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Depression

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• What is depression?

  

  Let me start by dispelling the notion that depression is just feeling sad or having a bad day. Sadly, it’s much more complicated than that.

  It’s a complex mental health disorder characterized by a persistent feeling of sadness and loss of interest in once-enjoyable activities. This condition can interfere with daily functioning, relationships, and overall quality of life.

  It occurs when the neurotransmitters serotonin or dopamine (molecules that signal a message to another cell, muscle, or gland) are out of whack. Of course, it can also result from both hormones being unbalanced simultaneously.

  And while both are considered our “happiness molecules”, they have some distinct differences.

  • Serotonin helps to regulate our temperament, appetite, sleep, and social behavior. Thus, it’s critical to establish a pleasant mood. Poor serotonin regulation typically expresses itself as a lack of enthusiasm for activities and things that were previously entertaining. This can range from hobbies, relationships, and food, to work. It can also cause insomnia, anger, and binge-eating.
  • Dopamine’s primary function is to stimulate our body and mind to act. It regulates our pleasure-reward system. Dopamine dysregulation is regularly expressed as a lack of motivation, apathy, and a general sense of hopelessness. That’s why people suffering from dopamine-related depression regularly try to counteract that imbalance by self-medicating with substances and activities that release dopamine in the brain. Think of actions such as watching an excessive amount of porn, binge-drinking alcohol, a lot of coffee, or engaging in risky, yet exciting behavior such as gambling.

  The clinical term for depression is Major Depressive Disorder (MDD), but it can also manifest in various forms, such as Persistent Depressive Disorder (PDD), which is a long-term (chronic) form of depression. Another type is bipolar disorder, which includes episodes of depression alternated with periods of mania or hypomania.

  Robert Lustig, MD and author of the book, “The Hacking of the American Mind”, considers the neurotransmitters dopamine and serotonin to be the neurological pathways of pleasure and dopamine respectively.

• Am I depressed?

  

  It can be hard to recognize depression. Especially if you don’t know precisely what the symptoms are. It also doesn’t help that depression and sadness can be hard to distinguish from each other, especially to the untrained eye.

  It’s a disease that’s on the rise in the entire world for various reasons.

  If you are wondering whether you’re depressed or not, then the DSM-5 criteria can guide you towards a general idea. But beware, only a healthcare professional can properly and officially diagnose you.

  Depression is typically officially diagnosed by a mental health professional, such as a psychiatrist or psychologist.

  That’s done through a combination of methods like interviews, standardized assessments, and observations.

  Here’s how the process generally works:

  1. Clinical interview

  • • The professional will talk with the individual about their symptoms, which may include persistent sadness, lack of interest in usual activities, fatigue, sleep changes, changes in appetite, and feelings of guilt or worthlessness.

  They’ll discuss how long these symptoms have been present, how intense they are, and how much they affect daily functioning.

  They’ll review medical history, family history of mental health issues, and any potential stressors or life events that might be contributing factors to these psychological difficulties.

  2. Standardized questionnaires

  • • Structured tools such as the PHQ-9 (Patient Health Questionnaire-9) or Beck Depression Inventory (BDI) can help measure how severe a person’s symptoms are.

  These surveys provide a score indicating symptom severity and can assist the clinician in deciding if the criteria for depression are met.

  3. Diagnostic criteria (DSM-5)

  • • The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) is typically used to assess if an individual meets the criteria for a major depressive disorder (MDD) or another depressive disorder in the United States.

  For a verdict of MDD, symptoms should persist most of the day, nearly every day, for at least two weeks, and include at least five of the DSM-5-specified symptoms, such as depressed mood, loss of interest, sleep problems, and low energy.

  4. Differentiating from other conditions

  • • The physician will rule out other possible causes of symptoms, such as other mental health disorders (e.g., anxiety disorders, bipolar disorder) or medical conditions like thyroid disorders or vitamin deficiencies.

  They may refer the individual for lab tests or consult with other healthcare providers to rule out physical health causes if needed.

  5. Assessing functional impairment

  • • Depression is also assessed based on how much it impairs an individual’s daily life, relationships, and responsibilities. This includes work and social life.

  Several other tools and techniques can aid in diagnosing depression in addition to the typical clinical interviews, questionnaires, and diagnostic criteria.

  Although these are not as widely used for making a primary diagnosis, they can still help support or confirm a diagnosis, especially in complex cases.

  Here are some additional approaches:

  6. Self-reported symptom tracking
     
     

  • • Tools like mood diaries or apps (e.g., Moodpath, Daylio) allow individuals to record their symptoms over time.

      These logs can be extremely valuable since they may reveal symptom patterns, triggers, and even the effectiveness of treatments. All these things can provide helpful information for doctors.

  7. Neuroimaging and brain Scans

  • • Neuroimaging is not used in routine clinical practice, but research has shown that people with depression regularly show specific patterns in brain activity, especially in areas like the prefrontal cortex and amygdala.

      Functional MRI (fMRI) and PET scans are being explored in research to improve our understanding of the biological underpinnings of depression. Hopefully, these advances in modern healthcare may one day assist in making an easier and more accurate diagnosis.

  8. Genetic testing

  • • In cases where treatment resistance is an issue, genetic testing can provide insights into how an individual may metabolize certain antidepressants.

      Although not a diagnostic tool, it helps to personalize treatment by predicting how a person will respond to certain medications.

  9. Blood tests for biomarkers (experimental)

  • • There is research going on to identify biological markers of depression, such as inflammation markers, cortisol levels, and BDNF (brain-derived neurotrophic factors).

