Introduction
Depression is a common mental health disorder that affects people of all ages and backgrounds across the world. It causes feelings of sadness and a loss of interest and can seriously impact how a person functions in their daily life. This condition can develop for a variety of reasons and it is important to understand the causes, symptoms and various treatment options available. This article aims to provide a comprehensive overview of depression, including statistics on how common it is, what causes it and what can be done to help those struggling with the illness.
Statistics on Depression
Depression is extremely widespread both in the UK and globally. According to official statistics from Mind, the mental health charity:
1 in 4 people in the UK will experience a mental health problem each year.
Around 1 in 6 adults experiences a common mental health problem like anxiety or depression in any given week.
In 2017, there were over 18 million prescriptions issued for antidepressants in England alone.
Women are nearly twice as likely as men to experience depression during their lifetime.
Prevalence of depression increases with age. Rates are highest in older age groups.
Suicide is one of the leading causes of death for men under 50 in the UK. 90% of those who die by suicide have an underlying mental health condition like depression or schizophrenia.
On a global scale:
More than 300 million people worldwide currently suffer from depression, making it one of the leading causes of disability.
Major depressive disorder is forecast to become the leading cause of disease burden worldwide by 2030 according to the World Health Organization (WHO).
These statistics clearly demonstrate just how widespread depression has become. It is a serious issue impacting many individuals, families and communities across the globe. Understanding its causes and having effective treatment options are critical to help manage this disorder.
Causes of Depression
There is no single cause of depression but rather multiple factors that can contribute to its development in a person. Some of the most common causes recognised by medical research include:
Genetics: Studies show that depression tends to run in families. Those with a first-degree relative with depression, like a parent or sibling, are more likely to develop it themselves. Genetics are thought to account for about 40% of the risk.
Brain chemistry: Imbalances in certain neurotransmitters in the brain like serotonin and norepinephrine have been linked to depression. Low levels of these important brain chemicals may underlie some causes. Certain antidepressants work by targeting these chemical messengers.
Life events: Stressful or traumatic life experiences such as bereavement, relationship breakdown or financial difficulties can trigger depressive episodes in vulnerable individuals. Loss of employment or adverse childhood experiences also feature prominently.
Medical conditions: Some physical illnesses like thyroid problems, Parkinson’s disease or chronic pain conditions have been associated with increased rates of depression. Dementia also often has depressive symptoms.
Alcohol and drug use: Substance abuse issues, particularly alcoholism, increase the risk of both depression and suicide. Alcohol is a central nervous system depressant that can worsen or even induce mood disorders.
Personality: Certain personality traits make some more predisposed than others, such as low self-esteem, pessimism or neuroticism. Perfectionist tendencies are also linked to depressive risk.
Seasonal affective disorder: Lack of natural sunlight exposure during winter months can bring on seasonal depression in those vulnerable people. This type of depression is generally milder and lifts in spring/summer.
Post-natal depression: The hormonal and lifestyle changes associated with giving birth and adjusting to motherhood also greatly increase depressive risk during the post-natal period in many women and some men.
As we can see, biological, genetic, situational and psychological causes all play a complex interconnected role. Identifying triggers and risk factors can help direct suitable treatment and management strategies.
Symptoms of Depression
As depression can be experienced in different ways, it presents with a wide variety of possible symptoms. The core symptoms as defined by diagnostic guidelines involve a depressed mood or loss of interest or pleasure that lasts for at least two weeks along with some of the following:
Feeling sad, anxious, empty or hopeless
Irritability and restlessness
Loss of energy and fatigue
Changes in appetite – either loss of or excessive eating
Sleep problems like insomnia or excessive sleeping
Slowed movements or speech
Loss of self-esteem, guilt or worthlessness
Difficulty concentrating or making decisions
Recurrent thoughts of death or suicide
Physical symptoms like headaches, back pain and digestive problems can also occur. Some people experience seasonal effects while others may temporarily feel better followed by periods where symptoms worsen. Severe depression often stops people from functioning normally and enjoying life. Mild or moderate depression may cause fewer problems, but if left untreated it risks worsening over time.
