Depression and Anxiety

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 Depression
o Anxiety Disorders
o Depression
 Seasonal Affective Disorder
o Eating Disorders
o Gender Dysphoria

o Schizophrenia
Depression
What Is Depression?
Depression (major depressive disorder) is a common and serious medical illness that negatively
affects how you feel, the way you think and how you act. Fortunately, it is also treatable.
Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It
can lead to a variety of emotional and physical problems and can decrease your ability to
function at work and at home.
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
 Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing)
or slowed movements or speech (these actions must be severe enough to be observable by
others)
 Feeling worthless or guilty
 Difficulty thinking, concentrating or making decisions
 Thoughts of death or suicide
Symptoms must last at least two weeks and must represent a change in your previous level of
functioning for a diagnosis of depression.
Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic
symptoms of depression so it is important to rule out general medical causes.
Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people
(16.6%) will experience depression at some time in their life. Depression can occur at any time,
but on average, first appears during the late teens to mid-20s. Women are more likely than men
to experience depression. Some studies show that one-third of women will experience a major
depressive episode in their lifetime. There is a high degree of heritability (approximately 40%)
when first-degree relatives (parents/children/siblings) have depression.
Depression Is Different From Sadness or Grief/Bereavement
The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for
a person to endure. It is normal for feelings of sadness or grief to develop in response to such
situations. Those experiencing loss often might describe themselves as being “depressed.”
But being sad is not the same as having depression. The grieving process is natural and unique to
each individual and shares some of the same features of depression. Both grief and depression
may involve intense sadness and withdrawal from usual activities. They are also different in
important ways:
 In grief, painful feelings come in waves, often intermixed with positive memories of the
deceased. In major depression, mood and/or interest (pleasure) are decreased for most of
two weeks.
 In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness

and self-loathing are common.
 In grief, thoughts of death may surface when thinking of or fantasizing about “joining”
the deceased loved one. In major depression, thoughts are focused on ending one’s life
due to feeling worthless or undeserving of living or being unable to cope with the pain of
depression.
Grief and depression can co-exist For some people, the death of a loved one, losing a job or
being a victim of a physical assault or a major disaster can lead to depression. When grief and
depression co-occur, the grief is more severe and lasts longer than grief without depression.
Distinguishing between grief and depression is important and can assist people in getting the
help, support or treatment they need.
Risk Factors for Depression
Depression can affect anyone—even a person who appears to live in relatively ideal
circumstances.
Several factors can play a role in depression:
 Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms

of depression.
 Genetics: Depression can run in families. For example, if one identical twin has
depression, the other has a 70 percent chance of having the illness sometime in life.
 Personality: People with low self-esteem, who are easily overwhelmed by stress, or who
are generally pessimistic appear to be more likely to experience depression.
 Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may

make some people more vulnerable to depression.
How Is Depression Treated?
Depression is among the most treatable of mental disorders. Between 80% and 90% percent of
people with depression eventually respond well to treatment. Almost all patients gain some relief
from their symptoms.
Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic

evaluation, including an interview and a physical examination. In some cases, a blood test might
be done to make sure the depression is not due to a medical condition like a thyroid problem or a
vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms).
The evaluation will identify specific symptoms and explore medical and family histories as well
as cultural and environmental factors with the goal of arriving at a diagnosis and planning a
course of action.
Medication: Brain chemistry may contribute to an individual’s depression and may factor into
their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain
chemistry. These medications are not sedatives, “uppers” or tranquilizers. They are not habit-
forming. Generally antidepressant medications have no stimulating effect on people not
experiencing depression.
Antidepressants may produce some improvement within the first week or two of use yet full
benefits may not be seen for two to three months. If a patient feels little or no improvement after
several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute
another antidepressant. In some situations other psychotropic medications may be helpful. It is
important to let your doctor know if a medication does not work or if you experience side effects.
Psychiatrists usually recommend that patients continue to take medication for six or more
months after the symptoms have improved. Longer-term maintenance treatment may be
suggested to decrease the risk of future episodes for certain people at high risk.
Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of

mild depression; for moderate to severe depression, psychotherapy is often used along with
antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective
in treating depression. CBT is a form of therapy focused on the problem solving in the present.
CBT helps a person to recognize distorted/negative thinking with the goal of changing thoughts
and behaviors to respond to challenges in a more positive manner.
Psychotherapy may involve only the individual, but it can include others. For example, family or
couples therapy can help address issues within these close relationships. Group therapy brings
people with similar illnesses together in a supportive environment, and can assist the participant
to learn how others cope in similar situations .
.Depending on the severity of the depression, treatment can take a few weeks or much longer. In
many cases, significant improvement can be made in 10 to 15 sessions.
Electroconvulsive Therapy (ECT) is a medical treatment that has been most commonly
reserved for patients with severe major depression who have not responded to other treatments. It
involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient
typically receives ECT two to three times a week for a total of six to 12 treatments. It is usually
managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist
and a nurse or physician assistant. ECT has been used since the 1940s, and many years of
research have led to major improvements and the recognition of its effectiveness as a mainstream
rather than a "last resort" treatment. .
Self-help and Coping
There are a number of things people can do to help reduce the symptoms of depression. For
many people, regular exercise helps create positive feeling and improves mood. Getting enough
quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also
help reduce symptoms of depression.
Depression is a real illness and help is available. With proper diagnosis and treatment, the vast
majority of people with depression will overcome it. If you are experiencing symptoms of
depression, a first step is to see your family physician or psychiatrist. Talk about your concerns
and request a thorough evaluation. This is a start to addressing your mental health needs.
Related Conditions
 Peripartum depression (previously postpartum depression)
 Seasonal depression (Also called seasonal affective disorder)
 Bipolar disorders
 Persistent depressive disorder (previously dysthymia) (description below)
 Premenstrual dysphoric disorder (description below)
 Disruptive mood dysregulation disorder (description below)
Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) was added to the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) in 2013. A woman with PMDD has severe symptoms of depression,
irritability, and tension about a week before menstruation begins.
Common symptoms include mood swings, irritability or anger, depressed mood, and marked
anxiety or tension. Other symptoms may include decreased interest in usual activities, difficulty
concentrating, lack of energy or easy fatigue, changes in appetite with specific food cravings,
trouble sleeping or sleeping too much, or a sense of being overwhelmed or out of control.
Physical symptoms may include breast tenderness or swelling, joint or muscle pain, a sensation
of “bloating,” or weight gain.
These symptoms begin a week to 10 days before the start of menstruation and improve or stop
around the onset of menses. The symptoms lead to significant distress and problems with regular
functioning or social interactions.
For a diagnosis of PMDD, symptoms must have occurred in most of the menstrual cycles during
the past year and must have an adverse effect on work or social functioning. Premenstrual
dysphoric disorder is estimated to affect between 1.8% to 5.8% of menstruating women every
year.
PMDD can be treated with antidepressants, birth control pills, or nutritional supplements. Diet
and lifestyle changes, such as reducing caffeine and alcohol, getting enough sleep and exercise,
and practicing relaxations techniques, can help.
Premenstrual syndrome (PMS) is similar to PMDD in that symptoms occur seven to 10 days
before a woman’s period begins. However, PMS involves fewer and less severe symptoms than
PMDD.
Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder is a condition that occurs in children and youth ages 6 to
18. It involves a chronic and severe irritability resulting in severe and frequent temper outbursts.
The temper outbursts can be verbal or can involve behavior such as physical aggression toward
people or property. These outbursts are significantly out of proportion to the situation and are not
consistent with the child’s developmental age. They must occur frequently (three or more times
per week on average) and typically in response to frustration. In between the outbursts, the
child’s mood is persistently irritable or angry most of the day, nearly every day. This mood is
noticeable by others, such as parents, teachers, and peers.
In order for a diagnosis of disruptive mood dysregulation disorder to be made, symptoms must
be present for at least one year in at least two settings (such as at home, at school, with peers)
and the condition must begin before age 10. Disruptive mood dysregulation disorder is much
more common in males than females. It may occur along with other disorders, including major
depressive, attention-deficit/hyperactivity, anxiety, and conduct disorders.
Disruptive mood dysregulation disorder can have a significant impact on the child’s ability to
function and a significant impact on the family. Chronic, severe irritability and temper outbursts
can disrupt family life, make it difficult for the child/youth to make or keep friendships, and
cause difficulties at school.
Treatment typically involves psychotherapy (cognitive behavior therapy) and/or medications.
Persistent Depressive Disorder
A person with persistent depressive disorder (previously referred to as dysthymic disorder) has a
depressed mood for most of the day, for more days than not, for at least two years. In children
and adolescents, the mood can be irritable or depressed, and must continue for at least one year.
In addition to depressed mood, symptoms include:
 Poor appetite or overeating
 Insomnia or hypersomnia
 Low energy or fatigue
 Low self-esteem
 Poor concentration or difficulty making decisions
 Feelings of hopelessness
Persistent depressive disorder often begins in childhood, adolescence, or early adulthood and
affects an estimated 0.5% of adults in the United States every year. Individuals with persistent
depressive disorder often describe their mood as sad or “down in the dumps.” Because these
symptoms have become a part of the individual’s day-to-day experience, they may not seek help,
just assuming that “I’ve always been this way.”
The symptoms cause significant distress or difficulty in work, social activities, or other important
areas of functioning. While the impact of persistent depressive disorder on work, relationships
and daily life can vary widely, its effects can be as great as or greater than those of major
depressive disorder.
A major depressive episode may precede the onset of persistent depressive disorder but may also
arise during (and be superimposed on) a previous diagnosis of persistent depressive disorder.
References
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental

Disorders (DSM-5), Fifth edition. 2013.
 National Institute of Mental Health. (Data from 2013 National Survey on Drug Use and
Health.) www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-
adults.shtml
 Kessler, RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV

Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry.
2005;62(6):593602. http://archpsyc.jamanetwork.com/article.aspx?articleid=208678
Physician Review By:
Felix Torres, M.D., MBA, DFAPA

October 2020
Expert Q & A: Depression
Find answers to your questions about depression written by leading psychiatrists.
View More
Patient Stories: Depression
Read patient stories about depression and learn how to share your story at psychiatry.org.
View More
Seasonal Affective Disorder
Learn about Seasonal Affective Disorder, including symptoms, risk factors and treatment
options.
Learn More
The American Psychiatric Association (APA) is committed to ensuring accessibility of its

website to people with disabilities. If you have trouble accessing any of APA's web
resources, please contact us at 202-559-3900 or apa@psych.org for assistance.
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Policy
I agree
 Depression
o Anxiety Disorders
o Depression
 Seasonal Affective Disorder
o Eating Disorders
o Gender Dysphoria
o Schizophrenia
Depression
What Is Depression?
Depression (major depressive disorder) is a common and serious medical illness that negatively
affects how you feel, the way you think and how you act. Fortunately, it is also treatable.
Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It
can lead to a variety of emotional and physical problems and can decrease your ability to
function at work and at home.
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
 Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing)
or slowed movements or speech (these actions must be severe enough to be observable by
others)
 Feeling worthless or guilty
 Difficulty thinking, concentrating or making decisions
 Thoughts of death or suicide
Symptoms must last at least two weeks and must represent a change in your previous level of
functioning for a diagnosis of depression.
Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic
symptoms of depression so it is important to rule out general medical causes.
Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people
(16.6%) will experience depression at some time in their life. Depression can occur at any time,
but on average, first appears during the late teens to mid-20s. Women are more likely than men
to experience depression. Some studies show that one-third of women will experience a major
when first-degree relatives (parents/children/siblings) have depression.
Depression Is Different From Sadness or Grief/Bereavement
The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for
a person to endure. It is normal for feelings of sadness or grief to develop in response to such
situations. Those experiencing loss often might describe themselves as being “depressed.”
But being sad is not the same as having depression. The grieving process is natural and unique to
each individual and shares some of the same features of depression. Both grief and depression
may involve intense sadness and withdrawal from usual activities. They are also different in
important ways:
 In grief, painful feelings come in waves, often intermixed with positive memories of the
deceased. In major depression, mood and/or interest (pleasure) are decreased for most of
two weeks.
 In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness

