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Depression: Types, Symptoms, Causes, Diagnosis, and Treatment

Depression stands as one of the most common mental health conditions worldwide. Statistics reveal that around 280 million people globally suffer from depression, making it one of the leading causes of disability (1).

What is Depression?

Depression is a mood disorder that is characterized by feelings of emptiness, sadness and a loss in motivation. It’s different from mood swings that the average person experiences throughout their life.

People with depression often experience symptoms that may last for weeks, months or even years. In many cases, people with depression often go through periods of improvement before relapsing again.

Depression varies from person to person, affecting individuals differently. It usually affects daily functioning which ends up in decreased productivity and a loss of time. The condition may also negatively impact relationships and worsen other existing medical conditions that the person may suffer from (2).

Occasional feelings of emptiness and sadness are a normal part of life, however, with depression, these feelings become more persistent, up to the point where they interfere with everyday life. It’s important to acknowledge depression as a serious mental health condition just like any other as symptoms may worsen over time if they neglect treatment (3).

Types of Depression

There are different types of depression, with each being characterized with their own unique symptoms. The main types of depression include:

  • Major Depressive Disorder (Clinical Depression): Clinical depression is characterized by low mood, feelings of worthlessness, sadness and loss of joy that persists for more than 14 days. Some other symptoms that follow clinical depression are disrupted sleeping patterns and changes in appetite. If not treated properly, clinical depression may worsen (4).
  • Persistent Depressive Disorder (PDD): PDD is a more persistent form of depression that usually lasts for years. Its symptoms are more mild and stretched out. PDD is usually characterized by feelings of low mood, fatigue and low motivation (5).
  • Prenatal Depression: This type of depression is characterized by constant feelings of sadness, low mood and anxiety during pregnancy. Different people experience prenatal depression with different intensities and emotional challenges. Research suggests that this form of depression is likely caused because of hormonal changes and stress (6).
  • Postpartum Depression: Postpartum depression usually starts after giving birth and may last a couple of months up to a year. It’s mainly characterized by feelings of sadness, being overwhelmed and fatigue (7).
  • Premenstrual Dysphoric Disorder (PMDD): PMDD usually lasts a couple of days or up to two weeks before menstruation. The following symptoms include low mood, being apathetic, irritability and in some cases feelings of emptiness. Symptoms usually go away after menstruation begins, however, PMDD significantly impacts daily life (8).
  • Seasonal Affective Disorder (Seasonal Depression): SAD usually occurs during the winter months but can also occur in the summer depending on the individual (9).
  • Atypical Depression: This is a form of clinical depression with atypical features. The condition is usually followed by an increased appetite, rejection sensitivity and mood reactivity (10).
  • Adjustment Disorder with Depressed Mood: This form of depression happens in response to a traumatic life event or crisis. It usually leads people affected by it to experience feelings of sadness, helplessness and a loss of enjoyment in previously interested activities (11).
  • Depressive Disorder Due to Another Medical Condition: Some serious medical conditions such as heart disease, Parkinson’s disease, hypothyroidism, or cancer, can cause a person to enter a state of depression due to loss of quality of life. Managing the symptoms of these medical conditions may lead to an improvement of depression (12).

It’s valuable to mention that people that are diagnosed with bipolar disorder also experience depressive episodes (13).

Understanding the different types of depression can help the person suffering from this condition find a treatment plan suited to their individual needs.

General Symptoms of Depression

Symptoms of depression vary in intensity, frequency, and duration. If you or your loved one has constantly experienced some of the following symptoms for more than 14 days, it’s a good idea to talk to a doctor for a more accurate diagnosis (14):

  • Feeling bothered, annoyed, or angry (15).
  • Ongoing feelings of sadness, anxiety, or a sense of emptiness (16, 17).
  • Frequent crying (18, 19)
  • Losing interest and motivation in doing things that were enjoyed in the past (20, 21).
  • Feeling hopeless, worthless, and having a generally pessimistic outlook (22).
  • Having difficulty concentrating and making decisions (23, 24).
  • Changes in eating habits (eating too much or too little) (25).
  • Difficulty sleeping, early morning awakening, or oversleeping (26, 27, 28).
  • Decreased energy levels or persistent fatigue (29, 30.
  • Slowed movement or speech (31, 32).
  • Chronic physical pain without a clear cause that does not improve with treatment (e.g., headaches, unexplained aches or pains, digestive issues, cramps) (33, 34, 35).
  • Thoughts of suicide, self-harm, or even suicide attempts (36, 37).

