Depression can be a heavy fog that blankets you in sadness day after day. Or, it can come in dark waves called episodes that wash over you and keep your head underwater for two weeks or more at a time.

More than 16 million adults in the United States — or nearly 7 percent of the population—have had at least one episode of major depression. Even if you’ve dealt with depression before, a new episode can blindside you and leave you unsure of how to cope.

Here’s a look at what sets off depressive episodes, how to recognize them when they appear, and the best ways to manage them.

Feeling down from time to time isn’t necessarily a symptom of depression. What sets a true depressive episode apart is that you have symptoms like these during most of the day, almost every day, for at least two weeks:

  • sad mood
  • feeling of hopelessness,
    worthlessness, guilt, or emptiness
  • anxiety
  • restlessness
  • anger or irritability
  • loss of interest in
    activities you once loved
  • lack of energy
  • fatigue
  • slowed thinking or
    movements
  • trouble concentrating,
    remembering, or making decisions
  • sleeping too much or too
    little
  • appetite loss or
    overeating and craving certain foods
  • unexplained headaches,
    stomachaches, or other aches and pains that don’t have a clear medical
    explanation
  • thoughts of death or
    suicide

If you have any of these symptoms for an extended period of time, see a psychologist, psychiatrist, or your primary care doctor for an evaluation. If the episodes start up again even once you’re on treatment, you might need to adjust your medication or try a different approach.

Primary care physicians (PCPs) are often the first providers people with depression consult, as common symptoms include feeling listless or poor sleep. Physicians can check for any underlying physical problems that may be causing symptoms. Also, a PCP will likely do a basic depression screening to assess severity (mild, moderate, or severe), while also assessing risk of suicide.

PCPs may prescribe antidepressant medication and can refer you to a depression specialist for further care.

Check out our Good Appointment Guide for tips on getting the most out of your doctor next visit.

Psychiatrists are licensed physicians who treat mental health conditions. Once they finish medical school, they have 4 more years of training in psychiatry. They specialize in mental health and emotional problems. A psychiatrist’s special training combined with the ability to prescribe medications can sometimes help when other methods haven’t. Some psychiatrists also do psychotherapy. They can help you talk through emotional issues that may be contributing to your condition. When used in combination with medication, talk therapy has proven very effective in treating clinical depression.

Your doctor may be able to provide a referral to a specialist in your area. Check out our Good Appointment Guide for tips on getting the most out of your next doctor visit.

Psychologists are professionals who have a doctorate degree in most states. In some states they can write prescriptions, but they mainly provide psychotherapy, or “talk therapy.” They have advanced training in the science of behavior, thoughts, and emotions. They go through internships to learn how to perform advanced psychological testing and therapy. Similar to physicians, they must be licensed in their state of practice in order to provide care. They help patients learn how to cope with mental health problems and day-to-day life issues.

Your doctor may be able to provide a referral to a specialist in your area. Check out our Good Appointment Guide for tips on getting the most out of your next doctor visit.

Social workers need a master’s degree in order to provide talk therapy. They are trained to help individuals with emotional situations. Although social workers have less schooling than psychologists, they can be just as helpful.

When people are having thoughts of harming themselves, suicide prevention hotlines can make all the difference. Crisis hotlines help millions of people every year and offer the option to speak with trained volunteers and counselors, either via phone or text message.

The National Suicide Prevention Lifeline is a national network of more than 150 local crisis centers. It offers free and confidential emotional support around the clock to those experiencing a suicidal crisis. You can contact the organization with the following ways:

Phone: 800-273-8255 (24/7)

Online chat: https://suicidepreventionlifeline.org/chat/ (24/7)

Website: https://suicidepreventionlifeline.org/

Depression doesn’t always need a trigger. Sadness can arrive without any unpleasant event or warning.

Yet certain situations are known to set off a negative mood. Common depression triggers include:

  • a major life change such
    as a move, graduation, or a new job
  • financial troubles,
    including bankruptcy or debt
  • relationship issues such
    as tension in the family, a breakup, or a divorce (your own or a loved one’s)
  • the death of a loved one
  • giving birth to a child
    (this is called postpartum depression)
  • loneliness — for
    example, if friends and family have moved away
  • stress at work or home
  • using alcohol or drugs
  • major illness

Some of these triggers are under your control. For example, you can avoid drinking alcohol or using drugs if they make your sadness worse. Others, like a chronic illness, are more difficult to avoid.

When you can’t avoid depression, your focus should turn to managing it. You may not be able to change your circumstances, but you can work with a psychologist or counselor to help you cope with your sadness.

When depression arrives like an unwelcome visitor, you don’t have to give up your quality of life. Medication, therapy, and at-home coping techniques can all make the symptoms more manageable.

Medications for depression

Antidepressants are the main medication therapy for depression. They increase levels of brain chemicals like serotonin and norepinephrine to relieve symptoms.

There are several different classes of antidepressants.

Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressant doctors prescribe. They include:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are the second most commonly prescribed antidepressants. They include:

  • desvenlafaxine (Pristiq)
  • duloxetine (Cymbalta)
  • venlafaxine (Effexor)

Norepinephrine-dopamine reuptake inhibitors (NDRIs) are another option. They include:

  • bupropion (Wellbutrin)
  • mirtazapine (Remeron)

Antidepressants can take up to three months to start working. If after that time, they still haven’t controlled your symptoms, your doctor can change your dose, switch you to a different class of medication, or add another drug.

Talk therapy

The second element to treating depression is psychotherapy — or talk therapy. Research finds that combining antidepressants with therapy works better than either treatment alone.

There are several different kinds of therapy for depression. Cognitive behavioral therapy (CBT) is very effective because it helps reverse the negative patterns of thinking that contribute to sadness. CBT is done over a series of 8 to 16 sessions.

Interpersonal therapy (IPT) is another approach. IPT focuses on issues in your relationships that contribute to your depression. Therapy sessions can also involve your partner or other family members if your relationships are problematic.

Along with medication and therapy, here are a few lifestyle tips to help you cope with depression symptoms:

  • Exercise. Run, ride a bike, swim — whichever activity you
    choose will boost levels of brain chemicals that make you feel better. Try to
    be active on most, if not all, days of the week.
  • Get enough sleep. Try to get seven to nine hours of rest a night.
    Sleeping too little can accentuate depression symptoms like irritability and
    mental fatigue.
  • Stay connected. Loneliness can worsen depression. Try to get
    out with friends, or connect with them by phone or computer.
  • Eat well. Avoid sugar and carb-heavy foods like chips and
    cookies. They cause blood sugar spikes and dips that can make you feel worse.
    Instead, nourish your body and mind with nutrient-rich foods like fruits, vegetables,
    fish, and whole grains.
  • Limit alcohol. Drinking a few glasses of wine might make you
    feel better in the moment, but it’s not an effective coping strategy. Alcohol
    acts as a central nervous system depressant, and it can worsen depression
    symptoms.