Clinical depression is a very serious medical condition that affects nearly 20 million teenagers and adults in the United States. Everyone can have a bad day, or two, now and again, but when you are depressed, those feelings of sadness never seem to end. Depression makes everyday tasks feel overwhelming and the motivation to do anything at all, very challenging. Depressed people often isolate themselves socially.

Depression is one of the most common mental health disorders in the US. Research suggests it is caused by a combination of genetic, biological, environmental and psychological factors. This difficult condition does not discriminate. It can begin anytime, in any race or gender, and at any income level.

Anxiety in childhood or adolescence is linked to depression in adulthood. Depression that occurs in midlife is often the result of a co-occurring medical or physical illness such as heart disease, diabetes or cancer. The good news is that there are many effective treatments for depression so recognizing the symptoms and seeking help is important.

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Not everyone who suffers from depression will experience every symptom but here are some of the most common:

  • Feelings of sadness that seem overwhelming
  • A loss of interest in your normal and favorite activities
  • Problems with your appetite, including overeating or not any interest in eating at all
  • Having trouble falling and staying asleep, or even sleeping too much during the day
  • Lethargy. Feeling very tired and without energy all of the time
  • Feeling irritable and grouchy for no particular reason
  • Thinking about death or even suicide
  • Physical aches and pains throughout your body 

What’s Cortisol Got to Do with It?

Depression is a disorder of the brain that can be treated with a variety of techniques including therapy, medication and lifestyle changes. For many people who live with depression, simple changes to diet and getting sufficient rest can go a long way toward alleviating the worst symptoms of depression. Much of it has to do with cortisol, an important hormone in the body that is secreted by the adrenal gland. Elevated levels of stress in the body can raise levels of cortisol and perpetuate the cycle of depression.

Also known as the stress hormone, cortisol is released in response to stress in the body triggering the heart rate to increase, blood pressure to rise, and muscles to become tenser. In the short term, that’s a good thing—cortisol helps us access the energy we need to perform our best. But having elevated levels of cortisol in the body for an extended period can actually affect your physical and mental health.

Research has shown that elevated cortisol interferes with learning and memory, negatively impact immune function, contributes to weight gain and is connected to depression. Long-term activation of the body’s response to stress can disrupt almost all of the body’s processes and put you at more risk of developing headaches, gastrointestinal problems, depression, and anxiety. Nearly every cell in the body has a cortisol receptor which is why elevated levels of the hormone have such a big impact.

Reducing stress is one of the best ways to correct the balance of cortisol in your body, says Michael McGee, MD, chief medical officer, Haven at Pismo, an addiction treatment center in California and author of The Joy of Recovery: The New 12-Step Guide to Recovery from Addiction. “Good self-care is a foundational part of a low-stress life. Self-care involves optimizing your biological, psychological, social, and spiritual well-being and involves basic things like eating healthy, getting plenty of sleep and exercise, having regular routines, being involved in your community, pursuing passions and spending time in solitude for contemplation or reflection,” explains Dr. McGee explains.

Techniques like meditation, massage, and journaling can also be effective. If sleep is a problem, speak to your healthcare provider. There are medications that treat both insomnia and depression but they’ll need to be managed by a physician or psychiatrist. 

Not All Depression is The Same

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) contains authoritative information used by health care professionals to diagnose mental health disorders. It is published by the American Psychiatric Association and reviewed and updated periodically.

There are several different types of depression including major depressive disorder (MDD), persistent depressive disorder or dysthymia, postpartum depression, atypical depression and seasonal affective disorder (SAD). Each type can range in severity and involve a variety of different symptoms.

SAD is a type of depression tied to the seasons—most commonly winter. According to the American Academy of Family Physicians, SAD may be related to changes in the amount of daylight we receive. Between 4 and 6% of the population is affected by the winter blues but an estimated 10 to 20% of the population may have a milder form of it. Women are affected more than men. Many people don’t realize that SAD it is a type of depression, not a symptom of it.

“A lot of people expect to hit the ground running immediately after Labor Day,” says Sanam Hafeez, PsyD, a New York City-based licensed clinical psychologist and teaching faculty member at Columbia University Teacher’s College. “Allow yourself a solid two weeks to a full month to get back into the swing of your fall routine. You can’t expect to go from a more relaxed summer mindset into a rushed pace.  A lot of people make the mistake of going from summer ease to fall hustle and they end up running themselves down leading to a cold. You want to get a realistic handle on the fall routine and make decisions about how much to take on. Planning ahead helps,” explains Dr. Hafeez.

For people who feel depressed during the winter, light therapy can help. Other types of depression benefit from medication and therapy. Non-medical treatments such as exercise can also be helpful.

