As a Licensed Professional Counselor and a Licensed Clinical Addiction Specialist, I am asked this question frequently. According to the National Institute of Mental Health, depression is one of the most common mental health disorders in the United States. Additionally, depression is the leading cause of disability worldwide. Depression, along with other mental health issues, can develop in anyone. Furthermore, depression comes in many forms, and can appear differently in different people. There are many symptoms of depression, and for some people, these symptoms can appear suddenly, while for others they can appear gradually over time.
There are clinical terms for symptoms of depression, but most people suffering from depression describe their feelings in simpler terms. I have heard people describe depression as feeling like a dark cloud is following them around, feeling dull and detached from life, and feeling overwhelming sadness for no apparent reason. These feelings can be confusing, especially since a person does not need to suffer a great tragedy, monumental loss, or an equally influential event to become depressed.
Often, people can have trouble recognizing that they are not acting or feeling like themselves, since symptoms can appear gradually. Sometimes, individuals can tell that they feel “down” or not like themselves, realize that they have stopped participating in activities they used to enjoy, or even begin experiencing thoughts of death or suicide. However, even if someone knows something has changed in them, that person may not realize how greatly depression is impacting them. Frequently, questions and concerns voiced by family and friends can convince those with depression to seek the help they need.
Depression can severely impact a person’s life, but why do certain people develop depression? There are many possible factors that contribute to the onset of depression. These factors might include a person’s brain chemistry, hormones, genetics, or personal risk factors. We are all unique, which means that the reasons people develop depression can vary greatly. In addition to the numerous reasons someone might develop depression, there are also several types of depression. In my own practice, I most often see three main types of depression:
- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Adjustment Disorder with Depressed Mood
The following overview of the signs and symptoms of each of these diagnoses highlight the various ways that someone can experience depression.
Major Depressive Disorder can include some of the following symptoms:
- Depressed mood for most of every day
- Not enjoying activities and experiences that you used to enjoy
- Changes in appetite or weight
- Sleeping too much or too little
- Feeling restless or feeling as if you are moving unusually slow
- Having low energy or feeling fatigued
- Experiencing feelings of worthlessness or guilt
- Difficulty concentrating
- Thoughts of death or suicide
Major Depressive Disorder describes individuals who experience symptoms that last at least two weeks, and their symptoms feel more intense than their usual mood. The National Institute of Mental Health estimated that in 2015, at least 16.1% of adults experienced a major depressive episode.
Persistent Depressive Disorder has similar symptoms as Major Depressive disorder, but it describes people who experience a depressed mood for a long period of time. Specifically, those with PDD feel depressed more often than they feel fine over a span of two years. Compared to Major Depressive Disorder, Persistent Depressive Disorder lasts longer and feels less intense.
Persistent Depressive Disorder can include some of the following symptoms:
- Poor appetite or overeating
- Sleeping too little or too much
- Having low energy or fatigue
- Experiencing low self-esteem
- Difficulty concentrating or making decisions
- Feelings of hopelessness.
The National Institute of Mental Health estimates that 3.3 million adults in the United States suffer from Persistent Depressive Disorder.
Adjustment Disorder with Depressed Mood is typically diagnosed when an individual experiences an identifiable stressor and then begins having depressive symptoms less than three months later. Examples of a stressor could be:
- Moving, whether from one residence to another or one state to another
- Changing jobs
- Going through a divorce
The stressor does not necessarily have to be a “bad” event or change. Instead, a stressor can simply be anything that has increased the amount of stress in a person’s life. Those with Adjustment Disorder with Depressed Mood often describe themselves as feeling down, tearful, or hopeless.
So, to recap:
- Major Depressive Disorder occurs when a person experiences depressive symptoms for at least two weeks.
- Persistent Depressive disorder, as the name suggests, is diagnosed when an individual experiences a depressed mood for at least two years.
- Adjustment Disorder with Depressed Mood describes individuals who experience symptoms within three months after a stressful event in their lives.
Now, let’s discuss the good news. Depression is treatable! Usually, some combination of therapy and medication management is recommended to treat depressive disorders. Cognitive Behavioral Therapy is one of the evidence-based approaches to therapy that is used to help those struggling with depression. Cognitive Behavior Therapy addresses the relationship between thoughts, behaviors, and emotions, and tends to be short-term and goal-oriented. Depression can also present itself along with other mental health diagnoses including, but not limited to, anxiety, posttraumatic stress disorder, personality disorders, attention deficit hyperactivity disorder (ADHD), and substance use disorders. Individuals commonly seek treatment for more than one issue. If an individual is suffering from more than one disorder, the patient and therapist work together to develop a treatment plan suitable to the patient’s needs.
There are two common questions most people have before attending therapy: “What can I expect on my first therapy visit?” and “What if I have tried therapy before and it didn’t work for me?”
“What can I expect on my first therapy visit?”
Typically, the first visit consists of an evaluation, which includes questions about your history and identifies any symptoms you may have that are currently distressing to you. The first visit is also a chance for the therapist to answer any questions you may have about the treatment process.
“What if I have tried therapy before and it didn’t work for me?”
Building a trusting relationship with your therapist and feeling comfortable in the therapeutic environment are essential. If you don’t like your therapist for some reason, seeing a different one is perfectly acceptable. As in everyday life, we all get along better with some people than we do others. Additionally, for those with severe depression that is not effectively managed with conventional treatment, there are alternatives available, which can be discussed with a mental health professional.
This article is a brief overview of specific types of depression and is not intended to be used for diagnosis or in place of an evaluation with a professional. If you are suffering from any of these symptoms, or think you might have depression, contact a mental health professional for an evaluation.
If you are experiencing suicidal thoughts, the National Suicide Prevention Lifeline provides free and confidential emotional support 24/7 at 1-800-273-8255. If you prefer communicating through text message, you may text the Crisis Text Line at 741741 for 24/7 free and confidential support. In the event of an emergency, call 911 immediately, or contact your local Emergency Department.