BeWell Health Clinic
Depression is a disorder that affects your mood and causes a continuous loss of interest along with feelings of sadness. It alters your feelings, thoughts, and behaviour and can result in various physical and emotional difficulties. You may sometimes feel that life is meaningless or have difficulties performing normal daily activities.
Everybody experiences low spirits at one point or the other. However, depression makes you feel relentlessly downcast and sad for weeks or even months in succession. Depression is not a weakness. It is a genuine health condition that you cannot merely snap out of. It requires long-term treatment, but you can recover fully.
Diagnostic Criteria for Depression
The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM - 5) specifies the criterion for diagnosing depression. You must experience at least five symptoms within two consecutive weeks. At least one sign should be either loss of pleasure or interest or a depressed mood.
The symptoms of depression are:
1. A depressed mood for a significant part of the day, almost daily
2. A noticeable decrease in pleasure or interest in most or all activities, nearly all day, almost daily
3. Considerable weight gain or loss without dieting, or a change in appetite almost daily
4. A decrease in your physical movement and slowing down of thoughts. It must be observable by other people, not just an internal feeling.
5. Loss of energy or fatigue nearly every day
6. Feeling worthless, or experiencing inappropriate or excessive guilt on most days
7. Indecisiveness or a decreasing ability to concentrate or think, almost every day
8. Recurring thoughts of death or suicidal fantasies without a particular strategy, attempting suicide or having a definite method of committing suicide
The symptoms must cause you clinically significant suffering or disruption in occupational, social, or other vital areas of functioning. Also, the symptoms should not be due to a medical condition or substance abuse.
DSM-5 also includes two additional specifiers for further classification of depression.
1. With Anxious Distress: Anxiety may affect your prognosis and your response to the various treatment options. Your physician must assess whether you are also presenting with anxious distress.
2. With Mixed Features: The specifier allows the diagnosis of depression when you exhibit manic symptoms, but you do not fulfill the entire criteria for a manic episode.
Types of Depression
Depression comes in various forms. It can be as a result of chemical changes inside your brain or due to experiences in your life. Types of depression include:
Also known as Major Depressive Disorder, it makes you feel depressed for most of the day and on most days in a week. Other symptoms include:
o Losing pleasure or interest in regular activities
o Losing or gaining weight
o Problems falling asleep or feeling sleepy in the daytime
o Feeling agitated or restless, or very sluggish and mentally or physically slowed down
o Feeling tired and out of energy
o Feeling guilty or worthless
o Difficulties making decisions or concentrating
o Experiencing suicidal thoughts
Persistent Depressive Disorder
This disorder consists of two conditions, chronic major depression and low-grade persistent depression, also known as dysthymia. The symptoms include:
o An increase or decrease in your appetite
o Sleeping too little or too much
o Fatigue or lack of energy
o Low self-esteem
o Difficulty making decisions or concentrating
o Feeling hopeless
If you have psychotic depression, you exhibit signs of major depression and psychotic symptoms like:
o Delusions: False beliefs
o Hallucinations: You hear or see things that are not there
o Paranoia: A misconception that others want to hurt you
Postpartum (Peripartum) Depression
This type of depression occurs in women in the weeks or months following childbirth. The symptoms are similar to those of major depression.
Premenstrual Dysphoric Disorder (PMDD)
This type of depression occurs at the beginning of your period. In addition to feeling depressed, you will also experience other symptoms such as:
o Mood swings
o A change in your sleeping habits or appetite
o Problems concentrating
o Feeling overwhelmed
Having atypical depression is different from experiencing the persistent sadness that characterizes normal depression. It is a specifier that details a set of depressive symptoms, and positive events can temporarily boost your mood. Other signs include:
o An increased appetite
o Oversensitivity to criticism
o A feeling of heaviness in the legs and arms
Seasonal Affective Disorder (SAD)
This disorder is a form of major depression that often occurs during winter when the days are short and you receive little sunlight. It usually clears during spring and summer. Treatment is usually through light therapy.
Also known as bipolar disorder, this condition causes varying and extreme mood changes from high energy episodes and an upbeat mood to low energy, depressive phases. When you are experiencing down moments, you exhibit symptoms of major depression.
The Evolution of Depression Treatment
Treatment of depression has evolved continuously with discontinuation of some past treatment methods and practices. Ancient Romans, Greeks, Babylonians, Egyptians, and Chinese believed that evil spirits caused depression. Their treatment methods were starvation, physical restraint, and beatings to exorcise the demons. However, some Roman and Greek doctors thought of depression as a psychological and biological illness. They treated their patients using music, diet, massage, gymnastics, baths, and medication containing donkey’s milk and poppy extract.