Stay Calm and Carry On

If you are feeling persistently sad, have lost interest in activities that used to bring you joy and just can’t seem to shake off those feelings as something temporary, make an appointment with your physician or healthcare provider (HCP).  Your HCP will examine you and ask a series of questions about your health. Be as honest and forthright as you can. Sharing accurate information will help your HCP determine if you are suffering from depression or have some other type of medical condition. And while there are no laboratory tests that can specifically diagnose depression, your physician may order some tests to rule out other medical conditions that may be connected to physical symptoms such as headaches and digestive distress.

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Do you feel depressed?

Take our 2-minute Depression quiz to see if you may benefit from further diagnosis and treatment.

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You may also be referred to a mental health professional, such as a therapist, psychiatrist, or mental health counselor to discuss your feelings and symptoms. During your first therapy session, you may feel anxious and nervous, and that is perfectly normal.  Try and stay calm, because the more relaxed you are when speaking with a mental health professional, the more you will gain from each session.  In the beginning, you will be asked questions about your family history of depression or other mental health disorders.  If sharing this kind of information causes shame or embarrassment, it may help to remember that depression is a common problem and that you are not alone. Seeing a mental health professional—and approaching therapy with a positive attitude—will help you feel better and is an important first step on your road to recovery.

Depending on your level of depression, a prescription drug may be recommended. If that happens, be sure to ask about side effects, dietary restrictions, how long the medication is typically prescribed and the amount of time for the medication to take effect (most of today’s antidepressants do not provide immediate relief from negative symptoms). 

What You Can Do to Help Yourself

If you’ve been diagnosed with depression, there are some effective ways you can help yourself, according to Carrie Carlton, LCSW,  clinical supervisor at Beachway Therapy Center in Florida.  “I always suggest to anyone who is dealing with depression that they create their own personal ‘wellness toolbox’ as a positive way to feel better,” says Carlton.

“Come up with a list of things that you can do for a quick mood boost. The more ‘tools’ for coping with depression, the better,” she explains.

Carlton suggests implementing a few of these ideas each day, even if you are feeling good:

  • Spend some time in nature
  • List what you like about yourself
  • Read a good book
  • Watch a funny movie or TV show
  • Take a long, hot bath
  • Accomplish a few small tasks
  • Play with a pet
  • Talk to friends or family face-to-face
  • Listen to music
  • Do something spontaneous
  • Join a support group online or in person 

5 Easy Ways to Eat Better

Nutrition can also impact mental health. “What you eat can have a direct impact on the way you feel,” says Susan McQuillan, MS, RDN. “And the way you feel can also have a direct impact on what you choose to eat.” Here are some simple ways to improve nourishment to your body.

1. Watch your diet. Limit foods that you already know have a negative effect on your mood and/or behavior, such as caffeine, alcohol, and foods high in sugar and fat.

2. Don’t skip meals. Going too long between meals can make you feel irritable and tired, so aim to eat something, even a snack, at least every three to four hours. “Instead of grabbing random foods, treat your snacks like ‘mini-meals’ and balance your plate with small amounts of several different types of food, just as you would a full meal,” McQuillan advises. “Well-balanced snacks—something like a cheese stick, a few whole almonds, and half an apple—not only contribute essential nutrients, they also provide steady energy to hold you until your next full meal.”

3. Eat mindfully. Take the time to sit still and do nothing else while you eat (other than engage in low-key conversation with others if you’re not eating alone.) Mindful eating helps you pay attention to what and how much you eat and develop better eating habits overall. 

4. Boost your B-vitamin intake. Deficiencies in B vitamins such as folic acid, B-6, and B-12 are associated with depression. The best sources of B vitamins include meat, poultry, fish, whole grains, leafy green vegetables, beans, nuts seeds, dairy products, and citrus fruit. In other words, a well-balanced diet! Talk to your health care provider to see if a B-complex vitamin supplement will help. 

5. Add more omega-3 fatty acids to your diet. Studies show mixed results but Omega-3 fatty acids may play an essential role in stabilizing mood. The best sources are fatty fish such as salmon, herring, mackerel, anchovies, sardines, tuna, and some cold-water fish oil supplements. Other sources include walnuts, flax seeds, hemp seeds, edamame (green soybeans) and other soy products. These foods contain fatty acids that can be converted in your body to Omega-3s.

If you are depressed, know that many others are struggling, too. “No one should worry or suffer alone,” Dr. McGee says. “There is a saying that a problem shared is a problem halved. It is amazing how just talking through a problem with others can bring peace and clarity.”

Last Updated: Jul 17, 2019