Five stages of depression

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).



  • Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
  • Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44. 4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily


  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism



  • In 2020, 20.7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
  • Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3. 4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals


  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program


  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes



  • Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose


  • Medication-Assisted Treatment
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program


  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network



  • In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.


  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.


  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 01/05/2023

causes, types, stages, symptoms, signs, diagnosis, treatment in women and men







Depression is a common mental disorder, the main features of which are a persistent decrease in mood, problems with memory and concentration, and minimal physical activity.

The causes of such a painful condition for a person in most cases are neuropsychic shock or chronic stress. Depression can be accompanied by severe illness, sudden changes in life.

Treatment is based on the use of psychotherapeutic techniques. In some cases, it is supplemented by taking medications.


Depending on the form, the disease is associated with external or internal factors. The causes of psychogenic reactive depression can be severe experiences, an acute psychotraumatic situation. Often, a violation develops after the loss of a loved one, loss of a job, divorce, relocation, injury.

Positively colored events, for example, finally gained wealth or popularity, can also cause upset. In this case, mental deviations are explained by the realization of a dream with the subsequent loss of the meaning of life, provided there are no other goals.

Neurotic depression is a consequence of chronic stress. In this state, it is usually not possible to establish a specific cause of experiences. A person finds it difficult to name any specific psycho-traumatic circumstance, sees his life as a whole as a series of losses and disappointments.

Depression in men often develops with regular use of alcoholic beverages, psychoactive substances.

Other risk factors for affective disorder in patients of either sex are:

  • very high or extremely low financial status;
  • impressionability, suspiciousness, poor resistance to stress;
  • low self-esteem, a tendency to self-flagellation;
  • pessimistic outlook on life;
  • high psycho-emotional stress in professional activities;
  • difficult childhood, psychotraumatic situations suffered at a young age;
  • divorce of parents or loss of one of them, upbringing in an incomplete family, orphanage;
  • the presence of mental or neurotic disorders, addictions among relatives;
  • loneliness, lack of support in the family and social environment;
  • economic and political instability in the country;
  • physiologically determined changes in the hormonal background - the process of puberty, the postpartum period, menopause.

Endogenous depressions develop as a result of neurochemical abnormalities due to genetic mutation or aging of the body. This group of disorders includes involutional melancholia and senile depression. This form of pathology also occurs in manic-depressive psychosis, characterized by a change in the phases of mania, depression and mental stability.

The likelihood of depression in women is higher in the postpartum and menopause periods, when there is a change in the level of sex hormones, which is stressful for the body. In a young mother, neuropsychic disorders can occur with complicated childbirth, problems with breastfeeding or the health of the baby, and the appearance of excess weight.

Diseases of various organs can also be accompanied by depression. They are divided into the following groups:

  1. Pathologies of the cardiovascular system - myocardial infarction, hypertension, circulatory failure, heart rhythm disturbances.
  2. Brain damage due to stroke, neuroinfection or head trauma.
  3. Endocrine disorders - diabetes mellitus, hyper- or hypofunction of the thyroid gland.
  4. Violation of the digestive system - cirrhosis of the liver, colitis.
  5. Rheumatic diseases with prolonged pain syndrome - rheumatism, systemic lesions of the connective tissue, arthritis.
  6. Oncological processes, especially malignant neoplasms.


Depending on the severity and nature of manifestations, depression is of the following types:

  • major or clinical;
  • postpartum;
  • atypical;
  • recurrent;
  • small;
  • dysthymia.

Latent or "masked" depression is characterized by the absence of signs of neuropsychiatric disorders and symptoms characteristic of somatic diseases. The following options are distinguished:

  • cardiology;
  • abdominal;
  • dermal.

Caused by an acute psycho-traumatic situation, reactive psychogenic depression proceeds in several stages:

  1. Denial. The psyche makes an attempt to isolate itself from the ongoing negative events, the patient stubbornly does not believe in what happened.
  2. Anger. Anger arises from a sense of injustice, and the search for the guilty begins.
  3. Trade. A person tries to negotiate in order to avoid consequences. This indicates active attempts to find a way out of the situation.
  4. Depression. There is a feeling of loss of control over what is happening, a feeling of powerlessness and the impossibility of correcting anything. This is accompanied by a depressed mood, apathy, laziness, sadness, pessimistic judgments.
  5. Acceptance. After a real assessment of the situation and the prospects that have opened up, a person resigns himself to his fate and mentally prepares for the consequences.


