Depression

Depression, also called major depressive disorder or clinical depression, often does not have one single cause, but occurs due to a complex set of changes in the brain, behavior, thinking and the environment. It causes symptoms of sadness, hopelessness and loss of interest in relationships or favorite activities.

It’s different from experiencing one or two days of a negative or lower mood, and that distinction is very important. For example, everyone feels sad or experiences a low mood sometimes, especially in response to negative life events. Clinical depression, however, is prolonged, persistent and impairs your ability to function, including going to work or school, maintaining relationships or performing daily tasks.

Depression can be life-threatening, but while it’s a serious medical condition that requires help from professionals, it is treatable. Many people with depression get better and stay healthy with proper treatment.

Types of depression

Clinical depression can be complex, and because of that, there are different types and subtypes. You’ll need to have a comprehensive initial assessment by a trained professional to determine the type of depression you’re experiencing.

This assessment and getting an accurate diagnosis are very important, because different types of depression respond better to different types of treatment.

Types of depression that we treat at Ohio State include:

• Major depressive disorder: the most common form of clinical depression that includes symptoms of sadness and hopelessness, most days and more days than not, over a period lasting longer than two weeks.
• Minor depressive disorder: a period of depression that might last less than two weeks in which the symptoms are intense enough to interfere with a person’s life.
• Persistent depressive disorder: a more chronic form of clinical depression that is present most of the day, more days than not, for two years or more.
• Seasonal affective disorder (SAD): a form of depression related to a certain season of the year — often coinciding with the onset of fall and winter, but for some it’s the opposite.
• Postpartum depression: a form of depression that begins in the weeks and months following childbirth.
• Premenstrual dysphoric disorder: depression symptoms that begin the week before a menstrual period but subside after it starts.
• Bipolar depression: associated with bipolar disorder, which typically involves a chronic cycling between periods of depression and periods of mania or hypomania (extreme happiness).
• Depression with psychotic features: a form of depression that’s accompanied by a distorted experience of reality.
• Difficult-to-treat depression (also known as treatment-resistant depression): a form of depression for which traditional treatment, such as medication and psychotherapy (talk therapy), aren’t adequately effective.

What causes depression?

Depression has been linked to various causes, including genetic, environmental, psychological and biochemical factors. The cause of one individual’s depression may not be the same as the cause for another individual’s depression.

The condition can also be brought about by substance use disorder or other medical conditions, such as cancer, stroke or other neurological disease.

Depression often starts in your late teens or 20s, but it can impact anyone at any stage of life. It’s more common in women, who face unique hormonal and emotional experiences across the lifespan. However, depression can be equally as debilitating in men and individuals who identify as transgender or nonbinary.

Depression symptoms

Depression affects everyone differently and doesn’t present the same way in any two people.

Signs of depression include:

• Feelings of sadness most of the day, nearly every day
• Loss of interest or pleasure in activities that you enjoy
• Weight or appetite changes, such as weight gain or a loss of appetite
• Difficulty sleeping or oversleeping
• Difficulty thinking or concentrating
• Excessive guilt or feelings of worthlessness
• Fatigue or loss of energy
• Thoughts of death or suicide 

When to get help for your symptoms

If you’re experiencing symptoms of depression, it’s important to seek help and be evaluated by a trained mental health professional. That way you can receive the treatment most likely to be effective for you.

How to help a loved one with depression symptoms

Although views of and treatment for depression may be improving, stigma of the disease persists. People often believe that you should be able to overcome mental health struggles on your own.

The most important thing you can do when you think someone in your life is depressed is to talk with the person, support them and encourage them to seek help. There are several strategies that can be quite helpful, including:

• Express concern and offer your observations in a nonconfrontational manner
• Explain that depression is a treatable condition, with a variety of options for treatment
• Suggest they speak to a medical or mental health professional
• Express your willingness to help and support them, and ask how you can help them
• Respect your loved one’s right to make their own decisions

Depression treatment

Because depression can be debilitating or even life-threatening, our providers at the Depression Recovery Center will work with you to determine what symptoms are most prominent or impairing, and what treatment will work best to alleviate these symptoms.

We have several different classes of treatments that work on different mechanisms that may be contributing to your depression, so we’re confident we’ll find the right therapy to get you back to being engaged and living the life you want.

After an initial evaluation, which will be during your first appointment with us, we’ll determine if you need one or more of the following:

Psychotherapy: Also known as “talk therapy,” this typically involves weekly, one-hour appointments where you and your clinician collaboratively incorporate and practice techniques to alleviate distress. We incorporate evidence-based treatments and offer various psychotherapy methods, including behavioral activation, cognitive-based therapy and mindfulness-based cognitive therapy.

Medications: Antidepressant medications affect brain chemicals called neurotransmitters and help regulate your mood. Each type, or class, of antidepressant can affect the neurotransmitters in different ways.

Classes of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants
• Monoamine oxidase inhibitors (MAOIs)
• Mood stabilizers
• Other antidepressants

Coping strategies for depression symptoms

When used alongside professional help, lifestyle modifications can also help manage your depression symptoms. Steps you can take include:

• Eat a healthy and well-balanced diet
• Exercise regularly
• Get plenty of sleep
• Avoid alcohol or recreational drugs
• Learn your triggers and what to do if your depression symptoms worsen
• Take medications as prescribed, even if you’re feeling better
• Follow your treatment plan, including attending all psychotherapy sessions

Advanced treatment for depression

Sometimes depression doesn’t respond well to psychotherapy or medications. In these cases, your mood disorder might be labeled difficult-to-treat or treatment-resistant depression.

Fortunately, at the Depression Recovery Center at the Ohio State Wexner Medical Center has been at the forefront of pioneering new therapies and technologies, including neurological therapies, for treating depression. These advanced treatments provide innovative, effective therapies for people who haven’t found help for their depression in the past.

Our interventional psychiatry treatments include:

Transcranial magnetic stimulation (TMS)

TMS uses magnetic pulses to stimulate areas of the brain believed to control mood. These areas may not be functioning properly for those who are experiencing depression. Sessions, which are conducted on an outpatient basis, are painless and last less than an hour.

Electroconvulsive therapy (ECT)

ECT is conducted while you’re under general anesthesia, meaning you’re asleep. ECT uses electricity to trigger a seizure, which lasts less than 60 seconds and won’t spread throughout the body.

Ketamine infusion therapy

Ketamine is used in high doses for anesthesia; however, lower doses have been shown to improve symptoms of depression and mood disorders. It works directly with brain receptors and can work almost immediately.

Intranasal esketamine treatment

This form of ketamine is an FDA-approved nasal spray that you inhale. Intranasal esketamine (Spravato) must be used in the doctor’s office so you can be monitored. It’s often used with antidepressants.

Vagus nerve stimulation (VNS)

VNS delivers timed electrical signals to change brain wave patterns. Before administering this therapy, physicians implant an adjustable pulse generator in the chest. It connects to a wire that’s threaded beneath the skin and wound around the left vagus nerve.

Recovery focused psychotherapies

Newer psychotherapy approaches such as augmented depression therapy (ADepT) have been developed to address chronic difficulties with depression. Augmented therapy for depression integrates approaches from several existing therapies (such as CBT) to help patients manage the ways that depression can get in the way of engaging in their lives.