Depression : What Do We Need to Know

Overview

What is Depression ?

Depression, also known as major depressive disorder, is a prevalent and severe medical condition that impacts one’s emotions, thoughts, and behavior, resulting in feelings of sadness, a lack of interest in previously enjoyable activities, and can contribute to various emotional and physical challenges, ultimately impairing one’s ability to function effectively both in professional and personal domains.¹Overview| Researched based study from Psychiatry.org

Types

Major types of Depression

There are 4 major types of Depression

• Situational depression
• Biological depression
• Psychological depression
• Existential depression

In detail the types of depression can be explained as follow:

Situational depression

• This involves experiencing intense sadness due to adverse events or isolating circumstances.
• It is a highly prevalent phenomenon.
• While these feelings are typically considered normal, if they persist beyond a few weeks or if a person begins to have suicidal thoughts, it may indicate a different type of depression.

Biological depression

• This originates from an imbalance in neurotransmitters (e.g., serotonin) as well as hormones, such as estrogen and thyroxine, which impact both mood and physiological functions.
• Consequently, these biochemical alterations can hinder daily activities, leading to increased stress levels, negative thought patterns, and diminished self-esteem.

Psychological depression

• Psychological factors, including unrealistic expectations, distorted perspectives, negative self-talk, and dysfunctional relationships, are closely associated with depression.
• The factors contribute to developing and maintaining depressive symptoms, influencing one’s mental well-being and interpersonal dynamics.²Types| Researched based study from Nlm.nih.gov

Existential depression

• This can be triggered by a positive event, such as the fulfillment of a long-awaited goal, as individuals may anticipate that achieving it will bring purpose, contentment, and a sense of well-being to their lives.
• However, if the expected happiness or fulfillment does not materialize, individuals may experience a sense of disappointment, feeling that they have wasted their time.

Other forms of Depression

There are seven common forms of depression, including:

Major Depressive Disorder (MDD)

• Characterized by persistent and severe depressive symptoms that interfere with daily life.

Persistent Depressive Disorder (PDD)

• Also known as dysthymia, it involves chronic low-grade depressive symptoms that last for at least two years.

Seasonal Affective Disorder (SAD)

• A type of depression that occurs during specific seasons, typically during the winter months when there is less sunlight.⁷Types| Researched based study from Nlm.nih.gov

Postpartum Depression

• Experienced by some women after giving birth, this type of depression involves intense feelings of sadness, anxiety, and exhaustion.

Bipolar Disorder

• It is distinguished by periods of depression interspersed with periods of mania or euphoria.

Psychotic Depression

• A serious episode of depression accompanied with psychotic symptoms like delusions or hallucinations.

Atypical Depression

• This kind of depression is distinguished by mood reactivity, which means that the person’s mood may momentarily improve in reaction to encouraging circumstances.

Symptoms

Symptoms of Depression

• Altered appetite
• Either weight loss or gain that is unrelated to intentional dieting
• Disruptions in sleep patterns (insomnia or excessive sleep)
• Decreased energy levels
• Increase in aimless physical activity
• Experiencing feelings of sadness or a persistent depressed mood
• Diminished sense of interest or pleasure in previously enjoyable activities
• Experiencing feelings of worthlessness or guilt
• Struggling with difficulties in thinking, concentration, and decision-making
• Having thoughts related to death or suicide.¹Symptoms| Researched based study from Psychiatry.org

Causes

Causes of Depression

There are two main categories in which the causes can be classified – biology and psychology.

Biological causes

Biological factors can potentially contribute to the development of depression, which involve:

• Genetics
• Hormones
• Neurotransmitters.⁴Causes| Researched based study from Health.wa.gov.au

Genetics

• The presence of depression within families implies that individuals may inherit genetic predispositions that increase their susceptibility to developing the condition.⁴Causes| Researched based study from Health.wa.gov.au
• While many individuals may inherit a predisposition to depression, a significant portion of them may never experience a depressive illness.

Hormones

• During depression, hormonal changes occur, and the brain undergoes alterations both before and during a depressive episode.⁴Causes| Researched based study from Health.wa.gov.au
• Specific regions of the brain are impacted, potentially leading to excessive or inadequate production of certain hormones.
• The hormonal imbalances could contribute to the manifestation of various depressive symptoms.

