Depression

Symptoms: Persistent sad, anxious, or “empty” mood; feelings of hopelessness or pessimism; feelings of irritability, frustration, or restlessness; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in hobbies and activities.

Causes: Stressful events, personality, family history, pregnancy and giving birth, menopause, loneliness, alcohol and drugs, illness.

Risk factors: Family history and genetics, chronic stress, history of trauma, gender, poor nutrition, unresolved grief or loss, personality traits, medication and substance use.

Prevalence: Depression affects an estimated 3.8% of the population, including 5% of adults (4% male and 6% female) and 5.7% of adults over the age of 60. Approximately 280 million people worldwide suffer from depression.

Severity: Mild to severe

Which doctor to consult: Neurologist or psychiatrist

Overview

Depression is a persistent poor mood that interferes with your daily life. Depression is a common yet dangerous mental illness. Depression can strike anyone at any age and from any race or ethnic background.

Depression reduces your hope, motivation, and vitality, and it keeps you in a state of constant misery. It begins with modest symptoms such as difficulties concentrating, poor remembering abilities, frequently feeling down, and changes in appetite. Most people overlook these warning signs until they appear as clinical illness, which can have major health consequences.

There's no single cause of depression. It can be caused by chemical imbalances in the brain, hormonal changes, family history and genetics, drugs, or events in your life. Different causes can often combine to trigger depression. The use of alcohol and drugs might worsen the disease.

Depression needs medical intervention like any other illness. Timely and appropriate medical therapy, together with self-care, can help to manage it. Depression is the most treatable of all mental diseases. Approximately 80% of depressed people can be successfully treated. Various types of therapy appear to work depending on the scenario.

Types of Depression:

Depression can manifest in various forms, each with its own set of characteristics and symptoms. Here are some common types of depression:

Major Depressive Disorder (MDD): Characterized by a persistent feeling of sadness and a lack of interest in activities normally enjoyed.
Dysthymia (Persistent Depressive Disorder): A chronic form of depression present for more days than not for at least two years.
Bipolar Disorder (Manic Depression): Involves episodes of depression and mania.
Postpartum Depression (Peripartum Depression): Occurs after childbirth.
Seasonal Affective Disorder (SAD): A type of depression related to changes in seasons.
Psychotic Depression: Depression accompanied by some form of psychosis.
Premenstrual Dysphoric Disorder (PMDD): Severe, sometimes disabling extension of premenstrual syndrome (PMS).
Atypical Depression: Depression with mood reactivity (mood brightens in response to positive events).
Disruptive Mood Dysregulation Disorder (DMDD): In children and adolescents, it is characterized by persistent irritability and frequent episodes of extreme behavioural dyscontrol.
Situational Depression: Often triggered by a significant life change or stressor.

Symptoms:

Everyone feels sad at times. People with depression feel sad most days. These feelings can get in the way of everyday life.
Symptoms of depression are categorised into:
•    Physical symptoms
•    Psychological symptoms
•    Social symptoms

The psychological symptoms of depression include:
Continuous low mood or sadness
Feeling hopeless and helpless
Feeling irritable and intolerant of others
Having low self-esteem
Finding it difficult to make decisions
Feeling anxious or worried
Feeling tearful
Feeling guilt-ridden
Having no motivation or interest in things
Not getting any enjoyment out of life
Having suicidal thoughts or thoughts of harming yourself

The physical symptoms of depression include:
Changes in appetite or weight (usually decreased, but sometimes increased)
Moving or speaking more slowly than usual
Unexplained aches and pains
Constipation
Disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning
Lack of energy
Low sex drive (loss of libido)

The social symptoms of depression include:
Avoiding contact with friends and taking part in fewer social activities
Neglecting your hobbies and interests
Having difficulties in your home, work or family life
Note: Talk to your healthcare provider about your feelings if you have noticed these signs for at least 2 weeks or immediately if you have any dangerous thoughts or behaviours. Only your healthcare provider or counsellor can tell you if you have depression.

Causes:

Depression is a complex condition with multiple contributing factors. Here are some of the common causes:

• Genetic Factors: A family history of depression may increase the risk.

• Brain Chemistry: Imbalances in neurotransmitters, which are chemicals in the brain that affect mood and emotions.

• Environmental Factors: Exposure to violence, neglect, abuse, or poverty.

• Psychological Factors: Personality traits such as low self-esteem or being overly dependent, self-critical, or pessimistic.

• Life Events: Traumatic or stressful events like losing a loved one, financial problems, or a divorce.