      Blood tests for these biomarkers are not part of routine practice yet since it’s still experimental but may be used in research settings.

  10. Electroencephalogram (EEG)

  • • EEGs are sometimes used in research, but in some cases, in clinical settings as well, to observe brain wave activity patterns that may be associated with depression.

      EEG-based tests like PEER (psychiatric EEG evaluation registry) give information that can help in predicting a person’s response to treatment.

  11. Behavioral and cognitive testing

  • • Some clinicians like to use tests that measure cognitive function (e.g., memory, attention) and reaction times to identify cognitive changes that often accompany depression.

      Cognitive symptoms such as reduced concentration and slowed thinking can be diagnostic clues.

  12. Observations by family members or friends

  • • Loved ones often notice changes that the average individual may not see.

      This information is critical to doctors as it brings a broader view of symptoms and their impact on daily functioning, especially in cases where the affected person may underreport or be unaware of their symptoms.

  13. Biopsychosocial assessments

  • • Physicians may evaluate the social and environmental factors affecting a person’s mood. Think of components like trauma history, lifestyle, relationships, and job stress.

      Understanding these aspects helps to determine how much external factors may be contributing to depressive symptoms.

      While these methods alone aren’t enough to diagnose depression, they add depth and context, contributing to a more accurate and comprehensive diagnosis.

      As such, it’s still useful to use them in conjunction with the primary methods to diagnose whether someone is depressed or not.

  DSM-V depression criteria
  
  

  DSM-5 outlines the following criteria to make the diagnosis of depression:

  • The individual must be experiencing five or more symptoms during the same 2-week period, and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
  • A minor depressive episode is characterized by 2–4 symptoms during the same 2-week period, and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
  • To receive the diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

  Primary DSM-5 depression disorders: criteria for adults

  Depressive diagnoses:	Symptoms:
  Major depressive episode: 5 or more depressive symptoms for ≥ 2 weeks. Must have either a depressed mood or loss of interest/pleasure. Symptoms must cause significant distress or impairment. No manic or hypomanic behavior. Minor depressive episode:* 2–4 depressive symptoms for ≥2 weeks. Must have either a depressed mood or loss of interest or pleasure. Symptoms must cause significant distress or impairment. No manic or hypomanic behavior.	Depressed mood most of the day, nearly every day. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Significant weight loss when not dieting, or weight gain, or a decrease/increase in appetite nearly every day. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down). Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt nearly every day. Diminished ability to think or concentrate, or indecisiveness, nearly every day. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide.
  Dysthymic disorder: Depressed mood for most of the time for at least two years. Presence of 2 or more symptoms of dysthymia. Never without symptoms for 2 months or more over 2 years. Symptoms must cause clinically significant distress or impairment. No major depressive disorder in the first two years, no manic, hypomanic, or mixed episodes.	Significant weight loss (or poor appetite) or weight gain. Insomnia or hypersomnia. Fatigue or loss of energy. Low self-esteem. Diminished ability to think or concentrate, or indecisiveness. Feelings of hopelessness.

  *Not a formal diagnosis, but considered a research category requiring further study.

  What does the DSM-5 stand for?

  DSM stands for “Diagnostic and Statistical Manual of Mental Disorders”. The V stands for the fifth edition of said handbook.

  In other words, it is a scientifically based classification system for mental and emotional disorders like depression, eating disorders, obsessive-compulsive personality disorders, and many other illnesses.

  It is used as a diagnostic tool for mental health assessments to determine if someone is suffering from a psychological disorder or not.

  Various healthcare professionals from all over the world, such as psychotherapists, clinicians, and psychiatrists, employ this tool to determine if someone is suffering from a mental disorder or not.

  Can you self-diagnose depression?
  

  Self-diagnosing depression can be difficult and risky because depression is a complex mental health condition with symptoms that can vary from person to person. However, there are self-assessment tools, such as questionnaires and online screenings, that can help identify potential symptoms that you might be suffering from depression or another mental disorder. Still, they cannot replace a professional evaluation since they’re educated to administer these tests.

  These self-evaluation tools are not intended to provide a formal diagnosis, but can give you a general sense of whether you should seek professional help. Here are a few of the most used models and tests:

  1. PHQ-9 (Patient Health Questionnaire-9)

  • • Purpose: Measures the severity of depression based on the nine criteria used in diagnosing major depression.
    • How it works: You rate the frequency of symptoms such as sadness, fatigue, changes in sleep or appetite, and feelings of hopelessness over the past two weeks. Each symptom is scored from 0 (“not at all”) to 3 (“nearly every day”).
    • Scoring: Scores range from 0 to 27, with higher scores indicating more severe depression.
      • 0-4: Minimal depression.
      • 5-9: Mild depression.
      • 10-14: Moderate depression.
      • 15-19: Moderately severe depression.
      • 20-27: Severe depression.

  2. Beck Depression Inventory (BDI)

  • • Purpose: Assesses the intensity of depression.
    • How it works: Consists of 21 multiple-choice questions that cover mood, behavior, and physical symptoms.
    • Scoring: Each question is scored from 0 to 3, leading to a total score between 0 and 63.
      • 0-13: Minimal depression.
      • 14-19: Mild depression.
      • 20-28: Moderate depression.
      • 29-63: Severe depression.

  3. Zung Self-Rating Depression Scale (SDS)

  • • Purpose: Measures the severity of depression symptoms.
    • How it works: A 20-item self-report questionnaire that covers cognitive, emotional, and physiological symptoms of depression. Each item is rated on a scale from 1 (“a little of the time”) to 4 (“most of the time”).
    • Scoring: The scores are converted into an index, which classifies depression as:
      • 25-49: Normal.
      • 50-59: Mild depression.
      • 60-69: Moderate to marked depression.
      • 70 and above: Severe depression.

