What It Means to Have Clinical Depression

The term “depression” gets thrown around a lot these days. But what’s the difference between feeling blue and having clinical depression?

Depression is a mental health disorder characterized by episodes of persistent low mood. Most of the time, “clinical depression” refers to major depressive disorder. But there are other types of depression too, such as bipolar depression, seasonal affective disorder (SAD), formally diagnosed as major depressive disorder with seasonal pattern, and postpartum depression, now formally diagnosed as major depressive disorder with peripartum onset - to name a few.

Read on to learn more about the symptoms, types, and causes of clinical depression, as well as treatments available to tackle this common but nefarious condition.

Symptoms of Clinical Depression

One of the well known symptoms of clinical depression is episodes of pervasive sadness. But you might not know that there are other significant symptoms of depression. In fact, there is a whole litany of symptoms that affect not just your mood but your sleep, your body, and how you think and behave.

Mood

Depression can change your mood in myriad ways. Along with sadness, you might experience a loss of interest in things that used to bring you pleasure—this is called “anhedonia.” Suddenly, your favorite TV show can’t hold your attention, or you no longer get a boost of endorphins after your favorite running route. You might experience your life as flat. 

You might also feel hopeless, like nothing will ever improve, or you could feel overwhelmingly and inappropriately guilty about things that, ordinarily, would not warrant that level of guilt. In addition, you might experience a general sense of apathy—things don’t matter to you like they used to, and it might feel hard to get motivated at work or to pursue your hobbies.

Anxiety also often goes hand-in-hand with depression. The combination of persistent worry and rumination with symptoms like low mood, anhedonia, and hopelessness can be a match made in hell.

Sleep

Another key element of clinical depression is how it affects your sleep. You might find that you are oversleeping or not sleeping enough—both can be signs of depression. 

Specifically, “early awakening” is common in those with depression. You might find yourself consistently waking up in the wee hours of the morning and not being able to fall back asleep. 

Insomnia and restless sleep—the inability to fall asleep and waking up over and over throughout the night—can also be hallmarks of depression.

Ironically, getting enough sleep, and enough restful sleep at that, is one key to managing depression, making these symptoms that much more insidious.

Body

Depression can affect your appetite, causing you to behave in uncharacteristic ways. You might suddenly feel ravenous all the time, as though your hunger can never be satiated no matter how much you eat; or you might lose your appetite completely. Associated with these are changes to your body—you might gain or lose a lot of weight unintentionally.

Other physical symptoms might include fatigue or, on the other side of the coin, restlessness. Feeling overly tired or overly activated can also be signs of depression.

Cognition and Behavior

Depression can make it feel difficult or impossible to think. You might feel slow, like you’re mentally wading through Jell-O, or like your brain is filled with cotton and you can’t create or connect cogent thoughts. You also might have difficulty paying attention. These symptoms can make everyday tasks like work or school especially hard.

You might suddenly be easily irritated, or have frequent crying spells. You might often feel agitated, even when there’s nothing to be agitated about. Friends and family might notice that you are isolating yourself so that you don’t have to be social (which can feel particularly difficult when dealing with depression). 

Suicidal Ideation

One of the most severe and challenging symptoms of depression is suicidality. If you’re depressed, you might feel as though there is nothing worth living for. Or, it can even go beyond that, with an inexplicable but overwhelming urge to die. 

These feelings don’t make sense to someone who is not experiencing them, and they can be the most difficult attributes of depression to talk about. You might feel ashamed or embarrassed for feeling suicidal, or you might feel as though you don’t want to burden your loved ones with these feelings. 

It is important to recognize these suicidal thoughts as a treatable symptom of your depression and reach out for help immediately.

Types of Clinical Depression

Clinical depression doesn’t just refer to one singular condition. There are many different types of depression, associated with many different disorders.

Major Depressive Disorder (Unipolar Depression)

When someone says “clinically depressed,” major depressive disorder, or MDD, is usually what they mean. This is also known as “unipolar” (as opposed to “bipolar”) depression.

