Clinical Depression: When It’s More Than “Just Feeling Down”

It can be normal to feel down occasionally. Sadness is a temporary emotional state that many people experience. However, sadness is not the same as depression, a mental illness that can cause severe functioning difficulties. If you believe you may be living with depression, knowing the definition of this condition and how to receive support can be helpful. 

What is clinical depression?

Clinical depression is a term often used to refer to major depressive disorder (MDD), one of ten depressive disorders in the DSM-5. Clinical depression is a mood disorder that can cause severe symptoms that occur most days and last at least two weeks. According to the World Health Organization, more than 300 million people worldwide live with depressive disorders. 

Signs and symptoms of clinical depression

The concept that clinical depression and situational depression are interchangeable is incorrect. Both share similarities, but these conditions' underlying symptoms and causes are distinct. 

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines symptoms of mental disorders, including clinical depression. For a health care professional to diagnose major depressive disorder, a person must experience at least five of the following symptoms nearly every day, for most of the day over two weeks or longer:

• A persistent sad mood

• A loss of pleasure and interest in previously enjoyed activities 

• Weight and appetite changes 

• Changes in sleep, such as insomnia or increased sleeping

• Restlessness or slow movement or speech

• Exhaustion, fatigue, and a lack of energy 

• Thoughts of worthlessness and hopelessness 

• Difficulty making decisions or concentrating 

• A loss of memory 

• Suicidal thoughts or suicide attempts

Other common signs of depression  can include:

• Leaving the house less often than usual

• Reduced motivation at school or work

• Withdrawal from family and friends

• Alcohol use

• Loss of confidence

• Aches and pains

• Physical conditions like heart disease or chronic pain

• A lack of pride in physical appearance

• Recurrent thoughts of death

Risk factors for clinical depression

While it is challenging to outline one cause of clinical depression, several risk factors can be linked to the development of the illness.

Gender

Statistics show that women are nearly twice as likely to be clinically depressed as men, although all genders are affected at the same rate as children. This statistic may be because women are more likely to report depression and seek help than men, as men often face unique stigmas. Relationships also factor in, with statistics showing that married people are less likely to be depressed. 

Genetics 

Depression can run in families, suggesting that there may be a genetic predisposition to the illness. However, having a parent or relative with depression doesn't mean you will be diagnosed with depression. Depression is a complex illness linked to a combination of genes. While abundant research has been conducted on this factor, the genetic influence is still uncertain. 

Personality traits 

Personality traits, including introversion and neuroticism, can also predispose some individuals to clinical depression. The following characteristics are also related:

• Tendency to worry 

• Low self-esteem

• Perfectionism

• Sensitivity to criticism

• Tendency to be critical of oneself 

If a person has a predisposition to depression due to genes or personality traits, several factors may incite the illness. For example, many people feel sad after the death or loss of a loved one. However, in some people, depression may develop. 

Traumatic events 

Physical, sexual, or emotional abuse may also cause depression, whether soon after or later in life. Major life events can sometimes cause depression, including happy occasions like getting married or starting a new job. However, stressful events like divorce or job loss are more likely to cause depression. 

If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text "START" to 88788. You can also use the online chat. 

Serious illness 

Clinical depression can also be caused by serious illness and is often linked to medical conditions. Certain medications can also incite clinical depression in some individuals. If you take a medication and experience symptoms of depression, contact your doctor before you stop taking the medication. 

Substance use 

Substance use is another significant risk factor for depression. Up to a third of clinically depressed people engage in substance use. 

Diagnosing clinical depression

If you are concerned that you may be experiencing depression, start by taking a depression screening online or with your doctor. If you receive a positive result or your symptoms are causing profound changes in your life, visit a professional in person for an accurate diagnosis and treatment recommendations. 

If you visit your primary care physician, they may start with blood tests or other diagnostic tools to determine if your symptoms are due to a medical condition, like thyroid disease or vitamin D deficiency, as these conditions can affect your mood. 