and self-loathing are common.
 In grief, thoughts of death may surface when thinking of or fantasizing about “joining”
the deceased loved one. In major depression, thoughts are focused on ending one’s life
due to feeling worthless or undeserving of living or being unable to cope with the pain of
depression.
Grief and depression can co-exist For some people, the death of a loved one, losing a job or
being a victim of a physical assault or a major disaster can lead to depression. When grief and
depression co-occur, the grief is more severe and lasts longer than grief without depression.
Distinguishing between grief and depression is important and can assist people in getting the
help, support or treatment they need.
Risk Factors for Depression
circumstances.
Several factors can play a role in depression:
 Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms

of depression.
 Genetics: Depression can run in families. For example, if one identical twin has
depression, the other has a 70 percent chance of having the illness sometime in life.
 Personality: People with low self-esteem, who are easily overwhelmed by stress, or who
are generally pessimistic appear to be more likely to experience depression.
 Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may

make some people more vulnerable to depression.
How Is Depression Treated?
Depression is among the most treatable of mental disorders. Between 80% and 90% percent of
people with depression eventually respond well to treatment. Almost all patients gain some relief
from their symptoms.
Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic

evaluation, including an interview and a physical examination. In some cases, a blood test might
be done to make sure the depression is not due to a medical condition like a thyroid problem or a
vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms).
The evaluation will identify specific symptoms and explore medical and family histories as well
as cultural and environmental factors with the goal of arriving at a diagnosis and planning a
course of action.
experiencing depression.
Antidepressants may produce some improvement within the first week or two of use yet full
benefits may not be seen for two to three months. If a patient feels little or no improvement after
several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute
another antidepressant. In some situations other psychotropic medications may be helpful. It is
important to let your doctor know if a medication does not work or if you experience side effects.
Psychiatrists usually recommend that patients continue to take medication for six or more
months after the symptoms have improved. Longer-term maintenance treatment may be
suggested to decrease the risk of future episodes for certain people at high risk.
Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of
mild depression; for moderate to severe depression, psychotherapy is often used along with
and behaviors to respond to challenges in a more positive manner.
Psychotherapy may involve only the individual, but it can include others. For example, family or
couples therapy can help address issues within these close relationships. Group therapy brings
people with similar illnesses together in a supportive environment, and can assist the participant
to learn how others cope in similar situations .
.Depending on the severity of the depression, treatment can take a few weeks or much longer. In
many cases, significant improvement can be made in 10 to 15 sessions.
Electroconvulsive Therapy (ECT) is a medical treatment that has been most commonly
reserved for patients with severe major depression who have not responded to other treatments. It
involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient
typically receives ECT two to three times a week for a total of six to 12 treatments. It is usually
managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist
and a nurse or physician assistant. ECT has been used since the 1940s, and many years of
research have led to major improvements and the recognition of its effectiveness as a mainstream
rather than a "last resort" treatment. .
Self-help and Coping
There are a number of things people can do to help reduce the symptoms of depression. For
many people, regular exercise helps create positive feeling and improves mood. Getting enough
quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also
help reduce symptoms of depression.
and request a thorough evaluation. This is a start to addressing your mental health needs.
Related Conditions
 Peripartum depression (previously postpartum depression)
 Seasonal depression (Also called seasonal affective disorder)
 Bipolar disorders
 Persistent depressive disorder (previously dysthymia) (description below)
 Premenstrual dysphoric disorder (description below)
 Disruptive mood dysregulation disorder (description below)
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder (PMDD) was added to the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) in 2013. A woman with PMDD has severe symptoms of depression,
irritability, and tension about a week before menstruation begins.
Common symptoms include mood swings, irritability or anger, depressed mood, and marked
anxiety or tension. Other symptoms may include decreased interest in usual activities, difficulty
concentrating, lack of energy or easy fatigue, changes in appetite with specific food cravings,
trouble sleeping or sleeping too much, or a sense of being overwhelmed or out of control.
Physical symptoms may include breast tenderness or swelling, joint or muscle pain, a sensation
of “bloating,” or weight gain.
These symptoms begin a week to 10 days before the start of menstruation and improve or stop
around the onset of menses. The symptoms lead to significant distress and problems with regular
functioning or social interactions.
For a diagnosis of PMDD, symptoms must have occurred in most of the menstrual cycles during
the past year and must have an adverse effect on work or social functioning. Premenstrual
dysphoric disorder is estimated to affect between 1.8% to 5.8% of menstruating women every
year.
PMDD can be treated with antidepressants, birth control pills, or nutritional supplements. Diet
and lifestyle changes, such as reducing caffeine and alcohol, getting enough sleep and exercise,
and practicing relaxations techniques, can help.
PMDD.
Disruptive Mood Dysregulation Disorder
Disruptive mood dysregulation disorder is a condition that occurs in children and youth ages 6 to
18. It involves a chronic and severe irritability resulting in severe and frequent temper outbursts.
The temper outbursts can be verbal or can involve behavior such as physical aggression toward
people or property. These outbursts are significantly out of proportion to the situation and are not
consistent with the child’s developmental age. They must occur frequently (three or more times
per week on average) and typically in response to frustration. In between the outbursts, the
child’s mood is persistently irritable or angry most of the day, nearly every day. This mood is
noticeable by others, such as parents, teachers, and peers.
depressive, attention-deficit/hyperactivity, anxiety, and conduct disorders.
Disruptive mood dysregulation disorder can have a significant impact on the child’s ability to
function and a significant impact on the family. Chronic, severe irritability and temper outbursts
can disrupt family life, make it difficult for the child/youth to make or keep friendships, and
cause difficulties at school.
Treatment typically involves psychotherapy (cognitive behavior therapy) and/or medications.

Persistent Depressive Disorder
A person with persistent depressive disorder (previously referred to as dysthymic disorder) has a
depressed mood for most of the day, for more days than not, for at least two years. In children
and adolescents, the mood can be irritable or depressed, and must continue for at least one year.
In addition to depressed mood, symptoms include:
 Poor appetite or overeating
 Insomnia or hypersomnia
 Low energy or fatigue
 Low self-esteem
 Poor concentration or difficulty making decisions
 Feelings of hopelessness
Persistent depressive disorder often begins in childhood, adolescence, or early adulthood and
affects an estimated 0.5% of adults in the United States every year. Individuals with persistent
depressive disorder often describe their mood as sad or “down in the dumps.” Because these
symptoms have become a part of the individual’s day-to-day experience, they may not seek help,
just assuming that “I’ve always been this way.”
The symptoms cause significant distress or difficulty in work, social activities, or other important
depressive disorder.
A major depressive episode may precede the onset of persistent depressive disorder but may also
arise during (and be superimposed on) a previous diagnosis of persistent depressive disorder.
References
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental

Disorders (DSM-5), Fifth edition. 2013.
 National Institute of Mental Health. (Data from 2013 National Survey on Drug Use and
Health.) www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-
adults.shtml
 Kessler, RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV

2005;62(6):593602. http://archpsyc.jamanetwork.com/article.aspx?articleid=208678
Physician Review By:
Felix Torres, M.D., MBA, DFAPA

October 2020
Expert Q & A: Depression
Find answers to your questions about depression written by leading psychiatrists.
View More
Patient Stories: Depression
Read patient stories about depression and learn how to share your story at psychiatry.org.
View More
Seasonal Affective Disorder
Learn about Seasonal Affective Disorder, including symptoms, risk factors and treatment
options.
Learn More
The American Psychiatric Association (APA) is committed to ensuring accessibility of its

website to people with disabilities. If you have trouble accessing any of APA's web
resources, please contact us at 202-559-3900 or apa@psych.org for assistance.
Become an APA Member Learn More