Neurotransmitters

• In the brain, nerve cells communicate through neurotransmitters, which are specific chemical substances.
• It is thought that a few of these networks of neurotransmitters become less active in depressive situations.
• The disruption affects specific brain regions responsible for regulating functions such as sleep, appetite, sexual drive, and potentially mood.

Psychological causes

Psychological causes involve:

• Loss
• Thinking patterns
• Feelings of failure
• Stressful life events.⁴Causes| Researched based study from Health.wa.gov.au

Loss

• At times, individuals go through situations involving loss, which can trigger depression.
• Loss can encompass various experiences, such as the death of a loved one, separation from someone significant, unemployment, or the termination of a friendship.⁴Causes| Researched based study from Health.wa.gov.au

Thinking patterns

Depression is associated with certain patterns of thinking, which can include:

• Focusing excessively on the negative aspects of situations.
• Taking responsibility for negative events while disregarding positive ones.

Feelings of failure

These can also contribute to depression.

• Some individuals may tie their happiness to specific achievements, such as academic success, securing a desired job, financial gains, or finding a life partner.
• If they are unable to accomplish these goals, they may perceive it as a personal failure, which can intensify or trigger depression.

Stressful life events

• Additionally, a depressive episode may start as a result of a series of life situations that are stressful.
• Examples of such events include unemployment, financial concerns, and other challenging circumstances.⁴Causes| Researched based study from Health.wa.gov.au

Prevalence

Prevalence of Depression

• Around 3.8% of the population is estimated to experience depression.
• The number includes 5% of adults (with a breakdown of 4% for men and 6% for women) and 5.7% of adults over 60 years old.
• The global prevalence of depression stands at approximately 280 million individuals.
• Depression is about 50% more prevalent in women compared to men.
• Furthermore, over 10% of pregnant women and those who have recently given birth experience depression worldwide.
• Tragically, more than 700,000 individuals lose their lives to suicide annually, making it the fourth leading cause of death among individuals aged 15 to 29.⁵Prevalence| Researched based study from Who.int

Diagnosis

Diagnosis of Depression

Although there is no specific laboratory test that can definitively diagnose depression, there is a standard procedure that is followed to determine a diagnosis.

• A doctor will typically conduct a comprehensive evaluation, which may include blood tests, to eliminate any underlying medical conditions that could be contributing to the symptoms of depression.

To receive a diagnosis of major depressive disorder (MDD), individuals should experience a minimum of five specific key symptoms from the following consistently for at least two weeks:⁷Diagnosis| Researched based study from Mayoclinic.org

• Depressive mood
• Altered appetite
• Difficulty concentrating
• Irritability and restlessness
• Persistent fatigue
• Feelings of worthlessness or excessive guilt
• Recurrent suicidal ideation or preoccupation with death
• Sleep disturbances
• Diminished interest in previously enjoyed activities
• A sense of detachment or slowed movement

Treatment

Treatment of Depression

Treatment with Medications

Antidepressants

• Antidepressants encompass a range of medications and drug categories that can effectively elevate mood and enhance motivation.⁸Treatment| Researched based study from Nlm.nih.gov
• They are frequently combined with psychological treatments. However, it typically takes several days or weeks for antidepressants to exhibit their therapeutic effects.
• In cases of acute depression, these medications need to be taken daily for several weeks or months before noticeable improvements are observed.
• Continuation treatment, lasting four to nine months, often follows this initial phase of treatment.
• During the concluding stages of treatment, the dosage of antidepressants is gradually tapered off over several weeks.
• Abruptly discontinuing antidepressant medication can result in temporary difficulties such as sleep disturbances, nausea, or restlessness. Therefore, it is important to follow a gradual and supervised approach when discontinuing antidepressants to minimize potential withdrawal symptoms.

Herbals

• St. John’s wort is widely recognized as one of the most common and well-known herbal medicines used for treating depression.⁸Treatment| Researched based study from Nlm.nih.gov
• It is primarily utilized for mild depression, although it is also employed in some cases of moderate depression.
• While herbal remedies can offer potential benefits, they also carry the risk of side effects and interactions with other medications.
• It is crucial to consult with a doctor before taking St. John’s wort or any herbal product for the treatment of depression.

