DEPRESSION

Depression, particularly Major Depressive Disorder (or clinical depression), is a common but serious mood disorder. Most people go through periods of feeling down, but when a person is depressed, they feel persistently sad for weeks or months, rather than just a few days. Depression causes feelings of sadness, a loss of interest in activities once enjoyed and many other symptoms. Depression may become a serious health condition; it can cause the affected person to suffer significantly, and function poorly at work, school and in the family. At its worst, depression can lead to suicide. It is a genuine health condition, a real illness with real symptoms. Depression isn't something that someone can just "snap out of" by "pulling him or herself together".

There are other forms of depression, which are slightly different to Major Depressive Disorder. Some of these include Persistent depressive disorder (also called dysthymia), Postpartum depression, Psychotic depression and Bipolar Disorder. Depression may start gradually, so it can be difficult to notice it at first. Many people try to cope with their symptoms of depression without recognizing that they are affected. Sometimes it may take a friend or family member to notice that something is wrong or different about the person. Depression can be mild, moderate or severe; mild to moderate depression has some/ significant impact on a person’s life. With severe depression however, it can sometimes be impossible for someone to get through daily life.

Grief/ Sadness and Depression

Some persons have experienced difficulties in life such as the death of a loved one, the loss of a job or the ending of a relationship. It is normal for feelings of sadness or grief to develop in response to these situations. Grief shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities, however they are different in many ways. For example in grief, self-esteem is usually maintained, but in major depressive disorder, feelings of worthlessness are common.

WHO Key facts

• Depression is a common mental disorder. Globally, more than 300 million people of all ages suffer from depression.
• Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.
• More women are affected by depression than men.

RISK FACTORS

Depression is caused by a combination of genetic, biological, environmental, and psychological factors. There may be many causes (and triggers), only a few are mentioned below.

• Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.
• Genetics: Depression can run in families.
• Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more prone to experience depression.
• Environmental factors: Continuous exposure to poverty, violence, neglect or abuse may make some people more susceptible to depression.

SYMPTOMS

In general persons who are depressed feel sad, hopeless and lose interest in things they used to enjoy. Symptoms must last at least two weeks for a diagnosis to be made. Not everyone who is depressed experiences every symptom; some people experience only a few symptoms while others may experience many.

Psychological Symptoms

• Constant low mood or sadness
• Feelings of guilt, worthlessness, or helplessness
• Feeling tearful
• Feeling irritable and intolerant of others 
• Having no motivation or interest in things
• Finding it difficult to make decisions
• Not getting any enjoyment out of life
• Thoughts of death or suicide, or suicide attempts

Physical Symptoms

• Decreased energy or fatigue
• Changes in appetite or weight
• Changes in sleep (insomnia, early-morning awakening, or oversleeping)
• Moving or speaking more slowly than usual 
• Unexplained aches and pains
• Low sex drive 

Social Symptoms

• Avoiding contact with friends
• Loss of interest in hobbies and activities
• Not doing well at work
• Having difficulties in home and family life

TREATMENT

Depression can be treated; the earlier treatment begins, the more effective it is. It is usually treated with medications, psychotherapy, or a combination of both.

Medication (Antidepressants)

1) Antidepressants are medicines that treat the symptoms of depression. Most persons with moderate or severe depression benefit from antidepressants, (however, not everyone does). The benefits of these medicines may not be seen for up to two months. It is important to give antidepressants adequate time to work before concluding that they are not effective. If a patient feels little or no improvement after several weeks, then the dose of the medication can be adjusted, another medication can be added or a new antidepressant may be recommended.

2) Most doctors advise patients to keep taking antidepressants for 6 to 12 months after they no longer feel depressed; after that time, the doctor will help you slowly and safely decrease the dose. Do not stop taking antidepressants without the help of a doctor. Persons, who stop taking antidepressants immediately after they feel better, are at risk of the depression returning. Stopping them abruptly can also cause withdrawal symptoms, (flu-like symptoms, anxiety, dizziness, vivid dreams at night, sensations in the body that feel like electric shocks).

3) Antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors), Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs), and Tricyclic antidepressants (TCAs), help to increase the level of serotonin and noradrenaline in the brain, which are considered to be ”good mood” chemicals. Examples include:

• Paroxetine (Seroxat)
• Fluoxetine (Prozac)
• Citalopram (Cipramil)
• Imipramine (Imipramil) 
• Amitriptyline
• Venlafaxine (Efexor)
• Duloxetine (Cymbalta or Yentreve)
• Mirtazapine (Zispin Soltab).

4) Antidepressants generally have side effects; these should improve within a few weeks, although some may persist for much longer. They include

• Feeling agitated
• Shaky or anxious
• Diarrhea or constipation
• Loss of appetite
• Not sleeping well (insomnia)
• Feeling very sleepy, headaches
• Low sex drive
• Difficulties achieving orgasm
• Erectile dysfunction in men

Psychotherapy

Psychotherapy or “talk therapy,” may be used alone for treatment of mild depression. For moderate to severe depression, psychotherapy is often used along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. Depending on the severity of the depression, treatment can take a few weeks or much longer.

Electroconvulsive Therapy (ECT)

This is a medical treatment most commonly used for persons with severe major depression who have not responded to other treatments. During ECT, a carefully calculated electric current is passed to the brain through electrodes placed on the head. This procedure helps relieve the symptoms of depression. The link below has FAQs and more information on ECT.
https://www.rcpsych.ac.uk/mentalhealthinformation/therapies/electroconvulsivetherapy,ect.aspx

 
Tip#1:

Diet and Exercise

Exercise is known to improve the mood. Ensure that you are regularly active; this can help to create positive feelings. Also ensure a healthy diet, and avoid alcohol and tobacco.

Tip#2:

Sleep

Some persons with depression suffer from insomnia or over sleeping. It is important to achieve a balance; try to get an adequate amount of sleep every night. (Ensure a healthy sleep environment also.)

Tip#3:

Socialize

Do not consistently isolate yourself; try to occasionally spend time with other people. Also you can confide in a trusted friend or relative about your illness and/or how you are coping. Research shows that ‘talking’ can help people recover from depression and cope better with stress.

Tip#4:

Be Patient

Expect your mood to recover gradually, not immediately. Also, remember to give psychotherapy and antidepressants a few weeks before you notice an improvement in symptoms. (Tell you doctor of any side effects.)

Tip#5:

Taking Care of someone with Depression

Caring for someone with depression may lead to a strained relationship between you and that person. Try finding a support group and/or talking to others in a similar situation; this might be very helpful.
Also, if you are having relationship or marriage difficulties, because your partner is depressed, consider seeing a relationship counselor. They may be able to talk things through with both of you.

Tip#6:

Suicide

The majority of suicide cases are linked to mental disorders, especially severe depression. Contact a health care provider as soon as possible if you are feeling suicidal, they will be able to assist you.
If you see or know a friend or relative who show any warning signs of being suicidal, let them know that they are not alone and that you care about them.  Offer them support and solutions to their problems, and get them professional help.

Tip#7:

Other Education Material

Persons who are depressed should continue to educate themselves about this illness. Download this booklet using the link below, for more information on depression.
https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/depression-what-you-need-to-know-pdf_151827_151827.pdf 
 

I hope that these tips on DEPRESSION were helpful; Remember, Your Health Is Invaluable.

By Dr. J. Lawarna Matthew

Acknowledgements
National Institute of Mental health (NIMH)
American Psychiatric Association
Visit https://www.nimh.nih.gov/health/topics/depression/index.shtml#part_145399  and https://www.psychiatry.org/patients-families/depression/what-is-depression  for more information.