Mood disorders
Depression
Depression differs from an ordinary low mood in its intensity and duration: low mood, loss of interest, and other symptoms persist for weeks and begin to affect sleep, appetite, thinking, and the ability to work.
A depressive episode may occur once or recur. Sometimes symptoms are less pronounced but persist for months or years — this course also requires attention.
There is no single universal cause of depression. Its development may be influenced by genetic predisposition, health factors, prolonged stress, difficult life events, and changes in life circumstances. At the same time, depression is well studied, and evidence-based methods are available for its diagnosis and treatment.
How depression can present
Depression can present in different ways. Diagnosis depends on the combination of symptoms, their duration, and the extent to which they interfere with everyday life.
- Mood — low mood, a sense of emptiness, or irritability. Sometimes a person does not feel distinctly sad but notices that they have very little emotional response to anything.
- Loss of interest and pleasure — work, socializing, hobbies, food, or intimacy no longer bring the same enjoyment; sexual desire may also decrease.
- Low energy — everyday tasks require more effort, and it becomes harder to work and manage routine responsibilities.
- Sleep and appetite — insomnia or, conversely, a need to sleep more than usual; appetite and weight may decrease or increase.
- Thinking and concentration — it may become harder to focus, read, make decisions, and remember information.
- Self-esteem — self-criticism may intensify, along with feelings of inadequacy or unwarranted guilt.
- Thoughts of death — thoughts about death, not wanting to live, or self-harm may occur. Their intensity can vary, and it is important to discuss these symptoms with a doctor.
When to seek help
It is worth consulting a specialist if changes in mood and well-being persist for about two weeks or longer and begin to noticeably affect everyday life.
For example, if:
- low mood, loss of interest, or low energy do not go away
- it has become harder to work, study, socialize, or manage everyday tasks
- sleep or appetite have changed noticeably
- the condition is gradually getting worse or has occurred before.
What depression can resemble
Low mood, fatigue, sleep disturbances, and difficulty concentrating can also occur in other mental and physical health conditions. During a consultation, the doctor therefore looks at the whole picture: when the symptoms began, how they have changed over time, and what preceded them.
- Anxiety disorders are often accompanied by low mood, fatigue, sleep problems, and difficulty concentrating, and frequently co-occur with depression.
- Bipolar disorder can begin with a depressive episode. That is why it is important for the doctor to know whether there have been previous periods of unusually elevated mood, increased activity, and reduced need for sleep.
- Reactions to stress or loss can involve symptoms similar to depression. The circumstances in which they developed, their duration, and how the condition has changed over time are all important.
- Sleep disorders can themselves lead to low energy, irritability, and difficulty concentrating.
- Physical health conditions and medication effects can also affect mood and well-being. If needed, the doctor may recommend further tests.
How diagnosis works
A psychiatrist diagnoses depression based on the clinical picture: the symptoms, their duration, and their impact on everyday life.
During the consultation, the doctor will ask in detail about your current condition and how it has changed over time: when the first symptoms appeared; what has been happening with sleep, appetite, and ability to work; and whether there have been similar episodes before, or periods of unusually elevated mood and activity. It is also important to discuss any medications you are taking, alcohol and other substance use, and previous treatment and its results. If needed, the doctor may recommend tests to rule out physical health conditions that can cause similar symptoms.
After the consultation, the doctor will discuss the diagnosis with you, along with possible treatment options and next steps.
Treatment options
Treatment for depression depends on the severity of the condition, its course, co-occurring conditions, and previous treatment experience. Depending on the clinical situation, it may include medication, psychotherapy, or a combination of both.
Medication. For moderate to severe depression, the doctor may recommend antidepressants. The medication is selected individually, taking into account symptoms, co-occurring conditions, other medications, and treatment tolerability. The effects of antidepressants develop gradually, so early in treatment the doctor monitors changes in the condition and adjusts treatment if needed. Once improvement has been achieved, the medication is usually continued for some time to reduce the risk of another episode. The duration of treatment and the tapering schedule are determined individually.
Psychotherapy. Evidence-based approaches used for depression include cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and schema therapy. The choice of approach depends on the nature of the condition and the goals of therapy.
How long treatment takes and what to expect
Treatment timelines vary and depend on the severity of the depression, the length of the episode, previous episodes, and response to treatment. Improvement is usually gradual: some symptoms may ease before the overall condition fully recovers.
After a depressive episode resolves, treatment may continue to help maintain the improvement and reduce the risk of relapse. If depression has occurred before, the doctor will also discuss how to recognize the early signs of a new episode and what to do if they appear.
Frequently asked questions
Do I always need to take antidepressants if I have depression?
No. For mild depression, psychotherapy alone may be sufficient; for moderate to severe depression, medication is more often needed. The decision depends on the severity and course of the depression, previous treatment experience, and the patient's preferences.
How can I tell whether treatment is helping?
Treatment is assessed not only by changes in mood. Changes in sleep, energy, concentration, interest in usual activities, and the ability to manage everyday life are also important. The doctor and patient assess changes in the condition together throughout treatment.
What if treatment did not help in the past?
A previous unsuccessful treatment experience does not mean that other options will not work. The doctor will assess how accurate the diagnosis was, which medications and doses were used, how long treatment lasted, and whether there were factors that may have affected the outcome.
Will I have to take antidepressants for the rest of my life?
Usually not. After improvement, treatment is continued for some time to reduce the risk of another episode, and the medication is then gradually tapered off. Longer-term treatment may be recommended for recurrent episodes of depression.
How often do I need to see a psychiatrist during treatment?
The frequency of consultations depends on the stage of treatment and the patient's condition. Appointments are usually more frequent at the start of treatment and when the treatment plan changes; once the condition is stable, the intervals between visits increase.
Do I need to see both a psychiatrist and a psychotherapist?
Not always. In some cases, psychotherapy or medication alone is sufficient; in others, a combination works best. This depends on the severity and course of the depression, as well as the goals of treatment.
Can depression be treated online?
Yes. Psychiatric consultations and psychotherapy can take place online. Whether remote treatment is appropriate depends on the patient's condition and is determined during the consultation.