  4. Hamilton Depression Rating Scale (HAM-D)

  • • Purpose: Used in clinical settings but can be administered in a simplified version for self-assessment.
    • How it works: Evaluates mood, feelings of guilt, insomnia, agitation, anxiety, weight loss, and somatic symptoms. It’s more often used by clinicians but can be found in online self-assessment forms.
    • Scoring: Higher scores indicate more severe depression.

  5. Center for Epidemiologic Studies Depression Scale (CES-D)

  • • Purpose: A screening tool for depression in the general population.
    • How it works: A 20-item scale designed to measure depressive symptoms in the past week.
    • Scoring: Scores range from 0 to 60. A score of 16 or higher suggests the need for further evaluation.

  Limitations of self-diagnosis tools:
  

  While self-diagnosing can be an accessible and convenient way of examining yourself, it does have some potential key downsides.

  • Screening, not diagnosis: These tools can suggest that you might have depression, but they cannot replace a clinical evaluation.
  • Lack of context: A clinician can consider your personal history, lifestyle, and other factors that a test cannot assess.
  • Risk of misinterpretation: It’s easy to misunderstand or over-interpret the results, especially if you’re distressed.

  If you score in a range that suggests moderate or severe depression, then it’s recommended to seek the aid of a professional mental healthcare provider. These examinations can be a helpful first step to figuring out if something is wrong, but depression should always be diagnosed by a professional. They can also help by providing you with the appropriate individual treatment and guidance throughout the whole process.

  Conclusion

  The DSM-5 can be used as an effective diagnostic tool by health professionals to determine if someone is suffering from a mental illness or not.

  However, it’s typically too complex for most untrained individuals to be used as a self-test tool with absolute certainty. Still, it can provide you with some general idea of whether you’re suffering from depression or not.

  Make sure to seek help from a professional, as well as close friends and family, if you suspect that you’re currently suffering from depression or another mental illness! It’s a battle that you don’t have to fight alone. I have sought assistance from others before when I was suffering, and I can honestly say that it helped me a lot!

• What are the symptoms of depression?

  

  Depression can express itself in a variety of emotional, physical, and cognitive symptoms that can vary widely among individuals.

  Nevertheless, it’s typically expressed by persistent sadness, hopelessness, and a loss of interest in previously enjoyable activities.

  Learning to recognize these indications is critical for a quick diagnosis and appropriate treatment, which has been shown to lead to better mental health outcomes.

  Here are some common symptoms:

  1. Emotional symptoms

  • • Persistent sadness or feeling empty.
    • Loss of interest in activities once enjoyed (anhedonia).
    • Feelings of guilt or worthlessness, often accompanied by low self-esteem.
    • Hopelessness or pessimism about the future.
    • Irritability or frustration, even over small, insignificant matters.
    • Feeling emotionally “flat” or numb, where a person might feel detached or unable to experience positive or negative emotions fully.
    • Loss of connection to others, with feelings of isolation even in social settings.
    • Worry and anxiety, which can often coexist with depression, are known as anxious distress.
    • Restlessness or feeling “on edge”.
    • Feeling like a burden or thinking that others would be better off without them.
    • Feeling “stuck” or trapped, as though unable to make changes.
    • Loss of motivation to initiate tasks, often even for simple daily routines.
    • Difficulty regulating emotions, which can lead to sudden outbursts or crying.

  2. Physical (somatic) symptoms

  • • Changes in sleep patterns (insomnia or oversleeping).
    • Appetite changes, often resulting in weight loss or gain.
    • Fatigue or decreased energy, making even daily tasks feel exhausting.
    • Physical aches and pains without a clear cause.
    • Decreased sex drive.
    • Digestive problems, such as stomachaches, nausea, or constipation, often occur without a physical cause.
    • Headaches or migraines that are stress-related.
    • Increased sensitivity to noise or light, which can feel overwhelming.
    • Altered taste or smell, with food sometimes tasting “bland” or unappealing.
    • Reduced pain sensitivity or sometimes increased sensitivity, depending on the individual.
    • Difficulty waking up in the morning or a preference for staying in bed.
    • Nighttime restlessness and difficulty settling down, even when tired.

  3. Cognitive symptoms

  • • Difficulty concentrating or making decisions.
    • Memory issues or trouble recalling details.
    • Negative thinking patterns and self-criticism.
    • Thoughts of death or suicide (typically more common in severe depression).
    • Rumination, or constant overthinking, often about past mistakes or perceived failures.
    • Catastrophic thinking, imagining the worst possible outcomes.
    • Perfectionism can contribute to feelings of inadequacy and self-blame.
    • Intrusive, repetitive thoughts about negative or distressing topics.
    • Black-and-white thinking, where situations are viewed in extremes (everything is either “amazing” or “horrible”).
    • Blaming oneself excessively for things outside of one’s control.
    • Feeling detached from reality or experiencing a sense of “unreality” (depersonalization).

  4. Behavioral symptoms

  • • Withdrawing from social interactions or isolating from friends and family.
    • Neglecting responsibilities at work, school, or home.
    • Reduced motivation to engage in previously enjoyable activities or complete daily tasks.
    • Substance abuse or increased alcohol or drug use, often as a way to manage feelings of despair.
    • Slowed movements or speech (psychomotor retardation).
    • Pacing, fidgeting, or an inability to sit still due to anxiety.
    • Difficulty with communication, struggling to express thoughts or feelings clearly.
    • Becoming overly dependent on others for reassurance and support.
    • Avoiding intimate relationships, sometimes because of feelings of inadequacy.
    • Reckless behavior, like risky driving or impulsive decisions, may be a sign of distress.
    • Lack of interest in self-care activities, such as bathing, grooming, or changing clothes.

