Depression (Major Depressive Disorder) – Symptoms, Causes, Coping Mechanism and Treatment

Depression is a common and serious mental illness. If you are suffering from depression then you are aware that it negatively affects feeling, thought, and action. Additionally, depression can also cause the feeling of sadness or loss of interest in activities you once enjoyed. Thus, can lead to a variety of emotional and physical issues and may hamper your ability to properly function at home or work. However, this is a treatable disorder.  
It is estimated that one in every 15 adults is affected by depression, in any given year and 1 in 6 people will suffer from depression at some stage in their lives. Depression may occur at any time, but on average, it is known to first show symptoms in the late teens or early 20s. It affects women more than men. There are studies that show that one-third of women will experience a major depressive episode in a lifetime. If a person has a first-degree relative with depression, there is an approximately 40% chances of developing depression

Key Facts:

1. Depression is a common mental disorder. Globally, it is estimated that 5% of adults suffer from depression. 
2. It is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease.
3. Women are more prone to depression than men.
4. This mental disorder can lead to suicide.
5. Mild, moderate, and severe depression have effective treatment options.

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What are the different types of depression?

There are two common forms of depression. They are as follows:

1. Major depression: In this the symptoms are severe. It typically interferes with your ability to work, sleep, study, and eat. These symptoms may last for at least 2 weeks. 
2. Persistent depressive disorder: this is also called dysthymia. The symptoms of which are not severe and lasts longer, generally lasts at least for 2 years.

There are other forms of depression as well, such as:

1. Perinatal depression: This kind of depression occurs for women during or after pregnancy. The depressive episodes after delivery are called postpartum depression.
2. Seasonal affective disorder: As the name suggests, this form of depression occurs during different seasons. It typically starts from late fall and early winter and may end during spring and summer.
3. Depression with psychosis symptoms: This is a severe form of depression where a person experiences delusions and hallucinations. 

Sometimes bipolar disorder patients may also experience depression.

Symptoms of Depression

Depression is different for every person. This condition occurs once in life and you may experience multiple episodes in your life. But there are certain signs which are common in most people suffering from this condition. Now, each of these symptoms could be a part of life’s normal lows. However, the more of these symptoms that you have, and the longer they last, it could point towards depression. These include:

1. Feeling helpless: A bleak outlook towards life is common during depression. You will tend to think that nothing will ever get better and you cannot do anything about it.
2. Loss of interest: Former hobbies and social activities which would excite you before has no value to you now. You have lost the ability to enjoy or take interest in any life activity. 
3. Sleep changes: Your entire sleep cycle will undergo a drastic change. You will develop insomnia or oversleep (hypersomnia), or even wake up in the wee hours of the morning. 
4. Irritability: Feeling agitated, restless and violent is uncommon during depression. The tolerance levels become low and the person tends to develop a short temper. 
5. Changes in weight: Your depression may be coupled with a significant loss or gain in weight. It implies a change of more than 5% in the body weight in the same month unintentionally, I.e., without any dieting etc. Also, you may experience an appetite loss. 
6. Loss of energy: During depression, one feels fatigue, sluggish, and physically drained at all times. Your whole body tends to feel heavy and you might get exhausted too soon. 
7. Reckless acts: If you have depression, you can take to reckless behaviour like substance abuse, dangerous sports, compulsive gambling and reckless driving.
8. Unexplained pains: There will be an increase in the incidence of headaches, back pains, stomach pains and aching muscles.
9. Self-loathing: Strong feelings of worthlessness and guilt take over. In severe cases, this could lead to suicidal thoughts and attempts.
10. Concentration issues: If you are depressed, you are more likely to have trouble making decisions, focusing or remember things. 
11. Delayed psychomotor skills: You will have slowed-down movements and speech.
12.  You may also experience anxiety, agitation, or restlessness
13.  Other symptoms that you may suffer are slowed thinking, speaking, and body movements.

