Uncommon signs 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

22 easy-to-miss signs of depression


Man among men Know thyself

Depression creeps up on the sly and often becomes apparent when it's too late. This is more than sadness and rivers of tears. This is a constant numbness that never goes away, and even trying to do what you love does not bring relief.

How to recognize it? As a rule, many do not realize what is happening to them. It is useless to ask, no one will give a definite answer. At the same time, a number of features indicate a depressive state. Perhaps by learning more about them, you will get some idea about the people affected by it.

1. Talent and excessive impulsiveness

Don't misunderstand - unreasonable sadness and detachment do not yet speak of rare talent. However, there is a correlation between impulsivity and a high risk of developing depression.

Some experts believe that the feelings and sensations of talented people are sharpened to such an extent that they are practically unable to resist negative emotions and, in particular, find fault with themselves too much.

2. Super sensitive defense mechanisms

Depressed people build impenetrable walls around themselves. Their reluctance to talk about troubles makes them keep others at a decent distance.

Gradually, they learn to masterfully hide emotions and develop powerful defense mechanisms so that no one asks uncomfortable questions. From the outside, they look quite cheerful and energetic. People around do not even notice that a loved one is in trouble, and when its signs become obvious, it is too late to help.

3. Feeling abandoned

Those who have experienced depression find it difficult to let someone into their lives. They don't want to be seen in such a terrible state. There is another reason: in the rare cases when they decide to open up, acquaintances are removed from them.

Such people sooner or later come to the conclusion that in time they will be abandoned by everyone. In addition, they create a false belief that depression only repels people, which means that it is necessary to keep it a secret so that others continue to communicate with them.

4. Strange eating habits

Depressed people often lose their sense of the middle: they either eat too much or don't eat at all. Sudden fluctuations in weight are a very alarming signal, and you need to intervene before it gets worse.

Changes in eating behavior should be a concern as it is manageable. Depressed people may deliberately ignore hunger cramps or consume food in incredible amounts. In addition, it has been proven that unhealthy foods, such as sweet or fried foods, cause the release of serotonin. This neurotransmitter elevates mood and reduces anxiety, which is why it becomes a kind of drug for those suffering from depression.

5.Sleep disorders

Sleeping too much or not enough sleep is an extreme characteristic of depression. The body is out of sync, the brain does not know how to react to failure, and releases melatonin either too much or not enough.

Normal sleep is the most important condition for mental and physical health. But the fact is that the mode of work and rest can also be controlled. Having regained control over at least one aspect of their life, a person feels a surge of strength, even if he thinks that he is not in control of the situation at all.

6. Obsessive thoughts

Depression makes one go deeper and deeper into oneself. The whirlpool of reflection and emotions is addictive, every trifle is diligently analyzed in vain attempts to understand “how it would be if…”

The head is so full of thoughts about the past that there is no room for current events in it. The endless scrolling of cause-and-effect relationships often leads to the fact that really important things fall off the schedule or are completely forgotten. It is important for loved ones to be patient and not demand an immediate return to reality, otherwise the person will close completely.

7. Showy independence

Depressed people believe that no one cares about them. They categorically do not accept outside help, because they want to maintain the illusion of complete control over the situation.

Many consider self-confidence to be a good quality, but in fact it is detrimental to the psyche. The desire to always and in everything rely only on oneself exhausts one's strength. Even satisfaction with independently performed work does not save: such people do not leave fatigue and a feeling of loneliness.

8. Constantly expecting the worst

Depressed people always expect the worst. Instead of remaining optimistic and trying to see a glimmer of light among the clouds, they pre-set up for a dysfunctional ending.

You may be told that this is a realistic attitude to life, but if the expectations are mostly negative, something is clearly wrong. It may be time to have a heart to heart talk, but if the depressed person refuses, it's best not to push.

9. Rescue rituals

When depressed, it is often necessary to adhere to a strict routine: in this way, the same feeling of control is maintained. Even if a person is taking medication and undergoing psychotherapy, he still follows certain rituals so as not to lose the right direction.

