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How are you feeling today? If you’ve found yourself reading this, probably pretty crappy. Maybe you’ve been feeling listless and down for a lot longer than you expected, and it’s making you worry that you might have depression. Maybe you’ve just received a diagnosis of clinical depression and you’re looking for answers. We get it. So many contributors to HealthCentral have felt just like you do now. But we won’t let depression swallow you up. We also won’t bombard you with a bunch of false promises and inaccurate information (that’s what your Facebook feed is for). Here, we share the reality of coping with depression, as well as expert advice from top doctors, the most successful treatments, and mood-lifting lifestyle changes.

Our Pro Panel Depression We asked some of the nation's top depression experts to bring you the most up-to-date information possible. Charles B. Nemeroff, M.D., Ph.D. Chief Medical Officer of the Anxiety and Depression Association of America, Professor and Chair of Psychiatry at Mulva Clinic for the Neurosciences Dell Medical School, The University of Texas

Austin, TX Jennifer L. Payne, M.D. Director of the Women's Mood Disorders Center and Associate Professor of Psychiatry Johns Hopkins School of Medicine

Baltimore, MD Carol A. Bernstein, M.D. Psychiatrist, Vice Chair for Faculty Development and Well-Being in the Departments of Psychiatry and Obstetrics and Gynecology Montefiore Medical Center/Albert Einstein College of Medicine

The Bronx, NY

What Is Depression, Really? It’s normal to experience sadness. (Who didn’t cry when Simba couldn’t wake up Mufasa?) But unlike typical sadness or grief, time can’t and won’t heal Major Depressive Disorder (MDD), the term for clinical depression, which most people just call “depression.” It’s a common mental health condition that shows up like an unwanted houseguest and refuses to leave. This extended period of sadness or emptiness comes with a constellation of other symptoms, like exhaustion, sleep trouble, a shrinking appetite, overeating, sudden crying spells, and sometimes thoughts of suicide. Symptoms range in severity and must last for two weeks or more to receive an MDD diagnosis, though it’s rare than an episode would only last for that short time. Most people have symptoms for six months to a year, and sometimes, they can last for years.

Nikki Cagle

Without treatment, depression won’t fade away on its own. Even if you do white-knuckle it through your first episode of depression, your chance of another recurrence is more than 50 percent. If you’ve had two episodes, that chance shoots up to 80 percent. Meaning, you’re going to want to deal with this sooner rather than later. One hallmark of depression is an inability to experience pleasure, which is literally no fun. Losing interest in things you once enjoyed often means that your capacity to function at work and home takes a dive. In fact, depression is one of the leading causes of disability in the U.S., as 7.2% of Americans—17.7 million people—experience Major Depressive Disorder, each year. Other Types of Depression We talked about MDD (a.k.a. depression) but there are other types of depression. They include: Persistent Depressive Disorder. This is a chronic form of depression, formerly known as dysthymia . Sometimes people call it “high functioning” or “smiling” depression. While symptoms aren’t as severe as MDD, they last for two years or longer. People with PDD might feel like they’ve always been depressed. (In cases of “double depression,” people experience severe episodes of MDD within their usual state of chronic depression.)

This is a chronic form of depression, formerly known as . Sometimes people call it “high functioning” or “smiling” depression. While symptoms aren’t as severe as MDD, they last for two years or longer. People with PDD might feel like they’ve always been depressed. (In cases of “double depression,” people experience severe episodes of MDD within their usual state of chronic depression.) Seasonal Affective Disorder (SAD). Depression symptoms start and end seasonally, around the same times every year. Most people get depressed in cold, dark winter, but some people’s mood plummets in summer.

Depression symptoms start and end seasonally, around the same times every year. Most people get depressed in cold, dark winter, but some people’s mood plummets in summer. Premenstrual Dysphoric Disorder (PMDD). Here, depression symptoms are tied to the luteal phase of the menstrual cycle, starting about one week before your period and ending just after your period. Though many of the symptoms mirror PMS— irritability, high anxiety, frequent crying —they’re much more severe. They interrupt your ability to work, destroy personal relationships, and can lead to thoughts of self-harm and suicide. This condition was added in 2013 as a form of depression to the DSM-5, the official guide of mental disorders.

