Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.
More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychological counselling or both.
Depression is a disorder of the brain. There are a variety of causes, including genetic, biological, environmental, and psychological factors. Depression can happen at any age, but it often begins in teens and young adults. It is much more common in women. Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder.
Symptoms
Although depression may occur only one time during your life, usually people have multiple episodes of depression. During these episodes, symptoms occur most of the day, nearly every day and may include:
Feelings of sadness, tearfulness, emptiness or hopelessness
Angry outbursts, irritability or frustration, even over small matters
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
Sleep disturbances, including insomnia or sleeping too much
Tiredness and lack of energy, so even small tasks take extra effort
Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
Anxiety, agitation or restlessness
Slowed thinking, speaking or body movements
Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren't your responsibility
Trouble thinking, concentrating, making decisions and remembering things
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
Unexplained physical problems, such as back pain or headaches
Other features may be noted by doctors, friends, or relatives:
Appearing miserable, tearful eyes, furrowed brows, down-turned corners of the mouth
Slumped posture, lack of eye contact and facial expression
Little body movement, and speech changes (for example, soft voice, use of monosyllabic words)
Gloomy, pessimistic, humourless, passive, lethargic, introverted, hypercritical of self and others, complaining
For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Other people may feel generally miserable or unhappy without really knowing why.
Children with attention-deficit/hyperactivity disorder (ADHD) can demonstrate irritability without sadness or loss of interest. However, major depression can occur with ADHD.
Causes
It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:
Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neuro-circuits involved in maintaining mood stability may play a significant role in depression and its treatment.
Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.
Risk Factors
Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women are diagnosed with depression than are men, but this may be due in part because women are more likely to seek treatment.
Factors that seem to increase the risk of developing or triggering depression include:
Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
Childhood trauma or depression that started when you were a teen or child
Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
Being lesbian, gay, bisexual or transgender in an unsupportive situation
History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
Abuse of alcohol or illegal drugs
Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)
Complications
Depression is a serious disorder that can take a terrible toll on individuals and families. It often gets worse if it isn't treated. Untreated depression can result in emotional, behavioural and health problems that affect every area of your life.
Examples of complications associated with depression include:
Excess weight or obesity, which can lead to heart disease and diabetes
Pain and physical illness
Alcohol or substance misuse
Anxiety, panic disorder or social phobia
Family conflicts, relationship difficulties, and work or school problems
Social isolation
Suicidal feelings, suicide attempts or suicide
Self-mutilation, such as cutting
Premature death from other medical conditions
According to the World Health Organization (WHO), depression is the most common illness worldwide and the leading cause of disability. They estimate that 350 million people are affected by depression, globally.
Here are some key points about depression.
Depression is more common among women than men
Life events such as bereavement produce mood changes that can usually be distinguished from the features of depression
The causes of depression are not fully understood but are likely to be a complex combination of genetic, biological, environmental, and psychosocial factors
Depression is a persistent problem, not a passing one - the average length of a depressive episode is 6-8 months.
Depression is different from the fluctuations in mood that we all experience as a part of a normal and healthy 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 a "complicated bereavement."
Unipolar Versus Bipolar Depression
If the predominant feature is a depressed mood, it is called unipolar depression. However, if it is characterized by both manic and depressive episodes separated by periods of normal mood, it is referred to as bipolar disorder (previously called manic depression).
Unipolar depression can involve anxiety and other symptoms - but no manic episodes. However, for around 40 percent of the time over a 13-year period, individuals with bipolar disorder are depressed, making the two conditions difficult to distinguish.
Major Depressive Disorder With Psychotic Features
This condition is characterized by depression accompanied by psychosis.
Psychosis can involve delusions - false beliefs and detachment from reality, or hallucinations - sensing things that do not exist.
Postpartum Depression
Women often experience "baby blues" with a newborn, but postpartum depression - also known as postnatal depression - is more severe.
