Understanding Depression: Symptoms, Tests, Antidepressants, and TMS
- Sophroneo Psychiatry
- 4 days ago
- 11 min read
Depression: Symptoms, Depression Test, Antidepressants, Ketamine, and TMS
Living with depression can feel isolating and overwhelming, but you are not alone, and effective, evidence-based treatments are available. At Sophroneo Behavioral Health & TMS, we approach depression as a treatable medical condition, not a personal failing. We are committed to providing a clear, compassionate path forward.
This article provides an overview of depression symptoms, the clinical tools we use like a depression test to measure them, and the full spectrum of modern treatments. We will cover antidepressants like SSRIs, discuss the role of serotonin, and explore advanced options like ketamine and our specialty, TMS (Transcranial Magnetic Stimulation).
What is depression and how common is it?
Depression, clinically known as Major Depressive Disorder (MDD), is a common and serious mood disorder characterized by a persistent low mood and a significant loss of interest or pleasure in daily activities. It is not simply sadness or a passing mood; it is a persistent medical condition that affects how you feel, think, and behave, and it can lead to a variety of emotional and physical problems.
According to the National Institute of Mental Health (NIMH), depression is one of the most common mental disorders in the United States. It can affect anyone at any age, but it often begins in adulthood.
What defines a major depressive episode?
A major depressive episode is defined by experiencing five or more specific depression symptoms for at least a two-week period, representing a change from previous functioning. Crucially, at least one of the symptoms must be either a depressed mood or anhedonia, which is the loss of interest or pleasure in almost all activities.
Other symptoms include:
Significant weight loss or gain, or a decrease or increase in appetite.
Insomnia (difficulty sleeping) or hypersomnia (sleeping too much).
Feeling physically agitated or, conversely, slowed down (psychomotor agitation or retardation).
Fatigue or a profound loss of energy nearly every day.
Feelings of worthlessness or excessive, inappropriate guilt.
Diminished ability to think, concentrate, or make decisions.
Recurrent thoughts of death or suicidal ideation.
Which depression symptoms should prompt urgent care?
Any mention of suicidal thoughts, self-harm, or wanting to die should be taken seriously and requires immediate attention. If depression symptoms include psychosis, such as hallucinations (seeing or hearing things that are not there) or delusions (fixed, false beliefs), it is a psychiatric emergency. These symptoms require urgent evaluation to ensure safety.
Which depression symptoms are most common and how do they feel day to day?
The most common depression symptoms are the persistent sadness and anhedonia described above, but the day-to-day experience of depression can vary. For one person, it might feel like "moving through mud," where every task requires immense effort. For another, it may manifest as a constant, irritable buzz of worthlessness and a short temper.
Patients often describe feeling "empty," "numb," or "hollow." This emotional pain is frequently coupled with physical depression symptoms like chronic fatigue, headaches, and digestive issues that do not respond to typical treatments. Social withdrawal is also very common, as interacting with others can feel exhausting.
Which red flags suggest severe or psychotic depression?
Red flags for severe depression include a significant decline in personal hygiene, a refusal to get out of bed, or stopping eating or drinking. The most severe red flags involve psychosis. Psychotic depression is when the illness is accompanied by a break from reality. These delusions are often mood-congruent, meaning the content is negative, such as a belief that one is personally responsible for a terrible event or is being punished for a sin. These symptoms require immediate psychiatric intervention.
Which depression test do doctors use and how are scores interpreted?
Clinicians commonly use a standardized depression test called the Patient Health Questionnaire-9 (PHQ-9) to screen for, diagnose, and monitor depression. This simple, 9-question tool asks you to rate how often you have been bothered by various depression symptoms over the past two weeks.
At Sophroneo Behavioral Health & TMS, we use the PHQ-9 as a cornerstone of our "measurement-based care" approach. It is not just a form; it is a vital tool that gives us a baseline score of your depression severity. This allows us and you to objectively track your progress together, seeing tangible proof as your score decreases with effective treatment.
