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Depression is often misunderstood as just feeling sad. But it’s a complex condition, and the facts about depression, depression symptoms, and depression management might surprise you.

What Is Depression?

Doctors diagnose major depression (also called major depressive disorder) based on criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-V. A depression diagnosis is made when at least five of the following symptoms occur nearly every day for at least two weeks:

• Depressed mood
• Loss of pleasure in all or most activities
• Significant weight change or change in appetite
• Change in sleep
• Change in activity
• Fatigue or loss of energy
• Diminished concentration
• Feelings of guilt or worthlessness
• Suicidality

In order to diagnose major depression, either depressed mood or loss of pleasure in activities must be one of the symptoms.

12 Things You Might Not Know About Depression

While the definition of major depression may seem simple enough, depression has profound and varying impacts. Here are some surprising facts:

1. Depression has different triggers. People have a higher risk of depression if they’ve recently been through a stressful life event, if they’ve had depression in the past, or if a close family member has been depressed. Sometimes depression develops without any obvious cause.
2. Genes provide some (but not all) of the answers. The genetic predisposition to depression is becoming better understood and might explain why one person becomes depressed and another doesn’t, says Ole Thienhaus, MD, professor of psychiatry at the University of Arizona in Tucson. A family history of depression matters, but it’s not always the only factor. For example, identical twins — siblings who have exactly the same genes — will both develop depression only about 30 percent of the time, according to the National Alliance on Mental Illness.
3. Depression affects the body. Headache, stomach problems, shortness of breath, and general physical tension can all be symptoms of depression, according to the National Institute of Mental Health.
4. Depression might be a “gut feeling.” A complicated relationship between the brain, the central nervous system, and the “good” bacteria in the gut could contribute to depression, according to a review of research published in January 2016 in the World Journal of Gastroenterology. A varied diet that includes probiotics and prebiotics may play a role in managing depression, the researchers theorize.
5. Depressed brains look different. Imaging studies of the brain can show some of the structures and brain circuits that work differently when a person is depressed, says a review of research published in June 2015 in theAmerican Journal of Psychiatry.
6. Depression is linked to other health problems. People with chronic conditions like diabetes, heart disease, and multiple sclerosis may also have a higher risk of depression.  
7. Depressed people might not look depressed. “Depression is a hidden illness,” says Jeremy Coplan, MD, professor of psychiatry at SUNY Downstate in New York. Some people can seem upbeat and cheerful, but inside they’re struggling with the symptoms of depression.
8. Exercise helps manage depression. “Exercise improves mood state,” Dr. Thienhaus says. He explains that exercise helps stimulate natural compounds in the body that can make you feel better. Aim for at least 30 minutes of physical activity most days. “We typically recommend that people with depression exercise, develop a healthy diet, and go to bed at a regular time.”
9. More than one antidepressant medication may be needed. Many people with depression don’t get relief from their first or second antidepressant. People who take a second medication without relief are considered to have treatment-resistant depression, Dr. Coplan says. His research, published in May 2014 in the journal Frontiers in Behavioral Neuroscience, suggests that for some depressed people, the physiology of their brains means that certain antidepressant medications won’t work to treat depression or must be used in combination with other medications to achieve and maintain relief.
10. Therapy is needed, too. Sometimes antidepressant medications will be used first to alleviate depression enough for therapy to be helpful, Coplan says. But psychotherapy, cognitive behavioral therapy, or other therapeutic strategies like transcranial magnetic stimulation are also needed for effective depression treatment.
11. Warming up could help. People who are depressed may have an altered thermoregulatory system. Exposure to heat may have potential as a sort of antidepressant, says Charles Raison, MD, professor of psychiatry at the School of Medicine and Public Health, University of Wisconsin-Madison. More research is needed, but hot yoga, a warm bath or shower, saunas, and hot tubs are low-cost ways to try this for yourself.
12. Depression is a leading cause of disability. The World Health Organization considers depression to be a leading cause of disability worldwide. “People routinely say that depression is the worst thing that’s happened to them,” Coplan says. “And the reason that’s offered is that their brains don’t work properly. They can’t make decisions and they aren’t sure of themselves — everything requires huge mental effort.”

