We’ve all had a day when we’ve felt a little blue or down in the dumps. That’s normal, and doesn’t necessarily mean you’re depressed, though a lot of American adults do have or have experienced depression. According to 2017 data from the National Institute of Mental Health, an estimated 17.3 million adults in the United States had at least one major depressive episode. That figure represents 7.1% of all U.S. adults.
Awstin Gregg, senior vice president and behavioral health expert and therapist at Vertava Health, a national behavioral health care system for mental health and substance use conditions that’s based in Nashville, Tennessee, says that symptoms of depression can vary from one person to the next, but common signs include:
— Changes in mood.
— Changes in appetite.
— Changes in ability to focus and concentrate.
— An overall sense of sadness.
— A lack of pleasure in things or activities that previously were enjoyable.
— A greater sense of irritability.
— A general disinterest in spending time with others, preferring to isolate instead.
These symptoms “are often considered to be hallmarks of a diagnosable mental disorder such as depression,” he adds.
The NIMH defines a major depressive episode as “a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration or self-worth.”
And the intensity of these feelings can fluctuate over time. “Depression can definitely get worse,” says Charmain Jackman, a psychologist and founder and CEO of InnoPsych, Inc,. an organization on a mission to disrupt racial inequities in mental health. “Depression symptoms range from mild to severe and often if left untreated, mild symptoms can lead to moderate or severe depression.”
Jay Fournier, director of the mood and anxiety program at the Ohio State University Wexner Medical Center in Columbus, says that symptoms are more likely to get worse “at the start of an episode, but it can happen at any point — even for people who have been struggling with depression for some time.”
These fluctuations can sometimes be influenced by “a particular event or change in circumstances. Other times, it’s not obvious why the depression is worsening.”
Signs My Depression May Be Getting Worse
“There are a number of things to look for that could indicate a worsening depression,” Fournier says.
First, the symptoms that you’ve been experiencing could:
— Become more frequent.
— Last longer.
“For example, someone might find that their mood is even lower than it had been, that it occurs on more days during the week, that it lasts for longer or that it no longer changes or brightens regardless of what’s happening around them,” Fournier explains.
In addition, new symptoms can develop. “For example, it’s possible for someone to start having trouble sleeping or notice new changes in their appetite or ability to think and concentrate.”
In more severe situations, thoughts about death or suicide can emerge or intensify. “Sometimes people start to think that life is not worth living or notice themselves taking new risks that they wouldn’t ordinarily take, not caring about the consequences,” Fournier adds.
Symptoms can become “significant enough to interrupt an individual’s ability to function effectively in their daily tasks such as going to and performing on the job, functioning at school, and engaging in everyday family life, this even includes eating, sleeping and engaging in proper hygiene regularly,” Gregg says.
For example, “people experiencing sleep disturbances may start arriving late to work or school or not at all. Some people with severe depression may experience sleep reversal, where they’re awake during the overnight hours and asleep during the daytime. This sleep reversal can then lead to other social issues such as losing their job, dropping out of school, relationship conflicts or interactions with social services if they have young children,” Jackman explains.
She adds that when depression is at its worst, some people “report thoughts of suicide or homicide and they may even make plans and take actions to end their life or someone else’s life. In some cases, people with severe depression may report hallucinations such as auditory, visual and tactile. These are strong indicators that your depression is getting worse and that you will benefit from interventions to help you stabilize.”
What To Do if Your Depression Seems Worse
Anytime your symptoms of depression worsen, you should talk with your health care provider. “If you’re not currently in treatment, talk with your providers about what kinds of treatment are available in your area,” Fournier says. “If you are in treatment, talk with your provider about your treatment plan, what to expect and what changes might be appropriate.”
And he cautions to “keep in mind that as with every other medical condition, not every person responds to every treatment option. It’s not your fault if a treatment winds up not working well for you. A different approach very likely will.” Additional or alternative treatment strategies may be able to not only alleviate symptoms but help you get better, Fournier says.
However, reaching out for help can be difficult for some people because of how the symptoms of depression progress, Gregg says. “It’s not unusual for those who struggle with worsening depression to develop a sense of helplessness or overwhelming hopelessness,” which can make it more difficult to seek help. For example, thoughts such as: ‘ No one can help me get better’ or ‘I will never feel better’ may develop in some people. “This sense of despondency can lead to a belief that others may be better off without the depressed person. Thus, suicide can become a rationalized option for those overwhelmed by the weight of their depression.”
Still, it’s imperative to seek help, and there are a range of professionals who can assist with mental health concerns, from your primary care provider or a counselor to a clinical social worker, a marriage and family therapist skilled in working with people struggling with depression or a psychiatrist.
Jackman recommends reaching out to your primary care provider first, as this person can “provide a referral to a mental health therapist,” who can “assess your symptoms and develop a treatment plan to help improve your functioning.”
If you’re in crisis contact a mental health hotline for support and referral. These services are available 24 hours a day, seven days a week and can offer a lifeline to anyone who’s struggling:
— National Suicide Prevention Lifeline at 1-800-273-8255 (which is also the Veterans Crisis Line).
— Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-662-HELP (4357).
For those who prefer texting, you can text TALK to the Crisis Text Line 24/7 at 741-741 for confidential support via text message.
If your crisis is specifically related to sexual assault, contact the RAINN National Sexual Assault Hotline at 1-800-656-HOPE (4673).
You can also search online for a local mental health hotline. That information is usually posted on your state government website.
The Importance of Seeking Care
Jackman notes that early intervention is best, because if it’s left too long and your symptoms become severe, feeling better may be a more complex undertaking. “People with severe symptoms may require additional interventions such as hospitalization and/or medication to address the depression and provide stabilization. Due to stigma and lack of information about mental health and therapy, people often think that referring a patient to a hospital is a first step, but it’s not. In fact, hospitalization is an intervention that’s used for people whose depression has reached a point that they or the people around them are concerned about their ability to make good judgments about their personal safety.”
No matter how severe your depression is, the good news is that it can be treated. Sometimes therapy alone can lead to vast improvement, and sometimes therapy is used in combination with a range of medications. “Depression is very responsive to treatment,” Gregg says. “Many people who have experienced depression have found success in alleviating their symptoms using this approach.”
But, “without proper intervention by a mental health professional, symptoms of depression are susceptible to worsening over time and may become grave enough to be a threat to the individual’s life,” Gregg says. Seek care at the first signs.
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