Depression & Mood Disorders

Depression and mood disorders are among the most common types of neuropsychiatric disorders. Like other neuropsychiatric disorders, the diagnosis of depression results from a combination of problems with brain function, controlling emotions and mood. Depression is a common but serious mood disorder with severe symptoms that affect how a person feels, thinks and handles daily activities, such as sleeping, eating or working.

There are different types of depression, some of which develop due to specific circumstances.

• Major depression: Includes symptoms of depression most of the time for at least two weeks that typically interfere with one’s ability to work, sleep, study and eat
• Persistent depressive disorder (dysthymia): Often includes less severe symptoms of depression that last much longer, typically for at least two years
• Perinatal depression: Occurs when a woman experiences major depression during pregnancy or after delivery (postpartum depression)
• Seasonal affective disorder: Comes and goes with the seasons, typically starting in late fall and early winter and going away during spring and summer
• Depression with symptoms of psychosis: A severe form of depression where a person experiences psychosis symptoms, such as delusions (disturbing, false fixed beliefs) or hallucinations (hearing or seeing things that others do not see or hear)

Individuals diagnosed with bipolar disorder (formerly called manic depression or manic-depressive illness) also experience depressive episodes, during which they feel sad, indifferent or hopeless, combined with a very low activity level. But a person with bipolar disorder also experiences manic (or less severe hypomanic) episodes, or unusually elevated moods, in which they might feel very happy, irritable or “up,” with a marked increase in activity level.

Other types of depressive disorders found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (that affects women around the time of their period).

The exact cause of depression is unknown. It may be caused by a combination of genetic, biological, environmental and psychological factors. Everyone is different‚ but the following factors may increase a person’s chances of becoming depressed:

• Having blood relatives who have had depression
• Experiencing traumatic or stressful events, such as physical or sexual abuse, the death of a loved one or financial problems
• Going through a major life change‚ even if it was planned
• Having a medical problem, such as cancer, stroke or chronic pain
• Taking certain medications. Talk to your doctor if you have questions about whether your medications might be making you feel depressed.
• Using alcohol or drugs

Depression is one of the most common mental disorders in the United States. Research suggests that genetic, biological, environmental and psychological factors play a role in depression. In general, about one out of every six adults will have depression at some time in their life. Depression affects about 16 million American adults every year. Anyone can get depressed, and depression can happen at any age and in any type of person.

Depression often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although children may express more irritability than sadness. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in childhood.

Depression, especially in midlife or older age, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease and Parkinson’s disease. These conditions are often worse when depression is present, and research suggests that people with depression and other medical illnesses tend to have more severe symptoms of both illnesses. The Centers for Disease Control and Prevention (CDC) has also recognized that having certain mental disorders, including depression and schizophrenia, can make people more likely to get severely ill from COVID-19.

Sometimes a physical health problem, such as thyroid disease, or medications taken for a physical illness cause side effects that contribute to depression. A healthcare provider experienced in treating these complicated illnesses can help work out the best treatment strategy. Learn more about getting help and finding a healthcare provider.

Additionally, smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population. About three out of every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions. Why smokers are more likely than nonsmokers to experience depression, anxiety and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause, smoking is not a treatment for depression or anxiety. Getting help for your depression and anxiety and quitting smoking are the best ways to feel better.

Many people who experience depression also have other mental health conditions. Anxiety disorders often go hand in hand with depression. People who have anxiety disorders struggle with intense and uncontrollable feelings of anxiety, fear, worry and/or panic. These feelings can interfere with daily activities and may last for a long time.

Other risk factors for depression include:

• Personal or family history of depression
• Major negative life changes, trauma or stress

If you feel you might be suffering from depression, see a mental health professional. Talk with your doctor or a mental health professional immediately, as symptoms are typically progressive and can affect your involvement in daily life.

Once treatment begins, you should gradually start to feel better. Here are some other things you can do outside of treatment that may help you or a loved one during treatment for depression:

• 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.
• Break up large tasks into small ones; do what you can as you can. Decide what must get done and what can wait.
• Try to connect with people. Talk with people you trust about how you are feeling.
• Delay making important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with people who know you well.
• Avoid using alcohol, nicotine or drugs, including medications not prescribed for you.

Clinical trials are research studies that look at new ways to prevent, detect or treat diseases and conditions, including depression. The goal of a clinical trial is to determine if a new test or treatment works and is safe. Although people may benefit from being part of a clinical trial, they should know that the primary purpose is to gain new scientific knowledge so that others can be better helped in the future.

If you have been experiencing some of the following signs and symptoms, most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

• 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
• Decreased energy, fatigue or feeling slowed down
• Difficulty concentrating, remembering or making decisions
• Difficulty sleeping, waking early in the morning or oversleeping
• Changes in appetite or unplanned weight changes
• Physical aches or pains, headaches, cramps or digestive problems that do not have a clear physical cause and do not go away with treatment
• Thoughts of death or suicide or suicide attempts

Not everyone who is depressed experiences every one of these symptoms. Some people experience only a few symptoms, while others experience many symptoms. Symptoms associated with depression interfere with day-to-day functioning and cause significant distress for the person experiencing them.

Depression can also involve other changes in mood or behavior that include:

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

Depression can look different in men and women. Although men, women and people of all genders can feel depressed, how they express those symptoms and the behaviors they use to cope with them may differ. For example, some men (as well as women) may show symptoms other than sadness, instead seeming angry or irritable. And although increased use of alcohol or drugs can be a coping strategy for any person with depression, men may be more likely to use alcohol or drugs to help them cope.

In some cases, mental health symptoms appear as physical problems, such as a racing heart, tightened chest, ongoing headaches or digestive issues. Men are often more likely to see a healthcare provider about these physical symptoms than their emotional ones.