A depression test score on the PHQ-9 is interpreted as follows:
0-4: Minimal depression
5-9: Mild depression
10-14: Moderate depression
15-19: Moderately severe depression
20-27: Severe depression
What is the PHQ-2 and when is it used?
The PHQ-2 is an even shorter depression test, consisting of just the first two questions of the PHQ-9 (focused on low mood and anhedonia). It is a rapid screening tool often used in busy primary-care settings. If a patient screens positive on the PHQ-2, the provider will typically follow up with the full PHQ-9.
How often should primary-care repeat a depression test?
A depression test should be administered at the initial assessment to establish a baseline. It should then be repeated at regular follow-up appointments (e.g., every 4-6 weeks) after starting a new treatment, such as antidepressants or therapy. This regular monitoring is key to measurement-based care, helping determine if a treatment is working or if a change in a plan is needed.
What are antidepressants and how do SSRIs affect serotonin?
Antidepressants are medications prescribed to help relieve the symptoms of depression, anxiety, and other conditions. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most common class of antidepressants prescribed today.
Serotonin is a neurotransmitter, a chemical messenger in the brain, that is heavily involved in regulating mood, sleep, and appetite. In depression, serotonin signaling is often dysregulated. SSRIs work by selectively blocking the "reuptake" pump on the neuron that sent the message. This blockage prevents the serotonin from being reabsorbed too quickly, leaving more of it available in the synapse (the gap between neurons) to transmit signals.
Which SSRI is often first-line and why?
Common first-line SSRIs include sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac). Clinicians often choose from this class first because, compared to older antidepressants, SSRIs have a well-understood safety profile, are effective for many people, and generally have fewer and less severe side effects.
Which side effects are common with antidepressants and SSRIs?
While SSRIs are generally well-tolerated, they can cause side effects, especially when first starting. These often lessen after a few weeks. Common side effects include nausea, headache, dry mouth, sleep disturbances (insomnia or drowsiness), and sexual dysfunction.
It is crucial to take antidepressants exactly as prescribed and to never stop them abruptly, which can cause withdrawal symptoms. If side effects are bothersome, speak to your provider. There are many different antidepressants, and finding the right one can sometimes take trial and error.
When did modern treatments begin and what is the history of antidepressants?
The modern history of antidepressants began largely by accident in the 1950s. Researchers discovered that a drug for tuberculosis (iproniazid, an MAOI) and a potential antihistamine (imipramine, a TCA) had profound mood-lifting effects in some patients. This launched the pharmacological era of depression treatment.
These first-generation antidepressants, MAOIs (Monoamine Oxidase Inhibitors) and TCAs (Tricyclic Antidepressants), were effective but had significant side effects and safety concerns, such as dietary restrictions for MAOIs and overdose risk for TCAs.
Why did SSRIs change practice in the late 1980s?
The history of antidepressants took a major turn with the introduction of fluoxetine (Prozac) in 1987. This was the first of the SSRIs. SSRIs were revolutionary because they were "selective," targeting serotonin with much less effect on other neurotransmitters. This meant they offered similar efficacy for depression as the older drugs but with a much cleaner side-effect profile and far less risk in overdose. This improved safety profile allowed primary care physicians, not just psychiatrists, to comfortably prescribe them, dramatically increasing access to depression treatment.
What is ketamine therapy and how is esketamine different?
Ketamine is a powerful anesthetic medication that works on a different brain system than antidepressants. Instead of targeting serotonin, ketamine primarily modulates the glutamate system, which is believed to help restore synaptic connections in the brain that have been damaged by chronic stress and depression.
Ketamine itself is not FDA-approved for depression and is used "off-label," typically administered through an IV infusion in a clinic. Esketamine (brand name Spravato) is a specific molecule derived from ketamine that is FDA-approved as a nasal spray for treatment-resistant depression.
Which safety rules and monitoring apply to esketamine?