According to the DSM 5 (the Diagnostic and Statistical Manual of Mental Disorders), in order to be diagnosed with MDD, you must be experiencing at least five of the following criteria:

• Depressed mood
• Loss of interest or pleasure in most or all activities
• Significant and unintentional weight loss or weight gain
• Sleep disturbance (insomnia or hypersomnia)
• Observable agitation or retardation (noticeable by others)
• Fatigue, tiredness, or loss of energy
• Feeling worthless or feeling excessive or delusional guilt
• Impaired ability to concentrate, think, or make decisions 
• Recurrent thoughts of death, suicidal ideation, or suicide attempts

In addition to these criteria, the following must also be true of your depressive symptoms:

• They cause significant distress and impairment in everyday life—professionally, socially, and/or at home
• They’re not better explained by medication side effects, drug use, or another medical condition
• You’ve never experienced a manic or hypomanic episode (which would indicate bipolar disorder rather than MDD)
• Your symptoms aren’t better explained by schizophrenia or another psychotic disorder (such as schizoaffective disorder, which also involves mood symptoms)

If you feel like you meet these requirements for MDD, talk to a psychiatrist or mental health professional about how you’re feeling.

Bipolar Depression

Depressive episodes are also a significant part of bipolar disorder. In this condition, you experience mood swings, from depression to mania or hypomania. Bipolar depression meets the same criteria for depression as MDD, but a person must have experienced at least one manic or hypomanic episode—people with MDD do not experience mania or hypomania.  

Psychotic Depression

Psychotic depression, also called depressive psychosis, or formally in the DSM major depressive disorder with psychotic features, is depression that is accompanied by psychotic symptoms. With psychotic depression, you might experience delusions (fixed/false beliefs), hallucinations (false sensory perceptions), or disorganization where it can be difficult to think or communicate clearly.

One key difference between psychotic depression and other psychotic disorders is that, in psychotic depression, the psychosis is only present during the depressive episode; in other conditions, like schizophrenia or schizoaffective disorder, you continue to have psychotic symptoms even when not in a depressive episode.

Postpartum Depression

Many people write off postpartum depression as the “baby blues,” but it is actually much more severe than that.

Postpartum depression describes a clinical depressive episode that occurs after the birth of a baby. In the DSM-5, major depressive disorder with peripartum onset is actually defined as a major depressive episode occurring during pregnancy as well as in the four weeks following delivery. However, many clinicians extend that period to include the first year after birth.

If left untreated, postpartum depression can negatively affect your the relationship with your newborn, interfering with bonding and potentially having significant long term impacts on the child. As with other types of depression, there can be an increased risk for suicide in the mother.

If this describes you, reach out for professional help and support as soon as you can. Postpartum depression is a treatable clinical condition, and should be treated as such.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder, or PMDD, is a very real depressive condition that is often dismissed as just “part of your period”—although it’s anything but.

Like MDD, PMDD has its own specific diagnostic criteria. In the week before your period, there must be at least one of these symptoms:

• Mood swings, crying spells, and emotional sensitivity
• Marked anger, irritability, or increased interpersonal conflict
• Depressed mood, hopelessness, or self-deprecating thoughts
• Increased anxiety, tension, or the feeling of being “on edge”

Some of the following symptoms must also be present, to create a total of five when combined with the above criteria:

• Anhedonia or decreased interest in activities
• Difficulty concentrating
• Lethargy, easily fatigued, or lack of energy
• Changes in appetite, including overeating or specific cravings
• Insomnia or hypersomnia
• Feeling overwhelmed or out of control
• Physical symptoms like breast swelling or tenderness, muscle or joint pain, or bloating

If this describes your period, you shouldn’t have to suffer in silence. It’s a real mood disorder and deserves real treatment.

Seasonal Affective Disorder (SAD)

Seasonal affective disorder—appropriately shortened to “SAD”—is a major depressive condition that begins and ends with the changing seasons. People with SAD experience clinical depression (the symptoms of MDD) that correlate exclusively to seasonal shifts, with all symptoms persisting throughout one season and remitting completely when that season is over. (For most people, this occurs in winter, but it can be experienced in summer as well.)

