Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine.

We often say, "I'm depressed," when life piles on too much stress. But how do we know when those day-to-day worries and low moods cross the line into something more serious? In this episode, we're digging into what really defines major depressive disorder, how its symptoms overlap with everyday stress, and the red flags that suggest it's time to seek help.

We'll talk about the influence of modern life—from the pressures of social media to the loneliness many of us feel in remote work settings—and why it's still possible to miss the signs of depression, even when you're surrounded by family, friends, or coworkers. We'll also explore the journey of diagnosing depression and finding a treatment plan that fits your unique circumstances.

What factors tip the balance between therapy alone and therapy plus medication? And what if you're juggling other concerns like anxiety, chronic stress, or even substance use? If you've been wondering how stress ties into depression, why you might keep quiet about feeling "off," or how to get started on the path toward relief, this conversation will offer helpful insights and encouragement.

First, let me introduce my guest, Dr Jessi Gold. Dr Gold holds the esteemed position of the first Chief Wellness Officer for the University of Tennessee system. She also serves as an associate professor of psychiatry at the University of Tennessee Health Science Center. Internationally recognized, Dr Gold is a speaker, media advocate, and mental health consultant with a special focus on college students, healthcare workers, and the entertainment industry. She's the author of the bestselling book How Do You Feel?

Welcome to the WebMD Health Discovered podcast.

Jessi Gold, MD, MS: Thank you so much for having me.

Pathak: So, I'd love to talk about the words we use because the word "depression" is used colloquially. We say it in conversation—we kind of throw out, "Yeah, I'm depressed," or, "She's depressed." And then there's clearly a clinical diagnosis. How do we define the term medically, and what do you think about its use colloquially?

Gold: Yeah, we use a lot of mental health words like that. We say we're anxious, but we don't mean we have an anxiety disorder. We say we're depressed, but we don't mean we have depression. Most of the time when people say, "I'm depressed," they mean they're sad. And we would maybe use a word like "the blues" or something a little more clinically appropriate instead of using the same word we already use.

But all it is, is a feeling, right? Like, all of us have feelings. Sometimes we feel sad. But when the sadness lasts for at least two weeks, when it comes with other symptoms, when it interferes with your life—that's very different from a feeling. I think we get used to using the word, and it makes it almost hard to know that it's a problem. Or there's an overuse of the desire to be diagnosed with something, which I think comes from social media in some way.

You just actually want to be treated, have a diagnosis, have a label. And so, either way, I feel like it helps normalize the conversation. We talk about feelings more because we're using the word "depressed" in regular sentences. But also, people then think, "I have depression—let's talk about that," when it might not be what they actually have.

I don’t think that every feeling is pathological, just like you might have worries, and they're not necessarily anxiety, right? I think we need to be able to differentiate that as a culture and be okay with our feelings—not necessarily assume that all feelings need to be treated or sent away.

And that's something I work on a lot with patients—but honestly, even myself. I don't like big feelings. They scare me. They interfere with life. And so you're sort of like, "Hey, feeling, how can I make you go away?" Right? But that's not the way we should approach them. We should sort of be like, "I guess I'm sad today. What about things is making me sad today? What could I do?"

But if that sadness sticks around, gets worse, interferes with your life, or comes with these other symptoms we associate with depression, then it starts to become something more serious. Those are the moments where you go, "Oh. Huh. This might be something more than just a feeling."

Pathak: So, talk to us a little bit more about those other symptoms that come along with a diagnosis of depression.

Gold: Yeah, so depression affects our whole body in a lot of ways. We think about things like changes in sleep patterns. That could actually be increased sleep or decreased sleep, which I think confuses people. You might sleep more because you feel sad, but you also might be up all night thinking about things that are making you sad.

A big one is loss of interest. We use a fancy term called anhedonia to describe that, but really, what we mean is: Is there something you used to like doing, and you might still be doing it, but you don't care as much about it anymore? Sometimes that's work because we get meaning from work. But sometimes it's something like running—you like to go running, you're still running, but you don't get that same excitement from it. Or maybe you watch TV shows, and usually, you laugh at the humor, but now you're not anymore. That's a change. And that's what we mean by loss of interest.

