Depression is more than feeling “blue” or “down”; it’s a persistent illness that can take the enjoyment out of once-pleasurable activities.¹ If you or someone you love struggles with depression, you aren’t alone.
In 2022, a study using data from the 2015-2020 National Survey on Drug Use and Health found that depression was prevalent in 9.2% of, or 1 in 10, Americans above age 12. A closer look at the data revealed that the increase in depression did not affect all groups equally. Results showed that 1 in 5 young adults and adolescents had a major depressive episode in the past year, nearly twice as much as adults.² Regarding older adults, the rates of depression range from 1% to 13.5%, depending on their health and living conditions.³
Overall, people do not seek enough help or support to treat their depression. This problem is so pervasive that researchers and mental health professionals alike have declared depression a public mental health crisis.²
Because depression has become so widespread, understanding the differences in its manifestation across different groups has never been more critical. Untreated depression may lead to suicidal ideation or death. In 2020 alone, 1.2 million adults attempted and 45,979 died by suicide.¹⁷ The need for intervention is dire. Our guide covers the presentations, causes, symptoms, and treatment of depression in women, men, adolescents, and older adults.
The symptoms of depression can come in many forms. When people mention depression, they’re typically referring to a specific form of the disorder known as "clinical depression" or "major depressive disorder.” Clinical depression is characterized by persistent negative moods and other symptoms (such as sleep disturbances) lasting at least two weeks.¹⁸
Some other common forms of depression include:
PDD is a persistent mild to moderate form of depression. Previously known as dysthymia or dysthymic disorder, symptoms may be less severe than clinical depression, but they are more consistent and pervasive. Symptoms of PDD last at least two years in adults or one year in children and adolescents. To meet persistent depressive disorder criteria, symptoms can’t be absent for more than two months in a row.¹⁹
DMDD is a form of depression that causes frequent, intense outbursts of anger and irritability in children. To meet diagnostic criteria, symptoms need to have been present in the child before age ten. Disruptive mood dysregulation disorder is not diagnosed in children under six or over 18.²⁰
A more severe form of PMS, premenstrual dysphoric disorder causes emotional and physical symptoms each menstrual cycle — usually a week or two before your period. This form of depression affects up to 10% of people assigned female at birth (AFAB) of reproductive age. Symptoms vary but commonly include irritability, anxiety, depression, fatigue, brain fog, food cravings, headaches, mood swings, and insomnia. Particularly severe cases can cause intense emotional distress and suicidal thoughts.²¹
This form of depression, sometimes abbreviated as SAD, is triggered by a change of seasons. Typically, seasonal depression comes about during the transition from summer to fall or fall to winter. While not as common, some people experience seasonal affective disorder in the summer. You’re at higher risk for SAD if you live in areas without much sun or are AFAB.²²
Prenatal depression occurs during pregnancy, while postpartum generally develops within four weeks of your child being born (but can also have a later onset). Surrogates, fathers, and adoptive parents can experience postpartum depression, too. Different from the “baby blues,” prenatal and postpartum depression are referred to as “major depressive disorder (MDD) with peripartum onset” in the DSM and typically don’t resolve without treatment.²³ ²⁴
Although depression can present differently across age groups, genders, and even individuals, there are some common symptoms to look out for, such as:¹
As with depression symptoms, the triggers for the condition can vary from person to person. There’s no single cause of depression — environmental, psychological, social, and biological factors can all play a role. Some common triggers for depression include:²⁵ ²⁶ ²⁷ ²⁸ ²⁹
There are many treatments for depression, including effective medications (such as antidepressants). The most common antidepressants prescribed are SSRIs such as Prozac, Zoloft, and Paxil, though there are many other options. Psychotherapies such as cognitive behavioral therapy (CBT) and interpersonal therapy are also effective and may be used in combination with prescription medication.¹ And with the increasing popularity of online therapy, you have even more options for tailoring your depression treatment plan to fit your individual needs.
Globally, depression affects women more than it does men, with 1 in 10 women having experienced an episode of major depression within the last year. The rates are even higher in postpartum women, 1 in 8 of whom report symptoms of postpartum depression after a live birth.⁴ Health experts theorize that women are more prone to developing depression due to certain biological and socioeconomic factors.
Depression can come and go throughout life, but a woman may be more at risk for developing depression during certain stages, especially if external stressors are at play. Take a look at the chart below for more information on the different contributors to depression in women.
