Depression is a major health concern in the US as well as globally. 3.76% of people of all ages globally are estimated to be affected by some type of depression, but in the US this estimate is much higher at 20.6%. Women, white individuals, and those with lower incomes are at higher risk according to a survey of almost 40,000 adults in the US.
As with many mental health disorders, it’s difficult to know how accurate these numbers are due to differences in how data is collected. But if you think you’re dealing with depression, know that you’re certainly not alone.
Everyone experiences mood fluctuations and occasional feelings of sadness or irritability sometimes, as a result of financial, health or relationship problems. Depression exists when these feelings persist beyond normal lows and interrupt people’s daily functioning.
Common symptoms of depression include trouble focusing, low self-esteem, hopelessness, difficulty sleeping, changes in appetite or weight, and feeling especially tired. Mild depression may come with just a couple of these symptoms, with moderate and severe cases including most of them.
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There are multiple types of depression, referred to as depressive disorders. Since healthcare providers like to have some kind of uniform system to diagnose off of, they often use the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to evaluate symptoms and make a recommendation.
Major depressive disorder. This is generally the most serious type of depression, with patients feeling depression symptoms most of the time for most days, at least two weeks in a row.
Major depressive disorder with seasonal pattern. You may also hear this referred to as seasonal affective disorder (SAD), winter depression, or seasonal depression. Patients with this type feel symptoms of depression for about 40% of the year during the months with the least sunlight.
Persistent depressive disorder. This is also known as dysthymia or low-grade persistent depression. This type of depression may not be quite as severe, but lasts over a much longer period of time, two years or longer.
Other subtypes of depression. Postpartum depression happens when women and men experience depression symptoms in the weeks and months after their child is born. Bipolar disorder (sometimes called manic depression) is a separate psychological condition from depression, but is included here because patients deal with depression symptoms during their extreme low moods, opposite their euphoric or anxious high moods.
A huge amount of non-drug treatment options have been and are being studied for depression since it is such a common problem. Some of these show better results than others and most need more study, but researchers are always looking for new ways to fight depression.
Cognitive behavioral therapy (CBT). CBT is recommended in treatment guidelines as a result of many studies that show its helpfulness in treating depression. It allows mental health experts to understand and try to change how depression is affecting people’s thoughts. This analysis of multiple studies compared CBT and antidepressant medications for treating depression. It concluded that the best approach for treating depression generally includes both of these options.
Exercise. The importance of exercise just keeps showing up. This study linked exercise with improved motivation and energy. This one done around peak COVID pandemic months found that more time spent sitting led to slower improvement of depressive symptoms. Another study linked emphasizing physical activity at a young age to better mental health later in life.
Neurostimulation-based treatments. These treatments all use electricity in different degrees of invasiveness to activate parts of your brain, in hopes that your mood will be better controlled. A few of these methods are electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and magnetic seizure therapy (MST). This review provides an overview of these methods and recommends them especially for patients who have failed other treatments.
Light therapy. Light therapy involves exposure to a bright light emitted from a special type of box that filters out damaging UV rays. This review of using light therapy to prevent seasonal affective disorder concluded limited evidence of how effective it is.
Herbal treatments. Products such as black cohosh, chamomile, lavender, ginseng and St. John’s Wort (SJW) are marketed to treat psychological conditions including depression and anxiety. Some evidence suggests that these may be worth further study in large, standardized trials. If you do decide to try an herbal supplement, it’s a good idea to let your doctor or pharmacist know, as some herbal products like SJW are notorious for interacting with common prescription medications.
In addition to the above non-drug treatment options, medication should usually be used in moderate to severe cases of depression. This list is not comprehensive, but is an overview of the drugs most commonly used to treat depression.
Guidelines for treatment recommend that once patients experience improvement with a certain drug, to continue on it for at least six months and up to two years. This reduces the chance of symptoms returning. It can be difficult to know which type of drug may work best for different people. Patients should try a drug for at least six weeks before it’s decided that the patient has failed that treatment, as sometimes it can take this long for antidepressants to demonstrate their full effects.
Selective serotonin reuptake inhibitors (SSRIs) Examples of SSRIs include sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), escitalopram (Lexapro), and fluoxetine (Prozac). One possible cause of depression is an imbalance of serotonin, a chemical that works in your brain to regulate energy and feelings like happiness. These drugs increase the amount of serotonin in your system, which can improve symptoms associated with depression.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) Common SNRIs are duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq). They work similarly to SSRIs, but increase the amount of both serotonin and norepinephrine in your system. Low levels of norepinephrine have been tied to depressive symptoms.
Tricyclic antidepressants (TCAs) Nortriptyline, imipramine, and clomipramine are all TCAs. They affect the pathways of multiple types of chemicals in the brain. TCAs are older drugs compared to the two groups above and can cause undesirable side effects such as dry mouth, sleepiness, weight gain and trouble urinating.
Bupropion (Wellbutrin). This drug is in its own category and the way it works is not well understood. It is frequently used for depression, as well as off-label purposes such as helping people quit smoking, and for treating ADHD in children.
Monoamine oxidase inhibitors (MAOIs). Including phenelzine, isocarboxazid and tranylcypromine, MAOIs were the first antidepressants introduced to the market. They are not commonly prescribed and should be used as more of a last resort because they interact with other common prescription drugs and also come with a list of foods that must be avoided while taking them.
Newer drugs for depression. There are a few drugs that the FDA has approved recently for different types of depression. Esketamine (Spravato) is available as a nasal spray and injection that is used along with oral antidepressant medicines for depression cases that have failed multiple treatments. Brexanolone (Zulresso) is an injectable drug that is approved to treat postpartum depression.
If you’ve been feeling particularly down for longer than you think is normal, seeking professional help is a smart move. Talking with a mental health expert who can provide customized treatment specific to your unique situation is a great first step in relieving symptoms and preventing them from getting worse. Lemonaid partners with health and wellness coaches that you can access from home or wherever you feel most comfortable. You can also message our team whenever you want and we can ship medications right to your door. Start feeling better today.
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