  5. Spiritual or existential concerns

  • • Questioning the purpose of life or feeling that life lacks meaning.
    • Loss of spiritual faith or practice (if it was a previous part of the person’s life).
    • Increased focus on mortality or existential themes, such as the meaning of suffering.

  Early warning signs of depression

  Fortunately, there are some early warning signs that you might be suffering from depression.

  Recognizing these initial elements can be crucial in seeking help early and managing symptoms before they worsen.

  These are the most common early warning signs of depression:

  1. Persistent sadness or low mood
     
     

  • • A feeling of sadness, emptiness, or hopelessness that lingers for days or even weeks.

  2. Loss of interest in daily activities

  • • A decreased interest in hobbies, socializing, or activities that used to bring joy and happiness.

  3. Changes in appetite and weight

  • • Significant weight loss or gain, or changes in appetite (eating much more or less than usual).

  4. Sleep disturbances

  • • Trouble falling asleep, staying asleep, or sleeping excessively.

  5. Fatigue and low energy

  • • Persistent tiredness, even after rest, and a lack of motivation to complete tasks.

  6. Increased irritability or agitation

  • • Feeling restless, agitated, or angry without a clear reason.

  7. Difficulty concentrating and making decisions

  • • Problems with memory, focusing, or decision-making can affect daily functioning.

  8. Feelings of guilt or worthlessness

  • • A sense of excessive guilt or self-blame, or feeling as though one is a burden to others.

  9. Physical aches and pains

  • • Unexplained physical symptoms like headaches, stomachaches, or muscle pain without a definite cause.

  10. Social Withdrawal

  • • Avoiding social interactions, pulling away from friends or family, and isolating oneself.

  Conclusion

  These subtle or complex symptoms highlight how depression can affect every area of life, sometimes in ways that aren’t immediately apparent.

  That’s why I believe we need a multifaceted treatment plan that “attacks” the disorder from all fronts, instead of relying solely on medication or therapy. It’s beneficial to collaborate with a professional if you’re suffering from severe depression since they can help provide insight into your experiences and explore treatment options for managing symptoms, but more importantly, the cause of the issue.

• What causes depression?

  

  Depression can have multiple causes, but most of the time, it’s a combination of:

  • Biological factors.
  • Social factors.
  • Psychological factors.

  The following review showed many determinants at work, such as inflammatory reactions, social and psychological factors, the microbiome, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. It indicates that physical issues may be proximal causes of depression, which can cause distal social factors such as social capital, environmental circumstances, and isolation.

  The World Health Organization, the Marmot Report, and Compton et al. conclude that people who are most socioeconomically disadvantaged in society face the most discomfort and difficulty. That comes as no surprise to me, seeing as having less money than average means having access to fewer or less-than-adequate resources like proper housing, food, and even clothing. At the end of the day, we all have bills to pay.

  This inequality in resources leads to worse outcomes for those who are less privileged.

  People who don’t have much social support, no early emotional attachments to others, or access to resources such as water, food, and proper nutrition have a higher chance of contracting a mental disorder such as depression.

  And finally, the timing of the events is also critical for our mental health. Early life is the most important because our mental faculties develop when we are young. That’s why experiencing damaging affairs such as stress in our youth can lead us down the path of depression during adulthood or later in life.

  This alone will not necessarily cause depression, but combined with a genetic predisposition can greatly increase the risk.

  Other risk factors include:
  

  • Genes: Depression regularly runs in families. Thus, a family history of depression can increase the risk of developing it yourself.
  • Gender: Women are twice as likely as men to become depressed.
  • Older people have a higher chance of getting depressed due to more frequently lacking appropriate social support, being less mobile, and having a higher chance of living alone.
  • Frequent conflicts with other people.
  • The loss or death of a loved one.
  • Personal problems, such as social isolation or other mental disorders.
  • Experiencing sexual, emotional, and physical abuse.
  • Major life events such as losing your job, retiring, getting divorced, or graduating from school.
  • Substance abuse, such as alcoholism.
  • Certain medications can increase the risk of becoming depressed.

• There's different types of depression?

  

  Depression is a multifaceted mental health condition characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities that were enjoyable in the past.

  It can be classified into various types in psychology, each with distinct features, causes, and treatment approaches. Understanding these different categories can aid in making an accurate diagnosis and effective management.

  Below are the primary types of depression recognized in the field:

  1. Major depressive disorder (MDD)

  Also known simply as major depression, it’s characterized by a persistent feeling of sorrow or a lack of interest in outside stimuli.

  To be diagnosed with MDD, symptoms must last for AT LEAST two weeks and represent a change from previous functioning. Common issues include:

  • • Significant weight loss or gain.
    • Insomnia or hypersomnia.
    • Fatigue or loss of energy.
    • Feelings of worthlessness or excessive guilt.
    • Difficulty concentrating or making decisions.
    • Recurrent thoughts of death or suicide.

  2. Persistent depressive disorder (PDD)

  Formerly known as dysthymia, PDD involves a chronic form of depression with less severe symptoms than MDD but lasting for a longer period, typically at least two years.

  Individuals may experience episodes of major depression along with periods of less severe symptoms, leading to a “double depression” scenario.

  3. Bipolar disorder

  While primarily classified as a mood disorder, bipolar disorder involves episodes of depression alternating with periods of mania or hypomania.

