Depression: what it is, how it feels and what helps

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People who live with depression often say the hardest part is how hard it is to explain. It can feel like moving through thick fog, like being cut off from everything that used to matter, or like a heavy blanket that makes even small tasks feel impossible. Others notice mostly irritability, exhaustion or emptiness, and do not think of it as depression at all.

This article describes what depression is, how it can show up, why it develops, and what research tells us about what helps. Depression looks different from person to person, so some parts may fit your experience and others may not.

What depression is

Depression is a common mental health condition that affects mood, thinking, the body and behaviour. It differs from an ordinary low phase in its depth and duration: the low mood or loss of interest lasts for weeks, most of the day, and gets in the way of daily life.

Common experiences include:

• a persistently low, empty or numb mood
• losing interest or pleasure in things you used to enjoy
• tiredness and lack of energy, even after rest
• changes in sleep and appetite
• difficulty concentrating or making decisions
• feelings of guilt, worthlessness or hopelessness
• slowing down, or feeling restless and agitated
• in some cases, thoughts of death or of ending one’s life

Depression can affect anyone, whatever their strength or willpower, and only a professional can make a diagnosis. If you recognise yourself in this description, it is a good reason to talk to your doctor or a mental health professional. You can also read Burnout, depression or just a low mood?

Why depression develops

There is rarely a single cause. Depression usually grows out of a combination of factors:

• Stress and life events: loss, separation, illness, unemployment, migration, long periods of overload.
• Psychology: patterns such as harsh self-criticism, rumination or perfectionism, and early experiences that shaped how we see ourselves.
• Social context: loneliness, discrimination, poverty and lack of support.
• Biology: genes, the stress system, inflammation, hormones and physical illness, described in more detail below.

Social connection is especially relevant. A meta-analysis of 64 studies from Iran found a clear positive relationship between social support and mental health (Harandi et al., 2017), in line with research from many other countries.

The biological side of depression

Depression involves the body as well as the mind, and the two keep influencing each other. Research on the biological side has grown a lot in recent years. These are some of the main areas.

Genes

Depression runs in families to some degree. A genetic study of more than 800,000 people identified 102 genetic variants linked to depression, many involved in how nerve cells connect and communicate (Howard et al., 2019). Each variant has only a tiny effect. Genes can raise or lower vulnerability, and they do not decide anyone’s fate.

The stress system

Long-lasting stress keeps the body’s stress hormone system active. A meta-analysis of 361 studies found that people with depression tended to have higher cortisol levels, although the difference was about half as large in studies with stricter methods (Stetler & Miller, 2011).

Inflammation

The immune system and mood are closely connected. Many people with depression show signs of increased inflammation, and inflammation in turn can make depression more likely and harder to treat. The relationship seems to work in both directions, and not everyone with depression has raised inflammation (Beurel et al., 2020).

Physical conditions and medications

Some physical conditions can cause or worsen depressive symptoms, and are worth checking, especially when depression appears without a clear reason:

• An underactive thyroid (hypothyroidism). A meta-analysis found a modest link with clinical depression, stronger for clear thyroid disease and in women (Bode et al., 2021).
• Low vitamin D. People with depression had lower vitamin D levels on average, and in long-term studies low levels were linked to a higher risk of later depression (Anglin et al., 2013). This does not prove that vitamin D causes depression, but it is easy to test.
• Anaemia, diabetes, chronic pain, heart disease, sleep apnoea and hormonal changes, for example after childbirth or around menopause.
• Medications. A large US survey found that more than a third of adults used at least one prescription medication that lists depression as a possible side effect, and that depression was more common among people who took several of them (Qato et al., 2018). Never stop a medication on your own, but it is worth asking your doctor about it.

What research says helps

Psychotherapy and medication

Both psychotherapy and antidepressant medication are established treatments for depression. A network meta-analysis of 101 studies with almost 12,000 patients found that psychotherapy alone and medication alone worked about equally well, and that the combination of both was more effective than either one alone for moderate to severe depression. Psychotherapy alone and the combination were also more acceptable to patients than medication alone (Cuijpers et al., 2020).

Which approach fits depends on the severity of the depression, your history and your preferences, and is best decided together with a doctor or therapist. Different forms of therapy are described in Which therapy is right for me?

Activity, step by step

One of the best-studied psychological approaches is behavioural activation. It works with a simple idea: depression makes us withdraw, and withdrawal deepens depression. By planning small, meaningful activities, the cycle can be reversed gradually. A meta-analysis found that behavioural activation reduced depression and anxiety and increased activity (Stein et al., 2021).

Movement

Exercise is linked with fewer depressive symptoms. A network meta-analysis of randomised trials found benefits for walking or jogging, yoga and strength training, with stronger effects for more intense activity (Noetel et al., 2024). Movement can complement treatment, and it is worth discussing with your doctor what is realistic for you.