Concentration comes into play here. I think people often just assume all concentration-related issues are related to ADHD. But I think it's really important to recognize that if you're sad, it's hard to concentrate. If you're not sleeping because you're sad, it's also hard to concentrate.

We also think about changes in appetite—same thing, it could be less or more. I'm sure people listening can think of times when that's happened to them either way. Sometimes we turn to food to cope; sometimes we avoid food because our bodies feel affected by what's going on—our stomach hurts, we have a headache, or whatever—and we don’t want to eat. That makes sense to people.

Sometimes our whole body just feels slowed down. We use a fancy term for that too—psychomotor retardation—which just means it kind of feels like you're moving through molasses. You're not at the speed you thought you were, and you can tell that your whole body feels slowed.

We also think a lot about guilt with depression—it's a big symptom. And then, finally, suicidal thoughts—thoughts of not wanting to be around anymore, including plans and intent. But that doesn’t always have to come with depression.

When we think of depression diagnostically, the two most obvious signs—the first two screening questions—are:

1. Depressed mood
2. Lack of interest

If you have one of those, then we dig deeper into the other symptoms to see if you're experiencing a major depressive episode. But those two are the first screening tools most people use when assessing for depression.

Pathak: Can you talk about the spectrum of what seeking care can look like?

Gold: For sure. I think it's a bit of a cruel punishment that a symptom can be lack of interest, which also can be low motivation. And we're like, "Hey, figure this out on your own," right? Ideally, we'd have thought about it before, but if we've never struggled with it or no one in our family struggled with it, why would we, right?

And so we're really kind of set up to be in an unfair situation dealing with our mental health in the moment. The easiest place to go is always going to be your primary care doctor. Hopefully, you have one, but that will be the fastest place you can get in—and a person who can hopefully suggest a psychiatrist if that's what you need.

I think it can be hard for people to just go right to psychiatry unless they know one, they feel like their symptoms are worse, their family history is bad, and they know that their family always took meds, so they might as well talk to someone about it. They’re concerned about other things happening at the same time. But it can be hard to make that leap on your own.

Sometimes you kind of need a primary care doctor to be like, "I could start you on something," or, "I think that this is too severe for me to be managing; we should get you in, but I'll also start you on something in the interim." So it's a good place to start because of access.

I think that primary care doctors are very used to dealing with mental health, especially sort of basic mental health things. They can say, "This is beyond me, you take it from here, psychiatrist." And I think that's an important thing that patients don't know, right? Unless you're so severe that you're coming in through a hospital where somebody's going to immediately give you a psychiatrist, how do you know if you are at a place where you shouldn’t be seeing that in primary care?

But you know, you can try to find a therapist in your community without going to your primary care doctor through something like Psychology Today, where there’s a big listing, and you can search and read their bios—sort of like a Facebook for therapists, in a way. You can see if you relate to what they're saying, their identities, the things you might be looking for. That’s a good search place.

Your insurance company is also a great place to start—just to make sure that they're covered. But you could also take those names and bring them to Psychology Today to see more about them there.

Outside of the bigger ways of doing that through insurance and figuring out what's covered, there are a lot of apps that do teletherapy. There are a lot of apps that will get you in pretty quickly. I often say to patients to think about that as an option if you want to get in quickly. But sometimes the quality is not as high as you'd like it to be, and that’s okay.

Sometimes, if you're sort of biding time or trying to make sure you can get seen quickly about something you're struggling with in the moment, but you might not feel like that's the best long-term solution, an app can be useful. Like, if a patient calls and the waitlist is five weeks—or more—to see the person they want, I might say that an app could be a good decision in the interim.

There are apps that are more self-help-focused, where you can work through coping skills. But again, if you're at the point where you're meeting more diagnostic criteria for depression, you're not going to be able to engage with those apps very well because you're not going to be able to, right?

So part of the reason meds and therapy sometimes go hand in hand is that you can't be a great therapy client or patient if you’re really struggling. You’ll just sit there, you won't retain anything, you won't do the things they're asking you to do, and you can't really interact in the same way. Once meds start to help, then you can. So they do have a good interplay in that way.