Activities can be quite simple: for example, every day at the same time, go for a walk, listen to music or do exercises. Simple at first glance, classes do not allow you to slip into an anxious state again and save you from obsessive thoughts.

10. Fictional stories

In most cases, depressed people do not want others to know what is happening to them, and therefore resort to deception. They invent reasons for their actions, unsightly appearance and scars on their hands.

The desire to hide the truth is dangerous because it is difficult for others to guess how much such people need help. Moreover, the person who pretends everything is fine refuses to admit that he is in trouble and rejects all support.

11. Heightened perception of life and death

Depression does not always lead to suicide, but it distorts the attitude towards life and death.

As a rule, awareness of the meaninglessness of being arises in moments of crisis and despair. In addition, with frequent mood swings, suicidal thoughts sometimes subside, then resume and can become sustainable.

12. Careful attention to metabolism

One who is aware of his depressive state listens intensely to his bodily sensations. Sometimes such people show a surprisingly high level of knowledge about physiological processes.

They clearly know that coffee and sweets improve mood, and which drugs act depressingly. They are aware of which drugs should not be mixed with food so as not to cause an adverse reaction. In fact, this is a personal responsibility that cannot be shared with someone, because you have to take care of your own psyche.

13. The endless search for meaning

Many depressed individuals are constantly searching for the purpose and meaning of life. They need to do something very important and necessary, so as not to stray from the course.

This is explained by the fact that low self-esteem and inadequate anxiety are transformed into an irresistible desire to continually prove one's worth. For them, this is a way to achieve happiness and not depend on anyone.

14. Acute need for love and recognition

They are so in need of love and recognition that they try to please everyone and everyone, just to win sympathy. In fact, inner demons are hidden behind helpfulness and courtesy.

They want to look nice to be considered friends. Not everyone is ready to see the ugly face of depression, so they hide it under a friendly mask so as not to scare others. There is no malice here, just a desire to appear the best version of yourself.

15. Weak cries for help

In our view, depression is a state in which we want to shut ourselves off from everyone and silently stare at the wall. To some extent this is true. People suffering from this disease try to isolate themselves from the outside world, but sometimes it becomes so unbearable for them that feelings spill out.

In rare cases, they dare to open up and talk about their condition. This means that the critical moment has come, the forces are running out, they are literally begging for salvation. Try to listen to them without irritation, otherwise they will “close” again and not say another word.

16.Change in lifestyle

If one of your friends used to play sports only from time to time, and then suddenly began to work hard on himself, it is likely that he is trying to cope with depression. Physical activity provides an opportunity to escape from a depressed mood.

Endorphins are produced during sports activities and overall well-being improves. Feeling a surge of energy, a person begins to seek salvation in regular training.

17. Avoidance

Depression often produces an avoidance reaction. I don’t want to do anything - communicate with friends, go somewhere, even important meetings are postponed. The consequences can be very serious, because, among other things, payments are ignored, lectures are missed, work is not done. Depression is a terrible and insidious monster that easily destroys human life.

Avoiding responsibilities and people is much more convenient - no need to pretend that everything is fine. Especially on nightmarish days, when such melancholy rolls in that it is better to oversleep from morning to evening.

18. Compulsive behavior

Sometimes depressed people show signs of obsessive-compulsive disorder. This again is connected with the desire to maintain at least some control over your life, and get rid of the feeling that the ground is slipping from under your feet. Some take showers several times a day because that is the only way to relax and recover, others go to self-harm, such as trichotillomania (the habit of pulling out their hair).

Such behavior may go unnoticed for a long time, especially for those who do not live with such a person. However, for those who know him well, it is easier to understand that something strange is happening.

19. Avoiding personal questions

Depressed people are the least likely to talk about themselves. They refuse to admit that their life is far from perfect, and they are afraid that they will be judged for their weakness and unwillingness to do something about it.

