Depression

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Dr. Bhushan Ambadkar
Psychiatrist

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All of us go through spells of sadness in our lives. Sorrow, like happiness, is a normal state of mind. However, prolonged phase of sadness may not be normal. It could signal a mood disorder known as depression. According to the World Health Organization, this mental health challenge is the major cause of disability worldwide.In the clinical psychology fraternity, depression is defined as a mood disorder in which feelings of sadness and loss of interest in otherwise favourite things persist for more than 2 weeks at a stretch. It is likely to affect daily functionalities and may last for weeks or months.  Different from frequent mood fluctuations, depression is a medical condition which is also characterised by anger, sense of loss, low self-worth and hopelessness. Certain health ailments, such as arthritis, asthma, cardiovascular disease, cancer, diabetes and obesity can worsen the symptoms of this mood disorder.

People experiencing depression describe it as feeling a significant loss, and feeling lifeless and apathetic. However, there is a way to get better, by finding the root cause of the depression and identifying various symptoms and types which can help to find a solution that enables people to feel better.

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Types

Depression can be classified into various categories depending on the severity and longevity of symptoms. Here are the most common types of this mental health disorder:

Major or clinical depressive disorder

This is the most severe form of depression where a person experiences certain symptoms for more than 2 weeks. They include:


  • Feeling sad for most part of the day

  • Loss of interest in daily activities

  • Unexplained weight loss or gain

  • Sleeping a lot or inability to snooze

  • Slow thinking

  • Indecisiveness

  • Recurring suicidal thoughts


 

Persistent depressive disorder (dysthymia)
A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms. However, these last for 2 years.

Seasonal affective disorder (SAD)
This type of depression sets in during the winter due to lack of sunlight.

Postpartum depression

Many women undergo this condition after giving birth to a baby. The major cause behind this form of depression is an alteration in hormones. Consult a psychologist if you experience postpartum depression for months after delivery.

Depression with symptoms of psychosis

Depression with symptoms of psychosis is a type of depression that is severe. People with this type of depression experience symptoms of psychosis such as hallucinations (seeing or hearing things that are not real) or delusions (Beliefs that are false).

Patients with bipolar disorder also experience depression.

Symptoms

Depression can affect a person emotionally as well as physically. Common symptoms of depression include unhappiness, loss of interest in activities which were earlier pleasurable, loss of appetite, lack of energy and motivation, difficulty in concentrating, inability to make decisions and sleep issues (mainly insomnia). Chronic, untreated depression can manifest through suicidal thoughts. Apart from these, there are other red flags of depression. Watch out for these:


  • Aggressiveness

  • Irritability

  • Anxiousness

  • Restlessness

  • Reduced sexual desire

  • Fatigue

  • Headache

  • Feeling of emptiness

  • Withdrawal from surroundings

  • Anxiety

  • Loss of appetite

Causes And Risk Factors

Causes

Depression is caused due to various factors. It may be triggered due to external factors (exogenous) or it may be triggered due to internally induced or already existing disease).Someone with depression in the family history is more likely to develop the same illness. 

As depression is a multifactorial illness, it is difficult to pinpoint the exact causes behind depression. However, certain factors listed below may work as triggers:


  • History of trauma or grief

  • Work stress

  • Love and relationship problems

  • Family history

  • Lack of exercise

  • Obesity

  • Certain medications

  • Low self-esteem


Risk Factors

There are various risk factors associated with depression. They are: 

  • Biochemistry: Certain chemical changes in the brain can cause symptoms of depression.

  • Genetics: Depression can be genetic in nature, for example, in case of identical twins if one has depression the other has a 70% chance of experiencing the same sometime in life.

  • Personality: People who are very easily overwhelmed by stress factors or who are more pessimistic in appearance and have low esteem are most likely to experience depression.

  • Environmental factors: Continuing exposure to abuse, poverty or other extremes may account for depression.

