Symptoms

Major depressive disorder and persistent depressive disorder involve a range of emotional and physical symptoms that persist over time. Common symptoms include:

• Persistent sad, empty, or hopeless mood
• Loss of interest or pleasure in activities that were once enjoyable
• Changes in appetite or weight — either increase or decrease
• Sleep disturbances — sleeping too much or too little
• Fatigue or loss of energy most days
• Feelings of worthlessness or excessive guilt
• Difficulty thinking, concentrating, or making decisions
• In severe cases, recurrent thoughts of death or suicide

Depression can also present primarily as physical symptoms — chronic pain, digestive problems, or persistent fatigue — without a prominent emotional component. A clinician's assessment is the right way to distinguish depression from other conditions.

When to seek care

If you have experienced five or more of the above symptoms for most of the day, nearly every day, for at least two weeks — especially if those symptoms include depressed mood or loss of interest — please speak with a clinician. Depression is not something to push through on your own.

If you are experiencing thoughts of death or suicide, please seek help immediately.

Treatment options

Depression is highly treatable. Most patients respond well to one or a combination of the following approaches:

• Psychotherapy — Cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and behavioral activation are among the most well-studied psychotherapies for depression. CBT in particular has strong evidence across a broad range of depression severity.
• Antidepressant medications (SSRIs and SNRIs) — First-line pharmacological treatment for moderate to severe depression. Common options include sertraline, fluoxetine, escitalopram, and duloxetine. These medications typically take 4–8 weeks to reach full effect. Side effects are common, especially in the first few weeks, and vary by medication. Your clinician will review risks and benefits with you.
• Combined therapy and medication — For moderate to severe depression, the combination of psychotherapy and medication is often more effective than either alone.
• Lifestyle factors — Regular physical activity has a meaningful evidence base for depression; structured exercise programs can reduce symptoms comparably to antidepressants in some studies. Sleep hygiene, social connection, and reduction of alcohol are also important factors.
• Important note on suicidality — Antidepressants carry an FDA black-box warning for increased risk of suicidal thinking in children, adolescents, and young adults during the early weeks of treatment. This risk must be weighed against the risks of untreated depression. Your clinician will discuss this with you and establish a safety plan before prescribing.

Treatment decisions depend on the severity and duration of symptoms, your personal history, and your preferences. There is no single correct path — your clinician will work with you collaboratively.