Because depression tends to make people think more negatively about themselves and the world, some people may also have thoughts of suicide or self-harm.

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

If you experience signs or symptoms of depression and they persist or do not go away, talk to a healthcare provider. If you see signs or symptoms of depression in someone you know, encourage them to seek help from a mental health professional.

To be diagnosed with depression, an individual must have five depression symptoms every day, nearly all day, for at least two weeks. One of the symptoms must be a depressed mood or a loss of interest or pleasure in almost all activities. Children and adolescents may be irritable rather than sad.

If you think you may have depression, talk to your healthcare provider. Primary care providers routinely diagnose and treat depression and refer individuals to mental health professionals, such as psychologists or psychiatrists.

During the visit, your provider may ask when your symptoms began, how long they last, how often they occur and if they keep you from going out or doing your usual activities. It may help to make some notes about your symptoms before your visit. Certain medications and some medical conditions, such as viruses or a thyroid disorder, can cause the same depression symptoms. Your provider can rule out these possibilities by doing a physical exam, interview and lab tests.

Depression treatment typically involves medication, psychotherapy or both. If these treatments do not reduce symptoms, brain stimulation therapy may be another treatment option. In milder cases of depression, treatment might begin with psychotherapy alone, and medication added if the individual continues to experience symptoms. For moderate or severe depression, many mental health professionals recommend a combination of medication and therapy at the start of treatment.

Choosing the right treatment plan should be based on a person’s individual needs and medical situation under a provider’s care. It may take some trial and error to find the treatment that works best for you. You can learn more about the different types of treatment, including psychotherapy, medication and brain stimulation therapies, on the National Institute of Mental Health (NIMH)’s depression webpage. For information on finding a mental health professional and questions to ask when considering therapy, visit NIMH’s psychotherapies webpage.

Antidepressants are medications commonly used to treat depression. They take time to work—usually four to eight weeks—and symptoms such as problems with sleep, appetite or concentration often improve before mood lifts. It is important to give medication a chance before deciding whether or not it works. Some individuals—especially children, teenagers and young adults—may experience an increase in suicidal thoughts or behavior when taking antidepressants, particularly in the first few weeks after starting or when the dose is changed. All patients taking antidepressants should be watched closely, especially during the first few weeks of treatment.

Treatment-resistant depression occurs when a person doesn’t get better after trying at least two antidepressants. Esketamine is a newer FDA-approved medication for treatment-resistant depression delivered as a nasal spray in a doctor’s office, clinic or hospital. It often acts rapidly—typically within a couple of hours—to relieve depression symptoms. Individuals usually continue to take an oral antidepressant to maintain the improvement in depression.

Another option for treatment-resistant depression is to add a different type of medication that may make an antidepressant more effective, such as an antipsychotic or anticonvulsant medication or bupropion, an antidepressant that works differently from most.

Medications prescribed by your healthcare provider for depression can have side effects, but these may lessen over time. Talk to your provider about any side effects that you have. Do not stop taking medications without the help of a healthcare provider. If you abruptly stop taking your medicine, you may experience severe withdrawal symptoms.

The FDA has not approved any natural products for depression. While research is ongoing, some people find natural products, including vitamin D and the herbal dietary supplement St. John’s wort, to help depression. Do not use St. John’s wort or other dietary supplements for depression before talking to your provider. For more information, visit the National Center for Complementary and Integrative Health website.

Psychotherapy (also called talk therapy or counseling) teaches individuals with depression new ways of thinking and behaving and helps with changing habits that contribute to depression. Most psychotherapy occurs with a licensed, trained mental health professional in one-on-one sessions or with other individuals in a group setting. Two effective psychotherapies to treat depression include cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). The use of older forms of psychotherapy, such as dynamic therapy, for a limited time also may help some people with depression.

With CBT, people learn to challenge and change unhelpful thinking patterns and behavior to improve their depressive and anxious feelings. Recent advances in CBT include introducing mindfulness principles and the development of specialized forms of therapy targeting particular symptoms, such as insomnia.

IPT focuses on interpersonal and life events that impact mood and vice versa. The goal of IPT is to help people improve their communication skills within relationships, establish social support networks and develop realistic expectations to help them deal with crises or other issues that may be contributing to or worsening their depression.

Brain stimulation therapy, which involves activating or inhibiting the brain directly with electricity or magnetic waves, is another option for some people when other depression treatments have not been effective.

The most common forms of brain stimulation therapy include electroconvulsive therapy and repetitive transcranial magnetic stimulation. Other brain stimulation therapies are newer and, in some cases, still experimental.

Once you begin treatment, you should gradually start to feel better. Go easy on yourself during this time. Try to do things you used to enjoy. Even if you don’t feel like doing them, they can improve your mood. 

Other things that may help:

• Try to get some 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 get done and what can wait.
• Try to connect with other people, and talk with people you trust about how you are feeling.
• Postpone important life decisions until you feel better.
• Avoid using alcohol, nicotine or drugs, including medications not prescribed for you.

If someone you know has depression, help them see a healthcare provider or mental health professional. You also can:

• 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 medications.
• Make sure they have transportation to therapy appointments.
• Remind them that, with time and treatment, the depression will lift.
• Take comments about suicide seriously, and report them to your loved one’s healthcare provider or therapist. If they are in immediate distress or thinking about hurting themselves, call the National Suicide and Crisis Hotline at 988, or chat at 988lifeline.org. 

Clinical trials are research studies that look at new ways to prevent, detect or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so others may receive better help in the future.

Researchers at the National Institute of Mental Health (NIMH) and around the country conduct many studies with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH’s clinical trials information.