Here, depression symptoms are tied to the luteal phase of the menstrual cycle, starting about one week before your period and ending just after your period. Though many of the symptoms mirror PMS— —they’re much more severe. They interrupt your ability to work, destroy personal relationships, and can lead to thoughts of self-harm and suicide. This condition was added in 2013 as a form of depression to the DSM-5, the official guide of mental disorders. Peripartum Depression. New mothers with this disorder typically develop symptoms of depression and even psychosis within a few weeks of giving birth. It used to be called postpartum depression and many people still use the term interchangeably. (In some cases, symptoms start during pregnancy; other times, when the baby is several months old—hence the name change.)

New mothers with this disorder typically develop symptoms of depression and even psychosis within a few weeks of giving birth. It used to be called and many people still use the term interchangeably. (In some cases, symptoms start during pregnancy; other times, when the baby is several months old—hence the name change.) Perimenopausal Depression. In midlife (specifically, the years leading up to menopause ), people experiencing this disorder have typical depressive symptoms plus perimenopause symptoms like hot flashes and night sweats.

In midlife (specifically, the years leading up to ), people experiencing this disorder have typical depressive symptoms plus perimenopause symptoms like hot flashes and night sweats. Substance/Medication-Induced Depressive Disorder. Substance abuse ( alcohol, opiates, sedatives, amphetamines, cocaine, hallucinogens, etc.) or taking some medications, like corticosteroids or statins , can trigger the symptoms of depression. If substance use (or withdrawal from using) is causing your symptoms, you may have this version of depression.

Substance abuse ( etc.) or taking some medications, like or , can trigger the symptoms of depression. If substance use (or withdrawal from using) is causing your symptoms, you may have this version of depression. Disruptive Mood Regulation Disorder. A child with this juvenile disorder is grumpy and bad-tempered most of the time. They have severe, explosive outbursts with parents, teachers, and peers several times a week. Their overreactions are extreme and inconsistent with their developmental level. Depression strikes people at a median age of 32, but it's important to remember that depression can happen to anyone, at any age, of any race, gender, or political affiliation. One out of every six adults will experience depression at some time in their life. Fortunately, depression is treatable. That’s why, at the first hint of symptoms, it’s important to make an appointment with a mental health professional who can help determine whether you have depression, and if so, which type—and most importantly, which treatment is appropriate for you.

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What Causes Depression? You’re not going to like this answer, but no one knows for sure. That said, for the past few decades, the prevailing theory is that depressed people have an imbalance in their brain chemistry—more specifically, low levels of neurotransmitters like norepinephrine, epinephrine, and dopamine, which help regulate mood, sleep, and metabolism. We now know it's a little more complicated than that. Certain circumstances put people at a higher risk of depression, including childhood trauma, other types of mental illness and chronic pain conditions, or a family history of depression, but anyone can get depressed. Scientists informed by decades of research believe that the following factors also up your risk of becoming depressed, but they can’t prove causality. Still, they can play heavily in the development of depression, so it’s important to be aware of them: Genetics. Research shows that having a first-degree relative with depression (a parent, sibling, or child) makes you two-to-three times more likely to have depression tendencies.

Research shows that having a first-degree relative with depression (a parent, sibling, or child) makes you two-to-three times more likely to have depression tendencies. Traumatic life events from childhood, such as abuse or neglect.

such as abuse or neglect. Environmental stressors, like a loved one’s death, a messy divorce, or financial problems.

like a loved one’s death, a messy divorce, or financial problems. Some medical conditions (e.g., underactive thyroid, chronic pain). Per science, the relationship between these physical conditions and depression is bidirectional, so there’s a chicken-or-egg thing going on because they feed each other.

(e.g., underactive thyroid, chronic pain). Per science, the relationship between these physical conditions and depression is bidirectional, so there’s a chicken-or-egg thing going on because they feed each other. Certain medications, including some sedatives and blood pressure pills.

including some sedatives and blood pressure pills. Hormonal changes, like those that come with childbirth and menopause.

like those that come with childbirth and menopause. Gut bacteria. There has been a link established between the microbiome and the gut-brain axis, but it’s only just starting to be studied.