Explore APA
 Psychiatrists
 About APA
 Work At APA
 Annual Meeting
Newsroom
 News Releases
 Message from President
 APA Blogs
Join APA
 General Members
 Early Career Psychiatrists
 Residents and Fellows
 Medical Students
 International
 International Resident-Fellows
 Semi-Retired and Retired
 Become a Fellow
APA Sites
 APA Publishing
 APA Foundation
 APA Learning Center
 APA Annual Meeting
 PsychiatryOnline
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Topics » Depression What Is Depression? Depression (major depressive disorder) is a common
and serious medical illness that negatively affects how you feel, the way you think and how you
act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of
interest in activities you once enjoyed. It can lead to a variety of emotional and physical
problems and can decrease your ability to function at work and at home. 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
Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or
slowed movements or speech (these actions must be severe enough to be observable by others)
Feeling worthless or guilty Difficulty thinking, concentrating or making decisions Thoughts of
death or suicide Symptoms must last at least two weeks and must represent a change in your
previous level of functioning for a diagnosis of depression. Also, medical conditions (e.g.,
thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it
is important to rule out general medical causes. Depression affects an estimated one in 15 adults
(6.7%) in any given year. And one in six people (16.6%) will experience depression at some time
in their life. Depression can occur at any time, but on average, first appears during the late teens
to mid-20s. Women are more likely than men to experience depression. Some studies show that
one-third of women will experience a major depressive episode in their lifetime. There is a high
degree of heritability (approximately 40%) when first-degree relatives (parents/children/siblings)
have depression. Depression Is Different From Sadness or Grief/Bereavement The death of a
loved one, loss of a job or the ending of a relationship are difficult experiences for a person to
endure. It is normal for feelings of sadness or grief to develop in response to such situations.
Those experiencing loss often might describe themselves as being “depressed.” But being sad is
not the same as having depression. The grieving process is natural and unique to each individual
and shares some of the same features of depression. Both grief and depression may involve
intense sadness and withdrawal from usual activities. They are also different in important ways:
In grief, painful feelings come in waves, often intermixed with positive memories of the
deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two
weeks. In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness
and self-loathing are common. In grief, thoughts of death may surface when thinking of or
fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on
ending one’s life due to feeling worthless or undeserving of living or being unable to cope with
the pain of depression. Grief and depression can co-exist For some people, the death of a loved
one, losing a job or being a victim of a physical assault or a major disaster can lead to
depression. When grief and depression co-occur, the grief is more severe and lasts longer than
grief without depression. Distinguishing between grief and depression is important and can assist
people in getting the help, support or treatment they need. Risk Factors for Depression
circumstances. Several factors can play a role in depression: Biochemistry: Differences in certain
chemicals in the brain may contribute to symptoms of depression. Genetics: Depression can run
in families. For example, if one identical twin has depression, the other has a 70 percent chance
of having the illness sometime in life. Personality: People with low self-esteem, who are easily
overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience
depression. Environmental factors: Continuous exposure to violence, neglect, abuse or poverty
may make some people more vulnerable to depression. How Is Depression Treated? Depression
is among the most treatable of mental disorders. Between 80% and 90% percent of people with
depression eventually respond well to treatment. Almost all patients gain some relief from their
symptoms. Before a diagnosis or treatment, a health professional should conduct a thorough
diagnostic evaluation, including an interview and a physical examination. In some cases, a blood
test might be done to make sure the depression is not due to a medical condition like a thyroid
problem or a vitamin deficiency (reversing the medical cause would alleviate the depression-like
symptoms). The evaluation will identify specific symptoms and explore medical and family
histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and
planning a course of action. Medication: Brain chemistry may contribute to an individual’s
depression and may factor into their treatment. For this reason, antidepressants might be
prescribed to help modify one’s brain chemistry. These medications are not sedatives, “uppers”
or tranquilizers. They are not habit-forming. Generally antidepressant medications have no
stimulating effect on people not experiencing depression. Antidepressants may produce some
improvement within the first week or two of use yet full benefits may not be seen for two to
three months. If a patient feels little or no improvement after several weeks, his or her
psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In
some situations other psychotropic medications may be helpful. It is important to let your doctor
know if a medication does not work or if you experience side effects. Psychiatrists usually
recommend that patients continue to take medication for six or more months after the symptoms
have improved. Longer-term maintenance treatment may be suggested to decrease the risk of
future episodes for certain people at high risk. Psychotherapy: Psychotherapy, or “talk therapy,”
is sometimes used alone for treatment of mild depression; for moderate to severe depression,
psychotherapy is often used along with antidepressant medications. Cognitive behavioral therapy
(CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on
the problem solving in the present. CBT helps a person to recognize distorted/negative thinking
with the goal of changing thoughts and behaviors to respond to challenges in a more positive
manner. Psychotherapy may involve only the individual, but it can include others. For example,
family or couples therapy can help address issues within these close relationships. Group therapy
brings people with similar illnesses together in a supportive environment, and can assist the
participant to learn how others cope in similar situations . .Depending on the severity of the
depression, treatment can take a few weeks or much longer. In many cases, significant
improvement can be made in 10 to 15 sessions. Electroconvulsive Therapy (ECT) is a medical
treatment that has been most commonly reserved for patients with severe major depression who
have not responded to other treatments. It involves a brief electrical stimulation of the brain
while the patient is under anesthesia. A patient typically receives ECT two to three times a week
for a total of six to 12 treatments. It is usually managed by a team of trained medical
professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant. ECT
has been used since the 1940s, and many years of research have led to major improvements and
the recognition of its effectiveness as a mainstream rather than a "last resort" treatment. . Self-
help and Coping There are a number of things people can do to help reduce the symptoms of
depression. For many people, regular exercise helps create positive feeling and improves mood.
Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a
depressant) can also help reduce symptoms of depression. Depression is a real illness and help is
available. With proper diagnosis and treatment, the vast majority of people with depression will
overcome it. If you are experiencing symptoms of depression, a first step is to see your family
physician or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a
start to addressing your mental health needs. Related Conditions Peripartum depression
(previously postpartum depression) Seasonal depression (Also called seasonal affective disorder)
Bipolar disorders Persistent depressive disorder (previously dysthymia) (description below)
Premenstrual dysphoric disorder (description below) Disruptive mood dysregulation disorder
(description below) Premenstrual Dysphoric Disorder Premenstrual dysphoric disorder (PMDD)
was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. A
woman with PMDD has severe symptoms of depression, irritability, and tension about a week
before menstruation begins. Common symptoms include mood swings, irritability or anger,
depressed mood, and marked anxiety or tension. Other symptoms may include decreased interest
in usual activities, difficulty concentrating, lack of energy or easy fatigue, changes in appetite
with specific food cravings, trouble sleeping or sleeping too much, or a sense of being
overwhelmed or out of control. Physical symptoms may include breast tenderness or swelling,
joint or muscle pain, a sensation of “bloating,” or weight gain. These symptoms begin a week to
10 days before the start of menstruation and improve or stop around the onset of menses. The
symptoms lead to significant distress and problems with regular functioning or social
interactions. For a diagnosis of PMDD, symptoms must have occurred in most of the menstrual
cycles during the past year and must have an adverse effect on work or social functioning.
Premenstrual dysphoric disorder is estimated to affect between 1.8% to 5.8% of menstruating
women every year. PMDD can be treated with antidepressants, birth control pills, or nutritional
supplements. Diet and lifestyle changes, such as reducing caffeine and alcohol, getting enough
sleep and exercise, and practicing relaxations techniques, can help. Premenstrual syndrome
(PMS) is similar to PMDD in that symptoms occur seven to 10 days before a woman’s period
begins. However, PMS involves fewer and less severe symptoms than PMDD. Disruptive Mood
Dysregulation Disorder Disruptive mood dysregulation disorder is a condition that occurs in
children and youth ages 6 to 18. It involves a chronic and severe irritability resulting in severe
and frequent temper outbursts. The temper outbursts can be verbal or can involve behavior such
as physical aggression toward people or property. These outbursts are significantly out of
proportion to the situation and are not consistent with the child’s developmental age. They must
occur frequently (three or more times per week on average) and typically in response to
frustration. In between the outbursts, the child’s mood is persistently irritable or angry most of
the day, nearly every day. This mood is noticeable by others, such as parents, teachers, and peers.
depressive, attention-deficit/hyperactivity, anxiety, and conduct disorders. Disruptive mood
dysregulation disorder can have a significant impact on the child’s ability to function and a
significant impact on the family. Chronic, severe irritability and temper outbursts can disrupt
family life, make it difficult for the child/youth to make or keep friendships, and cause
difficulties at school. Treatment typically involves psychotherapy (cognitive behavior therapy)
and/or medications. Persistent Depressive Disorder A person with persistent depressive disorder
(previously referred to as dysthymic disorder) has a depressed mood for most of the day, for
more days than not, for at least two years. In children and adolescents, the mood can be irritable
or depressed, and must continue for at least one year. In addition to depressed mood, symptoms
include: Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-
esteem Poor concentration or difficulty making decisions Feelings of hopelessness Persistent
depressive disorder often begins in childhood, adolescence, or early adulthood and affects an
estimated 0.5% of adults in the United States every year. Individuals with persistent depressive
disorder often describe their mood as sad or “down in the dumps.” Because these symptoms have
become a part of the individual’s day-to-day experience, they may not seek help, just assuming
that “I’ve always been this way.” The symptoms cause significant distress or difficulty in work,
social activities, or other important areas of functioning. While the impact of persistent
depressive disorder on work, relationships and daily life can vary widely, its effects can be as
great as or greater than those of major depressive disorder. A major depressive episode may
precede the onset of persistent depressive disorder but may also arise during (and be
superimposed on) a previous diagnosis of persistent depressive disorder. References American
Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth
edition. 2013. National Institute of Mental Health. (Data from 2013 National Survey on Drug
Use and Health.) www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-
adults.shtml Kessler, RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV
2005;62(6):593602. http://archpsyc.jamanetwork.com/article.aspx?articleid=208678 Physician
Review By: Felix Torres, M.D., MBA, DFAPA October 2020 Expert Q & A: Depression Find
answers to your questions about depression written by leading psychiatrists. View More Patient
Stories: Depression Read patient stories about depression and learn how to share your story at
psychiatry.org. View More Seasonal Affective Disorder Learn about Seasonal Affective
Disorder, including symptoms, risk factors and treatment options. Learn More The American
Psychiatric Association (APA) is committed to ensuring accessibility of its website to people
with disabilities. If you have trouble accessing any of APA's web resources, please contact us at
202-559-3900 or apa@psych.org for assistance. Become an APA Member Learn More Explore
APA Psychiatrists Residents & Medical Students Patients & Families About APA Work At APA
Annual Meeting Newsroom News Releases Psychiatric News Message from President APA
Blogs Join APA General Members Early Career Psychiatrists Residents and Fellows Medical
Students International International Resident-Fellows Semi-Retired and Retired Become a
Fellow APA Sites APA Publishing APA Foundation APA Learning Center APA Annual
Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Melvin Sabshin, M.D.
Library & Archives Terms of Use and Privacy PolicyCopyrightContact © 2020 American
Psychiatric Association. All Rights Reserved. 800 Maine Avenue, S.W., Suite 900, Washington,
DC 20024 202-559-3900 apa@psych.org About APA APA's Vision, Mission, Values, and Goals
Meet Our Organization Read APA Organization Documents and Policies Work at APA APA
Headquarters Contact Us Newsroom News Releases Message from the President Reporting on
Mental Health Conditions APA Blogs Annual Meeting Goldwater Rule Advocacy & APAPAC
APA Sites APA Publishing APA Learning Center APA Foundation APA Annual Meeting
Psychiatric News PsychiatryOnline Workplace Mental Health Melvin Sabshin, M.D. Library &
Archives Sign In Join General Residents and Fellows Medical Students International
International Resident-Fellows Psychiatrists COVID-19 / Coronavirus Structural Racism Task
Force Education Practice Diversity & Health Equity Awards & Leadership Opportunities
Advocacy & APAPAC Meetings Search Directories/Databases International Registry Residents
& Medical Students Residents Medical Students Patients & Families What Is Psychiatry? Find a
Psychiatrist Addiction and Substance Use Disorders Anxiety Disorders Depression Dissociative
Disorders Eating Disorders Gender Dysphoria Obsessive-Compulsive Disorder (OCD)
Personality Disorders Posttraumatic Stress Disorder (PTSD) Schizophrenia View More Topics »
Policy I agree Patients & FamiliesDepression Patients & Families What Is Psychiatry? Find a
Psychiatrist Addiction and Substance Use Disorders Anxiety Disorders Depression Seasonal
Affective Disorder Dissociative Disorders Eating Disorders Gender Dysphoria Obsessive-
Compulsive Disorder (OCD) Personality Disorders Posttraumatic Stress Disorder (PTSD)
Schizophrenia View More Topics » Depression What Is Depression? Depression (major
depressive disorder) is a common and serious medical illness that negatively affects how you
feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes
feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety
of emotional and physical problems and can decrease your ability to function at work and at
home. 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 Increase in purposeless physical activity (e.g., inability to sit still,
pacing, handwringing) or slowed movements or speech (these actions must be severe enough to
be observable by others) Feeling worthless or guilty Difficulty thinking, concentrating or making
decisions Thoughts of death or suicide Symptoms must last at least two weeks and must
represent a change in your previous level of functioning for a diagnosis of depression. Also,
medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic
symptoms of depression so it is important to rule out general medical causes. Depression affects
an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will
experience depression at some time in their life. Depression can occur at any time, but on
average, first appears during the late teens to mid-20s. Women are more likely than men to
experience depression. Some studies show that one-third of women will experience a major
when first-degree relatives (parents/children/siblings) have depression. Depression Is Different
From Sadness or Grief/Bereavement The death of a loved one, loss of a job or the ending of a
relationship are difficult experiences for a person to endure. It is normal for feelings of sadness
or grief to develop in response to such situations. Those experiencing loss often might describe
themselves as being “depressed.” But being sad is not the same as having depression. The
grieving process is natural and unique to each individual and shares some of the same features of
depression. Both grief and depression may involve intense sadness and withdrawal from usual
activities. They are also different in important ways: In grief, painful feelings come in waves,
often intermixed with positive memories of the deceased. In major depression, mood and/or
interest (pleasure) are decreased for most of two weeks. In grief, self-esteem is usually
maintained. In major depression, feelings of worthlessness and self-loathing are common. In
grief, thoughts of death may surface when thinking of or fantasizing about “joining” the
deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling
worthless or undeserving of living or being unable to cope with the pain of depression. Grief and
depression can co-exist For some people, the death of a loved one, losing a job or being a victim
of a physical assault or a major disaster can lead to depression. When grief and depression co-
occur, the grief is more severe and lasts longer than grief without depression. Distinguishing
between grief and depression is important and can assist people in getting the help, support or
treatment they need. Risk Factors for Depression Depression can affect anyone—even a person
who appears to live in relatively ideal circumstances. Several factors can play a role in
depression: Biochemistry: Differences in certain chemicals in the brain may contribute to
symptoms of depression. Genetics: Depression can run in families. For example, if one identical
twin has depression, the other has a 70 percent chance of having the illness sometime in life.
Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are
generally pessimistic appear to be more likely to experience depression. Environmental factors:
Continuous exposure to violence, neglect, abuse or poverty may make some people more
vulnerable to depression. How Is Depression Treated? Depression is among the most treatable of
mental disorders. Between 80% and 90% percent of people with depression eventually respond
well to treatment. Almost all patients gain some relief from their symptoms. Before a diagnosis
or treatment, a health professional should conduct a thorough diagnostic evaluation, including an
interview and a physical examination. In some cases, a blood test might be done to make sure the
depression is not due to a medical condition like a thyroid problem or a vitamin deficiency
(reversing the medical cause would alleviate the depression-like symptoms). The evaluation will
identify specific symptoms and explore medical and family histories as well as cultural and
environmental factors with the goal of arriving at a diagnosis and planning a course of action.
experiencing depression. Antidepressants may produce some improvement within the first week
or two of use yet full benefits may not be seen for two to three months. If a patient feels little or
no improvement after several weeks, his or her psychiatrist can alter the dose of the medication
or add or substitute another antidepressant. In some situations other psychotropic medications
may be helpful. It is important to let your doctor know if a medication does not work or if you
experience side effects. Psychiatrists usually recommend that patients continue to take
medication for six or more months after the symptoms have improved. Longer-term maintenance
treatment may be suggested to decrease the risk of future episodes for certain people at high risk.
Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild
depression; for moderate to severe depression, psychotherapy is often used along with
and behaviors to respond to challenges in a more positive manner. Psychotherapy may involve
only the individual, but it can include others. For example, family or couples therapy can help
address issues within these close relationships. Group therapy brings people with similar
illnesses together in a supportive environment, and can assist the participant to learn how others
cope in similar situations . .Depending on the severity of the depression, treatment can take a few
weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions.
Electroconvulsive Therapy (ECT) is a medical treatment that has been most commonly reserved
for patients with severe major depression who have not responded to other treatments. It involves
a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically
receives ECT two to three times a week for a total of six to 12 treatments. It is usually managed
by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a
nurse or physician assistant. ECT has been used since the 1940s, and many years of research
have led to major improvements and the recognition of its effectiveness as a mainstream rather
than a "last resort" treatment. . Self-help and Coping There are a number of things people can do
to help reduce the symptoms of depression. For many people, regular exercise helps create
positive feeling and improves mood. Getting enough quality sleep on a regular basis, eating a
healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.
and request a thorough evaluation. This is a start to addressing your mental health needs. Related
Conditions Peripartum depression (previously postpartum depression) Seasonal depression (Also
called seasonal affective disorder) Bipolar disorders Persistent depressive disorder (previously
dysthymia) (description below) Premenstrual dysphoric disorder (description below) Disruptive
mood dysregulation disorder (description below) Premenstrual Dysphoric Disorder Premenstrual
dysphoric disorder (PMDD) was added to the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) in 2013. A woman with PMDD has severe symptoms of depression,
irritability, and tension about a week before menstruation begins. Common symptoms include
mood swings, irritability or anger, depressed mood, and marked anxiety or tension. Other
symptoms may include decreased interest in usual activities, difficulty concentrating, lack of
energy or easy fatigue, changes in appetite with specific food cravings, trouble sleeping or
sleeping too much, or a sense of being overwhelmed or out of control. Physical symptoms may
include breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight
gain. These symptoms begin a week to 10 days before the start of menstruation and improve or
stop around the onset of menses. The symptoms lead to significant distress and problems with
regular functioning or social interactions. For a diagnosis of PMDD, symptoms must have
occurred in most of the menstrual cycles during the past year and must have an adverse effect on
work or social functioning. Premenstrual dysphoric disorder is estimated to affect between 1.8%
to 5.8% of menstruating women every year. PMDD can be treated with antidepressants, birth
control pills, or nutritional supplements. Diet and lifestyle changes, such as reducing caffeine and
alcohol, getting enough sleep and exercise, and practicing relaxations techniques, can help.
PMDD. Disruptive Mood Dysregulation Disorder Disruptive mood dysregulation disorder is a
condition that occurs in children and youth ages 6 to 18. It involves a chronic and severe
irritability resulting in severe and frequent temper outbursts. The temper outbursts can be verbal
or can involve behavior such as physical aggression toward people or property. These outbursts
are significantly out of proportion to the situation and are not consistent with the child’s
developmental age. They must occur frequently (three or more times per week on average) and
typically in response to frustration. In between the outbursts, the child’s mood is persistently
irritable or angry most of the day, nearly every day. This mood is noticeable by others, such as
parents, teachers, and peers. In order for a diagnosis of disruptive mood dysregulation disorder to
be made, symptoms must be present for at least one year in at least two settings (such as at home,
at school, with peers) and the condition must begin before age 10. Disruptive mood
dysregulation disorder is much more common in males than females. It may occur along with
other disorders, including major depressive, attention-deficit/hyperactivity, anxiety, and conduct
disorders. Disruptive mood dysregulation disorder can have a significant impact on the child’s
ability to function and a significant impact on the family. Chronic, severe irritability and temper
outbursts can disrupt family life, make it difficult for the child/youth to make or keep
friendships, and cause difficulties at school. Treatment typically involves psychotherapy
(cognitive behavior therapy) and/or medications. Persistent Depressive Disorder A person with
persistent depressive disorder (previously referred to as dysthymic disorder) has a depressed
mood for most of the day, for more days than not, for at least two years. In children and
adolescents, the mood can be irritable or depressed, and must continue for at least one year. In
addition to depressed mood, symptoms include: Poor appetite or overeating Insomnia or
hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making
decisions Feelings of hopelessness Persistent depressive disorder often begins in childhood,
adolescence, or early adulthood and affects an estimated 0.5% of adults in the United States
every year. Individuals with persistent depressive disorder often describe their mood as sad or
“down in the dumps.” Because these symptoms have become a part of the individual’s day-to-
day experience, they may not seek help, just assuming that “I’ve always been this way.” The
symptoms cause significant distress or difficulty in work, social activities, or other important
depressive disorder. A major depressive episode may precede the onset of persistent depressive
disorder but may also arise during (and be superimposed on) a previous diagnosis of persistent
depressive disorder. References American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders (DSM-5), Fifth edition. 2013. National Institute of Mental Health.
(Data from 2013 National Survey on Drug Use and Health.)
www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml Kessler,
RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the
National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593602.
http://archpsyc.jamanetwork.com/article.aspx?articleid=208678 Physician Review By: Felix
Torres, M.D., MBA, DFAPA October 2020 Expert Q & A: Depression Find answers to your
questions about depression written by leading psychiatrists. View More Patient Stories:
Depression Read patient stories about depression and learn how to share your story at
psychiatry.org. View More Seasonal Affective Disorder Learn about Seasonal Affective
Disorder, including symptoms, risk factors and treatment options. Learn More The American
Psychiatric Association (APA) is committed to ensuring accessibility of its website to people
with disabilities. If you have trouble accessing any of APA's web resources, please contact us at
202-559-3900 or apa@psych.org for assistance. Become an APA Member Learn More Explore
APA Psychiatrists Residents & Medical Students Patients & Families About APA Work At APA
Annual Meeting Newsroom News Releases Psychiatric News Message from President APA
Blogs Join APA General Members Early Career Psychiatrists Residents and Fellows Medical
Students International International Resident-Fellows Semi-Retired and Retired Become a
Fellow APA Sites APA Publishing APA Foundation APA Learning Center APA Annual
Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Melvin Sabshin, M.D.
Library & Archives Terms of Use and Privacy PolicyCopyrightContact © 2020 American
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Everything You Want to Know About

