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As described in the Privacy Policy of the American Psychiatric Association (APA), this website &
application utilize cookies. By closing this message, continuing the navigation or otherwise continuing to
view the APA's websites & applications, you confirm that you understand and accept the terms of the
APA's Privacy Policy, including the use of cookies. Read Our Privacy Policy

I agree

Depression

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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APA Headquarters

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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

As described in the Privacy Policy of the American Psychiatric Association (APA), this website &
application utilize cookies. By closing this message, continuing the navigation or otherwise continuing to
view the APA's websites & applications, you confirm that you understand and accept the terms of the
APA's Privacy Policy, including the use of cookies. Read Our Privacy Policy
I agree

Depression

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.

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

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Melvin Sabshin, M.D. Library & Archives As described in the Privacy Policy of the American Psychiatric
Association (APA), this website & application utilize cookies. By closing this message, continuing the
navigation or otherwise continuing to view the APA's websites & applications, you confirm that you
understand and accept the terms of the APA's Privacy Policy, including the use of cookies. Read Our
Privacy Policy I agree Depression 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. 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
PolicyCopyrightContactConflict of Interest Policy © 2021 American Psychiatric Association. All Rights
Reserved. 800 Maine Avenue, S.W., Suite 900, Washington, DC 20024 202-559-3900 apa@psych.org
Sign In Join General Residents and Fellows Medical Students International International Resident-
Fellows close menu Home Psychiatrists COVID-19 / Coronavirus Social Determinants of Mental Health
Task Force Structural Racism Task Force Education Practice Diversity & Health Equity Awards &
Leadership Opportunities Advocacy & APAPAC Meetings & Events 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 »
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 Press Registration
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 As described in the Privacy Policy of the American Psychiatric Association (APA), this
website & application utilize cookies. By closing this message, continuing the navigation or otherwise
continuing to view the APA's websites & applications, you confirm that you understand and accept the
terms of the APA's Privacy Policy, including the use of cookies. Read Our Privacy Policy I agree
Depression 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. 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
PolicyCopyrightContactConflict of Interest Policy © 2021 American Psychiatric Association. All Rights
Reserved. 800 Maine Avenue, S.W., Suite 900, Washington, DC 20024 202-559-3900 apa@psych.org
ShareThis Copy and Paste