An Overview of Clinical Depression

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Depression exists on a continuum of severity, ranging from relatively mild, transient states of low mood to severe, long term symptoms that have a major impact on a person’s quality of life. When a person’s symptoms have reached the chronic end of the spectrum and require professional treatment, it's typically referred to as clinical depression.

Although depression can take on many forms and may be categorized in several different ways, there are two primary types of clinical depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5): major depressive disorder (unipolar depression) and the depressive phase of bipolar disorder.

Symptoms

People experience depression in different ways. Some people only have a few symptoms, while others have many. Some symptoms might get better over time while others may get worse. It’s important to work with your mental health care team to identify which depression symptoms you experience and determine the best approach to treating them. 

For each type of clinical depression, as well as the various subtypes, there are some symptoms or features that are common in those who experience it. 

Major Depression

Also known as major depressive disorder or unipolar depression, this form is what most people think of when they hear “depression.” 

Major depression is typically characterized by the following symptoms:

  • Sadness, feelings of emptiness
  • Loss of enjoyment of hobbies, work, other activities
  • Appetite changes, weight loss or gain
  • Trouble sleeping (too much or too little)
  • Feeling "slowed down" or being excessively agitated
  • Tiredness, fatigue, lack of energy
  • Physical symptoms and pain (such as body aches, stomach upset, headaches)
  • Feelings of worthlessness or guilt
  • Problems with concentration or focus
  • Inability to make decisions or poor decision-making
  • Thinking about death or dying; planning or attempting suicide

Depressive Phase of Bipolar Disorder

Clinical depression can also be a feature of another mental health condition called bipolar disorder. People with bipolar disorder tend to alternate between periods of depression and periods of greatly elevated mood called mania

In the depressive phase, symptoms can be very similar major depression. During the manic phase, symptoms at the opposite end of the spectrum are more likely, such as:

  • Increased energy
  • Sleeplessness
  • Irritability
  • Rapid speech
  • Hypersexual behavior
  • Racing thoughts
  • Grandiose ideas
  • Greatly increased activity
  • Impulsivity
  • Poor judgment

Other Forms of Depression

Other forms of depression are classified a bit differently, often because they occur in specific situations or require different treatment approaches. 

  • Postpartum depression: Postpartum depression is depression that occurs after a person gives birth and can persist well into the first year postpartum. While is common and treatable, it needs to be promptly and correctly diagnosed. While many new parents experience ups and downs when caring for a new baby (especially on little sleep) the typical stress and anxiety of the newborn stage usually last only a few weeks, whereas postpartum depression is more serious and can last long after the birth of a child. 
  • Premenstrual dysphoric disorder (PMDD): With PMDD, people who have a menstrual cycle become depressed prior to the onset of their period. Hormonal changes can cause mild menstrual symptoms (PMS) in anyone who has periods, but it’s not the same as PMDD. In PMDD, symptoms are more intense, persistent, and require treatment. 
  • Psychotic depression: People who have mental health conditions that cause them to experience hallucinations or delusions may also have a form of depression. Psychotic depression can manifest with hallucinations that are focused on death or being gravely ill or delusions related to other major life stressors, such as losing a job or being poverty-stricken.
  • Seasonal Affective Disorder (SAD): Some people experience bouts of depression at certain times of the year, most often in the dark winter months (though it can occur at any time of year). It's referred to as seasonal affective disorder. The lack of sunlight has been associated with low mood for a number of reasons, including vitamin D deficiency and an increased likelihood that someone will be spending more time alone or at home (potentially due to colder weather and shorter days). Several holidays and celebrations also occur during this time of the year, which can contribute to depression and anxiety in some people.
  • Dysthymia (Persistent Depressive Disorder): If you have an episode of depression that lasts two years or more, you may be diagnosed with dysthymia. Sometimes, major depression also develops or alternates with periods of persistent depression. 
  • Situational depression: Many people will experience a period of depression in their lifetime in response to a specific event. Losing a job, caring for a parent or child who is ill, getting divorced, or experiencing a trauma such as a robbery, car accident, or a house fire are just a few examples of stressors that could lead to situational depression. Unlike more persistent forms of depression, situational depression can usually be treated and improves in response to positive change in a person’s situation, such as getting a new job and having social support, counseling, and in some cases, medication. 

The DSM-5 also mentions other forms of depression classified as atypical. If you are having symptoms of depression, the doctors and mental health professionals you’re working with will evaluate your symptoms carefully. You may experience more than one form of depression in your lifetime. 