The fluctuation of hormones, the onset of menses, and physical changes all contribute to feelings of moodiness and irritability. However, these feelings are temporary and normal. External factors have more of a role in whether normal mood swings turn into depression. Unsupportive families, unstable environments, peer pressure, and bullying lead to a higher risk of developing depression. Because girls reach puberty earlier than boys, they may also develop depression before boys. The onset of menses heralds the beginning of premenstrual syndrome (PMS), which includes irritability and moodiness, as well as physical symptoms like abdominal pain, cramping, and sore breasts.⁵ In some, PMS progresses to premenstrual dysphoric disorder (PMDD), which causes severe depression and anxiety in the weeks leading up to menstruation. PMDD occurs in 3 to 5% of women and requires medical intervention, such as hormone therapy, psychotherapy, or antidepressants.⁶
The hormonal fluctuations experienced during pregnancy can be drastic enough to cause some mood changes. Perinatal depression can become more likely if the pregnancy is unwanted, not supported, or results in a miscarriage. Not having a stable home life or relationship can also contribute to feelings of sadness or hopelessness.⁵ Some related concerns, such as miscarriage, unplanned pregnancy, and infertility, can also increase depression risk in women.³⁰ ³¹
Postpartum depression, or PPD, affects 10 to 15% of women after giving birth. It can be caused by fluctuations in hormones after delivery and having a history of depression. PPD can also be due to difficulty coping with circumstances such as little-to-no support for the mother and the baby, complications in the pregnancy and birth, difficulty caring for or bonding with the baby, and others. PPD is more than feeling emotional or stressed after delivery; it is a serious condition that requires medical intervention.⁵
Menopause can cause dramatic changes in estrogen, a sex hormone commonly associated with AFAB people. Perimenopause, early menopause, and post-menopause are stages in which estrogen fluctuates the most, which increases the risk of developing depression. The risk is higher if other factors come into play. Existing mental health conditions, weight gain, surgical removal of the ovaries, early-onset menopause, and poor sleep all increase the risk of developing depression.⁵
Women are more likely to be sexually abused than men; the UN reports that 1 in 3 women worldwide has experienced physical or sexual abuse. The rates are similar in the U.S., where 70% of women have experienced intimate partner physical or sexual abuse. Those who have experienced abuse are at greater risk of developing depression.⁵ In cases of domestic abuse, this risk is exacerbated if the woman has no support or means of escape.
In addition to depression, women are also more likely to experience poverty than men. Inequality (including unequal pay), difficulty finding employment, stress from juggling the responsibilities of family and work, and a lack of access to healthcare and resources are some causes of significant mental strain. This additional stress can raise the risk of developing depression.⁵ ⁶
Researchers have found evidence linking female sex hormones to increased rumination, or repetitive thinking, a behavior that can often precede depression. It’s also been suggested that AFAB people experience stress more intensely than those who are assigned male at birth (AMAB).³² ³³
In women, symptoms of depression manifest nearly the same as in other groups (irritability, thoughts of self-harm or suicide, lack of pleasure, changes in appetite, lack of energy, and so on). But certain types of depression that mainly affect AFAB people can present in distinct ways. For example, some of the unique symptoms of postpartum depression include:⁵ ²⁴
There are effective treatments available for depression in women. Therapy and prescription antidepressants have had wide success in treating patients with depression. There is also some research to indicate that birth control may also be an effective treatment. One study found that women who took oral contraceptives reported fewer symptoms of depression and anxiety than those who did not take them, leading researchers to believe that controlling fluctuations of estrogen may be protective against depression.⁷
Some studies have pinpointed disparities in when women choose to get treatment for depression. In one study, 17.2% of women above the age of 45 were prescribed antidepressants, compared to only 9.3% of women aged 25-44.⁷ This disparity in help-seeking behaviors implies that women who develop depression when young do not get the help they need until many years later. Untreated depression can become worse and may lead to suicidal ideation or attempts. Women attempt suicide twice as often as men, making early intervention essential.⁶
Although the rates of depression in men are lower than those in women, they have also increased. The 2015-2020 National Survey on Drug Use and Health showed a jump in male depression prevalence from 4.7% in 2015 to 6.4% in 2020.² These rates might seem modest, but barriers to help-seeking, such as lack of awareness, downplaying the disease’s severity, and social stigma, should be taken into account. AMAB people are more likely than those who are AFAB to hide their symptoms and resist treatment. They are also more likely to die by suicide, as they choose more lethal methods, show fewer warning signs, and are less likely to disclose their feelings to others.⁸
There is no specific cause of depression in men; rather, there are factors that increase the risk of them developing depression, including:⁹
Though not exclusive to men, a family history of depression or mental health issues can raise the risk of developing depression.
