. This involves looking at each of your roles and expectations. This type of therapy also involves educating your loved ones about depression and how it affects you.

MEDICATIONS

What are antidepressants?

Antidepressants are prescription medicines to treat depression. Researchers think antidepressants may help improve the way your brain uses certain chemicals that control mood or stress.

What are the different types of antidepressants?

 There are many types of antidepressants. Each one works differently. Providers usually prescribe newer antidepressants first because they don’t cause as many side effects as older types. They also seem to help more kinds of depression and anxiety problems.

Most of the newer antidepressants belong to one of these three groups:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Atypical antidepressants, which are newer antidepressants that don’t fit into the other groups

If these antidepressants don’t help, your provider might suggest one of the older antidepressants. The older types include tricyclic antidepressants (TCAs), tetracyclics, and monoamine oxidase inhibitors (MAOIs). Even though these antidepressants may cause more serious side effects, the benefits may outweigh the risks for some people.

Which type of antidepressant is right for me?

Our bodies and brains all work differently. That means one antidepressant won’t work for everyone. You may need to try two or more medicines before you find one that works for you.

Your provider will work with you to choose the best option to try first. You’ll consider questions such as:

• Which symptoms bother you most? Some antidepressants may do a better job of helping specific symptoms, such as trouble sleeping.
• What other medicines and supplements do you take? Some antidepressants can cause problems if you take them with certain medicines and herbs.
• Did a certain antidepressant work well for a close relative? An antidepressant that helped a parent, brother, or sister could be a good choice for you, too.
• Do you have other health conditions? Certain antidepressants can make some other conditions better or worse. Any other conditions that you have will be part of choosing your depression treatment.
• Are you pregnant, planning for pregnancy, or breastfeeding? If so, your provider will help you find a way to treat your depression that’s safe for you and your baby.

How long do antidepressants take to work?

Antidepressants usually take 4 to 8 weeks to work, so you’ll need to be patient. You may notice that some problems, such as sleeping and eating, get better before your mood improves. That’s a good sign. You may need to give the medicine a little more time to do its job.

Sometimes, an antidepressant helps at first, but symptoms return while you’re still taking it. But there’s usually another one you can try. To get more relief from depression, your provider may suggest combining two antidepressants, using another kind of medicine with an antidepressant, or adding talk therapy or other approaches to improve your mental health.

 How long will I need to take an antidepressant?

When an antidepressant starts to work, you and your provider can decide how long you need to stay on it. The typical length of treatment is 6 to 12 months, but some people may remain on antidepressants for much longer.

What are the side effects of antidepressants?

Not everyone has side effects from antidepressants. But if you do have them, they’re usually mild and may get better over time as your body gets used to the new medicine.

The most common side effects from antidepressants include:

• Nausea and vomiting
• Weight gain
• Diarrhea
• Sleepiness
• Sexual problems, such as a lack of desire or ability to have sex

When thinking about side effects, it’s important to remember that there are also risks from not treating depression. Your provider can help you think through the pros and cons of all your options.

If you have any side effects from antidepressants, your provider may suggest ways to manage them while you wait to see if the antidepressant will work. If the side effects bother you too much, you may need to change antidepressants. But you should never change your dose or stop taking an antidepressant on your own.

If you have serious problems or notice any changes that worry you, such as new or worsening symptoms, unusual changes in your mood, or you start acting differently, call your provider right away.

What can I do to take antidepressants safely?

Antidepressants are generally safe when you use them correctly:

• Tell your provider about everything you take. That includes medicines, herbs, supplements, and over-the-counter medicines you take, such as pain relievers and decongestants. Be honest about recreational drugs and alcohol, too.
• Try to get all your medicines from the same pharmacy. That way, the pharmacist can warn you and your provider if you take medications that may cause problems when used together.
• Follow all instructions about how to take your medicine.
• Talk with your provider if side effects bother you.
• Never stop taking antidepressants without your provider’s help. Stopping too fast may make depression come back. You could even make your condition worse. To stop antidepressants safely, you need to give your body time to get used to being without the medicine. Your provider can tell you the safest way to go off an antidepressant.