If you are a parent or young person, newer entries in the DSM-5 also categorize forms of depression that are more specific to children and teens. 

Depression in Children and Teens

It used to be believed that children couldn’t be depressed, but we now know that’s not true. Children, teens, and young adults can experience depression, but it may not look the same as it does in adults. 

Children may not yet have the language skills and emotional awareness to express exactly what they are feeling. An adult who is depressed may feel profound sadness, whereas a depressed child may appear angry, frustrated, and irritable. 

Symptoms of depression in school-aged children and teens may interfere with school work, social activities, or friendships. For example, a child who is depressed may begin to make poor grades in school, lose interest in after school activities like sports, or no longer want to hang out with their friends. 

As with teens and adults, children who are experiencing depression may also have trouble sleeping, lose their appetite, or have unexplained physical symptoms such as headaches and stomachaches. 

If you're concerned that your child or teen is depressed, talk to your pediatrician. There are some medical conditions that can cause depression which will need to be ruled out. If your child is diagnosed with depression, finding the appropriate treatment is critical to their well-being. 

You can help by putting together a network of mental health professionals, doctors, teams at school, as well as friends and people in the community, who can support your family as you learn about managing your child’s depression. 

Causes

The causes of depression are not completely understood, but it’s believed that there are several key factors, including genetics and environment, that make a person more likely to become depressed.

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Some Common Causes of Depression

Researchers have particularly been interested in investigating whether depression is an inherited condition. A major theory is that certain genetic changes make neurotransmitters (mood-regulating chemicals in the brain) ineffective or scarce. 

The other major component is environmental triggers which may make a person who is genetically predisposed to depression more likely to develop it. 

Certain factors that make it more likely a person will experience clinical depression include:

  • A family history of depression (especially a parent or sibling)
  • Experiencing a traumatic event or major life change (such as loss of a job, death or serious illness of a spouse, divorce)
  • Financial troubles (such as debt and worries about paying for big expenses)
  • Being very ill or injured (such as from cancer or a car accident), needing to have surgery or undergo medical treatment, or having to manage a chronic and/or progressive health condition (such as multiple sclerosis)
  • Caring for a loved one (spouse, child, parent) who has a major illness, injury, or disability
  • Taking certain medications that can cause symptoms associated with depression (including medications used to treat depression)
  • Using illegal drugs and/or misusing alcohol 

If you have experienced a form of depression before, you may be more likely to experience it again or develop another form in response to certain stressors or life changes (such as having a baby). 

Diagnosis

Your doctor may be the first health care professional to talk to you about depression. If you feel depressed, your doctor may want to start by ruling out medical conditions, such as thyroid disorders, that can cause depression symptoms. While your primary care doctor can diagnose clinical depression, they may want also you to be evaluated by someone with psychological expertise.

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If you will be taking medication to treat depression, your doctor may refer you to a psychiatrist. This type of doctor has special training for prescribing and monitoring medications used to treat mental health conditions. They can make sure that the medication you are taking for depression is the best fit for the form you have and that the dose is the safest and most effective for you.

Co-Occurring Conditions

In addition to physical medical conditions that can cause symptoms of depression or increase the likelihood someone will become depressed, there are also several other mental health conditions that people with depression may be diagnosed with.

When a person who has depression also has another mental health condition, it's referred to as a "co-occurring" condition.

Common co-occurring conditions in people with clinical depression include:

Sleep disorders, irritable bowel syndrome (IBS), headaches, chronic pain, and fibromyalgia are other conditions that may co-occur with depression.

Treatment

There are several different ways to treat depression. You may need to try different approaches or combine more than one method. What works well for one person with depression may not work for someone else. Your health care team will inform you of the options that are safe for you. 

If your symptoms are severe or your mental health team feels you are at risk of hurting yourself or someone else, you may need to start treating your depression in the hospital, an inpatient mental health care facility, and/or take part in outpatient treatment programs.

Keep in mind that the process can take time and you may need to adjust the way you manage your depression symptoms in response to changes in your life.

Different types of treatment for depression
Verywell / Cindy Chung

Medication

One of the first-line treatments for clinical depression is medication. There are several different types of antidepressants, however, those belonging to a class called selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed. 

SSRIs such as Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine) are generally preferred by both doctors and patients because they tend to have fewer and less bothersome side effects compared to older classes of antidepressants.

