Abstract
Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home. This paper examines what depression is, common signs and symptoms of depression, contributing factors and causes, diagnosis of depression and several evidence-based treatments for depression. Understanding depression better can help those suffering from depression seek appropriate evaluation and help to manage their condition. This allows people with depression to feel better and function better on a daily basis.
Introduction
Depression, also known as major depressive disorder, is a common but serious mood disorder that negatively affects how a person feels, thinks and behaves. Depression causes feelings of sadness and/or loss of interest in activities once enjoyed on a daily basis for at least two weeks and can vary in severity from mild to moderate to severe. It interferes with daily activities and normal functioning. Some key facts about depression include:
Depression is one of the most common mental disorders in the U.S. The National Institute of Mental Health reports that in 2015, an estimated 15.7 million adults aged 18 or older in the United States had at least one major depressive episode in the past year. This equates to approximately 6.7% of all U.S. adults.
Depression is a leading cause of disability worldwide according to the World Health Organization. Depression is the primary cause of suicide deaths. More than 800,000 people die due to suicide every year.
Depression affects both sexes. Women tend to develop depression approximately twice as frequently as men but this may partly reflect greater willingness to report depressive symptoms on the part of women. Depressive episodes can occur at almost any age but risk increases with age.
Untreated serious depression can last a long time or recur frequently. The course of the illness varies for each individual. Major depression that goes untreated can become a chronic or recurrent condition. Many factors contribute to the development and severity of depression including genetics, environmental factors and life stressors.
With proper treatment, people with depression can feel well again. Effective treatments are available for depression that can help most people who suffer from depression feel better. Treatment for depression involves psychotherapy, medication or a combination of both. Psychotherapies that are found effective for depression include cognitive-behavior therapy and interpersonal therapy.
This paper examines the signs and symptoms of major depression, risk factors and causes of depression, how depression is diagnosed and several evidence-based treatments for depression including psychotherapy and antidepressant medications. Understanding depression can help those suffering from this mental illness seek appropriate help and treatment to better manage their condition and live a happier and more productive life.
Symptoms of Depression
Persistent sad, anxious or “empty” mood. Symptoms of depression typically interfere with day-to-day activities to cause significant functional impairment.
Signs and symptoms of depression may include feelings of helplessness, guilt, worthlessness and uselessness. Depressed individuals often feel hopeless and unable to overcome the deep feelings of sadness, guilt and negativity they experience.
Loss of interest or pleasure in activities once enjoyed. Depressed individuals have no enthusiasm or interest in hobbies, activities or spending time with others.
Changes in appetite – significant weight loss or weight gain that results from changes in eating patterns. Depressed individuals either eat more or eat less and subsequently gain or lose weight.
Changes in sleep patterns – either insomnia or excessive sleeping. Waking up too early or oversleeping.
Physical slowing down or agitation noticeable by others. Depressed individuals talk slower or move more slowly. Others may report the individual is too restless or fidgety.
Fatigue or loss of energy nearly every day. Even small tasks take a lot of effort making the depressed individual feel exhausted.
Feeling worthless or excessive and inappropriate guilt. Individuals blame themselves for events they are not responsible for and make negative judgments about self.
Difficulty concentrating, thinking or making decisions. Depressed individuals describe their minds going blank and an impaired ability to read, think or solve problems.
Recurrent thoughts of death, suicide ideation or suicide plans or attempts. Wishing to be dead or thinking of harming oneself are key depression symptoms.
Risk Factors for Depression
Family history of depression. Depression tends to run in families, suggesting that a biological vulnerability may be inherited.
Certain physical illnesses, especially those known to affect body chemistry like thyroid disease, chronic pain or cancer diagnosis. Medical conditions often trigger or worsen depression.
Stressful life events or trauma in early life. Experiences of abuse, neglect, trauma or loss of a loved one raise risks for depression. Interpersonal difficulties or stressful life events also increase risks.
Personality. Individuals with low self-esteem, feelings of helplessness, or pessimistic styles of thinking are more prone. Perceiving stressors as overwhelming or uncontrollable also raises risks.
