Depression (also known as major depression, major depressive disorder, or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working.
To be diagnosed with depression, the symptoms must be present for at least 2 weeks.
Different types of depression
There are different types of depression, some of which develop due to specific circumstances.
- Major depression includes symptoms of depressed mood or loss of interest, most of the time for at least 2 weeks, that interfere with daily activities.
- Persistent depressive disorder (also called dysthymia or dysthymic disorder) consists of less severe symptoms of depression that last much longer, usually for at least 2 years.
- Perinatal depression is depression that occurs during or after pregnancy. Depression that begins during pregnancy is prenatal depression and depression that begins after the baby is born is postpartum depression.
- Seasonal affective disorder is depression that comes and goes with the seasons, with symptoms typically starting in the late fall and early winter and going away during the spring and summer.
- Depression with symptoms of psychosis is a severe form of depression in which a person experiences psychosis symptoms, such as delusions (disturbing, false fixed beliefs) or hallucinations (hearing or seeing things others do not hear or see).
People with bipolar disorder (formerly called manic depression or manic-depressive illness) also experience depressive episodes, during which they feel sad, indifferent, or hopeless, combined with a very low activity level. But a person with bipolar disorder also experiences manic (or less severe hypomanic) episodes, or unusually elevated moods, in which they might feel very happy, irritable, or “up,” with a marked increase in activity level.
Other types of depressive disorders found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (that affects women around the time of their period).
Who gets depression?
Depression can affect people of all ages, races, ethnicities, and genders.
Women are diagnosed with depression more often than men, but men can also be depressed. Because men may be less likely to recognize, talk about, and seek help for their feelings or emotional problems, they are at greater risk of depression symptoms being undiagnosed or undertreated.
Studies also show higher rates of depression and an increased risk for the disorder among members of the LGBTQIA+ community.
Signs and symptoms
If you have been experiencing some of the following signs and symptoms, most of the day, nearly every day, for at least 2 weeks, you may be suffering from depression:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness or pessimism
- Feelings of irritability, frustration, or restlessness
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy, fatigue, or feeling slowed down
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, waking early in the morning, or oversleeping
- Changes in appetite or unplanned weight changes
- Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
- Thoughts of death or suicide or suicide attempts
Not everyone who is depressed experiences every one of these symptoms. Some people experience only a few symptoms, while others experience many symptoms. Symptoms associated with depression interfere with day-to-day functioning and cause significant distress for the person experiencing them.
Depression can also involve other changes in mood or behavior that include:
- Increased anger or irritability
- Feeling restless or on edge
- Becoming withdrawn, negative, or detached
- Increased engagement in high-risk activities
- Greater impulsivity
- Increased use of alcohol or drugs
- Isolating from family and friends
- Inability to meet the responsibilities of work and family or ignoring other important roles
- Problems with sexual desire and performance
Depression can look different in men and women. Although men, women, and people of all genders can feel depressed, how they express those symptoms and the behaviors they use to cope with them may differ. For example, some men (as well as women) may show symptoms other than sadness, instead seeming angry or irritable. And although increased use of alcohol or drugs can be a coping strategy for any person with depression, men may be more likely to use alcohol or drugs to help them cope.
In some cases, mental health symptoms appear as physical problems. For example, a racing heart, tightened chest, ongoing headaches, or digestive issues. Men are often more likely to see a health care provider about these physical symptoms than their emotional ones.
Because depression tends to make people think more negatively about themselves and the world, some people may also have thoughts of suicide or self-harm.
Several persistent symptoms, in addition to low mood, are required for a diagnosis of depression, but people with only a few symptoms may also benefit from treatment. The severity and frequency of symptoms and how long they last will vary depending on the person, the illness, and the stage of the illness.
If you experience signs or symptoms of depression and they persist or do not go away, talk to a health care provider. If you see signs or symptoms of depression in someone you know, encourage them to seek help from a mental health professional.
If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at https://988lifeline.org. In life-threatening situations, call 911.
Risk factors of depression
Depression is one of the most common mental disorders in the United States. Research suggests that genetic, biological, environmental, and psychological factors play a role in depression.
Depression can happen at any age, but it often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although children may express more irritability than sadness. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in childhood.
Depression, especially in midlife or older age, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present, and research suggests that people with depression and other medical illnesses tend to have more severe symptoms of both illnesses. The Centers for Disease Control and Prevention (CDC) has also recognized that having certain mental disorders, including depression and schizophrenia, can make people more likely to get severely ill from COVID-19.
Sometimes a physical health problem, such as thyroid disease, or medications taken for a physical illness cause side effects that contribute to depression. A health care provider experienced in treating these complicated illnesses can help work out the best treatment strategy. Learn more about getting help and finding a health care provider.
Other risk factors for depression include:
- Personal or family history of depression
- Major negative life changes, trauma, or stress
Treatment of depression
Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Depression is usually treated with medication, psychotherapy, or a combination of the two.
Some people may experience treatment-resistant depression, which occurs when a person does not get better after trying at least two antidepressant medications. If treatments like medication and psychotherapy do not reduce depressive symptoms or the need for rapid relief from symptoms is urgent, brain stimulation therapy may be an option to explore.
