Depression, one of the most common mental health disorders in the United States, affects people of all ages and demographics. Additionally, major depressive disorders are among the top causes of disability in the country. Still, who is most affected by depression, and how prevalent is it? Learn more about depression trends and how the disorder is treated.
What Is Depression?
Depression is a general term for a mental health issue that affects your mood and causes symptoms like sadness, fatigue, and a loss of interest in activities. Though it’s one of the most common mental health issues in the United States, it can be serious. Depression can make it difficult to manage life tasks and reduce your quality of life. It can also cause physical symptoms like a loss of energy and general aches and pains.
The word depression is often used to refer to a general feeling of sadness, but there is a difference between sadness and a depressive disorder. Like other mental health issues, low mood becomes a disorder when it gets in the way of your life. If you’re struggling to attend to your obligations or your relationships start to suffer because of a long-lasting low mood, you may have a depressive disorder.
Depression falls under the category of mood disorders, a classification of disorders that has to do with low or high moods that cause serious problems in your life. There are several mood disorders, including major depressive disorder, which is among the most common.
Major depression involves several symptoms that you feel all day for at least two weeks. Major depressive episodes can be debilitating for some people and even lead to suicidal thoughts or actions. However, major depressive symptoms tend to go away for a while after a few weeks. Other forms of depression may be less severe but longer-lasting, like seasonal affective disorder (SAD) and persistent depressive disorder (PDD).
How Common Is Depression?
Major depressive disorder is one of the most common mental health issues in the United States, after anxiety disorders. It’s estimated that around 16 million U.S. adults have at least one major depressive episode in a given year. However, in recent years, that number has gone up. Major depression is just one kind of depression-causing mood disorder. Several other disorders can cause depression and low moods. Persistent depression and bipolar disorder are also common causes of depression.
Who Does Depression Affect?
Depression can affect people of any demographic. Mental health problems are widespread in the United States and abroad. However, people of different ages, races, and socioeconomic backgrounds may experience or respond to depression differently. For instance, children experience depression, but their symptoms may manifest differently than adults. While adults are more prone to feelings of worthlessness and sadness, children may become irritable.
Some people may have more risk factors than others. For instance, someone who has a parent with mental health issues may be more likely to experience them.
Depression by Age
According to the 2020 National Survey on Drug Use and Health (NSDUH), depression is a significant factor among people of all ages in the United States. Around 8.4% of adults age 18 or over experienced at least one major depressive episode in 2020. That accounts for 21 million people. The age group with the highest percentage of major depressive episodes was young adults aged 18-25. Around 17% of this age group was affected, accounting for 5.6 million people.
Among adults, the next highest percentage involved the ages between 25 and 49. Around 9.1 percent of this age group experienced major depressive episodes. More than 6 million adults aged 50 or older experienced a major depressive episode in 2020. Around 6% of adults age 18 or older experienced severe impairment because of a major depressive disorder.
Adolescents between ages 12 to17 also experienced major depressive disorders in 2020. Around 12% percent of adolescents in that age group experienced a major depressive episode with severe impairments in 2020.
Depression by Race
It can be difficult to determine racial disparities between mental health disorders like depression. Cultures express and respond to depression differently, so it can be difficult to get accurate statistics for how depression affects different races. As a 2019 paper in the journal Neuropsychiatric Disease and Treatment said, “Major depressive disorder is a chameleon, changing its stripes as it presents differently across racial and ethnic boundaries.” The paper also notes that Caucasians were more likely to experience severe major depressive episodes than ethnic minorities.
However, minorities were more likely to experience chronic depressive conditions. For instance, Caucasians have a lifetime prevalence of major depressive disorder of 17.9% compared to African Americans at 10.4%. However, 56% of African Americans experience chronic depressive symptoms compared to Caucasians at 38.6%.
Depression by Income Level
In the United States, socioeconomic status is a significant factor when it comes to mental health issues like depression. According to the Centers for Disease Control and Prevention (CDC), depression rates are higher among people with low incomes.
Depression rates also seem to decrease as income increases. However, that doesn’t mean middle and upper-class individuals are immune to depression. Children of affluent families may even have an elevated risk of developing issues like substance use problems, depression, and anxiety. Still, while several risk factors can apply to the full range of demographics in the United States, poverty and socioeconomic factors can increase your risk of depression.
Which Disorders Cause Depression?
Several mood disorders cause depression symptoms, and a few disorders can cause major depressive episodes. In some cases, other mental health issues can cause depression symptoms. For instance, persistent panic and anxiety disorders can leave you feeling hopeless and depressed.
The fifth edition of the DSM added three more mood disorders to more accurately diagnose certain conditions. The three new disorders involve disruptive mood dysregulation disorder, persistent depressive disorder, and premenstrual dysphoric disorder.