Stressful life events, such as the loss of a loved one, unemployment, relationship problems, health problems, and others, can allow depression to develop if help or effective coping mechanisms are not sought. Because men may be more reserved about their feelings and problems, it can be difficult noticing when they need help.⁹
The stigmatization of mental illness is a serious barrier to seeking help among men. Men who adhere to masculine norms are more likely to resist discussion of symptoms and treatment, believing or fearing they will be estranged from their communities or thought of as inept or weak. This resistance can lead to male-typical symptoms of depression, which are often destructive to themselves or others.¹⁰
Men can show the more common symptoms of depression, but they may also present with more male-typical symptoms. These include:⁸ ⁹ ¹⁰
Men are less likely to seek help than women, often bottling up their emotions until they become overwhelming. Additionally, AMAB people are less likely to recognize depression for what it is and will often mask or hide their emotions from their families and friends.⁸ When they do seek help, they often turn towards a medical professional whose diagnostic criteria for depression may not be the same as a mental health professional’s criteria. Men are also less likely to adhere to follow-up appointments with their doctors.¹⁰
These difficulties in recognizing depression and seeking appropriate avenues for diagnosis and treatment contribute to worsening mental health in men. Though women are more likely to attempt suicide, men are four times as likely to die by it. Researchers suspect that the rate of undiagnosed depression is higher in males than in females because of high suicide rates among men and the aforementioned barriers to care.¹⁰ Treatment for depression in men is similar to that for other groups: prescription medication and therapy. Men with depression may strongly benefit from therapy by learning coping mechanisms, dismantling harmful stigmas, and improving their understanding of their own mental health.⁸
The relationship between erectile dysfunction (ED) and depression is complex and can appear cyclical; the stress caused by erectile dysfunction can trigger depression, and the stress from depression can lead to erectile dysfunction.³⁴
Some antidepressants also can cause ED as a potential side effect, including SSRIs, SNRIs, tricyclic and tetracyclic antidepressants, and MAOIs. The antidepressants with the lowest chance of sexual side effects are:³⁵
If you prefer or are recommended an antidepressant type that is more likely to cause ED, there are other options. Prescription medications from your doctor or through online services, like Hims, have proven to be highly effective in treating ED and generally cause few side effects.³⁶
According to data from the 2015-2020 National Survey on Drug Use and Health, depression affects 1 in 5 adolescents and young adults — twice the rate of depression in adults over 25. Survey results showed that depression was prevalent in 17.2% of young adults aged 18-25 and in 16.9% of adolescents aged 12-17.²
Help-seeking behavior was low or modest, and most adolescents and young adults did not take medication or see a doctor about their symptoms. This trend is concerning, as untreated depression earlier in life may lead to worsening symptoms and the development of other mental health problems.² Untreated depression can also lead to suicide in young populations, the second most common cause of death in the world for those aged 15-29.¹¹
As with other groups, depression in teenagers doesn’t have one specific cause but can instead be thought of as resulting from a combination of risk factors.
Female adolescents may develop depression-like symptoms (such as PMS) around their menstrual cycle, which are temporary and normal. Premenstrual dysphoric disorder (PMDD) is a type of treatable depression that can occur if symptoms are severe.⁶ The same increase in depression around puberty is applied to males. Fluctuations in hormones, emerging sexuality, and physical changes may cause a bit of moodiness but can also increase the risk of depression. A family history of mental illness and depression can also increase the risk.¹¹
Stressful life events can trigger depression in young adults and adolescents. Parental divorce, abuse, change in schools, or the loss of a loved one are all things that increase the risk of depression. Experiencing child abuse can inhibit healthy coping mechanisms in future stressors and increase depressive symptoms.¹¹
Bullying, peer pressure, and certain parenting styles have a strong effect on adolescents and young adults. Body image concerns can also be particularly damaging; a 2013 study found that young girls who became fixated on unrealistic beauty standards were more likely to develop eating disorders and depression. An unstable, unwelcoming, and controlling home life is an important factor in predicting depression in adolescents. Punitive and controlling parenting styles are linked to maladjustment in school, and low parental support was associated with higher levels of anxiety and depression.¹¹
Because adolescents and young adults are still developing, it can be difficult to discern a symptom of depression from the normal moodiness of growing up. Depression in children can manifest in many ways, but it's important to look out for changes in normal emotions and behavior.¹²
Emotional and behavioral symptoms may include:¹²
Most of the signs of suicidal ideation in teens are similar to or the same as depression symptoms. However, some signs are unique to someone having potential suicide plans, including:³⁷
