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Clinical depression is a psychiatric condition that includes persistent low mood that affects everyday actions and behaviors, accompanied by other symptoms. Almost everyone has periods of sadness, grief, or low energy. The difference is that people with depression experience weeks or months of symptoms like hopelessness, sadness, and disinterest that affect their daily life.
Depression is a serious mental illness. It isn’t a sign of weakness or a mood you can simply “snap out of.” With treatment, most people with depression improve and return to full health.
What Causes Depression?Depression can have many causes. Researchers have found that both genetics and life experiences affect depression risk. Why some people suffer from depression and some don’t is unknown.
Different types of depression are linked with different causes and risk factors. The exact combination of factors will vary for each person. Usually, personal factors and stressful events can lead to depression.
Before the 20th century, depression was viewed as a spiritual or physical disorder in different cultures and eras. In ancient Mesopotamian texts, mental illness was thought to be caused by spiritual problems or demonic possession. Priests treated it with exorcisms.
Early Roman and Greek physicians believed that the human body contained four fluids called humors. These were yellow bile, black bile, blood, and phlegm. They believed an imbalance of the humors caused depression.
In the late 800s, the Persian physician Rhazes suggested an early form of behavior therapy to treat depression. It involved positive rewards for appropriate behavior.
Outside of Persia, however, depression was viewed as a spiritual affliction throughout the Middle Ages. Religious beliefs led many communities to fear people with depression.
In 1621, Robert Burton published “Anatomy of Melancholy.” It described physical and social causes of depression such as fear, poverty, and loneliness. Burton recommended some of the same treatments as the ancient doctors, like diet, exercise, and bloodletting. He also suggested some new ones, such as music therapy and travel.
In the 18th and early 19th centuries, depression was starting to be viewed as a “weakness in temperament” caused by genetics and couldn’t be changed. The term “depression” slowly replaced “melancholia.”
In the late 19th century, psychoanalysts such as Sigmund Freud popularized the idea that depression was the result of real or symbolic loss. Freud and other psychoanalysts promoted talk therapy as a treatment for depression.
By the end of the 20th century, doctors created a classification system that divided depression into subtypes. These classifications were based on symptoms and replaced psychoanalytic theories. The third volume of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was published in 1980.
The first modern depression treatment was identified in 1951. Doctors treating tuberculosis with the drug iproniazid noticed that their patients’ moods dramatically improved.
Researchers then studied people with depression who were treated with iproniazid for several weeks. They found that 70 percent of those people had few symptoms. Iproniazid became the first successful treatment for depression.
Iproniazid was classified as a monoamine oxidase inhibitor (MAOI). MAOIs were followed in the decades to come by new classes of antidepressants. Each adjusted neurotransmitter levels in the brain in a different way.
The groundwork of talk therapy started by Freud and others grew to include many different forms of psychotherapy. Today there are more treatments for depression than ever before.
How Common Is Depression?In 2021, about 8 percent of the U.S. population had at least one episode of major depressive disorder. Women are more likely to have depression than men. Some women also experience depression during pregnancy or after giving birth.
Depression can begin at any age. It’s most common between the ages of 18 and 25.
Depressive disorders affect millions of people, but they might not look the same for everyone. There are several different forms of depression. Each has unique symptoms and causes.
Many people are diagnosed with depression by their primary care physician. Doctors will ask about symptoms, their duration, and severity. Early on, depression symptoms may be mild and can be overlooked as stress or fatigue.
There are no tests to diagnose depression. Doctors may order blood or urine tests to rule out conditions with overlapping symptoms.
While everyone will be affected in different ways, common depression symptoms may include:
Low energy or sleep problems
Feelings of sadness or hopelessness
Restlessness or trouble concentrating
Changes in appetite and weight
Loss of interest in hobbies or regular activities
No matter how severe depression becomes, treatment is available. The two most common treatments are cognitive behavioral therapy (CBT) and medications. These may be used together or on their own.
There are many different classes of medications — such as selective serotonin reuptake inhibitors (SSRIs) — used to treat depression. No single treatment path works for everyone. You may need to try a few options before finding the best fit.
There are many effective treatments for depression. Long-lasting depression, especially if it goes untreated, can lead to self-harm and suicide.
If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or using the online chat. You can also contact 911 or go to your nearest emergency room.
People with depression are more likely to have a heart problem called coronary artery disease. Depressed people who also have coronary artery disease are at an even higher risk of having more heart problems, like a heart attack or sudden death, than people without depression.
Depression can also happen alongside cancer and other chronic illnesses, such as heart disease and diabetes. Many people with substance use disorders also have depression.
The prognosis for depression varies from person to person. Other medical conditions may influence it.
Most people improve with treatment and ongoing social support. Early diagnosis and treatment can help reduce symptoms and improve quality of life.
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