Depression symptoms in children and teens

The common signs and symptoms of depression in children and teenagers are similar to adults, but you may find some differences:

• In young children, the symptoms may include sadness, irritability, clinginess, worry, pains and aches, refusal to attend school, or being underweight
• The symptoms in teenagers may include sadness, irritability, negative thoughts and feeling, feeling of worthlessness, poor performance at school, feeling misunderstood, poor attendance in school, extremely sensitive, consumption of drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Getting diagnosed with depression is not normal when you are growing old. This condition should be taken seriously. Unfortunately, in many cases depression is undiagnosed and untreated in older adults. Older adults may also feel reluctant to seek medical help. Symptoms of depression can be different in older adults, they include:

• Personality changes
• Memory difficulties
• Physical aches or pain
• Fatigue
• Loss of appetite
• Sleep issues
• Loss of interest in sex – unrelated to medications or medical conditions
• Increased need to stay at home and minimal socialising or refusal to try new things
• Suicidal thoughts or feeling, mostly seen in older men

When to see a doctor?

If you or your loved one are experiencing depression, then seek medical help at the earliest. If you are reluctant to ask medical advice, talk to a friend, loved one, a faith leader, or any individual that you trust. However, if you or someone you know are having suicidal thoughts or if you or your loved is a threat to themselves or other, immediate medical attention is required. 
Also, consider the following options, if you or your loved ones are having suicidal thoughts:

• Immediately call your doctor or mental health professional
• Call or speak to a close friend or a loved one
• Get in touch with a spiritual leader or someone in your faith community
• If you have a loved one who is in danger of committing suicide or has attempted one, then it is important to not leave them alone. Ensure you give them company or leave them with a trusted individual. In such cases, it is advisable to call your local emergency number immediately. Hospitalisation is also an option to keep a suicidal person safe from self-harm.

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How is depression diagnosed?

Five depression symptoms must be present, nearly all day, for at least 2 weeks for a person to be diagnosed with depression. In an adult, one of the five symptoms must be a depressed mood or a loss of interest or pleasure in almost all activities. For children and adolescents, it may be irritability rather than sadness.
If you think you are experiencing depression, you should immediately talk to your healthcare provider. The doctor will complete a routine diagnosis, treat the illness, and may refer you to a mental health physician, such as psychologists or psychiatrists.
During your visit to the doctor, the healthcare professional may question you several health-related questions such as the symptoms, the duration, how often they occur, and whether or not these symptoms hinder you from completing or enjoying your usual activities. It is always a good idea to keep a note of all your symptoms before a doctor’s visit. The physician may prescribe certain medications and may also conduct few tests to rule out other medical conditions such as viruses or a thyroid disorder – that can cause depression-like symptoms. Your doctor will rule out these possibilities with a physical exam, interview, and lab tests.

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Causes of Depression

The exact causes of depression are not fully identified. It cannot be pinpointed to a single cause or reason. It is most likely to occur due to a complex combination of factors. Most of these factors are however out of your control. These include:

1. 1. Genetics: having first degree family members with depression puts you at higher risk of developing depression or other mood disorders. Researchers are constantly studying to find the genes that may be responsible in cause depression.
   2. Biological or neurological changes: People with depression may have changes in the brain i.e., altering neurotransmitter levels. The significance of these changes is unknown and, in the future, may help in pinpointing the causes. Some recent research also indicates that the changes in the function and the effects of these neurotransmitters may play a vital role in depression and its treatment.
   3. Imbalance in hormone levels: For women, changes in the hormone such as estrogen and progesterone during pregnancy, post-delivery of a baby, menopause, menstruation cycle, and perimenopause may increase the chances of depression. 
   4. Early childhood trauma: There are certain incidents during childhood that could affect the way your body reacts to fear and stressful situations.
   5. Medication conditions: Health issues such as chronic illness, insomnia, chronic pain, Parkinson’s disease, stroke, heart attack and cancer, may increase your chances of developing depression.
   6. Substance abuse: if you have a history of substance abuse, alcohol or drugs, then the chances of developing depression are higher.
   7. Pain: People suffering with chronic or physical pain for a long period of time can get depression.
   8. Brain structure: there is a greater risk of depression if the frontal lobe of brain is less active. It is unknown to the scientist if this occurrence happens before or after the onset of depression symptoms.
   9. Environmental changes: like leaving a close-knit, loved family at home to live alone
   10. Psychological and social changes: like undergoing a major trauma or death of a loved one or divorce

