Depression

    What is depression?

    Depression is a mental health disorder. It is a mood disorder characterized by persistently low mood and a feeling of sadness and loss of interest. Depression is a persistent problem, not a passing one – the average length of a depressive episode is 6-8 months.

    What does not class as depression?

    Depression is different from the fluctuations in mood that people experience as a part of normal life. Temporary emotional responses to the challenges of everyday life do not constitute depression likewise, even the feeling of grief resulting from the death of someone close is not itself depression if it does not persist. Depression can, however, be related to bereavement – when depression follows a loss, psychologists call it as “complicated bereavement.”

    Causes of Depression

    The causes of depression are not fully understood and may not be down to a single source. Depression is likely to be due to a complex combination of factors that include:

    • Genetics
    • Biological – changes in neurotransmitter levels
    • Environmental
    • Psychological and social (psychosocial)

    Some people are at higher risk of depression than others; risk factors include:

    • Life events – including bereavement, divorce, work issues, relationship with friends and family, financial problems, medical concern, or acute stress.
    • Personality – those with less successful coping strategies, or previous life trauma.
    • Genetic factors – first degree relatives of depressed patients are at higher risk.
    • Childhood trauma.
    • Some prescription drugs – including corticosteroids, some beta-blockers, interferon, and other prescription drugs.
    • Abuse of recreational drugs (including alcohol and amphetamines) – can accompany depression or result in it. There are strong links between drug abuse and depression.
    • A past head injury.
    • People who have had an episode of major depression are at higher risk of a subsequent one.
    • Chronic pain syndromes in particular, but also other chronic conditions, such as diabetes, chronic obstructive pulmonary disease, and cardiovascular disease.

    Symptoms of Depression

    • Frequent sad mood
    • Reduced interest or pleasure in activities previously enjoyed, loss of sexual desire
    • Unintentional weight loss (without dieting) or low appetite
    • Insomnia (difficulty sleeping) or hypersonic (excessive sleeping)
    • Psychomotor agitation (for example, restlessness, pacing up and down), or psychomotor retardation (slowed movements and speech)
    • Fatigue or loss of energy
    • Feeling of worthlessness or guilt
    • Worsened ability to think, concentrate, or make decisions
    • Recurrent thoughts of death or suicide, or attempt suicide

    Treatments for Depression

    Depression is a treatable mental illness. There are three components to the management of depression:

    • Support – ranging from discussing practical solutions to stressors, to educate family members regarding that.
    • Psychotherapy – also known as personal interaction with professionals
    • Drug treatment – antidepressants.

    Psychotherapy

    Psychological or talking therapies for depression include cognitive-behavioral therapy (CBT), interpersonal psychotherapy, and problem-solving treatment. In mild cases of depression, psychotherapies are the first option for treatment; in moderate and severe cases, they may be used alongside other treatment.

    CBT and interpersonal therapy are the two main types of psychotherapy used in depression. CBT may be delivered in individual sessions with a therapist, face-to-face, in groups, or over the telephone. Some recent studies suggest that CBT may be delivered effectively via computer.

    Interpersonal therapy helps patients to identify emotional problems that affect relationships and communication, and how these, in turn, affect mood and can be changed.

    Antidepressant Medications

    Antidepressants are drugs available on prescription from a doctor. Drugs come into use for moderate to severe depression, but are not recommended for children, and will be prescribed only with caution for adolescents.

    A number of classes of medications are available in the treatment of depression:

    • selective serotonin reuptake inhibitors (SSRIs)
    • monoamine oxidase inhibitors (MAOIs)
    • tricyclic antidepressants
    • atypical antidepressants
    • selective serotonin and norepinephrine reuptake inhibitors (SNRI)

    Each class of antidepressant acts on a different neurotransmitter. The drugs should be continued as prescribed by the doctor, even after symptoms have improved, to prevent relapse.

    A warning from the Food and Drug Administration (FDA) says that “antidepressant medications may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.”

    Any concerns should always be raised with a doctor – including any intention to stop taking antidepressants.

    Exercise and other therapies

    Aerobic exercise may help against mild depression since it raises endorphin levels and stimulates the neurotransmitter norepinephrine, which is related to mood.

    Brain stimulation therapies – including electroconvulsive therapy – are also used in depression. Repetitive Transcranial Magnetic stimulation sends magnetic pulses to the brain and may be effective in major depressive disorder.

    Electroconvulsive therapy

    Severe cases of depression that have not responded to drug treatment may benefit from electroconvulsive therapy (ECT); this is particularly effective for psychotic depression.

    Tests and diagnosis of depression

    Diagnosis of depression starts with a consultation with a doctor or mental health specialist. It is important to seek help of a health professional to rule out different causes of depression, ensure an accurate differential diagnosis, and secure safe and effective treatment.

    As for most visits to the doctor, there may be a physical examination to check for physical causes and coexisting conditions. Questions will also be asked – “taking a history” – to establish the symptoms, their time course, and so on.

    Some questionnaires help doctors to assess the severity of depression. The Hamilton depression rating scale, for example, has 21 questions, with resulting scores describing the severity of the condition. The Hamilton scale is one of the most widely used assessment instruments in the world for clinicians rating depression.

    Types of depression

    • Unipolar versus bipolar depression
    • Major depressive disorder with psychotic features
    • Postpartum depression
    • Major depressive disorder with seasonal pattern