Depression

What it is

Depression, also called major depressive disorder or clinical depression, is a medical condition that causes severe symptoms affecting how you feel, think and handle daily activities such as sleeping, eating or working [1]. Everyone feels low sometimes and those feelings usually pass, and depression is different [1].

Why this guide is written for Black patients

An estimated 21.0 million adults in the United States had at least one major depressive episode in the year measured, 8.3 percent of all US adults, and among Black or African American adults the figure was 6.7 percent [2]. Nationally, 61.0 percent of adults with major depressive episode received treatment in the past year [2].

Now the gap. In 2024, Black adults were 36 percent less likely than US adults overall to have received mental health treatment in the past year [3]. The share reporting any mental illness was not far apart, 20.9 percent against 23.4 percent [3].

Those numbers together describe under-treatment rather than under-illness. The difference is in who reaches care and who stays in it, which is why the practical advice in this guide is about the appointment as much as about the condition.

What to ask a clinician

• Is this depression, or something else that looks like it, and how are you telling them apart?
• Have my thyroid, iron and vitamin levels been checked?
• What are we starting with, therapy, medicine, or both, and why that order?
• How long before we should expect to see a change, and what do we do if we do not?
• If I stop feeling able to keep going, who do I call, and what number do I put in my phone today?

What good care looks like

Genetic, biological, environmental and psychological factors all play a role in depression [1], so a good first appointment asks about all four rather than only the last one. It also rules out physical causes, because thyroid problems and low iron produce a very similar picture.

Treatments include medications, talk therapy including telehealth and online options, and brain stimulation therapy [1]. Most people start with therapy, medicine, or both. Good care sets a review date at the first visit rather than leaving the next step to whether you feel well enough to chase it.

Good care also takes racism seriously as a stressor rather than treating it as an aside. If work, policing, housing or family strain is what is grinding you down, a clinician who wants to hear about that is more useful than one who moves quickly past it.

Depression is linked to increased health care costs and to other conditions such as heart disease and diabetes, and it is a risk factor for suicidal thoughts and behaviors [1]. That is the reason it gets treated as a medical problem rather than a mood.

When it is urgent

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988, or chat at 988lifeline.org [1]. In life-threatening situations, call 911 [1]. The 988 line is free and confidential, it runs every hour of every day, and you do not have to be about to act to be allowed to use it.

Go the same day for a plan to harm yourself, for hearing or seeing things others do not, for not eating or drinking, or for being unable to care for a child or yourself.

What to do next

Book with a therapist first if the symptoms are moderate and you want to start talking. See Black therapists.

Ask for a psychiatrist if symptoms are severe, if medicine is already involved and not working, or if there have been episodes of very high mood or psychosis. See Black psychiatrists. Put 988 in your phone before you need it, and tell one person you have done it.