ALTERNATIVE TREATMENTS

There are many ways to counter some of the symptoms of depression that don’t involve prescription medications. If you have depression, you might like to try managing it naturally without medication or supplement your antidepressant with other options. If so, check out these natural alternatives and then talk to your doctor about which might make sense as part of your treatment regimen.

Here are some natural treatments that may help fight depression, including lifestyle changes and supplements. It also covers other strategies you might try, such as practicing mindfulness or enhancing your home environment.

Get More Sleep

Sleep and mood go hand in hand. Get too little of the former, and the latter is bound to be affected whether you have depression or not. To support your emotional well-being, make sure you have what sleep experts call “good sleep hygiene.

This means you keep consistent bedtimes and wake-up times, your bedroom is set up for sound sleep (it’s dark, quiet, and uncluttered), you have a relaxing bedtime routine that doesn’t involve sitting in front of a screen, and so on.

The relationship between sleep and depression can be complex. Not only is poor sleep thought to contribute to the onset of depression, but depression may also cause low-quality sleep.

Whether you can’t seem to get any sleep or can’t seem to stop sleeping, there are steps you can take to try to improve the quality of your sleep:

• Give yourself time to unwind before you go to bed; do something relaxing and avoid stressful tasks or thoughts.
• Go to bed at the same time each night, and set an alarm so that you wake at the same time each morning.
• Have a consistent bedtime routine.
• Turn off your devices and try reading a book for a few minutes.

Also, try to spend a little time outside each day, even on days when you are tempted to draw the shades and hide indoors. Light plays an important role in regulating sleep cycles and circadian rhythms, so a lack of sunshine may be making it more difficult to sleep at night.

Cut Back on Caffeine

Coffee, tea, soda, and even chocolate are steeped in caffeine. It’s fine to consume a reasonable amount of caffeine in the morning if you enjoy it, but avoid it after late afternoon so it doesn’t interfere with sleep.

If you do tend to rely on caffeine, try cutting back gradually in order to avoid unpleasant symptoms of caffeine withdrawal. When you are craving a soda or cup of coffee, try going for a short walk around the block instead.

Get More Vitamin D

There’s some evidence that a vitamin D deficiency could play a role in depression. If you aren’t getting enough vitamin D through your diet and lifestyle (like sun exposure), ask your doctor if you should try taking a supplement.

Certain nutrient deficiencies can play a role in depression symptoms. If you are having a difficult time spending enough time outdoors or if overcast weather conditions make it hard to get sunshine, a supplement may be useful.

Try Natural Remedies

Some research suggests that there are natural antidepressants that may help reduce symptoms of depression. For treating mild to moderate depression, dietary supplements such as St. John’s Wort, S-adenosylmethionine (SAM-e), and 5-Hydroxytryptophan (5-HTP) may be worth a try.

In the past, 5-HTP has been contaminated with the same peak-x adulterant that led to eosinophilic-myalgic syndrome and caused nearly 300 deaths in Japan. It is important to note that dietary supplements are not regulated by the U.S. Food and Drug Administration, so it is essential to use them cautiously.

Research has shown that St. John’s wort is more effective than a placebo at relieving symptoms

Omega-3 fatty acids have also been investigated for their potential impact on depression. One 2015 study found that taking omega-3 supplements may help reduce symptoms of depression in both adults and children, although researchers are not entirely sure how or why.

While natural remedies can be good options for depression treatment, you should always consult your healthcare provider before taking them. Just because they’re available without a prescription and are touted as natural doesn’t mean they’re always safe.

Additionally, research on some of these natural antidepressants remains inconclusive and some may cause unwanted side effects or drug interactions. For example, mixing St. John’s wort with an SSRI such as Prozac can lead to a complication called serotonin syndrome. Also, SAM-e carries a risk for hypomania/mania in bipolar disorder.

Some herbs and other supplements may work as natural antidepressants, but that does not mean they are safe and appropriate for everyone or come without side effects. The effectiveness of these natural remedies is also not always clear, so always talk to your doctor first.

