Introduction

Depression is one of the most common mental health conditions in the world, yet it often remains misunderstood. Whether you're personally dealing with depression or supporting someone who is, it’s essential to understand what depression truly is, how it manifests, and the ways it can be managed. In this blog, we'll explore the signs, causes, treatments, and most importantly, ways to find hope and healing.

What is Depression?

Depression is a mood disorder marked by a continual sense of sadness and a disinterest in previously enjoyable activities. It may also create challenges in thinking, memory, eating, and sleeping.

While feeling sad or grieving during tough life events, like job loss or divorce, is normal, depression differs in that it persists nearly every day for at least two weeks and includes additional symptoms beyond just sadness.

There are various types of depressive disorders, with clinical depression, commonly referred to as major depressive disorder, being the most severe and recognized form. Without treatment, depression can intensify and persist longer, potentially leading to self-harm or suicide. Fortunately, many effective treatment options exist to relieve symptoms.

Types of Depression?

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies depressive disorders into several categories:

1. Major Depressive Disorder (MDD): This diagnosis is given when an individual has felt sad, low, or worthless most days for at least two weeks, in addition to experiencing other symptoms such as sleep problems, loss of interest in activities, or changes in appetite. This is the most severe form of depression and one of the most common.
2. Persistent Depressive Disorder (PDD): Previously known as dysthymia, PDD is a mild or moderate form of depression that lasts for at least two years. The symptoms are less severe than those of major depressive disorder.
3. Disruptive Mood Dysregulation Disorder (DMDD): This disorder leads to chronic irritability and frequent outbursts of anger in children, with symptoms typically beginning by age 10.
4. Premenstrual Dysphoric Disorder (PMDD): PMDD includes the symptoms of premenstrual syndrome (PMS) along with mood-related symptoms, such as severe irritability, anxiety, or depression. These symptoms usually improve within a few days after the onset of menstruation but can be severe enough to disrupt one's daily life.
5. Depressive Disorder Due to Another Medical Condition: Various medical conditions, such as hypothyroidism, heart disease, Parkinson’s disease, and cancer, can lead to depression. When the underlying medical issue is treated, the depression often improves as well.

Specific Forms of Major Depressive Disorder

Some specific forms of major depressive disorder include:

• Seasonal Affective Disorder (SAD): This typically occurs during the fall and winter months and improves in spring and summer.
• Prenatal and Postpartum Depression: Prenatal depression occurs during pregnancy, while postpartum depression develops within four weeks of delivery. Both are referred to in the DSM as "major depressive disorder (MDD) with peripartum onset.
• Atypical Depression: Also referred to as major depressive disorder with atypical features, this form features symptoms that differ slightly from typical depression. A key aspect is a temporary uplift in mood in response to positive events (mood reactivity), along with increased appetite and heightened sensitivity to rejection.

Individuals with bipolar disorder may also experience episodes of depression alongside manic or hypomanic episodes.

Symptoms of Depression

Symptoms of depression can range from mild to severe and may manifest differently for each individual. Common symptoms include:

1. Low mood and irritability
2. Losing interest or pleasure in activities you once enjoyed
3. Sleeping too little or too much
4. Feeling worthless
5. Experiencing excessive difficulty thinking, concentrating, forgetting things, or making minor decisions
6. Decreased energy or increased fatigue
7. Notable changes in appetite (eating much less or more than usual)
8. Weight changes (significant loss or gain unrelated to dieting)
9. Thinking of death, having suicidal ideation, or suicide attempts

It's normal to occasionally feel sad or "down in the dumps" as part of the human experience. However, a diagnosis of depression requires that these symptoms occur for most of the day, nearly every day, for more than two weeks, along with a noticeable change in daily functioning (e.g., work or school performance, personal relationships, and hobbies). The good news is that depression is highly treatable.

Causes of Depression

What Causes Depression?

