Depression

Overview

Everyone feels sad or low sometimes, but these feelings usually pass after a short time. Depression is different. It can cause persistent symptoms, with low mood present for most of the day, nearly every day for at least two weeks.

Depression is a common but serious mood disorder. It causes symptoms which can be severe, affecting how a person feels, thinks, and handles daily activities such as sleeping, eating, or working. Depression can affect anyone regardless of age, sex, race or ethnicity, income, culture, or education.

Women are diagnosed with depression more often than men, but men can also experience depression. Because men may be less likely to recognize, talk about, and seek help for their negative feelings, they are at greater risk of their depression symptoms being undiagnosed and undertreated.

In addition, depression can co-occur with other mental disorders or chronic illnesses, such as diabetes, cancer, heart disease, and chronic pain. Depression can make these conditions worse and vice versa. Sometimes, medicines taken for an illness cause side effects that contribute to depression symptoms as well.

Depression can contribute to suicide thoughts and behaviors. If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at chat.988lifeline.org. In life-threatening situations, call 911.

Related Terms:

• Major depression
• Major depressive disorder
• Clinical depression

Signs and Symptoms

Common signs and symptoms of depression include:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or pessimism
• Feelings of irritability, frustration, or restlessness
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Fatigue, lack of energy, or feeling slowed down
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, waking too early in the morning, or oversleeping
• Changes in appetite or unplanned weight changes
• Physical aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not go away with treatment
• Thoughts of death or suicide or suicide attempts

Depression can also involve other changes in mood or behavior, such as:

• Increased anger or irritability
• Feeling restless or on edge
• Becoming withdrawn, negative, or detached
• Increased engagement in high-risk activities
• Greater impulsiveness
• Increased use of alcohol or drugs
• Isolating from family and friends
• Inability to meet responsibilities or ignoring other important roles
• Problems with sexual desire and performance

Not everyone who has depression shows all these symptoms. Some people experience only a few symptoms, while others experience many. Depression symptoms interfere with day-to-day functioning and cause significant distress.

Depression can look different depending on age:

• Children may be anxious or cranky, pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.
• Older children and teens may get into trouble at school, sulk, be easily frustrated, feel restless, or have low self-esteem. They may have other disorders, such as anxiety, an eating disorder, attention-deficit/hyperactivity disorder, or substance use disorder. Older children and teens are also more likely to experience excessive sleepiness (called hypersomnia) and increased appetite (called hyperphagia).
• Young adults are more likely to be irritable, complain of weight gain and hypersomnia, and have a negative view of life and the future. They often have other disorders, such as generalized anxiety disorder, social phobia, panic disorder, or substance use disorder.
• Middle-aged adults may have more depressive episodes, decreased libido, middle-of-the-night insomnia, or early morning waking. They often report stomach problems, such as diarrhea or constipation.
• Older adults often feel sadness, grief, or other less obvious symptoms. They may report a lack of emotions or a lack of interest in activities rather than a depressed mood. Older adults are also more likely to have other medical conditions or pain that can cause or contribute to depression. Memory and thinking problems (called pseudodementia) may be prominent in severe cases.

Depression can look different depending on age:

• Children may be anxious or cranky, pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.
• Older children and teens may get into trouble at school, sulk, be easily frustrated, feel restless, or have low self-esteem. They may have other disorders, such as anxiety, an eating disorder, attention-deficit/hyperactivity disorder, or substance use disorder. Older children and teens are also more likely to experience excessive sleepiness (called hypersomnia) and increased appetite (called hyperphagia).
• Young adults are more likely to be irritable, complain of weight gain and hypersomnia, and have a negative view of life and the future. They often have other disorders, such as generalized anxiety disorder, social phobia, panic disorder, or substance use disorder.
• Middle-aged adults may have more depressive episodes, decreased libido, middle-of-the-night insomnia, or early morning waking. They often report stomach problems, such as diarrhea or constipation.
• Older adults often feel sadness, grief, or other less obvious symptoms. They may report a lack of emotions or a lack of interest in activities rather than a depressed mood. Older adults are also more likely to have other medical conditions or pain that can cause or contribute to depression. Memory and thinking problems (called pseudodementia) may be prominent in severe cases.

Depression can look different in men versus women: 

• Men (as well as women) may show symptoms other than sadness, instead seeming angry or irritable. 
• For some people, symptoms appear as physical problems, such as a racing heart, tightened chest, chronic headaches, or digestive issues. 
• Many men are more likely to see a healthcare provider about these physical symptoms than their emotional ones. 
• Men are also more likely to use alcohol or drugs as a coping strategy.