There’s no doubt that the use of antidepressants is on the rise — roughly 67 percent of people with major depression use medications as their primary form of treatment, says the National Alliance on Mental Illness (NAMI).

Yet despite this popularity, taking antidepressant drugs isn’t without risks and can lead to a lot of questions about safety and use. That’s why it’s essential to work with your doctor to make a well-informed decision about depression medication and to remain knowledgeable as you stay the course.

Types of Antidepressants

The two classes of drugs most commonly prescribed for depression are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), says Rajnish Mago, MD, director of the mood disorders program and an associate professor of psychiatry and human behavior at Thomas Jefferson University in Philadelphia. These medications work on the brain chemicals serotonin and norepinephrine, according to the National Institute of Mental Health. Another common antidepressant drug affects the chemical dopamine in the brain.

Tricyclics and monoamine oxidase inhibitors (MAOIs), two older classes of antidepressants, usually aren’t prescribed as first-line treatment.

FAQs About Depression Medication

Here are some of the questions psychiatrists hear most often about depression medication. Use these as a launching pad to starting a conversation with your own doctor.

Q: Are there side effects of antidepressant drugs?

A: Short-term side effects may develop during the first two weeks of taking an antidepressant drug, including headaches, nausea, hand tremors, and insomnia. If you experience any of these symptoms, remember that they’re temporary. Call your doctor and explain what’s happening, Dr. Mago says. There may also be long-term side effects such as weight gain, low libido, and fatigue that can be associated with taking SSRIs and SNRIs.

Antidepressant medication should only be taken if the benefits outweigh the risks, so be sure to tell your doctor what you’re experiencing. If side effects are intolerable, he or she may change your medication.

Q: Will depression get worse before it gets better?

A: Some people may feel that their depression symptoms worsen at first because of the initial side effects and because it can take two to six weeks for the medication to take full effect. Keep in mind that things will get better, Mago says.

Q: Are antidepressant drugs addictive?

A: Mago often hears this question from people, and says the answer is “no.” While you’ll have to taper off an antidepressant when you’re ready to stop taking the medication to avoid a recurrent episode of depression, it’s not the same as being addicted.

Q: Will antidepressant medication change my personality?

A: Antidepressant drugs don’t change your personality per se, but they can make some people feel emotionally numb, Mago says. “Some people who take antidepressant medication say they don’t feel depressed, but they don’t feel happy, either,” he notes. It’s rare, but when this does happen, it’s usually associated with drugs that work through the brain chemical serotonin. In that case, changing to a drug that affects dopamine may help.

Q: How long will I need to take medication for depression?

A: The goal is 100 percent improvement of your depression symptoms, Mago says, which may take several months. Once you’re there, he recommends continuing the medication for another 4 to 12 months before tapering off with your doctor’s guidance.

Someone who’s had at least three episodes of major depression may need long-term preventive antidepressant treatment, which would mean taking medication for several years.

Q: What if I still experience depression symptoms?

A: If you’ve been taking antidepressant medication for longer than six weeks and you’re still depressed, you may need a higher dose or a different medication. Tell your doctor if you’re experiencing symptoms and ask if it’s time for a change.

Q: What if I skip a dose of antidepressant medication?

A: Some people wrongly believe that they should only take an antidepressant on the days they’re feeling depressed, but you should take it every day. In general, if you miss a dose, take it as soon as you remember. But some antidepressant drugs shouldn’t be taken after a certain time of day because they may cause insomnia.

Q: Can I drink alcohol with antidepressant medication?

A: The effects of alcohol on a person who’s taking an antidepressant drug will vary. “Some people may feel no difference, while others may say one drink feels like three,” Mago says. What’s more, alcohol is a depressant and can cause feelings of depression, counteracting the benefits of your medication. But if having a drink at dinner is important to you, discuss it with your doctor first. And remember to drink in moderation, don’t drive, and don’t drink alone.

Q: Are antidepressants safe during pregnancy?

A: Antidepressant drugs have been associated with preterm birth, heart abnormalities, and even autism, Mago says. Talk to your doctor if you are pregnant or trying to conceive so you can make the right treatment decisions together.