Learn More About Depression Causes While there's no definitive cause for depression, it is definitely not your fault. Find out about the brain changes that can lead to depression. Read More

Do I Have the Symptoms of Depression? Wondering whether your feelings qualify for clinical depression? Those with MDD experience five or more of the below symptoms during the same two-week period, and at least one must be depressed mood or loss of pleasure. The symptoms would be distressing or affect daily functioning. You feel down most of the time. The things you liked doing no longer give you joy. Significant weight loss (without dieting) or weight gain or feeling consistently much less hungry or hungrier than usual. Having a hard time getting to sleep and staying asleep or oversleeping. A molasses-like slowdown of thought, becoming a couch potato, or spending days in bed. (This should be noticeable to others, not just subjective feelings of restlessness or slothiness.) So. So. Tired. You’re so exhausted you can’t even. Feeling worthless a lot of the time, even if you haven’t done anything wrong. Being super distracted, indecisive, and unable to concentrate. Recurrent thoughts of death or suicide(with or without a specific plan to actually do it). If you need help for yourself or someone else, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Nikki Cagle

How Do Doctors Diagnose Depression? When you’re having a depressive episode, it might feel like you’re destined to feel terrible forever. That’s not true. It’s just what your depressed brain wants you to think. The hardest step is ignoring that feeling and making an appointment with a doctor and/or mental health professional, such as a psychologist or psychiatrist. A mental health professional is the only expert that can help you figure out if you are depressed. Unfortunately, there’s no easy blood test that can determine if you have depression, though that would make diagnosis a lot easier. (Get on it, science!) The DSM-5 helps clinicians make that call with a targeted list of common symptoms. To be diagnosed with MDD, patients must experience five or more of the above symptoms (see “Do I Have the Symptoms of Depression?”)—one must be depressed mood or loss of pleasure—during a two-week period. Even if your symptoms match up to MDD, though, your doctor should rule out any underlying medical causes first. Some conditions, such as thyroid disease and vitamin deficiency, can mimic symptoms of depression. Next, consider any medications you’re currently taking.

If this sounds like you or someone you know, make an appointment with a mental health professional. Now. Don't wait! What's the worst thing that can happen? If you feel better by the time the appointment rolls around, you can always cancel it. If you don’t, you’ve saved yourself precious time (and unnecessary pain) by taking steps to managing your mental health.

Go Deeper into Signs and Symptoms of Depression Each type of depression can be linked to specific symptoms. Learn more about the signs and symptoms so that you can talk to your doctor. Read More

What Are the Best Treatments for Depression? Regardless of why you’re depressed, it’s important to get treatment before the condition starts to erode your quality of life. Studies and surveys show that most adults in the U.S. who screen positive for depression remain untreated. Don’t be one of them. As scientists continue to hash out theories about the root causes of depression, research shows that the most effective treatment is a mix of psychotherapy, medication, and lifestyle changes. It might take a (frustratingly long) while to find the right recipe —antidepressants work differently in different people so finding the right fit often takes some trial and error. Plus, the mental health professional you’re working with will be by your side. They won’t give up and neither should you. Some of the treatment options available are: Psychotherapy This doesn’t mean you’ll find yourself reclined on a couch, complaining about your relationship with your mother (though it might). A psychiatrist, psychologist, therapist, or licensed clinical social worker might use a variety of techniques to help change the negative thinking, beliefs, or behaviors that exacerbate your depression and make your world seem hopeless. Types of therapy include psychodynamic therapy, Cognitive Behavioral Therapy (CBT), and interpersonal therapy. Medication Your depression might require more than coaching. Doctors may prescribe medication including antidepressants, mood stabilizers, and/or antipsychotic pills in order to decrease the symptoms of depression. These include: SSRIs (selective serotonin reuptake inhibitors) like Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) and SNRIs (serotonin and norepinephrine reuptake inhibitors) like Cymbalta (duloxetine) and Effexor XR (venlafaxine) make neuro-transmitters serotonin and norepinephrine already existing in the brain more available.

like Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) and like Cymbalta (duloxetine) and Effexor XR (venlafaxine) make neuro-transmitters serotonin and norepinephrine already existing in the brain more available. TCAs (tricyclic antidepressants) like Tofranil (imipramine) and Norpramin (desipramine) and MAOIs (monoamine oxidase inhibitors) like Emsam (selegiline) and Marplan (isocarboxazid) are first-generation antidepressants that work similarly on neuro-transmitters, but they’re used less often because of unpleasant side effects.

like Tofranil (imipramine) and Norpramin (desipramine) and like Emsam (selegiline) and Marplan (isocarboxazid) are first-generation antidepressants that work similarly on neuro-transmitters, but they’re used less often because of unpleasant side effects. Doctors may also use atypical antidepressants like Zyban or Wellbutrin (bupropion) or Remeron (mirtazapine) that affect serotonin, norepinephrine, and dopamine levels in ways unique from other anti-depression drugs. Or they may add atypical antipsychotics, a.k.a. second-generation antipsychotics like Seroquel (quetiapine) or Abilify (aripiprazole). They’re “atypical” in that they affect dopamine and other neurotransmitters without the physical side effects, such as tics and tremors, that first-generation antipsychotics can cause.