Tap Into Your Spirituality

Religion can be an impactful source of support for many people dealing with depression, but there is no need to join a church, synagogue, or mosque unless you wish to. Simple daily practices such as meditation or adding to a list of things you’re grateful can help boost mood and overall well-being.

Mediation can have a range of beneficial effects, such as lowering stress levels and helping people to become more aware of their thoughts and reactions.

Research indicates that an intervention called mindfulness-based cognitive therapy (MBCT), which combines elements of cognitive behavioral therapy (CBT) with mindfulness meditation, can be helpful in treating depression and preventing future relapses of symptoms.

Studies also suggest that different types of mindfulness meditative practices can also be effective in the treatment of depression.

There are many different types of meditation, but you can get started with a simple meditative exercise with these steps:

1. Sit comfortably.
2. Close your eyes.
3. Breathe naturally.
4. Focus on how your body feels while you breathe.
5. When your mind wanders, redirect your attention back to your breathing.

Get More Exercise 

Getting more exercise doesn’t have to mean training for a marathon, but it does mean putting in a half-hour or so of low-intensity activity each day, which has been found to be effective in improving mood and quality of life. Even better, take it outdoors. Fresh air and sunshine are especially healing for folks dealing with a special form of depression known as seasonal affective disorder (SAD).

While research has shown that regular physical activity can be effective in both the prevention and treatment of depression, it can be hard to start an exercise habit when you’re depressed. Lack of energy and low mood may mean that you simply feel too fatigued to get up and get active.

Some things that you can try to stick to your habit:

• Enlist a friend. Ask a loved one to walk with you or do another form of exercise at least a few times a week. Having the support of a friend can not only help get you into a routine, but it can also help you maintain those social connections when you are feeling down.
• Remind yourself of the benefits. Getting started is tough, but doing it is something that will help you feel better in the long term.
• Start small. Try walking for just a few minutes each day, then work on gradually increasing your walks.

Avoid Alcohol

Alcohol in and of itself is a depressant. Drinking can interfere with sleep, and quality sleep is a key to battling the blues. While alcohol might seem like a quick fix to escape what you are feeling, it can actually make many of the symptoms of depression feel much worse.

Not only that, but it can decrease inhibitions and potentially lead to risky behaviors and bad decisions that can have long-term consequences.

If you’re taking any sort of antidepressant, you really shouldn’t drink at all. Alcohol doesn’t interact well with medications.

If you have been misusing alcohol or other substances and need help quitting, talk to your doctor. You may also have an alcohol or substance use disorder. Withdrawal symptoms may temporarily worsen symptoms of depression, so you may need extra assistance as you go through the recovery process.

Eat ‘Good Mood’ Food

What you eat can have a direct effect on how you think and feel. Make sure to eat a well-balanced diet that’s rich in nutrients. A nutritionist or dietitian can help you analyze your eating habits and pinpoint potential nutrient deficiencies that could contribute to depression.

Some foods that may be especially beneficial when you have depression include:

• Fish: Research has found that people who ate a diet high in fish were less likely to have symptoms of depression. Fish are high in omega-3 fats, which play a role in helping neurotransmitters such as serotonin work in the brain.
• Nuts: Nuts are also a good source of omega-3 fats and one study indicated that people who ate walnuts were 26% less likely to have symptoms of depression.
• Probiotics: Research is increasingly pointing to a connection between gut and brain health. Foods high in probiotics include yogurt, kefir, kimchi, and kombucha.

Get a Handle on Stress

Stress can drive up levels of a brain chemical called cortisol, which has been found to be higher in folks with depression. There are lots of strategies for coping with stress, such as time management, meditation, and biofeedback training.

Some stress-relieving activities that you might want to incorporate into your daily life include:

• Deep breathing: A few minutes to slow your breathing and focus your attention on your body in the moment can help you get a better handle on your worries.
• Exercise: Regular physical activity is a great way to blow off steam.
• Progressive muscle relaxation: This process involves intentionally tightening muscles throughout the body, holding that tension for several counts, and then releasing that tension until the muscles are completely relaxed. With regular practice, you may be able to learn how to intentionally relax your body fairly quickly whenever you are feeling tense.

