What if fatigue, insomnia, and brain fog aren’t just signs of stress, but rather warnings that your mental health has shifted? For the 1 in 6 U.S. adults experiencing depression, these physical symptoms often appear before emotional pain. (1)
Depression is a neurobiological condition marked by altered brain function, behavioral changes, and effects on physical health. (2) While sadness is the most widely recognized and common aspect of depression, most people experience a more complex range of symptoms. (1)
For those living in rural areas, challenges associated with depression can become even more severe due to geographic isolation. (4) However, options for care are within reach. Despite these added barriers, learning to recognize the signs of depression empowers you to seek timely support and begin your recovery.
What Does Depression Feel Like?
From low moods to cognitive difficulties to a feeling of numbness, depression can take many forms. If you experience any of the following symptoms consistently for weeks and they begin to interfere with your daily life, we recommend speaking with a trusted doctor, therapist, or psychiatrist to screen for depression. (2)
Emotional Shifts in Depression
Many people struggling with depression experience persistent poor moods, feeling heavy or anxious, as if nothing will improve. These low moods are sometimes (but not always) accompanied by increased frustration or annoyance, where minor annoyances trigger uncharacteristic anger, irritation, or restlessness. Feelings of guilt or worthlessness may arise as depression persists, leading individuals to experience self-doubt or perceive themselves as burdens to others.
Physical & Mental Changes of Depression
A constant fatigue from depression can leave you exhausted and make it very difficult to move or think quickly. Many people struggling with depression experience sleep problems, such as insomnia, waking up too early, or even sleeping too much. Difficulty focusing, remembering, or making decisions is also a common symptom as the brain struggles to feel pleasure, joy, or motivation as usual. Appetite changes are common, resulting in eating significantly more or less without intent. Unexplained aches, including headaches, cramps, or stomach issues may also arise without a clear cause.
Behavioral Changes with Depression
With the onset of depression, a loss of interest in previously enjoyable activities can lead to feelings of meaninglessness and exhaustion, often resulting in a desire to socially withdraw or neglect responsibilities at work, school, or home. To cope, some individuals may turn to unhealthy mechanisms, like alcohol or drugs, or engage in impulsive or reckless behavior. This overall experience can also create a sense of emotional numbness, shame, or detachment from life and relationships.
Types of Depression
Depression manifests in various forms, each with distinct patterns. Recognizing these differences is essential in finding adequate support. A few common types include: (2)
- Major Depressive Disorder (MDD): This is the most well-known form of depression, characterized by intense sadness or a loss of interest that disrupts daily life for at least two weeks. It often profoundly affects sleep, energy levels, and self-worth.
- Persistent Depressive Disorder (PDD): Previously known as dysthymia, this type is a low-grade depression that persists for two years or more. While the symptoms are generally less severe than those of MDD, they are more chronic, creating an ongoing feeling of weight or heaviness.
- Seasonal Affective Disorder (SAD): SAD is a cyclical biological response that links depression to nature’s rhythms. Symptoms typically emerge in late fall or winter as sunlight decreases and improve in spring as days become longer.
- Depression in Bipolar Disorder: Usually called depressive episodes, depression can show up for periods in individuals with bipolar disorder. These depressive episodes can resemble the severity of MDD. The key difference is that these depressive lows alternate with periods of elevated or irritable mood, rather than being a standalone diagnosis.
Always report your symptoms and how intense they are to your psychiatrist and/or therapist. They will help you determine which type of depression aligns with your symptom profile and then develop the most effective treatment strategy for you.
What Causes Depression?
Depression doesn’t develop from just a single issue or factor. Long thought to be solely the result of a chemical imbalance of serotonin in the brain, we now recognize depression as an interwoven set of biological, psychological, and environmental factors unique to each person. (6) Recognizing these diverse factors can reduce stigma and inform more effective support strategies. You’ll notice that some are controllable, while others are unarguably not. Risk factors for depression include: (1,2)
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Biological Factors
- Genetics: While there is no single “depression gene,” a family history of mental health issues increases susceptibility to depression.
- Health Conditions & Medications: Certain health conditions, like cancer, stroke, or chronic pain, along with specific medications, can disrupt the mind-body balance.
- Substance Use: Substance use can impair coping mechanisms and emotional responses.
- Neurochemical Shifts: Changes in the brain, particularly those involving serotonin, interact with stress pathways and can affect emotional well-being.
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Psychological Factors
- Hormonal Sensitivity: Women may experience an increased risk of depression during challenging hormonal phases, such as postpartum or menopause, and even during the premenstrual period each month. Postpartum depression and premenstrual dysphoric disorder (PMDD) are recognized subsets of depression in scientific literature.