• Medical Conditions: Chronic illness, insomnia, chronic pain, or ADHD.

• Substance Use: Abuse of alcohol, recreational drugs, and certain medications.
  It’s important to note that these factors can interact in complex ways, and depression can be triggered by a combination of genetic, biological, environmental, and psychological factors.

Risk Factors:

The risk factors for depression are multifaceted and can include a combination of genetic, psychological, and environmental factors. Here are some of the key risk factors:

• Family History and Genetics: Having a close family member with depression can increase the risk.

• Chronic Stress: Prolonged stress can lead to depression in some individuals.

• History of Trauma: Experiences such as abuse or neglect can contribute to the onset of depression.

• Gender: Women are more likely to experience depression, possibly due to hormonal factors.

• Poor Nutrition: Diet plays a role in mental health, and poor nutrition can contribute.

• Unresolved Grief or Loss: The loss of a loved one or unresolved grief can trigger depression.

• Personality Traits: Traits such as low self-esteem or pessimism can increase the likelihood of depression.

• Medication and Substance Use: Certain medications and substance abuse can lead to or exacerbate depression.
  It’s important to note that these factors can interact in complex ways, and a combination of these and other factors can trigger depression.

Possible complications:

Depression can lead to a range of complications that affect both mental and physical health. Here are some potential complications associated with depression:

Weight Gain and Obesity: Depression can lead to overeating and reduced physical activity, which may result in weight gain and obesity.
Chronic Illness: People with depression may have a higher risk of chronic illnesses such as heart disease, diabetes, and cancer.
Chronic Pain: There is a strong link between depression and increased sensitivity to pain.
Self-Harm: Individuals with depression may engage in self-harming behaviours as a way to cope with emotional pain.
Substance Misuse: Depression can increase the risk of alcohol or drug misuse, which can further exacerbate mental health issues.
Cognitive Changes: Depression can affect cognitive functions, leading to difficulties with concentration, memory, and decision-making.
Suicidal Thoughts: In severe cases, depression can lead to suicidal ideation or attempts.
It’s important to address depression early and seek professional help to prevent these complications. Treatment can include therapy, medication, lifestyle changes, and support from loved ones. If you or someone you know is struggling with depression, it’s crucial to reach out for help.

Diagnosis:

Depression is diagnosed based on history and physical findings. There are no diagnostic laboratory tests available to identify major depressive disorder.

Depression is often diagnosed through a combination of lab tests and simply talking to a patient.

Psychiatric evaluation 
The Beck Depression Inventory (BDI) is frequently used to test for depression as well as to assess behavioural symptoms and severity. The BDI is appropriate for people aged 13 to 80.

Blood tests: Depression is diagnosed based on a patient's history and physical findings. There are no diagnostic laboratory tests available to diagnose major depressive disorder. However, laboratory tests can aid in the exclusion of any underlying medical disorders that can appear as depression. These include:
•    Complete blood cell (CBC) count, 
•    Thyroid Function Panel (If the thyroid gland is under or overactive, mood symptoms can result)
•    Thyroid hormone: Influences on mood and cognition in adults. 
•    Folate and Vitamin B12 Levels (Low levels of folate (vitamin B9) or vitamin B12 can indicate a condition called pernicious anemia, which often causes symptoms of depression.)
•    Vitamin B-12, Blood alcohol level & Toxic screening test

Imaging tests: 
Imaging studies, like blood testing, can help rule out other medical reasons and disorders. CT scans and MRIs of the brain are two examples.

Treatment

Depression treatment typically involves psychotherapy, medication, or both. Brain stimulation therapy may be another treatment option.

Different types of depression require different treatments.

Mild symptoms may be relieved by:

• Knowing about the condition

• Changes in lifestyle, such as staying active

• Psychological treatment is conducted by a mental health practitioner or through online e-therapies.

For moderate to more severe depression, medical treatments are likely to be required:   

• Cognitive behaviour therapy (CBT)

• Behaviour therapy

• Interpersonal therapy (IPT)

•  Mindfulness-based cognitive therapy (MBCT)

There are different kinds of medicine for depression:

Selective Serotonin Reuptake Inhibitors (SSRI). Examples: Citalopram, Escitalopram.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). Examples: Duloxetine, Venlafaxine.
Tricyclic and Tetracyclic Antidepressants. Examples: Amoxapine and Doxepin.
Atypical Antidepressants. Examples: Trazodone, Nefazodone.
Monoamine Oxidase Inhibitors (MAOIs). Examples: Selegiline and Isocarboxzaid.
N-methyl D-aspartate (NMDA) Antagonist. Examples: Esketamine. 

