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It is fairly common to experience periodic ups and downs in overall mood from time to time. However, if you feel like your mood is consistently low, you may be suffering from clinical depression. The Diagnostic and Statistical Manual of Mental Disorders (current version “DSM‑5”) lays out the criteria necessary for a formal diagnosis of Major Depressive Disorder, among other depressive disorders. A depressive disorder will typically include some, if not all, of the following symptoms, experienced every day or most days over the duration of the same two week period, which represents a change from previous functioning, which are not attributable to another medical condition, and at least one of which is (1) depressed mood or (2) loss of interest or pleasure:

• depressed most of the day, nearly every day as indicated by subjective report or observations made by others

• markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

• significant weight loss or gain

• insomnia or hypersomnia (excessive sleep)

• psychomotor agitation or retardation

• fatigue or loss of energy

• feelings of worthlessness or excessive or inappropriate guilt

• diminished ability to think or concentrate, or indecisiveness

• recurrent thoughts of death, recurrent suicidal ideation

Depression has been part of the human experience for millenia, and researchers have been trying to answer this question for a very long time. While a definitive answer still remains a mystery, it has been determined that certain factors do seem to contribute to higher levels of depression, including genetics, innate personality traits, seasonal changes, significant negative life changes, lack of social support or meaningful relationships, underlying medical conditions, and chronic high stress levels.

No two people experience depression exactly the same way, and so different approaches need to be considered depending on how the depression presents itself. First, one must consider if there are any situational or physical contributors to the depression, such as a toxic environment or an undiagnosed medical (physiological) condition. Next, it is important to assess if basic needs of self-care are being met, e.g, proper sleep, nutritious diet, adequate exercise, exposure to sunlight, and healthy social interactions. Finally, if most of the above can be ruled out, one might consider psychotherapy and/or psychotropic medications. Some of the more common psychotherapeutic interventions used for depression include psychodynamic psychotherapy, cognitive behavioral therapy (CBT), and mindfulness techniques. You and your therapist will work together to formulate a plan that will work best for you.

Here are a few ways you can help:

• continue to educate yourself on depression and its causes and symptoms

• be an active listener, not a lecturer (a depressed person is usually also suffering with shame, and so telling them what they are doing wrong or not doing right can sometimes simply add fuel to the depressive fire)

• respect their boundaries

• encourage them to reach out to a mental health professional, reminding them that telehealth may be an easier way to get started with therapy if they don’t feel they have the energy to leave the house

• remember to not neglect your own self-care or well-being

Starting around puberty, depression is twice as common in females as compared to males. This may be due to biological, life cycle, hormonal, and psychosocial factors unique to women. The “Big 5” personality trait of neuroticism is statistically higher in women, with the typical women being 60% higher in neuroticism when compared to the general population of men and women combined. Neuroticism is a measure of general sensitivity to negative emotions such as pain, sadness, irritable or defensive anger, fear and anxiety. People with high levels of neuroticism are more likely to think that things have gone wrong in the past, are going wrong now, and will continue to go wrong into the future. They are also more likely to be unhappy, anxious, and irritable when just thinking or remembering, and when they encounter a genuine problem. They have substantially lower than average levels of self-esteem, particularly when they are also low in extraversion. Neuroticism is, therefore, a risk factor for anxiety disorders and depression.