Esketamine is only available through a strict, FDA-mandated safety program called REMS (Risk Evaluation and Mitigation Strategy). Because of the potential for sedation and dissociation, patients must self-administer the ketamine nasal spray in a certified clinic, like a psychiatry or TMS office. They are then monitored by a healthcare professional for at least two hours after each dose. This ensures safety and prevents misuse.
How does TMS work and who might benefit?
Transcranial Magnetic Stimulation (TMS) is an FDA-cleared, non-invasive treatment that uses targeted magnetic pulses to gently stimulate specific areas of the brain known to be underactive in depression. TMS is not medication, electroconvulsive therapy (ECT), or surgery. It is a safe, office-based procedure.
The magnetic pulses, similar in strength to an MRI, pass harmlessly through the skull and create a small electrical current in the target brain region (the dorsolateral prefrontal cortex). This stimulation helps "wake up" this part of the brain, strengthening connections and improving communication within the brain's mood-regulating circuits.
Which patients consider TMS after antidepressants or SSRIs?
TMS is an excellent option for patients who have not found relief from depression after trying antidepressants. This is often called Treatment-Resistant Depression (TRD). Many patients who come to Sophroneo for TMS fit this profile: they have tried multiple SSRIs or other antidepressants but still struggle with depression symptoms, or they experienced side effects that were too difficult to tolerate.
Because TMS is non-systemic (it does not circulate in the bloodstream), it does not cause the side effects associated with antidepressants, such as weight gain, sexual dysfunction, or drowsiness. During a TMS session, you are awake and alert in a comfortable chair. A typical session lasts about 20 minutes, and you can drive yourself home or back to work immediately after.
Why does postpartum depression occur and how long can it last?
Postpartum depression is a serious and specific form of depression that occurs during pregnancy or after childbirth. It is far more intense and persistent than the "baby blues," which are milder feelings of sadness and anxiety that typically resolve within two weeks.
The exact causes are complex, but postpartum depression is believed to be triggered by a combination of factors, including the rapid and dramatic drop in hormones (estrogen and progesterone) after delivery, profound sleep deprivation, and the immense physical and emotional stress of caring for a newborn. Postpartum depression is not a character flaw or a sign of being a "bad mother." It is a medical complication of childbirth. If left untreated, postpartum depression can last for many months or even years.
Which treatments are considered for postpartum depression?
Early intervention for postpartum depression is key.
Therapy: Talk therapy (psychotherapy), especially Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), is highly effective.
Antidepressants: Certain SSRIs are often prescribed as they are considered relatively safe for breastfeeding mothers, though this should always be a careful discussion with your doctor.
TMS: For mothers with postpartum depression who prefer a non-medication option or who have not responded to antidepressants, TMS is an effective and safe choice that does not enter the bloodstream or breastmilk.
Which treatment is right for me: therapy, antidepressants, ketamine, or TMS?
The right depression treatment is a personal decision made in partnership with your healthcare provider. It depends on your specific depression symptoms, your medical history, the severity of your depression, and your past experiences with other treatments.
At Sophroneo, we practice personalized, patient-first care.
For mild to moderate depression, therapy alone or combined with an SSRI is often a great starting point.
For moderate to severe depression, a combination of antidepressants and therapy is often recommended.
For treatment-resistant depression, where multiple antidepressants have failed, TMS is a primary, evidence-based recommendation.
For patients needing rapid relief from severe depression or who have also failed TMS, ketamine or esketamine may be considered.
Our team will conduct a thorough psychiatric evaluation, review your full treatment history (including the history of antidepressants you've tried), and discuss the pros and cons of each option to create a plan that fits you.
Which comparisons help patients and referrers decide?
This table provides a simple comparison of the most common evidence-based treatments for depression.
