Depression

What is depression?

Depression, also known as major depressive disorder (MDD), is a mood disorder which is characterized by persistent feelings of intense sadness, hopelessness, guilt, loneliness, as well as loss of confidence and belief in oneself. Other usual characteristics are loss of interest in things or activities that once offered pleasure, and lowered levels of willpower, energy, motivation and concentration. It is also common for there to be disturbed appetite and sleep, slowed movement and thought, physical pain, digestive issues, suicidal thoughts.

Depression is a common and serious issue, it can have different types and patterns of development and manifestation, different causes and different types of treatment. Because of this, informing oneself about it is important.

Today, it seems the word “depression” is ever more present in everyday language, usually representing a generally sad mood as well as feelings of fear, exhaustion and hopelessness. It is important to differentiate such colloquial use of the term from what it actually means in a clinical sense, a disorder that can have a serious, profound, and constant influence on the lives of individuals and those closest to them.

What is the difference between depression and normal sadness?

Mood shifts, emotional reactions to stress and intense sadness depending on the circumstance are normal things that are to be expected and that happen to all people, their function is to help us cope with different difficulties in life. What differentiates this normal sadness from clinical depression is the foremost length and intensity, depression can have multitudes of emotional, cognitive and physical symptoms that can last for years and influence the everyday lives of individuals. When diagnosing clinical depression practitioners pay attention to the intensity of the symptoms and their presence over time, are they present most of the time, almost every day, for a period of at least two weeks?

Typical symptoms of depression:

-       Persistent sadness and/or lowered mood (usually worse in the mornings)

-       Feelings of hopelessness and/or helplessness

-       Loss of interest/pleasure

-       Exhaustion/lower energy

-       Feelings of emptiness, emotional flatness

-       Fears of death, loss, suicide

-       Disturbed sleep (too much or too little)

-       Disturbed concentration, indecisiveness, problems with memory

-       Loss of confidence

-       Disturbed appetite (too much or too little)

-       Feelings of guilt and blaming oneself

-       Psychomotor agitation or retardation

-       Headaches, chronic pain, cramps, digestive issues

-       Suicidal thoughts and attempts

Typically, depression (a depressive episode) is characterized by the presence of more of these symptoms, almost every day, in the period of at least two weeks.

Depression affects all aspects of life, it leads to dysfunctionality in social interactions, familial relationships, work and self – sufficiency. The individual often has no willingness to take care of themselves and complete everyday tasks. It encapsulates emotional, cognitive, motivational, and somatic symptoms.

Types of depression:

Major depression (MDD): the most common type of depression, characterized by intense symptoms which disturb the everyday functioning of individuals, episodes can last from weeks to months. An often occurrence is the inability to face the day, the mood is drastically worse in the mornings getting gradually better over time. It is possible for a depressive episode to occur only once, but it’s more likely for it to happen multiple times during one’s life (recurrent depressive disorder).  

Dysthymia: a chronic form of depression, with less intense symptoms but they are constant and last at least two years. Sometimes individuals can accept these less intense symptoms as a normal part of their life, leading them to seek help only when the development of the disorder creates serious problems in their lives.

Bipolar disorder: depressive episodes with subsequent episodes of mania or hypomania which last at least two weeks.

Seasonal depression: depression which appears in certain time periods, most often in winter.

Postpartum depression: it appears after giving birth, the main causes are hormonal disbalance due to giving birth as well as pain, exhaustion, societal excitations and pressure, big lifestyle changes. It differs from the normal postpartum sadness (“baby blues”) in the same manner that depression differs from regular sadness, by intensity and length. The symptoms of postpartum depression are intense and longer lasting (at least two weeks), their manifestation is dependent on many factors and can appear in anyone, even fathers.

Psychotic depression: intense depression followed by psychotic symptoms, delusional thoughts and beliefs, as well as hallucinations. The delusions and hallucinations in these individuals are usually in accord with the deeply depressive mood, for example thoughts concerning guilt for something the individual didn’t do, or critiquing voices.

Causes of depression:

The causes of depression are explained as a complex combination of biological – heritable and psychosocial – surrounding factors.

Genetic predispositions, changes in the functioning of neurotransmitters and receptors in the central nervous system, reactions to certain medications, hormonal disbalance, and a bad immune system are all significant biological factors which can increase the risk of depression.

Also, and in combination with these, surroundings during childhood, relationship with parents, personality traits, consuming psychoactive substances, exposure to stress, significant changes or losses in life (death in the family, job loss, divorce…) can all influence depression.

Abuse is a significant risk factor, it can perpetuate the manifestation of depression later in life, this abuse can be physical, emotional or sexual.

Higher risk of depression is also influenced by older age, loneliness, no social support, stress, presence of other serious disorders or illnesses.

It is certain that such a complex disorder with its many types and manifestations will have a multitude of causes and ways to be treated. Every situation is specific and consulting with a doctor, psychiatrist, clinical psychologist is necessary for understanding the causes, consequences, and ways of treating a certain, specific, case.

Diagnosing depression:

The first step in treating depression is precise recognition and diagnosis.

Diagnosing depression requires the presence of multiple symptoms, most of the day, almost every day, in the time frame of at least two weeks. One of the symptoms must be either depressive mood or loss of interest or pleasure in most activities. A few more symptoms are necessary in the diagnosis of depression, their intensity and persistence can vary depending on the specific case.

If you think you might have depression, consult a doctor, psychiatrist or psychologist. Early recognition of depression can significantly help the treatment and cut expenses.

When being tested for depression, you can expect questions about your symptoms and the problems you are facing, as well as questions about familial disease history. Questionnaires, as well as clinical tests and performance tests are also used. It could be useful to think about and write down your symptoms and thoughts about them before the screening.

Similar symptoms like in depression can be caused by other medical conditions, so you should expect physical or laboratorial examinations which have the goal of checking your thyroid gland, deficiency of certain nutrients, hormonal disbalance and reactions to certain medications.

Treating depression:

Stigmatization and perception of depression as some sort of “weakness” leads to many people trying to hide their problems or handle them on their own, often abusing psychoactive substances or alcohol. For efficient depression treatment it’s mandatory you contact a doctor, psychiatrist or psychologist, who can help diagnose you and construct an adequate treatment plan.

Depression is most often treated using a combination of pharmacotherapy and psychotherapy.

Pharmacotherapy with antidepressants is often used to regulate neurotransmitter disbalance and alleviate symptoms, while psychotherapy has the role of helping understand the patterns and situations which lead to the development of such a condition. In some cases, psychotherapy is enough.

Different forms of psychotherapy and psychotherapeutic techniques, can be effective in bettering outlooks on life, understanding one’s negative patterns of thinking and behaving, developing social, emotional and cognitive skills, better understanding of oneself and one’s life context.

Some, more difficult forms of depression, can be resistant to such therapeutic measures, in these cases it is possible to use transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT), which have been refined in the past decades and are considered as safe as pharmacotherapy.

Written by: Bachelor of Psychology, Aleksa Holcer 

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*Image taken from https://www.pexels.com/photo/anxious-young-woman-cover-wing-ears-with-hands-sitting-on-chair-6382633/*

*This text is intended for informational purposes only. If you experience any symptoms, it is recommended that you seek advice from your doctor or a qualified healthcare professional.*