Depression is diagnosed when a person experiences five or more specific symptoms for more than two weeks, according to the American Psychiatric Association. Those symptoms include feelings of sadness and loss of pleasure in activities you once enjoyed, changes in appetite that cause weight loss or gain, sleeping too little or too much, feeling tired all the time, having difficulty concentrating and making decisions, and feeling angry and irritable. People with depression might also have feelings of worthlessness or guilt, unexplained physical pain like headaches or backaches, and frequent thoughts of death or suicide. “Everyone has bad days, the normal ups and downs of life where you feel better the next day, but depression is ongoing,” says David Hellerstein, MD, a psychiatry professor at Columbia University Medical Center in New York City. It’s also common, affecting more than 23 million adult Americans every year, according to the Depression and Bipolar Support Alliance. “People who have major depression have it for a lot more than two weeks; usually months or years,” Dr. Hellerstein says. They find it extremely difficult to function. Those with a milder form, known as dysthymic disorder, feel chronically lousy but are typically able to push through their days. RELATED: Surprising Pros and Cons of a Bad Mood A bad mood shares many of the same characteristics as depression but moves like a subway ride though the city: Before you know it, it’s over. With depression, however, you’re on a road trip that never seems to end. Candy McCarley, 62, of Cincinnati, was one such traveler. “I got to the point where I couldn’t even go out of the house,” McCarley says of her depression. She compares the feeling to trying to climb out of a jar of peanut butter. “I couldn’t make any headway, I just kept getting stuck,” she says. “I slept a lot. I cried a lot. I was really not aware of what was going on around me.” A friend who had been treated for depression told McCarley she needed help.
Is It Depression, or Not?
Not everyone experiences depression in the same way. Women suffering from depression often report feeling sad, while men with depression may be more likely to be irritable and aggressive, according to the Mayo Clinic. Depression in children can include clinginess, worry, and a desire to stay home from school. Teens may get angry, engage in self-harm, and withdraw socially. Older adults may experience memory problems and personality changes. Common symptoms across all groups include physical problems like chronic pain and digestive disorders that don’t respond to treatment, according to Mental Health America. Depression also can sometimes go from enduring feelings of sadness to a situation that is potentially deadly. Common suicide warning signs include feeling worthless, a lack of interest in previously enjoyed activities, withdrawal, reckless behaviors, giving away possessions, talking about death, and searching for ways to die by suicide, according to the National Alliance on Mental Illness. Suicidal people can sometimes appear to be feeling better just before they take their lives. If you feel you might be depressed, says Hellerstein, start by making an appointment with your family doctor. “The primary care physicians are the gatekeepers; the first source for seeking treatment,” Hellerstein says. For starters, your doctor will want to rule out other conditions with symptoms that can mimic depression. “Generally a person for whom a medical condition is the cause of the depression will have some abnormalities on those tests — for instance, abnormal thyroid hormone levels,” says Hellerstein. “At times, there is a hidden medical cause of depression, such as cancer, but that is pretty rare.” In addition to checking you physically, your doctor may do a psychological evaluation in which you’re asked about your thoughts and feelings. Although it shouldn’t replace a doctor’s visit, you can also do a test online to help determine if what you’re feeling and experiencing is truly depression. If you are depressed, your practitioner may start treatment by prescribing medication, referring you to a therapist or psychiatrist, or both. Though antidepressants generally provide relief in two to four weeks, “if there is no benefit after one month, that medication is probably not going to work,” Hellerstein says. Then, your doctor might try a higher dose or a different medication. Today, McCarley is no longer taking an antidepressant but recognizes that feeling good requires getting enough sleep, eating a well-balanced diet, exercising, and reaching out to others, particularly when she’s feeling down. She encourages those suffering with depression to seek help and be patient in finding the right course of action. “If a medication or treatment doesn’t work, try a different one,” she says. “Don’t give up — there is help out there that works.”