Mood disorders that cause depression include:
- Major depressive disorder. This is among the most common depressive disorders. It involves a period of several depression symptoms that last for two weeks or longer. Episodes can come and go over a longer period. In some cases, episodes can be severe.
- Bipolar disorder. Bipolar disorder, also called manic depressive disorder, involves periods of low moods and high moods. High moods are called mania, and the presence of a manic episode means you have bipolar I, and depressive episodes with sub-manic high moods are bipolar II.
- Seasonal affective disorder (SAD). This is also called seasonal depression because of how it seems to return with a specific season. SAD is usually associated with the fall and winter months, especially in northern regions that see long, dark winters.
- Cyclothymic disorder. This is similar to bipolar disorder, but it’s not as severe. It involves ups and downs in your mood without experiencing a full manic or major depressive episode.
- Premenstrual dysphoric disorder. It’s common for women to experience mood changes around menstruation, but premenstrual dysphoric disorder can cause significant mood changes in the premenstrual phase that disappear when menses starts.
- Persistent depressive disorder. This is also called dysthymia. Persistent depressive disorder is a chronic mood disorder that involves depression symptoms that can last for two years. Symptoms are generally less severe than major depression, but they last longer.
- Perinatal depression. Perinatal depression involves depressive symptoms during and after pregnancy. It may have roots in hormonal changes that occur during pregnancy.
- Disruptive mood dysregulation disorder. This mood disorder is diagnosed in children. It involves mood problems that cause persistent irritability and angry outbursts. In children, depression often presents as irritability.
Other health conditions can also cause depression symptoms. In many cases, depression is triggered by a frightening diagnosis or a medical condition that changes your life drastically. Conditions that lower your quality of life can also cause depression. Also, conditions that cause chronic pain can add a lot of stress that leads to mental health issues.
Depression can also be caused by certain medications and recreational drugs. Central nervous system depressants like alcohol, benzodiazepines, and prescription sleep aids can cause a low mood. Antidepressants and stimulants can cause depression when you stop taking them, especially when you quit cold turkey after a period of consistent use. Depression is closely associated with substance use disorders (SUDs), especially when drugs cause or worsen depression are involved.
How Is Depression Diagnosed?
If you’re feeling depressed, fatigued, and uninterested in things you used to enjoy, you may have one of several disorders that cause depressive symptoms. Several cause a low mood, and a few may even cause a major depressive episode. The first step in getting effective treatment is to get an accurate diagnosis.
There is no blood test or medical exam that can diagnose depression, but medical tests are a good place to start. Blood tests and medical exams can help rule out certain biological causes of mental health symptoms. For instance, deficiencies in certain vitamins and nutrients can cause you to feel drained of energy, anxious, and depressed. Chronic pain symptoms can also cause various mental health issues.
After exploring medical causes, you should go through a psychological evaluation. Most therapists used either the fourth or fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Your doctor or therapist may use the DSM-5 criteria to identify a major depressive episode.
There are nine common symptoms and a few other factors to be considered. To qualify as a major depressive episode, you have to experience five of the nine symptoms, and at least one of your symptoms has to involve a depressed mood or a loss of interest in almost all activities. Your symptoms also must be new or clearly worsened over two weeks. During those two weeks, you must have experienced symptoms every day, for most of the day.
The nine possible symptoms of depression include:
- Depressed mood. The hallmark of depression is a low mood that seems to get in the way of your regular activities. In children and adolescents, this can manifest as irritability.
- Loss of interest in activities. This is another common sign of depression. It’s common to drop interests from time to time, but depression can make you lose interest in most activities all at once.
- Weight change. The DSM notes that significant weight change involves gaining or losing 5% of your body weight in one month, unintentionally. Children who are growing may experience weight loss that causes them to fail to meet typical weight gains.
- Sleep problems. This can include hypersomnia, which is sleeping more than normal, or insomnia, which is being unable to sleep.
- Psychomotor changes. Movement changes severe enough to be noticed by others are a sign of mental distress. This can include agitating movements or slower movements that get in the way of everyday tasks.
- Low energy. Fatigue and low energy are common signs of depression. It can make it difficult to go about your everyday responsibilities and lead to hypersomnia.
- Feeling worthless. You may feel worthless or excessive guilt for your current situation.
- Impaired concentration. You may find it hard to concentrate, think, or make decisions. This can also get in the way of regular tasks or take the enjoyment out of leisure activities.
- Thoughts of death. Recurrent or persistent thoughts of death are troubling signs of depression. This may include suicidal ideation or actions.
In order to qualify as a major depressive disorder, your symptoms can’t be better explained by something else. For instance, if you experience a manic episode, you may have bipolar disorder. If you experience certain psychosis-related symptoms, you may have schizophrenia or schizoaffective disorder.
