Depression

Description of Depression

Description
 
It can be described as feeling sad, unhappy, hopelessness or lack of energy. The person having depression loses pleasure in activities that used to give joy in past. Even trivial daily routines like eating lacks interest. Depressed people feel completely unmotivated.
 
Causes and Risk Factors 
 
The exact cause of depression is unknown. It is generally believed that all mental disorders are caused by a complex interaction and combination of biological, psychological and social factors. Depression can occur due to genetic predisposition or triggered by certain stressful events. Sometimes it can be due to combination of both.
 
Following can be causative factors for depression:
1. Alcohol or drug abuse
2. Certain medical conditions, including hypothyroidism
3. Family history of depression
4. Central nervous system illnesses and injuries e.g., Brain  tumors, head trauma, multiple sclerosis, stroke
5. Chronic illness like cancer
6. Chronic pain
7. Certain medications such as steroids
8. Sleeping problems
9. Stressful life events, such as disappointment in love
 
 
Signs And Symptoms
 
Symptoms of depression can include:
1. Persistent sad, gloomy mood
2. Feelings of hopelessness and pessimism
3. Loss of interest in activities that were once enjoyed
4. Fatigue and lack of energy
5. Restlessness, and irritability
6. Isolation or social withdrawal
7. Difficulty in concentration, remembering details, decision making
8. Change in appetite, leading to either weight gain or loss
9. Feelings of worthlessness, self-hate, and guilt
10. Thoughts of death or suicide
11. Insomnia, difficult sleep or excessive sleepiness
 
Investigations
 
1. Physician can conclude depression by taking detailed medical history and a physical examination.
History of medications such as corticosteroids and drug or alcohol abuse should be noted.
2. Blood tests like electrolytes, liver function, and kidney function can help to detect possible causes of depression.
3.CT scan or MRI of the brain to rule out serious illnesses such as a brain tumor
4. EEG (electroencephalogram) for recording any abnormal brain activity
 
Treatment
 
It includes:

1. Medication: Anti-depressants such as 
a) Selective serotonin re-uptake inhibitors (SSRIs)
b) Serotonin nor epinephrine reuptake inhibitors (SNRIs)
c) Tricyclic antidepressants

2.Psychotherapy: This includes counseling the patient while talking about his feelings and thoughts, and guiding them about how to deal with depression. It helps patients to understand the issues behind the thoughts and feelings.It will include, 
a) Cognitive behavioral therapy teaches how to fight off negative thoughts. Patients are also taught self awareness of symptoms, managing the causative factors, problem-solving skills.
b) Group Therapy

3. Other treatments include,
a) Electroconvulsive therapy (ECT) is the single most effective treatment for severe depression, those with psychotic symptoms and it is generally safe.
b) Transcranial magnetic stimulation (TMS) consists of pulses of energy to stimulate nerve cells in the brain that are believe to affect mood.
 
Complications And When Should You See a Doctor
 
1. Suicide
2. Alcohol or substance abuse, smoking
3. Increased risk for other psychiatric diseases
 
Prevention and Prognosis 
 
To prevent the disease follow these DO’s and Don’ts, 
1. Do not drink alcohol or indulge in drugs. These can worsen depression and might lead to thoughts of suicide.
2. Take medication exactly as physician has instructed.
3. Do activities that give pleasure or do routine activities in different ways.
4. Divert attention in activities like reading books, listening music, etc. rather than brooding on thoughts that worsen depression
5. Do regular exercise or yoga.
6. Get involved in group activities
7. Talk and share feelings with closed ones