Major Depressive Disorder With Seasonal Pattern
Previously called seasonal affective disorder (SAD), this condition is related to the reduced daylight of winter - the depression occurs during this season but lifts for the rest of the year and in response to light therapy.
Countries with long or severe winters seem to be affected more by this condition.
Tests And Diagnosis Of Depression
Diagnosis of depression starts with a consultation with a doctor or mental health specialist (psychologist or psychiatrist).
It is important to seek the 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 the most widely used assessment instrument in the world for clinicians rating depression.
When To See A Doctor
If you feel depressed, make an appointment to see your doctor as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.
Treatments For Depression
Depression is a treatable mental illness. There are three components to the management of depression:
Support - ranging from discussing practical solutions and contributing stresses, to educating family members
Psychotherapy - also known as talking therapies, such as cognitive behavioural therapy (CBT)
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. Both talking therapies focus on the present and encourage the regaining of control over mood and functioning.
CBT may be delivered in individual sessions with a therapist, face-to-face, or over the telephone, but it can also be completed via a computer or in groups. Computerized cognitive behavioral therapy can help reduce depression symptoms in young people.
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 choice of antidepressant medications is available - the individual selection is a matter of personal preference, previous success or failure, adverse side-effects, whether overdose is likely and could be a danger, and interaction with any other treatments being used.
A number of classes of medication 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 - SSRIs, for example, increase the production of serotonin in the brain, while MAOIs block an enzyme that breaks down neurotransmitters. The exact way in which antidepressant medications work is not fully understood.
SSRIs are usually tried first. Antidepressant drugs need to be taken for some time before there is an effect - typically 2-3 weeks - and continued for 6-12 months. The drugs should be continued as prescribed by the doctor, even after symptoms have improved, to prevent relapse.
In some countries like the USA, there may be warning which 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.
Reach out to other people. Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or don’t want to be a burden to others. The simple act of talking to someone face to face about how you feel can be an enormous help. The person you talk to doesn’t have to be able to fix you. He or she just needs to be a good listener—someone who’ll listen attentively without being distracted or judging you.
Eat a mood boosting diet. Reduce your intake of foods that can adversely affect your mood, such as caffeine, alcohol, trans fats, sugar, and refined carbs. And increase mood-enhancing nutrients such as Omega-3 fatty acids.
Find ways to engage again with the world. Spend some time in nature, care for a pet, volunteer, pick up a hobby you used to enjoy (or take up a new one). You won’t feel like it at first, but as you participate in the world again, you will start to feel better.
Historical Legacy
Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions.
Racial Issue
There is a racial difference when considering people facing depression in the USA. For example, adult African-Americans are 20 percent more likely to report serious psychological distress than adult whites. Also, African American men suffer from serious chronic illnesses such as diabetes and cancer at much higher rates than white men, and these diseases and disorders are known to be significant risk factors for depression. By 2016 there is a huge lack of psychological specialists among black people. Whites dominate the psychological and psychiatric professions, as only 2 percent of licensed mental health professionals are African-American, and about three-fourths of these are women. Many African-American men feel uncomfortable revealing their feelings to people who do not share their cultural background, and a shortage of African-American male therapists also means a lack of role models for future scholars who might be searching for a way to give back to their communities. A research conducted by Sirry Alang, a Pennsylvania Lehigh University assistant professor of sociology and anthropology, shows that many African-Americans see depression as a sign of weakness and not a health issue.
....making effort to "STAY WELL"
REFERENCE:
https://medlineplus.gov/depression.html
http://www.mayoclinic.org/diseases-conditions/depression/basics/definition/con-20032977
http://www.medicalnewstoday.com/kc/depression-causes-symptoms-treatments-8933
https://en.wikipedia.org/wiki/Depression_(mood)
http://www.helpguide.org/articles/depression/depression-signs-and-symptoms.htm
http://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml
http://www.webmd.com/depression/understanding-depression-symptoms
https://www.nimh.nih.gov/health/topics/depression/index.shtml
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