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Depression is the leading mental health diagnosis in the United States, with more than three million people diagnosed each year, and a significant cause of disability around the world. Depression is a mood disorder that negatively affects the way one feels, thinks and acts. It affects males and females, and people of all ages and ethnicities.

Depression is complex, and not everyone who suffers from depression experiences it in the same way. Depression can be quite severe and debilitating, occurring independently or in conjunction with other mental health conditions, or it can be mild, though persistent in nature. Some may experience depression primarily during the winter months, when daylight and sunshine are more limited, known as seasonal affective disorder. Others may develop depressive symptoms in response to menstrual hormone changes, referred to as premenstrual dysphoric disorder.

The most common symptoms of depression are a pervasive feeling of sadness and a loss of interest in activities typically enjoyed. Depression may cause problems with concentration and decision making, even for very basic tasks. It may result in insomnia (difficulty falling or staying asleep) or sleeping too much, and can result in appetite and/or weight changes. Feelings of guilt and worthlessness commonly accompany depression. Those suffering from depression may feel hopeless. Suicidal thoughts and self harm behaviors may develop, and warrant immediate attention. Some may experience a more activated depression, marked by irritability, reactivity, anxiety and restlessness.

Depression may also manifest physically. Depressed individuals may experience chronic fatigue, increased aches and pains, and decreased sex drive. In addition, depression and immune function are intimately linked. Poor immune function may make one more susceptible to depression, and depression may contribute to reduced immune function and increased susceptibility to illness.

It is easy to miss the signs of depression in children and older adults, as symptom presentation in these age groups may be different than what one typically expects. Children who are depressed may present as extremely irritable and with frequent angry outbursts that are excessive for their developmental stage. They may complain of physical pains, such as stomach aches, for which there is no obvious cause or remedy. They may become socially withdrawn or suddenly struggle academically. Older adults may complain of fatigue, trouble sleeping, difficulties with attention, and confusion. Depression may be further difficult to recognize in older adults when it occurs alongside medical illness. However, depression increases the likelihood of death and disability in response to medical health issues, making early identification and treatment of this mental health issue of utmost importance.

There are many causes of depression. Those with first degree relatives who suffer from depression are at greater risk for becoming depressed. The mechanism for this is not clear, but research suggests that this genetic influence can make one more susceptible to responding to stressful life events with depressive symptoms. Even without a genetic predisposition, depression can develop in response to specific life events and circumstances. On the other hand, sometimes there is no obvious reason for depression and it appears “out of the blue.” Some research suggests depression may be a defense strategy, facilitating a shutdown of the body that is meant to preserve energy in times of threat.

Depression is often cyclical in nature, and early intervention and treatment can help to reduce symptoms and prevent recurrence. There are several approaches to treating depression, and the best approach for you or your loved one will depend on frequency, duration and severity of symptoms. Psychotherapy and antidepressant medication are the most common forms of treatment, and are often used in conjunction. Making lifestyle changes is also helpful in managing depression, such as limiting alcohol and other substance intake, getting quality sleep, and participating in regular exercise.

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