A depression, if it is not primarily a reaction to a life event, is called in psychiatry a major depressive disorder (MDD). It is a condition characterized by at least two weeks of low mood that is present across most situations.[1] It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and psychological pain without a clear cause. There may also be false beliefs and – in the more severe cases – acoustic or visual hallucinations. Major depression needs to be differentiated from sadness. Depression often actually means the subjective absence of feelings, such as sadness. Those afflicted with depression often cannot feel themselves anymore as before, which can cause additional anxiety.

Major depressive disorder affected approximately 253 million (3.6%) of people in 2013. [14] The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. [15] Lifetime rates are higher in the developed world (15%) compared to the developing world (11%). [15] Depression causes the second most years lived with a disability after low back pain. [5] The most common time of onset is in a person in their 20s and 30s. Females are affected about twice as often as males.[2][6]

The many forms of depression

Depression can come in many forms and guises. A mental health professional can help you to identify more closely if you are suffering from depression and form which form. Some ups and downs are a normal part of life. Life does not come in a straight line, which is actually good news, because a straight line would mean that we miss out on the excitement, the feeling alive, that life also offers. However, if the lows, or the highs in those suffering from a bipolar condition, take on intensity or frequency that reduces your quality of life or ability to perform everyday tasks, you should consult a mental health professional.

Melancholia is sometimes seen as a mild form. The cliche image is sitting curled up by a window on a rainy day. Dysthymia is usually the term for episodes of depression that stay just below the clinical threshold. While major forms of depression can occur in one episode or in multiple episodes. Still, however intense it feels, talking to someone about it is usually a good idea, even in milder cases. The view from the outside can be helpful. We may be caught so much by our feeling low that it begins to feel normal. Good indications for depression are not just the feelings one experiences, which in severe forms of depression can be almost absent, but also one’s daily activities and interactions with others. This is where the view from the outside can be helpful. Some people have only one episode of depression in their life, some have episodes of depression separated by years in which they feel normal, while others have symptoms almost constantly. But in all these different forms, from the single case to the recurring depression, treatment is usually effective.

DSM-5 Diagnostic Criteria

The DSM-V, the Diagnostic and Statistical Manual of Mental Disorders in its 5th edition, published by the American Psychiatric Association outlines the following criteria for a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

  1. Depressed mood most of the day, nearly every day.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
  5. Fatigue or loss of energy nearly every day.
  6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  8. Recurrent thoughts of death, without a specific plan, or a suicide attempt or a specific plan for committing suicide.

A diagnosis always needs to be carried out by a trained mental health professional.

Another form of depression is reactive depression, which occurs as part of a number of conditions, such as post-traumatic stress disorder (PTSD). I discuss these forms of depression within the articles on these conditions. For PTSD, for example, you may want to look at one of my articles on PTSD:

Communication-Focused Therapy (CFT) for PTSD (2)

Posttraumatic Stress Disorder (PTSD) is a relatively common disorder resulting from very different traumatic events or situations. A trauma represents information which cannot be processed by the organism in a way that is fully self-healing in the short-term. It causes a disturbance to internal communication systems which affects the internal and communication patterns a person ...

Intepersonal Psychotherapy and Exposure Therapies for PTSD (1)

Interpersonal Psychotherapy is a non-exposure-based PTSD treatment. Patients focus on current interpersonal encounters rather than past traumas. This approach may avoid some of the disadvantages of exposure oriented therapies, such as their lack of focus on individual processes, high attrition rates, lower effectiveness for symptoms of depression, association with fear induction and possible short-lived positive ...

Suicidal Thoughts

Suicidal thoughts can be quite common when one feels low or helpless. However, it should always be taken seriously and a mental health professional should be consulted. It does not automatically one has to stay in a hospital. Rather, it should be seen as a sign that something needs to be done quickly to address the mental health condition and raise the quality of life. Between 2-7% of adults with major depression die by suicide [3] and up to 60% of people who die by suicide had depression or another mood disorder [4]. With the right treatment early enough most of these suicides could have been prevented. Unfortunately, access to healthcare, particularly in the mental health area, is not the same everywhere. But in any case, if you experience suicidal thoughts, you should consult a healthcare professional right away. You can always call and go to an A&E. If none is available quickly, then you should contact a suicide hotline while making arrangements to see a mental health professional in person as soon as possible. Many people have experienced suicidal thoughts in their life, and it can be a strong starting point for very successful therapy.