The exact cause of depression is not fully understood, but researchers believe several factors contribute to its development, including:

• Brain Chemistry: An imbalance of neurotransmitters such as serotonin and dopamine may play a role in the onset of depression.
• Genetics: If you have a first-degree relative (such as a biological parent or sibling) with depression, you are about three times more likely to develop the condition compared to the general population. However, it is possible to experience depression without a family history of it.
• Stressful Life Events: Difficult experiences, such as the death of a loved one, trauma, divorce, isolation, and lack of support, can trigger depressive episodes.
• Medical Conditions: Chronic pain and other long-term medical conditions, like diabetes, can lead to depression.
• Medications: Certain medications might list depression as a side effect, and substance use (including alcohol) can exacerbate depressive symptoms.

It's normal to occasionally feel sad or "down in the dumps" as part of the human experience. However, a diagnosis of depression requires that these symptoms occur for most of the day, nearly every day, for more than two weeks, along with a noticeable change in daily functioning (e.g., work or school performance, personal relationships, and hobbies). The good news is that depression is highly treatable.

Diagnosis and Tests

How is Depression Diagnosed?

Healthcare providers diagnose depression by thoroughly assessing your symptoms, medical history, and mental health history. They may identify specific types of depression, such as seasonal affective disorder or postpartum depression, based on the nature of your symptoms.

To be diagnosed with depression, you must present five or more depressive symptoms nearly every day over two weeks. Your provider may also order medical tests, such as blood tests, to rule out any underlying medical conditions that might be causing your symptoms.

Management and Treatment

How is Depression Treated?

Depression is one of the most treatable mental health conditions, with approximately 80% to 90% of individuals who seek treatment responded well. Treatment options include:

• Psychotherapy: Also known as talk therapy, this involves discussions with a mental health professional who helps you identify and change unhealthy emotions, thoughts, and behaviors. Cognitive Behavioural Therapy (CBT) is the most common type, though some people may need therapy for only a short time, while others continue for months or years.
• Medication: Antidepressants are prescription medications that can help adjust the brain chemistry associated with depression. There are several types of antidepressants, and finding the right one may take some time. While some antidepressants have side effects, these often improve with time. If they do not, consult your healthcare provider for alternatives.
• Complementary Medicine: This approach includes treatments alongside traditional Western medicine. Individuals with mild depression or persistent symptoms may benefit from therapies such as acupuncture, massage, hypnosis, and biofeedback.
• Brain Stimulation Therapy: This option is for individuals with severe depression or depression accompanied by psychosis. Types of brain stimulation therapy include Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), and Vagus Nerve Stimulation (VNS).

Self-Care

In addition to professional treatment, there are various self-care strategies you can adopt at home to help alleviate depression symptoms, including:

• Regular exercise
• Quality sleep (not too little and not too much)
• A healthy diet
• Avoiding alcohol, as it can act as a depressant
• Spending time with loved ones

By combining professional help with self-care, individuals can work towards managing and improving their depressive symptoms effectively.

Prevention

Can I prevent depression?

While you can’t always prevent depression, you can lower your risk by:

• Maintaining a healthy sleep routine.
• Managing stress with healthy coping strategies.
• Practicing regular self-care, such as exercise, meditation, and yoga.
• If you've experienced depression before, you're more likely to have it again. Seek help promptly if symptoms arise.

Screening for Depression

Interpretation

Outlook/Prognosis

What is the prognosis of depression?

The prognosis varies based on:

• Severity and type.
• Duration (temporary vs. long-lasting).
• Treatment status (treated vs. untreated).
• Co-occurring conditions (mood disorders, medical issues, or substance use).

Untreated depression can:

• Worsen over time.
• Increase risks for other health issues, like dementia.
• Exacerbate existing conditions like diabetes.
• Lead to self-harm or suicide.

If you have suicidal thoughts, seek immediate help by calling emergency numbers.

When should I see my healthcare provider about depression?

If you have depression symptoms, consult a healthcare provider for an accurate diagnosis and treatment options. If your current treatment isn't effective or causes side effects, discuss alternatives with your provider.

Note: Depression is common and treatable. If you experience symptoms, reach out to your healthcare provider. Early intervention can lead to better outcomes.

References

https://med.stanford.edu/fastlab/research/imapp/msrs/_jcr_content/main/accordion/accordion_content3/download_256324296/file.res/PHQ9%20id%20date%2008.03.pdf