Depression: when sadness is something more, and where to start

Everyone has bad days and sad stretches. Depression is something else: a restful weekend does not fix it, and neither does “trying harder”. It affects how you feel, think, sleep, eat and work. And it can be treated.

How it differs from a rough patch

According to the National Institute of Mental Health (NIMH), a diagnosis generally requires symptoms most of the day, nearly every day, for at least 2 weeks, including a depressed mood or loss of interest in things.

The symptoms

NIMH lists these among the most common:

• A sad, anxious or “empty” mood that does not lift.
• Hopelessness, guilt or feeling worthless.
• Irritability or restlessness.
• Losing interest or pleasure in things you used to enjoy.
• Fatigue, or feeling slowed down.
• Trouble concentrating or making decisions.
• Changes in sleep, appetite or weight.
• Aches or digestive problems with no clear cause.
• Thoughts of death or suicide.

You do not need to have all of them. And they can look different at different ages.

Your family doctor is a good first step

NIMH recommends starting with a primary care doctor, a psychologist or a psychiatrist. A family doctor has one advantage: they can rule out medical causes that look like depression, such as thyroid problems, with an exam and lab tests.

The U.S. Preventive Services Task Force (USPSTF) also recommends screening all adults for depression, including pregnant and postpartum women and older adults, even without risk factors.

For the visit, write down when your symptoms started, how long they last and how often they come.

Treatment works

• Psychotherapy: such as cognitive behavioral therapy or interpersonal therapy, in person or online. For milder cases it is often tried first.
• Medication: antidepressants usually take 4 to 8 weeks to work, so give them time before deciding whether they help.
• Sometimes the two are combined.

Two cautions from NIMH: do not start or stop a medication without talking to your doctor, and check before taking supplements such as St. John’s wort or vitamin D. In children, teens and young adults under 25, starting an antidepressant or changing the dose can increase suicidal thoughts, so they should be watched closely.

If you need help now

If you or someone you know is having thoughts of suicide, call or text 988, the Suicide & Crisis Lifeline, open 24 hours a day. For Spanish, call 988 and press 2, or text AYUDA to 988. If there is immediate danger, call 911.

How we can help

At our family medicine clinic you can talk about how you feel, not only about what hurts. We listen, check whether there is a medical cause and, depending on the case, follow up with you or refer you to a mental health professional. In English or Spanish, whichever comes more easily.

Sources

• National Institute of Mental Health (NIMH). Depression.
• U.S. Preventive Services Task Force. Depression and Suicide Risk in Adults: Screening (2023).
• 988 Suicide & Crisis Lifeline. Get Help.
• 988 Suicide & Crisis Lifeline. Is the 988 Lifeline available in other languages?.

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This article is general information about our clinic and about depression. It is not medical advice and does not replace a consultation with a professional. Do not change or stop your medications without talking to your doctor. If you are in danger or have a medical emergency, call 911.