Depression symptoms and treatment

Depression is more than feeling sad. It's a common, treatable condition that changes how you feel, think and handle daily life, for weeks at a time. Clinicians diagnose major depression when low mood or a loss of interest in things you used to enjoy lasts most of the day, nearly every day, for at least two weeks, along with other symptoms. Most people who get treatment feel better.

What are the signs of depression?

Depression looks different from person to person. Common signs include:

• Feeling sad, empty or hopeless most of the time
• Losing interest or pleasure in things you used to enjoy
• Changes in sleep: trouble sleeping, or sleeping much more than usual
• Changes in appetite or weight
• Feeling tired or low on energy, even after rest
• Moving or speaking more slowly, or feeling restless
• Feeling worthless or guilty
• Trouble thinking, concentrating or making decisions
• Thoughts of death or suicide

Some people feel more irritable or numb than sad. Others mostly notice physical symptoms like aches, headaches or stomach problems.

If you're having thoughts of hurting yourself, you don't have to wait for an appointment: call or text 988 any time.

Is it depression or just a rough patch?

Sadness after a loss, a breakup or a hard stretch is normal, and it usually eases as time passes or things improve. Depression tends to stay, even when life gets better, and it makes ordinary things like getting out of bed, working or answering messages feel much harder than they should.

Grief and depression can look alike. With grief, painful feelings tend to come in waves, mixed with good memories. With depression, the low mood and loss of interest are more constant and often come with feeling worthless.

If you're not sure, the free depression self-check uses the PHQ-9, the nine questions doctors commonly use to screen for depression. It takes about three minutes.

What are the types of depression?

• Major depression: symptoms most of the day, nearly every day, for at least two weeks.
• Persistent depressive disorder (dysthymia): milder but long-lasting depression, for two years or more.
• Postpartum depression: depression during pregnancy or after giving birth. See the postpartum depression self-check.
• Seasonal affective disorder: depression that comes and goes with the seasons, usually in fall and winter.
• Bipolar depression: depressive episodes that alternate with periods of high energy or mood. This is treated differently, so it matters to tell them apart. See the bipolar self-check.

How common is depression?

Very common. About 8% of US adults, more than 21 million people, have at least one episode of major depression in a given year, according to the National Institute of Mental Health (NIMH). It's most common among young adults.

What causes depression?

Depression usually comes from several things at once:

• Genes and family history: depression often runs in families.
• Life events: loss, trauma, long-term stress, loneliness or money problems.
• Health: chronic illness, thyroid problems, hormonal changes and some medications.
• Alcohol and drugs: these can cause or worsen depression.

Depression isn't a weakness or a character flaw, and it isn't something you can just snap out of.

How is depression diagnosed?

A clinician diagnoses depression by asking about your symptoms, how long they've lasted and how they affect your life. Your doctor may also order blood tests to rule out causes like a thyroid problem or low vitamin B12. Questionnaires like the PHQ-9 help measure how severe things are and track progress.

How is depression treated?

Depression is one of the most treatable mental health conditions. Most people use therapy, medication, or both.

Therapy. Cognitive behavioral therapy (CBT), interpersonal therapy and behavioral activation all have strong evidence for depression. Therapy helps you change thought patterns, rebuild routines and handle what's weighing on you.

Medication. Antidepressants such as SSRIs, SNRIs and bupropion are common choices. They usually take four to eight weeks to reach their full effect, and finding the right one can take a try or two. Young adults under 25 should be watched closely when starting an antidepressant, because of a small risk of increased suicidal thoughts early on.

When first treatments don't work. There are still good options; see treatment-resistant depression below.

Everyday habits. Movement, sunlight, regular sleep and time with people you trust support recovery alongside treatment.

What is treatment-resistant depression?

Depression is called treatment-resistant when it hasn't improved enough after trying at least two antidepressants at a proper dose for long enough. It's common: in a large NIMH study (STAR*D), only about a third of people had their depression lift fully on the first antidepressant they tried. Treatment-resistant doesn't mean untreatable. Options include:

• Adjusting medication: a higher dose, a different antidepressant, or adding a second medicine
• TMS: magnetic pulses to the brain's mood regions, five days a week for several weeks, with no anesthesia
• Spravato: an FDA-approved esketamine nasal spray that can work within days, given in a certified clinic
• Ketamine therapy: IV infusions used off-label, usually paid out of pocket
• Electroconvulsive therapy (ECT): safe and the most effective option for severe depression

A psychiatrist can help you decide which to try next, and most insurers cover TMS and Spravato once you've tried two or more antidepressants.

Who should I see for depression?

Your primary care doctor is a fine place to start: they can screen for depression, rule out physical causes and prescribe common antidepressants. A therapist can provide talk therapy, which helps many people with mild to moderate depression. For more severe depression, or if a first medication hasn't helped, a psychiatrist or psychiatric nurse practitioner can fine-tune treatment.

Our guides to psychiatrist vs therapist and how to find a psychiatrist who can see you soon can help you pick a starting point.

Does insurance cover depression treatment?

Usually, yes. Most health plans cover therapy and medication visits for depression, and federal parity rules mean most plans can't make mental health care harder to use than comparable medical care. Your cost depends on your plan and whether the provider is in-network. See how much does therapy cost for typical prices.