Diagnosing Depression
For depression to be formally diagnosed requires a thorough clinical assessment by a medical professional like a GP or psychiatrist. They will examine the patient’s medical history, symptom profile and conduct a physical exam to rule out any underlying medical cause. Certain screening tools may also be used such as questionnaires to objectively rate symptom severity and impact on daily life.
Major depression is diagnosed if five or more core symptoms are present for at least two weeks according to diagnostic criteria in internationally recognised manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This includes at least one core symptom of low mood or lack of pleasure. Related conditions on the depressive spectrum include dysthymia (chronic, mild depression), persistent depressive disorder and seasonal affective disorder.
A diagnosis looks at both symptoms and duration to differentiate normal low mood from a pathological illness. It provides confirmation of the problem and guides appropriate specialist help. Establishing causes also helps determine treatment – as some biological treatments may be more fitting than psychotherapy alone depending on triggers identified. Diagnosis can aid access to support, benefits and workplace adjustments too.
Treating Depression
Thankfully, depression is highly treatable in most cases with a combination of therapeutic interventions and medical support. Finding the right treatment plan requires trial and error sometimes but many people recover fully or experience substantial improvement. Options include:
Antidepressant medication: These are often first line treatment for moderate to severe depression. They work to rebalance brain chemicals like serotonin and help relieve symptoms within 4-6 weeks. Common types are SSRIs (e.g fluoxetine), SNRIs (venlafaxine) and TCAs. Side effects can occur initially but often subside.
Psychotherapy: Cognitive behavioural therapy (CBT) in particular has strong evidence and aims to change negative thought patterns linked to depression. Interpersonal therapy (IPT) looks at relationships. Counselling methods like psychodynamic therapy may also benefit some. Therapy may be short or long term depending on root causes identified.
Lifestyle adjustments: Supporting mental wellbeing through regular exercise, diet, reducing alcohol intake, practicing relaxation techniques like yoga, meditation or deep breathing, getting good quality sleep and connecting with others socially.
Light therapy: Using special light therapy boxes in winter months to mimic natural daylight and boost mood for SAD sufferers.
Brain stimulation therapies: Newer options gaining traction include repetitive transcranial magnetic stimulation (rTMS) which uses magnetic fields to activate neurons and electroconvulsive therapy (ECT) for severe refractory depression not helped by other means.
Self-help strategies: Tracking mood and triggers through daily journals or self-care plans, guided self-help books and online courses can empower people between therapy sessions. Support groups and helplines provide peer support.
Inpatient treatment: For the most severe, dangerous cases where risk to self is very high, admission to a psychiatric hospital may be needed for intensive stabilization through medication adjustment and intense therapy before stepping down to lower levels of care.
Treatment is coordinated by a medical professional and tailored to the individual needs and situation. Support also extends to relationship or workplace counselling, signposting to local support groups and help with benefits access where required. Taking a holistic multi-modal approach with medication, therapy, lifestyle factors and social support usually provides the best outcomes. Relapse prevention plans can then maintain long term remission.
Living with Depression
For many, depression becomes a long term or recurrent condition to be managed rather than cured outright. This requires developing coping strategies and flexibility to fight symptoms as they arise without losing hope altogether of good quality days ahead. Some helpful approaches include:
Accepting the illness and seeking help without shame or embarrassment to prevent downward spirals.
Prioritising self-care like healthy routine, social interaction and activities that provide a sense of purpose even on low motivation days.
Challenging negative thoughts by keeping a thoughts diary and disputing irrational beliefs that fuel low mood.
Practicing relaxation techniques and mindfulness regularly to build psychological resilience against stress triggers.
Communicating needs clearly with loved ones so they can offer proper support without enabling avoidance of challenges altogether.
Establishing a strong therapeutic alliance with counsellor or doctor to check in regularly, adjust treatment if needed and gain coping skills.
Joining online support forums to share experiences confidentially with others also battling the illness on a daily basis.
Monitoring warning signs of forthcoming relapse like sleep/appetite changes or excessive worrying to seek help urgently as indicators emerge.
Developing crisis plans with emergency contacts listed for very difficult periods to ward off danger to self or others.
With patience and consistency, living well is achievable even for those managing chronic depression long term through skill-building, self-care,
Andrew Stroud