Depression

Depression is a type of mood disorder that causes symptoms which can have a negative impact on a person’s daily life. Over the years, there has been a marked increase in the number of people being affected by this problem and it has become increasingly common in young adults and children. A common misconception about depression is that depression just means that a person tends to be sad all the time. However, there is much more to depression than a general feeling of sadness. It can significantly alter a person’s ability to work, study, interact and carry out daily activities. Another aspect of depression is that its interpretation may vary from person to person. This means that different people suffering from depression describe it using different ways to explain how they feel. With increasing awareness about mental health issues, people are now able to understand depression better and can identify its symptoms. This helps people with depression to cope with the illness more efficiently and improve their quality of life. Depression can be treated effectively and with ample awareness, it is expected that more and more people will seek help regarding their depression.

What Is Depression?

Depression is defined as a feeling of sadness lasting at least for two weeks along with a feeling of guilt, worthlessness, loss of desire to do anything, changes in sleep and appetite. It is not merely feeling low after a disappointment or failure, but a persistent unhappiness that affects your everyday routine, work, and personal and social life. It is a common psychiatric disorder that can be easily treated with counselling and medication if detected in time.

According to the National Institute of Mental Health, there are various forms of depression. Some of them are:

• Postpartum Depression
  Postpartum depression refers to depression experienced by women who have recently given birth. Some women may experience severe depression during their pregnancy as well. Postpartum depression is far more serious than what most people call “baby blues”. It is accompanied by thoughts of sadness, helplessness, and feeling of extreme anxiety and sometimes thoughts of harming the child. Its characteristic symptoms include anxiousness, talking negatively about the child, refusing to feed the child, and an inability to return to normal life.
• Dysthymia
  Dysthymia, also known as the persistent depressive disorder, refers to a depressed mood which lasts for two or more years. A person diagnosed with dysthymia may experience episodes of major depression with fluctuating intensity. The symptoms may seem to become less severe but can return suddenly. It may also lead to what psychologists refer to as learned helplessness wherein a person simply gets used to discomfort and does not initiate an effort to change existing conditions due to past failures.
• Psychotic depression
  Psychotic depression is characterized by the presence of severe depression along with psychotic symptoms like hallucinations or delusions. While experiencing a hallucination, the person may claim to see or hear things which are not there in reality. While experiencing a delusion, the person will appear to have a false yet fixed belief. For example, the person may have a strong belief that someone is trying to kill him/her and refuse to leave the house despite being told that he/she is safe.
• Seasonal affective disorder
  This kind of depression is known to occur with the onset of the winter season due to a decreased presence of natural light. The symptoms usually go away as the season begins to change and there is more natural light outside. Its symptoms are usually not very severe. These symptoms include feeling extremely drowsy during the day, reluctance to move out in the open, weight gain, and laziness, especially during daytime.
• Bipolar disorder
  Bipolar disorder is not the same as depression. However, a severe episode of depression can be seen in bipolar disorder. A person with bipolar disorder tends to experience an episode of euphoria or mania (extreme high) which is then followed by an episode of severe depression. This pattern tends to continue.

There are four stages or phases of depression:

• Origin of depression
  Having a source of stress or some kind of loss may cause a person to have several thoughts which seem overwhelming and problematic to handle. A negative turn of events may contribute to the origin of depression.
• Establishment of depression
  The person may feel sad, dejected, and hopeless regarding various things which matter the most to him/her. When such feelings are present for a prolonged period, depression becomes more prominent.
• Behavioural inhibition
  Emotional pain and mental stress cause a person to pull back from activities which are usually of interest to him/her. The person may limit interaction with the close ones like family and friends and may show a lack of interest in a hobby or other pleasant activities.
• Behavioural inhibition of compulsory activities
  Once the person begins to pull back from his/her pleasurable activities, performing daily life tasks, even the ones which are as simple as they could be, seem tedious. As the depression progresses, the person may find it extremely difficult to carry out daily life activities like going to work, performing self-care tasks, and even having his/her meals. This withdrawal from life itself indicates the seriousness of depression. At this stage, professional help and intervention become extremely important.

There are various symptoms of depression which one can identify in others or in themselves. However, the presence of a few of these symptoms does not confirm the presence of depression. These symptoms may vary in intensity in different people.