Substance abuse. Illicit drug use or alcohol dependency increases risk for depression. Those struggling with addiction often use substances to cope with negative emotions leading to a vicious cycle.
Social isolation. Lack of strong social connections, loss of social roles and difficulties with peers, family or spouse increase risks. Social support provides protective buffering against life stressors.
Diagnosis of Depression
No laboratory test can confirm depression but careful evaluation of symptoms is important for accurate diagnosis. Experienced mental health professionals like psychologists and psychiatrists conduct clinical interviews to gather details about onset, duration and severity of symptoms.
Mental health professionals use standardized criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or International Classification of Diseases, Tenth Revision (ICD-10) to determine if depressive symptoms constitute major depression or another mood disorder.
Symptoms must persist for at least two weeks and interfere with daily functioning for a diagnosis of major depression. Those with milder or briefer depressive symptoms receive alternate diagnoses. Other psychological and physical factors must also be considered to rule out other potential underlying causes.
Diagnosis aims to determine severity and duration of depression through thorough medical history, physical exam, and discussion of symptoms, challenges faced, and how depression impacts daily activities and relationships. Other diagnostic tools include self-report questionnaires to rate and monitor symptoms.
Physical exams, medical testing and more detailed diagnostic procedures are undertaken if needed to rule out other physical health problems like thyroid disease or vitamin deficiencies that may mimic or worsen depression. Biomarkers in blood or imaging scans are utilized but remain experimental.
Treatment for Depression
Effective treatments are available for many people experiencing clinical depression. Treatment choices depend on severity of symptoms, duration of illness, age and personal preferences. Psychotherapy, antidepressant medications or a combination of both are common evidence-based treatments.
Psychotherapies: Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are most strongly supported by research for depression. CBT focuses on identifying and replacing dysfunctional thoughts and behaviors that exacerbate symptoms. IPT focuses on current interpersonal difficulties and relationships that may maintain or trigger depression. Both are effective standalone treatments or useful when combined with antidepressants.
Antidepressant medication: Several classes of antidepressants are available by prescription only including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and others. Medications mainly help increase levels of serotonin, norepinephrine and other neurotransmitters in the brain. Several medications require 4-6 weeks for full effectiveness.
Psychiatrists should closely monitor treatment for side effects and efficacy. Medication management is usually 6-12 months or longer depending on risk of relapse. Side effects from antidepressants may include temporary nausea, headache, insomnia or nervousness but usually disappear within 2-4 weeks.
Hospitalization may be recommended for those posing immediate danger to self or severely unable to function due to dangerous depression. Hospital programs combine medication management with intensive psychotherapy and support.
Brain stimulation therapies like electroconvulsive therapy (ECT) provide effective treatment for severe treatment resistant depression. ECT involves electricity administered briefly while under anesthesia. Results are seen more rapidly than with other therapies but memory loss remains a risk. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive alternative with fewer risks.
Lifestyle changes and holistic therapies including exercise, meditation, omega-3 supplements, acupuncture or light therapy can boost formal treatment, though unproven as stand-alone alternatives. Support groups, peer counseling or respite care also aid depression management. Integrated treatment plans offer best outcomes with depression, a serious but highly treatable mental health condition.
Conclusion
Clinical depression is a common but serious mood disorder impacting how one feels, thinks and acts. Depression symptoms cause distress substantially interfering with daily life. Risks are influenced by both biological and environmental factors but the condition is highly treatable. Evidence-based treatment options including psychotherapies and antidepressant medications effectively alleviate depression symptoms for many individuals. With appropriate evaluation and carefully managed treatment, people affected by depression are able to recover, manage symptoms successfully and return to normal or satisfying daily functioning at home and work. Understanding depression and its management options enables those struggling with persistent sadness to seek effective treatments and feel better over time. Overall, depression responds well to professional mental healthcare allowing individuals suffering to live happier and healthier lives.
Andrew Stroud