  The depressive episodes share similarities with MDD, including persistent sadness and loss of interest, but are distinguished by the presence of manic phases.

  4. Seasonal affective disorder (SAD)

  SAD is a type of depression that occurs at a specific time of year, usually in the fall and winter months, when daylight hours are shorter.

  Symptoms often improve with the arrival of spring and longer daylight periods. Light therapy is a common treatment for SAD that can provide some relief.

  5. Postpartum depression
     
     

  This form of depression can occur in women after giving birth. It is more severe than the “baby blues” and can interfere with a mother’s ability to care for her child and handle daily tasks.

  Common symptoms include extreme sadness, anxiety, exhaustion, and changes in sleeping or eating patterns.

  6. Psychotic depression

  Includes symptoms of psychosis, such as delusions or hallucinations.

  The psychotic symptoms typically have a depressive “theme,” such as intense feelings of guilt or worthlessness.

  7. Atypical depression

  Atypical depression is characterized by mood reactivity (moods can improve in response to positive events) and specific symptoms like:

  • • Increased appetite or weight gain.
    • Excessive sleep.
    • A heavy feeling in the limbs.
    • Strong sensitivity to rejection.

  8. Premenstrual dysphoric disorder (PMDD)

  PMDD is a severe form of premenstrual syndrome (PMS) with marked mood swings, irritability, depression, and anxiety occurring during the luteal phase of the menstrual cycle.

  These symptoms significantly interfere with daily functioning.

  9. Disruptive mood dysregulation disorder (DMDD)

  DMMD is primarily diagnosed in children and adolescents.

  It’s characterized by chronic, severe irritability and frequent temper outbursts disproportionate to the seriousness of the situation at hand.

  10. Situational (adjustment) depression

  This can happen in response to a specific, identifiable life event or stressor, such as the loss of a loved one, divorce, or job loss, for example.

  Symptoms are similar to MDD but are directly related to the triggering event and typically improve once the individual adapts to the change.

  11. Double depression

  Double depression means the manifestation of major depressive episodes on top of persistent depressive disorder (dysthymia).

  Individuals experience chronic depressive symptoms with intermittent episodes of more severe depression.

  12. Agitated depression
      
      

  Agitated depression is defined by harsh restlessness, agitation, and anxiety alongside typical depressive symptoms.

  Afflicted individuals may exhibit extreme irritability, pacing, or even an inability to sit still.

  There are a few other specialized forms and subtypes of depression that are less commonly discussed, but are still important within psychology and psychiatry.

  These subtypes often overlap with broader categories but have specific features or occur under certain conditions:

  1. Treatment-resistant depression

  This term refers to depression that does not respond adequately to standard treatments, such as antidepressants or psychotherapy.

  Symptoms of treatment-resistant depression are the same as major depressive disorder, but the key feature is the lack of response to at least two different treatments.

  Treatment often requires alternative treatments like electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or ketamine infusions.

  2. Depression with catatonia

  A rare form of depression that includes symptoms of catatonia, which is characterized by motor immobility or excessive purposeless movement.

  Individuals may exhibit extreme physical rigidity, stupor, or repetitive movements, alongside the typical symptoms of depression.

  Regularly treated with medications like benzodiazepines or ECT in more severe cases.

  3. Endogenous depression

  This term was historically used to describe depression that arises from within the individual and is thought to have a biological or genetic cause, rather than being triggered by external stressors.

  Symptoms are similar to those of a major depressive disorder but with a stronger focus on biological origins (e.g., disruptions in brain chemistry).

  This term is less commonly used today, but it highlights depression, which is believed to have a more significant biological component.

  4. Exogenous (reactive) depression

  In contrast to endogenous depression, exogenous depression is triggered by external events or stressors, such as the death of a loved one, job loss, or divorce.

  Symptoms are comparable to major depressive disorder, but closely tied to a precise external cause.

  Although these terms (endogenous vs. exogenous) are somewhat outdated, they still underscore the importance of understanding whether depression is more biologically driven or situational.

  5. Masked depression

  A form of depression in which the typical symptoms (such as sadness and hopelessness) are hidden or “masked” by other complaints, often physical (somatic) symptoms.

  Affected people may report physical symptoms like headaches, digestive issues, or chronic pain, rather than emotional distress. These individuals may not report feeling sad, but they experience depression through other symptoms.

  Addressing both the physical complaints and underlying depression is crucial for remedying said illness.

  6. Substance-induced depressive disorder
     
     

  This type of depression is directly related to the use of alcohol, drugs, or medications, or during withdrawal from them.

  Depressive symptoms appear during or shortly after substance use and may include mood disturbances, irritability, and sadness.

  The cure for this ailment focuses on stopping substance use and addressing the symptoms through therapy or medication.

  7. Depression due to a medical condition

  This can happen when a medical illness or condition causes depressive symptoms.

  Frequent medical conditions associated with depression include chronic illnesses such as cancer, heart disease, Parkinson’s disease, and thyroid disorders.

  The symptoms can mimic those of other depressive disorders, but they are typically linked to the presence or progression of the medical condition.

  8. Perinatal depression

  This type of depression occurs during pregnancy or within the first year after childbirth. Postpartum depression, which occurs after delivery, is a subset of perinatal depression.

  Symptoms can include severe mood swings, anxiety, feelings of detachment from the baby, or guilt about parenthood.

  Treatment typically involves therapy, support groups, and, in some cases, medication.

  9. Depression with mixed features

  A subtype of depression where an individual experiences some symptoms of mania or hypomania (e.g., irritability, restlessness, increased energy) during a depressive episode, but not enough to qualify as bipolar disorder.

