Depression

Depression is often quieter than people expect. Not everyone who is depressed is tearful or in bed. Many of the people who come to us for depression are functioning on the outside — holding down a job, showing up for family — and have been, for months or years, quietly losing every source of meaning underneath. The food doesn’t taste like anything. The things that used to interest you don’t. You are tired in a way that sleep doesn’t fix.

Clinical depression is a medical condition, not a character flaw, and it is one of the most treatable conditions in psychiatry. The great majority of people who commit to treatment recover.

What it looks like

The clinical core of depression is persistent low mood and/or loss of interest or pleasure, for most of the day, most days, for at least two weeks. Supporting features usually include some combination of: changes in sleep (either direction), changes in appetite (either direction), fatigue, difficulty concentrating, feelings of worthlessness or inappropriate guilt, slowed thinking or movement, and — sometimes — thoughts of death or suicide.

Some depressions look like sadness. Some look like numbness. Some look like irritability, especially in men and in teenagers. The condition is broader than the stereotype.

Kinds worth naming

• Major depressive disorder (MDD). The condition above, with episodes lasting weeks to months. Most common.
• Persistent depressive disorder (dysthymia). A lower-grade but longer-running version. People with dysthymia often describe it as “my personality” because they can’t remember not feeling this way.
• Seasonal affective disorder (SAD). Episodes tied to a specific season (usually winter). Worth naming in Colorado — we see less of it than northern latitudes but more than people expect, and it responds well to morning light therapy added to standard treatment.
• Postpartum depression. Distinct from the “baby blues” of the first two weeks; typically starts in the first few months after delivery and needs treatment. Also under-recognized. If this is you, do not wait.

How treatment works

Depression has one of the strongest evidence bases in psychiatry, and there are real options across medication, therapy, and lifestyle. None of them work equally well for everyone, which is why much of the first visit is about figuring out what’s most likely to fit your history, your preferences, and whatever you’ve already tried.

For milder episodes, therapy alone, medication alone, or a combination can all be appropriate. For more severe or persistent depression, the combination generally outperforms either one. Your clinician walks you through what the evidence says, what side effects to expect, and what a realistic timeline for improvement looks like — so the plan is one you’ve agreed to, not one handed to you.

When an episode hasn’t responded to first-line treatment, options widen considerably. Some people benefit from switching or augmenting; some from a very different approach altogether. We’ll talk through the next options with you when first-line treatment hasn’t gone far enough.

The exercise conversation

Worth calling out because exercise is the advice people most often bounce off of when they’re depressed. “I know I should, but I can’t” is the disorder talking. The point of treatment is to get the floor under you high enough that a 20-minute walk is possible — and then it becomes a force multiplier for everything else. Trying to exercise your way out of an active episode of depression rarely works and mostly produces more shame. Treatment first, exercise alongside.

When to come in now

• Thoughts of suicide or self-harm, even without a specific plan
• Inability to eat, sleep, or care for yourself
• Postpartum depression, at any severity

For immediate crisis support, the footer of this page has 988 and Colorado Crisis Services. Trend does not provide emergency or after-hours care.

For non-emergency depression that has been going on for more than a few weeks, book an appointment or call 720-443-1691. You don’t have to hit a severity bar to deserve treatment.