Depression
 Symptoms
 Causes
 Test
 Types
 Treatment
 Natural treatment
 Prevention
 Bipolar
 And anxiety
 And OCD
 With psychosis
 Pregnancy
 And alcohol
 Outlook
What is depression?
Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or

anger that interfere with a person’s everyday activities.
It’s also fairly common. The Centers for Disease Control and Prevention (CDC)Trusted Source
estimates that 8.1 percent of American adults ages 20 and over had depression in any given 2-
week period from 2013 to 2016.
People experience depression in different ways. It may interfere with your daily work, resulting
in lost time and lower productivity. It can also influence relationships and some chronic health
conditions.
Conditions that can get worse due to depression include:
 arthritis
 asthma
 cardiovascular disease
 cancer
 diabetes
 obesity
It’s important to realize that feeling down at times is a normal part of life. Sad and upsetting
events happen to everyone. But, if you’re feeling down or hopeless on a regular basis, you could
be dealing with depression.
Depression is considered a serious medical condition that can get worse without proper
treatment. Those who seek treatment often see improvements in symptoms in just a few weeks.
Depression symptoms
Depression can be more than a constant state of sadness or feeling “blue.”
Major depression can cause a variety of symptoms. Some affect your mood, and others affect
your body. Symptoms may also be ongoing, or come and go.
The symptoms of depression can be experienced differently among men, women, and children
differently.
Men may experience symptoms related to their:
 mood, such as anger, aggressiveness, irritability, anxiousness, restlessness

 emotional well-being, such as feeling empty, sad, hopeless
 behavior, such as loss of interest, no longer finding pleasure in favorite activities, feeling
tired easily, thoughts of suicide, drinking excessively, using drugs, engaging in high-risk
activities
 sexual interest, such as reduced sexual desire, lack of sexual performance
 cognitive abilities, such as inability to concentrate, difficulty completing tasks, delayed
responses during conversations
 sleep patterns, such as insomnia, restless sleep, excessive sleepiness, not sleeping
through the night
 physical well-being, such as fatigue, pains, headache, digestive problems
Women may experience symptoms related to their:
 mood, such as irritability

 emotional well-being, such as feeling sad or empty, anxious or hopeless
 behavior, such as loss of interest in activities, withdrawing from social engagements,
thoughts of suicide
 cognitive abilities, such as thinking or talking more slowly
 sleep patterns, such as difficulty sleeping through the night, waking early, sleeping too
much
 physical well-being, such as decreased energy, greater fatigue, changes in appetite,
weight changes, aches, pain, headaches, increased cramps
Children may experience symptoms related to their:
 mood, such as irritability, anger, mood swings, crying

 emotional well-being, such as feelings of incompetence (e.g. “I can’t do anything right”)
or despair, crying, intense sadness
 behavior, such as getting into trouble at school or refusing to go to school, avoiding
friends or siblings, thoughts of death or suicide
 cognitive abilities, such as difficulty concentrating, decline in school performance,
changes in grades
 sleep patterns, such as difficulty sleeping or sleeping too much
 physical well-being, such as loss of energy, digestive problems, changes in appetite,
weight loss or gain
The symptoms can extend beyond your mind.
These seven physical symptoms of depression prove that depression isn’t just all in your head.
Depression causes
There are several possible causes of depression. They can range from biological to
circumstantial.
Common causes include:

