Depression is a mood disorder that is characterized by a persistent feeling of sadness and loss of interest in activities. It is also called clinical or major depression. It is more than just about feeling low or blue. It affects one’s thoughts, feelings and behavior and sometimes makes day to day activities difficult. There is a sense of loss of control over one’s moods and one cannot simply snap out of it. Depression is not a ‘weakness.’ But depression is treatable, with a combination of medication, psychotherapy, newer treatments such as rTMS, and certain lifestyle changes.
During an episode of major depression, individuals may experience the following symptoms, for most of the day, nearly everyday, for atleast two weeks:
Feelings of sadness
Irritability or angry outbursts
Tearfulness or crying spells
Loss of interest or pleasure in most or all activities, such as social interactions, hobbies, sex, etc.
Difficulty falling asleep, difficulty staying asleep or sleeping excessively
Low energy and excessive fatigue
Decreased appetite and weight loss, or increased appetite with food cravings leading to weight gain
Diminished concentration and forgetfulness
Feeling anxious and agitated or excessive slowing down of movements
Feelings of helplessness and hopelessness
Feelings of worthlessness or excessive inappropriate guilt
Frequent or recurrent thoughts of death, suicidal thoughts or suicide attempts
Unexplained aches and pains such as headaches, backache, etc
Among children, depression can manifest as irritability, sadness, aches and pains, clinginess, school phobia and weight changes.
Among teenagers, depression can present as irritability or sadness, anger outbursts, negative thoughts, feelings of worthlessness, becoming extremely sensitive and feeling that no one understands them, diminished interest in usual activities, avoiding people, academic decline, increased sleep, increased appetite, alcohol or drug abuse, and even self-harm.
Among older adults, depression often goes undiagnosed, and can present with memory difficulties, aches and pains, fatigue, decrease interest in interacting with people and in severe cases, even suicidal thoughts.
Symptoms of depression vary from mild to severe, and affect one’s daily functioning socially, at work and at home.
The exact cause of depression is unknown. Several factors may be involved, including genetics, altered brain networks that regulate mood, altered neurochemicals, hormonal imbalances, past trauma, etc. Life stress events can act as triggers for depression in vulnerable individuals.
Among depressive disorders, major depression is the most common, affecting approximately 20% of the world’s population at some point during their lives. Women are more likely to experience depression compared to men. Depression can begin at any age, and often starts in one’s teenage years or young adulthood.
Depression can manifest differently in different people. Symptoms can vary from mild to severe, and episodic to chronic. A few subtypes of depression include:
Dysthymia: is characterized by a low grade, chronic depression lasting at least 2 years.
Depression with atypical features: is characterized by “mood reactivity” i.e. mood bjustifyens temporarily in response to positive stimuli. The individual may also experience increased appetite, significant weight gain, increased sleep, heavy feeling in arms or legs and extreme sensitivity to rejection.
Depression with anxious distress: depression with unusual anxiety, restlessness, worry about possible events or about loss of control.
Seasonal pattern: depression related to changes across seasons with reduced exposure to sunlight.
Melancholic depression: severe depression with lack of response to something that brought joy and pleasure earlier, associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt and worthlessness.
Depression with peripartum onset: depression that occurs during pregnancy or in the postpartum phase i.e. in the weeks or months after delivery.
Depression is a serious condition that can take a massive toll on individuals and their families. It often gets worse if not treated and can result in severe emotional, behavioral, and health problems.
Some of the complications include:
Problems at school, college, or work
Interpersonal problems and relationship difficulties, including social isolation, family and marital conflicts
Excess weight or obesity, which in turn can lead to diabetes, heart disease, and other medical disorders
Alcohol or substance misuse or dependence
Self-harm behaviours such as cutting
Suicidal thoughts or suicide attempts
Premature death from suicide or other medical conditions
Depression is usually treated with medication (antidepressants) and counselling (psychotherapy). Antidepressants primarily work on brain chemicals (neurotransmitters), especially serotonin, norepinephrine, and dopamine. Several antidepressants are available with fewer side-effects compared to older medications. Some of these include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), and atypical antidepressants. Medication must be taken only under a doctor’s supervision and not stopped abruptly or taken irregularly. A discussion with one’s treating psychiatrist is helpful in selecting an antidepressant.
Some individuals may not respond to medication or may experience too many side-effects. Newer, state of the art, safe, and effective treatments such as Repetitive Transcranial Magnetic Stimulation (rTMS) are now available which can be helpful in treating depression. rTMS is a non-invasive treatment that uses a magnetic field administered externally on the scalp to stimulate specific areas of the brain to treat depression, anxiety, and other clinical conditions. No sedation is required, individuals are awake and alert during rTMS treatment and can even drive themselves home, or resume work immediately following treatment. rTMS was approved by the United States Food & Drug Administration (US-FDA) for the treatment of depression in 2008 and has been in use globally for over 20 years.
rTMS has replaced electro-convulsive therapy (ECT) in many individuals with resistant depression. However, in some very severe cases in which the safety of the patient is at risk (such as suicidal depression), ECT may be very helpful and may even be life-saving. For very severe depression, hospital admission may be required.
Psychotherapy includes techniques such as Cognitive Behavioural Therapy (CBT) or Rational Emotive Behavioral Therapy (REBT) which, in combination with medication, can be useful for some individuals with depression.
i) Educate yourself about depression and its treatment.
ii) Ensure that you follow your treatment plan.
iii) Lower your stress levels.
iv) Follow a healthy lifestyle: get enough sleep, exercise, follow a healthy diet, avoid alcohol and substances of abuse, including smoking.
v) Do not ignore early symptoms or warning signs of depression; get treatment immediately.
vi) Seek professional help when necessary.
vii) Harness support from your friends and family.