Major depressive disorder is a mental health issue with a substantial footprint across the globe, affecting nearly 300 million people each year. Even with strides in awareness seen in recent years, too often people facing depression avoid or delay seeking help due to stigmas received, perceived or internalized.

October, as National Depression and Mental Health Screening Awareness Month, presents a timely opportunity to shine a light on the condition. Three experts from the Department of Psychiatry and the Behavioral Sciences at the Keck School of Medicine of USC have stepped up to share valuable knowledge and dispel pernicious myths.

Depression is more than just a sad feeling.

It’s important to understand that major depression isn’t the same thing as “a case of the blues.”

“There’s a misconception that depression is not a medical condition,” said Carlos Figueroa, MD, medical director of Keck Psychiatric Services. “Depression is not a sign of weakness, and people can’t just ‘shake it off’ or ‘work through it.’”

In fact, the disorder doesn’t always manifest with stereotypical indications of sadness.

“People think that individuals affected by depression are down, sad, and low on energy, but it can be the opposite,” said clinical assistant professor Jonathan Wong, PsyD, director of Psychological and Behavioral Health Services in the Department of Psychiatry and the Behavioral Sciences and clinical director of Keck Medicine of USC’s Care for the Caregiver office. “Some individuals experience increased restlessness, feeling on edge and irritability rather than a low mood, particularly in children and adolescents.”

More than that, the impact of major depression is far-reaching — and can be life-threatening.

“Depression is a disease that affects every aspect of a person’s life, not just mood,” said clinical professor Ashraf Elmashat, MD, associate medical director of Keck Outpatient Psychiatry and Behavioral Health Services. “It is not just debilitating; it can be deadly. An estimated one out of five people with depression will attempt suicide at some point.”

If you’re experiencing depression, you’re not alone.

According to 2017 estimates by the National Institute of Mental Health, 7.1 % of all adults in the U.S. had experienced at least one episode of major depression, with the rate in women about two-thirds higher than the rate in men.

“Major depression is one of the most common mental health disorders in the United States,” Wong said. “Depression can happen to anyone, and can be the result of a combination of genetic, environmental, psychological and biological factors.”

As with many health conditions, the coronavirus pandemic and the stress associated with it hasn’t helped; some studies show that rates of depression have doubled since March 2020. Young adults between 18 and 23 years of age are particularly vulnerable according to a survey by the American Psychological Association. Three-quarters of respondents in that age group reported feeling so tired in the previous two weeks that they sat around and did nothing, a warning sign for depression. 

There are numerous treatment options for depression.

Major depression can be addressed with a wide variety of treatments, including widely known ones such as psychotherapy and medication. There are a growing number of options that involve neuromodulation, in which brain pathways are stimulated using electricity, magnetism or other forms of energy. Keck Medicine of USC offers techniques including electroconvulsive therapy, vagus-nerve stimulation, transcranial magnetic stimulation, ketamine infusion and experimental deep-brain stimulation.

“No two people are affected in the same way by depression,” Wong said. “It’s recommended that you consult with mental health professionals for the best treatment options for you.”

Treatment is personalized to the specific details of each patient’s case, and each patient’s needs.

“There are a number of key factors that guide choice of therapy,” Elmashat said. “These include the nature and severity of depression, past responses to treatment and the beliefs and preferences of the patient and their family.”

There are things that can be done to help manage depression.

Research has identified a number of practices that lessen the effects of depression.

“Studies show that aerobic-type exercise at least four times each week for 40 minutes over a period of six months can be equivalent to taking an antidepressant,” Figueroa said. “Meditation at least 30 minutes twice daily has also been shown to be beneficial.”

In addition to habits of body and mind, experts also recommend combating depression by seeking social support and avoiding things that can bring serious stress.

“You should fight the urge to isolate yourself, and instead spend time with people you trust and can confide in,” Wong said. “When you’re experiencing depression, it’s best to postpone important decisions such as getting married, getting divorced or changing jobs as much as you can. You should discuss decisions with other people who know you well and might have an objective view of your situation.”

Screening makes a difference.

Because depression reaches into every aspect of life for those affected, it frequently appears part of a constellation of issues and risks, potentially worsening in a vicious cycle. Thus, experts encourage people to seek evaluation — or help — if they feel as though they’re struggling.

“Depression can co-occur with serious medical illnesses, major life changes, chronic stress and trauma,” Wong said. “Early detection through screening is instrumental in getting help sooner rather than later.”

Warning signs include feeling sad, hopeless, tearful or socially withdrawn over a period of two or more weeks. Changes in sleep and appetite can also be indicators. Some people find themselves with decreased energy and unable to enjoy themselves. It’s vital to attend to thoughts that life is not worth living or ideas of self-harm.

“Don’t feel embarrassed to let your primary care physician know during a medical examination that you have been feeling depressed,” Figueroa said. “And if you see a friend or family member suddenly appear disengaged, withdrawn, sad and depressed, help them find a clinic, doctor or therapist for evaluation and treatment.”