Demystifying Depression: Breaking the Stigma and Unraveling The Complexities

• What is Depression?
• What are the Symptoms of Depression?
• Who is at Risk for Depression?
• What Causes Depression?
• What are Some Other Types of Depression?
• What are My Treatment Options?
• How Do I Find Help for Depression?
• How Do I Get Help if I Am Suicidal?

Key Takeaways

• Depression is more than just a passing sadness. While everyone experiences occasional feelings of sadness due to stressful events, depression is more persistent and intense.
• Factors associated with a higher risk of depression include gender, family and personal history, substance misuse, and adversity.
• Medications that can cause depression symptoms include steroids, opioids, interferons, and beta-blockers.
• Some other mental health disorders have symptoms similar to depression but are not classified as major depression.
• Depression and its link to the food we eat is discussed in Improving Your Mood with Food: The Powerful Connection Between Nutrition and Mental Health.

What is Depression?

Everyone has days when they feel sad or down, for example, during a stressful event. That’s a normal emotional response and a normal part of life.

But how do you differentiate these feelings from depression?

In depression, the sad feelings and symptoms stay around longer than usual. You may continue to feel down even after the stressful event, or without any reason, or the sadness may last two or more weeks.

Depression is more than just a passing sadness. While everyone experiences occasional feelings of sadness due to stressful events, depression is more persistent and intense.

Understanding the symptoms and causes of depression is crucial in getting proper help and support.

What are the Symptoms of Depression?

The medical criteria for Major Depressive Disorder (also known as Clinical Depression) are listed below.

To meet these criteria, you must have at least five symptoms occurring during the same two-week period. In addition, these symptoms must be causing significant distress or problems with relationships, work, or other important areas of functioning.

Depression Symptoms

• Depressed mood. For children and teens, this could also be an irritable mood.
• Decreased interest or pleasure in doing everyday activities.
• Significant change in appetite or weight (either up or down).
• Significant change in sleep (often difficulty sleeping, but also sleeping excessively).
• “Psychomotor agitation or retardation”. If you have psychomotor agitation, you move with no purpose, such as pacing or toe-tapping. If you have psychomotor retardation, you may be slow in speech, thought, or movements.
• Fatigue or low energy.
• Feelings of worthlessness.
• Difficulty concentrating.
• Recurrent thoughts of death or suicidal thoughts.

Who is at Risk for Depression?

Some factors associated with a higher risk of depression are listed below.

1. Gender. Women are twice as likely to be diagnosed with depression compared with men.
2. Family History. You are more likely to have depression if others in your family have had it or other mental health conditions like anxiety or bipolar disorder.
3. Personal History. If you have previously had episodes of anxiety or depression, you are more likely to have another.
4. Substance Misuse. If you misuse drugs or alcohol, your risk of depression is higher.
5. Adversity. You are more likely to have depression if you have had serious trauma in your life, stressful life events in the last year, marital problems, a low level of social support or education, or parental problems. Parental problems can include the loss of your parents, parental substance abuse, parental crime, or lack of affection from your parent.

What Causes Depression?

Depression can either be primary, meaning a disorder in and of itself, or secondary to something else.

Medical conditions or medications cause secondary depression.

Medications that may cause depression symptoms as side effects include:

• • Steroids (hormones such as prednisone, dexamethasone, and methylprednisolone)
  • opioids (also known as narcotic pain medications)
  • Interferons (medicines resembling proteins used in our immune system)
  • beta-blockers (used for high blood pressure, abnormal heart rhythms, migraine prevention, and others)

However, a recent review of studies on beta-blockers found they are not associated with a higher risk of depression.

Sometimes, it’s hard to tell the difference between side effects from medicine, symptoms of primary depression, and symptoms from the health problem the medication is supposed to treat. Because of this, you should talk to your doctor if you think your side effects are from your medicines instead of just stopping it.

Many medical problems are associated with depression, including:

1. Endocrine or Hormonal Disorders: Low thyroid, diabetes, vitamin deficiencies such as vitamins D and B12, and anemia.
2. Heart Disease: Heart failure and coronary artery disease. For example, people commonly have depression after a heart attack.
3. Infections: HIV/AIDS and syphilis involving the brain.
4. Neurological Disorders: Epilepsy, Parkinson’s, multiple sclerosis, head injury, strokes, and dementia.
5. Tumors: Brain tumors, whether benign or cancerous; certain other cancers, such as breast, stomach, leukemia, and lymphoma; small cell lung cancer, ovarian, pancreatic, and kidney.

If you experience depression not associated with medication or a separate medical condition, then you have primary depression.