The main manifestations of the disease are united under the name "depressive triad" and include:

  • a persistent decrease in mood, despair, melancholy, a sense of hopelessness for several weeks and even months;
  • slowing down of thinking, problems with memorizing and analyzing information, fixation on one's own experiences;
  • decreased motor activity, slowness, lethargy, prolonged stay in the same position.

The patient ceases to enjoy activities that previously brought positive emotions, becomes withdrawn and taciturn, can spend most of the day lying in bed or sitting, hunched over, bowing his head and resting his elbows on his knees. Feelings of guilt appear, self-esteem falls, suicidal thoughts arise. Fatigue is characteristic, the solution of simple everyday tasks requires great effort.

In some cases, depression may present with the following symptoms:

  • nocturnal insomnia, often associated with drowsiness during the day;
  • decreased appetite and weight loss;
  • increased heart rate;
  • constipation;
  • dilated pupils;
  • loss of sexual desire;
  • menstrual disorders;
  • intense pain in different parts of the body without objective causes;
  • aggressive behavior, attacks and accusations against other people;
  • dryness and flabbiness of the skin, the appearance of wrinkles;
  • increased hair loss, brittle nails.

With endogenous depression, the intensity of symptoms peaks in the morning, gradually weakening during the day, and the manifestations of psychogenic affective disorders increase in the evening. A feature of postnatal depression is a decrease in the mother's interest in the child, irritation from the need to take care of him.

Clinical depression is severe, including all of the triad and many additional symptoms. The small form is characterized by only a couple of signs of the disease that persist for two or more weeks. The atypical variant proceeds with increased appetite, drowsiness, emotional arousal, and anxiety.

Recurrent depression is characterized by a short duration of several days with a monthly recurrence. Seasonal affective disorder is associated with the change of seasons, the symptoms begin and end at about the same time interval. With dysthymia, the mood is steadily reduced for several years, but negative emotions and experiences do not reach the intensity characteristic of clinical depression.


The greatest danger is suicidal thoughts arising from the disease. They can provoke appropriate actions and lead to tragic consequences. With postpartum depression, a woman can harm not only herself, but also the child. In order to alleviate symptoms, the patient may resort to taking alcohol, drugs.


With somatogenic or latent forms of the disease, a person can seek help from a general practitioner, cardiologist, neurologist, gastroenterologist and other doctors. In the case of psychogenic affective disorder, self-referral to a psychologist is possible. It is important that these specialists promptly refer the patient to a psychotherapist who diagnoses depression. It detects the disease by questioning the patient, during which complaints and symptoms are clarified, possible causative factors. Based on the data received, the doctor will tell you how to get out of depression as soon as possible and draw up a treatment plan.

Special tests for depression are carried out to determine the severity of the process. They include standardized tasks designed and tested by experts. Thus, personal needs, character traits, emotional responses, intelligence levels, anxiety and stress are studied. The Beck Depression Scale with a test questionnaire is often used to identify and assess symptoms of the disease.


With a mild course of the disease, it is possible to undergo only a course of psychotherapy without the use of medications. Additionally, massage, hydrotherapy and exercise therapy may be recommended. Moderate and severe affective disorders also require medication.

The essence of drug therapy for depression is to take drugs that affect the production of biologically active substances that cause the transmission of a neurochemical impulse through the neurons of the limbic system of the brain. For this purpose, antidepressants are used. A large clinical form of the disease, as a rule, requires hospitalization. According to indications for severe depression, pills for insomnia and anxiety are also prescribed - sedatives, tranquilizers.

Psychogenic reactive disorders are successfully treated, and soon after the onset of the disease comes the way out of depression. The clinical picture of the somatogenic form of the disease depends on the severity of the organic pathology. Endogenous disorders are not amenable to psychotherapy, but medication can often achieve long-term remission. Neurotic depression is prone to a long, chronic course.

The author of the article:

Ivanova Natalya Vladimirovna


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