  They regularly experience mood swings, agitation, and risk-taking behavior while going through symptoms of depression at the same time.

  As we can see, these additional subtypes and special cases show the wide variability in how depressive symptoms can manifest.

• Evidence based depression treatments?

  

  It only makes sense to employ a multifaceted treatment approach since depression impacts so many aspects of our daily lives.

  It influences our motivation, sleeping patterns, thoughts, mood, etc. Thus, we must attack this mental illness from several angles by combining multiple treatment options, in my opinion.

  How to care for depression depends on individual circumstances and the severity. The more depressed you are, the larger the combination of approaches is typically necessary.

  These are the most common techniques that are typically employed:

  1. Psychotherapy (professional talk therapy)

  • • Cognitive behavioral therapy (CBT): CBT is effective at handling depression by identifying negative behaviors in addition to incorrect thinking patterns. It then rephrases these flawed actions and opinions into more accurate, positive notions.

      In short, unhelpful performances are stopped or changed to benefit the individual.

    • Psychodynamic therapy (PDT): Explores unconscious patterns, behaviors, and past experiences that can negatively affect our lives without our knowledge.

      Although it can be helpful, one glaring disadvantage of PDT is that it can be hard to isolate the effectiveness of the therapy because of the constraints of measurable interventions, since it focuses on unconscious patterns and past experiences.

    • Interpersonal therapy (IPT): Focuses on improving relationships and communication with friends, family, and acquaintances. This is important because people are social animals who need social stimulation to be and remain content and healthy.

      This meta-analysis shows its effectiveness both as a standalone treatment and in combination with others.

  • • Mindfulness-based cognitive therapy (MBCT): Combines CBT techniques with mindfulness exercises to prevent relapses in recurrent depression.

      It’s been shown to be notably effective for those with a history of multiple depressive episodes.

    • Behavioral activation: Encourages engagement in activities that bring joy or a sense of accomplishment.

      This is helpful since motivation and positive emotions tend to drop when depressed, meaning we need every optimistic experience we can get to keep us going. It also breaks the cycle of inactivity and withdrawal.

  • • Acceptance and commitment therapy (ACT): Focuses on accepting negative thoughts and feelings rather than avoiding them and committing to actions aligned with personal values.

      I think this works because avoiding things and events that you know you should tackle might reduce feelings of anxiety in the short term, but it doesn’t eliminate those emotions. Thus, the issues grow larger over time, and the mental strain remains present unconsciously.

      This study suggests that ACT aids in reducing depressive symptoms in the short term and in those who are mildly depressed. Still, more research is necessary for moderate to severe depression and a longer follow-up period.

      This is effective for mild to moderate depression, especially when accompanied by chronic stress or anxiety. It helps lower avoidance behaviors and enhances psychological flexibility.

  • • Dialectical behavior therapy (DBT): DBT was originally developed for borderline personality disorders and includes mindfulness, emotional regulation, and distress tolerance.

      It’s beneficial for depression in individuals with co-occurring emotional dysregulation or self-harming behaviors.

  • • Problem-solving therapy (PST): Problem-solving therapy is a structured approach that aims to help people develop coping skills to tackle specific problems and stressors they experience. In return, reducing feelings of helplessness and improving your overall mood due to having less tension.

      Problem-solving therapy is just as effective as other medications and psychosocial interventions, and much more beneficial than receiving no treatment.

  • • Exposure therapy: Gradual exposure to avoided situations or stimuli that maintain the depression.

      It’s most effective for depressive symptoms related to avoidance behaviors or simultaneous anxiety disorders.

  2. Positive lifestyle changes
     
     

  • • Exercise: Physically exerting ourselves aids in improving our mood because it releases endorphins, which can be considered our “happiness” hormones. It also helps to clear our minds of negative thoughts and the more stressful parts of life.

      This systematic review states that exercise has a clear therapeutic effect on depression in people of all ages, making it a great natural way to stave off and treat mental illnesses.

    • Sleep hygiene: One of the most critical things we can do to improve our mood is getting our much-needed, uninterrupted hours of sleep. Many people, even those who are not suffering from depression, don’t realize just how sleep-deprived they are.

      Yet, it’s essential to establish a regular sleep schedule to help regulate our mood and overall health. Impaired sleep can be a symptom of depression, but also be a risk factor. This can make it hard in some cases to decipher whether it caused the mental disorder or if it’s merely a result of the issue.

    • Healthy diet: Our diet not only has a significant influence on our physical appearance, but it also impacts our mental health. That’s why we should aim to limit unhealthy, pro-inflammatory foods such as greasy, processed foods, and liquids such as soda. A Mediterranean-style diet, with an emphasis on fruits, vegetables, whole grains, and lean proteins, has shown promise in reducing depression symptoms.
    • Avoid alcohol and drugs: Drugs such as alcohol can make depression worse, especially the day after consuming them when the effects wear off. There is even research that suggests the possibility that drugs can cause depression, although the evidence is suggestive and not conclusive.

      Yet, many people suffering from a mental disorder turn to these substances unconsciously in an attempt to self-medicate. And while this can make them feel better in the present, it will end up having a negative effect in the end.       

    • Stress reduction: Practices like yoga, meditation, and breathing exercises are extremely useful mindfulness-based techniques to lower stress and reduce depressive symptoms.

  3. Medication
     
     

  • • Antidepressants: Antidepressants such as SSRIs (Prozac, Zoloft) and SNRIs (Effexor, Cymbalta) can be used to help regulate brain chemistry since depression involves a problem with dopamine and serotonin.

