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Everyone experiences emotional highs and lows. But sometimes the lows can be more severe and last longer than usual. In this case, it may be symptoms of clinical depression, a serious medical illness that affects more than 20 million Americans.

John Williams, M.D., professor of medicine at Duke University Medical Center and the Durham Veterans Administration Medical Center, says the reported incidence of clinical depression has been on the rise in recent years, with estimates ranging between one in 10 and one in 12 persons. "These numbers appear both to be increasing," he says, "and also we're doing a better job of recognizing those people who are depressed."

Certain groups, including the elderly, are statistically at greater risk for depression, adds Williams. "There are also family factors," he says, "If there is a history of depression in your family, you're at higher risk. People who are dealing with chronic illness, such as diabetes or heart disease, or someone recovering from a stroke, are clearly at higher risk."

There are a number of common warning signs for depression, according to experts. Among these are increased fatigue, irritability, changes in appetite and a general loss of enjoyment in life.

"If these feelings persist for more than a couple of weeks and if you feel this way most of the time, day after day, that's when you should be concerned that this may be something more than just being down; it may in fact be clinical depression," Williams explained.

Williams says there are many validated screening instruments that can help determine whether a person is likely to be depressed. Many clinics offer free, confidential screenings and can refer patients for treatment. "Whether you do it online, or a clinician administers the screening, you should recognize that this is not diagnostic. But if the instrument shows that you are likely to be depressed, the next step is to see a clinician to do a follow-through evaluation."

For many patients diagnosed with depression, there are excellent treatment options. The two best evaluated and commonly used are antidepressant medications and talk therapy. For some patients, these treatments are used successfully in combination.

Williams also urges doctors and patients to discuss their concerns about depression during regular office visits. "Often, people are reluctant to bring up these symptoms of depression with their physicians, or they're in denial about the possibility themselves. So it can be very useful for clinicians to routinely ask about symptoms of depression in their patients."