It can be challenging to know how to approach your teen about depression or other mental health concerns. The following table offers some do’s and don’ts to consider.³⁸
|…actively listen to your child||…argue with your teen or blame them|
|…reassure them that their feelings are normal||…downplay their emotions|
|…ask about their mental health needs||…tell them what to do or command certain actions|
Timely medical or psychological intervention is crucial in curbing the rate of depression in younger populations, as they are at high risk of attempting or committing suicide. According to the National Alliance on Mental Illness (NAMI), 20% of US high school students have thought about suicide, and 9% have attempted it. Although suicide affects all youth, Black, Indigenous, and LGBTQIA+ youth are at higher risk.¹³ Treatment in young adults and adolescents includes prescription medication and therapy. As of now, the FDA has only approved two prescription medications, Prozac and Lexapro, for treating adolescent depression. Medication combined with therapy has proven to be very effective.¹⁴
It’s important to note that antidepressants carry a black box warning in the U.S.; this warning notes a potential risk of increased suicidal thoughts or behavior in some people under age 25. While no children in the antidepressant trials analyzed by the U.S. Food and Drug Administration attempted suicide, there were some study participants who experienced an increase in suicidal thinking. This was considered concerning enough to the FDA that they added the black box warning.³⁹
For more information on adolescent mental health, including resources and tips to support the teens in your life, view our dedicated guide on the topic.
Although older adults are not exempt from developing depression, the good news is that most are not depressed. Depression prevalence ranges from 1-5% in those still living in their own homes, but increases in those who are hospitalized or require home healthcare to 11.5% and 13.5%, respectively.³ Those who do have depression suffer severe symptoms and consequences. Older adults are more likely than young adults to die from depression-related suicide. They can experience different types of depression, which are classified into either early or late-onset depression. Early-onset depression refers to a previous diagnosis before old age, and late-onset depression refers to a new diagnosis later in life.¹⁵
Certain things can increase the risk of depression in old age, such as:¹⁵
Older adults can present with different depression symptoms than younger populations. They are less prone to showing dysphoria, or unease and dissatisfaction. They are also less likely to feel low self-esteem, worthlessness, and guilt. Older adults are more prone to exhibiting the following symptoms:¹⁵
Depression in older adults is often misdiagnosed and undertreated due to the nuances of how it manifests. Some healthcare professionals may mistake depression symptoms for a normal response to aging and cognitive decline. Depression in older adults is effectively treated with antidepressants, therapy, or both.³
There is some evidence linking antidepressants such as SSRIs to bone loss in older adults. Results from two NIH-funded studies found decreases in bone mineral density in participants taking SSRIs. However, the researchers claim the relationship is not causal and advise against stopping antidepressant use without the consultation of a medical professional.¹⁶
If you’re looking to add some self-help strategies to your treatment regimen, there are many evidence-backed ways to improve your mental outlook.
Improving your mental health takes time, and it’s okay to start small. When setting a desired goal, try to follow SMART criteria: Specific, Measurable, Achievable, Relevant, and Time-bound.⁴⁰ This type of goal-setting can help you keep track of your progress and prevent you from becoming overwhelmed. More information on SMART goals from the University of Rochester can be found here.
Feeling down or depressed can make it hard to be active, but research shows that exercise can boost your mood. Even a 10-20 minute walk outside can be beneficial for your mental well-being.⁴¹ ⁴² When it comes to your diet, more research is required to directly link healthy eating with depression. However, researchers note that a balanced diet can reduce your risk of some health issues that could increase the risk of or lead to depression.⁴²
Individuals reporting loneliness or a lack of social support are at increased risk of depression.⁴² ⁴³ Social and emotional support can protect you from some of the effects of stress and actually help you better deal with things on your own through a heightened sense of autonomy and self-esteem. One way to meet friends is to find classes, clubs, or groups of people who share your interests. And, while research shows in-person interactions lead to better results, you can also utilize the Internet and social media to connect with loved ones or others with similar interests.⁴⁴
Meditation (both mindful and regular) may be able to improve your mood and reduce the severity of depressive episodes.⁴² While evidence shows that meditation isn’t as effective as other established treatments, researchers state that it can be used alongside other treatments to achieve cumulative health benefits.⁴⁵ Practicing yoga may also lead to reduced stress and enhanced mood in those with depression or anxiety.⁴⁶
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