 Family history. You’re at a higher risk for developing depression if you have a family
history of depression or another mood disorder.
 Early childhood trauma. Some events affect the way your body reacts to fear and
stressful situations.
 Brain structure. There’s a greater risk for depression if the frontal lobe of your brain is
less active. However, scientists don’t know if this happens before or after the onset of
depressive symptoms.
 Medical conditions. Certain conditions may put you at higher risk, such as chronic
illness, insomnia, chronic pain, or attention-deficit hyperactivity disorder (ADHD).
 Drug use. A history of drug or alcohol misuse can affect your risk.
About 21 percent of people who have a substance use problem also experience depression. In
addition to these causes, other risk factors for depression include:
 low self-esteem or being self-critical

 personal history of mental illness
 certain medications
 stressful events, such as loss of a loved one, economic problems, or a divorce
Many factors can influence feelings of depression, as well as who develops the condition and
who doesn’t.
The causes of depression are often tied to other elements of your health.
However, in many cases, healthcare providers are unable to determine what’s causing
depression.
Depression test
There isn’t a single test to diagnose depression. But your healthcare provider can make a
diagnosis based on your symptoms and a psychological evaluation.
In most cases, they’ll ask a series of questions about your:
 moods
 appetite
 sleep pattern
 activity level
 thoughts
Because depression can be linked to other health problems, your healthcare provider may also
conduct a physical examination and order blood work. Sometimes thyroid problems or a vitamin
D deficiency can trigger symptoms of depression.
Don’t ignore symptoms of depression. If your mood doesn’t improve or gets worse, seek medical
help. Depression is a serious mental health illness with the potential for complications.
If left untreated, complications can include:
 weight gain or loss

 physical pain
 substance use problems
 panic attacks
 relationship problems
 social isolation
 thoughts of suicide
 self-harm
Types of depression
Depression can be broken into categories depending on the severity of symptoms. Some people
experience mild and temporary episodes, while others experience severe and ongoing depressive
episodes.
There are two main types: major depressive disorder and persistent depressive disorder.
Major depressive disorder
Major depressive disorder is the more severe form of depression. It’s characterized by persistent
feelings of sadness, hopelessness, and worthlessness that don’t go away on their own.
In order to be diagnosed with clinical depression, you must experience 5 or more of the
following symptoms over a 2-week period:
 feeling depressed most of the day

 loss of interest in most regular activities
 significant weight loss or gain
 sleeping a lot or not being able to sleep
 slowed thinking or movement
 fatigue or low energy most days
 feelings of worthlessness or guilt
 loss of concentration or indecisiveness
 recurring thoughts of death or suicide
There are different subtypes of major depressive disorder, which the American Psychiatric
Association refers to as “specifiers.”
These include:
 atypical features
 anxious distress
 mixed features
 peripartum onset, during pregnancy or right after giving birth
 seasonal patterns
 melancholic features
 psychotic features
 catatonia
Persistent depressive disorder
Persistent depressive disorder (PDD) used to be called dysthymia. It’s a milder, but chronic,
form of depression.
In order for the diagnosis to be made, symptoms must last for at least 2 years. PDD can affect
your life more than major depression because it lasts for a longer period.
It’s common for people with PDD to:
 lose interest in normal daily activities

 feel hopeless
 lack productivity
 have low self-esteem
Depression can be treated successfully, but it’s important to stick to your treatment plan.
Read more about why depression treatment is important.
Treatment for depression

Living with depression can be difficult, but treatment can help improve your quality of life. Talk
to your healthcare provider about possible options.
The Healthline FindCare tool can provide options in your area if you don’t already have a doctor.
You may successfully manage symptoms with one form of treatment, or you may find that a
combination of treatments works best.
It’s common to combine medical treatments and lifestyle therapies, including the following:
Medications
Your healthcare provider may prescribe:
 antidepressants
 antianxiety
 antipsychotic medications
Each type of medication that’s used to treat depression has benefits and potential risks.
Psychotherapy
Speaking with a therapist can help you learn skills to cope with negative feelings. You may also
benefit from family or group therapy sessions.
Light therapy
Exposure to doses of white light can help regulate your mood and improve symptoms of
depression. Light therapy is commonly used in seasonal affective disorder, which is now called
major depressive disorder with seasonal pattern.
Alternative therapies
Ask your healthcare provider about acupuncture or meditation. Some herbal supplements are
also used to treat depression, like St. John’s wort, SAMe, and fish oil.
Talk with your healthcare provider before taking a supplement or combining a supplement with
prescription medication because some supplements can react with certain medications. Some
supplements may also worsen depression or reduce the effectiveness of medication.
Exercise
Aim for 30 minutes of physical activity 3 to 5 days a week. Exercise can increase your body’s
production of endorphins, which are hormones that improve your mood.
Avoid alcohol and drugs
Drinking or misusing drugs may make you feel better for a little bit. But in the long run, these
substances can make depression and anxiety symptoms worse.
Learn how to say no
Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your
professional and personal life can help you feel better.
Take care of yourself
You can also improve symptoms of depression by taking care of yourself. This includes getting
plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable
activities.
Sometimes depression doesn’t respond to medication. Your healthcare provider may recommend
other treatment options if your symptoms don’t improve.
These include electroconvulsive therapy (ECT), or repetitive transcranial magnetic stimulation
(rTMS) to treat depression and improve your mood.
Natural treatment for depression

Traditional depression treatment uses a combination of prescription medication and counseling.
But there are also alternative or complementary treatments you can try.
It’s important to remember that many of these natural treatments have few studies showing their
effects on depression, good or bad.
Likewise, the U.S. Food and Drug Administration (FDA) doesn’t approve many of the dietary
supplements on the market in the United States, so you want to make sure you’re buying
products from a trustworthy brand.
Talk to your healthcare provider before adding supplements to your treatment plan.
Supplements
Several types of supplements are thought to have some positive effect on depression symptoms.
St. John’s wort
Studies are mixed, but this natural treatment is used in Europe as an antidepressant medication.
In the United States, it hasn’t received the same approval.
S-adenosyl-L-methionine (SAMe)
This compound has shown in limited studies to possibly ease symptoms of depression. The
effects were best seen in people taking selective serotonin reuptake inhibitors (SSRIs), a type of
traditional antidepressant.
5-hydroxytryptophan (5-HTP)
5-HTP may raise serotonin levels in the brain, which could ease symptoms. Your body makes
this chemical when you consume tryptophan, a protein building block.
Omega-3 fatty acids
These essential fats are important to neurological development and brain health. Adding omega-
3 supplements to your diet may help reduce depression symptoms.
Essential oils
Essential oils are a popular natural remedy for many conditions, but research into their effects on
depression is limited.
People with depression may find symptom relief with the following essential oils:
 Wild ginger: Inhaling this strong scent may activate serotonin receptors in your brain.
This may slow the release of stress-inducing hormones.
 Bergamot: This citrusy essential oil has been shown to reduce anxiety in patients
awaiting surgery. The same benefit may help individuals who experience anxiety as a
result of depression, but there’s no research to support that claim.
Other oils, such as chamomile or rose oil, may have a calming effect when they’re inhaled.
Those oils may be beneficial during short-term use.
Vitamins
Vitamins are important to many bodily functions. Research suggests two vitamins are especially
useful for easing symptoms of depression:
 Vitamin B: B-12 and B-6 are vital to brain health. When your vitamin B levels are low,
your risk for developing depression may be higher.
 Vitamin D: Sometimes called the sunshine vitamin because exposure to the sun supplies
it to your body, Vitamin D is important for brain, heart, and bone health. People who are
depressed are more likely to have low levels of this vitamin.
Many herbs, supplements, and vitamins claim to help ease symptoms of depression, but most
haven’t shown themselves to be effective in clinical research.
Learn about herbs, vitamins, and supplements that have shown some promise, and ask your
healthcare provider if any are right for you.
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Preventing depression
Depression isn’t generally considered to be preventable. It’s hard to recognize what causes it,
which means preventing it is more difficult.
But once you’ve experienced a depressive episode, you may be better prepared to prevent a
future episode by learning which lifestyle changes and treatments are helpful.
Techniques that may help include:
 regular exercise
 getting plenty of sleep
 maintaining treatments
 reducing stress
 building strong relationships with others
Other techniques and ideas may also help you prevent depression.
Read the full list of 15 ways you may be able to avoid depression.
Bipolar depression
Bipolar depression occurs in certain types of bipolar disorder, when the person experiences a
depressive episode.
People with bipolar disorder may experience significant mood swings. Episodes in bipolar 2, for
instance, typically range from manic episodes of high energy to depressive episodes of low
energy.
This depends on the type of bipolar disorder you have. A diagnosis of bipolar 1 only has to have
the presence of manic episodes, not depression.
Symptoms of depression in people with bipolar disorder may include:
 loss of interest or enjoyment from normal activities

 feeling sad, worried, anxious, or empty
 not having energy or struggling to complete tasks
 difficulty with recall or memory
 sleeping too much or insomnia
 weight gain or weight loss as a result of increased or decreased appetite
 contemplating death or suicide
If bipolar disorder is treated, many will experience fewer and less severe symptoms of
depression, if they experience depressive episodes.
These 7 treatments may help ease symptoms of bipolar depression.
Depression and anxiety

Depression and anxiety can occur in a person at the same time. In fact, research has shown that
over 70 percentTrusted Source of people with depressive disorders also have symptoms of
anxiety.
Though they’re thought to be caused by different things, depression and anxiety can produce
several similar symptoms, which can include:
 irritability
 difficulty with memory or concentration
 sleep problems
The two conditions also share some common treatments.
Both anxiety and depression can be treated with:
 therapy, like cognitive behavioral therapy

 medication
 alternative therapies, including hypnotherapy
If you think you’re experiencing symptoms of either of these conditions, or both of them, make
an appointment to talk with your healthcare provider. You can work with them to identify
coexisting symptoms of anxiety and depression and how they can be treated.
Depression and obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. It causes unwanted and
repeated thoughts, urges, and fears (obsessions).
These fears cause you to act out repeated behaviors or rituals (compulsions) that you hope will
ease the stress caused by the obsessions.
People diagnosed with OCD frequently find themselves in a loop of obsessions and compulsions.
If you have these behaviors, you may feel isolated because of them. This can lead to withdrawal
from friends and social situations, which can increase your risk for depression.
It’s not uncommon for someone with OCD to also have depression. Having one anxiety disorder
can increase your odds for having another. Up to 80 percentTrusted Source of people with OCD
also have major depression.
This dual diagnosis is a concern with children, too. Their compulsive behaviors, which may be
first developing at a young age, can make them feel unusual. That can lead to withdrawing from
friends and can increase the chance of child developing depression.
Depression with psychosis

Some individuals who have been diagnosed with major depression may also have symptoms of
another mental disorder called psychosis. When the two conditions occur together, it’s known as
depressive psychosis.
Depressive psychosis causes people to see, hear, believe, or smell things that aren’t real. People
with the condition may also experience feelings of sadness, hopelessness, and irritability.
The combination of the two conditions is particularly dangerous. That’s because someone with
depressive psychosis may experience delusions that cause them to have thoughts of suicide or to
take unusual risks.
It’s unclear what causes these two conditions or why they can occur together, but treatment can
successfully ease symptoms. Treatments include medications and electroconvulsive therapy
(ECT).
Understanding the risk factors and possible causes can help you be aware of early symptoms.
Read more about depressive psychosis, how it’s treated, and what healthcare providers
understand about why it occurs.
Depression in pregnancy
Pregnancy is often an exciting time for people. However, it can still be common for a pregnant
woman to experience depression.
Symptoms of depression during pregnancy include:
 changes in appetite or eating habits

 feeling hopeless
 anxiety
 losing interest in activities and things you previously enjoyed
 persistent sadness
 troubles concentrating or remembering
 sleep problems, including insomnia or sleeping too much
 thoughts of death or suicide
Treatment for depression during pregnancy may focus entirely on talk therapy and other natural
treatments.
While some women do take antidepressants during their pregnancy, it’s not clear which ones are
the safest. Your healthcare provider may encourage you to try an alternative option until after the
birth of your baby.
The risks for depression can continue after the baby arrives. Postpartum depression, which is also
called major depressive disorder with peripartum onset, is a serious concern for new mothers.
Recognizing the symptoms may help you spot a problem and seek help before it becomes
overwhelming.
Depression and alcohol
Research has established a link between alcohol use and depression. People who have depression
are more likely to misuse alcohol.
Out of the 20.2 million U.S. adults who experienced a substance use disorder, about 40 percent
had a cooccurring mental illness.
According to a 2012 study, 63.8 percentTrusted Source of people who are alcohol dependent
have depression.
Drinking alcohol frequently can make symptoms of depression worse, and people who have
depression are more likely to misuse alcohol or become dependent on it.
Outlook for depression

