Depression is a serious illness that can significantly impact your life and functioning. People suffering from depression may turn to substance use to shield themselves from painful thoughts or get relief from extreme depression. Too often, we see this develop into a comorbid substance use disorder, requiring treatment for both conditions separately but simultaneously.
What Is Depression?
Depression is a mood disorder that causes symptoms affecting feelings, thoughts, and daily functioning. It is one of the most common mental health conditions in the United States, and it can have severe and lasting effects.
Major depressive disorder is diagnosed after someone experiences two weeks of a specific number of symptoms combined with depressed mood or loss of interest.
In 2019, approximately 19.4 million adults in the United States had at least one major depressive episode, about 7.8% of the adult population. Among adolescents, an estimated 3.8 million people aged 12–17 years in the United States had at least one major depressive episode in 2019, about 15.7% of that population.
In 2019, about 13.1 million U.S. adults, or about 5.3% of the population, had at least one major depressive episode with severe impairment. Approximately 2.7 million adolescents, or around 11.1% of those aged 12–17, experienced this.
Research has shown that there is not one single cause of depression, but instead, it is a combination of psychological, genetic, biological, and environmental contributing factors. It often begins in adulthood, but it is seen in children and adolescents, often appearing differently in these age groups than in adults. Especially in adults, depression can be comorbid (co-occurring) with other medical illnesses, like diabetes, heart disease, cancer, and Parkinson's disease.
Some risk factors for depression include:
Personal history of depression
Family history of depression
Significant life changes
Specific physical illnesses and medications
Signs and Symptoms
Depression can impact many aspects of life with various signs and symptoms. However, every individual does not experience all the symptoms, and some people may experience additional symptoms. Typically, symptoms are experienced most of the day, almost every day, for at least two weeks.
Common symptoms of depression include:
Feelings of guilt or worthlessness
Anhedonia (loss of interest or enjoyment in hobbies and activities)
Fatigue or decrease in energy
Talking or moving slower than usual
Restlessness or trouble sitting still
Difficulty sleeping or sleeping too much
Drop (or increase) in appetite or weight changes
Thoughts of death or suicide
Some people may also experience other physical symptoms of aches or pains, headaches, or digestive issues that are unexplained and do not ease with treatment. Every individual experience is different, so severity, frequency, and the length of time symptoms last will vary from person to person.
There are several different types of depression, which vary in timing and symptoms. The most common ones are:
Major depressive disorder (MDD): Causes a depressed mood or loss of interest combined with other symptoms that last for at least two weeks.
Psychotic depression: This is depression that occurs with psychotic symptoms, like delusions (fixed, false beliefs) or hallucinations (typically seeing or hearing things that others do not see or hear).
Persistent depressive disorder: Also called dysthymia, leads to at least two years of depressive symptoms, sometimes with major depressive episodes and periods of less severe symptoms.
Peripartum depression: This diagnosis is when depression occurs during or after pregnancy (postpartum).
Seasonal affective disorder (SAD): This is depression occurring seasonally, typically during the winter months, with less sunlight.
Bipolar disorder: This is not specifically a depressive disorder, but bipolar disorder does include episodes of major depression along with periods of mania, which is a highly elevated or euphoric mood, or hypomania, a less severe form.
Screening and Diagnosis
If you are experiencing symptoms of depression, it is important to speak with your healthcare provider or other healthcare professional. Your medical doctor will perform a physical exam, take a history and obtain lab tests to determine if there may be a medical contribution to your symptoms. Once this is ruled out, they will possibly refer you to a mental health professional for further treatment, like a psychiatrist, psychologist, or therapist.
Screening for depression in a primary care setting usually is done using the Patient Health Questionnaire (PHQ-2 or PHQ-9), a diagnostic tool for mental health conditions. Many family medicine practices use a two-step screening process, first with the two-question PHQ followed by the PHQ-9 if the first questionnaire points to positive signs.
PHQ-9 Screening for Depression
The questions on the PHQ-9 are:
Over the last two weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself—or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed—or the opposite, being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead or of hurting yourself in some way
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
The diagnostic criteria for major depressive disorder are from the most recent fifth edition of the "Diagnostic and Statistical Manual for Mental Disorders" (DSM-5), the authority used by mental health professionals to diagnose psychiatric conditions. Depression is diagnosed when someone has at least five symptoms all day and nearly every day for at least two weeks. One of these symptoms needs to be a depressed mood or loss of interest in activities. However, for children and adolescents, the mood might be irritability instead.
Prevention of Depression
Nonmedical interventions that can help improve mood include:
Physical activity, even 30 minutes of walking
Regular bedtime and wake-up times
Eating frequent and healthy meals
Prioritizing tasks, doing what is needed when you can
Connecting with other people
Talking with trusted people about how you feel
Avoiding alcohol, tobacco, and other drugs
When to Seek Professional Help
Should you notice symptoms of depression in yourself or a loved one, and it's affecting daily life and functioning, it is important to seek professional help from a healthcare provider, such as a primary care provider, psychiatrist, or psychologist. They can provide resources, appropriately diagnose, and provide treatment if necessary.
If you are concerned about yourself or a loved one and have been self-medicating for depression with pills or alcohol and can't stop, we can help.
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Article courtesy of A Very Well Mind
Published on October 29, 2021
Medically reviewed by