Your doctor or psychiatrist may recommend you take more than one type of antidepressant or add another pharmaceutical treatment, such as anti-anxiety medications, to your routine.

Antidepressants can worsen some mental health conditions. For this reason, it’s very important to work closely with your doctor and therapist to ensure you have the most accurate diagnosis, and that the treatment you choose is a safe and effective way to manage your symptoms.

Before you start taking antidepressants, you should know that it can take some time for the medication to work. Your doctor or psychiatrist will likely have you try taking the medication for a certain period of time—usually several weeks or months—before adjusting the dose or trying a different medication. 

After starting an antidepressant it can take several weeks for you to feel a difference in your symptoms. It may also take weeks for side effects to resolve.

Even if you have side effects or don't feel your medication is working, do not stop taking it suddenly. This can cause withdrawal, which can be serious. Talk to your doctor if you want to stop taking your antidepressant.

If your doctor wants you to switch to a different medication, they will instruct you to gradually lower your dose over several weeks. Tapering off antidepressants can help prevent symptoms of withdrawal. 

In some cases, your doctor may start you on a new medication while you are still slowly reducing your dose of your old one. If you are changing antidepressants or adjusting to a new dose, it’s very important that you stay in touch with your mental health care team. 

The health care provider prescribing medication will discuss the risks and benefits with you. There may be some circumstances when taking a particular drug to treat depression would not be advised or you may need an adjusted dose.

For example, if you are pregnant or breastfeeding, your doctor will talk to you about any risks associated with the medications you take or are considering taking. They will help you evaluate the risks and benefits of each decision.

Children, teens, and young adults with depression may have serious side effects when taking certain antidepressants. People under the age of 25 taking these medications can be at an increased risk of worsening symptoms, including suicidal ideation.

Research has indicated that the risk of attempting suicide can also be markedly increased, which is why these medications get a black box warning from the FDA. 

Psychotherapy

Psychotherapy is another popular choice for treating depression, both on its own and combined with antidepressants. 

Psychotherapy involves working with a therapist, either by yourself or with a group, to talk through how you feel, your experiences, and how you view yourself and the world. Together, you may be able to identify certain underlying causes or triggers that influence your depression. Once you are aware of them, you can begin to work on effective coping strategies. 

One example is cognitive-behavioral therapy, which research has found can be effective for treating depression. Other studies indicate the combination of medication and psychotherapy may be the most effective treatment, as each method targets depression in a different way. When both are used together, the underlying chemical imbalance and individual psychological factors can be addressed.

If you have depression, therapy can help you better understand yourself and your depression symptoms. It’s also an essential component of your support system. If you are taking antidepressant medications, a psychiatrist can help by monitoring your dose to ensure it continues to work well and be safe.

There can be barriers to accessing therapy, such as a lack of providers where you live, not having reliable transportation, and cost. A relatively new option you may want to learn more about is using an internet connection or cellphone to communicate with a mental health provider. These options may also be more appealing to teens with depression.

Therapists can use email or text messaging, video chatting, or voice calls to connect with people who need help managing depression. You can also download mental health apps on your smartphone or tablet to help you track your symptoms or communicate with your provider. There are even some apps that offer interactive self-help resources and games to help you practice new coping skills, like mindfulness.

Alternative and Complementary Treatment

You may choose to explore complementary or alternative therapies for depression. One of the most common is an herbal supplement called St. John’s wort

The FDA has not officially approved St. John’s wort to treat depression, but it is often suggested by alternative health practitioners. Research has indicated that St. John’s wort may be beneficial for some people who have symptoms of depression. The supplement comes in various doses and preparations and can be purchased over-the-counter and at most health food stores. There is no standard dose and you may want to work with a practitioner as you undertake some “trial and error” to determine the dose that feels right for you. 

Similar to how prescription medications affect neurotransmitter levels, St. John’s wort may influence the levels of a specific neurotransmitter called serotonin in the brain. When people have too little serotonin, they can feel depressed. Increasing the amount of serotonin can help improve symptoms. However, having too much serotonin can lead to a serious condition called serotonin syndrome

If you are taking a medication that carries a risk of increasing your serotonin levels too much, your doctor will teach you about the signs of serotonin syndrome to watch for. They will also want you to make sure that you never take more than one medication, herb, or supplement that can raise your serotonin levels at the same time (including St. John’s wort). 

While St. John’s wort may be helpful for some people with mild-to-moderate depression, it can also interact with a number of prescription medications. If you are already taking an antidepressant, do not start taking St. John’s wort until you’ve discussed it with your doctor.  