If you're in school, going to the school counselor is an access point, just like going to the school nurse or your primary care doctor, right? They're overwhelmed, just like everybody, but they’re used to that stuff. They usually have a pretty good view of the community, so they might say, "Oh, I'm not the right person for this, but these are the psychiatrists we like," or, "These are the therapists we like," because they’ve been working with them in their school district and know it really well.

If you're in college, same thing—you might go right to the college counseling center, because that's your school-based option. They might say, "We only do short-term care, so if you want something more regular, we recommend these folks in the community." At least you have a curated list that someone you trust put together.

So again, just like going to your primary care doctor as an option for a list, those people also often have good recommendations with partners in the community.

Pathak: So let’s talk about the treatment side first. Can you talk us through the step-by-step approach you take in starting someone on a treatment journey?

Gold: I will have a very long conversation. Psychiatrists still get an hour intake with people, which probably makes you jealous as a primary care doctor, because you're probably doing my job in 15 minutes. But, you know, we still get an hour.

We have a long conversation about your history—what your mental health symptoms have been like, ruling out other mental health conditions, what your family history is, what you're doing socially, what substances you use—all these things that could change my diagnosis and affect my treatment approach.

I then decide, based on severity and what makes sense, whether this is the first episode and if they should go right to therapy with no medication or if we should talk about meds.

The first-line medication for depression is often an antidepressant—that’s why they're called that. Some of our meds are named that, but we use them for other reasons too, right? They're still used for anxiety, but that’s where the name came from. The most common kind are selective serotonin reuptake inhibitors, or SSRIs—you’ve probably heard them called that.

Those are what I think of immediately, but not always, right? Sometimes people have other reasons to try something else. Like, they have chronic pain, and there’s a med that's good for both depression and chronic pain called duloxetine. Or maybe they’ve been sleeping and eating all the time, so we go for something more activating, like bupropion or Wellbutrin, because that medicine particularly targets those symptoms.

So we look at patients holistically, but for the most part, SSRIs are the first line based on evidence. We also consider other factors—other conditions, symptom profiles—to decide on the best option.

Not everybody needs medication. Let me just say that, right? I’m a medication prescriber, but I also know the value of therapy and do it myself. I go every week as a human. I very much value therapy as a part of this.

A lot of studies show therapy plus medication is the best approach, but not everybody needs medication. It depends on severity, genetics, whether this has happened before—factors that might make it make sense to introduce a medication early.

For me, I have a lot of conversations about, "What have you heard about medication? What scares you? Who told you that?" Because with mental health meds, buy-in matters. You have to believe that it might help for me to keep giving it to you.

I also acknowledge that if you Google mental health meds, you’ll see a lot of misinformation. It can get in your head—you might hear something from a friend, see it on TikTok—so I want to have those conversations upfront. I also want to make it clear that if you read something later and get worried, you can bring that back to me. I don’t want you thinking about it alone at home and just stopping meds. That’s not helpful.

Obviously, we go over risks, benefits, and side effects. Our meds take a little while to work—four to six weeks on a good day, though I’ve seen them work in two. That means you're more likely to have side effects before you see benefits, which is frustrating, even if side effects go away.

I wish we had faster solutions. But this is what we have, and they do work. I’ve seen them work wonders. You just have to have some patience.

Pathak: Can you talk about how you create a personalized plan for someone, including lifestyle pillars that might vary from person to person?

Gold: I mean, I listen a lot, right? So I want to hear what you want and what would make you committed to treating yourself in a holistic way, right? I have a lot of patients who are interested in using lifestyle changes at the same time, and I think with those patients, you know, you talk about all of these things. It might be baby steps, right? We call it behavioral activation. If you're really sad and you don't want to get out of bed, maybe you can't be out all day and do all of the things, but maybe you could be out for 5–10 minutes, and you start there, right?

It's a slow process, but there are ways to work that into your schedule, to start being more structured. I think as we get more depressed, we tend to stay in bed more and wear sweatpants more—especially if we work from home, right? So even just putting on regular clothes can make a difference.

