Depression

What Does Depression Look Like?

We’ll raise your question with a few Q’s of our own: Are you female? Are you a teen? Depression can also affect different ages and genders in unique ways:

Women are more likely to ruminate (worry, dwell on, or rehash negative feelings). This can look like negative self-talk, sudden crying spells, feelings of guilt, or blaming oneself. Women are also more likely to have depression at the same time as an anxiety disorder, such as panic disorder, eating disorder, or obsessive-compulsive behavior.

Men with depression are more likely to show signs of irritability, anger, apathy, escapist behavior (like spending more time at work), or reckless behavior (like misusing alcohol or other substances).

Younger people can struggle with depression and MDD (even though the average age of onset is 32). Children and teens may sometimes exhibit oversensitivity, social withdrawal, poor school performance, frequent physical complaints (like headaches and stomachaches), or feelings of incompetence and despair (like they can’t do anything right or that everything is their fault).

Older adults and the elderly are often misdiagnosed or undertreated for depression because their symptoms can be mistaken for other disorders (for example, confusion or memory problems caused by depression can look like Alzheimer’s disease), or they may assume their feelings are just an inevitable part of aging. For many, sadness isn’t the biggest indicator of depression; instead, physical complaints (aches and pains, worsening headaches) are often the predominant symptom. Sleep trouble, low motivation, neglect of personal care or hygiene, and fixation on death are other signs of depression in older adults.

How Is Depression Diagnosed?

These days, a routine doctor’s visit with your general health practitioner may be all it takes to receive a diagnosis. Standard screening tools like the Patient Health Questionnaire (PHQ-9)—a survey of yes, nine items, that physicians use to assess the severity of depression—are becoming widely used in primary care settings to screen for the condition.

In fact, “most patients with depression are going to be diagnosed and treated by primary care doctors, not specialists or psychiatrists,” says James Murrough, M.D., Ph.D., Director of the Depression and Anxiety Center for Discovery and Treatment at Mount Sinai.

Depression is mainly diagnosed by history and clinical presentations, or a specific pattern of symptoms, says Dr. Murrough, which is to say there’s no blood test for MDD. But if you have symptoms like changes in sleep or appetite, your doctor may look into other conditions unrelated to mental health (a thyroid issue is the classic example).

“The first thing your doctor might do is order blood tests—not to make the diagnosis of depression, but to rule out things that could be masquerading as depression,” explains Dr. Murrough. “For example, an underactive thyroid can present as low mood and feeling sluggish, and iron deficiency anemia is another reason why some people might have low energy.”

Ultimately, doctors are looking for a consistent pattern of symptoms that represent a “clear change from the way someone was before, as well as objective signs of functional impairment,” says Dr. Murrough. They’ll ask when your symptoms started and how you felt before, look at your family history, and use your score from the PHQ-9 to aid in the diagnosis. It’s also important to note that when a patient mentions thoughts of suicide, that’s a major red flag.

Depression and Pregnancy

Between hormonal changes, stress, and other environmental changes, getting pregnant can supercharge the D-word.

Perinatal Depression

What to expect when you’re expecting? For as many as 23% of people who conceive, this period can come with the unwelcome arrival of depressive symptoms. Perinatal depression includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery.

During pregnancy, hormone changes can affect the chemicals in your brain, and it can sometimes result in exacerbated anxiety or depression. But possible triggers can also include infertility treatments, previous pregnancy loss, and having complications during pregnancy. The signs and symptoms for depression during pregnancy, also known as antepartum depression, are similar to MDD and can be effectively treated with the right help (even with drug-free approaches like talk therapy).

The Post-Baby Blues

If you experience a bit of emotional “baby blues” after childbirth—mood swings, crying spells, and anxiety that keeps you up at night—go easy on yourself because most new mothers go through this (hello, major life change!). If after two weeks, these symptoms have persisted, it could be postpartum depression.

Studies have shown that one in seven mothers experience postpartum depression in the year after they give birth. People with a previous history of depression may have a higher chance of developing postpartum depression. Talk with your doctor about a game plan for treatment and make it a point to ask for help from friends and family whenever you need it (parenthood is stressful enough!). And as always, remember that perinatal depression is neither shameful, nor a character flaw or sign of weakness.

What Are the Treatments for Depression?

There are ever-evolving ways to treat depression, and the mix will depend on everything from how long you’ve had it and the severity of your symptoms.

Medications

There’s no shame in taking medication to manage your depression. People routinely take medication for physical ailments, and having a mental illness isn’t any different.

