Depression: Signs, Diagnosis, and Treatment in New Jersey

If you or someone else is in immediate danger, or you have already hurt yourself, call 911 now. If you are having thoughts of death or suicide, call or text 988, the Suicide & Crisis Lifeline. It is free, confidential, and open 24/7. Our crisis page lists New Jersey's county screening centers too.

Everyone has bad weeks. Feeling low for a while after a breakup, a layoff, or a long winter of poor sleep is a normal response to something hard, and it usually eases as the situation does.

Major depression is a specific diagnosis, and how sad you feel on your worst day is not what defines it. Clinicians look at how many things have changed at once, whether the changes have lasted at least two weeks, and whether they are getting in the way of work, school, or the people around you.

What clinicians mean by "major depression"

Clinicians in the U.S. use the criteria in the DSM-5, the American Psychiatric Association's diagnostic manual. As summarized in the 2022 VA/DoD depression guideline, a diagnosis requires five or more of these nine symptoms during the same two-week period:

• Depressed mood most of the day, nearly every day
• Markedly less interest or pleasure in almost all activities, most of the day, nearly every day
• Significant weight loss or gain when not dieting, or a change in appetite
• Sleeping too little or too much, nearly every day
• Moving or speaking noticeably slower, or restlessness others can see
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Trouble thinking, concentrating, or making decisions
• Recurrent thoughts of death, suicidal thoughts, a plan, or an attempt

At least one of the five has to be the first or second item: depressed mood or loss of interest. The symptoms also have to cause real distress or get in the way of work, school, or relationships. And they cannot be better explained by a substance or another medical condition. Some medical conditions, medications, and heavy drinking can produce symptoms that look like depression, which is one reason a proper evaluation matters.

Treat the list as a preview of what a clinician will ask about, and be wary of using it as a self-test. Counting your own symptoms can miss things in both directions. A clinician also asks about history, medical causes, and patterns you may not have noticed.

A hard stretch vs. major depression

In practice, the difference tends to show up in five places.

If the right-hand column sounds familiar, get evaluated. A clinician can sort out whether it is depression or something that looks like it. Our guide on recognizing the signs covers the broader question of when to reach out.

Other forms of depression

The National Institute of Mental Health (NIMH) describes several types beyond major depression. Three of them change how depression gets recognized or treated.

Persistent depressive disorder. Symptoms are usually milder but last much longer, generally at least two years. Because it has been there so long, people often describe it as "I have always been like this," which is one reason it can go unrecognized.

Perinatal depression. This is depression during pregnancy or after childbirth. It is different from the "baby blues," the milder, short-lived mood changes many new parents have. Zuranolone (Zurzuvae), a pill taken once a day in the evening for 14 days, is FDA-approved for postpartum depression in adults. Its label carries a boxed warning: do not drive or do other potentially dangerous activities for at least 12 hours after each dose. An earlier IV treatment, brexanolone (Zulresso), is no longer available; the FDA withdrew its approval in April 2025. Anyone pregnant or postpartum who feels persistently low should tell their OB, midwife, or pediatrician.

Bipolar depression. Bipolar disorder includes depressive episodes and manic or hypomanic ones. This matters for treatment. NIMH notes that antidepressants are not used alone in bipolar disorder because they can trigger a manic episode or rapid cycling, and that people with bipolar II often seek help only when depressed. If you have ever had a stretch of days with unusually high energy, little need for sleep, racing thoughts, or risky decisions, tell the person evaluating you. It can change the treatment plan.

NIMH also describes seasonal affective disorder and depression with psychosis, a severe form that needs prompt care.

How common is it?

Very. In 2025, an estimated 7.4% of U.S. adults, about 19.7 million people, had a major depressive episode in the past year, according to SAMHSA's National Survey on Drug Use and Health (NSDUH). The rate was highest among adults ages 18 to 25, at 14.2%. Among adolescents ages 12 to 17, it was 15.1%.

The same survey shows a gap in care. About 66% of adults with a past-year major depressive episode received any mental health treatment that year. Among adolescents, it was about 58%.

What treatment looks like

Depression is treatable, and most treatment happens in an ordinary outpatient office. The two main approaches are therapy and medication, used alone or together.