Prevention

Practical approaches to prevent depression are developing and implementing a school-based program that motivates children and adolescents to think positively. Programs promoting exercises for the elderly have also proven effective in the prevention of depression.

Diagnosis

To confirm depression, a person must be suffering from at least five symptoms of depression every day for the entire day for two weeks. Depressed mood, loss of interest and enjoyment, and increased fatiguability are regarded as typical symptoms of depression.

A physician may consider when the symptoms began to show up and how long they last, and how much they interfere with a patient’s day-to-day activities. Physical exams, interviews and, lab tests are usually used for confirming the diagnosis.

Treatment

Pharmacotherapy
Doctors prescribe antidepressants for this mental health condition. Each type of these medicines works differently. However, their aim is to regulate brain chemicals to make the patient feel upbeat. Patients should not resort to self-medication when it comes to taking anti-depressants. Also, they should consult a doctor before they stop taking them once the symptoms subside.

An option for treatment-resistant depression is adding a different type of drug, such as antipsychotic or anticonvulsant medication, that helps in the management of symptoms in a better way. Medications prescribed for depression are recommended to be taken regularly as prescribed.

Psychotherapy
Talking to a trained counsellor goes a long way in easing the symptoms of depression. Counsellors may resort to several techniques to help with the condition. One of the most commonly used therapies is cognitive behavioural therapy (CBT). It focuses on a person’s thought process, belief and attitude, and equips them with coping skills for negative emotions.

Brain stimulating therapy

This involves activation or inhibition of the brain impulses with the help of magnetic or electric waves. The most known forms of brain stimulation therapy are electroconvulsive therapy, repetitive transcranial magnetic stimulation and transcranial direct current stimulation.

Lifestyle/management

Alongside medications and psychological counselling, patients need to make some lifestyle modifications to manage depression well.

Eat mindfully

A growing body of research associates processed and sugar-loaded foods with mental health conditions like depression. Various studies have also found that loading up on green vegetables, fruits and foods rich in monounsaturated fats like omega-3 and omega-6 fatty acids improve cognitive capacity. The best sources of these fatty acids are nuts and olive oil.

Exercise regularly

Regular workouts release the happy hormones, endorphins and stimulate the secretion of a brain chemical called norepinephrine, which is associated with mood. Also, yoga is known to alleviate stress, a contributing factor behind depression.  Walking every day will also help deal with depression.

Sleep well

Several studies have associated poor sleep quality with depression. Sleep regulates many brain chemicals that are linked to your mood. So, getting sound sleep is essential to manage depressive disorders. Sticking to a bedtime every night and creating bedtime rituals enhance snooze time.

Prognosis And Complications

Prognosis

Lifestyle changes,such as avoiding alcohol, cutting down on smoking, and increasing exercise and being active, benefit several people suffering from depression.

Proper therapy, diet and early treatments make it easier to live with depression. Lack of treatment and care may result in progression of the illness causing loss of job, suicidal thoughts and ultimately an early death.

Complications

Depression is a serious disorder that can take a toll on individuals and their families. However, this mood disorder may be accompanied by these other complications too:


  • Excess weight or obesity, which can lead to heart disease and diabetes

  • Alcohol or substance abuse

  • Anxiety, panic disorder or social phobia

  • Family conflicts and relationship difficulties

  • Work or academic problems 

  • Social isolation

  • Self-mutilation such as cutting the wrist

  • Premature death from other medical conditions

  • Suicidal thoughts

References


  1. Depression [Updated 2021]. NIMH. Available at: https://www.nimh.nih.gov/health/publications/depression/index.shtml

  2. Depression [Updated Sep, 2020]. Helpguide. Available at: https://www.helpguide.org/articles/depression/depression-symptoms-and-warning-signs.htm

  3. What is depression?. Psychiatry. Available at: https://www.psychiatry.org/patients-families/depression/what-is-depression

  4. Clinical Depression. NHS.Available at: https://www.nhs.uk/conditions/clinical-depression/

  5. Depression.WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/depression.

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