Depression is a serious illness which can have a profound impact on the day-to-day life of someone who suffers from the illness.
While the majority of people go through periods of feeling down or unhappy, those who are depressed feel persistently sad or have a low mood for weeks, or perhaps even months.
Depression can make life appear pointless, and often leads to suicidal ideation. Depression is a common mental illness, and is usually classed as either mild, moderate or severe.
Clinical Depression is the most common form, though there are a range of types, including Postpartum Depression and Seasonal Affective Depression.
The good news is that unlike many mental health conditions, with the right treatment, support and lifestyle, many people with depression will gain full remission.
Types of Depression
There are several subtypes of Depression. It is useful for patients to know what the exact type of Depression they suffer from is. This allows any treatment to be tailored to their needs.
Clinical Depression (Also Known as Major Depressive Disorder): This is the most common form of Depression. This is where an individual will feel depressed for the majority of a day, for at least a few consecutive weeks. Typical symptoms include the loss of interest and pleasure in normally enjoyable activities, sleep problems, tiredness, and sometimes suicidal ideation.
Dysthymia (Also Known as Persistent Depressive Disorder): If a patient’s feelings of depression lasts for 2 years or longer, it is referred to as Dysthymia, or Persistent Depressive Disorder. The symptoms of Dysthymia are the same as Clinical depression – but the difference lies in how a Dysthymia sufferer will have persistent depression – while someone with Clinical depression will often have bouts of regular mood between depressive episodes. People with Dysthymia will often suggest they have never been happy, and that they cannot remember a time where they haven’t been depressed.
Atypical Depression: Atypical Depression involves an individual suffering from persistent feelings of depression for long periods of time. However, a positive event taking place will lead to a temporary improvement in mood for the individual. While someone suffering from other forms of Depression typically will find little enjoyment in formerly enjoyable activities, someone who has Atypical Depression will find temporary happiness from positive event. Other symptoms include an increased appetite, being oversensitive to criticism, and the need to sleep longer.
Seasonal Affective Disorder: Seasonal Affective Disorder is another form of depression, although this disorder usually takes place during the winter months. Unlike other forms of depression, this disorder is limited to lasting the winter months, with shorter days and less sunlight leading to depressed moods for some individuals. By the time winter has gone, the disorder normally goes away, with Spring and Summer resulting in a reduction in symptoms.
Psychotic Depression: Psychotic depression can be a very difficult illness to live with, as it involves all of the symptoms of Clinical depression, along with some symptoms of psychosis. The most common forms of psychosis that would accompany depressive symptoms include hallucinations, delusions or paranoia. This disorder has many similarities with Schizophrenia, though someone suffering from Psychotic depression will typically know their psychotic episodes are not real – while those with Schizophrenia are steadfast in their belief that their symptoms are true.
Postpartum Depression (Also Known as Peripartum Depression or Postnatal Depression): Unlike the majority of other types of Depression, there is a clear cause of Postpartum depression. Women who have given birth, only to develop depressive symptoms in the subsequent weeks, will normally be diagnosed with Postpartum Depression. Equally, men can also suffer from Postpartum Depression. The symptoms in both cases are the same as Clinical Depression, only this illness can only come after the birth of a child – usually within a year of birth.
Treatment Resistant Depression (Also Known as Refractory Depression): This form of Depression is only diagnosed once treatments to relieve symptoms of depression have failed to yield a suitable response. Depression is treatable, though sometimes regular treatments don’t work. For someone to be diagnosed with this form of depression, they typically will have tried at least two talking therapies, and at least three medications from a minimum of two classes of antidepressants.
Premenstrual Dysphoric Depression (PMDD): This type of Depression involves women who have symptoms of depression at the start of their period. The regular depressive symptoms will normally be accompanied by fatigue, irritability and mood swings. These symptoms however will generally disappear within a few days. However, they will return at the start of the next month, and so the cycle goes on. This can be an ongoing cycle which can last for a considerable length of time, and typically causes functional impairment in many different contexts.
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Symptoms of Depression
While the symptoms of each sub-type of Depression vary, in general, symptoms include, but aren’t limited to:
- Continuous low mood or sadness
- Hopelessness and helplessness
- Low self esteem
- Lack of emotion or excessive crying
- Concentration difficulties
- Suicidal or self-harm ideation
- Lack of energy
- Loss of libido
- Losing/gaining weight
- Insomnia or excessive sleep
- Muscle aches
These symptoms will typically lead to an individual behaving in a different way. For example, due to their low mood, they may avoid social activities and/or hobbies that would normally be enjoyable. Perhaps they will adopt coping strategies that have the potential to harm them, such as abusing drugs or alcohol.
As alluded to above, the exact symptoms depend on which type of Depression is present.
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Causes of Depression
Depression is a very complex illness that no one entirely understands. Fortunately, great strides have been made in recent times, which have helped health professionals understand mental health more.
In any case, the cause of Depression isn’t completely known. It appears that depression can be triggered by a multitude of factors, such as:
- Genetics: It appears that a family history of depression can increase the risk of developing. Depression is complex however, but it is believed many different genes can contribute towards depression developing. But it should be emphasised that depression isn’t purely caused by genes. Yet depression will often run in families.