Depression can be temporary, or it can be a long-term challenge. Treatment doesn’t always make
your depression go away completely.
However, treatment often makes symptoms more manageable. Managing symptoms of

depression involves finding the right combination of medications and therapies.
If one treatment doesn’t work, talk with your healthcare provider. They can help you create a
different treatment plan that may work better in helping you manage your condition.
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Last medically reviewed on December 3, 2019
16 sourcescollapsed
Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research
institutions, and medical associations. We avoid using tertiary references. You can learn more
about how we ensure our content is accurate and current by reading our editorial policy.
 Brody DJ, et al. (2018). NCHC Data Brief, No. 303: Prevalence of depression among
adults aged 20 and over: United States, 2013–2016.
cdc.gov/nchs/products/databriefs/db303.htm
 Chaudhary RK, et al. (2016). Depression and risk of suicide in patients with obsessive-
compulsive disorder: A hospital-based study. DOI:
10.4103/ipj.ipj_63_16
 Depression. (2017).
nami.org/Learn-More/Mental-Health-Conditions/Depression
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nimh.nih.gov/health/publications/depression/index.shtml
 Depression in women: 5 things you should know. (n.d.).
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 Key findings: U.S. children with diagnosed anxiety and depression. (2019).
cdc.gov/childrensmentalhealth/features/anxiety-and-depression.html
 Kura MW, et al. (2012). The association between alcohol dependence and depression
before and after treatment for alcohol dependence. DOI:
10.5402/2012/482802
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mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
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nimh.nih.gov/health/publications/men-and-depression/index.shtml
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 Pearson RM, et al. (2018). Prevalence of prenatal depression symptoms among 2
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 Regier DA, et al. (2013). The DSM-5: Classification and criteria changes. DOI:
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 Zhang Y, et al. (2014). Depression, alcohol dependence and abuse, and drinking and
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Medically reviewed by Timothy J. Legg, Ph.D., CRNP — Written by Valencia Higuera —

Updated on February 11, 2020
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Depression
Overview
Depression (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. To be diagnosed with depression, the symptoms must be
present for at least two weeks.
Some forms of depression are slightly different, or they may develop under unique
circumstances, such as:
 Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for
at least two years. A person diagnosed with persistent depressive disorder may have
episodes of major depression along with periods of less severe symptoms, but symptoms
must last for two years to be considered persistent depressive disorder.
 Postpartum depression is much more serious than the “baby blues” (relatively mild
depressive and anxiety symptoms that typically clear within two weeks after delivery)
that many women experience after giving birth. Women with postpartum depression
experience full-blown major depression during pregnancy or after delivery (postpartum
depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany
postpartum depression may make it difficult for these new mothers to complete daily care
activities for themselves and/or for their babies.
 Psychotic depression occurs when a person has severe depression plus some form of
psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing
upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms
typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
 Seasonal affective disorder is characterized by the onset of depression during the winter
months, when there is less natural sunlight. This depression generally lifts during spring
and summer. Winter depression, typically accompanied by social withdrawal, increased
sleep, and weight gain, predictably returns every year in seasonal affective disorder.
 Bipolar disorder is different from depression, but it is included in this list is because
someone with bipolar disorder experiences episodes of extremely low moods that meet
the criteria for major depression (called “bipolar depression”). But a person with bipolar
disorder also experiences extreme high – euphoric or irritable – moods called “mania” or
a less severe form called “hypomania.”
Examples of other types of depressive disorders newly added to the diagnostic classification
of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and
adolescents) and premenstrual dysphoric disorder (PMDD).
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 two weeks, you may be suffering from depression:
 Persistent sad, anxious, or “empty” mood
 Feelings of hopelessness, or pessimism
 Irritability
 Feelings of guilt, worthlessness, or helplessness
 Loss of interest or pleasure in hobbies and activities
 Decreased energy or fatigue
 Moving or talking more slowly
 Feeling restless or having trouble sitting still
 Difficulty concentrating, remembering, or making decisions
 Difficulty sleeping, early-morning awakening, or oversleeping
 Appetite and/or weight changes
 Thoughts of death or suicide, or suicide attempts
 Aches or pains, headaches, cramps, or digestive problems without a clear physical cause
and/or that do not ease even with treatment
Not everyone who is depressed experiences every symptom. Some people experience only a few
symptoms while others may experience many. Several persistent symptoms in addition to low
mood are required for a diagnosis of major depression, but people with only a few – but
distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The
severity and frequency of symptoms and how long they last will vary depending on the
individual and his or her particular illness. Symptoms may also vary depending on the stage of
the illness.
Risk Factors
Depression is one of the most common mental disorders in the U.S. Current research suggests
that depression is caused by a combination of genetic, biological, environmental, and
psychological factors.
Depression can happen at any age, but often begins in adulthood. Depression is now recognized
as occurring in children and adolescents, although it sometimes presents with more prominent
irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high
levels of anxiety in children.
Depression, especially in midlife or older adults, 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. Sometimes medications taken for these physical
illnesses may cause side effects that contribute to depression. A doctor experienced in treating
these complicated illnesses can help work out the best treatment strategy.
Risk factors include:
 Personal or family history of depression
 Major life changes, trauma, or stress
 Certain physical illnesses and medications
Treatment and Therapies
Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the
more effective it is. Depression is usually treated with medications, psychotherapy, or a
combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy
(ECT) and other brain stimulation therapies may be options to explore.
Quick Tip: No two people are affected the same way by depression and there is no "one-size-
fits-all" for treatment. It may take some trial and error to find the treatment that works best for
you.
Medications
Antidepressants are medicines that treat depression. They may help improve the way your brain
uses certain chemicals that control mood or stress. You may need to try several different
antidepressant medicines 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.
Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep,
appetite, and concentration problems improve before mood lifts, so it is important to give
medication a chance before reaching a conclusion about its effectiveness. If you begin taking
antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking
antidepressants feel better and then stop taking the medication on their own, and the depression
returns. When you and your doctor have decided it is time to stop the medication, usually after a
course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose.
Stopping them abruptly can cause withdrawal symptoms.
Please Note: In some cases, children, teenagers, and young adults under 25 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. This warning from the U.S. Food and Drug
Administration (FDA) also says that patients of all ages taking antidepressants should be
watched closely, especially during the first few weeks of treatment.
If you are considering taking an antidepressant and you are pregnant, planning to become
pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your
unborn or nursing child.
To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.
You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling
botanical product, the FDA has not approved its use as an over-the-counter or prescription
medicine for depression, and there are serious concerns about its safety (it should never be
combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort
before talking to your health care provider. Other natural products sold as dietary supplements,
including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have
not yet been proven safe and effective for routine use. For more information on herbal and other
complementary approaches and current research, please visit the National Center for
Complementary and Integrative Health website.
Psychotherapies
Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling)
can help people with depression. Examples of evidence-based approaches specific to the
treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT),
and problem-solving therapy. More information on psychotherapy is available on the NIMH
Psychotherapies webpage.
Brain Stimulation Therapies
If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may
be an option to explore. Based on the latest research:
 ECT can provide relief for people with severe depression who have not been able to feel
better with other treatments.
 Electroconvulsive therapy can be an effective treatment for depression. In some severe

cases where a rapid response is necessary or medications cannot be used safely, ECT can
even be a first-line intervention.
 Once strictly an inpatient procedure, today ECT is often performed on an outpatient

basis. The treatment consists of a series of sessions, typically three times a week, for two
to four weeks.
 ECT may cause some side effects, including confusion, disorientation, and memory loss.
Usually these side effects are short-term, but sometimes memory problems can linger,
especially for the months around the time of the treatment course. Advances in ECT
devices and methods have made modern ECT safe and effective for the vast majority of
patients. Talk to your doctor and make sure you understand the potential benefits and
risks of the treatment before giving your informed consent to undergoing ECT.
 ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a
patient is put under brief anesthesia and given a muscle relaxant. Within one hour after
the treatment session, which takes only a few minutes, the patient is awake and alert.
Other more recently introduced types of brain stimulation therapies used to treat medicine-
resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve
stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn
more about these therapies on the NIMH Brain Stimulation Therapies webpage.
If you think you may have depression, start by making an appointment to see your doctor or
health care provider. This could be your primary care practitioner or a health provider who
specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for
Mental Illnesses if you are unsure of where to start.
Beyond Treatment: Things You Can Do
Here are other tips that may help you or a loved one during treatment for depression:
 Try to be active and exercise.
 Set realistic goals for yourself.
 Try to spend time with other people and confide in a trusted friend or relative.
 Try not to isolate yourself, and let others help you.
 Expect your mood to improve gradually, not immediately.
 Postpone important decisions, such as getting married or divorced, or changing jobs until
you feel better. Discuss decisions with others who know you well and have a more
objective view of your situation.
 Continue to educate yourself about depression.
Join a Study
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and
conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe.
Although individuals may benefit from being part of a clinical trial, participants should be aware
that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may
be better helped in the future.
Researchers at NIMH and around the country conduct many studies with patients and healthy
volunteers. We have new and better treatment options today because of what clinical trials
uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your 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:
 NIMH’s Clinical Trials webpage: Information about participating in clinical trials
 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
Free Brochures and Shareable Resources
 Chronic Illness & Mental Health: This brochure discusses chronic illnesses and
depression, including symptoms, health effects, treatment, and recovery.
 Depression Basics: A brochure on depression that explains what it is and how to get
help.
 Depression and Older Adults: Depression is not a normal part of aging. This brochure
describes the signs, symptoms, and treatment options for depression in older adults.
 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.
 Perinatal Depression: This brochure provides information about perinatal depression

including how it differs from the “baby blues”, causes, signs and symptoms, treatment
options, and how you or a loved one can get help.
 Seasonal Affective Disorder: This fact sheet includes a description of seasonal affective
disorder (SAD), signs and symptoms, how SAD is diagnosed, causes, and treatment
options.
 Teen Depression: This flier for teens describes depression and how it differs from
regular sadness. It also describes symptoms, causes, and treatments, with information on
getting help and coping.
 Shareable Resources on Depression: Help support depression awareness and education

in your community. Use these digital resources, including graphics and messages, to
spread the word about depression.
Federal Resources
 Depression: MedlinePlus
 Moms’ Mental Health Matter: Depression and Anxiety Around Pregnancy (National
Institute of Child Health and Human Development)
Research and Statistics
 Journal Articles: This webpage provides information on references and abstracts from
MEDLINE/PubMed (National Library of Medicine).
 Statistics: Major Depression: This webpage provides information on the statistics
currently available on the prevalence and treatment of depression among people in the
U.S.
Multimedia
 Watch Discover NIMH: Personalized and Targeted Brain Stimulation Therapies:

Brain stimulation therapies can be effective treatments for people with depression and
other mental disorders. NIMH is supporting studies exploring how to make brain
stimulation therapies more personalized while reducing side effects. This video describes
transcranial magnetic stimulation and electroconvulsive therapy for treatment-resistant
depression.
 Watch Discover NIMH: Drug Discovery and Development: One of the most exciting
recent breakthroughs from research funded by the NIMH is the development of a fast-
acting medication for treatment-resistant depression based on ketamine. This video shares
the story of one of the patients participating in a NIMH clinical trial, and how ketamine
infusions changed her life and gave her a sense of purpose. In addition, Dr. Carlos Zarate,
a senior clinical investigator in NIMH’s Intramural Research Program, describes his
groundbreaking research on ketamine.
Last Revised: February 2018
Unless otherwise specified, NIMH information and publications are in the public domain and
available for use free of charge. Citation of the NIMH is appreciated. Please see our Citing
NIMH Information and Publications page for more information.
Share
Science News About Depression
 Dr. Carlos Zarate Elected to National Academy of Medicine

 Infant Temperament Predicts Personality Over 20 Years Later
 Fast-Fail Trial Finds Possible Target for Treating Anhedonia
More
Join A Study
 Depression Studies for Adults
 Depression Studies for Children
Publication About Depression
Depression Basics
A brochure on depression that explains what it is and how to get help.
More Publications About Depression
Research Results
 Treatment choices for resistant depression – STAR*D trial

 Treatment for Adolescents with Depression Study (TADS)
 Treatment of SSRI-resistant Depression in Adolescents (TORDIA) study
 PubMed: Journal Articles about Depression
Anxiety is your body’s natural response to stress. It’s a feeling of fear or apprehension about
what’s to come. The first day of school, going to a job interview, or giving a speech may cause
most people to feel fearful and nervous.
But if your feelings of anxiety are extreme, last for longer than six months, and are interfering
with your life, you may have an anxiety disorder.
What are anxiety disorders?