The signs and symptoms of depression can look different depending on the person and their cultural background. In some cultures, depression may be displayed primarily as physical symptoms, such as aches or pains, headaches, cramps, or digestive problems.

Related Health Effects

Depression is linked to increased healthcare costs and other health conditions. It is also a risk factor for suicidal thoughts and behaviors.

People who have depression are at higher risk of developing certain chronic diseases, including heart disease, diabetes, pain, osteoporosis, and Alzheimer’s disease. People who have a chronic disease and depression tend to have more severe symptoms of both illnesses. This may be due to:

• Challenges completing tasks that are good for health, such as eating well and exercising, because of symptoms like fatigue
• Challenges accessing medical care that could help prevent, detect, or treat physical health issues early and avoid the progression of a chronic disease
• Changes in the way the body functions because of depression, such as increased inflammation, reduced blood circulation and heart rate control, and abnormalities in stress hormones

Causes and Risk Factors

Research suggests that genetic, biological, environmental, and psychological factors play a role in depression.

General risk factors include:

• Medical conditions such as stroke or cancer
• A personal or family history of depression
• Stress, including caregiver stress
• Sleep problems
• Social isolation and loneliness
• Lack of exercise or physical activity
• Functional limitations that make engaging in activities of daily living difficult
• Alcohol or substance use disorder
• Other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD)
• A history of trauma or trauma exposure
• Loneliness or social isolation, which can increase with age

Depression can also be triggered by:

• Anxiety, stress, or other challenges caused by a chronic disease
• Brain changes from a chronic disease such as Parkinson’s disease or stroke
• Medicine used to treat a chronic disease

All people can feel depressed, but the disorder is especially common among women because of unique biological, hormonal, and social experiences. 

Pregnancy, the postpartum period, the menstrual cycle, and perimenopause are associated with physical and hormonal changes that can bring on a depressive episode in some women.

• Premenstrual dysphoric disorder is a more severe form of premenstrual syndrome, or PMS, that occurs in the weeks before menstruation.
• Perinatal depression occurs during pregnancy or after childbirth. It is more than the “baby blues” many new moms experience after giving birth.
• Perimenopausal depression affects some women during the transition to menopause. Women may experience feelings of intense irritability, anxiety, sadness, or loss of enjoyment.

Depression and Dementia

Depression is common in people with Alzheimer’s disease and related dementias. Dementia can cause some of the same symptoms as depression, and depression can be an early warning sign of possible dementia. Suicide attempts may also increase in people recently diagnosed with dementia. More research is needed to determine effective depression treatment options for people with dementia.

Prevention Guidance

While not all cases of depression can be prevented, healthy lifestyle changes can have long-term benefits for your mental health.

Changes to consider include:

• Be physically active and eat a healthy, balanced diet. These choices may help reduce the risk of illnesses that can bring on depression and help manage chronic conditions that increase risk factors for depression.
• Get seven to nine hours of sleep each night and try to maintain a regular, consistent bedtime and wake-up time.
• Stay in touch with friends and family.
• Participate in activities you enjoy.
• Let friends, family, and your healthcare provider know when you are experiencing symptoms of depression.

Seasonal affective disorder is a type of depression characterized by a recurrent seasonal pattern, with symptoms lasting about 4−5 months out of the year. Because the onset of seasonal affective disorder is so predictable, people with a history of the disorder might benefit from starting treatments before the fall (for the more common winter-pattern seasonal affective disorder) or spring (for summer-pattern seasonal affective disorder) to help prevent or reduce depression symptoms.

Diagnosis

To be diagnosed with depression, a person must have symptoms most of the day, nearly every day, for at least 2 weeks. One of the symptoms must be a depressed mood or a loss of interest or pleasure in most activities. For children and adolescents, depressed mood may show up as symptoms of irritability rather than feelings of sadness.

Although several persistent symptoms in addition to low mood are required for a depression diagnosis, people with only a few symptoms may benefit from treatment. The severity and frequency of symptoms and how long they last vary depending on the person.

If you think you may have depression, talk to a healthcare provider, such as a primary care doctor, psychologist, or psychiatrist. During the visit, the provider may ask when your symptoms began, how long they have lasted, how often they occur, and if they keep you from going out or doing your usual activities. It may help to take some notes about your symptoms before the visit. Learn more about how to talk with a doctor or healthcare practitioner about mental health.

Certain medicines and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms as depression. A provider can rule out these possibilities by doing a physical exam, interview, and lab tests.

Treatment and Management

Depression, even severe depression, can be treated. For most people, depression gets better with treatment.

