Trigger warning: This article mentions depression and suicidal ideation. If you’re experiencing thoughts of suicide, you can call the National Suicide Prevention Hotline at 1-800-273-8255, 24 hours a day.
Major depression, also called clinical depression or major depressive disorder, is one of the most common mental disorders in the United States. Often, depression can emerge as a result of stressful or difficult life events, but experts think there’s a genetic element, too.
To be considered clinical depression, a person has to meet diagnostic criteria. Most people respond well to treatment, so it’s important to consult with a health care provider if you’re experiencing symptoms.
In order to find a treatment that works for you, you’ll need to get an individualized diagnosis from your doctor. But for more general information about symptoms and treatment of clinical depression, we spoke to two mental health providers.
What are the symptoms of depression?
Depression can look different on everyone, but there are two primary components of clinical depression, according to Sarah E. Valentine, a psychologist at Boston Medical Center and an assistant professor at Boston University School of Medicine. She tells Allure that people with depression experience a depressed mood for most of the day nearly every day, along with diminished interest or pleasure in things someone used to enjoy. “Most primary care providers are using these two items at least to screen,” she says.
While it’s normal for people to feel sad from time to time, clinical depression is distinguished by persistence in symptoms that interfere with their lives. Jennifer Lanier Payne, director of the Women’s Mood Disorders Center and associate professor of psychiatry and behavioral sciences at Johns Hopkins University, says people with major depressive disorder can experience a variety of symptoms, including low mood, an irritable mood, poor concentration, low energy, difficulty sleeping, and negative thought patterns.
In some cases, Lanier Payne says people might have somatic symptoms, including physical pain and headaches. Some people with depression might have symptoms like appetite changes, decreased energy or fatigue, including oversleeping (other people experience difficulty sleeping, in spite of fatigue). Suicidal thoughts and hopeless feelings can also emerge in major depressive disorder.
How is depression diagnosed?
When your mood is low, you might feel depression as an emotion — but diagnosis requires feeling depressed for a longer period of time. “It’s someone being persistently in a sad mood all day nearly every day for a span of two weeks or more,” says Valentine. “It’s about the persistence of the symptoms.”
Lanier Payne says suicidal ideation is another way to distinguish clinical depression from depression that’s more situational. “Anytime someone is having suicidal thoughts or really significant impairment, it’s more than situational depression,” she says.
To diagnose depression, a doctor — whether a mental health or primary care provider — will conduct structured, clinical interviews or have a patient take self-report inventories. In either scenario, Valentine says doctors are looking for two, persistent elements: diminished interest in things someone normally enjoys and a depressed mood. Once depression is diagnosed, a doctor will work with a patient to come up with the most effective course of treatment.
How is depression treated?
According to Lanier Payne, the best treatment for depression is a combination of psychotherapy, often cognitive behavioral therapy, and antidepressants. But antidepressants can take time to make a difference. “Antidepressants are the mainstay of treatment,” she says. “A patient has to be on a good dose for eight weeks or longer before deciding it’s not working.”
Along with the support of a therapist and medication, healthy lifestyle factors like exercise can lessen symptoms of depression. But Lanier Payne notes that when someone is struggling with severe depression, it can be difficult to get out of bed to go to the gym. That’s why a multi-dimensional approach is so important for people with depression.
“It’s a whole-picture thing. It’s never just a pill, and it’s never just exercise. It’s everything working together,” Lanier Payne says.
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