7 Facts You Should Know About Depression

Depression is one of the most common mental health disorders. The Centers for Disease Control and Prevention estimates that 1 in 5 adults in the United States have received a depression diagnosis in their lifetime.

Depression is a very real and treatable illness. But myths, misunderstandings, and stigma continue to be barriers to treatment for many, and the consequences of untreated depression can be life-threatening. Here are seven things everyone should know about depression and depressive disorders.

Depression Doesn't Always Have a "Good" Reason

Sometimes people become depressed for what seems like a "good" reason—maybe they lost their job or a family member passed away. However, with clinical depression, there doesn't necessarily have to be a reason for how you feel.

In fact, 16 million adults have depression without experiencing a negative event or facing some type of life change. This can lead to reduced compassion from others, simply because they don't understand that depression can exist without a trigger or external stressor.

One explanation for this is that depression has been linked to an imbalance in the neurotransmitters that help regulate moods. The theory is that having too much or too little of these chemical messengers can cause (or contribute to) depression.

So, the brain chemicals that are responsible for your mood may be out of balance, causing you to feel bad even when everything in your life is seemingly going well.

Many Factors Can Cause Depression

The cause of depression isn't always completely understood, and many believe that this mental health condition is often the result of a combination of factors. The many causes of depression can include:

• Genetics: Over 80 genetic variants have been identified as being linked to depression. Some studies have found that when a parent has depression, a child's risk of depression is elevated during adolescence and continuing into adulthood. This suggests that genetics may play a role in this disease's development.
• Hormones: Any flux in the production or function of hormones—such as those related to pregnancy, menstruation, menopause, or the thyroid—can contribute to depression. For example, one study found that when premenopausal women had higher levels of the hormone testosterone, they had more depressive symptoms.
• Seasonal changes: Major depressive disorder with seasonal patterns (also known as seasonal affective disorder) is triggered by disruptions in the body's circadian rhythm at different times of the year. A change in seasons can also disrupt sleep, which can contribute to a depressed mood. 
• Stress and trauma: The loss of a loved one, trauma, abuse, chronic stress, and big life changes (such as going through a divorce or losing a job) can trigger depression. Researchers blame this on high levels of the hormone cortisol that are secreted during stressful, traumatic times. Cortisol affects the neurotransmitter serotonin and can trigger depression. 
• Substance use: Depression rates are also higher among people with a history of substance use. One explanation for this is that the stigma of depression leads people to turn to substances as a way of coping, or that depression leads to substance use. Other theories suggest that substance use leads to depression, or that both substance use and depression are the result of a separate underlying issue.

Other potential causes of depression include the presence of a physical health condition that often co-occurs with this disease—such as cancer, diabetes, or Parkinson's—or taking medications that have depression as a side effect.

Depression Is More Than Ordinary Sadness

Sadness is part of being human, a natural reaction to painful circumstances that all of us experience at some point in our lives. Depression, however, is an illness with many symptoms that extend well beyond an unhappy mood.

Signs of depression include: 

• Changes in appetite, weight, and sleep patterns
• Difficulty with concentration, memory, and decision-making
• Feeling anxious, hopeless, or helpless
• Feeling irritable or restless
• Persistent feelings of sadness or an “empty” mood
• Physical symptoms (such as headaches, digestive issues, body aches, and pain) that don’t subside with treatment
• Loss of interest in activities you once enjoyed
• Low energy or feelings of fatigue
• Slowness when talking and/or moving
• Trouble sleeping

Unfortunately, you can't just snap yourself out of depression. If you recognize these signs, seek help from a mental health professional.

Children Are Not Immune to Depression

It's a myth that childhood is always a joyful, carefree time. While children may not experience the same issues as adults, such as work-related stress or financial pressures, this doesn't mean that they can't become depressed.

The Centers for Disease Control and Prevention (CDC) says that 4.4% of children aged 3 to 17 are diagnosed with depression, or roughly 2.7 million in total. Additionally, 73.8% of children with depression also have anxiety and 47.2% have behavior problems.

Childhood brings its own unique set of stressors, such as bullying (whether in person or online) and the struggle for peer acceptance. Children can also feel stressed about schoolwork, sports, bodily changes, or issues going on at home, like if their parents are going through a separation or divorce.

Signs of depression in children include:

• Changes in eating habits
• Changes in sleeping patterns
• Mood changes
• No longer enjoying activities they once loved
• Reduced energy levels
• Trouble at school

Depression Is a Real Illness

Some people with depression feel as if they are weak or "crazy." They may question whether what they feel is real, especially if the depression appears without being triggered by a negative event. But depression is a real illness that some experts are even starting to frame as a systemic disease (meaning it affects the whole body, not just the brain).