There are little things you can do to start that process if it feels daunting, and we talk about that a lot. I think looking for a therapist plus meds will be part of the conversation, but the type of therapist also depends on the person. Sometimes people want to have open-ended conversations, and sometimes they want to be taught skills. Those are two different types of therapists. You might have a therapist who can do both, but someone specializing in cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT) will focus more on skills.

For example, with behavioral activation, if you want to go from sleeping all day to being up and active, they will give you homework and ask you to take steps. That structure might feel too rigid for some people or just structured enough for others, right? Having those conversations is important. Because I went through training to do therapy and have experience with different types, I can help patients understand what they're looking for, how to make a plan, and how to think about it.

Self-care is always part of the conversation, but you wouldn't just "self-care" your way out of depression. It's important to recognize that socializing impacts mental health. Exercise impacts mental health. The question is when you feel able to do it, how you do it, and how it fits with everything else. That's part of the conversation.

Pathak: I think the point you made about the various types of therapy is so critical. People often think of therapy as just one umbrella term and don’t necessarily recognize the different approaches. There's also the factor of cultural concordance.

I know some studies have shown that considering cultural fit can be helpful because it creates a bit of a shorthand—helping patients process lived experiences, stigma, and recovery in a way that resonates with them. Can you talk a little bit about that?

Gold: We sometimes use the word "fit," and study after study shows that therapy is most effective when there's a good fit or a strong therapeutic alliance. Therapists are the tools. If you don’t trust your therapist—if you don’t feel safe, heard, or understood—you’re not going to follow their advice, do the homework, or have open and honest conversations. And if that trust isn’t there, therapy can’t be helpful.

If you meet a therapist and immediately know they’re not a good fit, I’d encourage you to try someone else if you have that option. I recognize that time, waiting lists, and availability all play a role. But if possible, I’d give them a chance beyond the first session because the first session is usually more about gathering information. Later on, there will be more listening and discussion.

When it comes to cultural fit, people don’t always want to educate their therapist about their identity or experiences—they want to feel understood. There aren’t a lot of Black psychiatrists, but that doesn’t mean they’re impossible to find. Still, it does mean that therapists like me need to be more informed in these conversations. I know that cultural understanding is important, and I work to be aware of that.

If someone said, "Hey, I want to see someone who looks like me," I would help them get there. As hard as it can be to find that match, it can provide extra trust, safety, and a deeper understanding that helps people feel more comfortable opening up. Mental health is deeply tied to culture. You might come from a background where religion is suggested instead of mental health treatment. Talking to someone who understands that might feel safer than talking to someone who doesn’t.

That said, many of us try to keep up with different perspectives to be as helpful as possible, especially given the limitations of availability and access.

Pathak: Let’s talk about social media. You mentioned remote and hybrid work environments, where there’s less socialization during the day. Given the loneliness epidemic we hear so much about, how are you processing these shifts in the way we interact with each other? Do you see a connection between these changes and either the first experience of depression or how people experience mental health over time?

Gold: When I think about these things, it's never just one factor. It’s not just social media that’s causing an increase in mental health concerns. The data on social media is mixed. Some studies suggest that using it makes people depressed. Others show that people who are depressed use it and feel better because they find community and connection.

Loneliness is a feeling, not just a reality. You can have many friends and still feel lonely. You can socialize and still feel lonely. You can be active on social media and still feel lonely. It’s about how you experience connection, not just whether or not you're interacting with others.

When I talk to patients, I ask: How often are you using social media? How do you feel when you’re using it? Have you ever asked yourself that? Because most people haven’t. It’s incredibly passive. And we also absorb news through social media, and news has never been passive—especially as global events become more complex or personally impactful.

People scroll and assume it’s fine, but it’s not always fine. That’s why I try to discuss "mindful scrolling"—being aware of how social media impacts your mood. Taking breaks from it doesn’t mean you don’t care about the world; it just means you need a break, and that’s okay.

On college campuses, especially after COVID, I hear a lot about people feeling less comfortable making friends. That has a significant impact on mental health. Social anxiety, depression, and burnout can all be worsened by a lack of connection. And research shows that having even one close friend makes a big difference. Just one.

