What is Depression & How to Get Help?

Depression is one of the most common mental illnesses the U.S. More than 17 million adults in the United States live with depression, according to the latest statistics. Depression affects all ages, ethnic and socioeconomic groups. From the boardroom to the classroom, no one is immune to the effects of this disease.¹ Everyone feels down or sad sometimes, but depression is more than just a case of the blues. Depression is characterized by a relentless sense of despair and sadness. With depression, these feelings persist. Depression is a chronic condition that requires treatment. A person with depression cannot “just snap out of it” on their own. The good news is that there are many effective treatments for depression and researchers are developing new therapies all the time.²

In spite of the fact that depression is so prevalent and there are so many effective treatments for the disorder, many people don’t get help. Research indicates that less than 30 percent of people diagnosed with depression get treatment.³ There are many reasons why people don’t seek treatment for depression. Although we have come a long way in terms of changing the public perception of depression, there is still a stigma associated with the disorder. According to the National Alliance on Mental Illness (NAMI), many people with depression are still discriminated against when it comes to housing, employment and more.⁴ Another reason why people don’t seek treatment is that they don’t recognize the symptoms. Sadness isn’t the only sign that you could be struggling with depression. Some of the signs of this illness are quite surprising or subtle.

Symptoms of Depression

Here are some of the most common signs of depression.⁵

• Difficulty making decisions. When you are depressed, it can be very hard to make even simple decisions. Little things that you don’t normally think about become hard — like deciding whether to have eggs or oatmeal for breakfast.
• Unexplained physical problems. Things like chronic pain and constant stomach aches with no physical cause can be a sign of depression.
• Irritability. Agitation and irritable mood is a common sign of depression, especially in children and teens.
• Persistent feelings of sadness. A crushing feeling of sadness that doesn’t go away after two weeks could be a sign of depression. Everyone feels sad from time-to-time. However, with depression, the feeling of sadness prevents you from doing things that you normally do, like going to work. You might call in because you feel down in the dumps. Or you might binge eat a quart of ice cream to bring up your mood. Those are signs that it is depression.
• Social isolation. Depression can cause you to become isolated from friends and family. People with depression may seem distant and isolated.
• A crippled sense of self-worth. Depression causes self-worth to plummet.
• Exhaustion. When you are depressed, even minor exertion can cause extreme fatigue. Depression can make it hard to even get out of bed in the morning.
• No interest in enjoyable activities. With depression, you no longer care about doing the activities you used to enjoy. If yoga used to be the highlight of your day, but you haven’t been in a month or you could less about your favorite television show, depression could be the cause of your disinterest in these things you used to love.
• Significant weight gain or loss. Have you recently lost a lot of weight? Maybe you no longer enjoy eating. A lack of appetite is common in depression, which can cause weight loss. Conversely, depression can cause some people to overeat, leading to weight gain
• Restlessness or agitation. Depression sometimes causes agitation and restlessness. If you are depressed, you might feel wound up or fidgety. These sensations can make it hard to relax and interrupt sleep.
• Sluggishness. Psychomotor retardation is one sign of depression. Psychomotor retardation can cause a person to move slower than normal. It might take longer to perform tasks. Psychomotor retardation can also affect speech, causing a person to speak slower, as well.

Types of Depression

There are different types of depression, each with unique causes, effects, and symptoms. Since treatment differs depending on the type of depression, knowing what type of depression you have can go a long way in helping to manage symptoms. Your therapist or physician will determine what kind of depression you have and develop a treatment plan based on that.

Major Depressive Disorder

When people use the term depression, they are typically referring to major depressive disorder. To be diagnosed with major depressive disorder, you would need to have five or more of the above symptoms for a period of at least two weeks. There are several different subtypes of major depression. Here are a few of the most common ones.⁵

• With seasonal pattern. This subtype of major depression is often referred to as (SAD) seasonal affective disorder. People with this type of depression only experience symptoms during one part of the year, typically during fall or winter. The symptoms go away during the rest of the year.
• With peripartum onset. Depression with peripartum onset refers to depression that begins sometime during pregnancy to four weeks after delivery. This type of depression is also known as “postpartum depression.”
• With psychotic features. Depression with psychotic features is a type of depression that also includes symptoms of psychosis, such as delusions or false beliefs and hallucinations, which refers to seeing or hearing things that are not real.
• With anxious distress. This type of depression also features symptoms of anxiety. The person must have at least two of the following symptoms of anxiety to be diagnosed with this type of depression: feeling on edge or keyed up, difficulty concentrating because of worry, feelings of restlessness, and fear of losing control.
• With atypical features. Sometimes called atypical depression, this subtype includes the following specific symptoms: increased appetite or weight gain, sleeping too much, feeling weighed down, and being really sensitive to criticism or rejection.