It’s normal to feel anxious about moving to a new place, starting a new job, or taking a test. This
type of anxiety is unpleasant, but it may motivate you to work harder and to do a better job.
Ordinary anxiety is a feeling that comes and goes, but does not interfere with your everyday life.
In the case of an anxiety disorder, the feeling of fear may be with you all the time. It is intense
and sometimes debilitating.
This type of anxiety may cause you to stop doing things you enjoy. In extreme cases, it may
prevent you from entering an elevator, crossing the street, or even leaving your home. If left
untreated, the anxiety will keep getting worse.
Anxiety disorders are the most common form of emotional disorder and can affect anyone at any
age. According to the American Psychiatric Association, women are more likely than men to be
diagnosed with an anxiety disorder.
What are the types of anxiety disorders?

Anxiety is a key part of several different disorders. These include:
 panic disorder: experiencing recurring panic attacks at unexpected times. A person with
panic disorder may live in fear of the next panic attack.
 phobia: excessive fear of a specific object, situation, or activity
 social anxiety disorder: extreme fear of being judged by others in social situations
 obsessive-compulsive disorder: recurring irrational thoughts that lead you to perform
specific, repeated behaviors
 separation anxiety disorder: fear of being away from home or loved ones
 illness anxiety disorder: anxiety about your health (formerly called hypochondria)
 post-traumatic stress disorder (PTSD): anxiety following a traumatic event
What are the symptoms of anxiety?
Anxiety feels different depending on the person experiencing it. Feelings can range from
butterflies in your stomach to a racing heart. You might feel out of control, like there’s a
disconnect between your mind and body.
Other ways people experience anxiety include nightmares, panic attacks, and painful thoughts or
memories that you can’t control. You may have a general feeling of fear and worry, or you may
fear a specific place or event.
Symptoms of general anxiety include:
 increased heart rate

 rapid breathing
 restlessness
 trouble concentrating
 difficulty falling asleep
Your anxiety symptoms might be totally different from someone else’s. That’s why it’s
important to know all the ways anxiety can present itself. Read about the many types of anxiety
symptoms you might experience.
What is an anxiety attack?

An anxiety attack is a feeling of overwhelming apprehension, worry, distress, or fear. For many
people, an anxiety attack builds slowly. It may worsen as a stressful event approaches.
Anxiety attacks can vary greatly, and symptoms may differ among individuals. That’s because
the many symptoms of anxiety don’t happen to everyone, and they can change over time.
Common symptoms of an anxiety attack include:
 feeling faint or dizzy

 shortness of breath
 dry mouth
 sweating
 chills or hot flashes
 apprehension and worry
 restlessness
 distress
 fear
 numbness or tingling
A panic attack and an anxiety attack share some common symptoms, but they’re not the same.
Learn more about each so you can decide if your symptoms are the result of either.
What causes anxiety?
Researchers are not sure of the exact cause of anxiety. But, it’s likely a combination of factors
play a role. These include genetic and environmental factors, as well as brain chemistry.
In addition, researchers believe that the areas of the brain responsible for controlling fear may be
impacted.
Current research of anxiety is taking a deeper look at the parts of the brain that are involved with
anxiety. Learn more about what the researchers are finding.
Are there tests that diagnose anxiety?

A single test can’t diagnose anxiety. Instead, an anxiety diagnosis requires a lengthy process of
physical examinations, mental health evaluations, and psychological questionnaires.
Some doctors may conduct a physical exam, including blood or urine tests to rule out underlying
medical conditions that could contribute to symptoms you’re experiencing.
Several anxiety tests and scales are also used to help your doctor assess the level of anxiety
you’re experiencing. Reach about each of these tests.
What are treatments for anxiety?

Once you’ve been diagnosed with anxiety, you can to explore treatment options with your
doctor. For some people, medical treatment isn’t necessary. Lifestyle changes may be enough to
cope with the symptoms.
In moderate or severe cases, however, treatment can help you overcome the symptoms and lead a
more manageable day-to-day life.
Treatment for anxiety falls into two categories: psychotherapy and medication. Meeting with a
therapist or psychologist can help you learn tools to use and strategies to cope with anxiety when
it occurs.
Medications typically used to treat anxiety include antidepressants and sedatives. They work to
balance brain chemistry, prevent episodes of anxiety, and ward off the most severe symptoms of
the disorder. Read more about anxiety medicines and the benefits and advantages of each type.
What natural remedies are used for anxiety?

Lifestyle changes can be an effective way to relive some of the stress and anxiety you may cope
with every day. Most of the natural “remedies” consist of caring for your body, participating in
healthy activities, and eliminating unhealthy ones.
These include:
 getting enough sleep

 meditating
 staying active and exercising
 eating a healthy diet
 staying active and working out
 avoiding alcohol
 avoiding caffeine
 quitting smoking cigarettes
If these lifestyle changes seem like a positive way to help you eliminate some anxiety, read about
how each one works—plus, get more great ideas for treating anxiety.
Anxiety and depression

If you have an anxiety disorder, you may also be depressed. While anxiety and depression can
occur separately, it’s not unusual for these to mental health disorders to happen together.
Anxiety can be a symptom of clinical or major depression. Likewise, worsening symptoms of

depression can be triggered by an anxiety disorder.
Symptoms of both conditions can be managed with many of the same treatments: psychotherapy
(counseling), medications, and lifestyle changes.
How to help children with anxiety

Anxiety in children is natural and common. In fact, one in eight children will experience anxiety.
As children grow up and learn from their parents, friends, and caretakers, they typically develop
the skills to calm themselves and cope with feelings of anxiety.
But, anxiety in children can also become chronic and persistent, developing into an anxiety
disorder. Uncontrolled anxiety may begin to interfere with daily activities, and children may
avoid interacting with their peers or family members.
Symptoms of an anxiety disorder might include:
 jitteriness
 irritability
 sleeplessness
 feelings of fear
 shame
 feelings of isolation
Anxiety treatment for children includes cognitive behavioral therapy (talk therapy) and
medications. Learn more about the signs of an anxiety disorder as well as techniques to help
calm your child’s anxiety.
How to help teens with anxiety

Teenagers may have many reasons to be anxious. Tests, college visits, and first dates all pop up
in these important years. But teenagers who feel anxious or experience symptoms of anxiety
frequently may have an anxiety disorder.
Symptoms of anxiety in teenagers may include nervousness, shyness, isolationist behaviors, and
avoidance. Likewise, anxiety in teens may lead to unusual behaviors. They may act out, perform
poorly in school, skip social events, and even engage in substance or alcohol use.
For some teens, depression may accompany anxiety. Diagnosing both conditions is important so
that treatment can address the underlying issues and help relieve symptoms.
The most common treatments for anxiety in teenagers are talk therapy and medication. These
treatments also help address depression symptoms.
Anxiety and stress

Stress and anxiety are two sides of the same coin. Stress is the result of demands on your brain or
body. It can be the caused by an event or activity that makes you nervous or worrisome. Anxiety
is that same worry, fear, or unease.
Anxiety can be a reaction to your stress, but it can also occur in people who have no obvious
stressors.
Both anxiety and stress cause physical and mental symptoms. These include:
 headache
 stomachache
 fast heartbeat
 sweating
 dizziness
 jitteriness
 muscle tension
 rapid breathing
 panic
 nervousness
 difficulty concentrating
 irrational anger or irritability
 restlessness
 sleeplessness
Neither stress nor anxiety is always bad. Both can actually provide you with a bit of a boost or
incentive to accomplish the task or challenge before you. However, if they become persistent,
they can begin to interfere with your daily life. In that case, it’s important to seek treatment.
The long-term outlook for untreated depression and anxiety includes chronic health issues, such
as heart disease. Learn why anxiety and stress occur and how you can manage the conditions.
Anxiety and alcohol

If you’re anxious frequently, you may decide you’d like a drink to calm your nerves. After all,
alcohol is a sedative. It can depress the activity of your central nervous system, which may help
you feel more relaxed.
In a social setting, that may feel like just the answer you need to let down your guard.
Ultimately, it may not be the best solution.
Some people with anxiety disorders end up abusing alcohol or other drugs in an effort to feel
better regularly. This can create a dependency and addiction.
It may be necessary to treat an alcohol or drug problem before the anxiety can be addressed.
Chronic or long-term use can ultimately make the condition worse, too. Read more to understand
how alcohol can make symptoms of anxiety or an anxiety disorder worse.
Can foods treat anxiety?

Medication and talk therapy are commonly used to treat anxiety. Lifestyle changes, like getting
enough sleep and regular exercise, can also help. In addition, some research suggests the foods
you eat may have a beneficial impact on your brain if you frequently experience anxiety.
These foods include:
 salmon
 chamomile
 turmeric
 dark chocolate
 yogurt
 green tea
Read more about the many ways these foods can boost your brain health and lower your anxiety.
Outlook
Anxiety disorders can be treated with medication, psychotherapy, or a combination of the two.
Some people who have a mild anxiety disorder, or a fear of something they can easily avoid,
decide to live with the condition and to not seek treatment.
It’s important to understand that anxiety disorders can be treated, even in severe cases. Although,
anxiety usually doesn’t go away, you can learn to manage it and live a happy, healthy life.
Last medically reviewed on September 19, 2018
9 sourcescollapsed
Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research
institutions, and medical associations. We avoid using tertiary references. You can learn more
about how we ensure our content is accurate and current by reading our editorial policy.
 Anxiety disorders. (2018).

nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml
 Anxiety disorders. (2018).
nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
 Anxiety disorders in children. (n.d.).
adaa.org/sites/default/files/Anxiety%20Disorders%20in%20Children.pdf
 Children and teens. (n.d.).
adaa.org/living-with-anxiety/children
 Depression. (n.d.).
adaa.org/sites/default/files/Anxiety%20Disorders%20in%20Children.pdf
 Mayo Clinic Staff. (2017). Generalized anxiety disorder.
mayoclinic.com/health/generalized-anxiety-disorder/DS00502/
 Mayo Clinic Staff. (2018). Anxiety disorders.
mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
 Naidoo U. (2016). Nutritional strategies to easy anxiety.
health.harvard.edu/blog/nutritional-strategies-to-ease-anxiety-201604139441
 What are anxiety disorders? (2017).
psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
Medically reviewed by Timothy J. Legg, Ph.D., CRNP — Written by Kimberly Holland —

Updated on September 3, 2020
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Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.
Everyone has feelings of anxiety at some point in their life. For example, you may feel worried
and anxious about sitting an exam, or having a medical test or job interview.
During times like these, feeling anxious can be perfectly normal.
But some people find it hard to control their worries. Their feelings of anxiety are more constant
and can often affect their daily lives.
Anxiety is the main symptom of several conditions, including:
 panic disorder
 phobias, such as agoraphobia or claustrophobia
 post-traumatic stress disorder (PTSD)
 social anxiety disorder (social phobia)
The information in this section is about a specific condition called generalised anxiety disorder
(GAD).
GAD is a long-term condition that causes you to feel anxious about a wide range of situations
and issues, rather than 1 specific event.
People with GAD feel anxious most days and often struggle to remember the last time they felt
relaxed.
As soon as 1 anxious thought is resolved, another may appear about a different issue.
Information:
Coronavirus advice
Get advice about coronavirus and looking after your mental wellbeing:
 Every Mind Matters: how to look after your mental wellbeing while staying at home
 Mind: Coronavirus and your wellbeing
Symptoms of generalised anxiety disorder (GAD)

GAD can cause both psychological (mental) and physical symptoms.
These vary from person to person, but can include:

 feeling restless or worried
 having trouble concentrating or sleeping
 dizziness or heart palpitations
When to get help for anxiety

Although feelings of anxiety at certain times are completely normal, see a GP if anxiety is
affecting your daily life or causing you distress.
Your GP will ask about your symptoms and your worries, fears and emotions to find out if you
could have GAD.
Find out more about diagnosing GAD
What causes generalised anxiety disorder (GAD)?