In order to be diagnosed with SAD, you need to have experienced major depressive symptoms during this season and only this season for at least two years, and over the course of a lifetime, you need to have had more seasonal depressive episodes than not. Essentially, a SAD diagnosis establishes a consistent pattern of seasonal depression.

Persistent Depressive Disorder (Dysthemia)

Persistent depressive disorder—previously known as “dysthymia”— is where, over the course of at least two years, someone will have a depressed mood most days or for most of the day. They’ll also experience at least two of the following criteria:

• Insomnia or hypersomnia
• Poor appetite or overeating
• Feelings of hopelessness
• Fatigue or low energy levels
• Poor concentration or difficulty making decisions
• Low self-esteem

Having persistent depressive disorder also means that you’re not without depressive symptoms for more than two months out of the year— hence, “persistent.”

A lot of the qualifiers for this disorder are the same as for MDD: for instance, it can’t be better explained by a drug reaction or physical condition, there’s never been mania or hypomania, there’s no psychotic disorder, and it causes significant distress and disruption in everyday life. In addition, your symptoms can’t be more accurately attributed to MDD or partially remitted MDD.

Situational Depression

Sometimes, dealing with a stressful or traumatic event can make us feel depressed; however, when this depression is specific to a certain situation and does not meet criteria for a mental health condition, it’s not considered “clinical depression.” In fact, the technical term for situational depression is “adjustment disorder with depressed mood.” This describes marked distress or difficulty handling or coping with a stressful event that results in short-term depressive symptoms. 

If you have situational depression, you might feel overly sad, angry, or irritated; your sleep and appetite might be disrupted; carrying out daily tasks might feel difficult or impossible. But the key to situational depression is that these symptoms dissipate in time as you get further from the initiating event or its consequences.

Atypical Depression

Atypical depression, or major depressive disorder with atypical features, is a subtype of depression characterized by mood reactivity (your moods can change in the face of environmental circumstances) and the "atypical" features of increased sleep, increased appetite, "leaden paralysis" which is an extreme type of fatigue, and interpersonal rejection sensitivity.

An “atypical” diagnosis can be applied to MDD, bipolar depression, and persistent depressive disorder.

Causes and Risk Factors

“Clinical depression” doesn’t stem from just one source or risk factor—it describes a wide variety of complicated conditions affected by many things, including genetics, your environment, and biology.

Genetic Factors

It’s been found that certain genes have been linked to a higher prevalence of clinical depression, and if you have those genes, you’re more likely to develop a depressive disorder. However, it’s difficult to narrow down specific genes that cause depression because many people with mental illnesses are affected by many different genes (“polygenic” sources) that contribute to their conditions.

The emergence of depression can be influenced not just by your DNA, but by epigenetics, or how those genes get expressed. Adverse life events and environmental exposures have been shown to affect your epigenetics.

Environmental Factors

There are also elements of your environment that can make you more susceptible to mental illnesses like depression. Experiencing adverse childhood experiences, or ACEs, when you were young can increase your risk of depression—these things include child abuse or neglect and stressful life experiences like divorce or domestic violence. 

Being raised in a low-income household can have negative effects on your mental well-being as a child that can be carried with you to adulthood. In addition, being a victim of prejudice, bigotry, and racism can negatively affect your mental health, and make it more likely that you will at some point experience depression.  

Biological Factors

While genetics are certainly a biological contribution to depression, there are many other factors that can play a role. In particular, physical co-occurring health conditions can greatly increase your chance of experiencing depression. Not only can chronic illnesses affect your physical health, their biological and emotional effects can increase your risk for depression.

People who experience persistent or chronic stress are also more likely to develop depression. This is in some degree due to the dysregulation long term effects of stress has on the HPA system, or “hypothalamic-pituitary-adrenal axis”— the stress regulation system in the body. It’s no wonder that stress on the body results in stress on the mind.