Coping

Medication and therapy can be valuable components of depression treatment, but each individual person with depression will need to find their own ways of coping with the condition. 

If you have depression, there are a variety of avenues you can explore to help you manage your symptoms. Depending on your lifestyle, physical health, and preferences, you can work with your mental health care team to develop the strategies that work best and feel like a good fit for you.

Physical Activity

Research has shown that the physical and mental symptoms of depression may benefit from getting your body moving. When you exercise, your body releases endorphins, which can boost your mood. Regular physical activity also helps keep your muscles and bones strong, improves cardiovascular health, and promotes a healthy weight.

Exercise not only helps keep your body and mind in working order, but it can give you the opportunity to connect with others. Even if you prefer working out alone, going to the gym or taking your dog for a stroll through the park can help lessen feelings of isolation that come with depression. Other ideas include joining a community sports team or taking a group fitness, dance, or yoga class.

Hobbies and Creativity

A major symptom of depression is losing interest in hobbies or activities you used to enjoy. Motivation and focus can be challenged when you have depression. It's not easy, but finding ways to keep your mind engaged is an important part of learning to cope with depression.

You may find it helpful to start with a hobby or activity you already know you like and try to give yourself small milestones to work toward. While you may not feel up to teaching yourself an entirely new skill if you’re depressed, keeping your mind engaged without putting too much pressure on yourself can be a healthy strategy for coping. It can also help you reconnect with the parts of your life you might feel you have “lost” to depression or even find an entirely new interest or hobby.

If you enjoy being creative, you may find these activities help you deal with your depression symptoms. It can also be an opportunity for you to express how you are feeling in a new way. You may even be able to use your creativity as part of your therapy. Kids especially benefit from using creative expression to help them communicate and understand feelings of depression. Other creative outlets such as reading and making music can be coping strategies, though they may be difficult to stick with if you are having trouble focusing.

You can also use these activities as a way to encourage yourself if you are having a hard time leaving the house or have not had an interest in social activities. For example, one day you may find a quiet afternoon alone at an art gallery or museum feels doable. On another day, you may feel up to seeing a movie or attending a concert or theatrical performance with a friend. 

Self-Care and Staying Connected

Depression can make it very hard to take care of yourself physically, emotionally, mentally, and spiritually. If you are struggling with self-care such as showering or cleaning your home, buying groceries, working, or other day-to-day pursuits, you may feel guilty and ashamed. 

It can feel impossible to ask for help, but even making small, healthy changes can make coping with depression symptoms more manageable. Having help tidying up your room, getting your trash taken out, stocking up your kitchen with easy-to-prepare meals, and making sure you can get to your doctor or therapy appointments are just a few ideas. 

It’s also important to stay connected to others. Depression can be incredibly isolating. In fact, you may feel like you need to stay far away from other people–even the people you love most. 

Sometimes, especially when you are first diagnosed, you may not feel ready to talk to your loved ones about your depression. At first, it might be easier to explore how you are feeling with other people who are going through the same process. 

Start by asking your doctor or therapist about support groups in your local community. If you don’t have a wide network of support or you do not feel ready to talk to people face-to-face, you may find it helpful to seek out online depression support groups. Message boards, forums, and social media groups can be a place to share experiences that may feel less intense for you, as it provides a little distance and sense of anonymity. 

Online support networks may continue to be valuable to you even after you have opened up about your depression with your loved ones and have the support of your mental health team. Whether you are primarily connecting with others in-person or talk to them online, the most important thing is that you feel safe doing so.

A Word From Verywell

If you or a loved one has clinical depression, you may be overwhelmed by all the different aspects of living with mental illness there are to consider. While everyone's experience with depression will be unique, there are some commonalities when it comes to symptoms, causes, and treatment. You will want to discuss your specific symptoms with your mental health care team. They will help you find the safest and most effective treatment for you, which may include medication, therapy, or both.

Your support network, whether in-person or online, can be there for you as you learn to cope with the symptoms of depression. When you're depressed, it can be hard to ask others for help. It's important to remember that you don't need to address all the different aspects of living with depression at the same time—and you don't have to face it alone.

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Article Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

  • American Psychological Association. Depression. APA website. Published 2019.

  • National Alliance on Mental Illness. Depression overview. NAMI website. Reviewed August 2017.

  • National Institute of Mental Health. Depression. The National Institute of Mental Health Information Resource Center. Revised February 2018.