All of us have loosely used the word “depression” to describe when we feel sad or down without giving it a second thought. Most of us can probably name several people we know who are taking anti-depressant medications. However, actual clinical depression is quite different and more complex, and in fact there are diagnostic criteria for all of the types and severities.I see patients with various forms, severities, and symptoms, of depression. One may be struggling with balancing Bi-Polar (lifting the depression without swinging into mania) and another may be dually diagnosed with chemical dependence/addiction and Bi-Polar struggling to overcome strong cravings to use (drink or drug) triggered by depression. While another is fighting to combat the depressive effects of his cocaine and alcohol intoxication and withdrawal. Depression presents itself in many different ways but always makes an impact. It can have devastating effects, which can be chronic or acute and last for short or long periods of time, sometimes leaving the person incapacitated. Mania is the opposite polar extreme of depression rendering the individual in a state of heightened energy and extreme behaviors, which are very consequential. In a manic state, a person may speak rapidly, go without sleep for long periods of time or only sleep 3-4 hours a night. Because of this, they may also become very productive and goal oriented (which is why many do not like to come out of their manic state). They may go on extreme shopping sprees, spend ridiculous amounts of money, accumulate debt, or engage in promiscuous/ risky sex. Depression can be caused by a chemical imbalance in the brain, which is often hereditary and permanent, or non-hereditary and more short-term. Depression can also be a reaction to external circumstances such as emotionally upsetting events (trauma, loss, death), brain damage caused by physical trauma, or be alcohol/drug induced. The severity of depression varies greatly depending on the type and on the individual person. In the case of chemical imbalance, psychiatric medications are often required. The individual’s degree of depression and response to treatment depends on many physical factors including genetics (family history of mental illness), neurological involvement (brain), and assimilation of and subsequent physiological response to the medications. In other cases of depression, the individual’s response to the external event greatly determines onset, duration, and severity of the depression. Whether the emotionally upsetting event is a divorce, loss of job, loss of a loved one, or a natural disaster, for example, each of us responds differently and not all of us end up with depression from the same or similar events. Our capacity to manage and cope, as well as our interpretation of the events and the psychological threat they represent are important factors and considerations. Some physiologically induced depression can be caused by specific internal changes/events such as hormonal imbalance, postpartum depression (PPD), brain injury, and be alcohol/drug induced. The effects can be relatively short-lived in the case of hormonal imbalance, PPD, or the intoxicating and withdrawal effects of alcohol or drugs, or they can be more long-term in the case of brain injury. Of course depression can lead to suicidal thoughts, gestures, and/or actual attempts, particularly if it goes undiagnosed and/or untreated. The immediate question of anyone who is depressed is whether they feel suicidal and if they have a plan to carry it out. If they do have a plan do not leave them alone (or keep them on the phone until someone can physically get to their house), and get them help immediately and take them to the hospital.