Depression is an Illness, let’s treat it

We all feel sad or low once in a while, but if a person is sad most of the time and that state of sadness affects their day-to-day life, the person has clinical depression. According to a study in 2019, an estimated 19.4 million people in the US had at least one major depressive episode. The number represented about 7.9% of all US adults. Major depressive disorder has been more prevalent among females (10.6%) than males (7.0%). Let us discuss depression in detail.

What is depression?

Depressive disorder is a state of mind in which a person undergoes a mood disorder involving a persistent loss of interest or pleasure in day-to-day activities. This constant feeling of sadness or feeling down is different from mood fluctuations that people often experience as a part of their life. Depression could be caused by significant life events like grief or losing a job. It is an ongoing problem and not a passing one. Depression consists of episodes in which the symptoms persist for at least two weeks. It can last for many weeks, months, or years.

Symptoms of Depressive disorder

The signs and symptoms of depression are:

• reduced pleasure or interest in activities once enjoyed
• sleeping too little or too much
• difficulty making decisions, thinking, or concentrating
• recurrent thoughts of suicide, or an attempt at suicide
• restlessness, pacing up and down, fatigue, and agitation
• unintentional weight gain or loss and changes in appetite

In Females

Depression occurs about two times more in women than in men, as per the Centers for disease control and Prevention (CDC).

Following are the symptoms of depression that are more common among females:

• Anxiety
• Irritability
• Fatigue
• Mood swings
• Ruminating (dwelling on negative thoughts)

Some types of depression that are unique to females are:

• Premenstrual dysphoric disorder, which is a severe form of the premenstrual syndrome
• Postpartum depression, which occurs after giving birth 

In Males

Depression often leads to men drinking alcohol in excess, engaging in risk-taking, and displaying anger.

Other symptoms of depression that are common in men are:

• Working without a break
• avoiding social situations and families 
• displaying controlling or abusive behavior in relationships 
• experiencing difficulty keeping up with family responsibilities and work

In College Students

Times at college can be stressful, and a person can be dealing with other experiences, cultures, and lifestyles for the first time.
Students might have difficulties coping with the changes and may develop anxiety, depression, or both as a result.

Depression symptoms in college students include:

• insomnia
• difficulty concentrating on studies
• an increase or decrease in appetite
• sleeping too much
• avoiding social situations

In Teenagers

Peer pressure, physical changes, and other factors can lead to depression in teens.

Symptoms of depression in teenagers may include:

• difficulty concentrating on schoolwork
• withdrawing from family and friends
• restlessness, like the inability to sit still
• feeling worthless, helpless, or guilty

In Children

In children with depression, social activities, and schoolwork may be challenging. 

Symptoms of depression in children may include:

• low energy
• crying
• vocal outbursts
• defiant behavior
• clinginess

Younger children may experience difficulty expressing their feelings in words. This makes it harder for them to describe their feelings of sadness.

Causes of Depression

There could be many possible causes, and various factors can combine to trigger symptoms of depression.

Factors that can play a role are:

• changes in the brain’s neurotransmitter levels
• genetic features
• social and psychological factors
• environmental factors
• some additional conditions, like bipolar disorder

Treatment of depression

Depression is treatable, and controlling symptoms generally involve three components:

Psychotherapy: This is also called talking therapy. Some options are cognitive behavioral therapy (CBT) and one-to-one counseling.

Support: Support can range from discussing possible causes and practical solutions to educating family members.

Drug treatment: The doctor can prescribe antidepressants.

Medication for the treatment of depression

Antidepressants may help in treating moderate-to-severe depression. 

There are several classes of antidepressants available, like:

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

Each class works on a different neurotransmitter or a combination of neurotransmitters. A patient should only take drugs as the doctor prescribes. Some medications may take a while to be effective. By stopping the medication, a patient can not experience the drug’s benefits. Some patients stop taking medicines as their symptoms improve. However, stopping the medication may lead to a relapse.

Medication side effects 

SNRIs and SSRIs may have side effects. A patient can experience:

• constipation or diarrhea
• nausea
• sexual dysfunction
• low blood sugar
• a rash
• weight loss

Natural remedies for depression

Some patients use natural remedies, like herbal medicines, for treating mild-to-moderate depression. However, because the Food and Drug Administration (FDA) does not monitor herbal remedies, the quality of these herbal products can not be determined. These herbal medicines may not be practical or safe.

The following are some of the commonly used plants and herbs to treat depression:

Ginseng: Traditional medicine practitioners often reduce stress and improve mental clarity.

St. John’s wort: This may not be suitable for patients who have bipolar disorder.

Lavender: This can help reduce insomnia and anxiety.

Chamomile: This herbal product contains flavonoids that can have an antidepressant effect.

It is essential to consult a doctor before consuming any herbal supplement or remedy for treating depression. Some herbs may interfere with the action of medications or make symptoms worse.

Supplements

A patient can take the herbs mentioned above as supplements for treating the symptoms of mild-to-moderate depression. Some other types of supplements can also help in treating these symptoms.
Non-herbal supplements that can help in treating depression are:

5-hydroxytryptophan: It can help boost serotonin, the neurotransmitter in the brain that affects a person’s mood.

S-adenosyl methionine (SAMe): SAMe is a synthetic chemical that is naturally present in the human body.

Research suggests that SAMe can be as effective as escitalopram and imipramine in treating depression. However, more investigation is required.