Your doctor may also ask you about your mood, symptoms you are experiencing, when symptoms occur, and how they affect your daily life, including work and relationships with friends and family. Your doctor may also ask you to complete a questionnaire about how often you have experienced specific symptoms. 

Some doctors may ask questions about anxiety disorders, which are common in those with clinical depression. Feeling uncomfortable or exposed to answering such personal questions can be expected. However, try to answer honestly, as it can lead to you receiving a proper diagnosis and support. 

Clinical depression treatment

While some people experience symptom remission over time, clinical depression can be long-term without support. However, you can take a few steps at home to relieve symptoms and encourage a routine. Maintaining a healthy lifestyle can be valuable, so try to eat a balanced diet and exercise regularly. Below are a few other ways to receive support. 

Sleep hygiene 

Sleep can be essential for your mood, and depression commonly impacts the quality of sleep people experience. Decide on a regular bedtime routine to help you wind down. Try to cut down on caffeine, as it can cause difficulty sleeping. Reducing and managing stress levels can also relieve the symptoms of depression before you sleep.

Spend time with your support system 

Spending more time with family and friends may aid in recovering from depression. Consider talking to them about what you're experiencing and how they can help you. Opening up to someone close to you can help you realize that you are not alone. 

Try medication 

If you are experiencing clinical depression, taking these steps may not be enough to experience symptom remission. As clinical depression is a complex mental illness, different treatments affect people differently. 

Your doctor may be able to prescribe antidepressant medications if they believe they would be effective for you. Medications are often highly effective in treating moderate to severe clinical depression and anxiety disorders. 

While it is often an effective treatment, medication can take weeks or months to work and may not work the same for everyone. Depression is a complex mental illness that cannot always be treated biologically in the same way that a physical illness can. If one antidepressant does not help you, your doctor may prescribe others. 

If a particular treatment worked for someone in your family, it may also be effective for you, as genetics can determine whether a medication is helpful. Even if you start to feel much better, do not stop taking medication without consulting your doctor. 

Psychological treatments

Psychological treatments aim to treat clinical depression by allowing clients to discuss the symptoms of their condition with a mental health professional. These treatments can help you to:

• Adjust to life changes positively 

• Identify maladaptive thoughts, beliefs, and behavioral patterns 

• Improve your coping skills to better cope with stress

• Identify factors that contribute to your symptoms 

• Regain a sense of satisfaction and control in your life

• Learn to set realistic, achievable life goals

Below are a few of the most common psychological treatments available for depression. 

Cognitive behavioral therapy (CBT) 

One of the most common psychological treatments is cognitive-behavioral therapy (CBT), which involves identifying thoughts and behaviors contributing to your symptoms. The therapist can help you change these thought and behavior patterns into positive, problem-solving techniques.

Interpersonal therapy 

Another common psychological treatment is interpersonal therapy (IPT), a structured psychological therapy based on relationships. Relationships can significantly affect the mood and behaviors of someone experiencing clinical depression. IPT helps you recognize patterns in relationships that may be affecting your depression and change these patterns to improve relationships. 

Support groups 

There are various support groups for people with depression, such as the Depression and Bipolar Support Alliance. Support groups are also available for the families of those with depression through organizations like the National Alliance on Mental Illness (NAMI).

Alternative treatment options 

Certain factors can sometimes stand in the way of someone receiving support. Some people might not have time to take off work for therapy or want to answer questions about where they're going. Others might not be able to afford treatment. Online therapy through a platform like BetterHelp can offer a solution to this challenge. 

Some people with depression struggle to find the motivation to get out of bed, and the thought of getting dressed and commuting to an office for therapy might be overwhelming. With an online platform, you can attend sessions from the comfort of your home, or anywhere you have an internet connection. You can communicate with your therapist via phone, video, or live chat sessions. In addition, you can schedule sessions at a time that works for you. 

Studies show that online therapy is effective. One review of 17 studies found that online CBT for depression could be more effective than in-person treatment in some cases.