Depression

Depression is one of the most prevalent mental health disorders in the US. According to the National Institute of Mental Health (NIMH); 8.3% of all U.S. adults experienced at least one depressive episode in 2021. Everyone feels down from time to time, but depression, or “Major Depressive Disorder”, is a diagnosable health concern. The good news is that it is also treatable. 

Depression occurs when certain neurotransmitters in the brain are low or unbalanced. Serotonin, dopamine, and norepinephrine boost your mood in various ways and are usually released based on what you’re experiencing at a given moment. 

When you’re depressed, your brain doesn’t release these neurotransmitters in the abundance it should.  All three play a part, but low serotonin is usually the main culprit for depressive episodes. 

Signs and Symptoms of Depression

Depression, in all of its forms, goes beyond feeling down. It happens over a long period of time, and it usually triggers frequent, intense “downer” emotions that those without depression experience less often (or not at all).

Symptoms of Depression

While everyone’s battle with depression may vary slightly, the symptoms shared in common with most types of depressive disorders include:

• Persistent sadness or emptiness
• Hopelessness
• Irritability
• Fatigue
• Mind fog and memory problems
• Sleeping too much or too little
• Major appetite changes
• Thoughts of suicide or “not wanting to exist.”

Not everyone diagnosed with a depressive disorder will have all of these symptoms, or even consistently show them. However, if they occur frequently enough to affect your everyday life, it’s time to seek a doctor for treatment.

Signs of Depression

The effects of depression on everyday life might look like:

• Missing work due to depression
• Loss of interest in hobbies or activities, such as sex or social interactions
• Significant weight loss or weight gain

Without treatment, these effects may compound and lead to a significant reduction in quality of life and loss of income or housing. It’s not an uncommon thought for those with depression to battle feeling hopeless about whether life can ever get better. 

There are thousands (if not more) stories of people who have found hope despite and even healing from struggles with depression. Seeking professional guidance is one of the most effective ways to discover what types of treatment may work for you.

Types of Depression

Depression has many faces. It affects every demographic, but it can present itself differently in each person. Doctors may diagnose someone with any number of depressive disorders—or even more than one at a time. Each has its own unique causes and signs.

Major Depressive Disorder

Some people experience Major Depressive Disorder (MDD)—also referred to as “clinical depression”—for weeks, months, or even years. 

Though someone might be diagnosed with MDD, they may not necessarily “feel” it every day. Typically, people are diagnosed with MDD if they display the corresponding symptoms for the majority of the time over two weeks.

Bipolar Disorder: Formerly “Manic Depression”

Many people recognize Bipolar Disorder by its former name of “manic depression”. The ‘bi’ prefix indicates duality, where bipolar disorder manifests itself with two extremes of the emotional spectrum.

Those with bipolar disorder show the same symptoms as those with major depressive disorder. These experiences are sometimes referred to as the ‘low.’

The difference is that bipolar also includes “highs” called “mania”. While depressive episodes involve a lack of energy or even, sometimes, emotion, manic episodes are the opposite. Someone in a manic episode will have enormous amounts of energy. They might be extremely happy and overjoyed for a period of time.

Other indicators of mania include:

• Being easily distracted
• Talking quickly
• Making rash, sometimes dangerous decisions
• Not sleeping
• Increased self-esteem

Depressive and manic episodes rarely follow a pattern. Clinical depression indeed comes in “waves.” However, for most people, their “emotional baseline” when they’re not in the middle of a depressive episode is generally less aggressive and less recognizable than mania.

Seasonal Affective Disorder (SAD)

As the weather gets gloomy, our emotions tend to follow. Feeling down or tired in winter happens to a lot of people. For some, it’s much more than that.

Those who develop Seasonal Affective Disorder, or SAD, will have a depressive episode around the same time every year. It corresponds to the seasons changing—usually appearing as colder weather sets in. However, some people develop SAD during other seasons.

The symptoms of SAD match those of clinical depression, but the episodes are far more cyclic and predictable. Conventional depression treatments do work, but some doctors and therapists also recommend light therapy. People can often seek preventative treatment before SAD sets in.

Postpartum Depression

Simply put, this is depression that occurs after giving birth. Many women experience mood swings and the ‘baby blues’ for a few days or weeks after birth, but postpartum depression is more extreme and long-lasting.

Postpartum depression is caused by the sudden and significant drop in the hormones estrogen and progesterone after birth. This, compounded with the lack of sleep and self-care that often comes with caring for a newborn, can lead to depression. 

Related to postpartum depression is perinatal depression, where symptoms show while still pregnant. 

Premenstrual Dysphoric Disorder

Also called PMDD, this form of depression is seen as a more extreme form of PMS, or premenstrual syndrome. Typically, women who experience PMDD will experience a depressive episode or anxiety around two weeks before their period. It usually goes away after their cycle.

Those who have PMDD will usually have a dual diagnosis of some form of ongoing depression or anxiety.

Atypical Depression

Usually, when someone is having a depressive episode, they experience “dark” feelings the whole time, where things that would normally bring joy do nothing for them. This is not true for someone with atypical depression.

Atypical depression exhibits in much the same way as most other types, with feelings of emptiness and sadness. The difference is that these feelings can dissipate with positive, happy stimuli. 