Antidepressants work by affecting neurotransmitters in the brain. Common types of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and norepinephrine-dopamine reuptake inhibitors (NDRIs). See a list and descriptions of these medications here, and speak with your doctor to determine which drug is right for you. If you’re worried about the possible side effects, remember that any medication can be tapered down or ceased.

One major development that’s under psychopharmacological research for treatment-resistant depression is ketamine, which is used in medicine as an anesthetic. “It’s important to know that ketamine is beneficial for only a very specific subset of the population,” says psychologist Jessica Stern, Ph.D., clinical assistant professor in the Department of Psychiatry at NYU Langone Health, “and is only to be used after several other full courses of therapies—both psychotherapy and multiple other medications—have been tried extensively.” Meaning, ketamine wouldn’t normally be a first or second line of treatment.

Therapy

Who doesn’t go to therapy these days? It’s as much a part of regular conversation as the weather. Psychotherapy (aka talk therapy), sometimes along with medication, can be highly beneficial in treating, managing, and reducing the duration of an episode of depression.

“Evidence-based treatments, such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy, and Dialectical Behavior Therapy have been shown to be very effective in the treatment of depression,” says Dr. Stern. “These psychotherapies are active skills-based therapies that help individuals develop and maintain skills to manage difficult thoughts and feelings.”

Trained experts like psychiatrists and psychologists can offer many types of these treatments, from light therapy for seasonal affective disorder to CBT that works to change your thought processes. One goal of CBT includes behavioral activation, an effective treatment and technique in which a therapist can help you schedule more enjoyable activities that bring fulfillment, meaning, or pleasure into your life. According to Dr. Stern, behavioral activation may even potentially decrease the likelihood of depression for those seeing a therapist for reasons other than MDD.

Therapy may be even more accessible now than ever before. Due to the pandemic, over three-quarters of clinicians say they’re now providing their services remotely, primarily via phone or video on a designated telehealth platform. So, you have no excuse not to make an appointment. Whether you have MDD or just everyday mental health struggles, “research has shown, prior to COVID-19 and now increasingly with COVID-19, that telehealth-based psychotherapy is incredibly effective,” Dr. Stern explains. “It allows psychotherapy to be conducted very similarly to in-person psychotherapy, while decreasing barriers that may make it difficult to attend sessions in person.” In other words, there’s no need to travel or find childcare, and your session happens comfortably in your own home.

Other Treatments

“Device treatments such as Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT) may be beneficial and appropriate for certain individuals,” adds Dr. Stern. TMS, ECT, and vagus nerve stimulation (VNS)—a newer treatment that involves surgically implanting a device similar to a pacemaker along the peripheral nerve in the neck—are all types of brain-stimulating approaches that may sound very sci-fi but can be effective after first trying therapy and medication.

Healthy Habits

Any treatment for depression should coincide with maintaining a healthy diet, regular exercise, a productive sleep schedule, and—yes—even mindful self-care practices. These are all helpful in alleviating or reducing the severity of symptoms, says Dr. Stern.

Exercise helps you better cope with stress, and the endorphins released during exercise may give you a mental boost. Increased research shows that “exercise and physical activity can have significant effects on depression, and particularly in those with mild-to-moderate depression,” she adds. “This may include cardiovascular workouts, stretching, or mindfulness-based physical activity like yoga.” The Centers for Disease Control and Prevention (CDC) reports that physical activity also helps you sleep better at night—setting off a chain reaction for a more supportive routine.

Meditation is another highly effective way of clearing your head and calming your body. You can also try keeping a journal—some people find that it helps to express their thoughts on paper instead of bottling them inside. Talk to close friends and family about your struggles, too. Having a social support system plays a key part in maintaining your mental health and wellbeing.

Recovery is a journey, not a destination. Bad days will still come, but with well-targeted treatment, you should be able to overcome extreme lows. While science has yet to find a cure for mental disorders such as depression, it is entirely possible to live a happy and fulfilling life in spite of it.

Relationship RX

The catch-22 with depression is that your social network is incredibly important for maneuvering through feeling better, but it’s so easy to sabotage your connections to friends and family because you think you want to be alone, or you become so withdrawn that people start to leave you alone. Read our article, “Living with a Depressed Person” if someone you care about is in a bad place.

Depression and Suicide Risk

Depression usually does not lead to suicide ideation. But, according to the US Department of Health and Human Services, studies have shown that about two percent of people who have been treated for depression in an outpatient setting will die by suicide. If the treatment is inpatient, the number doubles to four percent. Men are more likely to die by suicide after depression than women. Find hotlines and organizations for support in our emergency mental health resources directory.

Depression FAQs