A Vicious Cycle

Many people with milder forms of depression eventually come out of an episode, either spontaneously or because they have a good support network, are able to manage their stress in life, look after their sleep hygiene, exercise (in healthy moderation), and meditate, for example. However, psychotherapy or counselling is helpful at all levels of depression, and it can help prevent another episode. The problem is that depression can lead to a vicious cycle. The consequences of depression on one’s social life, for example, can make it more difficult to get out of the depression. Major depressive disorder can negatively affect a person’s family, work or school life, sleeping or eating habits, and general health, which distances us from an important resource for better mental health, other people.


The cause is believed to be a combination of genetic, environmental, and psychological factors. [1] Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse. [1] [2] About 40% of the risk appears to be related to genetics. [2]

Some other common symptoms of depression

Major depression significantly affects a person’s family and personal relationships, work or school life, sleeping and eating habits, and general health. [7] Its impact on functioning and well-being has been compared to that of other chronic medical conditions such as diabetes. A person having a major depressive episode usually exhibits a very low mood, which pervades all aspects of life, and unhedonia, the inability to experience pleasure in activities that were formerly enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred. [8] In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant.[9]

Other symptoms of depression include

  • poor concentration and memory
  • withdrawal from social situations and activities
  • reduced sex drive, irritability,
  • insomnia
  • and thoughts of death or suicide (which requires immediate professional help).

Insomnia is a common symptom. In the typical pattern, a person wakes very early and cannot get back to sleep.[25] Hypersomnia, or oversleeping, can also happen.[25] Some antidepressants may also cause insomnia due to their stimulating effect.[26]

A depressed person may report multiple physical symptoms such as

  • fatigue
  • headaches, or
  • digestive problems.

Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. Family and friends may notice that the person’s behavior is either agitated or lethargic.



The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression.

On the biological side, the monoamine hypothesis is still the predominant biological explanation of depression. The monoamines are serotonine, norepinephrine, and dopamine. The antidepressants act on the neurotransmitter levels or on the receptors.

synapse-and-monoamine-hypothesis psychiatry psychotherapy depression
Chemical Transmission at the Synapse

Serotonin is hypothesized to regulate other neurotransmitter systems; decreased serotonin activity may allow these systems to act in unusual and erratic ways.[43] According to this “permissive hypothesis”, depression arises when low serotonin levels promote low levels of norepinephrine, another monoamine neurotransmitter.[44] Some antidepressants enhance the levels of norepinephrine directly, whereas others raise the levels of dopamine, a third monoamine neurotransmitter. These observations gave rise to the monoamine hypothesis of depression. In its contemporary formulation, the monoamine hypothesis postulates that a deficiency of certain neurotransmitters is responsible for the corresponding features of depression.

For further articles on depression on this site:

Pilot Testing C-STRESS: A Mental Health App for College Students With Depression

Conditions:   Depression;   Anxiety;   Stress, Psychological;   Mobile Phone UseIntervention:   Device: C-STRESSSponsors:   Benten Technologies, Inc.;   University of California, IrvineCompleted

Chatbot Intervention for Anxiety and Depressive Symptoms in Young Adults

Conditions:   Anxiety;   DepressionInterventions:   Behavioral: Chatbot;   Behavioral: Control (book)Sponsors:   University of Social Sciences and Humanities, Warsaw;   Ministry of Science and Higher Education, PolandCompleted

Effectiveness of yoga for major depressive disorder: A systematic review and meta-analysis

Major depressive disorder (MDD) has a relapse rate that cannot be ignored and places a tremendous burden on the patient in the prevention and treatment process. Yoga, a combination of physical and mental exercises, is effective and acceptable for the adjunctive treatment of MDD. This study aimed to explore further the evidence of yoga’s efficacy ...

A cross-sectional study of sleep, mood, well-being, motivations, and perceived support in Ukrainian veterans and active-duty military personnel with disability, and their supporters, preparing for a sporting event

PurposeThe benefits of sports and exercise to the lives and rehabilitative journeys of military veterans with disabilities is increasingly well-documented but veteran sporting events remain underexplored. Addressing this topic, the current article seeks to provide insight into the health and well-being of Team Ukraine during a 5-week preparatory camp in the UK before attendance at ...