Remember that 16 million adults have depression without experiencing a negative event or life change. In these individuals, disruptions in normal levels of neurotransmitters can contribute to the onset of a depressive episode. These neurotransmitters play an important role in regulating mood:

• Dopamine: Helps regulate emotion, memory, thinking, motivation, and reward
• Norepinephrine: Makes your heart rate and blood pressure soar during a "fight or flight" response or stressful time
• Serotonin: Helps regulate mood and plays a role in your overall sense of well-being; known as the "feel-good" chemical

Researchers are continuing to learn more about what causes these imbalances, as well as studying other neurotransmitters that may also play a role in depression, such as acetylcholine, GABA, and glutamate.

Depression Is Treatable

There are several effective treatment options available for depression. In addition, new treatments are being developed, providing hope for people who've had less success with traditional depression remedies.

Your treatment should be tailored to best suit your symptoms and overall health. A combination of psychotherapy, medication, and lifestyle changes is often used to help alleviate symptoms of depression.

Therapy

Depending on your situation, you may participate in individual, group, family, or couples psychotherapy. Therapy can help you better identify, understand, and learn how to cope with your depression symptoms.

While there are many different therapeutic approaches, these have been scientifically proven to treat depression:

• Behavioral activation
• Cognitive behavioral therapy
• Interpersonal therapy
• Problem-solving therapy
• Psychodynamic therapy
• Social skills therapy
• Supportive counseling

Medications

There are also many medications that have been found effective in the treatment of depression, especially when used in conjunction with psychotherapy. The classes of medications commonly prescribed to treat depression include:

• Atypical antidepressants: Including Wellbutrin (bupropion) and Remeron (mirtazapine)
• Monoamine oxidase inhibitors (MAOIs): Including Marplan (isocarboxazid), Nardil (phenelzine), and Parnate (tranylcypromine)
• N-methyl D-aspartate (NMDA) antagonists: Spravato (esketamine)
• Selective serotonin reuptake inhibitors (SSRIs): Including Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram),  Lexapro (escitalopram), and Luvox (fluvoxamine)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): Including Effexor (venlafaxine), Cymbalta (duloxetine), Pristiq (desvenlafaxine), and Fetzima (levmilnacipran), the most balanced SNRI (5HT:NE reuptake inhibition ration).
• Tricyclic antidepressants (TCAs): Including Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline)

Since depression treatment is not a one-size-fits-all approach, it may take some trial and error to find the medication that alleviates your symptoms with the fewest side effects.

If a medication you've been prescribed isn't working, let your mental health professional know. Finding relief from your depression symptoms may require changing the dosage or trying a new medication.

Lifestyle Changes

In addition to therapy and medication, there are a few lifestyle changes that can help you better manage symptoms of depression (as well as managing medication side effects). Talk with your mental health professional to learn which changes may be best for you.

• Diet: There's no cure-all diet for depression, but certain foods can impact mood and emotional regulation. Processed foods, alcohol, caffeine, sugar, and refined grains can hijack your mental health, so they should be limited or avoided. Conversely, whole foods like fruits and vegetables, fish, turkey, chicken, beans, nuts, and seeds can provide mood-boosting benefits. Organic food may also be beneficial since pesticides, herbicides, steroids, and antibiotics—all of which are found in non-organic food—disrupt the gut microbiome. This may lead to the release of immune pro-inflammatory chemicals (cytokines) that can cross the blood-brain barrier and disrupt neurotransmitter balance.
• Exercise: A good workout can help lift your mood, reduce stress, and alleviate symptoms of depression. The type of exercise you choose should be based on your fitness level and health. Pick something you enjoy. Your routine can include aerobic exercises such as jogging, swimming, cycling, or brisk walking, along with mind-body activities like yoga and tai chi.
• Stress management: Stress can trigger depression and intensify its symptoms. Long-term habits like good nutrition, regular exercise, proper sleep, and meditation help to build resilience. Incorporate daily stress management techniques once you find what works for you. A support group or mental health professional can provide additional ideas.

Untreated Depression Is a Common Cause of Suicide

The National Alliance on Mental Illness reports that 45% of those who die by suicide are suffering from some sort of mental illness. This includes people with undiagnosed, untreated, or under-treated depression.

Many of the warning signs of suicide are also signs of depression. Proper depression diagnosis and treatment are extremely important for preventing suicidal thoughts, ideations, or actions.

If You or Someone You Love Has Depression

If you or someone you love is showing signs of depression, you may wonder what steps to take. You can begin by learning more about depression, including its symptoms and treatment as well as myths, misunderstandings, and stigmas. This can provide a better picture of what to expect and make you a better-informed patient or caregiver.

Set up an appointment with a medical doctor or mental health professional. They can do a physical exam, run blood tests to rule out any medical conditions that mimic depression, and refer you to a mental health professional for further evaluation and treatment.

During the visit, you might also ask your doctor or therapist for reputable sources of depression information and support. They may be able to connect you with area resources that specialize in depression diagnosis or treatment.