Causes, Symptoms, and Treatments of Clinical Depression:

Feelings of sadness can strike anyone from time to time and are a normal part of life, and they are usually temporary and manageable. When those feelings stick around it could be a sign that you might be dealing with clinical depression.

What is clinical depression?

Clinical depression is a mental illness where depressive feelings become chronic, and frequently require some kind of professional treatment. It's the most common kind of mood disorder, with over 11% of Canadian adults meeting the criteria for clinical depression at some point in their lifetime.

Clinical depression is also referred to interchangeably as major depression. When someone with clinical depression is unable to perform basic tasks such as getting out of bed, it’s a more extreme case of clinical depression known as crippling depression.

Symptoms of clinical depression

The symptoms for clinical or major depression can vary from one person to the next, with different people experiencing different combinations of the most common symptoms. The symptoms also won't necessarily all begin and end at the same time. Knowing the list of potential symptoms of depression can make it easier for you to identify which ones you may be dealing with so that you can discuss them with your health care practitioner.

Common symptoms of clinical depression include:

• Persistent sadness
• Feelings of emptiness
• A loss of interest or lack of enjoyment in things that you used to like, such as hobbies or your job
• Changes in appetite in either direction
• Dramatic weight change in either direction
• Sleeping too much or an inability to sleep
• Fatigue and low energy
• Feelings of worthlessness or guilt
• Difficulty concentration or making decisions
• Feeling sluggish and slowed down
• Feeling restless
• Physical symptoms, such as headaches and stomach aches
• Recurring thoughts of death, dying, or suicide

If you are having suicidal thoughts, contact the Canada Suicide Prevention Service at 1-833-456-4566 for support available 24/7.

Other types of depression

While clinical depression is the most common type of depression, there are other forms of depression that share some similar symptoms but have other defining characteristics that distinguish them from major depressive disorder.

Depressive phase of bipolar disorder

Major depressive disorder, or clinical depression, is also referred to as unipolar depression. This distinguishes it from bipolar disorder, which causes people to alternate between depressive stages and manic stages.

The depressive stage of bipolar disorder can have symptoms that are very similar to the ones experienced by people with clinical depression.

Psychotic depression

Psychotic depression is a more severe form of clinical depression. Those suffering from psychotic depression experience symptoms of psychosis, such as delusions or hallucinations, in addition to the symptoms we've already discussed.

Postpartum depression

The first few weeks at home with a newborn can be stressful and anxiety-inducing, especially coupled with the disruption to normal sleep patterns. However, if the symptoms of depression persist longer than a few weeks after the birth of a child, it is considered postpartum depression.

Premenstrual dysphoric disorder (PMDD)

While you may be more familiar with premenstrual syndrome, premenstrual dysphoric disorder is a rarer and more severe disorder that can cause people to become depressed in the stage of their menstrual cycle prior to getting their period.

Seasonal Affective Disorder (SAD)

Seasonal affective disorder refers to bouts of depression that occur at certain times of the year, typically during the dark winter months. Less sunshine means less natural vitamin D production, and the increased time spent indoors and alone for many people may contribute to symptoms of depression.

Low-grade depression

Low-grade depression is a symptom of persistent depressive disorder, previously called dysthymia. It refers to cases where the patient has been experiencing a depressed mood for over two years for adults and over one year for children. It is also sometimes referred to as mild depression.

Situational Depression

Situational depression occurs in response to a situation such as job loss or the death of a loved one. This type of depression can typically be resolved as the situation is resolved or accepted. 

Who is at risk for clinical depression?

Depression can affect people at all stages of life from childhood to older adulthood, but some groups are at higher risk than others.

Risk of clinical depression for women

In Canada and around the world, women are about 1.7 times more likely to experience major depression than men. The risk seems to increase during the perimenopausal period, suggesting at least some of the increased risk women experience has a hormonal cause.

Risk of clinical depression for men

Depression in men is underreported, and men who suffer from clinical depression are less likely to seek help or discuss their experiences. It is possible that large numbers of men experience clinical depression without reporting it. For this reason, men may cope in different ways. Some signs of major depression can include:

• Escapist behaviour such as throwing yourself into work
• Headaches, digestive problems, and pain
• Substance abuse
• Controlling or abusive behaviour
• Irritability or anger
• Risky behaviour, such as driving recklessly

Clinical depression in children and teens

Children and teens may not have the vocabulary or tools to express themselves when they are experiencing depression, and adults shouldn’t expect them to act the way an adult might. Depression may manifest itself in kids and teens in the following behaviours:

• Feelings of unhappiness, worry, anger, helplessness, hopelessness, or another negative change in feelings that persists.
• Unexpected weight loss or weight gain, beyond normal growth for their age
• Headaches and pains
• Difficulty sleeping
• Withdrawal and lack of interest in their usual activities

Causes and triggers of clinical depression

The causes of depression aren't always easy to identify or easily understood. However, there are factors that can contribute to the likelihood of experiencing depression.

• Family history of depression, particularly in a parent or sibling
• Experiencing a traumatic event such as the death of a loved one, a diagnosis of serious illness, job loss, or divorce
• Major life changes that may not seem traumatic on the surface, such as moving or graduating
• Physical, sexual, or emotional abuse
• Being socially isolated or deprived of contact with others
• Financial stress, such as debt or a large unexpected expense
• Becoming injured or seriously ill
• Managing a chronic or progressive health condition
• Being the primary caretaker of a loved one who is dealing with injury, illness, or disability
• Taking medications that may cause symptoms of depression as a side effect
• Substance abuse

Diagnosis of clinical depression

It is possible for an underlying medical condition, such as a thyroid disorder, to be the cause of symptoms of depression, and a doctor will be able to order tests that confirm if this is the case.