Co-Occurring Conditions

People living with depression often have co-occurring mental health conditions. The most common of these is anxiety. This can be as the anxiety symptoms that often accompany depressive disorders, as well as co-occurring anxiety disorders, Many depressive and anxiety symptoms overlap—for instance, both conditions can be characterized by irritability, rumination, difficulty concentrating or making decisions, and trouble sleeping. But it is also not uncommon for those with anxiety disorders such as panic disorder, generalized anxiety disorder or social phobia to also have a depressive disorder.

It’s also possible for people with different kinds of mental illnesses to experience depression as well. Someone with schizophrenia, a psychotic disorder, or a personality disorder like borderline personality disorder might also experience episodes of a major depressive disorder.

Diagnosis of Clinical Depression

Getting diagnosed with a form of clinical depression begins by getting an assessment by a mental health or medical professional, and can be quite straightforward.

A psychiatrist, a psychologist, or a licensed clinical social worker can provide a diagnosis. Besides evaluating you for the DSM-5 diagnostic criteria we discussed earlier, there are other assessments that your provider can use to help with a diagnosis.

"Technically all that is needed is a diagnostic interview with a provider, and if that provider determines that there is enough information and evidence that symptoms are present, they can issue a diagnosis." However, she explains, “they might use screening tools with cutoff scores, which can indicate whether symptoms are causing significant distress, or norm-referenced tools, which can provide information on how significant the symptoms are compared to the general population.”

Initial Assessment

Two of the most common depression assessment tools are the Beck Depression Inventory (BDI) and the PHQ-9 (Patient Health Questionnaire).

The BDI is a 21-question, multiple-choice quiz that relies on self-reporting of possible depressive symptoms. It evaluates the presence of certain symptoms and their severity based on your ratings from 0 to 3, with 0 signifying no presence of that symptom to 3 signifying the symptom at its worst.

The BDI is meant for people ages 13 to 80, and requires a 6th-grade reading level in order to properly understand and fill out the questionnaire. The comprehensiveness of this inventory means it takes about 10 minutes to complete.

The PHQ-9 is also a self-reporting measure designed to determine the presence and seriousness of depressive symptoms, but it is much shorter than the BDI (nine questions rather than 21—hence, the “9” in “PHQ-9”). The PHQ-9 also has you rate your symptoms from 0 to 3, but in terms of frequency rather than severity.

For both assessments, your score from each question is tallied and the range of your total score represents a certain level of depression. In the BDI, the lowest score means “these ups and downs are considered normal” and the highest score means “extreme depression;” in the PHQ-9, the lowest score means “minimal depression” and the highest score means “severe depression.”

There are also specific depression assessments designed to measure depression both before and after treatment (the Hamilton Depression Rating Scale), depression in children (such as the Children’s Depression Inventory, based on the BDI), and depression in older adults (the Geriatric Depression Scale).

Differential Diagnosis

A differential diagnosis is the process of distinguishing your symptoms from the symptoms of other conditions when those symptoms overlap. For depression, a differential diagnosis would involve ruling out other psychiatric disorders, such as: 

• Anxiety disorders
• Obsessive compulsive disorder
• Post-traumatic stress disorder
• Personality disorders

Symptoms of physical conditions must also be ruled out, such as:

• Sleep disorders
• Parkinson’s, MS, dementia, and other central nervous system disorders
• Drug use and misuse or side effects from medication
• Thyroid issues (hypothyroidism or hyperthyroidism)
• Infectious diseases

Treatment Options

There are many ways to manage and treat clinical depression, including medication, therapy, and lifestyle changes.

Medication

Medications that treat depression are called antidepressants (although they are also commonly used to treat anxiety and other disorders as well), and there are many kinds that work on different mechanisms in the brain. The most common kinds are selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), atypical antidepressants, and monoamine oxidase inhibitors (MAOIs).