That's why they try to turn the conversation around to others. It is preferable for them to carefully listen to other people's sorrows than to discuss their own and think how bad everything is. Most of all, they are afraid that they will have to convey feelings in words, and they are silent, hoping that they will manage somehow.

20. Manner of hiding eyes

In those who are depressed, self-esteem drops to zero. They think that they are the worst and generally unworthy of attention. Because of this, almost no one manages to catch their eye when talking. They look at the floor, at the corner, at any distracting object. This makes it easier to distance yourself from your interlocutor.

21. Unexpected outbursts of aggression

Depression is exhausting. It is very difficult to look for explanations for your actions when you do not want your friends to know the truth, and you are trying to deal with your problems alone.

Desperate efforts overwhelm the cup of patience, and sometimes some trifle becomes the last straw, which from the outside looks like an inadequate reaction. Such disruptions indicate that far from everything is safe and something is tormenting a person. It's more than "just a bad mood."

22. Prolonged disappearances

Faced with severe depression, some try to overcome it on their own and disappear from view for a long time. Deciding to disappear for a while, they sit at home without getting out or suddenly leave in an unknown direction without warning anyone.

Fighting depression one on one is incredibly difficult: a person has to literally disconnect from the whole world just to stay on the edge of the abyss. If you notice similar signs in someone you know, it's time to intervene. At least to make sure everything is in order.

Text: Elena Anisimova Photo source: Getty Images

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Not just words: what expressions in a conversation indicate depression


© timur repin/unsplash

Author Irina Rudevich

November 26, 2019

Depressive states are becoming more common, but few people know how to recognize them in themselves and others. Psychologists have conducted a study that helps identify signs of depression in speech.

© mimi thian/unsplash

Depression can only be diagnosed by a doctor, but some people are used to calling it such a bad mood, low energy and seasonal gloom. A person cannot be cheerful and cheerful all the time, sometimes you can and even need to be bored, sad and indulge in sad memories. But with depression, everything is different - the disease can destroy health and life, while few people think about the danger and try to prevent it. The problem is that a depressed person from the outside may seem contented and happy, so others do not know about his problems, missing the time for which you can help.

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In 2018, the journal Clinical Psychological Science published a study that examined the records of almost 6,500 people who were depressed. A special algorithm called Linguistic Inquiry collected statistics from 63 mental health forums. Among the texts of ordinary people, the diaries of celebrities - musician Kurt Cobain and writer Sylvia Plath - were considered, and the data obtained were studied in terms of content and style. Scientists relied on the fact of distortion of thinking under the influence of depression and anxiety, which occupied a person’s thoughts.

The first conclusion of scientists is unlikely to surprise anyone: people suffering from depression often use words with a negative connotation: “sad”, “sad”, “unhappiness”. In addition, in the posts and diaries of most of them there was categorical and maximalism in relation to life. Those on the verge of depression often talk about the absolute, using the words "nothing", "nobody", "everything", "always", "inevitably" and "never". On this basis, one can suspect the disease in most of the acquaintances, because the point is the number of such references, and it is not easy to count them and compare them with the statistics of psychiatrists.

© siavash ghanbari/unsplash

The second interesting discovery is that depressed people prefer to use "I-messages", that is, they talk mostly about themselves. In their speech, there is a lot of the pronoun "I" and little "we", "they", "he" and "she". There are two explanations for this. First, a depressed person is so immersed in himself that he simply does not notice what is happening around him, loses interest in social life and other people, and often turns into a recluse. The second explanation is the original absence of these people. Perhaps the cause of depression was the fact that a person does not have close relatives and friends, those who could play an important role in his life. Scientists have noted that the use of a large number of personal pronouns and their derivatives is a primary sign of depression.

If you notice a lot of learned words being used while talking to a friend, don't panic. Most often, depression leads to changes in habits and lifestyle. For example, a person loses his appetite, suffers from insomnia, or, conversely, overcomes drowsiness. Depressed people may begin to drink alcohol more often and hide their condition behind the usual smile and friendliness.

Learn more