Learning to manage your stress takes time and practice. Talk to your doctor or therapist about other strategies you might try to minimize the stress and your response to it.

Add Greenery to Your Home or Office

You may also find it helpful to add indoor plants to your home or office environment. Natural settings are associated with improved mental well-being, so it makes sense that “bringing the outdoors in” might help improve your mood. 

Studies have shown that adding indoor plants to your home or office can help in a variety of ways, including:

• Improving the workplace: Research has shown that office spaces enhanced with indoor plants improve worker concentration and workplace satisfaction.
• Reducing stress levels: Another study found that actively interacting with indoor plans by caring for them can reduce both physiological and psychological stress.
• Decreasing depression and anxiety: Research has found that students who spent most of their time at home during the COVID-19 pandemic had better mental health if they were exposed to more green plants. While about a third of the participants reported symptoms of moderate depression, those exposed to more greenery had lower levels of depression and anxiety.

Choosing certain plants may provide additional benefits. For example, research suggests that the scent of a lavender plant can help people feel calmer and more relaxed. No matter what type of plants you choose, greenery can be a great way to beautify your surroundings and potentially improve your mood.

Tend to Your Social Life

When you’re depressed, there’s no reason to go it alone, and there are all sorts of reasons to reach out to friends and family. Make plans with loved ones and keep those dates. Join a club or sign up for a group activity such as a local dodgeball league or a French class.

Other things you might try:

• Join a support group. Talking to other people who are going through similar experiences and challenges can be informative and helpful.
• Schedule activities. Having routines can be helpful when you are going through depression. Create a daily schedule that includes spending time with others. You are more likely to stick to it if it’s a scheduled event.
• Volunteer. Joining a cause that you care about is a great way to meet new people and expand your social circle.

The problem is that depression often causes people to withdraw, which only further exacerbates feelings of isolation and loneliness. Even when you don’t feel like going out or being social, try reaching out in whatever way is most comfortable for you. Enlist a few of your closest loved ones who understand what you are experiencing.

Doing the things you used to do might not bring you quite the same enjoyment when you are depressed, but getting out of the house and spending time with people who care about you can help you feel better.

Try New Things

Depression often zaps your interest and motivation to explore new things. You might find it helpful to develop a list of things you might like to try, then work through them one at a time. You might have to compel yourself to try them, and you might find that you don’t necessarily have the motivation to pursue new things beyond your initial attempt.

But over time, you might find that something sparks your interest or helps you feel more motivated. It’s not always easy, but consider making it a goal to try at least one new thing each week. It may help you fight off a sense of boredom and give you something to look forward to.

Have a Daily Routine

The symptoms of depression can also make it difficult to stick to a schedule, but research suggests that having a routine can be critical for mental health.  Maintaining a routine can also help you hold on to a sense of normalcy and stability when you are dealing with feelings of depression, stress, or anxiety.

Not having a daily routine, on the other hand, can increase your feelings of stress and leave you feeling overwhelmed and unable to focus. So work on having a schedule that includes the basic things you need to get done as well as plenty of self-care.

Listen to Upbeat Music

There’s no doubt that music can have an impact on how you feel, so choosing the right music when you’re feeling down might be an effective way of lifting your mood.

Research has found people who are depressed may have a tendency to choose music that intensifies rumination, sadness, and emotion-focused coping.  So while you might be tempted to turn to somber tearjerkers when you’re feeling down, consider listening to more upbeat songs to boost your mood and inspire positive feelings.

Disclaimer

If you are in crisis or if you are experiencing thoughts of self-harm, please seek help immediately. Dial 988 (in the USA) to contact the National Suicide Prevention Hotline, where trained professionals are available to assist you. You can call, text, or chat to access the support you need. Your well-being is of utmost importance, and resources are available to provide the help and care you deserve. Your well-being is of utmost importance, and resources are available to provide the help and care you deserve.

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