The exact cause of GAD is not fully understood, although it's likely that a combination of several
factors plays a role.
Research has suggested that these may include:
 overactivity in areas of the brain involved in emotions and behaviour

 an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in
the control and regulation of mood
 the genes you inherit from your parents – you're estimated to be 5 times more likely to
develop GAD if you have a close relative with the condition
 having a history of stressful or traumatic experiences, such as domestic violence, child
abuse or bullying
 having a painful long-term health condition, such as arthritis
 having a history of drug or alcohol misuse
But many people develop GAD for no apparent reason.
Who's affected
GAD is a common condition, estimated to affect up to 5% of the UK population.
Slightly more women are affected than men, and the condition is more common in people from
the ages of 35 to 59.
How generalised anxiety disorder (GAD) is treated

GAD can have a significant effect on your daily life, but several different treatments are
available that can ease your symptoms.
These include:
 psychological therapies – you can get psychological therapies like cognitive behavioural
therapy (CBT) on the NHS; you do not need a referral from a GP and you can refer
yourself for psychological therapies service in your area
 medicine – such as a type of antidepressant called selective serotonin reuptake inhibitors
(SSRIs)
With treatment, many people are able to control their anxiety levels. But some treatments may
need to be continued for a long time and there may be periods when your symptoms worsen.
Self-help for generalised anxiety disorder (GAD)

There are also many things you can do yourself to help reduce your anxiety, such as:
 going on a self-help course

 exercising regularly
 stopping smoking
 cutting down on the amount of alcohol and caffeine you drink
 trying 1 of the mental health apps and tools in the NHS Apps Library
Video: anxiety
In this video, a psychiatrist discusses the symptoms and treatments of anxiety.
Media last reviewed: 12 October 2018

Media review due: 12 October 2021
Page last reviewed: 19 December 2018

Next review due: 19 December 2021
 Next : Symptoms
Anxiety and panic attacks

Explains anxiety and panic attacks, including possible causes and how you can access treatment
and support. Includes tips for helping yourself, and guidance for friends and family.
Coronavirus (Covid-19) is affecting all our lives, and we know that our usual advice may not
currently apply. Some ways of looking after yourself or getting support might not be possible or
feel realistic during the pandemic.
We hope that you can still find information here that helps. You can visit our coronavirus
information hub to find lots of information on coping during the pandemic.
View this information as a PDF (new window)
Order this information as a print booklet
 About anxiety
 Anxiety disorders
 Anxiety symptoms
 Panic attacks
 Causes of anxiety
 Self-care for anxiety
 Anxiety treatments
 For friends & family
 Useful contacts
What is anxiety?
Anxiety is what we feel when we are worried, tense or afraid – particularly about things that are
about to happen, or which we think could happen in the future. Anxiety is a natural human
response when we perceive that we are under threat. It can be experienced through our thoughts,
feelings and physical sensations.
"For me, anxiety feels as if everyone in the world is waiting for me to trip up, so that they can
laugh at me. It makes me feel nervous and unsure whether the next step I take is the best way
forward."
Most people feel anxious at times. It's particularly common to experience some anxiety while
coping with stressful events or changes, especially if they could have a big impact on your life.
(See our pages on managing stress for more information about stress.)
What is the 'fight, flight or freeze' response?
Like all animals, human beings have evolved ways to help us protect ourselves from danger.
When we feel under threat our bodies react by releasing certain hormones, such as adrenaline
and cortisol. These hormones:
 make us feel more alert, so we can act faster

 make our hearts beat faster, quickly sending blood to where it's needed most.
After we feel the threat has passed, our bodies release other hormones to help our muscles relax.
This can sometimes cause us to shake.
This is commonly called the 'fight, flight or freeze' response – it's something that happens
automatically in our bodies, and we have no control over it.
"Going out of the house is a challenge because I [have a] fear of panicking and feel that I'm
being watched or judged. It's just horrible. I want to get help but I'm afraid of being judged."
When is anxiety a mental health problem?
Anxiety can become a mental health problem if it impacts on your ability to live your life as fully
as you want to. For example, it may be a problem for you if:
 your feelings of anxiety are very strong or last for a long time
 your fears or worries are out of proportion to the situation
 you avoid situations that might cause you to feel anxious
 your worries feel very distressing or are hard to control
 you regularly experience symptoms of anxiety, which could include panic attacks
 you find it hard to go about your everyday life or do things you enjoy.
If your symptoms fit a particular set of medical criteria then you might be diagnosed with a
particular anxiety disorder. But it's also possible to experience problems with anxiety without
having a specific diagnosis. Our pages on self-care and treatment for anxiety problems offer
suggestions for help and support.
What do anxiety problems feel like?
Watch Lewis, Polly, Faisal, Shelley and Brian talk about what living with anxiety problems feels
like for them, and what helps them cope:
Gus' story
Heart FM DJ Matt Wilkinson talks to Gus Marshall about his experience of anxiety and panic
attacks.
Read the transcript of the podcast here. Find out more about our podcasts or subscribe to our
podcast on iTunes or Audioboom.
"You know that feeling when you're rocking on the back legs of your chair and suddenly for just
a split second you think you're about to fall; that feeling in your chest? Imagine that split second
feeling being frozen in time and lodged in your chest for minutes/hours/days, and imagine with it
that sense of impending doom and dread sticking around too, but sometimes you don't even
know why."
Anxiety and panic attacks

Explains anxiety and panic attacks, including possible causes and how you can access treatment
and support. Includes tips for helping yourself, and guidance for friends and family.
Coronavirus (Covid-19) is affecting all our lives, and we know that our usual advice may not
currently apply. Some ways of looking after yourself or getting support might not be possible or
feel realistic during the pandemic.
We hope that you can still find information here that helps. You can visit our coronavirus
information hub to find lots of information on coping during the pandemic.
View this information as a PDF (new window)
Order this information as a print booklet
 About anxiety
 Anxiety disorders
 Anxiety symptoms
 Panic attacks
 Causes of anxiety
 Self-care for anxiety
 Anxiety treatments
 For friends & family
 Useful contacts
What is anxiety?
Anxiety is what we feel when we are worried, tense or afraid – particularly about things that are
about to happen, or which we think could happen in the future. Anxiety is a natural human
response when we perceive that we are under threat. It can be experienced through our thoughts,
feelings and physical sensations.
"For me, anxiety feels as if everyone in the world is waiting for me to trip up, so that they can
laugh at me. It makes me feel nervous and unsure whether the next step I take is the best way
forward."
Most people feel anxious at times. It's particularly common to experience some anxiety while
coping with stressful events or changes, especially if they could have a big impact on your life.
(See our pages on managing stress for more information about stress.)
What is the 'fight, flight or freeze' response?
Like all animals, human beings have evolved ways to help us protect ourselves from danger.
When we feel under threat our bodies react by releasing certain hormones, such as adrenaline
and cortisol. These hormones:
 make us feel more alert, so we can act faster

 make our hearts beat faster, quickly sending blood to where it's needed most.
After we feel the threat has passed, our bodies release other hormones to help our muscles relax.
This can sometimes cause us to shake.
This is commonly called the 'fight, flight or freeze' response – it's something that happens
automatically in our bodies, and we have no control over it.
"Going out of the house is a challenge because I [have a] fear of panicking and feel that I'm
being watched or judged. It's just horrible. I want to get help but I'm afraid of being judged."
When is anxiety a mental health problem?
Anxiety can become a mental health problem if it impacts on your ability to live your life as fully
as you want to. For example, it may be a problem for you if:
 your feelings of anxiety are very strong or last for a long time
 your fears or worries are out of proportion to the situation
 you avoid situations that might cause you to feel anxious
 your worries feel very distressing or are hard to control
 you regularly experience symptoms of anxiety, which could include panic attacks
 you find it hard to go about your everyday life or do things you enjoy.
If your symptoms fit a particular set of medical criteria then you might be diagnosed with a
particular anxiety disorder. But it's also possible to experience problems with anxiety without
having a specific diagnosis. Our pages on self-care and treatment for anxiety problems offer
suggestions for help and support.
What do anxiety problems feel like?
Watch Lewis, Polly, Faisal, Shelley and Brian talk about what living with anxiety problems feels
like for them, and what helps them cope:
Gus' story
Heart FM DJ Matt Wilkinson talks to Gus Marshall about his experience of anxiety and panic
attacks.
Read the transcript of the podcast here. Find out more about our podcasts or subscribe to our
podcast on iTunes or Audioboom.
"You know that feeling when you're rocking on the back legs of your chair and suddenly for just
a split second you think you're about to fall; that feeling in your chest? Imagine that split second
feeling being frozen in time and lodged in your chest for minutes/hours/days, and imagine with it
that sense of impending doom and dread sticking around too, but sometimes you don't even
know why."

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 About APA

o APA's Vision, Mission, Values, and Goals

o Meet Our Organization

o Read APA Organization Documents and Policies

o Message from the President

o Reporting on Mental Health Conditions

 Advocacy & APAPAC

o APA Learning Center

o APA Annual Meeting

o Workplace Mental Health

o Melvin Sabshin, M.D. Library & Archives

o Residents and Fellows

o Structural Racism Task Force

o Diversity & Health Equity

o Awards & Leadership Opportunities

o Advocacy & APAPAC

 Residents & Medical Students

 Patients & Families

o Addiction and Substance Use Disorders

o Obsessive-Compulsive Disorder (OCD)

o Posttraumatic Stress Disorder (PTSD)

o View More Topics »

 Patients & Families

 Patients & Families

o Addiction and Substance Use Disorders

 Seasonal Affective Disorder

o Obsessive-Compulsive Disorder (OCD)

o Posttraumatic Stress Disorder (PTSD)

o View More Topics »

 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

 Feeling worthless or guilty

 Difficulty thinking, concentrating or making decisions

 Thoughts of death or suicide

Depression Is Different From Sadness or Grief/Bereavement

 In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness

Risk Factors for Depression

Several factors can play a role in depression:

 Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms

 Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may

How Is Depression Treated?

Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic

Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of

Self-help and Coping

 Peripartum depression (previously postpartum depression)

 Seasonal depression (Also called seasonal affective disorder)

 Persistent depressive disorder (previously dysthymia) (description below)

 Premenstrual dysphoric disorder (description below)

 Disruptive mood dysregulation disorder (description below)

Premenstrual Dysphoric Disorder

Disruptive Mood Dysregulation Disorder

Treatment typically involves psychotherapy (cognitive behavior therapy) and/or medications.

Persistent Depressive Disorder

In addition to depressed mood, symptoms include:

 Poor appetite or overeating

 Low energy or fatigue

 Poor concentration or difficulty making decisions

 American Psychiatric Association. Diagnostic and Statistical Manual of Mental

 Kessler, RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV

Physician Review By:

Felix Torres, M.D., MBA, DFAPA