SSRIs are the most prescribed medications for depression. They allow for more serotonin to be passed from neuron to neuron in the brain. SSRIs include:

• Prozac (fluoxetine)
• Celexa (citalopram)
• Zoloft (sertraline)
• Lexapro (escitalopram)
• Paxil (paroxetine)

SNRIs work similarly to SSRIs, but impact both serotonin and norepinephrine, and are commonly prescribed for depression as well as anxiety disorders. SNRIs include:

• Cymbalta (duloxetine)
• Effexor (venlafaxine)
• Pristiq (desvenlafaxine)
• Fetzima (levomilnacipran)

TCAs also affect the reabsorption of serotonin and norepinephrine in the brain, as well as impacting other neurotransmitters. These were some of the first antidepressants and tend to come with more side-effects than the SSRI, SNRI and atypical antidepressants. Along with depression, TCAs can be used to treat insomnia, anxiety, and chronic pain. TCAs include:

• Amitriptyline
• Norpramin (desipramine)
• Tofranil (imipramine)
• Pamelor (nortriptyline)
• Amoxepin
• Doxepin
• Protriptyline
• Trimipramine

Atypical antidepressants are called so because they do not function like these other types of antidepressants, and instead work differently on the neurotransmitter systems in the brain. Atypical antidepressants include:

• Wellbutrin (bupropion)
• Remeron (mirtazapine)
• Desyrel (trazodone)

MAOIs were the first type of antidepressants ever developed, and can be quite effective, but currently are rarely prescribed as the newer kinds of antidepressants cause fewer side effects and are generally considered to be safer. Specifically, people taking MAOIs must follow a strict restrictive diet and avoid certain medications because of potentially serious interactions. MAOIs include:

• Emsam (selegiline) 
• Nardil (phenelzine)
• Marplan (isocarboxazid)
• Parnate (tranylcypromine)

It is important to bear in mind that, like any psychotropic medication, there are possible side effects when taking antidepressants. Common ones include:

• Agitation and anxiety
• Nausea and stomach pain
• Diarrhea or constipation
• Insomnia
• Headaches
• Loss of sex drive, inability to orgasm, or erectile dysfunction
• Loss of appetite
• Dizziness
• Weight gain
• Drowsiness
• Heart problems like palpitations or a fast heartbeat

Most of these side effects dissipate over time, but if they persist or are unbearable, talk to your psychiatrist. You don’t need to put up with side effects if they are making you miserable.

Be aware that some rare side effects can be medically serious, such as: 

• Serotonin syndrome (too much serotonin in the brain) usually caused when serotonin antidepressants are used with other agents that impact serotonin
• Hyponatraemia (low salt levels that can impact the brain)
• Increased risk of bleeding (particularly when used with anticoagulants)

In addition, there has been a reported association with some antidepressants and increased suicidal ideation, especially in children, teenagers and young adults. If you are feeling suicidal, contact your doctor immediately.

Psychotherapy

Therapy is a great option for those living with clinical depression. There are a wide range of approaches and modalities that have been proven effective in the treatment of depression, so you’re sure to find one that works for you.

The most important aspect of treating depression with psychotherapy is finding the right therapist. Don’t be afraid of trying out different providers until you find one you really click with.

Common therapeutic approaches for treating depression include:

• Cognitive behavioral therapy (CBT): Considered a gold standard in the treatment of depression, CBT teaches you to recognize and change maladaptive (harmful) thoughts, behaviors and coping strategies. It is important to recognize that, while you may not have the power to control what happens to you in life, you do have the power to control your reactions to what happens.
• Psychoanalysis: This modality focuses on experiences in your life, past and present, and your unconscious thoughts, habits, and motivations that may be contributing to your depression. Although formal psychoanalysis (several times a week on the couch) is less common nowadays, the principles involved (psychodynamic psychotherapy) are commonly employed in a variety of psychotherapeutic approaches and can be quite helpful in people better understanding themselves and growing in capacities that can mitigate depression.
• Acceptance and commitment therapy (ACT): A spin-off of CBT, ACT teaches you to accept your feelings, thoughts, and reactions to emotional triggers rather than avoiding them, trying to change them, or acting on them. This allows you to stop judging yourself for your depressive symptoms, and then focuses on using your values to guide your actions in your life.

Dr. Marschall weighs in about the most common approach, CBT: “Cognitive behavioral therapy has a lot of research behind it as an effective tool for treating depression, although this is partially because cognitive behavioral therapy is one of the easiest modalities to implement in a research setting,” she explains. “Basically, a therapist trained in CBT can help someone who is experiencing depression recognize how their thoughts and perception of the world around them might perpetuate depressive symptoms. For example, CBT techniques can help you catch negative self-talk reflecting harmful beliefs, like thinking, ‘I am a failure,’ after making a small mistake.”