Somatic symptom profiles are associated with pre-treatment depression and anxiety symptom severity but not inpatient therapy outcomes


Sustained increase in depression and anxiety among psychiatrically healthy adolescents during late stage COVID-19 pandemic

Increased symptoms of depression and anxiety were sustained at the later stage of the pandemic in healthy adolescents. Replication of these findings with a larger sample size would be required to draw firm conclusions.

Relationship of insight to neurocognitive function and risk of recurrence in depression: A naturalistic follow-up study

… Lack of insight may affect patients’ motivation to seek treatment, resulting in poor clinical outcomes. … Patients with MDD, without insight, had significantly higher total and factor scores (anxiety/somatization, weight, retardation, and sleep) on the HAM-D and worse performance in the neurocognition task, compared to those with insight. Furthermore, binary logistic regression revealed that ...

Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis

This study was designed to investigate the prevalence of predictors of depression in patients after pacemaker implantation during the COVID-19 pandemic in addition to identifying specific depressive symptoms associated with quality of life (QOL) using network analysis (NA).

Communication and Connectedness against Depression and Anxiety

Haverkampf-CJ-Communication-and-Connectedness-against-Depression-and-Anxiety-J-Psychiatry-Psychotherapy-Communication-2022-Jun-30-62-21-24Download   Communication and Connectedness against Depression and Anxiety Christian Jonathan Haverkampf Abstract—Connectedness with others is an important criterion for mental health. While understanding the underlying content and dynamics is essential, connectedness with others can help reduce anxiety and depression. In addition, external connectedness requires internal connectedness. Index Terms—connectedness, communication, depression, anxiety, treatment, psychotherapy, psychiatry I.     INTRODUCTION Connectedness is a feeling of ...

Depression and the Emotions

Depression is a state of low mood and aversion to activity that can affect a person’s thoughts, behaviour, feelings, and sense of well-being. In its extreme form, depression leads to a state where one no longer feels one’s emotions, which is ultimately meant by the term ‘depression’, an overall decrease in feeling one’s emotions, including ...

Seasonal Affective Disorder (SAD): the link between sunlight and health

Sunlight helps to regulate the hormones serotonin and melatonin, it has also been shown to affect brain blood flow. Thus, sunlight may not only affect mood directly, but also via its effect on cognition, because cognitive impairment can underlie a depressive episode. A lack of vitamin D, which is synthetized in the presence of sunlight, can ...

Psychotherapy to Treat and Manage Depression For this video and more information about depression see the National Alliance on Mental Illness Psychotherapy helps people with depression: * Understand the memories, thoughts, emotions and behaviours that contribute to their depression * Understand unresolved emotions and life events from one’s personal history which may contribute to the depression * Understand interpersonal difficulties and maladaptive interpersonal interaction patterns * ...

Building on the Basic Parameters (1)

Building on the Basic Parameters: Living the Good Life Christian Jonathan Haverkampf, M.D. Living according to the basic parameters means an increased quality of life, living a better life. The basic parameters are the needs, values and aspirations of an individual. Communication helps to make this possible. Keywords: depression, treatment, psychotherapy, psychiatry Contents Introduction. 3 References. 4 Introduction Building on the basic parameters ...

Communication-Focused Therapy® (CFT) for Depression

Communication-Focused Therapy® (CFT) for Depression Christian Jonathan Haverkampf, M.D. Depression is a mental health condition that affects a large part of the population at least once over their life span, significantly reducing life quality and impairing work and relationships. Psychotherapy and medication are the main treatments for the condition. Communication-Focused Therapy® (CFT) is a therapy developed by ...

Depression (5)

Depression Christian Jonathan Haverkampf, M.D. Depression is one of the most common medical conditions, which can interfere significantly with a person’s quality of life, relationships and ability to work. Several effective treatments are available, including psychotherapy and medication. This article contains a brief overview of both areas, while focusing on psychotherapy, particularly Communication-Focused Therapy® (CFT), as developed ...


Depression Christian Jonathan Haverkampf, M.D. Depression is one of the most common medical conditions, which can interfere significantly with a person’s quality of life, relationships and ability to work. Several effective treatments are available, including psychotherapy and medication. This article contains a brief overview of both areas, while focusing on psychotherapy, particularly Communication-Focused Therapy® (CFT), as developed ...