It’s important to talk to your doctor if you or your loved one is experiencing these symptoms frequently and impacting their daily life. Through proper intervention, people with depression can see substabtial improvements.

Symptoms in Females

According to the Centers for Disease Control and Prevention (CDC), depression is twice as common among females (AFAB ) than males (AMAB ) (38). The exact cause for this varies. Some researchers suggest that females are more likely to seek treatment for depression and get diagnosed. Gender discrimination is also a huge factor for this, with females boing more likely to be discriminated against in society (39) . Also, some major forms of depression such as PMDD, postpartum depression and prenatal depression are all being more common among females. The most common depressive symptoms in females are low mood, feelings of worthlessness, emptiness and fatigue (40).

Symptoms in Males

Statistics from the Centers for Disease Control and Prevention (CDC) reveals that 5.5% of males report having depression symptoms (38). This percentage is half when compared to 10.4% of females that report signs of the condition. The most common depressive symptoms in males are primarily related to mood, emotional well-being, sleeping patterns and physical health (41).

Note: Although this article references the different symptoms between males and females, it’s important to mention that symptoms vary from person to person. Depressive symptoms are not strictly confined to binary gender differences. Anyone despite their age, sex, race and background can experience depression in diverse ways.

Symptoms in Children

The Centers for Disease Control and Prevention (CDC) claims that 4.4% of children and teens ages 3 to 17 are diagnosed with some form of depression in the United States. The symptoms in children can vary with the most common being low energy, loss of motivation, clinginess, vocal outbursts and frequent crying. Figuring out if your child suffers from depression can be difficult as it can be difficult for children to communicate their feelings effectively (42).

Understanding how depression manifests can help identify the symptoms better and increase the likelihood of early detection, diagnosis and treatment. By recognizing the unique symptoms found in females, males and children, healthcare specialists can offer better support by personalizing each treatment plan.

Causes of Depression

Better understanding depression involves learning about its potential causes and becoming aware of its complex forms in each individual.

  • Hormonal Influence: Hormonal changes in females, typically progesterone and estrogen, throughout the month may increase the risk of depression. Other hormonal imbalances caused by menopause, pregnancy, and postpartum can also cause depression. However, more research is needed to better understand the connection between hormonal fluctuations and depression (434445).
  • Brain Chemistry and Mood Regulation: Depression might be caused because of chemical imbalances in the brain that are responsible for regulating mood, thoughts, appetite, sleep and behavior (464748).
  • Childhood Trauma: Traumatic events during childhood can impact how the body regulates mood and responds to stress. This may increase the likelihood of depression and anxiety disorders(495051)
  • Family History and Genetic Predisposition: People that have one or more family members experiencing depression or other mood disorders have an increased chance of experiencing symptoms of depression. Researchers believe that this might have to do with a genetic component that runs in the family (525354).
  • Medical Conditions and Associated Risks: Other medical conditions that negatively impact one’s quality of life can increase the likelihood of developing depression (555657).
  • Brain Structure and Activity: Scientists have found that the chances of experiencing depressive symptoms may be higher in people with a less active frontal lobe. However, there isn’t enough research done to understand why this occurs (585960).

Researchers continue to find more about how depression works and what causes it. With more research being done, treatment and prevention tactics may be improved in the near future.

Depression Risk Factors

Risk factors of depression arise by many influences, such as medical, social, genetic and environmental factors. Some of the most common risk factors of depression include:

  • Genetic Influence: A family history of depression is linked to an increased risk of depression (52).
  • Sexual Disparities: Females are twice as likely to be depressed. This may indicate that sex-related factors play a role in depression (61).
  • Medications and Depression: Certain medications may alter hormones, increasing the likelihood of depression. Some medications known to cause depression are hormonal birth control, corticosteroids, and beta-blockers (62).
  • Socioeconomic Status: Financial struggles and low social status increase the risk of depression (63).
  • Vitamin D and Depressive Symptoms: Research has found a connection between low vitamin D levels and depression. This sheds light on the importance of nutrition in relation to mental health (64).
  • Gender Identity and Depression: Transgender people are more likely to experience depression when compared to cisgendered people. Studies suggest that this is likely due to discrimination (65).

By better understanding these risks, we can improve our support and approach towards people who are battling depression. This increases the chances of them getting early intervention and becoming more open to treatment strategies.

