You immediately get help. That means setting up an appointment with a qualified professional, whether it be a psychiatrist or licensed professional counselor. I always encourage people to be responsible for their mental health care, meaning accept there is responsibility beyond medication. I use the comparison of medication being like a cast with a broken bone. The cast doesn't actually heal the bone, but it allows the bone to heal. And medication is very similar -- it does not heal or eradicate the disorder, but it puts the brain in a frame in which it can learn. So it is important to help the brain make good decisions, translating into new behavior, which over time can bring changes that will contribute to the improvement of the depressive symptoms.
That depends. First and foremost I recommend a professional assessment. It is important to understand if there have been life events that cause the current feelings. Typically sadness is associated with loss (either the actual loss of something or somebody) or the threat of losing something or somebody that is valuable to you. Sadness and depression have both been identified as steps in the grief process. Denial, anger, sadness, or certain theorists have suggested that there's denial, anger, and depression. But almost in any grief theory you are going to see both sadness and depression as being stages of grief.
When I educate people on the difference, what I tell them is if we get stuck in the sadness too long and it becomes chronic, that it can develop into depression, an overwhelming sense of worthlessness or hopelessness. With sadness, people typically can continue to be active. They can continue to make decisions, they can continue to move forward through whatever it is that's making them sad. But depression is much more debilitating. There is an inability to distinguish certain perspectives, to make decisions, or to take certain actions to improve your current circumstances.
Sometimes you have to have help to pull yourself out of it. I think that we always want to explore the least restrictive measure initially when we experience depression. But sometimes we don't become aware early enough with the onset of the depression that our own efforts can be enough to pull ourselves out. So, again, this is where a qualified professional would come in to do a comprehensive assessment, in order to make a recommendation as to whether therapy alone is needed, and if so for approximately how long. Therapy can evaluate what that individual client's learning style is and the best type of therapy that they're more likely to respond favorably to, and whether they will need to be evaluated for medication, and possibly be placed on a combination of medication and therapy under the supervision of a psychiatrist for a specific period of time. There are many patients who are uncomfortable or resistant to medication, and so it would be important that they choose a physician that is very conservative and very proactive, that if medication is needed they are committed to using it for only a limited amount of time. Self-care, the client continuing to seek therapy and counseling as an ongoing commitment for their mental health, is necessary for long term improvement.