Communication-Focused Therapy® (CFT) for Depression

Communication-Focused Therapy® (CFT) for Depression Christian Jonathan Haverkampf, M.D. Depression is a mental health condition that affects a large part of the population at least once over their life span, significantly reducing life quality and impairing work and relationships. Psychotherapy and medication are the main treatments for the condition. Communication-Focused Therapy® (CFT) is a therapy developed by ...


Burnout Dr Christian Jonathan Haverkampf, M.D. Burnout is a type of psychological stress. Occupational burnout or job burnout is characterized by exhaustion, lack of enthusiasm and motivation, feelings of ineffectiveness, and often a sense of frustration and higher irritability. Efficacy within the workplace is usually reduced, no matter how much the individual tries to work even harder ...

Haverkampf CJ Atypical Depression J Psychiatry Psychotherapy Communication 2018 Dec 31 9(4) 91-97

Body Work and Exercise for Anxiety Panic Attacks Depression and OCD

Body Work and Exercise for Anxiety, Panic Attacks, Depression and OCD Christian Jonathan Haverkampf, M.D. Working with the body is often neglected in major schools of psychotherapy, such as psychodynamic psychotherapy and CBT. Depression and anxiety disorders are some of the most prevalent psychiatric disorders with close to one in five of adults exhibiting symptoms. Exercise has ...

Psychopharmacological Frontiers (1)

Psychopharmacological Frontiers Christian Jonathan Haverkampf, M.D. New developments in psychopharmacology have driven much of the progress over the last decades. This article discusses new developments in the area of antidepressants and antipsychotics. Keywords: depression, SSRI, SNRI, ketamine, glutamate antagonist, NMDA, scopolamine, magnesium, glutamine, CP-AMPA, serotonin, norepinephrine, dopamine, antidepressants, major depressive disorder, medication, treatment psychiatry Table of Contents Introduction. 4 Discovery. 5 From ...

Tell me about Your Life – Narrative Communication and Change

Communication-Focused Therapy (CFT) for Depression

Communication-Focused Therapy (CFT) for Depression Christian Jonathan Haverkampf, M.D. Depression is a mental health condition that affects a large part of the population at least once over their life span, significantly reducing the quality of life and impairing work and relationships. The condition is mostly treated with psychotherapy and medication. Communication-Focused Therapy (CFT) is a therapy form ...

Depression and Psychotherapy (6)

Abstract – Depression has become highly treatable and this article explores some ways of treating it with the use of psychotherapy. The approach presented is a communication focused psychotherapy which has been developed and described by the author before. Psychotherapy alone may not be sufficient in more severe cases, where medication is usually added to ...

Depression and Medication (3)

Abstract – Depression is the medical condition with one of the highest prevalence rates, but also one of the costliest ones in terms of human suffering, missed work hours, higher mortality and the higher incidence of physical illnesses. First-line treatment is usually a combination of medication and psychotherapy. In milder cases, psychotherapy alone may be ...

Depression in pregnancy needs to be treated

News items are not checked for factual correctness or safety. Much attention has focused on postpartum depression (that is, the occurrence of depression in the mother after giving birth), which occurs in about one in 8-10 women. But depression during the nine months of pregnancy occurs as frequently, yet has received less spotlight. For the full article ...


[1] “Depression”. NIMH. May 2016.

[2] American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 160–168, ISBN 978-0-89042-555-8

[3] Richards, C. Steven; O’Hara, Michael W. (2014). The Oxford Handbook of Depression and Comorbidity. Oxford University Press. p. 254. ISBN 9780199797042.

[4] Lynch, Virginia A.; Duval, Janet Barber (2010). Forensic Nursing Science. Elsevier Health Sciences. p. 453. ISBN 0323066380.

[5] Global Burden of Disease Study 2013, Collaborators (22 August 2015). “Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.”. Lancet (London, England). 386 (9995): 743–800. doi:10.1016/S0140-6736(15)60692-4. PMID 26063472.

[6] Kessler, RC; Bromet, EJ (2013). “The epidemiology of depression across cultures.”. Annual review of public health. 34: 119–38. doi:10.1146/annurev-publhealth-031912-114409. PMC 4100461. PMID 23514317.

[7] Depression (PDF). National Institute of Mental Health (NIMH).

[8] American Psychiatric Association 2000a, p. 349

[9] American Psychiatric Association 2000a, p. 412

© 2012, 2016 Dr Christian Jonathan Haverkampf. All rights reserved.


Psychotherapy & Counselling, Communication, Medicine (Psychiatry); Dublin, Ireland

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This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition.

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