Risk Factors

• Life events like work issues, stress, financial problems, strained relationships with loved ones and others.
• Personality traits like low self-esteem, self-critical, being pessimist, worrying too much, failing at coping strategies, childhood traumas etc.
• Certain prescription drugs like corticosteroids, beta blockers, and others
• Abuse of recreational drugs
• A previous episode of major depression
• A past head injury
• Chronic conditions like diabetes, cardiovascular diseases, cancer, stroke, chronic pain, heart disease and others.
• Living in isolation
• Biochemistry: when there are differences in certain chemicals in the brain, it may contribute to depression symptoms.
• Genetics: Family history of depression plays a vital role. For example: if one identical twin has depression, sometimes, the chances of the other twin having the same illness increases to 70%
• Environmental factors also contribute to depression. Factors such as constant exposure to violence, abuse, poverty, or neglect.
• Certain medications for high blood pressure or sleep pills increases the risk of depression
• History of other mental illnesses such as anxiety, eating disorder, or post traumatic stress order.
• Sometimes, being lesbian, gay, bisexual, transgender, or having variation in the development of genital organs that aren’t clearly male or female in an unsupportive situation.

Complications

Depression is serious mental disorder that can take a toll on you and your family’s health. If left untreated, it may result in emotional, behavioural, and problems that may affect every area of your life. Some of the examples associated with depression include:

• Increased weight or obesity, leading to heart disease and diabetes
• Misuse of alcohol or drug
• Anxiety, panic disorder, or social phobia
• Social isolation
• Self-mutilation such as cutting
• Suicidal feelings, suicide attempts, or suicide
• Family conflicts, relationships difficulties, and work or school problems
• Pain or physical illness

Treatment for Depression

There is various treatment option for depression. You can read all about them in the following section.

Medication

If you are diagnosed with depression, your doctor may prescribe the following:

• Selective serotonin reuptake inhibitor (SSRIs): These are the most commonly prescribed medications with few side effects. It increases the neurotransmitter serotonin in your brain to treat depression. Caution should be taken when consuming SSRIs with certain other medications including monoamine oxidase inhibitors and, in some cases, thioridazine or orap.
  • Pregnant women should discuss with their doctors before taking SSRIs and also be careful if you are having narrow-angle glaucoma. Some examples of SSRIs are citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil, Paxil XR, Pexeva), and sertraline (Zoloft).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): it increases the amount of neurotransmitters serotonin and norepinephrine in your brain to treat depression. This should not be taken with MAOIs or if you should discuss with your doctor before taking SNRIs medications if you are suffering from liver or kidney problems or have narrow-angle glaucoma. Examples of SNRIs include desvenlafaxine (Pristiq, Khedezla), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), milnacipran (Savella), and venlafaxine (Effexor XR).
• Tricyclic and tetracyclic antidepressants: Tricyclic antidepressants (TCAs) and tetracyclic antidepressants (TECAs) treat depression by increasing the amount of the neurotransmitters such as serotonin and norepinephrine in your brain. it is best advised not to take these medications with MAOIs. Use caution if you are suffering from narrow-angle glaucoma. TCAs may cause more severe side effects than SSRIs or SNRIs. Examples of tricyclic antidepressants include amitriptyline, doxepin, imipramine, trimipramine, desipramine, nortriptyline, and protriptyline.
• Atypical antidepressants: 
  • Noradrenaline and dopamine reuptake inhibitors (NDRIs): is one of the atypical antidepressants that can treat depression as it increases the levels of dopamine and noradrenaline in your brain. Examples of this medication is bupropion.
  • Monoamine oxidase inhibitors (MAOIs): it increases norepinephrine, serotonin, dopamine, and tyramine in your brain. As this medication has side effects and safety concerns, it is not a doctor’s first choice for treating any mental health concerns. MAOIs are typically used only if other medications are ineffective at treating depression. Examples of MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate).
  • N-methyl-D-aspartate (NDMA) antagonists: Increases the levels of glutamate in the brain to treat depression. This is prescribed by doctors only if other treatments are unsuccessful in treating depression or other mental disorders. Only one NDMA medication, esketamine (Spravato), for the treatment of depression is approved by the FDA. Esketamine is a nasal spray is only available through a restricted program called Spravato REMS. Once a patient is administered this medication, they may experience tiredness and dissociation (difficulty with attention, judgment, and thinking).