Choosing the right treatment plan is based on a person’s needs, preferences, and medical situation and in consultation with a mental health professional or a healthcare provider. Finding the best treatment may take trial and error. For many individuals with mild-to-moderate depression, beginning treatment with a non-medicine approach, such as an evidence-based psychotherapy or “lifestyle” intervention, e.g., aerobic or resistance exercise, is appropriate. If remission is not achieved, antidepressant medicine or a neuromodulation treatment can be added. Most people whose depression is in the moderate-to-severe range require medicine or neuromodulation treatment; psychotherapy and/or lifestyle changes can be useful additions to the regimen.

Psychotherapy

Psychotherapy (also called talk therapy or counseling) can help people with depression by teaching them new ways of thinking and behaving and helping them change habits that contribute to depression. Psychotherapy occurs under the care of a licensed, trained mental health professional in one-on-one sessions or with others in a group setting.

Psychotherapy can be effective when delivered in person or virtually via telehealth. A provider may support or supplement therapy using digital or mobile technology, like apps or other tools.

Evidence-based therapies to treat depression include:

• Cognitive behavioral therapy (CBT): With CBT, people learn to challenge and change unhelpful thoughts and behaviors to improve their depressive and anxious feelings. Recent advances in CBT include adding mindfulness principles and specializing the therapy to target specific symptoms like insomnia or depressive subtypes, such as wintertime seasonal affective disorder.
• Interpersonal therapy (IPT): IPT focuses on interpersonal and life events that affect mood and vice versa. IPT aims to help people improve their communication skills within relationships, form social support networks, and develop realistic expectations to better deal with crises or other issues that may be contributing to or worsening their depression.

Using other forms of psychotherapy, such as psychodynamic therapy, for a limited time also may help some people with depression.

Medicine

Antidepressants are medicines commonly used to treat depression. They work by changing how the brain produces or uses certain chemicals involved in mood or stress.

Commonly prescribed types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine-dopamine reuptake inhibitors (NDRIs)

These medicines are commonly prescribed because they improve the symptoms of a broad group of depressive and anxiety disorders and are associated with fewer side effects than older antidepressants.

Antidepressants take time, usually 4 to 8 weeks, to work, and problems with sleep, appetite, and concentration often improve before mood lifts. Giving medicine a chance to work is important before deciding whether it is right for you.

Suicide Risk: In some cases, children, teenagers, and young adults under 25 years may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. The FDA advises that patients of all ages taking antidepressants be watched closely, especially during the first few weeks of treatment for depression symptoms and side effects.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at chat.988lifeline.org. In life-threatening situations, call 911.

Treatment-Resistant Depression

Treatment-resistant depression occurs when a person does not get better after trying at least two antidepressant medicines. Research is ongoing in the search for other safe and effective rapidly acting antidepressant interventions. Low intravenous doses of the anesthetic agent, ketamine (with a previously negative reputation as the abusable “party drug” known as “Special K”) could be effective for severe, treatment-resistant depressive symptoms in a matter of hours. It remains available “off-label” in networks of “ketamine clinics,” and continues to lack formal approval by the U.S. Food and Drug Administration (FDA), which has warned against the use of unregulated use of ketamine.

A drug related to ketamine, esketamine, is approved by the FDA for treatment-resistant depression. Delivered as a nasal spray in a doctor’s office, clinic, or hospital, the medicine acts quickly to relieve depression symptoms.

Another option for treatment-resistant depression is to combine an antidepressant with a different type of medicine that may make it more effective, such as an antipsychotic or anticonvulsant medicine.

Brain Stimulation Therapy

Brain stimulation therapy is an option when other depression treatments have not worked or are unwanted. The therapy involves activating or inhibiting the brain with electricity or magnetic waves.

Although brain stimulation therapy is less frequently used than psychotherapy and medicine, it can play an important role in treating depression in people who have not responded to or wish to avoid other treatments. The therapy is generally used only after a person has tried psychotherapy and medicine, and those treatments usually continue. Electroconvulsive therapy is sometimes used as an earlier treatment option when severe depression has become life-threatening, such as when a person has stopped eating or drinking or is at a high risk of suicide.

The FDA has approved several types of brain stimulation therapy. The most used are:

• Electroconvulsive therapy (ECT) is a noninvasive procedure that treats serious mental disorders by using an electric current to induce seizure activity in the brain. It has the longest history of use for depression. The use of general anesthesia and muscle relaxants have increased the safety of ECT, while modern approaches to delivery of the electrical stimulus have reduced the risk of serious memory problems from the treatment.
• Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive therapy that uses an electromagnet to stimulate the brain using repeated low-intensity pulses. The magnetic field it creates is about the same strength as an MRI scanner. The magnetic field is turned on and off very rapidly, inducing weak electrical currents that stimulate neurons and neural circuits in the brain. Recent FDA-approved “accelerated” forms of rTMS have reduced the length of a treatment course from weeks to days. Most individuals require some form of maintenance treatment to sustain improvement after completion of a course of treatment.