Digital programmes

Internet-based programmes based on cognitive behavioural therapy have been shown to reduce symptoms of depression, especially when they include guidance from a professional (Karyotaki et al., 2021). In some countries, health systems or insurers give access to some of these programmes.

Things that may help in everyday life

• Keep a basic rhythm: similar times for getting up, eating and going to bed.
• Plan one small pleasant or meaningful thing per day, even if you do not feel like it.
• Stay in contact, even briefly. Tell one person how you are really doing.
• Be careful with alcohol, which can deepen low mood and disturb sleep.
• Treat yourself with patience. Recovery from depression often comes in waves.

Depression far from home

For people who live abroad, depression can be harder to recognise. Symptoms may be mistaken for homesickness or the stress of adapting, and family may be far away. Some people find it easier to talk in their first language, others feel comfortable in the language of their new country. What matters most is finding someone you can trust. More on this in Loneliness after moving abroad.

If you are reading this for someone else

Maybe you came here because someone you love seems low, withdrawn or exhausted. You cannot make depression go away for another person, and your presence can still matter a great deal. Ideas for what to say and do are collected in How to support a friend or family member with depression.

When to seek help urgently

If you have thoughts of ending your life, if you feel you cannot keep yourself safe, or if you cannot manage basic daily needs, please seek help immediately. Depression is treatable, and you deserve support.

More about therapy with me.

References

• Anglin, R. E., Anglin, R. E., Samaan, Z., Walter, S. D., & McDonald, S. D. (2013). Vitamin D deficiency and depression in adults: systematic review and meta-analysis. The British Journal of Psychiatry, 202, 100–107. https://doi.org/10.1192/bjp.bp.111.106666
• Beurel, E., Toups, M., & Nemeroff, C. B. (2020). The bidirectional relationship of depression and inflammation: Double trouble. Neuron, 107(2), 234–256. https://doi.org/10.1016/j.neuron.2020.06.002
• Bode, H., Ivens, B., Bschor, T., Schwarzer, G., Henssler, J., & Baethge, C. (2021). Association of hypothyroidism and clinical depression: A systematic review and meta-analysis. JAMA Psychiatry, 78(12), 1375–1383. https://doi.org/10.1001/jamapsychiatry.2021.2506
• Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020). A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92–107. https://doi.org/10.1002/wps.20701
• Harandi, T. F., Taghinasab, M. M., & Nayeri, T. D. (2017). The correlation of social support with mental health: A meta-analysis. Electronic Physician, 9(9), 5212–5222. https://doi.org/10.19082/5212
• Howard, D. M., Adams, M. J., Clarke, T. K., Hafferty, J. D., Gibson, J., Shirali, M., Coleman, J. R. I., Hagenaars, S. P., Ward, J., Wigmore, E. M., Alloza, C., Shen, X., Barbu, M. C., Xu, E. Y., Whalley, H. C., Marioni, R. E., Porteous, D. J., Davies, G., Deary, I. J., . . . McIntosh, A. M. (2019). Genome-wide meta-analysis of depression identifies 102 independent variants and highlights the importance of the prefrontal brain regions. Nature Neuroscience, 22(3), 343–352. https://doi.org/10.1038/s41593-018-0326-7
• Karyotaki, E., Efthimiou, O., Miguel, C., Bermpohl, F. M. G., Furukawa, T. A., Cuijpers, P., Individual Patient Data Meta-Analyses for Depression (IPDMA-DE) Collaboration, Riper, H., Patel, V., Mira, A., Gemmil, A. W., Yeung, A. S., Lange, A., Williams, A. D., Mackinnon, A., Geraedts, A., van Straten, A., Meyer, B., Björkelund, C., . . . Forsell, Y. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry, 78(4), 361–371. https://doi.org/10.1001/jamapsychiatry.2020.4364
• Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., Del Pozo Cruz, B., van den Hoek, D., Smith, J. J., Mahoney, J., Spathis, J., Moresi, M., Pagano, R., Pagano, L., Vasconcellos, R., Arnott, H., Varley, B., Parker, P., Biddle, S., & Lonsdale, C. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ, 384, e075847. https://doi.org/10.1136/bmj-2023-075847
• Qato, D. M., Ozenberger, K., & Olfson, M. (2018). Prevalence of prescription medications with depression as a potential adverse effect among adults in the united states. JAMA, 319(22), 2289–2298. https://doi.org/10.1001/jama.2018.6741
• Stein, A. T., Carl, E., Cuijpers, P., Karyotaki, E., & Smits, J. A. J. (2021). Looking beyond depression: a meta-analysis of the effect of behavioral activation on depression, anxiety, and activation. Psychological Medicine, 51(9), 1491–1504. https://doi.org/10.1017/s0033291720000239
• Stetler, C., & Miller, G. E. (2011). Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research. Psychosomatic Medicine, 73(2), 114–126. https://doi.org/10.1097/psy.0b013e31820ad12b

This article is exploratory and meant for information and reflection. It cannot capture the full complexity of any individual situation, and your own experience may be different. It does not replace a diagnosis or treatment.

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