Comparison/Table
Comparison of Depression Treatment Options
Treatment | How It Works (Simplified) | Best For | Key Considerations |
Psychotherapy | Talking with a therapist to change negative thought patterns and behaviors. | Mild, moderate, or severe depression. Can be used alone or in combination. | Requires patient commitment and time. No physical side effects. |
SSRIs / Antidepressants | Medications that increase levels of brain chemicals like serotonin. | First-line treatment for moderate to severe depression. | Takes 4-8 weeks for full effect. Potential systemic side effects (nausea, weight gain, sexual dysfunction). |
TMS Therapy | Non-invasive magnetic pulses stimulate underactive brain regions. | Treatment-resistant depression (when antidepressants fail) or for those who cannot tolerate medication side effects. | Non-systemic (no medication side effects). Requires daily in-office visits for 4-6 weeks. |
Ketamine / Esketamine | Modulates the glutamate system for rapid antidepressant effects. | Treatment-resistant depression requiring rapid results. | Esketamine requires in-clinic administration and 2-hour monitoring due to potential for sedation and dissociation. |
When should I seek emergency help for depression symptoms?
You should seek emergency help immediately if you or a loved one are experiencing thoughts of suicide, have a plan for self-harm, or are showing any signs of psychosis (hallucinations or delusions). Your safety is the number one priority.
Which resources and hotlines can I contact today?
988 Suicide & Crisis Lifeline: Call or text 988 anytime in the U.S. and Canada.
911 or Local Emergency Services: If there is an immediate danger to life.
FAQs (Frequently Asked Questions)
1. What is the difference between sadness and clinical depression?
Sadness is a normal human emotion that is usually a temporary reaction to a specific event. Clinical depression is a medical illness that is persistent (lasting at least two weeks) and involves a cluster of other depression symptoms, like changes in sleep, appetite, and energy, that interfere with your daily life.
2. How does a depression test like the PHQ-9 actually work?
A depression test like the PHQ-9 is a self-report questionnaire. It works by translating your reported experiences of depression symptoms into a numerical score. This score gives your clinician an objective measure of your depression severity, which helps confirm a diagnosis and track your response to treatment over time.
3. Are antidepressants the only option for depression?
No, antidepressants are not the only option. Psychotherapy is a highly effective treatment, especially for mild to moderate depression. For those who do not get relief from antidepressants or cannot tolerate the side effects, non-medication treatments like TMS therapy are powerful, FDA-cleared alternatives.
4. Is TMS therapy painful?
Most patients do not find TMS therapy painful. During the treatment, you may feel a tapping or pulsing sensation on your scalp. This is generally mild and typically subsides after the first few sessions as you get used to it. There is no sedation, and you can resume normal activities right after.
5. Why do SSRIs stop working for some people?
It is a common and frustrating experience for SSRIs or other antidepressants to become less effective over time, an effect sometimes called "Prozac poop-out" or tachyphylaxis. The exact reasons are not fully understood but may involve changes in brain chemistry, receptor sensitivity, or the progression of the underlying depression. This is a key reason why alternative treatments like TMS are so important.
6. What makes postpartum depression different from other depression?
While many depression symptoms overlap, postpartum depression is unique because it is directly linked to the biological, hormonal, and environmental changes of pregnancy and childbirth. It often includes intense anxiety, obsessive worries about the baby's health, and profound feelings of guilt or inadequacy as a new parent.
Ready to Explore NeuroStar TMS?
At Sophroneo Behavioral Health & TMS, we understand the mental and financial weight of seeking treatment. That is why we offer personalized consultations, transparent pricing, and compassionate guidance to help you determine if NeuroStar TMS is right for you.
You can find us at either location:
Powder Springs / Austell area: 4170 Old Austell Rd, Powder Springs, GA 30127
Stone Mountain: 5300 Memorial Dr, Suite 219B, Stone Mountain, GA 30083
Visit us or call 770-999-9495 to book your consultation.
Please Note: This blog shares insights from real medical studies on treatment-resistant depression and TMS therapy. It is for educational purposes only and not a substitute for medical advice. If you are considering TMS, talk with your healthcare provider or connect with Sophroneo’s care team to explore the best options for you.
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