If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

• Persistent sad, anxious, or “empty” mood

• Feelings of hopelessness, or pessimism

• Irritability

• Feelings of guilt, worthlessness, or helplessness

• Loss of interest or pleasure in hobbies and activities

• Decreased energy or fatigue

• Moving or talking more slowly

• Feeling restless or having trouble sitting still

• Difficulty concentrating, remembering, or making decisions

• Difficulty sleeping, early-morning awakening, or oversleeping

• Appetite and/or weight changes

• Thoughts of death or suicide, or suicide attempts

• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

• Personal or family history of depression

• Major life changes, trauma, or stress

• Certain physical illnesses and medications

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH website and in the NIMH publication Depression: What You Need to Know.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

• ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.

• Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.

• Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.

• ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.

• ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

• Try to be active and exercise.

• Set realistic goals for yourself.

• Try to spend time with other people and confide in a trusted friend or relative.

• Try not to isolate yourself, and let others help you.

• Expect your mood to improve gradually, not immediately.

• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

• Continue to educate yourself about depression.

What are Clinical Trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including depression. During clinical trials, some participants receive treatments under study that might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. Other participants (in the “control group”) receive a standard treatment, such as a medication already on the market, an inactive placebo medication, or no treatment. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please Note: Decisions about whether to participate in a clinical trial, and which ones are best suited for a given individual, are best made in collaboration with your licensed health professional.

How do I find a Clinical Trials at NIMH on Depression?

Doctors at NIMH are dedicated to mental health research, including clinical trials of possible new treatments as well as studies to understand the causes and effects of depression. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with one of our clinicians. Find NIMH studies currently recruiting participants with depression by visiting Join a Research Study: Depression.

How Do I Find a Clinical Trial Near Me?

To search for a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world (search: depression). ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from health professionals.

Free Booklets and Brochures

• Chronic Illness & Mental Health: This brochure discusses chronic illnesses and depression, including symptoms, health effects, treatment, and recovery.

• Depression and Older Adults: Depression is not a normal part of aging. This brochure describes the signs, symptoms, and treatment options for depression in older adults.

• Depression: What You Need to Know: This booklet contains information on depression including signs and symptoms, treatment and support options, and a listing of additional resources.

• Postpartum Depression Facts: A brochure on postpartum depression that explains its causes, symptoms, treatments, and how to get help.

• Teen Depression: This flier for teens describes depression and how it differs from regular sadness. It also describes symptoms, causes, and treatments, with information on getting help and coping.

Clinical Trials

• Join a Study: Depression – Adults

• Join a Study: Depression – Children

• Join a Study: Perimenopause-Related Mood Disorders

• Join a Study: Postpartum Depression (PPD)

Federal Resources

• Depression: MedlinePlus

• Moms’ Mental Health Matter: Depression and Anxiety Around Pregnancy (National Institute of Child Health and Human Development)

Research and Statistics

• Journal Articles: This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).

• Statistics: Major Depression: This webpage provides information on the statistics currently available on the prevalence and treatment of depression among people in the U.S.

Multimedia

• Watch: “Baby Blues” – or Postpartum Depression?: This video provides patient testimony and information on the signs and symptoms of postpartum depression and reinforces the importance of seeking help and treatment from a health professional.

• Watch: One Woman's Experience With Depression: This video by the National Institute on Aging tells the story of an older woman who struggled for years with depression, but who is now in recovery. Learn more about older adults and depression.

Last Revised: February 2018

Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of the NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.

Source: NIHM, NIH

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Definitions

Major depression is one of the most common mental disorders in the United States. For some individuals, major depression can result in severe impairments that interfere with or limit one’s ability to carry out major life activities.

Additional information can be found on the NIMH Health Topics page on Depression.

The past year prevalence data presented here for major depressive episode are from the 2017 National Survey on Drug Use and Health (NSDUH). The NSDUH study definition of major depressive episode is based mainly on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

• A period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth.

• No exclusions were made for a major depressive episode symptoms caused by medical illness, substance use disorders, or medication.

Prevalence of Major Depressive Episode Among Adults

• Figure 1 shows the past year prevalence of major depressive episode among U.S. adults aged 18 or older in 2017.

  • • An estimated 17.3 million adults in the United States had at least one major depressive episode. This number represented 7.1% of all U.S. adults.

    • The prevalence of major depressive episode was higher among adult females (8.7%) compared to males (5.3%).

    • The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (13.1%).

  • The prevalence of major depressive episode was highest among adults reporting two or races (11.3%).

Major Depressive Episode with Impairment Among Adults

• In 2017, an estimated 11 million U.S. adults aged 18 or older had at least one major depressive episode with severe impairment. This number represented 4.5% of all U.S. adults.

• Figure 2 shows overall past year prevalence of major depressive episode with and without severe impairment. Of adults with major depressive episode, 63.8% had severe impairment.

Treatment of Major Depressive Episode Among Adults

• Figure 3 shows data on treatment received within the past year by U.S. adults aged 18 or older with major depressive episode. Treatment types include health professional only, medication only, and health professional and medication combined.