We need to talk about how to make friends, what barriers exist, and where to look—whether as a student, a parent, or even a doctor. I think people struggle with this more than they talk about. We hear "people are lonely," but the real issue might be that they don’t know how to start conversations or build relationships.

When I assess depression, I ask early on: "Do you have a friend you can talk to about this openly and honestly?" If the answer is no, I’m more concerned about outcomes, safety, and overall well-being.

We shouldn’t ignore these factors. As clinicians and as humans, they impact us. It’s not just one thing—but all of these influences together are making it harder for people to feel good day-to-day. That’s why it’s important to ask: What does your day look like? What’s your work environment like? How is it affecting you? These are things therapists should be tuned into because they can make a big difference in how people process their emotions—and even in how medications work.

Pathak: Can you talk to us a little bit about action items for having this type of difficult conversation? If we're talking to a listener who might be navigating a difficult experience when it comes to depression and being able to communicate that with someone they're close to in an open way as they start that treatment journey?

Gold: For sure. I think that this applies if you're the person struggling or you're the friend or family member who is concerned.

First off, do not do this in a public setting. You will not have success if this is in the middle of a movie theater or a mall or something. You want to have this conversation somewhere private.

You also want to make sure that the person you're talking to is someone you're pretty sure is a good person to talk to about this. I wouldn't take your first shot with someone you've heard say negative things about depression or mental health. Even if you have to have that conversation eventually with a parent who might not be receptive, I think that’s probably not the first place you should go. If you go there immediately and they say something that makes you feel bad, it might make you question your ability to get care in the right way. It might make you think differently about yourself and your self-esteem.

So, starting with someone you think is safe matters. Having an open conversation—being as vulnerable as you feel comfortable—but also knowing you don’t have to tell anybody everything is key. You can say, "I've really been struggling with my mood lately. I think I'm depressed. Has that ever happened to you?" That could be a way to open the door.

From a friend’s or family member's perspective, don't start with blaming their behaviors, like saying, "You haven't been doing this" or "You always do that." Instead, try something like, "Sometimes I really struggle with getting out of bed. Is that ever a problem for you?" Something that's very open-ended and non-judgmental. Maybe they don't respond in the way you hope because they’re not ready, but at least it's a place to start.

I think these conversations with friends and family should always be ongoing. You shouldn’t just have one and be done. Maybe the first time, all you're comfortable sharing is one layer of an onion, but based on how they react—how they listen and validate your experience—when you go to the doctor, you might feel better coming back to them and peeling the onion back one more layer.

And we don’t ever owe our friends or family everything. That’s just not a thing. I'm a vulnerable human—I write about myself, I write about being on medication—but I don’t actually tell everybody everything. There are still some things I’d like to keep for myself and maybe my therapist.

You're not failing at talking about it if you don’t disclose everything. Social media can sometimes make people feel like the answer is oversharing—saying everything—but that’s not necessarily how you share. How you share is really about where your comfort level is, who you’re talking to, and where you want to start. Based on reactions, how you felt, and what the experience was like, you can decide whether to share more as you’re comfortable—or just stick with what you’ve shared. But at least someone knows you're struggling, and you have someone to turn to when you need to talk.

Pathak: Thank you so much for joining us on this exploration into understanding and managing major depressive disorder. We discovered that feeling down isn't always a clinical condition, and true depression goes beyond a few bad days. It can involve persistent low mood, lack of interest, and other symptoms that last for at least two weeks.

We learned how factors like family history, additional medical issues, and everyday stressors—from social media pressures to living in a more isolated, work-from-home culture—can shape someone's experience with depression. We also explored the variety of support options out there, whether it’s starting with your primary care doctor, seeking specialized help from a psychiatrist, or adding therapy into the mix—sometimes alongside medication.

Even though there’s no one-size-fits-all solution, it’s crucial to remember that you’re not alone and that treatment can be tailored to meet you where you are. Whether you’re wondering if your symptoms are more than just a rough patch or looking for ways to help a friend, the core message is the same:

Depression is treatable. Help is out there. And taking the first step to talk about how you feel is the bravest and most important move you can make.

To find out more information about Dr Jesse Gold, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered podcast.