- Chemical Imbalance: Most people have heard the term ‘chemical imbalance’ in terms of explaining depression. It is believed that the brains of people who have clinical depression are different in some ways to those who don’t. Serotonin, dopamine and other neurotransmitters in the brain appear to be linked to processing emotions and regulating mood. An imbalance in some of these neurotransmitters may result in depression – though this isn’t fully understood.
- Abuse: Physical, sexual or emotional abuse can lead to depression developing in some people, and may act as a trigger in many cases.
- Childhood Events: Childhood events help shape the personality of an individual. Personality defects can often appear as a result, or someone may struggle to make friends or trust someone. This can lead to loneliness.
- Trauma: A traumatic event can cause an individual sadness and regret, and spiral into depression.
- Major Life Event: Major life events, such as retirement, divorce, or losing a job can all have a negative effect on an individual that leads them spiralling into depression. In some cases, even supposedly positive events like marriage, graduating or having a child can cause depression.
- Other Mental Health Conditions: Depression is closely aligned to several other mental health conditions, or can develop alongside these conditions – such as Eating Disorders, Anxiety or Adjustment Disorders.
- Medication: Certain medications have unfortunately been linked to depression developing. Some medicines for acne like Roaccutane is often associated with depression. Corticosteroids and high-strength opioids can also lead to changes in moods. All drugs are unpredictable, and could potentially lead to mood changes.
- Death or Loss: A period of grief is a perfectly natural response to either a death or loss. However, grief can turn into depression in some cases.
- Personality Traits: Some personality traits like low self-esteem or self-loathing can leave someone being vulnerable to developing Depression. This is even more of an issue if these traits have been inherited from your parents.
- Substance Abuse: Those that suffer from substance abuse problems commonly contract depression as a result.
- Giving Birth: Sometimes giving birth can lead to depression being triggered – though this is called Postpartum Depression – a certain type of depression.
It is often not a matter of there being one singular cause of Depression. Usually, a range of events or factors contribute to its development.
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Diagnosis of Depression
Depression cannot be diagnosed through a laboratory test or any other medical examination. Instead, a Doctor will aim to make a diagnosis based on a patient’s answers to a wide range of questions.
These questions will focus on the individual’s symptoms – including when they first arose. Any possible cause could be investigated.
Sometimes, a blood test or physical examination could be conducted if the doctor believes another illness e.g. Hypothyroidism is causing the symptoms.
Each type of Depression has a different diagnostic criteria that needs to be fulfilled in order for a diagnosis to be made. For example, Clinical Depression requires a patient to show at least five of the following symptoms:
- Depressed mood for the majority of the day, over the course of a few weeks.
- Loss of interest and enjoyment in formally-enjoyable activities
- Increase or decrease in appetite and subsequent weight gain/loss.
- Problems sleeping.
- General fatigue or lack of energy.
- Feelings of guilt or worthlessness.
- Poor concentration, difficulty in decision-making.
- Lethargy or the feeling of being slowed down, as noticed by those around you.
- Thoughts of self-harm and/or suicidal ideation.
Depression is normally considered to either be mild, moderate or severe based on the severity of symptoms.
Seeking help for depression as soon as possible is important. The illness usually doesn’t clear up on its own, and therefore the earlier help is sought, the sooner recovery will be possible.
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Treatment of Depression
While Depression is a serious illness that has a debilitating effect on those that suffer from the condition, the good news is that with the right treatment and support, many will make a full recovery.
The treatment for Depression is based around which sub-type of the condition is present. In general however, the following interventions will be used:
- Watchful Waiting: The patient is told to wait a short period of time and see if Depression disappears on its own. After all, sometimes it can be a short-term condition. A follow-up appointment is recommended.
- Exercise: There is strong evidence to suggest that regular exercise helps alleviate some of the symptoms of Depression.
- Self-Help: Engaging in self-help materials on the internet or joining a local discussion group for depression can also be helpful.
- Talking Therapy: Types of therapy that could be used include:
Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.
Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.
- Medication: Medication can be used.
Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.
As well as the above, people with Severe Depression may be treated with:
Community Mental Health Team (CMHT): CMHT’s work with those in the community that have severe mental health problems. They can provide more support and intensive treatment.
Electroconvulsive Therapy (ECT): Electroconvulsive Therapy (commonly referred to as shock treatment) is a treatment that sees an electric current sent through the brain of an individual. The aim is to trigger an epileptic seizure, with the ultimate objective to relieve symptoms of a mental health problem. The human body is fully restrained during the procedure, which also involves a general anaesthetic. Electroconvulsive therapy is normally a last resort. Despite this, ECT actually has an impressive efficacy rate, with many people finding it helps immeasurably.
There are plenty of potential treatment options for Depression. Hopefully it will be possible to find a strong combination of treatment options, which can then lead to recovery.
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Living with Depression
Depression can have a considerable effect on an individual. Those with Depression can find it difficult to function on a daily basis, especially in social situations.
It is highly recommended that those suffering from Depression seek help. Engaging in treatment too is very important, especially taking medication correctly and timely.
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Prognosis of Depression
Depression is a very debilitating condition, which continues to plague the lives of many. It is a very complex condition, and requires a multi-faceted approach to treatment.
In general, recovery is certainly a possibility, and in many cases will be attained. However, this isn’t always possible.
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