Alternative and Complementary Therapies

Although medication and psychotherapy are the mainstays of managing depression, there are a few complementary alternative approaches that have been proven to be helpful. Regular exercise has been proven to lessen depressive symptoms, for example. Yoga and mindfulness-based practices have also been shown to be helpful in managing depression,

You might see acupuncture as a recommended alternative therapy for depression, but multiple studies have questioned its efficacy. In addition, St. John’s Wort is sometimes recommended as an alternative to medication, but its effectiveness is not reliable; it also interferes with the efficacy of certain prescription medications, and can even result in serious health conditions (like serotonin syndrome) if taken alongside some kinds of antidepressants.

Self-Care and Lifestyle Changes

Everyone has different self-care needs, says Dr. Marschall, but “an important starting point is ensuring that your basic physical needs are met. Depression is like carrying around an enormous invisible weight that makes every activity more difficult even if there is not a clear, visible reason why these challenges have arisen. 

“Many people experiencing a depressive episode will struggle with eating, hygiene, and other basic tasks,” explains Dr. Marschall. “Not only can this be bad for your physical health, but it can create a vicious cycle. It's hard to come out of feeling depressed when you feel unclean from not showering for several days." When someone has very limited energy due to depression, I encourage them to keep things very basic.

There are also lifestyle changes that have been proven to help day-to-day symptoms. Incorporating exercise into your daily routine is an important and effective way to help you manage your depression. Not only does it produce immediate endorphins, boosting your current mood, but a healthier body supports a healthier mind in the long run.

Starting a meditation or mindfulness practice can also help with mood symptoms. Taking the time each day to focus on what’s going on inside of you can help you identify your current mood state and tackle challenges and symptoms head-on. Meditation can also help you calm your mind and think more carefully about what you need in order to feel your best that day.

Bedtime routines are also helpful. Make sure you have good sleep hygiene: wind down before bed by weaning yourself off your screens and devices, and try to go to bed at the same time every night and wake up at the same time every morning. 

If you need to take a break at work, take a break; if you need a mental health day, respect that feeling and take the day off. The world isn’t going to fall apart if you’re out of commission for the day. Do things that normally boost your mood—go for a walk, watch your favorite TV show, go to the dog park and pet some dogs. 

Even if you can’t feel better today, that’s ok. You have the emotional flu—so treat yourself with the kindness you would if you had the actual flu.

Coping Strategies and Support

There are lots of things you can do to cope with depression, both daily and in the long term.

To begin, Dr. Marschall advises paying close attention to your emotional patterns. “Noticing when you are starting to enter an episode is important. Since your brain's job is to give you information about the world around you, it does not always accurately cue you to what it is experiencing in the moment,” she says. “It's kind of like when my former employer's contact button broke on their website, and no one could find contact information to let them know that the link had broken. If you document what signs you experience at the start of an episode, you can get support before things get worse.”

Building a Support Network

Make sure you have people around you whom you trust. This might be family members, friends, or coworkers—anyone you know you can talk to when you’re feeling low. Being able to be honest with the people around you, especially loved ones, can keep you from feeling isolated in your depression. Suffering in silence doesn’t help anyone.

You might not feel as though the people around you will understand how you’re feeling, and you might be right—they might not be able to completely understand. But chances are they’d like to. Chances are you have people in your life who want to be there to support you, through better or worse. 

Practice talking about your depression. Making it less scary to talk about your symptoms means more people will know what you’re going through and can offer themselves as a source of support.

Managing Daily Life

Routines are very helpful for people with depression. Having stability and a plan for the day can help ensure that if and when depressive symptoms do arise, you can deal with them without having to worry about throwing off your entire life. 

Make sure you eat, even if you don’t feel like it. 

Get some form of exercise, even if it’s just going for a short walk.