Diagnosis of Depression

Diagnosing depression takes time, effort and patience as it’s not a straightforward process. This means that there is no one size fits all test to diagnose depression. In most cases, depression diagnosis often begins by talking to your doctor about various aspects of your life. Some general questions you might be asked are:

  • Mood: How are you feeling?
  • Appetite: Has there been a change in your eating habits recently?
  • Sleep Pattern: Have you had trouble with your sleeping patterns?
  • Activity Level: How physically active have you been in the past weeks/months?
  • Thoughts: What do you often think about during the day?

Based on the answers you will give and the conversation you will have with your doctor, you will likely go through another evaluation that may include sharing your medical records, family medical records.

Your doctor might then recommend you to take a mental status exam and a bloodwork to see if you are experiencing some types of depression such as SAD, PMDD, postpartum or prenatal depression.

It’s important to not let depression take a hold of your life. If you notice that your symptoms get worse, it’s highly advised to seek medical attention as soon as possible. Depression, just like any other health condition, should be taken seriously as it can become severe if left untreated. Some complications of depression may include:

  • Physical pain
  • Changes in weight (gain or loss)
  • Relationship problems
  • Substance use disorder
  • Thoughts of suicide
  • Social isolation
  • Self-harm

It’s important to keep in mind that diagnosing depression isn’t a one step process. It’s different for every individual. Seeking professional help is the best thing you can do to receive a proper treatment plan to manage symptoms (66).

Treatment Options for Depression

Treatment options for depression vary from person to person. For some people, finding the treatment that works best for them can be a journey of its own because options often involve combining a series of treatments. Lifestyle modifications, medication and therapy are all helpful in fighting symptoms of depression (67).

Medical Treatments

There are many effective medical treatments available out there to help with depression. There are several types of antidepressants to treat various forms of depression.

  • Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): Some examples are duloxetine (Cymbalta), levomilnacipran (Fetzima), desvenlafaxine (Pristiq), and venlafaxine (Effexor XR). SNRIs help boost serotonin and norepinephrine levels to reduce the symptoms associated with depression. Some side effects of SNRIs include liver or kidney complications. It is also advised to not be taken hand in hand with MAOIs (68).
  • Selective Serotonin Reuptake Inhibitors (SSRIs): Some mentions include escitalopram (Lexapro), fluvoxamine (Luvox), citalopram (Celexa), paroxetine (Paxil XR, Paxil, Pexeva), and sertraline (Zoloft). SSRIs are the most common antidepressants prescribed to patients as they have less severe side effects while successfully increasing serotonin levels in the brain. It’s important to remain cautious when taking them along with other medications during pregnancy or if you are diagnosed with narrow-angle glaucoma (69).
  • Atypical Antidepressants – Noradrenaline and Dopamine Reuptake Inhibitors (NDRIs): An great example of NDRIs is bupropion (Wellbutrin), which raises dopamine and noradrenaline levels (70).
  • Monoamine Oxidase Inhibitors (MAOIs): Some mentions include selegiline (Emsam), isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate). These types of medications are prescribed when other treatments have failed to show success in patients. The reason behind this is due to high risk of side effects and other safety concerns (70).
  • N-methyl D-aspartate (NMDA) Antagonists: NMDA such as Esketamine (Spravato) is usually used when all of the above medications are unsuccessful in managing the symptoms of depression. This is due to its negative side effects such as constant fatigue and dissociation (71).
  • Tricyclic and Tetracyclic Antidepressants: These include imipramine (Tofranil), amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor). TCAs and TECAs boost serotonin and norepinephrine levels in the brain. They aren’t frequently prescribed due to having more side effects than SSRIs or SNRIs. It’s crucial to avoid taking this medication if you’re diagnosed with narrow-angle glaucoma or are taking other MAOI medications (72).

All the medications mentioned above have their own unique benefits as well as their potential side effects. It’s always important to consult with a doctor before getting on antidepressant medication.

Psychotherapy

Psychotherapy is a great treatment option for people suffering from depression. It usually helps individuals by changing their negative thought patterns while also teaching them new positive behavioral changes.

