Depression can be a heavy fog that blankets you in sadness day after day. Or, it can come in dark waves called episodes that wash over you and keep your head underwater for two weeks or more at a time.

More than 16 million adults in the United States — or nearly 7 percent of the population—have had at least one episode of major depression. Even if you’ve dealt with depression before, a new episode can blindside you and leave you unsure of how to cope.

Here’s a look at what sets off depressive episodes, how to recognize them when they appear, and the best ways to manage them.

Spotting the symptoms of depression episodes

Feeling down from time to time isn’t necessarily a symptom of depression. What sets a true depressive episode apart is that you have symptoms like these during most of the day, almost every day, for at least two weeks:

  • sad mood
  • feeling of hopelessness, worthlessness, guilt, or emptiness
  • anxiety
  • restlessness
  • anger or irritability
  • loss of interest in activities you once loved
  • lack of energy
  • fatigue
  • slowed thinking or movements
  • trouble concentrating, remembering, or making decisions
  • sleeping too much or too little
  • appetite loss or overeating and craving certain foods
  • unexplained headaches, stomachaches, or other aches and pains that don’t have a clear medical explanation
  • thoughts of death or suicide

If you have any of these symptoms for an extended period of time, see a psychologist, psychiatrist, or your primary care doctor for an evaluation. If the episodes start up again even once you’re on treatment, you might need to adjust your medication or try a different approach.

What triggers episodes of depression?

Depression doesn’t always need a trigger. Sadness can arrive without any unpleasant event or warning.

Yet certain situations are known to set off a negative mood. Common depression triggers include:

  • a major life change such as a move, graduation, or a new job
  • financial troubles, including bankruptcy or debt
  • relationship issues such as tension in the family, a breakup, or a divorce (your own or a loved one’s)
  • the death of a loved one
  • giving birth to a child (this is called postpartum depression)
  • loneliness — for example, if friends and family have moved away
  • stress at work or home
  • using alcohol or drugs
  • major illness

Some of these triggers are under your control. For example, you can avoid drinking alcohol or using drugs if they make your sadness worse. Others, like a chronic illness, are more difficult to avoid.

When you can’t avoid depression, your focus should turn to managing it. You may not be able to change your circumstances, but you can work with a psychologist or counselor to help you cope with your sadness.

Treating depression episodes

When depression arrives like an unwelcome visitor, you don’t have to give up your quality of life. Medication, therapy, and at-home coping techniques can all make the symptoms more manageable.

Medications for depression

Antidepressants are the main medication therapy for depression. They increase levels of brain chemicals like serotonin and norepinephrine to relieve symptoms.

There are several different classes of antidepressants.

Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressant doctors prescribe. They include:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are the second most commonly prescribed antidepressants. They include:

  • desvenlafaxine (Pristiq)
  • duloxetine (Cymbalta)
  • venlafaxine (Effexor)

Norepinephrine-dopamine reuptake inhibitors (NDRIs) are another option. They include:

  • bupropion (Wellbutrin)
  • mirtazapine (Remeron)

Antidepressants can take up to three months to start working. If after that time, they still haven’t controlled your symptoms, your doctor can change your dose, switch you to a different class of medication, or add another drug.

Talk therapy

The second element to treating depression is psychotherapy — or talk therapy. Research finds that combining antidepressants with therapy works better than either treatment alone.

There are several different kinds of therapy for depression. Cognitive behavioral therapy (CBT) is very effective because it helps reverse the negative patterns of thinking that contribute to sadness. CBT is done over a series of 8 to 16 sessions.

Interpersonal therapy (IPT) is another approach. IPT focuses on issues in your relationships that contribute to your depression. Therapy sessions can also involve your partner or other family members if your relationships are problematic.

Managing depression symptoms

Along with medication and therapy, here are a few lifestyle tips to help you cope with depression symptoms:

  • Exercise. Run, ride a bike, swim — whichever activity you choose will boost levels of brain chemicals that make you feel better. Try to be active on most, if not all, days of the week.
  • Get enough sleep. Try to get seven to nine hours of rest a night. Sleeping too little can accentuate depression symptoms like irritability and mental fatigue.
  • Stay connected. Loneliness can worsen depression. Try to get out with friends, or connect with them by phone or computer.
  • Eat well. Avoid sugar and carb-heavy foods like chips and cookies. They cause blood sugar spikes and dips that can make you feel worse. Instead, nourish your body and mind with nutrient-rich foods like fruits, vegetables, fish, and whole grains.
  • Limit alcohol. Drinking a few glasses of wine might make you feel better in the moment, but it’s not an effective coping strategy. Alcohol acts as a central nervous system depressant, and it can worsen depression symptoms.