If you’re feeling depression symptoms, but you don’t meet the qualifications for major depressive disorder, you may have another mood disorder. For instance, persistent depressive disorder is very common, but if you have it, you may not meet the criteria for major depressive disorder.
It’s important to note that your doctors and therapists only work with the information you tell them and anything that’s revealed in tests. It’s important to work with your treatment professionals to find the most accurate diagnosis. If you receive a diagnosis and find that it doesn’t seem to explain your symptoms, follow up with your therapist and let them know about new or changing symptoms.
What Causes Depression?
Various factors can cause depression. Like other mental health issues, it may be hard to pinpoint a single cause, and it’s more likely to be caused by several factors working together. Still, some common factors seem to contribute to a person’s risk of developing a depressive disorder. Those factors may include:
- Biochemistry. Depression may be caused by biochemical issues in the brain. Chemical imbalances may make it so that your mood and energy levels are low. Serotonin is an important neurotransmitter often associated with mood and depression. Many antidepressant medications increase serotonin levels.
- Genetics. Many mental health issues are linked to genetic risk factors. That means you may be more likely to experience depression if your parents or grandparents have a history of depressive disorders. Though, if you have a family history of mental illness, it doesn’t mean it’s inevitable for you.
- Development. Mental health and behavioral health problems may be rooted in developmental issues. As you develop, you may learn poor coping mechanisms when it comes to dealing with stress that leads to mental health problems.
- Personality. Your personality may be made up of a combination of your development and genetics. However, some personality traits may make you more vulnerable to depression. For instance, people with low self-esteem may be at greater risk for depression.
- Socioeconomics. Socioeconomic status can be a significant factor in mental health problems. Financial issues may lead to stress and mental health issues.
Are Depression and Anxiety Related?
In many ways, anxiety and depression are opposites. Anxiety is associated with overexcitement and moods that are too high. Manic episodes, which are high moods, can involve symptoms like anxiety and paranoia. However, even though anxiety is associated with high moods and depression is a low mood, they may be more related than you’d assume. People with depression may experience anxious thoughts and panic attacks. In some cases, persistent anxiety symptoms can lead to feelings of depression and hopelessness. 
Anxiety disorders are a group of mental health conditions that include generalized anxiety disorder, obsessive-compulsive disorder (OCD), and panic disorder. Like depression, anxiety can get in the way of your daily life. Anxious thoughts may be rooted in stress and worries, but they can also happen with no particular cause.
Panic disorder falls under the category of anxiety disorders. It involves episodes of high anxiety and panic that can also include physical symptoms, such as heart palpitations, shortness of breath, and chest pains. People who have panic attacks may also experience low-level anxiety and panic symptoms in between panic attacks.
Anxiety symptoms may come without warning and be hard to control. The stress that anxiety adds to your life can lead to depressive thoughts like hopelessness or worthlessness. Panic disorders can also lead to avoidance behavior, which is when you avoid places and activities that trigger a panic attack. This can lead to social isolation, which is a common factor in depression.
A worldwide survey found that 45.7% of people with major depression in their lifetime also had an anxiety disorder. These seemingly opposite disorders also routinely occur at the same time. Around 41.6% of people experienced major depressive disorder and an anxiety disorder during the same year.
Can Depression Be Cured?
There is no cure for depression, but it is highly treatable. Like many mental health disorders, depression can be complex, causing different problems in different people. The treatment process may be individualized based on your specific needs. In many cases, a combination of medications and psychotherapy is the best option.
Medications for Depression
The most common medications used to treat depression are drugs that increase your serotonin levels. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) are among the first-line medications to help treat depression. Reuptake inhibitors stop serotonin from being removed from your system, causing an increase in the levels of the chemical that can bind to and activate receptors.
Serotonin is associated with positive emotions and a general feeling of well-being. Common SSRIs like fluoxetine (Prozac) and sertraline (Zoloft) are generally safe and well-tolerated. However, it’s important to pay attention to your symptoms and side effects and work closely with your doctor to find the right medication for your needs.
Other antidepressants that aren’t in the SSRI or SNRI category include mirtazapine and imipramine. If your depression is rooted in anxiety symptoms, you may take an anxiolytic medication that works to relieve anxiety. Buspirone is a common anxiolytic that may be used to treat depression.
Psychotherapies for Depression
General talk therapy may be helpful in addressing some of the root causes of your depression and coping methods. Behavioral therapies are also common in treating depression and various mental health issues. Cognitive-behavioral therapy (CBT) is used to identify thoughts that lead to poor coping responses. It can also be used to plan out better coping strategies. CBT is also used to treat other problems that commonly occur alongside depression, like anxiety and substance use disorders.
