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We have all experienced times when we have been sad or felt down.  This is normal.  However, these episodes should be short and are usually related to a specific event, for example, death, job loss, or illness.  Clinical depression is an abnormal mental state that affects your mood, is nearly all-consuming, and persists for extended periods of time.  It interferes with your ability to work, maintain healthy relationships, and perform simple everyday tasks.  

Major depression is the second leading cause of disability in the United States among all illnesses and injuries.

Depression is the most common psychiatric disorder in the world and may be more common than we currently know because those with depression typically do not discuss their condition with family, friends, or medical professionals. 

Hesitancy to discuss depression is usually due to a few reasons. 

1) There is still a stigma about mental illness which makes people hesitant to admit they are struggling. 

2) Many still perceive depression as a mental weakness or something they should be able to talk themselves out of. 

3) Many worry about how a documented mental illness will affect their ability to maintain a driver’s license, obtain life insurance, keep certain professional licenses, and many other concerns.  

Clinical depression is a true illness that needs treatment.  Untreated depression leads to poor quality of life, risk of self-harm and suicide, and development or worsening of other health conditions.  People with depression are statistically more likely to have other health problems and will have a more difficult time treating or managing these other health problems.  People with depression are more than twice as likely to die from other diseases than those who are not depressed with the same medical condition (for example, diabetes, heart disease, and kidney disease).

General Overview
Risk Factors for Depression

Types of Depression

Depression is not straightforward.  There are several causes and types of depression.  Some types of depression are:


  • ​​Unipolar major depression (major depressive disorder)

  • Persistent depressive disorder (dysthymia; major depression lasting more than 2 years)

  • Premenstrual dysphoric disorder (PMS, PMDD)

  • Substance/medication-induced depressive disorder

  • Seasonal affective disorder (SAD)


This list is not complete, there are other types of depression.  Because depression is complex patients must be evaluated by a medical professional.

Risk Factors for Depression

People with certain risk factors and personality characteristics are more likely to have depression.  Some of these include:

  • A personal or family history of depression

  • Excessive worry

  • Negative view of life

  • Low self-esteem

  • Alcohol or drug abuse

  • Childhood or adult trauma

  • Stressful life events in the past year

  • Divorce or marital/relationship problems

  • Inadequate social support

Emergency Resources

If you ever feel like you might hurt yourself or someone else, do one of these things:


Diagnosing Depression

There are several variations of depression and a depressed mood can be part of other mental disorders or even co-exist with other mental illnesses (such as anxiety, substance abuse disorder, PTSD) which is why it is important to be properly evaluated by a medical professional trained in psychiatry or psychology.  To be diagnosed with major depression, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), you must have five of the symptoms listed below that are present most of the day, nearly every day for a least two consecutive weeks.  One of the symptoms must be depressed mood or loss of interest/pleasure.

The diagnostic criteria for depression include:

  • Depressed mood (Feeling sad, down, hopeless, anxious, annoyed, irritable, angry, and/or having no feelings.)

  • Loss of interest or pleasure in most things (No longer enjoy things you used to enjoy.)

  • Sleeping too much or too little (Difficulty falling or staying asleep, never feeling rested, no energy to get out of bed.)

  • Change in appetite or weight (Eating more or less than you used to enough to result in weight loss or gain.)

  • Restlessness or sluggishness (Inability to sit still or slow speech/movements.)

  • Fatige or low energy (Feeling exhausted.  Difficulty starting or finishing tasks.)

  • Feeling worthless or guilty

  • Decreased ability to think, concentrate, or make decisions

  • Thoughts of hurting or killing yourself (Feeling life isn’t worth living, you would be better off dead, or having specific plans on how to kill yourself.)

Diagnosing Depression
Types of Depression
Depression Screening Tool
Emergency Information

Treating Depression

The goal of treatment is to resolve your symptoms enabling you to resume a functional life.  Initial therapy usually consists of medication, psychotherapy, or both.  There are several types of medication used to treat major depression and the choice of medication varies depending on your symptoms, age, other mental health conditions, medical problems, cost, possible side effects, and other considerations.  One of the difficulties in treating depression is the fact that not everyone responds to treatment in the same way.  Sometimes different doses and combinations of medications need to be tried to find the right medication for an individual patient.  Additionally, it is common for medication that was once helpful to stop working over time making it necessary to change or adjust medications.

Psychotherapy is an effective treatment for major depression.  The difficulty of therapy is that many depressed individuals find it challenging to do the work required for therapy to be effective.  It can be difficult to make and keep appointments and do the recommended self-work assigned by the therapist. 


Transcranial magnetic stimulation (TMS) is another type of therapy shown to be effective for some patients who have not improved with medication or psychotherapy.  This consists of placing a device on the patient’s head that passes a magnetic wave into the brain.


For those with severe symptoms who have not seen improvement with other treatments, electroconvulsive therapy (ECT) may be used.  This therapy passes an electrical current through the patient’s brain.


A new treatment for major depression that has not improved with other treatments is ketamine.  Ketamine is an anesthetic medication that disrupts the connection to the conscious mind.  It has shown promising results for many with treatment-resistant major depression.

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Where to Go from Here

If you already have an official diagnosis of major depressive disorder, dysthymia, bipolar I or II, generalized anxiety disorder, PTSD, or OCD and treatments have not been helping, contact our patient coordinator to see if you are a good candidate for ketamine treatments





If you need a mental health provider, contact your insurance for providers who take your insurance.  If you are uninsured and live in Arizona, please visit:


Connections Urgent Psychiatric Clinic 


Virginia G. Piper Medical Clinic

420 West Watkins Road

Phoenix, AZ 85003



Below is a link for a list of providers in Arizona who charge based on the patient’s ability to pay.

Call or Text Now 480.341.5174

The following organizations also provide reliable health information.

●National Library of Medicine

●National Institute of Mental Health

●American Psychiatric Association

●American Psychological Association

●American Academy of Child and Adolescent Psychiatry

●Depression and Bipolar Support Alliance

●Mental Health America

●National Alliance for the Mentally Ill

Where to go from here
Treating Depression

This information is NOT comprehensive and should NOT be used as a substitute for medical advice, diagnosis, or treatment by a health care provider.  This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient.  All patients must be examined and diagnosed individually to determine the appropriate diagnosis and treatment for each individual patient.


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