Persistent Depressive Disorder

This disorder used to be known as dysthymia. It refers to a less severe, but chronic, form of depression. People with persistent depressive disorder may experience low-grade symptoms of depression over a period of years. The symptoms are mild but persistent.

Premenstrual  Dysphoric Disorder (PMDD)

This is a type of depression that some women experience that occurs about a week before a period. It includes symptoms of premenstrual syndrome (PMS), such as frequent crying or moodiness, agitation, irritability, lack of interest in enjoyable activities, physical symptoms, problems sleeping and appetite changes. The symptoms are much more severe than with PMS and they impact daily functioning. They also occur between one and two weeks before every period.

Treatment for Depression

There is a range of effective treatments for depression. Approximately 80 to 90 percent of people with depression experience significant improvement with treatment, according to the American Psychiatric Association.⁶ For most people with depression, treatment usually consists of a combination of treatments, including medication and psychotherapy.

There have been thousands of studies that have looked at what works in treating depression. The following treatments are evidenced-based meaning that they have been found to be effective in helping people with depression. ⁷

Medication

There are several different types of medications that are used to treat depression. Here are the most common ones: ⁸

• Tricyclic antidepressants. These drugs have been around a while. They were among the earliest drugs used to treat depression. They include protriptyline (Vivactil), desipramine (Norpramin), and imipramine (Tofranil). Tricyclic antidepressants can be very effective for some people. However, they tend to cause more severe side effects than some of the newer antidepressants. So, they are typically used for people who do not experience an improvement of symptoms with the newer antidepressants.
• Selective serotonin reuptake inhibitors (SSRIs). These types of medications are most often prescribed for depression. They are considered safer and cause fewer side effects than tricyclic antidepressants. SSRIs include sertraline (Zoloft), fluoxetine (Prozac), and citalopram (Celexa).
• Monoamine oxidase inhibitors (MAOIs). These medications are usually reserved for people who do not get better with other types of treatment. These drugs, which include phenelzine (Nardil) and tranylcypromine (Parnate), can have serious side effects. They can cause deadly interactions with certain supplements and foods, such as wines and pickles. So, they require a strict diet. MAOIs are effective for some people though and provide relief when other medications don’t work.
• Zulresso (brexanolone). The United States Food and Drug Administration (FDA) recently approved a new medication for postpartum depression (PPD). This medication, Zulresso (brexanolone) must be injected intravenously at a certified health care facility. It is specifically approved for the treatment of peripartum depression (PPD) in adult women. Zulresso is the very first drug specifically approved by the FDA for PPD. ⁹
• Spravato (esketamine). Spravato is a nasal spray that was also recently approved by the FDA for depression. It is used to treat resistant depression that has not responded to other treatments. This medication is related to ketamine, a drug that is sometimes abused recreationally. Therefore, it is also available only from a certified medical office.¹⁰

The above medications are just a few of the antidepressants available for depression. As you can see, new medications come on the market all the time. Your doctor will help you find the right medications for you.

Psychotherapy

Psychotherapy is an effective treatment for medication and the research backs this up. In fact, over the long-term, therapy works better than medications — and it is more cost effective. The key is finding a good therapist. To find a good therapist, look for someone who:¹¹

• Is Trustworthy
• Has good interpersonal skills
• Offers hope and optimism
• Monitors progress
• Is flexible and willing to change treatment if it isn’t working
• Relies on research
• Improves through professional development

There are several different types of psychotherapy. They all have the same goal and that is to help you understand your depression, teach you ways to cope and help you feel more in control.  Here are some of the most common types of therapy:

• Individual therapy. One of the most common types of individual therapy is cognitive behavioral therapy or CBT. this therapy involves changing thought patterns and behaviors that contribute to depression. You’ll learn healthier ways of coping with your symptoms.
• Couples therapy. Depression can affect relationships. Couples or relationship therapy helps address the impact that depression has on a person’s relationships.
• Family therapy. Family therapy helps examine family dynamics that contribute to depression and assists family members with identifying ways to provide support to their loved one with depression.
• Group therapy. Group therapy can help you gain insight into your depression from other people suffering from the same issue.