Depressive episodes typically end quickly, but atypical depressive episodes are interrupted by happy events, and patients with this type of depression tend to respond very well to treatment.

Risk Factors of Depression

Sometimes, traumatic events can trigger depression. In those cases, it usually happens to a person who is already predisposed to depression. Some people are at higher risk for developing a depressive disorder than others.

Genetic Risks of Depression

The role of genetics in depression is not yet fully understood. There have been certain connections found, but researchers have noted a need for more tests before proving an association with DD.

That being said, genes play a role in many mental health disorders, and there may be some connections to depression.

Other Mental Health Disorders

Unfortunately, health issues tend to show up in groups. Someone is at a higher risk of having a depressive disorder if they’ve been diagnosed with another mental health disorder. 

Anxiety and depression are often co-occurring, or comorbid. In fact, half of those diagnosed with anxiety will also be diagnosed with depression.

Causes of Depressive Episodes

Like other physical health problems, biology is responsible for many of the underlying causes of depression. Those who are predisposed to it can work to prevent depressive episodes, and learning what causes it may help you find effective coping mechanisms.

Brain Chemistry

Brain chemistry is responsible for the brain systems that directly lead to depression-related chemical imbalances. However, they are still considered a risk factor for developing depression, not a cause.

When the neurotransmitters that trigger our brain’s reward systems and positive emotions are out of whack, they can cause depression. Unfortunately, some people naturally have lower levels of these neurotransmitters or receptors.

Trauma and Stressful Events

Whether in childhood or adulthood, trauma can have lasting effects. Events like the death of a loved one or abuse can trigger a depressive episode in a person who might not otherwise have had one before. 

Trauma can mean anything from big, life-threatening events to seemingly smaller, but consistently damaging actions over time. Depending on brain chemistry and risk factors, several traumatic events could trigger depression.

Hormones

PMDD and postpartum depression are the types of depression most people think of first when talking about the connection between hormones and depression.

Studies have shown that estrogen and progesterone can affect parts of the brain that are also responsible for mood regulation. They share some of the same receptors as those ‘happiness’ hormones.

Those who experience postpartum or perinatal depression are at a higher risk of developing clinical depression later on. Women are nearly twice as likely to be diagnosed with depression as men. 

While that number may be skewed by an unjust perception of men with mental health issues, there is a link to certain sex hormones and the likelihood of depression.

Women are nearly twice as likely to be diagnosed with depression as men.

Common Depression Comorbidities

Serotonin, dopamine, and norepinephrine are the top mood regulators in the brain. If the systems that conduct these neurotransmitters are “off,” they can affect the brain in a few different ways:

Anxiety

Certain anxiety disorders have up to a 70% comorbidity rate with depression. Anxiety and depression, for example, are closely linked to each other and to low levels of norepinephrine. 

Most doctors agree that depression and anxiety are cyclical. Anxiety can be triggered by worrying about behaviors when you’re depressed, and depression can be triggered by the feelings of helplessness associated with anxiety.

Addiction

Substance Use Disorders (SUDs) are also closely linked to depression. It’s not uncommon for people with depression to turn to alcohol or other substances to cope.

Just as stressful events can trigger a depressive episode, so can addiction or substance use. Most drugs affect the reward center of the brain, which involves dopamine. Once the substance is out of your system, your brain is depleted of dopamine. Thus, the physiological reaction to and the psychological effects of substance abuse can send someone who is at risk into depression.  

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Treatment Options for Depression

Luckily, depression has been heavily researched, and treatment is more easily accessed than ever. Therapy and medication are two of the most common and most researched methods for effective treatment. 

Therapy

One common type of therapy to treat depression is called Cognitive Behavioral Therapy, or CBT. In a sense, CBT ‘rewires’ your brain. Learning how to replace negative, emotional thoughts with rational ones helps those with depression to adjust their “knee-jerk reactions,” behaviors, and emotions toward stimuli.

Some therapists may recommend Dialectical Behavioral Therapy (DBT). This therapy shares some similarities with CBT; however, it also incorporates mindfulness and interpersonal effectiveness. 

Each person should be treated on an individual level. What is helpful for one person might not do much for another. Be honest with yourself and your therapist about your progress. It’s ok if treatment isn’t working and you need to try something different.

Medication

Usually reserved for moderate-to-severe cases of depression, certain medications—under professional medical supervision—can be an effective treatment option.

The most common medications are selective serotonin reuptake inhibitors, or SSRIs. These essentially block your brain’s ability to take back serotonin, leaving it available to your brain to boost your mood.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also common. They allow serotonin and norepinephrine to remain in your system. Regulating norepinephrine also means it can be effective at treating comorbid anxiety and depression.

If those medications prove ineffective, your doctor may prescribe tricyclic antidepressants. Though they work in a slightly different way, the goal is still to keep serotonin and norepinephrine in your brain.

Find Freedom At Sequoia Behavioral Health

Depression can be debilitating and challenging to face by yourself. You may find yourself having difficulty sleeping or sleeping too much, having issues in your relationships, no longer finding interest in things you once enjoyed, or having feelings of harming yourself. 

Please do not attempt to battle depression on your own. Our clinically-trained psychologists and behavioral health professionals are experienced working with people with depression, and can develop a personalized treatment plan to help you recover. 

Reach out and let us help guide you down the road to a brighter day.