  • Cognitive Behavioral Therapy (CBT): Tries to pinpoint negative thought patterns while promoting positive thinking (73).
  • Light Therapy: Natural light exposure has been proven to help feel better. This type of therapy may work best for people that suffer from seasonal affective disorder but might be a less common option for those that are diagnosed with bipolar disorder (74).
  • Electroconvulsive Therapy (ECT): This treatment uses electrical currents through the brain to treat severe forms of depression. It’s often a last resort since it has many side effects such as headaches, nausea, muscle aches, and memory problems (75).
  • Dialectical Behavior Therapy (DBT): DBT practices validating and accepting negative thoughts and learning to let them go (76).
  • Psychodynamic Therapy: Explores the reality of each individual by linking it based on the way they experienced childhood (77).
  • Alternative Therapies: Meditation, acupuncture, and deep breathing techniques have been shown to reduce stress and boost feelings of calmness. Research also shows meditation to be a great way to combat depression when combined with other traditional treatments (78).

Combining therapy and with other medical treatments shows promising results in managing symptoms of depression. It’s important to talk to a healthcare specialist to figure out the best therapy options that meet your needs. (79)

Lifestyle Changes

Making healthier lifestyle choices is another way people with depression have been successful in managing symptoms.

  • Limiting drug and alcohol use: Taking mind-altering drugs and drinking alcohol can soothe depression symptoms in the short term, but they make depressive and anxiety symptoms even worse in the long run (80).
  • Exercising: Aim for 30-60 minutes of light to moderate exercise at least 3 times a week. Exercising (especially outdoors) is known to boost mood and manage symptoms of depression (81).
  • Self-Care Practices: Taking care of yourself and completing small self-care tasks throughout the day can help make you feel better. Some tasks to try and accomplish are getting enough sleep, eating a nutritious and balanced diet, going out for a short walk, taking a soothing shower, and adding other activities that bring you joy along the way (82).

When lifestyle changes are used in combination with other medical treatment options, individuals may see a positive change in their overall quality of life. Before starting a treatment plan or changing a current plan on your own, it’s important to always talk to your doctor first.

Depression and Alcohol

Multiple studies show that there is a strong tie between excessive alcohol consumption and depression. The interesting thing about depression and alcohol is that they work both ways. This means that people that suffer from depression are at a higher risk for alcohol misuse, but also the more a person drinks the higher their depression symptoms become (83).

Statistics show that 50% of those that have experienced a substance use disorder also have a mental use disorder. The relations between alcohol and mood disorders such as depression may vary based on environmental factors, genetic predisposition, and overall health (84, 85).

Depression and Anxiety

Depression and anxiety often coexist with each other. According to research, more than 50% of those that suffer from depression also suffer from anxiety (86). Although they anxiety and depression both have different symptoms and triggers, they do have some overlapping symptoms such as:

  • Irritability
  • Difficulty with Memory or Concentration.
  • Sleep Problems

The good news is that depression and anxiety can be successfully managed through different types of treatments including:

  • Therapy, including Cognitive Behavioral Therapy (CBT)
  • Alternative Therapies, such as Hypnotherapy
  • Medication

If you think you are experiencing both anxiety and depression it’s important to reach out to a healthcare provider for proper diagnosis (87).

Preventing Depression

There are many ways to manage the symptoms of depression. The only downside is that finding and sticking to a treatment plan that works for you is oftentimes a long process that requires patience and hope (88).

There are many ways to naturally help prevent symptoms of depression from getting worse including:

  • Regular Exercise: Exercising regularly can help with mood and boost endorphin and serotonin levels in the brain.
  • Stress Reduction: Finding coping mechanisms to reduce stress can keep depression symptoms from worsening.
  • Adequate Sleep: Practicing good sleep hygiene keeps you feeling more energized and achieving more throughout the day.
  • Building Strong Social Connections: Creating strong bonds and meaningful connections with others may help reduce depressive episodes.
  • Sticking to treatment plans: Taking medication, maintaining a healthy lifestyle and/or seeking therapy are all crucial in minimizing depression.

There are many other ways to prevent depressive symptoms from progressing. However, you should always keep in mind that while some approaches can work for some people, others may find them to be ineffective or even make symptoms worse in rare occasions.

Conclusion

Depression is a serious mood regulation disorder that can affect various aspects of life. Symptoms of depression can range from mild to severe depending on the type of depression an individual struggles with. While there are many treatment options for depression, finding the right combination of treatments is important in order to see results and minimize depressive episodes.

Successfully managing depression requires a combination of treatment options that include medication, therapy and lifestyle modifications. If certain treatment plans fail to be ineffective, talking to your doctor for an adjustment is advisable. Finding the perfect approach to minimize depression requires some trial and error at first. Keeping hopes up and being patient will eventually lead you to a better quality of life.