Q: Can I take a supplement with antidepressant medication?

A: Some dietary supplements should not be taken with antidepressant drugs. For example, an SSRI should never be taken with the supplement St. John’s wort because they work in similar ways, Mago says. But taking fish oil is probably okay, he says. Always ask your doctor before combining any supplements with prescription drugs.

Depression is different for everyone, so managing it should also be unique. Medication, talk therapy, and other approaches are essential for treating major depression. But that doesn’t mean you can’t enhance your everyday habits to help boost your mood.

Lifestyle changes can go a long way toward a happier you, says Nicholas R. Forand, PhD, a clinical psychologist and an assistant professor in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center in Columbus. “The good news is that if you keep these changes up, they can make you less likely to become depressed in the future.”

Implementing daily healthy habits is good for the mind, body, and spirit, says Eric Bouwman, a licensed clinical social worker at Kaiser Permanente in Colorado. “By adjusting your diet, sleeping pattern, and caffeine intake, your body can start to regulate itself normally,” he says.

Small Steps to Help Fight Depression

Each day you make a choice to do all you can to be healthy and happy. From simple to silly, these tips can help you manage depression:

• Set achievable goals. Don’t overwhelm yourself with lofty ambitions. As “the old saying goes, ‘You can only eat an elephant one bite at a time.’ The same thinking should apply to improving your mental or physical health,” Bouwman says.

• Do something you enjoy. “Small, enjoyable activities are often the first to go when someone starts to get depressed,” Dr. Forand says. “Re-engaging in these things can have a big influence on how you feel.” Schedule a regularly recurring activity that you enjoy, be it a new hobby, an exercise class, or a lunch date with a friend.

• Laugh. When you’re feeling down, a laugh can lift you up. “Laughter really is great medicine,” says Judy Sturm, president of the Depression and Bipolar Support Alliance (DBSA) of Greater Chicago, who’s been in recovery from bipolar disorder for the last 14 years. For her, laughter is “an even better release than crying.” Share a funny story, tell a joke, or just engage in something silly.

• Create a routine. “Structure is good,” Forand says. “It makes your life predictable.” Jot down your schedule as a list or on a calendar, or make a note or schedule reminders on your phone — anywhere it’s visible to you. “Writing your schedule down can also help you stay motivated to stick with it,” he says.

• Be kind. Don’t underestimate the power of simple kindness. “Kindness to others, in any way, shape, or form, is great therapy,” Sturm says. “Holding a door open for someone, picking up a stranger’s dropped item, telling someone they’re dragging their coat on the floor — their gratitude can help your attitude.” Sturm also recommends donating money, goods, services, or time to an organization or project that inspires you.

• Practice smiling. “This may seem a little strange, but I do smiling practice,” says Douglas Cootey, creator of the blog A Splintered Mind. “A fake smile begins to work its magic on the brain until the smile becomes real. I feel so silly making grin after grin in front of the mirror that it elevates my mood.” Cootey also likes to take silly selfies. “Between the two activities, I can limber up my face to counter the somber effect of depression and feel better about myself in the process,” he says.

• Try natural ways to treat depression. Massage may help ease symptoms of depression and anxiety, according to the University of Maryland Medical Center. Add some aromatherapy oils (try lavender, orange, or basil) to further engage your senses and relax your mind and body. Or just head outside and let nature work its wonders on your spirit. Cootey says he tries to get outdoors as much as possible to boost his mood and energy level.

• Add stress management techniques. “Stress is a major cause of depression,” Forand says. The DBSA suggests deep breathing, yoga,meditation, guided imagery, and any other activity that helps you de-stress.

• Maintain your relationships. “Social interaction is very important and something depressed people often don’t prioritize,” Forand says. And when you make plans to socialize, keep them, he says: “Avoiding something usually makes you feel worse.”

• Treat yourself well inside and out. Each day dedicate a little energy toward your appearance. “If you look good and feel clean and comfortable, you’ll feel better,” Forand says. Don’t neglect the staples of a healthy lifestyle — get plenty of sleep, eat a nutritious diet, and make time for regular exercise — and don’t forget to take your medication.