In the Common Era, harsh treatment methods continued, but Rhazes, a Persian doctor, believed that depression was a brain illness. He recommended bath treatment and behavioural therapy that involved rewards for proper behaviour. In the middle age, Christianity dominantly attributed mental illness to evil spirits. Treatment methods included exorcism, burning, drowning, and locking up patients in asylums.
Between the 14th and 17th centuries, doctors revisited the concept of mental illness arising from natural causes. In 1621, R. Burton published the psychological and physical causes of depression. He recommended treatments such as exercise, diet, travel, music therapy, herbs, bloodletting, and purgatives. In the era of enlightenment, the treatment also included vomiting, enemas, water immersion, a spinning stool to “reset” brain contents, and electroshock to induce seizures.
From the late 19th into the early 20th century, lobotomies, surgeries that damage the brain’s frontal section, were reputed to relieve symptoms of depression. However, they caused poor judgment, impaired decision making, personality changes, and sometimes death.
Modern medicine introduced pharmacology as a first-line treatment for depression. Previous treatments (many of which are now regarded as inhumane) were discontinued. Currently, psychology/psychiatry professionals agree that the best standard of treatment for depression would be a combination of medication and therapy along with lifestyle modifications.
Medications Used to Treat Depression
The major types of antidepressants are:
· Selective serotonin reuptake inhibitors (SSRIs)
These are modern types of antidepressants that increase levels of serotonin, the ‘good mood’ chemical in your brain. They are generally safer and produce fewer side effects compared to other antidepressants. They may cause headaches, nausea, sexual dysfunction, and a dry mouth, but these side effects improve with time. SSRIs are unsuitable for patients under 18 years except for Fluoxetine, which must still be given only on prescription by a specialist.
· Tricyclic antidepressants (TCAs)
These antidepressants treat moderate or severe depression. They raise the levels of serotonin and noradrenaline to lift your mood. They are usually a second option after you have tried SSRIs without improvement. TCAs are very useful, but they cause blurred vision, sweating, constipation, difficulties passing urine, excessive drowsiness, and light-headedness. The side effects last about ten days before your body adjusts.
· Serotonin-norepinephrine reuptake inhibitors (SNRIs)
These antidepressants work slightly differently from SSRIs and TCAs. They alter serotonin and noradrenaline levels in your brain like TCAS. Although they are more effective than SSRIs, doctors do not routinely prescribe them because they can raise your blood pressure.
· Monoamine oxidase inhibitors (MAOIs)
Physicians only prescribe these medications when other drugs are ineffective because MAOIs cause significant side effects. To use them, you must observe a strict diet due to potentially fatal interactions with foods, herbal supplements, and some medications. You cannot combine MAOIs with SSRIs.
· Atypical antidepressants
These are antidepressants that do not fit into single categories of antidepressants. Also known as second-generation antidepressants, they act on depression symptoms in an atypical manner. They uniquely affect levels of dopamine, norepinephrine, and serotonin in your brain. The side effects vary by drug but include dry mouth, nausea, vomiting, insomnia, blurry vision, constipation, sexual dysfunction, and weight gain.
Benefits of Therapy in Depression
Talk therapy can be extremely useful, especially if your depression symptoms do not have an underlying medical cause. Individual therapy provides individualized attention and helps you develop a secure connection with one person. It also offers an opportunity for you to voice sensitive information. Listening to peers in group therapy validates your experiences and builds your self-esteem. It offers ideas and inspirations and helps grow your social network and activities.
Therapy gives you insight and skills that empower you to prevent a relapse. You gain practical techniques to reframe your negative thinking and apply behavioural skills to combat depression. Through therapy, you understand the cause of your feelings, the triggers, and how to remain healthy.
Therapy applies some main ideas to help you deal with depression:
1. Handling problems in life: You get feedback on positive ways of handling issues and challenges in life.
2. Setting healthy boundaries: You identify and validate the right limits for you. You learn to set boundaries and to say no to avoid feeling overwhelmed and relieve stress.
3. Relationships: You understand your relations, improve current connections, and build better ones. Healthier ties develop social support and help reduce isolation, a primary factor in the prevention of depression.
Get Help for Depression!
Depression is an illness, and you do not need to suffer in silence. With therapy, medication, or both, you can resume a healthy life and fully participate in all activities of daily living. Talk to a professional who will listen to your concerns and create a treatment plan that works for you.
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