Quick tip: No two people are affected the same way by depression, and there is no “one-size-fits-all” treatment. Finding the treatment that works best for you may take trial and error.
Antidepressants are medications commonly used to treat depression. They work by changing how the brain produces or uses certain chemicals involved in mood or stress. You may need to try several different antidepressants before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered first.
Antidepressants take time—usually 4–8 weeks—to work, and problems with sleep, appetite, and concentration often improve before mood lifts. It is important to give a medication a chance to work before deciding whether it’s the right one for you.
New medications, such as intranasal esketamine, can have rapidly acting antidepressant effects, especially for people with treatment-resistant depression. Esketamine is a medication approved by the U.S. Food and Drug Administration (FDA) for treatment-resistant depression. Delivered as a nasal spray in a doctor’s office, clinic, or hospital, it acts rapidly, typically within a couple of hours, to relieve depression symptoms. People who use esketamine will usually continue taking an oral antidepressant to maintain the improvement in their symptoms.
Another option for treatment-resistant depression is to take an antidepressant alongside a different type of medication that may make the antidepressant more effective, such as an antipsychotic or anticonvulsant medication. Further research is needed to identify the best role of these newer medications in routine practice.
If you begin taking an antidepressant, do not stop taking it without talking to a health care provider. Sometimes people taking antidepressants feel better and stop taking the medications on their own, and their depression symptoms return. When you and your health care provider have decided it is time to stop a medication, usually after a course of 9–12 months, the provider will help you slowly and safely decrease your dose. Abruptly stopping a medication can cause withdrawal symptoms.
Note: In some cases, children, teenagers, and young adults under 25 years may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. The FDA advises that patients of all ages taking antidepressants be watched closely, especially during the first few weeks of treatment.
If you are considering taking an antidepressant and are pregnant, planning to become pregnant, or breastfeeding, talk to a health care provider about any health risks to you or your unborn or nursing child and how to weigh those risks against the benefits of available treatment options.
To find the latest information about antidepressants, talk to a health care provider and visit the FDA website www.fda.gov.
Several types of psychotherapy (also called talk therapy or counseling) can help people with depression by teaching them new ways of thinking and behaving and how to change habits that contribute to depression. Evidence-based approaches to treating depression include cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Learn more about psychotherapy at https://www.nimh.nih.gov/health/topics/psychotherapies.
The growth of telehealth for mental health services, which offers an alternative to in-person therapy, has made it easier and more convenient for people to access care in some cases. For people who may have been hesitant to look for mental health care in the past, telemental health services might be an easier first step than traditional mental health services.
Brain stimulation therapies
If medication or psychotherapy does not reduce symptoms of depression, brain stimulation therapy may be an option to explore. There are now several types of brain stimulation therapy, some of which have been authorized by the FDA to treat depression. Other brain stimulation therapies are experimental and still being investigated for treating mental disorders like depression.
Although brain stimulation therapies are less frequently used than medication and psychotherapy, they can play an important role in treating mental disorders in people who do not respond to other treatments. These therapies are used for most mental disorders only after medication and psychotherapy have been tried and usually continue to be used alongside these treatments.
Brain stimulation therapies act by activating or inhibiting the brain with electricity. The electricity is given directly through electrodes implanted in the brain or indirectly through electrodes placed on the scalp. The electricity can also be induced by applying magnetic fields to the head.
The brain stimulation therapies with the largest bodies of evidence include:
- Electroconvulsive therapy (ECT)
- Repetitive transcranial magnetic stimulation (rTMS)
- Vagus nerve stimulation (VNS)
- Magnetic seizure therapy (MST)
- Deep brain stimulation (DBS)
ECT and rTMS are the most widely used brain stimulation therapies, with ECT having the longest history of use. The other therapies are newer and, in some cases, still considered experimental. Other brain stimulation therapies may also hold promise for treating specific mental disorders.
ECT, rTMS, and VNS have authorization from the FDA to treat severe, treatment-resistant depression. They can be effective for people who have not been able to feel better with other treatments or for whom medications cannot be used safely and in severe cases where a rapid response is needed, such as when a person is catatonic, suicidal, or malnourished.
Whereas ECT involves using electricity to induce seizures, in rTMS, a magnet is used to activate the brain. Unlike ECT, in which stimulation is more generalized, in rTMS, the stimulation is targeted to a specific brain site. Both procedures are noninvasive and do not require surgery to perform. In contrast, VNS is usually a surgical procedure that involves implanting a device under the skin to activate the vagus nerve.
Additional types of brain stimulation therapy are being investigated for treating depression and other mental disorders. Learn more about these brain stimulation therapies at https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies. Talk to a health care provider and make sure you understand the potential benefits and risks before undergoing brain stimulation therapy.
The FDA has not approved any natural products for depression. Although research is ongoing, some people use natural products, including vitamin D and the herbal dietary supplement St. John’s wort, for depression. However, these products can come with risks. For instance, dietary supplements and natural products can limit the effectiveness of some medications or interact in dangerous or even life-threatening ways with them.
