When Is It More Than Just Sad?

Depression is a serious medical illness that involves the brain. It's more than just a feeling of being "down in the dumps" or "blue" for a few days. If you are one of the more than 20 million people in the United States who have depression, the feelings do not go away. They persist and interfere with your everyday life.

According to the US Substance Abuse and Mental Health Services Administration or SAMSHA, symptoms of depression can include:

  • Feeling sad, anxious or "empty" much of the time.
  • Feeling negative.
  • Feelings of guilt.
  • Feeling worthless, helpless and/or hopeless.
  • Irritability, restlessness.
  • Loss of interest or pleasure in activities or hobbies that you once enjoyed, including sex.
  • Fatigue or less energy.
  • Trouble with concentration, remembering details and making decisions.
  • Insomnia, early–morning wakefulness, or excessive sleeping.
  • Overeating, or appetite loss.
  • Thoughts of suicide, suicide attempts.
  • Aches or pains, headaches, cramps or digestive problems that do not get better even with treatment.

Depression can run in families, and usually starts between the ages of 15 and 30. It is much more common in women. Women can also get depression after the birth of a baby. Some people get depressed in the winter, called “get seasonal affective disorder.” Depression is also one part of bipolar disorder.

What causes depression?

There is no single known cause of depression. Rather, it may be caused by a combination of factors. It is thought it is a disorder of the brain. Brain-imaging has shown that the brains of people who have depression look different from the brains of people who do not have depression. The parts of the brain that control mood, thinking, sleep, appetite and behavior do not appear to work normally. But is it not known what causes these changes.

Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of depression as well.

In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger depression. Then, depression that returns may occur with or without an obvious trigger.

How is depression detected and treated?

Depression, even the worst cases, can be treated. As with many illnesses, the sooner you get help, the more effective it is.

The first step is to visit a doctor. Other illnesses can cause the same symptoms as depression. A doctor can rule these out with a physical exam, interview and lab tests.

Then, the doctor or a mental health expert can find out if you have depression. There are effective treatments for depression, including antidepressants and talk therapy. Most people do best by using both.

How can I help a friend or relative who is depressed?

The best thing you can do for a friend or relative who has depression is to find them get help. You may need to make a doctor appointment for your friend or relative. You could also go together to see the doctor. Encourage him or her to stay in treatment.

To help a friend or relative:

  • Offer emotional support, understanding, patience and encouragement.
  • Talk with your friend or relative and listen carefully.
  • Never laugh at the feelings of your friend or relative, but point out realities and offer hope.
  • Never ignore comments about suicide. Report them to the therapist or doctor.
  • Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon.
  • Remind your friend or relative that with time and treatment, the depression will lift.

How can I help myself if I am depressed?

If you have depression, you may feel tired, helpless and hopeless. It may be very hard to take any action to help yourself. It is important to realize that these feelings are part of the depression. They may not reflect reality. As you begin to learn about depression and get help, negative thoughts will fade. Some ideas to help your mood are to:

  • Engage in mild activity or exercise. Go to events or do things that you once enjoyed. Join in religious, social or other activities.
  • Set realistic goals for yourself.
  • Break up large tasks into small ones. Do the most important ones first. Do what you can as you can.
  • Try to spend time with other people.  Talk with a trusted friend or relative. Try not to isolate yourself. Let others help you.
  • Expect your mood to improve a little at a time. Do not expect depression to suddenly leave. Sleep and appetite may begin to improve before your depressed mood lifts.
  • Try not to make important decisions, such as get married or divorced or change jobs. Talk about decisions with others who know you well.  They may see your situation more clearly and have wise advice.
  • Remember that positive thinking should replace negative thoughts as your depression responds to treatment.

Where can I go for help?

If you are not sure where to go for help, ask your family doctor. Others who can help are listed below.

  • Mental health experts
  • Community mental health centers.
  • Hospitals and outpatient clinics.
  • Mental health programs at universities or medical schools.
  • Family services, social agencies or clergy.
  • Peer support groups.
  • Private clinics and facilities.
  • Special programs at your work.
  • Check the phone book under "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

What if I or someone I know is in crisis?

If you are thinking about harming yourself, or know someone who is, tell someone who can help right away.

  • Call your doctor.
  • Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
  • Call a toll-free, 24-hour suicide prevention center to talk to a trained counselor.
  • Make sure you or the suicidal person is not left alone.

Click on the links below to learn more.


National Mental Health Information Center     


This information is for education only. It is not medical advice. Please ask your doctor for advice about changes that may affect your health. 

Reviewed by:

Richard L. Lane MD., Managing Medical Director, KY

Lynette Cooper RN CMCN  Legal Specialist Sr