Your doctor may rule out medical conditions and diagnose clinical depression themselves by discussing your symptoms with you, or they may recommend that you be evaluated by a psychologist for a more specialized assessment.

Co-occurring conditions

If you are suffering from common co-occurring conditions that can present alongside major depression, your doctor may consider them in the diagnosis of depression. These include:

• Sleep disorders
• Irritable bowel syndrome (IBS)
• Anxiety disorders, including high-functioning anxiety
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Eating disorders and body dysmorphia

Clinical depression treatment

A range of treatments is available for depression, and people with depression respond differently to each of them. Treatment can also take some time to work. This means you shouldn't be discouraged if the first treatment you try isn't very effective, since it may take trying various treatments and combinations of treatments until you find what works best for you.

Medication

Antidepressants are a common treatment for people with depression and may be the first treatment recommended by your doctor. There are several types of antidepressants, including:

• Selective serotonin reuptake inhibitors (SSRIs), the most common class
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Monoamine oxidase inhibitors (MAOIs)
• Atypical antidepressants
• Tricyclic antidepressants

These may be prescribed in some combination with one another or with another treatment for a co-occurring condition, such as anxiety.

Antidepressants can have serious side effects, including the possibility of worsening some of the symptoms of depression. That's why it's important to be properly diagnosed by a doctor, and to take these medications only as prescribed and under the guidance of a healthcare practitioner.

It can take several weeks or months for the medications to take effect, so patience is key. When going off of an antidepressant or switching to a new one, withdrawal can be uncomfortable, so changing your dose should also happen under the guidance of a healthcare practitioner. They can help you taper off your current clinical depression treatment so that you can minimize withdrawal symptoms before switching to a different treatment.

Psychotherapy

Psychotherapy may be used on its own or in combination with antidepressants. You might work one-on-one with a therapist, or in a group setting. While there are different approaches to therapy out there, it typically involves discussing your emotions, experiences, self-image, and how you view others and the world around you.

Talking to a professional therapist can help you identify some of the triggers or causes of your depression so that you can learn how to manage them. One common approach which can be very effective in treating depression is cognitive behavioural therapy, or CBT.

The approach in CBT is to help you identify your patterns of thinking that may contribute to your depression and to give you tools to change those patterns and replace them with new ways of thinking that may better enable you to cope with depression.

Therapy is more accessible today than in the past thanks to the increase of internet and phone-based practitioners. Many people still prefer in-person therapy sessions, but these additional options can make attending therapy more accessible and even affordable for some.

Complementary and alternative medicine (CAM)

While medication and psychotherapy are the most common treatments for depression, alternative treatments are sometimes explored in response to treatment-resistant cases of depression or as a complement to conventional clinical depression treatments.

Herbal remedies and supplements such as St. John's Wort and folic acid are sometimes used to treat depression. While there is limited large-scale data on the efficacy of these therapies, the Royal College of psychiatrists in the UK has a useful summary of the existing data on CAMs.

Even if these alternative clinical depression treatments are available over the counter at your local drug store, you should still consult with your healthcare practitioner about taking them. They can also come with the risk of side effects and may interact with other treatments prescribed by a doctor. For example, taking a supplement that helps to boost serotonin while also taking an antidepressant can lead to too much serotonin in the system, also known as serotonin syndrome.

Physical therapies, such as yoga or light therapy, also fall under the umbrella of complementary treatments. These can help make day-to-day life more manageable.

Coping with clinical depression

In addition to treatment, there is a range of things you can try incorporating into your life to help you cope with the symptoms of depression and improve your mood

Physical activity

In addition to being good for your overall health, exercising can help you feel better by releasing mood-boosting endorphins. 

This can take whatever form is most realistic for you. You can join pick-up games of a sport you enjoy, go for runs or walks, take a fitness class, or even follow along to a yoga or other exercise video at home if that's more comfortable for you.

Hobbies and creativity

Staying engaged with hobbies or creative pursuits you used to enjoy can help you feel more like yourself. It can also be a good way to keep your mind engaged on something positive, making it easier to cope with the symptoms of depression from day to day.

Self-care and connecting with others

If you're feeling too overwhelmed to manage your daily chores, getting some help during difficult periods can be an effective coping strategy. Your network, such as friends or family, may be able to help if you can't hire somebody to help you.

Staying connected with loved ones can also help, since isolating yourself can exacerbate symptoms of depression.

Can clinical depression be prevented?

Being familiar with the triggers or causes of episodes of major depression you've experienced in the past may help you avoid them or be better able to cope with them. If you've been prescribed depression medication, continuing to take it for as long as your healthcare practitioner recommends can help to prevent a relapse.

Finally, being aware of the symptoms of clinical depression can help you identify when you might be experiencing them so that you can talk to a professional and get the help you need early.

You're not alone

While navigating clinical depression is challenging, remember that there are tools and mental health resources available to you to start feeling better. Millions of Canadians experience clinical depression at some point in their lives, and if you find yourself among them, there are many effective clinical depression treatments available. Seeking professional help, and making use of your support network, will get you on the path to feeling like your old self again.

Want to discuss your options? Connect with one of Felix's healthcare practitioners today.

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If you are having suicidal thoughts, please seek help immediately by going to your nearest emergency department or by calling 911. You can also contact Crisis Services Canada's national suicide-prevention hotline at 1-833-456-4566 if you are considering suicide or are concerned about someone who may be.