Talk to someone. If you’re feeling bad and want to talk it through, do it. If you don’t want to talk about how you’re feeling, that’s fine too. Send a stupid meme to your bestie. Remind yourself that you have people around you if you need them.

If you’re having a particularly hard day, it’s ok to stay in bed for just that day. It’s ok if the only exercise you get that day is moving from the bed to the couch. It’s ok if the only thing you feel like eating is Cheetos. Be kind to yourself. However, if this becomes a pattern, it should be discussed with your mental health professional.

Long-Term Management

In the long run, it’s especially important to maintain consistent treatment. Working with a therapist is a great way to manage your depression—don’t get discouraged if the work you’re doing in therapy is difficult or you feel like you’re not making progress fast enough. Trust the system, trust your therapist, and trust yourself. (Though if you have been in therapy for a long time and are not noticing any changes or feeling supported in your therapy, it might be time for a consultation or to switch therapists.)

If you and your providers have decided that you need medication in order to treat your depression, make sure you are taking it consistently the way it is prescribed. It might take you a few tries or combinations to get on the right medication—take note of how you are feeling day-to-day, and let your providers know if you start feeling worse.

Maintain interpersonal connections. Make sure you are talking to friends on a regular basis, even if it’s just a text here and there to check in. Having a strong support system is imperative in living with and managing depression.

My Personal Experiences with Depression

I have been dealing with some form of clinical depression since I was in high school. At first, I was misdiagnosed with unipolar depression, then bipolar disorder; as it turns out, I have schizoaffective disorder, which is characterized by both mood symptoms (like depression and mania) and psychotic symptoms that persist even when one is not is a mood episode. 

I have been on upwards of 30 different medications over the past 20-ish years. My first experience with an antidepressant was in high school. I tried Celexa, and within two weeks I was experiencing suicidal ideation (sometimes antidepressants can have destabilizing effects, particularly in those with bipolar vulnerabilities). Next, in college, was Wellbutrin, which I was on for a few years until a psychotic break landed me in the hospital and I was diagnosed with bipolar disorder. After that, I was put on lithium, which is a go-to mood stabilizer for people with bipolar.

In my depressed states, it’s difficult to think—it feels like I am on a permanent delay while the world rushes past me at twice its normal speed. To this day, that is how I experience my depressive episodes. There’s also a deep sadness that descends over me that’s not related to a situation or a problem; it’s just there, like a weighted blanket I do not want or need, pushing me down. 

There have been times when I physically could not move, I was so depressed. I’ve laid on my bed or on the couch, immobile with pain. There have been times I haven’t eaten for days, weeks where I couldn’t sleep or slept far too much. I feel my depression in my chest—a gaping hole where my ribcage should be. 

The episodes tend to end more quickly, and I haven’t felt suicidal in a very long time—all wins in my book. But I recognize that depression will most likely be a major part of my life for the rest of my life.

I also recognize that my depression doesn’t have to define me, or keep me from living the way I want to.

Conclusion

There are many different types of clinical depression—major depressive disorder, bipolar depression, and postpartum depression, to name a few—and a myriad of ways to treat them. Talk therapy can help you deal with your depressive symptoms as they arise, and antidepressant and other medications can make your depression more manageable or even disappear. Lifestyle changes can also help with depression—for example, regular exercise and a stable support system are invaluable when dealing with depressive symptoms.

If you are feeling depressed, you don’t need to suffer in silence. If you are already in therapy, talk to your therapist about how you are feeling; if you already have a psychiatrist, explain to them what you are experiencing. 

Online therapy companies and online therapy directories can connect you with mental healthcare providers who can treat depression and might even take your insurance, making their services that much more feasible.

If you are feeling suicidal or in crisis, there are emergency resources for you:

• 988: The Suicide and Crisis Lifeline. Dial or text 988 to be connected to emergency mental health services. However, bear in mind that, if you are determined to be a danger to yourself or others, the police might get involved as first responders.
• The Crisis Text Line: Text “HOME” to 741741 to be connected anonymously to a crisis text line volunteer.

Depression doesn’t have to be your end-all, be-all. Don’t be afraid to reach out for help if you are depressed.