Psychotherapy

This is also called ‘talk therapy.’ In this therapy, you can speak to a trained professional to identify and learn skills to cope with the factors contributing to the mental illness. You can also benefit from family or group therapy sessions as well. It is an effective treatment in improving symptoms in depression patients and other patients with psychiatric disorders and is often used alongside pharmaceutical treatment. There are several types and often, people respond to one psychotherapy or another.

• Cognitive behavioural therapy: here, the therapist works with you to uncover unhealthy patterns of thoughts and identify the stressors that may be causing harmful behaviours, reactions, and beliefs about yourself. Your therapist may recommend you to start an assignment that helps you practice replacing negative thoughts with more positive ones.
• Dialectical behaviour therapy (DBT): This is similar to CBT but DBT stresses on validation or accepting uncomfortable thoughts, feelings, and behaviours instead of fighting them. Here, you may need to come to terms with the harmful thoughts and emotions, accept the changes, and understand that a recovery plan is possible.
• Psychodynamic therapy: It is one of the forms of talk therapy where you get help to understand and cope with your everyday life. This is based on the idea that your present-day reality is formed by your unconscious childhood experiences. Here, you will be asked to reflect and examine your childhood and experience to help and cope with your life.

Light therapy

When you are exposed to doses of white light, it can help you regulate the mood and improve symptoms of depression. This is typically used in seasonal affective disorder, which is now called as major depressive disorder with seasonal pattern.

Electroconvulsive therapy (ECT)

This is mainly used on people with symptoms on severe depression or depression that is resistant to other treatments or medications. The therapy uses electrical currents to induce a seizure and has been shown to help people with clinical depression. During this procedure, you will be anaesthetised to place a cardiac monitoring pad on your chest and four electrodes are placed on specific areas of your head. Then, the doctors will deliver short electrical pulses for a few seconds. You will neither convulse nor feel the electrical current and will awaken about 5 to 10 minutes after treatment. The side effects may include headaches, nausea, muscle aches and soreness, and confusion or disorientation. The patients may also develop memory problems, but these usually reside in the weeks and months after treatment

Alternative therapies

Talk to your doctor about alternative therapies for depression. There are many people choose alternative therapies with traditional psychotherapy and medication. The following are the examples of alternative therapies:

• Medications: It can help change the way your brain responds to triggers of depression such as stress, anxiety, and anger. There are studies that show that meditation can help in improving symptoms of depression and may lower the chances of a depression relapse.
• Acupuncture: In this form of traditional Chinese medicine, may ease some of the symptoms of depression, where a practitioner uses needles to stimulate certain areas in the body. There are research suggests that acupuncture may help clinical treatments work better and may be as effective as counselling.

Natural remedies

• Exercise: Aiming to exercise for at least 30 minutes of physical activity every 3 to 5 days a week can increase your body’s production of endorphins. Endorphins are hormones that improves your mood.
• Avoid alcohol and substance use: sometimes drinking alcohol or misusing substance may make you feel better for a little while. But these can worsen the symptoms.  
• Learn to set limits: When you feel overwhelmed it can worsen anxiety and depression symptoms. It is best to set limits in your professional and personal life to help you feel better.
• Take care of yourself: When you start taking care of yourself, your symptoms of depression may also improve. Taking care of yourself includes getting plenty of sleep, having an eating healthy diet, avoiding negative people, and participating activities that you enjoy.  In certain cases where the depression does not respond to medication, your doctor may recommend other treatment options such as Electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS). These treatments help in depression and improve your mood.