Nikki Cagle

Brain Stimulation For treatment-resistant depression that doesn’t get better after exhausting psychotherapy and more than two classes of antidepressants (such SSRIs and TCAs), there are more hardcore options. Severe depression may warrant electroconvulsive therapy (ECT), which you might remember from One Flew Over the Cuckoo's Nest. Fear not—modern ECT is safe, performed under anesthesia, and much less aggressive than you see in the movies. There is also repetitive transcranial magnetic stimulation (rTMS) which some docs refer to as “ECT Lite”. For severe depression, some people receive vagus nerve stimulation (VNS), a surgical implant that works kind of like a pacemaker, sending electric pulses to the brain. Other Treatment Approaches These may include: For severe, treatment-resistant depression , the FDA recently approved esketamine , a nasal spray based on the party drug/anesthetic ketamine . Experts say it works by kicking up production of glutamate, a neurotransmitter that helps prompt the brain to form new neural connections.

, the FDA recently approved , a nasal spray based on the party drug/anesthetic . Experts say it works by kicking up production of glutamate, a neurotransmitter that helps prompt the brain to form new neural connections. Sadness during seasonal depression (SAD) can be alleviated with melatonin-regulating light therapy .

can be alleviated with melatonin-regulating . Postpartum depression may be treated with Brexanolone (Zulresso), an IV version of the body’s own neurosteroid allopregnanolone.

(Zulresso), an IV version of the body’s own neurosteroid allopregnanolone. Research shows that lifestyle changes like incorporating exercise and mindfulness can amplify results of medication and therapy. Even if they aren’t foolproof mood-lifters, it never hurts to build a health-supportive routine.

Get Even More Info on Depression Treatment Don't let depression deteriorate your quality of life. Get more info on all your treatment options. Read More

Frequently Asked Questions Depression What’s the difference between being sad and being depressed? Sadness is a normal reaction to disappointment, bad news, and loss. (Remember when Jaime Lannister left Brienne of Tarth heartbroken to go canoodle with Cersei in King’s Landing?) Sadness and grief eventually let up over time, even after a devastating loss. Depression doesn’t go away, and it interferes with your ability to do what you need to do on a daily basis. Besides a gloomy mood, depressed people have other symptoms like fatigue, apathy, insomnia or too much sleep, noticeable weight change, crying jags, and (sometimes, but not always) thoughts of suicide. How long does depression last? To meet the clinical definition of a depressive episode, symptoms must last a minimum of two weeks (though research puts the median duration at six months). Chronic depression (aka Persistent Depressive Disorder) lasts a minimum of two years, but often lasts much longer. Depression can hang around forever, especially when left untreated. Do I have to see a therapist in real life for depression or can I use an app? That depends on the severity of your depression. Meeting with a therapist in person can be inconvenient, nerve-wracking, and just plain awkward. But is it really possible to text your way to better mental health? Experts are torn on the efficacy of virtual mental health apps (a.k.a. telepsychology). Research shows that text therapy like Talkspace, one-on-one chat, or video counseling makes getting help easier than ever, especially for super-busy people, those in rural areas where docs are scarce, or those who fear the stigma of being seen at a mental health office. Many experts caution against virtual therapy for people who are seriously mentally ill, have alcohol or drug addiction, or are at risk of harming themselves or others. In those scenarios, more intensive treatment is required. To find out how to get the most out of virtual therapy, check out the American Psychological Association’s guidelines for telepsychology. If someone is depressed will they become suicidal? Not necessarily. But they might. Suicide is the 10th leading cause of death in the U.S. for all age groups. Depression can wear on a person’s psyche, making every minute feel like an hour, stealing sleep, and creating a sense of hopelessness. We’re not trying to freak you out, but it’s important to keep an eye open for signs of suicidal ideation, like withdrawing from social life, engaging in uncharacteristically reckless behavior (e.g. drug abuse, speeding, unsafe sex), getting their affairs in order (making a will, giving away prized possessions), or outright saying they want to die (even if it’s in a joking manner). The U.S. Department of Health and Human Services estimates that around 60% of people who die of suicide have a mood disorder like MDD, Persistent Depressive Disorder, or Bipolar Disorder. If you need help for yourself or someone else, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).