Behavioural symptoms:

• Loss of interest in hobbies.
• Loss of interest in daily life activities.
• Decreased social interaction even with close family members.
• Difficulty in concentrating.
• Constant fidgeting or inability to stay still or finish a task.
• Preferring isolation.
• Difficulty in recalling things.
• Trouble in falling asleep. (Read more - Insomnia treatment)
• Oversleeping.

Physical symptoms:

• Decreased energy.
• Constant fatigue.
• Decreased speech or talking more slowly.
• Loss of appetite.
• Oversleeping.
• Sudden weight loss (this could be indicative of an eating disorder as well).
• Headaches.
• Digestive problems without a clear physical cause.
• Having cramps or body aches. (Read more - Muscle cramps)
  
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Psychological symptoms:

• Persistent sadness.
• Feeling excessive guilt.
• Anxiety.
• Feeling hopeless or worthless.
• Having thoughts of suicide or self-harm.
• Feeling irritated or provoked.
• Loss of interest in pleasant activities.

There are various causes and risk factors that contribute to depression. These include:  

Causes

It is important to understand that the causes of depression can be different for different people. This is because depression is closely related to the events of daily life and the surroundings. Experiencing a tragic event can make a person prone to developing depression. However, the interpretation of the same event may vary from person to person. This means that the same event may be perceived differently by different people. However, there are several risk factors which are associated with depression.

Risk Factors

Depression has become one of the most common mental disorders to affect people. However, there are studies which show that the presence of certain factors can put one at a higher risk of developing depression. These factors include:

• A family history of depression.
• Experiencing major trauma.
• Going through a major change.
• Presence of a physical illness.
• Being on certain medications.
• Substance abuse.

However, none of these factors necessarily imply that a person will have depression. A major factor to consider in depression is that it is closely related to life events and a person’s surroundings. However, each person’s response to trauma or to major life changes is different. Availability of resources also changes the way a person deals with these issues. Hence, the risk factors tend not to be definite.

There can be several helpful strategies to prevent depression or a relapse.

Self-care measures include:

• Take good care of yourself.
• Practise a regular daily routine.
• Pay attention to your daily diet and make sure it is a healthy and balanced diet.
• Work on your self-esteem and self-confidence. This will make you more capable of dealing with difficulties.
• Reach out to friends and family. Do not shut them out.
• Find ways to handle stress. You may find comfort in a hobby, reading inspirational books, watching a motivational movie or video, listening to music, meditation, dancing, a physical exercise, or a talking session.
• Do not be shy to seek help. Getting help at the right time will prevent the depression from getting worse.
• Do not self-medicate when feeling low.
• Try to develop a positive outlook on life events.

With increasing awareness of depression in the society, it has become easier for people with depression to identify their symptoms and relate these symptoms to depression. Mental health professionals suggest that if a person experiences the symptoms of depression for more than two weeks, they must seek professional help from a psychologist or a therapist. It becomes essential to speak to a therapist or a professional counsellor if the symptoms of depression do not get better and are coming in the way of daily functioning.

For many, it may seem like an uncomfortable idea to open up about their personal issues to a stranger. But, it helps to understand that counsellors and therapists are well trained with such tasks and talking to them can be very therapeutic. When a person visits a therapist or a counsellor, they will feel a lot better after having a conversation.

There are no physical tests for diagnosing depression, although, the doctor may recommend a few health tests to rule out the presence of any underlying medical problem such as thyroid issues.

The therapist will ask you a set of questions depending on your background and will encourage you to talk about your feelings, recent thoughts, and actions. Depending on the amount of insight the therapist needs, the therapist may even want to speak with a few family members to get a different perspective.

One must try to be as honest and open as possible, although, there is no pressure to discuss the issues that make you uncomfortable. Opening up with the therapist will help your therapist or doctor to identify the symptoms better and provide help. The diagnosis is based on the personal information that a person provides. If talking is a bit uncomfortable, the therapist may also provide questionnaires where written answers can be given. Assessment of these questionnaires can also help the therapist in diagnosing depression.

Any signs of self-harm such as cuts on the body or burn marks will also help the doctor in making a diagnosis.

Based on the severity of depression one is experiencing, there can be different courses of treatment that can be followed.