Self-Help Strategies For Depression

Depression isn’t a disorder that you can treat on your own. Self-help strategies are a good supplement to therapy and medications for depression. Changing some simple lifestyle habits can help you naturally fight depression. Here are some of the best self-help treatments for depression.

Exercise Regularly

Exercise is an excellent natural treatment for depression. It encourages the production of chemicals called endorphins, which help boost mood. Regular exercise — at least two to three times per week — has been found to help ease depression symptoms. ¹²

Practice Good Sleep Hygiene

Depression often affects sleep in many ways. People with depression may sleep too little or too much. To minimize the effect of depression on sleep, make sure you practice good sleep hygiene. Stick to the same sleep schedule. Go to bed at the same time each evening. And, wake up at the same time every morning. Avoid taking naps during the day. Stop using electronics about an hour before bed.

Eat A Healthy Diet

There are no certain diets or foods that will ease depression, regardless of what some online blog posts claim. However, it is a good idea to stick to a healthy diet. Research has confirmed that a diet high in vegetables, fruits, and whole grains is associated with a lower risk of depression while a diet high in processed foods, high-fat dairy products and a low intake of fresh fruits and vegetables is associated with an increased risk of depression.¹³ One of the reasons for this could be that depression triggers unhealthy eating behavior. Another reason is that diet affects all aspects of health, including mental well-being.

Join a Support Group

Find a Therapist for Help with Depression

The first step in getting help for depression is to find a therapist. TherapyTribe can connect you with therapists and mental health professionals online or near where you live. Search TherapyTribe for a mental health counselor or psychologist online or near you who specializes in depression.

References

1. National Institute of Mental Health (2019, February). Major Depression. Retrieved April 9, 2019, from: https://www.nimh.nih.gov/health/statistics/major-depression.shtml.
2. Brain And Behavior Research Foundation. (2019, February), Advisory Panel Recommends FDA Approval of Esketamine, with New Mechanism to Treat Resistant Depression. Retrieved April 10th from: https://www.bbrfoundation.org/content/advisory-panel-recommends-fda-approval-esketamine-new-mechanism-treat-resistant-depression.
3. Olfson, M., Blanco, C., Marcus, S.,  Treatment of Adult Depression in the United States. JAMA Intern Med. 2016;176(10):1482–1491. doi:10.1001/jamainternmed.2016.5057.  
4. National Alliance of Mental Illness (2019, March). It’s Not Stigma, It’s Discrimination. Retrieved April 10th, 2019, from:  https://www.nami.org/Blogs/NAMI-Blog/March-2019/It-s-Not-Stigma-It-s-Discrimination
5. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
6. American Psychiatric Association. (2017, January). What Is Depression? Retrieved April 10th, 2019, from:  https://www.psychiatry.org/patients-families/depression/what-is-depression
7. Khan A, Faucett J, Lichtenberg P, Kirsch I, Brown WA. A systematic review of comparative efficacy of treatments and controls for depression. PLoS One. 2012;7(7):e41778. doi:10.1371/journal.pone.0041778.
8. Mayo Clinic. (2019, April). Depression (major depressive disorder). Retrieved April 10th, 2019 from: https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013
9. U.S. Food & Drug Administration. (2019, March). FDA Approves First Treatment For Post-partum Depression. Retrieved April 10th, 2019, from: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm633919.htm
10. U.S. Food & Drug Administration. (2019, March). FDA Approves New Nasal Spray Medication For Treatment-resistant Depression; Available Only At A Certified Doctor’s Office Or Clinic. Retrieved April 10th, 2019, from: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632761.htm
11. American Psychological Association. (2011, October). Psychotherapy Is Effective And Here’s Why. Retrieved April 10th, 2019, from: https://www.apa.org/monitor/2011/10/psychotherapy
12. Béland M, Lavoie KL, Briand S, et al. Aerobic exercise alleviates depressive symptoms in patients with a major non-communicable chronic disease: a systematic review and meta-analysis. Br J Sports Med. Published Online First: 06 February 2019. doi: 10.1136/bjsports-2018-099360.
13. Ye, L., Mei-R., Yan-Jin, W., Ling, Sun., Ji-Xiang, Z., Huai-Guo, Z., Bin, L. (July, 2017). Dietary patterns and depression risk: A meta-analysis. Psychiatry Research. Retrieved April 10th, 2019 from:  https://www.sciencedirect.com/science/article/pii/S0165178117301981