Reviewed by Virginia Lindahl, Ph.D.
Jude Evans-McCarthy found herself struggling with feelings of despair, but she kept them to herself, not wanting to be labeled as “crazy,” and even withheld information from her doctors.
Then one day, after years of struggling, she nearly drove her car into the path of a semi-truck.
“The only thing that stopped me was that my pets were in the car. And I didn’t want to [kill myself] and have my son dealing with the aftermath of it, wondering if I didn’t love him,” she said.
Evans-McCarthy was eventually diagnosed with depression. She described it as having an elephant on her chest. “The elephant has its trunk around my throat. It’s hard to crawl out from under it.”
Evans-McCarthy is not alone. The Anxiety and Depression Association of America (ADAA) reports that clinical depression, or major depressive disorder (MDD), affects more than 21 million American adults over the age of 18.
“Depression is one of the most commonly diagnosed psychiatric illnesses in the world and can have a significant effect on your relationships and your day-to-day life,” said Drew Pate, M.D., chief of psychiatry at LifeBridge Health in Baltimore, Maryland.
It’s normal to be sad as a reaction to external events, but that sadness eventually passes, and it doesn’t usually cause difficulty with functioning in daily life. Clinical depression interferes with a person’s daily functioning and is an extended period of sadness that may not be connected to external factors or causes.
“People can have a temporary depressed reaction to an upsetting situation lasting less than two weeks,” said Karen Lynn Cassiday, Ph.D., ACT, owner and clinical director of the Anxiety Treatment Center of Greater Chicago and former president of the ADAA. “During this time, they may find it more difficult to function, but are able to quickly get back to their normal daily activities even though they might feel sad, negative, grief-stricken, etc. … Clinical depression, or major depression, occurs when someone has two weeks or more of sadness, low mood, loss of interest in things that normally brought them pleasure, irritability or negativity.”
According to Cassiday, these changes in mood, mental energy and physical energy must be out of character for the person as well.
The National Institute of Mental Health (NIMH) states that there are
several forms of depression, including MDD; persistent depressive disorder, which is less severe but can last for years; and seasonal affective disorder. Major depression can present with depressive symptoms for two weeks or more, and interfere with the person’s daily activities.
The ADAA reports that MDD is more prevalent in women than in men. “Women are at unique risk for clinical depression during the peripartum period, when they are stay-at-home moms and when they have broken sleep [in the postpartum period]. Women need extra support both emotionally and physically to weather the changes associated with motherhood without getting stuck in depression,” said Cassiday.
The symptoms of clinical depression can vary widely from person to person, but can include these ongoing symptoms:
Changes in sleep patterns or an inability to sleep
Loss of appetite
Cravings for carbohydrates
Unexplained weight loss of 10 or more pounds
Loss of interest in sex or relationships
Loss of interest in friends and hobbies
Inability to feel love or affection
Talking and moving more slowly than normal
Impaired concentrationFeelings of hopelessness or powerlessness
Treatment for depression varies and can include psychotherapy as well as medication. Treatment-resistant depression, which is depression that doesn’t get better with standard treatments, is sometimes treated with other methods, including electroconvulsive therapy, transcranial magnetic stimulation or ketamine.
Medications for depression must be taken as directed and may not begin to work for weeks after the first dose. All treatments, including herbal remedies, should be discussed with and prescribed by your healthcare provider.
You can also take action steps to help alleviate your symptoms, including:
Eating low-inflammatory foods
Practicing gratitude and mindful meditation
How to ask for help for depression
If you find yourself experiencing symptoms of depression for more than two weeks, or if you are having thoughts of suicide, you should seek help. Asking for help can be a difficult step to take. If you’re not ready to reach out to a mental health professional, you can start by making an appointment with your primary care provider.
Your healthcare provider will look for symptoms that can identify depression, ask about any events that may have contributed to the symptoms and look at any family history of depression. No tests are available to diagnose depression, but your doctor may order lab tests to look for hormone issues or other physical problems that can cause the same symptoms.
Evans-McCarthy found seeking help and accepting treatment to be helpful in managing her depression. “Medication is one of the tools in my toolbox,” she said. “You need other tools — therapy, friends, exercise, hobbies — to use when you need them.”
If you or someone you know is having a crisis, please call or text the Suicide and Crisis Lifeline at 988.
American Foundation for Suicide Prevention
988 Suicide and Crisis Lifeline
National Institute for Mental Health Depression Overview Page