Psychotherapy

NIMH names two well-studied talk therapies for depression:

• Cognitive behavioral therapy (CBT), which teaches you to notice and challenge unhelpful thought patterns and change behaviors that keep depression going.
• Interpersonal therapy (IPT), which focuses on relationships and communication, often around a loss, conflict, or major life change.

Many therapists blend approaches. If you are not sure whether you need a therapist, psychologist, or psychiatrist, our guide to who does what lays it out.

Medication

Antidepressants are prescribed by a psychiatrist, psychiatric nurse practitioner, or primary care clinician. The FDA's list of approved depression medicines includes several families: SSRIs (such as sertraline, fluoxetine, and escitalopram), SNRIs (such as duloxetine and venlafaxine), bupropion, mirtazapine, older tricyclics, and MAOIs.

What to expect once you start:

• NIMH says antidepressants usually take 4 to 8 weeks to work. Feeling no different after one week is common and is not a sign of failure.
• Finding the right medication can take more than one try.
• Do not stop an antidepressant suddenly. The FDA advises talking to your prescriber first, because stopping abruptly can cause withdrawal symptoms.

The boxed warning, stated plainly

Antidepressants carry an FDA boxed warning, the agency's most prominent kind. As NIMH summarizes it: children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants. The FDA's consumer guidance points to the start of treatment and any dose change as the times to watch.

That does not mean young people should avoid treatment. Untreated depression carries its own risk. It means the first weeks deserve close watching. If you or your child starts an antidepressant, know who to call, and contact the prescriber right away about new or worsening suicidal thoughts, agitation, or unusual changes in behavior.

When the first treatments do not work

Some people do not improve after several adequate tries. This is often called treatment-resistant depression, and there are more options:

• Esketamine (Spravato). The FDA has approved this nasal spray for adults with treatment-resistant depression, and NIMH notes that it often acts within hours. Under its FDA safety program, it is given only in a certified health care setting, where staff monitor the patient for sedation, dissociation, and breathing problems for at least two hours after each dose. It is not a take-home prescription.
• Brain stimulation. NIMH lists electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) as the most used. Both are FDA-cleared devices for certain cases of depression.

These are usually considered after other treatments, and a psychiatrist is the right person to talk them through.

How to get evaluated in New Jersey

Many people can start without a referral, though some insurance plans require one before you see a specialist, so check your plan. Any of these doors works:

• Your primary care doctor. A primary care clinician can check for medical causes, and many can start treatment or refer you.
• A therapist or psychiatric prescriber. Our guide to finding a therapist in Middlesex and Camden counties covers how to search and what to ask.
• NJMentalHealthCares, the state's free information and referral line, at 1-866-202-4357. New Jersey's Division of Mental Health and Addiction Services lists its hours as 8 a.m. to 8 p.m., seven days a week.
• Local resources. Our Middlesex County and Camden County pages list verified clinics, sliding-scale options, and the county screening centers.

If weekly therapy does not feel like enough, read how the levels of mental health care work. More structured outpatient programs exist between a weekly appointment and a hospital stay.

When it is urgent

Some situations should not wait for an intake appointment:

• Thoughts of suicide, a plan, or a recent attempt
• Thinking or talking about being a burden or that others would be better off without you
• Hearing or seeing things others do not, or beliefs that seem out of touch with reality
• Not eating, drinking, or getting out of bed for days
• Depression combined with heavy alcohol or drug use

If there is immediate danger, or someone has made a recent attempt or taken something, call 911 and say it is a mental health emergency. Otherwise, call or text 988 any time. Each New Jersey county also has a 24-hour psychiatric emergency screening center. In Middlesex County that is Rutgers University Behavioral Health Care at 732-235-5700. In Camden County it is Oaks Integrated Care at 856-428-4357.

The two-week rule of thumb

You do not have to settle whether it is "really" depression before asking for help. A hard stretch tends to lift as the situation around it improves. Major depression usually does not lift on that schedule, and it is treatable. If two weeks have passed and the changes are still there, make the appointment.

If suicidal thoughts are part of the picture, do not wait for an appointment. Call 911 in an emergency. Call or text 988 any time.