DEPRESSION

Causes & Risk Factors for Depression

Biological Factors

• Family history of depression or other mental health conditions
• Chemical imbalances in brain neurotransmitters (e.g., serotonin, dopamine, norepinephrine)
• Hormonal changes, such as during postpartum or thyroid dysfunction
• Chronic medical conditions (e.g., diabetes, chronic pain, heart disease)
• Certain medications (e.g., corticosteroids, some blood pressure meds)

Psychological Factors

• Negative thinking patterns or cognitive distortions
• Low self-esteem or excessive self-criticism
• History of trauma or abuse (physical, emotional, or sexual)
• Grief or unresolved emotional losses
• Perfectionism or internalized pressure to succeed

Environmental & Life Circumstances

• Stressful life events, such as divorce, job loss, or financial strain
• Loneliness or social isolation
• Lack of support systems (friends, family, or community)
• Early childhood adversity or unstable home environments
• Substance use or dependency

Other Risk Factors

• Previous episodes of depression
• Co-occurring mental health conditions, like anxiety, OCD, or PTSD
• LGBTQ+ individuals facing discrimination or lack of support
• Major life transitions (retirement, empty nest, moving)

  Common Symptoms

Mental/Emotional Symptoms

• Persistent feelings of sadness, emptiness, or hopelessness
• Loss of interest or pleasure in activities once enjoyed
• Low self-esteem or feelings of worthlessness/guilt
• Difficulty concentrating or making decisions
• Thoughts of death or suicide (may or may not include intent)

Physical Symptoms

• Changes in appetite (eating too much or too little)
• Sleep disturbances (insomnia or sleeping too much)
• Fatigue or low energy nearly every day
• Slowed movements or speech (or restlessness)
• Aches and pains with no clear medical cause

 

Assessment

Clinical Interview

• Discuss mood patterns, symptom duration, and impact on functioning
• Assess for any contributing life stressors, trauma, or medical history
• Rule out medical causes (e.g., hypothyroidism, vitamin deficiencies, chronic illness)

Standardized Screening Tools

• PHQ-9 (Patient Health Questionnaire)
• Beck Depression Inventory (BDI)
• Hamilton Depression Rating Scale (HDRS)

Criteria (DSM-5)

• At least 5 symptoms present nearly every day for 2 weeks or more, including either:
  • Depressed mood
  • Loss of interest or pleasure (anhedonia)
  • Significant weight loss when not dieting, weight gain, or decrease/increase in appetite 
  • Insomnia or hypersomnia 
  • Psychomotor agitation or retardation, observable by others (not just feeling restless or slowed down)
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive/inappropriate guilt
  • Diminished ability to think, concentrate, or make decisions
  • Recurrent thoughts of death, suicidal ideation, or a suicide attempt/plan
• Symptoms cause significant distress or functional impairment
• Not attributable to substance use or medical conditions

Treatment

Medication

• SSRIs (e.g., fluoxetine, sertraline, escitalopram) – First-line for most
• SNRIs (e.g., venlafaxine, duloxetine) – Especially helpful with co-occurring anxiety or pain
• Bupropion – Can boost energy and motivation; lower risk of sexual side effects
• Mirtazapine – Often used for poor appetite or sleep problems
• Mood stabilizers or antipsychotics – If depression is severe, recurrent, or bipolar-related

Note: All medications should be prescribed with regular monitoring and discussion of side effects.

Therapy

• Cognitive Behavioral Therapy (CBT)
  Identifies negative thinking patterns and builds healthier behaviors
• Interpersonal Therapy (IPT)
  Focuses on relationship patterns and social functioning
• Behavioral Activation
  Encourages re-engagement with enjoyable or meaningful activities
• Psychodynamic Therapy
  Explores underlying emotional conflicts and life history

Lifestyle & Self-Care

• • Regular physical activity (even short walks or stretching)
  • Create and stick to a sleep routine
  • Healthy meals and consistent hydration
  • Reduce alcohol and avoid recreational drugs
  • Journaling or expressive outlets
  • Mindfulness, yoga, or breathing exercises
  • Reaching out to others—even when it’s hard

Long-Term Management Tips

• • Track your mood and triggers in a journal or app
  • Break down tasks into smaller, achievable steps
  • Build a routine and try to stay connected to others
  • Celebrate small wins and progress
  • Regular follow-ups for medication management and therapy check-ins
  • Be patient with yourself—healing isn’t linear