Depression

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Depression

Introduction

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.


Research About Depression

Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the word have depression. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when recurrent and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Over 700 000 people die due to suicide every year. Suicide is the fourth leading cause of death in 15-29-year-olds.


What are the types of depression

Healthcare providers name depression types according to symptoms and causes. These episodes often have no obvious cause. In some people, they can linger much longer than in others for no clear reason.


Types of Depression

Major depressive disorder (MDD): Major depression (clinical depression) has intense or overwhelming symptoms that last longer than two weeks. These symptoms interfere with everyday life.

Bipolar Depression: People with bipolar disorder have alternating periods of low mood and extremely high-energy (manic) periods. During the low period, they may have depression symptoms such as feeling sad or hopeless or lacking energy.

Pennatal and postpartum Depression: “Perinatal” means around birth. Many people refer to this type as postpartum depression. Perinatal depression can occur during pregnancy and up to one year after having a baby. Symptoms go beyond “the baby blues,” which causes minor sadness, worry or stress.

Persistent Depressive Disorder (PDD): PDD is also known as dysthymia. Symptoms of PDD are less severe than major depression. But people experience PDD symptoms for two years or longer.

Premenstrual Dysphoric Disorder (PMDD): Premenstrual dysphoric disorder is a severe form of premenstrual disorder (PMS). It affects women in the days or weeks leading up to their menstrual period.

Psychotic Depression: People with psychotic depression have severe depressive symptoms and delusions or hallucinations. Delusions are beliefs in things that are not based in reality, while hallucinations involve seeing, hearing, or feeling touched by things that aren’t actually there.

Seasonal Affective Disorder (SAD): Seasonal depression, or seasonal affective disorder, usually starts in late fall and early winter. It often goes away during the spring and summer.


Symptoms And Patterns

During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks. Several other symptoms are also present, which may include poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling especially tired or low in energy.
In some cultural contexts, some people may express their mood changes more readily in the form of bodily symptoms (e.g., pain, fatigue, weakness). Yet, these physical symptoms are not due to another medical condition.
During a depressive episode, the person experiences significant difficulty in personal, family, social, educational, occupational, and/or other important areas of functioning.
A depressive episode can be categorized as mild, moderate, or severe depending on the number and severity of symptoms, as well as the impact on the individual’s functioning.

There are different patterns of mood disorders including:

  • Single episode depressive disorder, meaning the person’s first and only episode);
  • Recurrent depressive disorder, meaning the person has a history of at least two depressive episodes; and
  • Bipolar disorder, meaning that depressive episodes alternate with periods of manic symptoms, which include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behavior

Depression Is Different from Sadness or Grief/Bereavement

The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”
But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:
In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks. In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.
Grief and depression can co-exist for some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.
Distinguishing between grief and depression is important and can assist people in getting the help, support or treatment they need.


Risk Factors For Depression

Depression can affect anyone—even a person who appears to live in relatively ideal circumstances.

Several Factors can play a role in depression

Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.
Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.
Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.
Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.
During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks. Several other symptoms are also present, which may include poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling especially tired or low in energy.
In some cultural contexts, some people may express their mood changes more readily in the form of bodily symptoms (e.g., pain, fatigue, weakness). Yet, these physical symptoms are not due to another medical condition.
During a depressive episode, the person experiences significant difficulty in personal, family, social, educational, occupational, and/or other important areas of functioning.
A depressive episode can be categorized as mild, moderate, or severe depending on the number and severity of symptoms, as well as the impact on the individual’s functioning.


There are different patterns of mood disorders including:
single episode depressive disorder, meaning the person’s first and only episode);
recurrent depressive disorder, meaning the person has a history of at least two depressive episodes; and
bipolar disorder, meaning that depressive episodes alternate with periods of manic symptoms, which include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour


Contributing factors and prevention

Depression results from a complex interaction of social, psychological, and biological factors. People who have gone through adverse life events (unemployment, bereavement, traumatic events) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and the depression itself.
There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.
Prevention programs have been shown to reduce depression. Effective community approaches to prevent depression include school-based programs to enhance a pattern of positive coping in children and adolescents. Interventions for parents of children with behavioral problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programs for older persons can also be effective in depression prevention.

Diagnosis And Treatment

There are effective treatments for depression.

Depending on the severity and pattern of depressive episodes over time, health-care providers may offer psychological treatments such as behavioral activation, cognitive behavioral therapy and interpersonal psychotherapy, and/or antidepressant medication such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Different medications are used for bipolar disorder. Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists. Antidepressants are not the first line of treatment for mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.



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