Depression is a mood disorder characterized by persistently low mood and a feeling of sadness and loss of interest. It is a persistent problem, not a passing one, lasting on average 6 to 8 months. According to the Centers for Disease Control and Prevention (CDC), 7.6 percent of people over the age of 12 have depression in any 2-week period. This is substantial and shows the scale of the issue.
According to the World Health Organization (WHO), depression is the most common illness worldwide and the leading cause of disability. They estimate that 350 million people are affected by depression, globally.
Depression is different from the fluctuations in mood that people experience as a part of normal life. Temporary emotional responses to the challenges of everyday life do not constitute depression. Likewise, even the feeling of grief resulting from the death of someone close is not itself depression if it does not persist. Depression can, however, be related to bereavement – when depression follows a loss, psychologists call it a “complicated bereavement.”
Unipolar and bipolar
If the predominant feature is a depressed mood, it is called unipolar depression. However, if it is characterized by both manic and depressive episodes separated by periods of normal mood, it is referred to as bipolar disorder (previously called manic depression).
Unipolar can involve anxiety and other symptoms – but no manic episodes. However, research shows that for around 40 percent of the time, individuals with bipolar disorder are depressed, making the two conditions difficult to distinguish.
Major depressive disorder with psychotic features
This condition is characterized by depression accompanied by psychosis. Psychosis can involve delusions – false beliefs and detachment from reality, or hallucinations – sensing things that do not exist.
Women often experience “baby blues” with a newborn, but postpartum depression- also known as postnatal depression – is more severe.
Major depressive disorder with seasonal pattern
Previously called seasonal affective disorder (SAD). This condition is related to the reduced daylight of winter – the depression occurs during this season but lifts for the rest of the year and in response to light therapy.
- Depressed mood.
- Reduced interest or pleasure in activities previously enjoyed, loss of sexual desire.
- Unintentional weight loss (without dieting) or low appetite.
- Insomnia (difficulty sleeping) or hypersomnia (excessive sleeping).
- Psychomotor agitation, for example, restlessness, pacing up and down.
- Delayed psychomotor skills, for example, slowed movement and speech.
- Fatigue or loss of energy.
- Feelings of worthlessness or guilt.
- Impaired ability to think, concentrate, or make decisions.
- Recurrent thoughts of death or suicide, or attempt at suicide.
Causes and Risk Factors
The causes are not fully understood and may not be down to a single source. Depression is likely to be due to a complex combination of factors that include:
- biological – changes in neurotransmitter levels
- psychological and social (psychosocial)
Some people are at higher risk than others; risk factors include:
- Life events: These include bereavement, divorce, work issues, relationships with friends and family, financial problems, medical concerns, or acute stress.
- Personality: Those with less successful coping strategies, or previous life trauma are more susceptible.
- Genetic factors: Having a first-degree relatives with depression increases the risk.
- Childhood trauma.
- Some prescription drugs: These include corticosteroids, some beta-blockers, interferon, and other prescription drugs.
- Abuse of recreational drugs: Abuse of alcohol, amphetamines, and other drugs are strongly linked to depression.
- A past head injury.
- Having had one episode of major depression: This increases the risk of a subsequent one.
- Chronic pain syndromes: These and other chronic conditions, such as diabetes, chronic obstructive pulmonary disease, and cardiovascular disease make depression more likely.
How to Effectively Handle Depression
Depression is a treatable mental illness. There are three components involved in the management:
- Support, ranging from discussing practical solutions and contributing stresses, to educating family members.
- Psychotherapy, also known as talking therapies, such as cognitive behavioral therapy (CBT).
- Drug treatment, specifically antidepressants.
Psychological or talking therapies for depression include cognitive-behavioral therapy (CBT), interpersonal psychotherapy, and problem-solving treatment. In mild cases, psychotherapies are the first option for treatment; in moderate and severe cases, they may be used alongside other treatment.
CBT and interpersonal therapy are the two main types of psychotherapy used. CBT may be delivered in individual sessions with a therapist, face-to-face, in groups, or over the telephone. Some recent studies suggest that CBT may be delivered effectively through a computer. Interpersonal therapy helps patients to identify emotional problems that affect relationships and communication, and how these, in turn, affect mood and can be changed.
Antidepressants are drugs available on prescription from a doctor. Drugs come into use for moderate to severe, but are not recommended for children, and will be prescribed only with caution for adolescents. A number of classes of medication are available in the treatment of depression:
- selective serotonin reuptake inhibitors (SSRIs)
- monoamine oxidase inhibitors (MAOIs)
- tricyclic antidepressants
- atypical antidepressants
- selective serotonin and norepinephrine reuptake inhibitors (SNRI)
Each class of antidepressant acts on a different neurotransmitter. The drugs should be continued as prescribed by the doctor, even after symptoms have improved, to prevent relapse. Any concerns should always be raised with a doctor – including any intention to stop taking antidepressants.
Exercise and other therapies
Aerobic exercise may help against mild forms since it raises endorphin levels and stimulates the neurotransmitter norepinephrine, which is related to mood.
Brain stimulation therapies
Electroconvulsive therapy are also used in depression. Repetitive transcranial magnetic stimulation sends magnetic pulses to the brain and may be effective in major depressive disorder.
Severe cases that have not responded to drug treatment may benefit from electroconvulsive therapy (ECT); this is particularly effective for psychotic depression.