      Multiple studies have shown that the effectiveness of antidepressants depends on the severity of the depression. The more severe, the better the results typically are.

  Never start using medication without consulting a doctor, since you need a prescription for most and because some can potentially be dangerous when misused or abused.

  • • Selective serotonin reuptake inhibitors (SSRIs): Medications like Fluoxetine (Prozac), Sertraline (Zoloft), and Escitalopram (Lexapro) are regularly used as a first-line treatment for moderate to severe depression.

      They’re effective with relatively few side effects.

    • Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs such as Venlafaxine (Effexor) and Duloxetine (Cymbalta) are useful for depression with co-occurring anxiety or chronic pain.
    • Atypical antidepressants: Antidepressant drugs like Bupropion (Wellbutrin) and Mirtazapine (Remeron) are helpful for specific symptoms such as low energy (bupropion) or insomnia (mirtazapine).
    • Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs): Amitriptyline (TCA) and Phenelzine (MAOI) are both valuable but typically reserved for treatment-resistant cases due to side effects.
    • Adjunctive medications: Lithium, atypical antipsychotics (aripiprazole), and thyroid hormones are frequently used in combination for treatment-resistant depression.

  • • Mood stabilizers and antipsychotics: Sometimes used and necessary for more severe cases or in combination with antidepressants when at risk for self-harm or when the symptoms are too harsh to function properly.

  4. Support networks

  • • Social support networks (family and friends): Sharing your struggles with trusted individuals such as your family and best friends can make you feel supported and understood, which can aid in reducing feelings of isolation as a result.

      From personal experience, it’s important not to try carrying the burden and pain of your illness alone, since we all go through bad experiences at some point during our lives. That’s why we must assist each other when the time calls for it.

      A sense of social connectedness has been shown to protect adults from depressive disorders and symptoms.

    • Support groups: Connecting with peers who have similar experiences can provide comfort and understanding since it’s typically difficult for people who have never experienced depression to fully comprehend the depth and pain that it can produce.

      Peer support groups lessen the symptoms typically associated with depression.

  5. Stress reduction
     
     

  • • Mindfulness: Mindfulness can help us to live in the moment instead of worrying about the past and future. That can go a long way to reduce negative thoughts and self-talk.

      Mindfulness is effective at treating depression and anxiety. It performs comparably to cognitive behavioral therapy (CBT) and outperforms non-evidence-based treatments.

    • Meditation: Meditation can help focus and calm the mind.

      Meditation-type therapy can create moderate to substantial reductions in depression symptoms in people suffering from acute major depressive episodes and lingering subacute clinical symptoms.

    • Yoga: This practice combines physical activity with relaxation techniques. As some of you may already know, exercise is a great natural antidepressant since it releases dopamine and serotonin, which makes us feel better and allows us to clear our minds.

      There is currently a medium amount of evidence for positive short-term effects of yoga in patients with elevated levels of depression and established depressive disorders.

  • • Exercise and physical activity: Exercising is important to stay physically healthy, but for our mental state as well. Especially aerobic exercise like running, swimming, or even simply walking, has been shown to reduce symptoms of depression significantly. That’s because it boosts the mood through the release of endorphins, improving our mental health in the process.

      Some studies even suggest that exercising might be as effective as antidepressants to relieve symptoms and improve mental health.

  6. Self-care and coping strategies

  • • Set small and realistic goals: It’s better to set small, realistic goals because achieving small tasks can build a sense of accomplishment, while failing because of large, hard-to-accomplish goals can lower our morale.

      This research shows that failing to attain a specific, high goal can damage self-related aspects such as motivation and self-esteem. Not to mention the later behavioral outcomes. This is something we can miss since these things are already commonly impacted negatively when depressed.

      These temporary consequences may lead to major long-term consequences, particularly when repeatedly failing to hit goals, and when the person has no resources to offset the effects.

      Just because you start small doesn’t mean that they’re insignificant either. These tiny increments will compound and pay off in the future.

    • Journaling: Expressing your thoughts and feelings by writing them down can help you to understand yourself better, but it can also assist you in relaxing because you can pen down your bottled-up frustrations and emotions.

      It’s also a convenient way to track how your mood and progress are evolving.

      The data shows that journaling as an intervention results in a higher discount of negative mental health symptoms. Unfortunately, the number of high-quality studies is still lacking. Nevertheless, it’s a low-risk and convenient treatment option. So, I would advise everyone to try it out for themselves.
      

    • Avoiding isolation: No matter how introverted you might be, that still doesn’t change the fact that we’re social animals. Thus, everyone should make it a point to avoid prolonged isolation by interacting with one another.
      The ideal would be to meet in real life since it’s the most natural and stimulating way of keeping in touch. But if that isn’t possible, or if you don’t want to leave the house since you’re so depressed, then calling a friend, or talking with your loved ones via a program like Skype can be decent alternatives to get some much-needed social stimulation.

      Social isolation is a strong predictor of poor physical and mental health. It has been shown that social support protects our overall well-being.  Levels of depression and anxiety are typically significantly higher among socially isolated people. Interestingly, the type of support that socially isolated people receive can be important in reducing depression and anxiety.

  7. Hospitalization or intensive outpatient programs

  • • In severe cases where there is a risk of harm to oneself or others, more intensive treatment settings may be necessary, such as hospitalization or intensive outpatient programs.

      Just because you may need to go through such an intervention doesn’t make you any less of a person, nor does it make you weak. If anything, it makes you a strong, reasonable person because you recognize and admit to yourself and others that you have an issue that needs to be sorted out to start living again.

