Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest in activities. It is sometime referred to as major depression, major depressive disorder or clinical depression. There will be alterations in the behavior of the individual, leading to various emotional and physical problems. Depression causes people to lose pleasure from daily life.
Approximately15% of the population experience episode of major depressive disorder at some point time. The lifetime risk of depression among male is 8-12% and among female is 20-26%. As per statistics, depression affects approximately 10% of adults, up to 8% of teenagers and 2% of children experience some kind of depressive disorder. Postpartum depression is the most common mental health disorder to afflict women after childbirth. Depression is often associated with variety of medical conditions. Unfortunately, major depression often goes unrecognized and untreated and there are scientific evidence showing depression as an underlying factor in many suicides, especially in the adolescent and aged populations.
Depressive disorders have been described since the beginning of mankind. Bible have an evidence that King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile.
A depressive disorder is a syndrome that reflects a sad and/or irritable mood exceeding normal sadness or grief. These group of symptoms deteriorates the functional capacity of the individual.Earlier, depression was categorized into two types, endogenous and neurotic. Endogenous depression means that the depression comes from within the body, probably of genetic origin. Neurotic or reactive depression has a identifiable precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job.
Types of depression :
All depression types are not the same. The most common types are major depression (clinical depression) and chronic depression (dysthymia). Based on the severity, it is categorized as mild, moderate and severe.
Major depression, affect daily activity like sleep, study, eat, and happy life. This may occur only once in a person’s lifetime, but sometimes person may have several episodes.
Persistent depressive disorder—This usually lasts for at least 2 years. Patient with persistent depressive disorder may have episodes of severe depression along with periods of less severe symptoms and symptoms will be present for at least 2 years.
Some forms of depression may develop under unique circumstances. They include:
- Psychotic depression, which occurs when a person has severe depression with psychosis, such as delusions, or hallucinations.
- Postpartum depression, occurs when a women experience after a child birth. This is caused due to hormonal or physical changes or may be due the new responsibility of caring for a newborn can be overwhelming. It is found to affect 10 to 15 percent of women .
- Seasonal affective disorder (SAD) occurs when there is less natural sunlight, usually during the winter months.
Bipolar disorder or manic-depressive illness, is characterized by cycling mood changes—from extreme highs to extreme lows .This is not found as common as major depression or persistent depressive disorder.
Causes of Clinical Depression:
There are several theories that suggest the cause for depression.
- Biological - there are certain chemicals called neurotransmitters which regulate the biological functions of the body. Researchers suggest that decreased levels of serotonin and norepinephrine causes depression. The dysregulation of acetylcholine and GABA is also associated with depression.
- Cognitive - Those with negative thinking patterns and low self-esteem are more likely to develop depression.
- Endocrine - The malfunction in the hypothalamo-pituitary-adrenal (HPA) axis leads to depression. Alterations in the level of cortisol, stress hormone will affect the cognition.
- Gender - Women are more prone to develop depression than men. The risk is twice in women.
- Co-occurrence -Depression is more likely to occur along with certain illnesses, such as heart disease, cancer, Parkinson's disease, diabetes, Alzheimer's disease and hormonal disorders.
- Medications - Certain medications have depression as its side-effect.
- Genetic - A family history of clinical depression increases the risk for developing the illness.
- Sociological - Stressful life situations, financial loss, prolonged grief, trauma etc will contribute to depression
- Drug or Alcohol abuse
Symptoms of Clinical Depression:
- Depressive mood. Persistent sadness, loss of pleasure in activities.
- Feeling of hopelessness, helplessness, guilt, low self-esteem.
- Sleep disturbances and early morning awakening, at-least 2 or more hours before the usual time of waking up.
- Suicidal thoughts and tenancies
- Difficulty in thinking and concentration.
- Low levels of activities. Slowed speech. Increased response time to questions etc.
- Poor appetite and weight loss, or increased appetite and weight gain
- Restlessness, irritability
- Menstrual or sexual disturbances
- Increased dependency
Diagnosis of depression includes physical examination, personal interview, and lab tests. Physical examination and personal interview reveals overall health of patient, symptoms, duration, cause, any medication, other diseases and family history of depression or other mental illness. There are internationally approved tools containing a list of questionnaire, which helps to indicate depression, to measure the severity of depression and evaluate recovery. Lab tests are usually done to detect drug toxicity, thyroid and other hormone level, calcium levels and anemia. Sometime patient will be asked to take MRI scan.
Diagnosis of depression sometimes make difficult because clinically depression show sign and symptoms in different ways. For example, some depressive patients shows lack of interest, some may get irritated, sometimes the symptoms may be evident or aggravate only when there is change in eating or sleeping patterns or change in season.
Treatments for Depression:
There are different treatment modalities for depression.
- Physical therapies
- Psychosocial treatments
- Complementary therapies
There are wide range of effective drug treatments available for depressive disorder. The treatment goal is to maximize patient function, relieve symptoms and prevent recurrence as well. Either taken alone or in combination of medicines. The treatment also depends on the age of the patient and duration of the depression. Current treatment for depressive patient is practiced as per the American Psychiatric Association (APA) guideline updated in 2011. APA emphasis that the treatment should be started only after careful investigation and assessment of risk and benefits
II. Physical Therapies
- Electroconvulsive therapy (ECT) or shock therapy.
- Light therapy. The patient is exposed to artificial light source during winter to relieve seasonal depression.
- Vagus nerve stimulation that can affect the brain function directly.
III. Psychosocial Therapy :
- Cognitive therapy that aims to correct the negative thoughts of the client. It helps to improve self-esteem.
- Psychotherapy is used to help the patient gain insight. It is based on psychoanalytic theory.
- Group therapy is used in minor depression to alleviate the negative emotions of the patient.
- Behavioral therapy include problem solving techniques, social skill training, self-control training etc.
- Family therapy calls for the participation of family members in treating depression. Compliance to drugs is given emphasis.
IV. Complementary Therapies :
- Relaxation techniques
- Guided imagery
- Music or art therapy
- Yoga or tai chi
- Massage therapy