  • An estimated 65% received combined care by a health professional and medication treatment.

  • Treatment with medication alone was least common (6%).

  • Approximately 35% of adults with major depressive episode did not receive treatment.

Prevalence of Major Depressive Episode Among Adolescents

• Figure 4 shows the past year prevalence of major depressive episode among U.S. adolescents in 2017.

  • An estimated 3.2 million adolescents aged 12 to 17 in the United States had at least one major depressive episode. This number represented 13.3% of the U.S. population aged 12 to 17.

  • The prevalence of major depressive episode was higher among adolescent females (20.0%) compared to males (6.8%).

  • The prevalence of major depressive episode was highest among adolescents reporting two or more races (16.9%).

Major Depressive Episode with Impairment Among Adolescents

• In 2017, an estimated 2.3 million adolescents aged 12 to 17 in the United States had at least one major depressive episode with severe impairment. This number represented 9.4% of the U.S. population aged 12 to 17.

• Figure 5 shows overall past year prevalence of major depressive episode with and without severe impairment among U.S. adolescents. Of adolescents with major depressive episode, approximately 70.77% had severe impairment.

Treatment of Major Depressive Episode Among Adolescents

• Figure 6 shows data on treatment received within the past year by U.S. adolescents aged 12-17 with major depressive episode in 2017. Treatment types included health professional only, medication only, and combined health professional and medication.

  • An estimated 19.6% received care by a health professional alone, and another 17.9% received combined care by a health professional and medication treatment.

  • Treatment with medication alone was least common (2.4%).

  • Approximately 60.1% of adolescents with major depressive episode did not receive treatment.

Data Sources

Statistical Methods and Measurement Caveats

Diagnostic Assessment:

• For the NSDUH survey — no exclusions were made for a major depressive episode symptoms caused by medical illness, substance use disorders, or medication.

• For the NSDUH survey, methodology developed prior to the 2013 publication of the current DSM-5 was used to facilitate year-to-year comparisons.

• The adult and adolescent questions were adapted from the depression module in the National Comorbidity Survey Replication (NCS-R). Revisions to the questions in the modules were made primarily to reduce their length and to modify the NCS-R questions, which are interviewer-administered, to the audio computer-assisted self-interviewing (ACASI) format used in NSDUH. In addition, some revisions, based on cognitive testing, were made to improve comprehension. Furthermore, even though titles similar to those used in the NCS-R were used for the NSDUH modules, the results of these items may not be directly comparable. This is mainly due to differing modes of administration in each survey (ACASI in NSDUH vs. computer-assisted personal interviewing in NCS-R), revisions to wording necessary to maintain the logical processes of the ACASI environment, and possible context effects resulting from deleting questions not explicitly pertinent to major depression.

• Some questions in the adult depression module differ slightly from questions in the adolescent depression module; as such, major depressive episode data for adults aged 18 or older should not be compared to or combined with major depressive episode data for youths aged 12 to 17.

• The Sheehan Disability Scale (SDS) was used to assess the impact of major depressive episode on a person’s life. The SDS is a brief self-report tool with ratings from 0 to 10 (with 10 being the highest) for the level of impairment caused by the disorder in each of four role domains: home management, work, close relationships with others, and social life. A rating of ≥7 in at least one domain is considered to be severe impairment. Respondents were excluded if SDS role impairment severity was unknown, or if particular activities listed in the SDS were not applicable. For SDS level of impairment, the role domains for adolescents aged 12 to 17 were slightly modified from those for adults to be made age appropriate.

Population:

• The entirety of NSDUH respondents for the major depressive episode estimates is the civilian, non-institutionalized population aged 12-17 (adolescents) and 18 years old or older (adults) residing within the United States.

• The survey covers residents of households (persons living in houses/townhouses, apartments, condominiums; civilians living in housing on military bases, etc.) and persons in non-institutional group quarters (e.g., shelters, rooming/boarding houses, college dormitories, migratory workers' camps, and halfway houses).

• The survey does not cover persons who, for the entire year, had no fixed address (e.g., homeless and/or transient persons not in shelters); were on active military duty; or who resided in institutional group quarters (e.g., correctional facilities, nursing homes, mental institutions, long-term hospitals).

• Some adults and adolescents in these excluded categories may have had a major depressive episode in the past year, but they are not accounted for in the NSDUH major depressive episode estimates.

Survey Non-response:

• In 2017, 32.9% of the selected NSDUH sample did not complete the interview.

• Reasons for non-response to interviewing include: refusal to participate (23.1%); respondent unavailable or no one at home (5.0%); and other reasons such as physical/mental incompetence or language barriers (4.8%).

• Adults and adolescents with major depressive episode may disproportionately fall into these non-response categories. While NSDUH weighting includes non-response adjustments to reduce bias, these adjustments may not fully account for differential non-response by mental illness status.

Please see the 2017 National Survey on Drug Use and Health Methodological Summary and Definitions report for further information on how these data were collected and calculated.

Last Updated: February 2019