      Studies show that both inpatient and outpatient complex treatment programs are effective at treating depression. Outpatient groups show a higher response rate, although not clinically significant.

      Outpatient treatment programs can be an attractive alternative for individuals needing more than one treatment session per week, but not necessarily as many as a day clinic or inpatient program.

  8. Light therapy

  • • Light therapy can provide solace when you’re affected by Seasonal Affective Disorder (SAD), such as winter depression. It involves exposure to bright light, typically from a lightbox, to mimic natural sunlight and regulate mood.

      This can be particularly helpful during the winter periods when there’s less natural sunlight and daylight to simulate a similar experience. It’s not something I have used, but it’s worth considering.

      Bright light therapy has shown promise for disorders that have seasonal variations in symptoms, depressive symptoms, and a delayed circadian phase.

  9. Bibliotherapy
     
     

  • • Reading self-help books and therapeutic literature can be beneficial since we must first know how to solve our issues before we can treat them. Especially articles based on CBT principles since that’s a proven method to cure and improve depression.

      Bibliotherapy is an effective way of treating mild to moderate depression or subthreshold depressive symptoms yourself. Nevertheless, I think it’s optimal to combine it with other practices rather than employing it as your sole treatment option. It might not be as effective in treating severe depression since more professional guidance may be in order.

      Still, it won’t harm you and it’s better to be informed rather than ignorant! Great as a low-entry alternative.

  10. Digital and online therapies

  • • Online programs and apps that provide guided therapy or support, such as mood tracking, CBT exercises, or mindfulness training, can help treat mental disorders. They’re a particularly interesting alternative for those with limited access to in-person therapy.

      This meta-analysis shows that internet-based cognitive behavioral therapy is more effective when guided by a professional rather than doing so all by yourself. Unguided online therapy is best reserved for mild depression, while guided digital therapy is more appropriate for moderate to severely depressed individuals.

  11. Gratitude practice

  • • It’s good practice to reflect regularly on and note things you’re grateful for. This can shift your focus away from negative thoughts and self-talk and help improve your mood.

      Humans always want more. And those who have the most are frequently not happy while lamenting what they don’t possess.

      There seems to be a direct correlation between practicing gratitude and experiencing fewer depressive symptoms. Positively reframing, in addition to experiencing positive emotions, also has positive effects on depressive symptoms.

  12. Animal-assisted therapy

  • • Interacting with animals such as dogs or horses in a therapeutic setting has been shown to lessen symptoms of depression and anxiety.

      Those with pets will surely know how they can cheer you up even on the most terrible days just with their presence and unconditional love.

      Dog-assisted therapy is effective in reducing symptoms of depression in institutionalized elderly. Possibly because the dog stimulates social interaction and positive emotions. More studies in a younger, non-institutionalized population are required to determine its effectiveness for all age groups.

  13. Creative therapies
      
      

  • • Art, music, and drama therapies provide alternative ways to express emotions and work through complex feelings.

      This can aid those who typically have trouble admitting, showing, or discussing their feelings with themselves and others.

      The current meta-analysis indicates that music therapy can provide short-term benefits in depressed people. It also aids in decreasing anxiety and improving the overall functioning of depressed individuals. It seems more effective to combine music therapy with other, more conventional treatment options.

  Future trials with a larger sample of adults and youth will be necessary to attain conclusive evidence regarding its effectiveness.

  14. Biofeedback and neurofeedback

  • • These are techniques that teach you how to control bodily functions, such as heart rate or brain waves. Studies have shown that engaging the parasympathetic nervous system can help reduce stress and improve mood.

  15. Brain stimulation therapies

  • • Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS): These are typically used for severe depression that hasn’t responded to other treatments. Several studies about ECT show favorable results for treating severe and treatment-resistant depression.

  • • Vagus nerve stimulation (VNS): Involves implanting a device to stimulate the vagus nerve.

  It’s approved for treatment-resistant depression but is less commonly used.

  I don’t have real-life experience with these regimens, but they might be worth exploring, especially for treatment-resistant depression.

  16. Alternative treatments

  • • Acupuncture: Some find acupuncture helpful for reducing symptoms, which helps make the suffering more bearable.

      This meta-analysis showed major clinical drops in the severity of depression compared to usual care. There seems to be a positive correlation between the number of acupuncture treatments received and the reduction in depression. Nevertheless, it should be noted that there’s a high risk of personal biases in these studies!

    • Herbal supplements: St. John’s Wort and other supplements may help if you’re suffering from mild to moderate depression. However, it’s a supplement, and thus, it will usually not be sufficient as a stand-alone treatment.

      Omega−3 Polyunsaturated Fatty Acids (PUFA), probiotics, and vitamin D can be beneficial dietary supplements to manage depression.

  • • Psychedelic-assisted therapy: Modern research is exploring the use of psychedelics like psilocybin and MDMA in a therapeutic setting for treatment-resistant depression.

      These are still experimental and tightly regulated, so employ these options at your peril. My advice would be not to try anything too risky or untested, since there can be hidden and undiscovered dangers.

      This systematic review implies a reduction of depressive symptoms in both the short and long term after being administered LSD, ayahuasca, or psilocybin with psychological support. Symptom reduction was significant for various time points, including 1 day, 1 week, and 3-5 weeks, except the 6-8 weeks follow-up point, which was less conclusive.

  Conclusion

  A large variety of evidence-based treatment options exist these days to deal with depression. I’ve listed the most helpful and common ones to help you get started on your way to recovery.

  Perhaps my best tip would be to not limit yourself to just one form of therapy. A combination of multiple approaches is always better than putting all your eggs in just one basket concerning depression.

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