- Negative Self Talk & Thought Patterns: Persistent or obsessive negative beliefs, like “I’m not good enough” or “I’m a burden,” can alter the brain’s processing of challenges, leading to emotional difficulties. These are just a few of the countless examples of thought patterns and self-talk that can set the brain off course.
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Environmental Factors
- Major Stressors: Significant life events and ongoing challenges, including financial or relational strain and major life transitions, even planned ones, can deplete emotional reserves and alter brain resilience. At times, this can lead to circumstantial depression which may lift after a period of time. Either way, talking with a provider is a wise step to manage symptoms and prevent long-term impact when possible.
- Traumatic Experiences: Events such as abuse or loss can weaken brain resilience over time. When chronic trauma happens during childhood, it is more likely to have a long-lasting negative impact than at other times in life. Major childhood traumas are sometimes called Adverse Childhood Experiences and are measured and considered by providers when diagnosing and treating.
- Discrimination & Isolation: Attacks on a person’s identity and threats to their safety can severely harm mental health. In the same way, ongoing isolation due to a person’s identity or any other factor is a risk factor for depression, as community and relationships are critical components of overall wellness.
You Don’t Need to Know the Cause or Type of Depression to Ask for Help
Sometimes, depression can arise without clear origins, but that doesn’t invalidate your symptoms. Even if you don’t know the source, your provider can help you connect the dots and empower you on your recovery journey.
When to Get Help for Depression
Before going any further, know that depression feels and looks different for everyone. You don’t need to experience every symptom (or even most of them) to seek assessment and help. Some experience a few intense symptoms, while others experience many more mildly. What matters is how much these symptoms disrupt your daily life. (2) If any signs of depression are persistent and make your thoughts or everyday activities feel overwhelming or abnormally difficult, you may need support. (1)
If You are Experiencing a Crisis:
At times, depression can make people feel trapped or hopeless enough to consider suicide. You might have heard this called suicidal ideation (when someone is thinking about suicide) or suicidal intent (when someone is planning to complete suicide). (1) If you or someone you know is experiencing thoughts of suicide, reach out for help immediately. You are not alone - people recover from suicidal ideation and intent all the time. You matter, and support is closer than you might think. If you need help:
- Call or Text 988: The Suicide & Crisis Lifeline is free, confidential, and open 24/7. Trained responders get rural struggles.
- Go to the Nearest ER or Call 911: Emergency rooms are equipped to keep you safe during a crisis.
- Contact Your Therapist or Doctor: If you already have a mental health provider or primary care clinician, call them now. They know you and want to help.
- Lean on People You Trust: Tell a close friend, family member, or community member. You don’t have to face this alone.
Exploring Depression Treatments
Effective depression treatment is typically a journey, not a quick fix. A combination of approaches can also be helpful to address the symptoms and underlying causes of depression, rather than just hitting it from one direction. Most people benefit from a personalized treatment plan which may combine: (2,5)
Therapy
Therapy provides science-backed tools to reclaim your life through work with a licensed therapist, counselor, social worker, or psychologist. It is available for individuals and families and in group formats for peer support. Regular sessions can help you: (2)
- Identify and reshape destructive thought patterns.
- Build healthy coping strategies.
- Repair impacted relationships.
- Prevent relapse long-term.
While talk therapy is the most common and well-known type of therapy, there are many different modalities for addressing depression, the effects of past trauma, and negative thought patterns, which can be helpful when talk therapy doesn’t seem like enough.
Medication
Antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) can help regulate brain chemicals linked to mood and are often prescribed first due to their safety and efficacy. Since depression involves more than just serotonin, finding the right medication may require patience and collaboration with your provider. (6)
Other options include Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), which target serotonin and norepinephrine, and atypical antidepressants, which work through different mechanisms. These alternatives and others are commonly considered when SSRIs are ineffective or cause unwanted side effects.
Advanced Treatment Options
For individuals with moderate to severe depression who do not respond to antidepressants or therapy, advanced treatment options such as Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT) show promising results.
TMS is an outpatient procedure that uses targeted magnetic pulses to stimulate underactive mood-regulated areas of the brain, aiming to restore proper function. TMS is best suited for moderate to severe depression, typically requiring multiple weeks of short sessions. (2) Two types of TMS are currently available and used to treat depression - one called Deep TMS (or dTMS) and one called repetitive TMS or (rTMS). Depending on your diagnosis, insurance, and previous treatment attempts, insurance may cover TMS for depression.
In contrast, ECT is an inpatient procedure performed under anesthesia, inducing a brief seizure to “reset” the brain. It is used for high-severity cases, and several treatment sessions are required. (2)
Thankfully, TMS and ECT are just the beginning of available scientific advancements to treat depression. A variety of other tools exist, are in studies, or are still being tested. Some people have found support for their depression through vagus nerve implants, ketamine-assisted psychotherapy, neurofeedback, and more. Please speak in depth with your provider before pursuing any of these advanced treatments for depression. And also know there is so much hope for the science addressing depression in the coming months and years.
