The National Institute of Mental Health estimates that 16.2 million adults in the United States — approximately 6.7 percent of the population — had at least one major depressive episode in 2016. For some, major depression can result in severe impairments that interfere with or limit one’s ability to carry out life activities, like going into work, meeting a friend for coffee, or even getting out of bed.

Given the prevalence of depression, it’s encouraging to see our culture and the media start to address and normalize it. Actress Kristen Bell, for example, made headlines when she opened up about her experience with depression, and bubbly TV host Ellen Degeneres revealed her depression was “severe.”

Despite the staggering statistics and growing acceptance, it’s still hard for many to truly understand and empathize with depression. While advice like “Cheer up!” is well intentioned, it’s important to recognize that depression is much more than just sadness. We turned to trustworthy resources and people who have experienced depression first-hand to better understand some of the signs and symptoms, which extend far beyond having an “off day.”

Loss of interest or pleasure in most or all normal activities
“I’ve struggled with depression for almost 10 years now,” says Addie, a 31-year-old in Santa Cruz. “When I’m in a depressed state, I notice I stop doing the things that usually bring me joy, like cuddling with my dog and cooking.” As Addie describes, depression can cause you to stop engaging in the hobbies or interests you once enjoyed, whether that’s sports, hanging out with friends, gardening, or reading. It can also lessen the amount of happiness you derive from them.

Feelings of worthlessness or guilt
“I remember looking in the mirror, cringing, and telling myself how ugly, pathetic, and worthless I was,” recalls Sarah, a 25-year-old in Asheville, North Carolina. “When friends called me or asked me to hang out, I’d ignore them because I figured, ‘What’s the point?’ I’ll only disappoint them. But afterwards, I’d feel guilty, incessantly apologize, and tell myself I didn’t deserve to have such caring friends.” Sarah’s cycle of self-disgust, guilt, and inadequacy — known as self-blaming emotions — are common with depression.

Tiredness or lack of energy, so even small tasks take extra effort
“Brushing my teeth — let alone getting out of bed — was a challenge when I was depressed in college,” says Evelyn, a 27-year-old in Alabama. “I remember feeling this constant sensation of heaviness, like I was moving through molasses. I felt weak and sluggish.”

This 2011 study published in Innovations in Clinical Neuroscience states that fatigue is seen in a majority of patients with depression. Additionally, it says that fatigue can affect one’s cognitive, physical, and emotional functioning, as Evelyn experienced. In turn, this can impact things like schoolwork, job performance, and personal relationships.

It’s OK to spend an occasional Saturday on the couch
Keep in mind, it’s normal to experience occasional or mild forms of these symptoms. One weekend, you might y not budge from underneath your comforter, or do anything but binge-watch Netflix on your couch. We all have moments of negative self-talk or feeling inadequate, especially in the age of social media. And as much as you may love early morning yoga or preparing healthy meals, some days, all you might want (or need) to do is sleep in or order pizza.

Here’s the difference: to be diagnosed with depression, five or more these symptoms (here’s a full list) must be present for most of the day, nearly every day, for at least two weeks, and at least one of those symptoms has to be a depressed mood or loss of interest or pleasure in daily activities. Lastly, these symptoms must be causing significant distress or impairment in your life, whether it’s your job, relationships, or general functioning. Essentially, depression is much more pervasive than a crappy week at work. Clinicians use the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-5) to officially diagnose depression. You can check out a copy of the clinical diagnosis criteria for depression here.

How to care for others and yourself
While your friends, who tell you to “just do something that makes you happy!”, have good intentions, they often lack a true understanding of depression if they haven’t experienced it themselves. They likely want to help, but may not know how. The National Institute on Mental Health has a long list of ways to be truly supportive of someone struggling with depression, like simply listening, expressing support, and keeping things as “normal” as possible.

If you’re concerned you may have depression, know that you’re not alone and there are ways to start feeling better. Psychotherapy, medication, or a combination of both are scientifically proven to improve symptoms. You can also take this online test to help you determine what your next step might be, whether that’s consulting a therapist, reaching out to a trusted friend, or calling a 24-hour hotline. Again, you’re not alone.

English Taylor is a San Francisco-based women’s health and wellness writer and birth doula. Her work has been featured in The Atlantic, Healthline, Refinery29, NYLON, and Modern Fertility. Follow English and her work at https://medium.com/@englishtaylor or on Instagram at @englishtaylor.