Depression (major depressive disorder) - Symptoms and causes (2023)

Overview

What is depression? A Mayo Clinic expert explains.

Learn more about depression from Craig Sawchuk, Ph.D., L.P., clinical psychologist at Mayo Clinic.

Hi, I'm Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I'm here to talk with you about depression. Whether you're looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.

What is depression?

Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.

What causes depression?

While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.

The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.

(Video) Major Depressive Disorder | DSM-5 Diagnosis, Symptoms and Treatment

To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.

Help is available. You don't have to deal with depression by yourself. Take the next step and reach out. If you're hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn't easy and you're not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Depression care at Mayo Clinic

Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

(Video) Symptoms of Major Depressive Disorder

  • In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
  • In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

  • Memory difficulties or personality changes
  • Physical aches or pain
  • Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
  • Often wanting to stay at home, rather than going out to socialize or doing new things
  • Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

  • Call your doctor or mental health professional.
  • Contact a suicide hotline.
    • In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
    • U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line. Or text 838255. Or chat online.
    • The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
  • Reach out to a close friend or loved one.
  • Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

More Information

  • Depression (major depressive disorder) care at Mayo Clinic
  • Male depression: Understanding the issues
  • Nervous breakdown: What does it mean?
  • Pain and depression: Is there a link?

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(Video) Major Depressive Disorder - Diagnosis Criteria, Symptoms, and Treatment

Causes

It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

  • Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
  • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
  • Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
  • Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

More Information

  • Depression (major depressive disorder) care at Mayo Clinic
  • Marijuana and depression
  • Vitamin B-12 and depression
(Video) Signs of Major Depressive Disorder

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

  • Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
  • Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
  • Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
  • Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
  • History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
  • Abuse of alcohol or recreational drugs
  • Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
  • Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

  • Excess weight or obesity, which can lead to heart disease and diabetes
  • Pain or physical illness
  • Alcohol or drug misuse
  • Anxiety, panic disorder or social phobia
  • Family conflicts, relationship difficulties, and work or school problems
  • Social isolation
  • Suicidal feelings, suicide attempts or suicide
  • Self-mutilation, such as cutting
  • Premature death from medical conditions

More Information

  • Depression (major depressive disorder) care at Mayo Clinic
  • Depression and anxiety: Can I have both?

Prevention

There's no sure way to prevent depression. However, these strategies may help.

  • Take steps to control stress, to increase your resilience and boost your self-esteem.
  • Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
  • Get treatment at the earliest sign of a problem to help prevent depression from worsening.
  • Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

Oct. 14, 2022

FAQs

What is the main cause of major depression? ›

There's no single cause of depression. It can occur for a variety of reasons and it has many different triggers. For some people, an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy and job or money worries, can be the cause. Different causes can often combine to trigger depression.

What are the 8 symptoms of major depressive disorder? ›

It is diagnosed when an individual has a persistently low or depressed mood, anhedonia or decreased interest in pleasurable activities, feelings of guilt or worthlessness, lack of energy, poor concentration, appetite changes, psychomotor retardation or agitation, sleep disturbances, or suicidal thoughts.

What is depression and causes? ›

It's complicated, and there are multiple causes of major depression. Factors such as genetic vulnerability, severe life stressors, substances you may take (some medications, drugs and alcohol) and medical conditions can affect the way your brain regulates your moods.

What are 3 cause of depression? ›

Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events.

What are two causes of major depressive disorder? ›

Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems. Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide.

What are the 9 causes of depression? ›

Lesson 2: There are nine common reasons for depression, mostly from hard life situations.
  • Disconnection from meaningful work. ...
  • Disconnect from others. ...
  • Disconnect from meaningful values. ...
  • Childhood trauma. ...
  • Disconnect from status. ...
  • Disconnect from nature. ...
  • Disconnect from a secure and hopeful future. ...
  • Genes.
16 Aug 2019

What are 5 suspected causes of depression? ›

Some examples of chronic illnesses that may cause depression are diabetes, heart disease, arthritis, kidney disease, HIV and AIDS, lupus, and multiple sclerosis (MS). Hypothyroidism may also lead to depressed feelings.

What is the most common symptom of depressive disorders? ›

While each person may experience symptoms differently, these are the most common symptoms of depression:
  • Lasting sad, anxious, or “empty” mood.
  • Loss of interest in almost all activities.
  • Appetite and weight changes.
  • Changes in sleep patterns, such as inability to sleep or sleeping too much.

What are the 5 effects of depression? ›

Depression doesn't just affect the mind; it also affects the body. Some of the physical effects include erratic sleep habits, loss of appetite (or increased appetite with atypical depression), constant fatigue, muscle aches, headaches, and back pain.

What are the 7 causes of depression? ›

In this section you can find information on the following possible causes of depression:
  • childhood experiences.
  • life events.
  • other mental health problems.
  • physical health problems.
  • genetic inheritance.
  • medication, recreational drugs and alcohol.
  • sleep, diet and exercise.