Psychological treatment

• It typically involves engaging in in-depth discussions and participating in behavioral exercises.

Cognitive behavioral therapy

• In the context of depression, negative thought patterns such as self-doubt and guilt can exacerbate the problem.
• Cognitive behavioral therapy (CBT), which involves cognitive therapy and behavioral therapy, aims to gradually break these patterns, leading to improved self-perception and overall well-being.⁸Treatment| Researched based study from Nlm.nih.gov
• Cognitive therapy focuses on the understanding that problems are often influenced by the significance individuals attribute to things and situations. By changing one’s perspective, significant progress can be made.
• The objective of behavioral therapy is to identify harmful behavior patterns, actively work on them, and bring about positive changes.

Psychoanalytic approaches

• The approaches operate on the premise that unresolved conflicts, buried in the unconscious mind, can contribute to the development of depression.
• The primary objective is to uncover and address undisclosed issues through dialogue with a therapist.
• Individuals undergoing psychoanalytic therapy must be willing to confront potentially distressing past experiences.

Systemic therapy

• It emphasizes the significance of interpersonal relationships, such as those within families, friendship circles, or workplaces.
• The relationships can contribute to the onset of depression.
• The therapy focuses on enhancing communication and dynamics within these relational systems, with the goal of alleviating depressive symptoms.

Additional therapies

Relaxation techniques

• Progressive easing of muscles, autogenic training, therapy with music, and yoga are a few techniques that have shown promise in the treatment of mild to moderate depression.

Sports

• Jogging, biking, swimming, or trekking demonstrated efficacy in reducing depressive symptoms or lowering the likelihood of developing depression.

Light therapy

• It is a therapeutic approach utilized in the management of seasonal affective disorder, which is a type of depression that affects certain individuals during the months with less daylight.
• Light therapy entails sitting in front of a specialized bright light, typically a light therapy device, for approximately thirty minutes each morning.⁸Treatment| Researched based study from Nlm.nih.gov

Sleep deprivation therapy

• It is a treatment method that involves intentionally depriving the patient of sleep for a designated period.
• It typically involves staying awake throughout the night and then allowing the patient to sleep the following night.
• The underlying belief is that sleep deprivation can induce metabolic changes in the brain, potentially resulting in an improvement in mood.

Electroconvulsive therapy (ECT)

• With the patient under general anesthesia, it is often given in a hospital setting.
• Electrodes are positioned on the patient’s head, and a brief surge of electrical current is transmitted through the brain, triggering a controlled seizure.
• It is typically considered a treatment option for individuals with clinical depression when other interventions have proven ineffective.

Risk

Who are at risk?

• While depression can occur at any stage of life, it frequently emerges during adulthood.
• Anyone with thyroid disease or taking certain medications to treat physical illnesses.
• a history of depression in one’s life or in their family.
• Experiencing major negative life changes, trauma, or high levels of stress.
• Older age people with other significant medical conditions, including cancer, Parkinson’s, etc.
• Depression is more frequently diagnosed in women than in men.⁹Risk| Researched based study from Nimh.nih.gov

Prevention

Prevention of Depression

• Ensuring an adequate amount of sleep.
• Engaging in sports and exercise.
• Practicing meditation or relaxation exercises.¹⁰Prevention| Researched based study from Biomedcentral.com
• Cultivating positive social connections.
• Maintaining a healthy diet.
• Ensuring early implementation of the most appropriate therapy to prevent the escalation of symptoms and the development of chronic depression.
• Engaging in screening procedures and preventative examinations for early detection.
• Participating in supportive training programs for patients and their families to develop the ability to recognize early warning signs of depression.

Prognosis

Prognosis of Depression

• Major depressive disorder carries a substantial risk of morbidity and mortality, particularly due to its association with suicide.
• However, with proper treatment, a significant reduction in symptoms can be achieved in 70-80% of individuals diagnosed with major depressive disorder.¹¹Prognosis| Researched based study from Sciencedirect.com
• It is important to note that up to 50% of patients may not respond favorably to the initial treatment attempt.
• Poor prognoses are often observed in depressed patients who report severely stressful life events, with considerably worse outcomes associated with the reporting of three or more events.
• Pretreatment symptoms of irritability and psychosis may also be linked to poorer treatment outcomes.