Mild depression

The management of mild or early stage depression includes:

• Exercise
  Regular exercise can be very helpful in improving the symptoms of depression. Daily exercise not only improves the mood but also helps an individual in staying active. It proves to be very helpful for people suffering from mild to moderate depression. The therapist may recommend a daily exercise routine of 30 minutes to one hour that should be practised at least three times a week. For older people, a 15 minutes evening walk can be helpful.
• Self-help groups
  For mild depression, especially one that is associated with some tragic life event, a counsellor may recommend the person to be a part of a self-help group. Being part of the self-help group can help a person feel more comfortable to talk about his/her feelings and thoughts, knowing that they are not alone.

Mild to Moderate depression

If the depression is moderate, then different types of therapies are recommended. Cognitive behavioural therapy encourages one to focus on a person’s thoughts and aims at changing the person’s thinking and helping them in being more positive and optimistic. Counselling is another way of treating moderate depression. Every counselling session can serve as a channel for emotional release which can tremendously assist the patient in dealing with depression.

Moderate to Severe depression

For moderate to severe depression, there are various courses of treatment which can be helpful. These include:

• Antidepressants
  Antidepressant medications are usually available in the form of pills. These medications not only reduce the feelings of anxiety but also help the person become happy. There are different types of antidepressants available which treat different kinds of depression. Individuals with depression report that these medications are very helpful and provide immediate results. However, there can be a few side effects of these medications. These include constipation, dizziness, nausea, upset stomach, and itchy skin.  The major side effects associated with antidepressants are the withdrawal symptoms. These symptoms may occur when a person stops taking the medications.
• Combination therapy
  A combination therapy proves to be the most helpful treatment in people with mild to moderate depression. It makes use of antidepressant medications along with cognitive behavioural therapy (CBT).
• Psychiatric treatment
  In case of severe depression, one may be referred to a mental health team comprising of psychologists, psychiatrists, and occupational therapists. These teams help in providing intensive care in terms of medication, discussing different treatments, and functionality. In people with severe depression along with symptoms of psychosis, ECTs (electroconvulsive therapy) and brain stimulation techniques may be recommended.

A few other important things to remember when seeking professional help for depression are:

• The information shared with the therapist or the counsellor is confidential. One can feel safe revealing personal information to their counsellor as none of it will be shared with a third person.
• Consent is an important aspect of seeking professional help. None of the medications can be given to an individual without their consent. There can be an exception in cases of psychotic depression.
• Family members of the individual seeking help can also be helpful in making one’s treatment successful.

Lifestyle management

When a person is dealing with depression and undergoing treatment, there are several factors which can help in the healing process. While in cases of physical health diseases, the use of medications may be continued for a long time, such dependence on medicines in treating depression is not considered good.

Any kind of therapy aims to make the person self-sufficient in dealing with problematic thoughts and behaviour. There are several steps one can take to cope with depression in a positive way:

• Do not isolate yourself.
• Talk to friends and close family members about treatment progression.
• Be honest with the therapist.
• Give yourself time to heal.
• Engage in physical activities such as hobbies and exercises.
• Do not view your depression as a stigma.
• Stay away from processed foods. Their sugar content can interfere with the medications and can also negatively impact your mood.
• Try introspecting your own thoughts
• Express your thoughts in a journal.
• Do not resort to alcohol or drugs to alleviate your symptoms by yourself as these will interfere with the treatment negatively and will eventually worsen your condition.

Prognosis

Depression is a growing mental health issue with many factors coming into play. While a person may not have full control over the events and factors which lead to depression, he/she can in the least, prepare himself/herself to face these situations and have an optimistic attitude. Depression can be dealt with individually or along with the help of a professional mental health practitioner. The social stigma around mental health issues should not prevent one from seeking help.

Complications

There are several ways of dealing with the different stages of depression. In many cases, the gloominess felt in depression may vanish after a certain period of time. However, if left untreated for a prolonged time period some complications may follow:

• Development of self-harm practices.
• Having suicidal thoughts.
• Showing suicidal gestures or attempting suicide.
• Unemployment.
• Social isolation.
• Development of other mental disorders such as an eating disorder or anxiety disorder.
• Deterioration of physical health.

The most serious risk associated with depression is suicide. If the depression has progressed to the point where a person is having suicidal thoughts, then professional intervention becomes absolutely necessary and must not be delayed.