Food and diet

It is believed that eating more of these foods helps reduce symptoms of depression:

• vegetables
• fruits
• olive oil
• fish

Psychotherapy

Talking or psychological therapies for depression include cognitive-behavioral therapy or CBT, problem-solving treatment, and interpersonal psychotherapy.

Psychotherapy is generally the first-line treatment for some forms of depression, while some patients respond better to the combination of medications and psychotherapy. Interpersonal psychotherapy and CBT are the two significant types of psychotherapy for treating depression. A person may have cognitive-behavioral therapy in individual sessions with the therapist, online, telephone, or in groups.

Interpersonal therapy aims to help people identify:

• the emotional problems affecting communication and relationships
• how these problems also affect the person’s mood
• techniques to change all of this

Exercise

Aerobic exercises increase endorphin levels and stimulate norepinephrine, which is the neurotransmitter that affects a person’s mood. This may relieve depression.

Brain stimulation therapies

Another option used for the treatment of depression is brain stimulation therapy. Repetitive transcranial magnetic stimulation may help treat major depression by sending magnetic pulses to the brain. If depression does not improve from drug treatment, the patient may benefit from ECT or electroconvulsive therapy. This can be effective if depression comes along with psychosis.

Types of depression

Persistent depressive disorder

Persistent depressive disorder is also known as dysthymia, and it causes symptoms that last for a minimum of two years. A patient with persistent depressive disorder can have episodes of major depression and may also experience milder symptoms of depression.

Major depression

Major depression causes a person to be in a constant state of sadness. The patient can lose interest or pleasure in activities that they once enjoyed. Treatment generally involves psychotherapy and medication.

Bipolar disorder

Depression is a common symptom of bipolar disorder, and studies show that patients with bipolar disorder can have symptoms around half the time. This may make bipolar disorder challenging to differentiate from depression. 

Psychotic depression

Some people may experience depression with psychosis. Psychosis may include delusions, like a detachment from reality and false beliefs. It may also involve hallucinations- sensing things that don’t exist.

Postpartum depression

Many women experience what is called baby blues after giving birth. This occurs when hormone levels readjust after giving birth so that mood changes can result. However, postpartum depression, also called postnatal depression, is even more severe. There isn’t a single cause for postpartum depression, and it may persist for months or years. Women who experience postpartum depression after childbirth should seek medical help.

Premenstrual Dysphoric disorder

Women with premenstrual dysphoric disorder have depression and other symptoms when their period starts.

Besides feeling sad, women may also have:

• Irritability or anxiety
• mood swings
• trouble concentrating
• change in sleep habits or appetite
• feelings of being overwhelmed
• fatigue

Antidepressant drugs or oral contraceptives can sometimes treat premenstrual dysphoric disorder or PMDD.

Situational depression

Situational depression is not a technical term in psychiatry. You can experience a depressed mood when you have trouble managing a stressful circumstance in your life, like losing your job or divorce. The doctor can call this stress response syndrome. Psychotherapy may often help you get through a period of depression linked to a stressful life event.

Major depressive disorder with seasonal pattern

This was previously called SAD, or seasonal affective disorder. This form of depression is linked to the decrease in daylight during the winter and fall. It lifts during the remaining year and also in response to light therapy. People living in countries with severe or long winters are likely to be affected more by this type of depression.

Diagnosis of depression

If a person is suspected of having depression, they must seek professional attention from a mental health specialist or doctor. A qualified health expert can rule out different causes, ensure a precise diagnosis, and provide effective and safe treatment.
They will question the patient about symptoms, like how long they have been present. The doctor can also conduct a test to check for other possible causes such as some physical condition and order the patient to take a blood test to rule out other health issues.

Is depression genetic?

A person with a sibling or parent who has depression is more likely than others to develop depression. However, many people having depression have no family history of the same. Susceptibility to depression may not necessarily result from genetic variation. While depression can be inherited, several other issues also can influence the development of depression.

Is depression a disability?

According to the World Health Organization WHO, depression is the primary cause of disability worldwide. In the United States, the social security administration considers bipolar, depressive, and related disorders disabilities. When a person’s depression restricts them from doing their tasks, they can be eligible for social security disability insurance benefits. The patient must have worked recently enough and long enough to be eligible for disability benefits.

Is it curable?

Though a cure for depression can not be guaranteed, the treatments mentioned above effectively help recover. The earlier the treatment starts, the chances are that it may be more successful in treating depression. Many people who have depression recover with the right treatment plan. However, the chances are that relapse may occur even with effective treatment. To prevent relapse, patients taking medication for depression must continue with treatment even if symptoms go away or improve, till the doctor advises them to.

Triggers

Triggers are physical, psychological, or emotional circumstances or events that may cause depression symptoms to return or appear. Following are some of the common triggers:

Medical conditions, like obesity and heart disease.
Incomplete recovery after stopping treatment too soon.
Stressful life events, like family conflicts, loss, or changes in relationships.

Risk factors

Some people are more prone to develop depression than their counterparts.
The risk factors are:

• experiencing certain life events or circumstances, like work issues, grief, financial problems, changes in relationships, constant pain, acute stress, and medical concerns
• having a family member with depression
• having a lack of effective coping strategies
• using some prescription drugs, like interferon, beta-blockers, and corticosteroids, or recreational drugs, like amphetamines or alcohol
• having had an earlier episode of major depression
• having a severe ailment, like cardiovascular disease, chronic obstructive pulmonary disease or COPD, or diabetes, or having sustained a head injury.