Supplements

• S-adenosyl-L-methionine (SAMe): Some research suggests this compound can ease symptoms of depression. However, the results are inconclusive and need more research.
• 5-hydroxytryptophan (5-HTP): This may increase serotonin levels in the brain that can ease the symptoms. However, there needs more studies on the same. 
• Omega-3 fatty acids: these are important for neurological development and brain health and adding this to your diet reduces depression symptoms. However, you can find conflicting evidences and more research is needed. It is best to talk to your doctor before taking supplements, as they may interact with other medications or have negative effects.
• Vitamins: It is important to several bodily functions. Researchers are of the opinion that 2 vitamins – vitamin B and D – for easing the symptoms. There are several herbs, supplements, and vitamins claim to help but these haven’t shown any proven results in any clinical trials.

Depression test

Your healthcare provider does not rely on one test. Instead, the doctor can provide a diagnosis after listening to your symptoms and a psychological evaluation. However, depression is linked to other health concerns, your doctor may also recommend physical examination and can order blood tests. In certain cases, thyroid issues and vitamin D deficiency may cause depression like symptoms. In most cases, your doctors will ask the following questions about:

• Mood
• Appetite 
• Sleep pattern
• Activity level
• Thoughts

As you know, depression is a serious illness and if left untreated can be life-threatening. If your mood doesn’t improve or worsen, medical help should be gained immediately.

Difference between Depression, Anxiety, OCD, Psychosis and Bipolar Disorder

Depression is Different from Sadness or Grief/Bereavement

Losing a job, ending a relationship, or death of a loved one are some of the hard truth of lives that we have to endure. In such situation it is normal to feel sadness or grief and those experience loss of a person may describe the experience as being depressed. 
However, being sad or grieving is not the same.  Each individual has their own natural and unique way to grieve. But it is important to note that grieving shares certain features of depression. Both grief and depression may involve intense feeling of sadness and also withdrawal from normal activities. Differentiating the two is vital for our well-being, and the difference is as follows:

1. When you are grieving, painful feelings often appear in waves and are intermixed with positive memories of the deceased. While in depression, you lose mood or interest for at least 2 weeks.
2. You maintain your self-esteem when you are in grief. However, when depressed feeling of worthlessness and self-loathing are common.
3. Suicidal thoughts may arise when thinking about the deceased, this is a grieving phase. But when a person is depressed, the thoughts are mainly focused on ending your life as a result of feeling worthless or undeserving of living.

Coping Mechanism

When you are under depression, you could feel like there is no end to the misery. But there are many things which you could do to stay positive and lift your mood. The key is to start with baby steps and slowly build it up from there. Feeling better could take time but it is surely attainable by making the correct choices for you. These include:

• Reach out to others: Isolation makes depression worse. So, you need to reach out to your friends and family as much as possible. The simple act of talking to a person could be a huge help. All they need to be is a good listener and listen to you speak your heart out without judging you.
• Eat well: You should follow a healthy diet to feel better. Follow a diet which is less in trans-fat, caffeine, alcohol, sugar and refined carbs. Nutrients like omega-3 fatty acids help to enhance and elevate the mood.
• Get active: When you are depressed, even getting out of the bed could seem to a big task. But you need to get moving, exercise regularly, or put on some music and dance around, to battle the depression.
• Reduce stress: You should try to relax and fight stress by indulging in activities like medication or yoga.
• Stick to your treatment: One of the most important things to overcome depression is to take your medicines as prescribed by the doctor without fail. Do not skip your therapy sessions and speak to the doctor regarding all your troubles.
• Stay occupied: You need to look for ways to stay engaged to start feeling better. You could spend time amongst nature, get a pet, volunteer for a cause, pick up an old or new hobby and spend your days occupied.

Prevention of Depression

If you or a loved one is trying to overcome depression, you might have an idea that treatments do work. But experts think it cannot be prevented. You may not be able to protect yourself from this mental illness in a sure way, but you can stop things from getting worse or even prevent it from coming back.

• Indulge in ways which will reduce your stress. It will help you to improve your self-esteem.
• You need to love yourself and take good care of your body & mind. You should get enough sleep, eat well, and exercise regularly.
• You should get medically checked on a regular basis. Consult professionals whenever you feel things are getting serious.
• If you feel you are depressed, you should seek help and not shy away from others.

Conclusion

Depression is an issue that is becoming greater by the day and harms individuals irrespective of age, caste, sex, nationality. Thus, it is very important for one to identify depression early, seek the correct diagnosis and prompt treatment for it.