Do not use vitamin D, St. John’s wort, or other dietary supplements or natural products without talking to a health care provider. Rigorous studies must be conducted to test whether these and other natural products are safe and effective.
Daily morning light therapy is a common treatment choice for people with seasonal affective disorder. Light therapy devices are much brighter than ordinary indoor lighting and considered safe, except for people with certain eye diseases or taking medications that increase sensitivity to sunlight. As with all interventions for depression, evaluation, treatment, and follow-up by a health care provider are strongly recommended. Research into the potential role of light therapy in treating non-seasonal depression is ongoing.
How can I find help?
If you think you may have depression, start by making an appointment to see a health care provider. This could be your primary care provider; a psychiatrist, psychologist, or social worker; or another provider who specializes in diagnosing and treating mental health conditions.
Once you enter treatment, you should gradually start to feel better. Here are some other things you can do outside of treatment that may help you or a loved one during treatment for depression:
- Try to get physical activity. Just 30 minutes a day of walking can boost your mood.
- Try to maintain a regular bedtime and wake-up time.
- Eat regular, healthy meals.
- Break up large tasks into small ones; do what you can as you can. Decide what must get done and what can wait.
- Try to connect with people. Talk with people you trust about how you are feeling.
- Delay making important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with people who know you well.
- Avoid using alcohol, nicotine, or drugs, including medications not prescribed for you.
Clinical trial for depression
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including depression. The goal of a clinical trial is to determine if a new test or treatment works and is safe. Although people may benefit from being part of a clinical trial, they should know that the primary purpose is to gain new scientific knowledge so that others can be better helped in the future.
Researchers at NIMH and around the country conduct many studies with patients with depression and healthy volunteers. We have new and better treatment options today because of what clinical trials have uncovered. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you.
To learn more or find a study, visit:
- Clinical Trials – Information for Participants: Information about clinical trials, why people might take part in a clinical trial, and what people might experience during a clinical trial
- Clinicaltrials.gov: Current Studies on Depression: List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
- Join a Study: Depression—Adults: List of studies currently recruiting adults with depression being conducted on the NIH campus in Bethesda, MD
- Join a Study: Depression—Children: List of studies currently recruiting children with depression being conducted on the NIH campus in Bethesda, MD
- Join a Study: Perimenopause-Related Mood Disorders: List of studies on perimenopause-related mood disorders being conducted on the NIH campus in Bethesda, MD
- Join a Study: Postpartum Depression: List of studies on postpartum depression being conducted on the NIH campus in Bethesda, MD
Learn more about depression
Free brochures and shareable resources
- Chronic Illness and Mental Health: Recognizing and Treating Depression: This brochure provides information about depression for people living with chronic illnesses, including children and adolescents. It discusses signs and symptoms, risk factors, and treatment options.
- Depression: This brochure provides information about depression, including different types of depression, signs and symptoms, how it is diagnosed, treatment options, and how to find help for yourself or a loved one.
- Depression in Women: 5 Things You Should Know: This brochure provides information about depression in women, including signs and symptoms, types of depression unique to women, treatment options, and how to find help for yourself or a loved one.
- Perinatal Depression: This brochure provides information about perinatal depression, including how it differs from “baby blues,” causes, signs and symptoms, treatment options, and how to find help for yourself or a loved one.
- Seasonal Affective Disorder: This fact sheet provides information about seasonal affective disorder, including signs and symptoms, how it is diagnosed, causes, and treatment options.
- Seasonal Affective Disorder (SAD): More Than the Winter Blues: This infographic provides information about how to recognize the symptoms of seasonal affective disorder and what to do to get help.
- Teen Depression: More Than Just Moodiness: This fact sheet is for teens and young adults and provides information about how to recognize the symptoms of depression and what to do to get help.
- Digital Shareables on Depression: These digital resources, including graphics and messages, can be used to spread the word about depression and help promote depression awareness and education in your community.
Research and statistics
- Journal Articles: This webpage provides articles and abstracts on depression from MEDLINE/PubMed (National Library of Medicine).
- Statistics: Major Depression: This webpage provides the statistics currently available on the prevalence and treatment of depression among people in the United States.
- Depression Mental Health Minute: Take a mental health minute to watch this video on depression.
- NIMH Experts Discuss the Menopause Transition and Depression: Learn about the signs and symptoms, treatments, and latest research on depression during menopause.
- NIMH Expert Discusses Seasonal Affective Disorder: Learn about the signs and symptoms, treatments, and latest research on seasonal affective disorder.
- Discover NIMH: Personalized and Targeted Brain Stimulation Therapies: Watch this video describing repetitive transcranial magnetic stimulation and electroconvulsive therapy for treatment-resistant depression. Brain stimulation therapies can be effective treatments for people with depression and other mental disorders. NIMH supports studies exploring how to make brain stimulation therapies more personalized while reducing side effects.
- Discover NIMH: Drug Discovery and Development: One of the most exciting breakthroughs from research funded by NIMH is the development of a fast-acting medication for treatment-resistant depression based on ketamine. This video shares the story of one patient participating in an NIMH clinical trial and how ketamine infusions changed her life and gave her a sense of purpose.