Are There Natural Solutions for Depression?
While some people report relief from depression using natural remedies like vitamin D or St. John’s Wort, (8) it’s important to know that the FDA hasn’t approved these for this purpose. (2) Research on their effectiveness is inconclusive, and they may carry risks, including dangerous interactions with prescription medications. Supplements can certainly be helpful tools for some, but they pose risks for others. Always consult your healthcare provider before trying any natural remedies.
The Importance of Self-Care
Healing from depression takes time, but most people gradually feel better with professional treatment. While you are recovering, focus on making small, steady improvements. Prioritize daily movement, avoid alcohol and unprescribed drugs, maintain a regular sleep schedule, eat balanced meals, and lean on trusted people in your life. Recovery isn’t linear, but every choice to care for yourself is a win.
Determining Your Treatment Plan
Functional care differs for each person. Treatment plans combining therapies and collaboration with a provider who considers your unique needs can lead to significant improvements. Modern psychiatry offers more options than ever to help relieve the burden of depression, no matter your location.
Rural Mental Health Challenges and Solutions
If you’re struggling with depression in a rural community, know you’re not alone. In 2023, one in four rural adults (roughly 7.7 million people) faced mental health challenges such as depression and anxiety. (4) Despite this prevalence, many are reluctant to seek care due to barriers such as long travel times, provider shortages, high costs, and higher stigma surrounding mental illness in remote areas. (4)
Fortunately, recent state initiatives have expanded access to affordable, effective, and confidential mental health support for rural communities.
Telehealth: Convenient, Confidential Support
Telehealth provides secure remote care through video calls, phone consultations, or messaging, making it an essential resource for patients in rural areas. Research shows that virtual mental health is as effective as in-person care, leading to equivalent improvements in symptoms, quality of life, and satisfaction, (7) and many remote residents are catching on. According to a 2021 report, 43% of rural mental health patients accessed telehealth services. (4) Medicare’s coverage for virtual specialist appointments alleviates concerns about travel and missed work and enables patients to establish a safe and private home care environment.
How to Find A Provider
To find a telehealth specialist near you, contact your primary healthcare provider or insurance company for a referral. You can also use SAMHSA’s treatment locator here. Enter your zip code in the search bar and filter the results for “telehealth.”
Depression thrives in isolation, but telehealth delivers evidence-based care to your home, overcoming distance, stigma, and shortages. If help feels too far away, these resources offer hope.
Telepsychiatry in Montana and Beyond
Most virtual visits in Montana focus on mental health, increasing the need for telepsychiatry. (8) To enhance accessibility, Montana has increased broadband access and expanded Medicaid coverage to include telehealth services. Frontier Psychiatry serves Montana, Idaho, and Alaska, focusing on the specific needs of rural populations.
Take Your First Step Today
Depression can feel debilitating, but there is hope. If fatigue, isolation, or hopelessness impact your life, you have options, even remotely. Frontier Psychiatry specializes in personalized telepsychiatry that meets you where you are. Call or text us today at (406) 200-8471 to start your journey toward relief.
References
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Centers for Disease Control and Prevention (2023, October 13). Mental Health Conditions: Depression and Anxiety. CDC. https://www.cdc.gov/tobacco/campaign/tips/diseases/depression-anxiety.html
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U.S. Department of Health and Human Services (Rev 2024). Depression. National Institutes of Health. https://www.nimh.nih.gov/health/publications/depression
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Rural Health Information Hub (2025, May 9). Rural Mental Health. https://www.ruralhealthinfo.org/topics/mental-health
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U.S. Department of Health and Human Services (2025, March 17). Antidepressants. MedlinePlus. https://medlineplus.gov/antidepressants.html
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Moncrieff, J., Cooper, R.E., Stockmann, T. et al. (2023). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry 28, 3243–3256. https://doi.org/10.1038/s41380-022-01661-0
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Scott, A. M., Clark, J., Greenwood, H., Krzyzaniak, N., Cardona, M., Peiris, R., Glasziou, P. (2022). Telehealth v. face-to-face provision of care to patients with depression: a systematic review and meta-analysis. Psychological Medicine, 52(14), 2852–2860. https://doi.org/10.1017/S0033291722002331
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Montana State Library (June 2024). Information Guide - Libraries & Telehealth. https://msl.mt.gov/libraries/library_development/Directors/Library-Info-Guide-Telehealth-2024-MSL-Brand.pdf
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U.S. Department of Health and Human Services (May 2025). St. John’s Wort. National Institute for Complementary Medicine and Integrated Health. https://www.nccih.nih.gov/health/st-johns-wort