An invasive approach, Vagus Nerve Stimulation (VNS) is FDA-approved for treatment-resistant depression, but the need for surgery (an implantable pulse generator in the chest, with wires wrapped around the left vagus nerve in the neck) and the advances in noninvasive brain stimulation interventions make VNS use uncommon today.

Other brain stimulation therapies, including Deep Brain Stimulation (DBS), FDA-approved for the treatment of Parkinson’s Disease and under study for depression, are newer and, in some cases, still considered experimental. Bright light therapy, the “gold standard” treatment for seasonal affective disorder, has been found effective for some people with non-seasonal depression, probably related to its action in correcting delayed-phase circadian rhythms associated with many cases of depression.

Natural Products

The FDA has not approved any natural products for treating depression. Although research is ongoing and findings are inconsistent, some people report that natural products, including vitamin D and the herbal dietary supplement St. John’s wort, helped their depression symptoms. However, these products can come with risks, including interactions with prescription medicines in some cases.

St. John’s wort is not consistently effective for depression and limits the effectiveness of many prescription medicines. With S-Adenosyl-L-methionine (SAMe), the evidence that SAMe supplements might be helpful for depression is not conclusive, and information on long-term safety is limited.

Do not use vitamin D, St. John’s wort, or other dietary supplements or natural products without first talking to a healthcare provider. Do not use a complementary health approach to replace conventional care or to delay seeing a healthcare provider about depression. Learn more about talking with your doctor about complementary health approaches.

Collaborative Care

Research suggests that a “collaborative care model,” an evidence-based, team-driven approach for treating mental disorders, can improve the overall health of people with depression. In this approach, primary care providers, care managers, and psychiatric consultants work together to provide mental and physical healthcare at the same location. Collaborative care is not yet available in all primary care offices or clinics, so ask your healthcare provider if it is an option for you.

Living With Depression

Most people with depression benefit from mental health treatment. Once you begin treatment, you should gradually start to feel better.

Things that may help you during treatment:

• Try to get physical activity. Just 30 minutes a day of walking can boost your mood.
• Try to maintain a regular bedtime and wake-up time.
• Eat regular, healthy meals.
• Do what you can as you can. Decide what must be done and what can wait.
• Connect with people. Talk to people you trust about how you are feeling.
• Delay making important life decisions until you feel better. Discuss decisions with people who know you well.
• Avoid using alcohol, nicotine, or drugs, including medicines not prescribed for you.

If someone you know is depressed, you can help:

• Encourage them to seek medical treatment and stick with the treatment plan the doctor prescribes.
• Help set up medical appointments or accompany them to the doctor’s office or a support group.
• Offer support, understanding, patience, and encouragement.
• Invite them out for walks, outings, and other activities.
• Help them stick to their treatment plan, such as setting reminders to take prescribed medicines.
• Make sure they have transportation or access to therapy appointments.
• Remind them that, with time and treatment, their depression can lift.
• Listen for clues that the person may be feeling worse, such as feeling sad, numb, or empty for long periods of time. Knowing the warning signs for suicide and how to get help can save lives.

Do not shy away from asking if a family member or friend is feeling depressed or suicidal. Asking if someone is having thoughts of suicide will not make them more likely to act on those thoughts. Your questions may help the person open up about how they have been feeling and encourage them to seek treatment.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on depression.

Find Treatment

If you have concerns about your or your loved one’s mental health, talk to a primary care provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help you figure out the next steps. Find tips for talking with a healthcare provider about your or your child’s mental health.

You can learn about finding support and locating mental health services in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Community Support

Additional resources are available to learn more about depression:

• Anxiety and Depression Association of America
• American Psychological Association
• Depression and Bipolar Support Alliance
• Mental Health America
• National Alliance on Mental Illness

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH funds and conducts research to learn more about what causes depression, how it affects the brain, and how to treat it effectively. NIH is working to improve existing treatments like medicines, talk therapy (including telehealth and online options), and brain stimulation therapy.

NIH is investigating ways to identify which treatment will work best for a specific person and tailor treatments based on a person’s unique characteristics and traits. NIH is also supporting research to develop and test therapies for people with treatment-resistant depression who do not improve after trying multiple treatment options. In addition, NIH is exploring new methods to prevent and treat depression and improve the delivery of care for people living with depression.

More research is needed to determine effective depression treatment options for people with dementia.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.  

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Mental Health Minute: Depression