Neuroactive Steroid Gamma-Aminobutyric Acid (GABA)-A Receptor Positive Modulator. Examples: Brexanolone.

Lifestyle & home remedies:

What to do if you suspect you have depression

Self-care

Self-care can be beneficial in controlling depressive symptoms and boosting general well-being.
•    Be aware of your feelings
•    Create a support network
•    Stay connected to the outside world
•    Look after your physical health
•    Review your diet
•    Challenge negative thinking
•    Do things you enjoy
•    Avoid negative influences
•    Seek expert assistance.
•    Follow a healthy diet

Be aware of your feelings: Being depressed is an uncomfortable emotion. Take the time to recognize and consider your feelings, as they may assist you in understanding the cause of what is causing you to feel depressed, allowing you to take action toward resolving the issue and improving your overall well-being.

Create a support network or stay in touch: Don't give up on life. Socializing can lift your spirits, and maintaining contact with friends and family ensures you have someone to talk to when feeling down.

Stay connected to the outside world: Attending social events and spending time with other people will help minimize your depression symptoms and keep them at bay in the future.

Look after your physical health: Exercise has long been considered to be an effective antidepressant. If you feel well enough, go outside and get some fresh air. Even if it's only a quick stroll in the park, being outside can help your mental health.

Review your diet: If you've been overeating or comfort eating as a way of dealing with your depression, try not to overdo it.

Challenge negative thinking: Depression is characterized by feelings of pessimism and hopelessness. These unreasonable or unrealistic beliefs are defined as 'cognitive distortions' but can be overcome if challenged correctly. Examining your thought process is an excellent way to build more balance in approaching events that arise around you.

Do things you enjoy: In the long run, you'll require a complete arsenal of coping mechanisms. Finally, do things you know you enjoy to stay motivated when feeling down. Some of these activities include creative hobbies such as performing music or producing art, petting a dog, watching your favourite movie, reading a book, and listening to music.

Avoid negative influences: Many people are bombarded with negative images, altered photos, and perfectionist viewpoints due to the news and social media. It can be difficult to believe you cannot fulfil the standards set. Consider taking a vacation or consuming more positive news and postings if your media exacerbates your symptoms. You can unfollow social media accounts that make you feel like you need to compete or that you aren't "enough."

Seek expert assistance:
•    Individual therapy can often effectively manage symptoms of depression, whether the person influencing your mental health is someone close to you or someone you spend time with. You can look for a local therapist who specializes in helping individuals suffering from depression.

Diet:
Poor dietary practices were linked to depression symptoms.
According to the latest study, the researchers identified the following seven lifestyle factors as lowering the incidence of depression:
•    Maintaining a healthy diet
•    Physical activity on a regular basis
•    Never smoke
•    Keeping alcohol consumption to a minimum
•    Having regular social interactions
•    Getting enough sleep
•    Maintaining a low level of sedentary behaviour

Additional information:

Key Facts
Usually seen in
•    Depression can strike anyone at any age. Usually, 60 plus are more prone to depression.

Gender affected
•    Both men and women are affected; however, women are more likely to be affected.
•    One in every four women will experience depression at some point in their lives.

Body part(s) involved
•    Brain
Technically, depression usually affects the brain; it also has an impact on your physical health. It might affect the health of your heart, kidneys, brain system, and immune system.

Mimicking Conditions or Similar Conditions
•    Anxiety
•    Bipolar disorder
•    Cyclothymic disorder
•    Chronic fatigue syndrome
•    Depression
•    Diabetes
•    Disruptive mood dysregulation disorder
•    Eating disorders
•    Fibromyalgia
•    Hypothyroidism
•    Persistent depressive disorder
•    Premenstrual dysphoric disorder
•    Seasonal affective disorder
•    Substance use disorder

Transmission:
Depressive thinking can be contagious. You can't "catch" depression like a cold or flu virus; psychologists believe that your behaviour, vocabulary, and mood can influence the individuals you deal with.

As social creatures, humans frequently adopt behavioural patterns that imitate those they engage with. The more time you spend with someone, the more their actions will affect you. When you are around someone who exhibits symptoms of depression, you are more likely to pick up on these symptoms and even suffer depression yourself.

For example, you may pick up on your mother's walking style, just as you may feel more pleased when she smiles or laughs. You may copy your partner's towel-folding technique while also adopting their tendency to become upset while waiting in long lines at the supermarket.
People frequently compare themselves to others in person or on virtual channels such as social media. These comparisons may be used to establish emotions of self-worth, which can negatively impact mental health.