What are the 11 symptoms of depression? ›

The most common symptoms of depression include:
  • Feelings of sadness.
  • Loss of interest in once-enjoyed activities.
  • Angry outbursts.
  • Sleep issues.
  • Lack of energy.
  • Anxiety.
  • Weight loss or loss of appetite.
  • Feelings of worthlessness and guilt.
5 days ago

What are the risks of depression? ›

Risk Factors
  • Genetics: A history of depression in your family may make it more likely for you to get it. ...
  • Death or loss: Sadness and grief are normal reactions. ...
  • Conflict: Personal turmoil or disputes with family or friends may lead to depression.
  • Abuse: Past physical, sexual, or emotional abuse can bring it on, as well.

What is the biggest risk factor for depression? ›

Risk Factors for Depression
  • Mental Illness in Your Family. If you have people in your family with mental health problems, your risk is higher for depression. ...
  • Long-term Health Problems. ...
  • Major Life Changes. ...
  • Little or No Social Support. ...
  • Mental Health. ...
  • Gender. ...
  • Money Problems. ...
  • Age.

What exactly are the symptoms of depression? ›

Depression symptoms can vary from mild to severe and can include:
  • Feeling sad or having a depressed mood.
  • Loss of interest or pleasure in activities once enjoyed.
  • Changes in appetite — weight loss or gain unrelated to dieting.
  • Trouble sleeping or sleeping too much.
  • Loss of energy or increased fatigue.

What causes depression naturally? ›

Hormone changes: Changes in hormones may cause symptoms of depression. Hormones may change because of thyroid problems, menopause, or another condition. Life changes: The loss of a loved one, the end of a job or a relationship, financial stress, or trauma may trigger depression.

Is major depressive disorder serious? ›

Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.

What is the difference between major depressive disorder and depression? ›

Answer From Daniel K. Hall-Flavin, M.D. Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more-severe form of depression, also known as major depression or major depressive disorder.

What are the four types of symptoms of major depressive disorder? ›

Major depressive disorder (MDD) is a mood disorder in which a person experiences most of the following symptoms for more than two weeks:
  • Low mood.
  • Lack of interest in activities that were previously enjoyable (known as anhedonia)
  • Weight loss or weight gain.
  • Changes in sleep.
  • Fatigue.
30 Mar 2021

What happens to your body after depression? ›

Depression can affect the immune system, making it harder for your body to fight infection. Some vaccinations, such as the shingles vaccine, may even be less effective in older adults with depression. Depression has also been linked to heart disease and increased risk for substance abuse.

What major depression does to the brain? ›

According to an fMRI study, decreased brain activity in the hippocampus was reported82 in depressive patients. Reduced gray matter volume and reduced functional activity in the hippocampus would lead to negative emotion and the inability of cognitive processing in depressive patients.

Can MDD be cured? ›

It's one of the most common and most treatable mental health disorders. With early, continuous treatment, people can gain control of their symptoms, feel better, and get back to enjoying their lives.

What type of people get depressed? ›

Depression is common in people of all ages, races, gender identities, and socioeconomic status. According to the 2017 report from the National Institute of Mental Health, depression affects approximately 17.3 million people in the United States.

What is the most common way to treat depression? ›

Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

What is the prevention of depression? ›

Can depression be prevented? You can help prevent depression by getting enough sleep, eating a healthy diet and practicing regular self-care activities such as exercise, meditation and yoga. If you've had depression before, you may be more likely to experience it again. If you have depression symptoms, get help.

What are two core symptoms of a major depressive episode? ›

Depressed mood” and “loss of interest or pleasure in nearly all activities” are core features of a major depressive episode, though a strong case can be made to pay increasing attention to symptoms of fatigue, sleep disturbance, anxiety, and neurocognitive and sexual dysfunction in the diagnosis and evaluation of ...

What are the 2 key features of a major depressive episode? ›

A major depressive episode (MDE) is characterized by five or more of the following symptoms being present every day, or almost every day, for a minimum of two weeks: Depressed mood for most of the day. Loss of interest or enjoyment in all or most activities.

What is the final symptoms of depression? ›

Signs of severe depression can include feelings of hopelessness, increased irritability, loss of pleasure, trouble concentrating or sleeping, or thoughts of death of suicide. 1 Technically, severe depression isn't a formal mental health diagnosis. Rather, it refers to depression that is more debilitating in nature.

What is major depression also called? ›

Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.

What part of the brain is affected by major depressive disorder? ›

The main subcortical limbic brain regions implicated in depression are the amygdala, hippocampus, and the dorsomedial thalamus. Both structural and functional abnormalities in these areas have been found in depression.

Is major depressive disorder permanent? ›

Dr. Dunner: To conclude, some patients may experience recurring depressive episodes throughout their lives unless maintenance therapy is used to prevent relapse. Treatment should include both psychotherapy and pharmacotherapy, and medication dosage typically should not be decreased after remission.

Is MDD a disability? ›

Background: Major depressive disorder (MDD) represents a leading cause of disability.

Is major depressive disorder considered a disability? ›

Depression is considered a psychiatric disability under the Americans with Disabilities Act (ADA). It's a significant mood disorder that's known to interfere with daily activities, which may include your ability to work. Depression sometimes becomes so severe that you can no longer go to work.

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