It is a common misconception that depression is a personal weakness, or “all in your head,” and not a medical disorder. This is simply not true.

Research has found that the brains of people with depression are different from those without depression. The levels of neurotransmitters (chemicals that nerves use to talk to each other and other parts of the body) are at abnormal levels in people with depression.

Scientists are still studying this, and there is still much to learn. But it’s clear that depression is a complex issue. The health and functionality of specific nerve cells and brain connections affect our mental health. It’s not “just an emotional problem.”

If depression is common in your family, you can say you’ve inherited nerve problems. But, it’s not clear why stress causes depression. Some people may say, or you may even think, that you need to be tougher when facing stress. But it’s more complex than that.

Scientists believe that when your adrenal glands make too much of a stress hormone called cortisol, it can cause depression. This is how short-term stress can cause depression.

If you have high levels of these stress hormones for a long time, it might even change your gene expression. This is how long-term stress can cause chronic depression.

For instance, this could explain why traumatic childhood experiences make you more likely to be diagnosed with depression later in life. You cannot control these stress hormones and gene expression changes. The idea that you need to “be stronger” is simply incorrect.

What are Some Other Types of Depression?

Some other mental health disorders have depression symptoms but are not classified as major depression.

It can be tricky for medical professionals to differentiate between depression and other mental health conditions because the symptoms can overlap. In some cases, it will take some time before a diagnosis is made.

Establishing the correct diagnosis may take some time, so it’s beneficial to have an ongoing relationship with your healthcare provider.

If you have any of the conditions discussed in this article, consult a medical or mental health professional so they can help you get the correct diagnosis and treatment.

Mental Health Conditions With Symptoms Similar to Depression:

1. Seasonal Affective Disorder. This is a type of depression that is seasonal, often just in the winter. Doctors treat this like major depression with the addition of artificial light therapy.
2. Persistent Depressive Disorder (aka Dysthymia). Some call this a persistent low-level depression. You have fewer and milder depression symptoms, but they are nearly continuous and last two or more years.
3. Complicated Grief. Prolonged and severe grief will have symptoms similar to major depression.
4. Adjustment Disorder with Depressed Mood.Doctors often make this diagnosis if you have depressive symptoms connected to recent stress in your life but do not meet the criteria for major depression.
5. Bipolar Disorder. This used to be called Manic Depression because people who experience this have periods of both mania and depression. However, mania can be infrequent or not recognized as such. So, it is important to consider a bipolar diagnosis in anyone with depression, as the treatments are very different. In fact, typical antidepressants can make bipolar disorder symptoms worse and cause them to cycle into a manic phase.
   Some Symptoms of Mania:
   1. Decreased need for sleep, such as feeling rested after only a few hours.
   2. More talkative than usual or pressured speech.
   3. Racing thoughts
   4. Very distractible
   5. Inflated feelings of self-importance or grandiosity.
   6. Overactive at work, school, socially, sexually, or even overactive in purposeless activity.
   7. Increase in risk-taking behavior such as buying sprees, sexual indiscretions, or ill-advised business ventures.

What Are My Treatment Options?

The treatment options for depression are the same as those previously published in our article on anxiety.

How do I Find Help for Depression?

Your primary care doctor is an excellent place to start. They may be able to help you themselves, but if not, they can refer you to a mental health provider.

If you do not have a doctor and you have health insurance, call the customer service number on the back of your insurance card. Tell them that you need to see a mental health provider, and they will be able to provide you with names of providers in your area covered by your insurance.

If you do not have insurance, your area may have low-cost options. You can access the American Academy of Family Physicians Neighborhood Navigator. Click on the link for Neighborhood Navigator and enter your zip code. Then click on “Health” and “Mental Health.” This tool will generate different referral options. You can narrow your results by using various filters.

How do I Get Help if I am Suicidal?

If you are feeling suicidal now or at any other time, contact the National Suicide Prevention Lifeline or simply call 988. There is someone available 24/7. The National Suicide Prevention Lifeline provides emotional support and assistance through thoughts of suicide or any emotional crisis. The service is free, confidential, and available nationwide throughout the United States.

If a friend or family member is talking about suicide, encourage them to call the Lifeline above at 1-800-273-TALK (8255). Even if they aren’t in immediate danger, the trained counselor can help and point them in the right direction for treatment.

If you, or someone you know, is in immediate danger of suicide or has attempted suicide, call 911.

Written by: myObMD physician writing team | Editor: Jennifer Abayowa and Dr. Dayna Smith, MD | Reviewed: March 26, 2024 | Copyright myObMD, Inc. 2024.