Many people think they would be able to pick up on the signs of depression, but it does not look the same on everyone or affect them in similar ways. For this and other reasons, it can be challenging to know when someone is experiencing depressive symptoms. Women’s Health illustrates this with its profile on “smiling depression,” another name for high-functioning depression or persistent depressive disorder (PDD). 

This condition happens when people experience a chronic level of sadness. But instead of staying in bed or avoiding social outings, people with “smiling depression” carry on with their everyday lives with facial expressions and actions that do not betray how depressed they are. 

This facade perfectly illustrates why someone’s laughter or smiling is not always about joy or happiness. Their cheerful nature can be rooted in pain, but this reality is one some hide well because they might not know what is going on with them or might not want to know.

More than 300 million people live with depression worldwide, and according to the Anxiety and Depression Association of America, the disorder is the main cause of disability in the U.S. among people ages 15 to 44.3, affecting more than 16.1 million American adults.

What is Depression?

When many people hear “depression” mentioned, they immediately think of a person who mopes around, looking sad. Some people casually say they’re depressed when something doesn’t work out the way they planned, or if they want to describe a general overall state of feeling down. But for many people, depression is more than a temporary low mood. 

For millions of people, depression, formally known as major depressive disorder (MDD) or clinical depression, is a serious medical condition that affects a person’s thoughts, actions, and feelings every day for considerable periods.

As the American Psychiatric Association (APA) explains, “Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.”

Symptoms of Depression

MDD can range from mild to severe and affects various aspects of a person’s life, from how much they sleep they get to how much they eat or if they eat at all. Changes in someone’s eating, or sleeping patterns is a sign that a person may be struggling with depression. A person may also have trouble focusing at work or school or staying on task.

Other symptoms of MDD, according to the APA, include:

  • Nagging feelings of sadness
  • Loss of interest in everyday activities
  • No interest or pleasure in hobbies, once enjoyable activities
  • Non-diet-related weight loss or gain
  • Little to no energy
  • Increased tiredness
  • Restlessness, irritability (pacing, hand-wringing)
  • Slowed movements and speech
  • Feeling worthless or guilty
  • Trouble with thinking clearly
  • Struggling to concentrate, make decisions
  • Suicidal thoughts
  • Thoughts about death

Mayo Clinic reports that depression is not a normal part of growing older and that the condition can be difficult to detect in older people because it presents differently. According to the Mayo Clinic, symptoms of depression in senior adults include:

  • Memory problems
  • Personality changes
  • Physical aches, pains
  • Lack of interest in leaving home
  • Avoiding people, no interest in socializing
  • Suicidal thoughts or feelings (older men in particular, according to Mayo Clinic)

Other symptoms associated with depression can also present in older adults, such as fatigue, loss of appetite, sleep problems, or a loss of interest in sex that isn’t related to a medical condition or medications.

Who Depression Can Affect and Why

No one is immune from experiencing depression. People cope with a stressful, ever-evolving world in different ways, and depression can result from this ability to cope. Other factors can increase or contribute to someone’s chances of developing depression. The APA lists them as:

  • Biochemistry: Differences in a person’s brain chemistry can bring on depressive symptoms.
  • Genetics: Depression can run in someone’s family history.
  • Personality: People with low self-esteem or those easily overcome by stress or pessimism are more likely to experience depression, the Mayo Clinic says.
  • Environmental factors: Continuous exposure to violence, neglect, abuse, or poverty may make some people more vulnerable to depression.

How Do I Know if I am Depressed?

If you have any of the symptoms mentioned earlier for persistent periods, you might want to see a medical or mental health professional to determine if you are experiencing depression. According to the APA, a person can receive a diagnosis of depression if their symptoms last at least two weeks. 

While serious, the condition is treatable, and the APA writes that people can receive relief from their symptoms with treatment. It also reports that between 80 and 90 percent of people with MDD will respond to treatment. 

Treatment for Depression

Treatment for depression can be long-term, as the Mayo Clinic explains, but it also depends on the individual’s needs. A person being treated for depression might be prescribed antidepressant medications and therapies.


Antidepressants can be prescribed to treat depression. These medications attempt to balance the brain’s natural chemicals that are related to mood, emotions, and behavior. Healthcare professionals regard antidepressants as safe to use because they work slowly and are not habit-forming, which is important for people who are susceptible to developing a substance use disorder or have a history of substance misuse. 

In addition to depression, antidepressants can be prescribed to treat the following conditions:

  • Generalized anxiety disorder (GAD)
  • Obsessive-compulsive disorders (OCD)
  • Manic-depressive disorder
  • Post-traumatic stress disorder (PTSD)
  • Social Anxiety Disorder

They can also be prescribed to treat eating disorders, such as bulimia nervosa or binge-eating disorder, fibromyalgia, hot flashes, and Tourette syndrome.

Antidepressants are grouped by the brain chemicals they affect, as explains. Of the five classes of antidepressants available, two are widely used, and they are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). The latter affects the brain chemicals serotonin and norepinephrine.

Some SSRI medications are:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Some SNRI medications are:

  • Duloxetine (Cymbalta, Irenka)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq, Khedezla, Ellefore)

Each of these medications come with their benefits and side effects. Some of the trade names listed above might be recognizable because they are popular. Still, as the Mayo Clinic notes, you still need to make sure you select the right antidepressant that works for you. 

Therapies for Depression

Psychotherapy can also be used as part of a treatment program for depression. Cognitive behavioral therapy (CBT), widely used to treat various conditions, aims to help individuals become aware of their thinking and help them change it so that they find positive solutions for the issues they face. The idea is that a person must correct their negative thinking before their behavior can change.

Interpersonal therapy (IPT) is another form of therapy used to help people with depression. It lasts for three to four months (12 to 16 weeks) and can be done on an individual basis or a group setting. 

According to Psychology Today, the primary goal of IPT is to help individuals improve their relationships and social functioning so that they can reduce their distress. The publication also explains that IPT is different from cognitive and behavioral therapies because it targets dysfunctional thoughts and behaviors that apply to interpersonal relationships and aims to change relationship patterns instead of related depressive symptoms.

If you enter a treatment program for depression, a mental health professional can work with you and your specific needs to find the therapies that work for you. 

Why Depression Should Not Go Untreated

Depression often accompanies other mental health disorders and substance use disorders. Leaving the condition untreated leaves the door open for it to get worse, further putting a person’s well-being at risk.

For example, a person who struggles with depression might self-medicate with alcohol or prescription drugs, illicit drugs, or even over-the-counter drugs to find relief from their symptoms. In doing so, they can aggravate their mental health while putting themselves at risk of developing an alcohol addiction. Substance addiction disorders also need not go untreated. The chances of overdose and death are high when they are left untreated.

A person who is living with a substance use disorder and a mental health disorder has dual diagnosis, which means they have both conditions at the same. Therefore, substance addiction treatment for dually diagnosed individuals needs to address both disorders at the same time to give the individual the best chance at managing both conditions and avoiding a life-threatening relapse.

Depression can also be a symptom of other mental health disorders, such as bipolar disorder or panic disorder. Getting a formal diagnosis from a medical health professional can shed light on these disorders so that a person can be treated for them.

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