Frequently Asked Questions about Depression

If you are feeling depressed, convey the same to your family doctor or a general practitioner. If the signs and symptoms match to that of depression, you will be referred to a mental health professional, i.e., a psychologist (who will provide therapy) or a psychiatrist (who will prescribe medication).
Depression is known to run in families. An individual with parents or siblings suffering from depression is three times more likely to suffer from it. The ‘3p25-26’ chromosome is observed in families suffering from depression. Nonetheless, only 40% cases have been linked to genetic factors.
Five suggestions for getting out of depression: 1) Planning a daily schedule is important. Designing a plan for routine activities can help the patient lead back a normal life. 2) Getting proper sleep helps a patient fight signs of depression. Insomniac patient on the other hand may experience worsened depression symptoms. 3) Following healthy dietary patterns may not directly treat depression, but may watch for overeating habits during depression. Some studies suggest a beneficial role of adequate nutrition among depression patients. 4) Studies suggest that exercising regularly helps release endorphins that helps improve depression signs and symptoms. 5) Thinking about depression over and again may enhance the problem. Instead, one should try and keep oneself engaged in activities that motivate logical thinking.
According to the brain imaging studies, the following three parts of the brain are primarily affected in depression: 1) Hippocampus: It functions to preserve memories and orchestrate the production of important hormones. 2) Prefrontal cortex: It plays a role in decision-making and shaping memories. 3) Amygdala: It regulates emotions such as pleasure and fear.
Attention seeker only gets depressed when he does not get his way or there is a setback. When he gets his way, he is perfectly ok. Attention seekers are over-concerned with physical appearance and are emotionally dramatic and expressive which is in contrast to a depressive person.
Regular exercise probably helps in reducing depression in a number of ways, which may include: Releasing feel-good brain chemicals that may ease depression (neurotransmitters, endorphins, and endocannabinoids) and reducing immune system chemicals. Also, a person gains confidence by getting in shape.
Generally, medications for depression are only stopped after the symptoms improve significantly. Usually, they are prescribed for at least 6 months and are continued for a few months even after the symptoms subside, depending on the intensity of the problem. Antidepressants cannot be suddenly stopped, but need to be gradually tapered.
You may find it surprising, but laziness can be a sign of depression. It is established that depression is related to insomnia or other sleep disorders. Patients with depression may sleep for longer than usual hours or may not sleep at all. As a result, a patient may feel listless or fatigue. This is treatable, therapies such as medical management and cognitive behavioral therapy have been seen to be helpful in such cases. Other interventions may also include breathing and relaxation exercises.
Although there is inconclusive data regarding the most effective treatment for depression, some researchers suggest oral antidepressant medications along with psychotherapy to be the most effective while others indicate high potential of electroconvulsive therapy. However, the response to treatment with these therapies may differ depending on the factors underlying depression.
People with depression usually appear sad, anxious, or in a depressed mood. They may walk or talk slower than usual, and sometimes have tearful eyes. They present with feelings of hopelessness, pessimism, guilt, and helplessness. In addition, they generally lack interest in activities around them and face difficulty in concentrating, remembering, and making decisions.
There does not seem to be a significant risk of damage to the unborn baby following the use of antidepressants during pregnancy. Most clinicians prescribe selective serotonin reuptake inhibitors (SSRIs) (a class of antidepressants) to depressed pregnant women due to their good tolerability profiles. Among SSRIs, fluoxetine and sertraline have more evidences of safety during pregnancy compared to other drugs.
Serotonin is a hormone which plays a role in changes in mood and appetite. Serotonin imbalance in depression may give rise to a tendency towards emotional overeating (mainly carbohydrate-rich foods) along with a resistance towards engaging in physical activity. If unchecked, this can lead to weight gain.
Social isolation and decreased talkativeness are among the most frequent signs of depression. Depressed people mostly keep away from gatherings, and prefer to be left alone. This is because depression is accompanied by a loss of interest in social activities, appetite changes, and bouts of anger and irritability.
Graduate students go through multiple types of emotional, familial, and social stressors such as staying away from family, unstable social communications, eating problems, and apprehensions about the future. Therefore, they are deemed a susceptible group for the development of depression.
A depressed person needs proper care, attention, and appropriate treatment. People who are depressed are often unaware of their disorder or are misdiagnosed. There are various effective treatments for depression such as psychological treatments [like behavioral activation, cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT)] or antidepressant medication that help in treating depression. Any person suffering from depression needs assurance and support. Ask him or his relative to seek help of psychiatrist. Do not isolate him from family. Guidance, trust, assurance, and support from family are most important.
No, antidepressants are not addictive. It is possible that sometimes the patient may experience an exacerbation of their illness if they decrease or discontinue their antidepressant medications. Most antidepressants exhibit least addictive properties, absences of acute desirable effects and no other features of addiction such as tolerance and compulsive use.
Simple lifestyle modifications can boost your mood and prevent depression. These include getting adequate sleep, regular physical activity, indulging in hobbies, managing blood glucose levels, and having a healthy diet rich in antioxidants. It is important that you stop blaming yourself for the situations in life and keep a positive attitude.
It is seen that 14% to 23% of pregnant women show the symptoms of depression, which is mainly caused by hormonal changes. Depression causes the feeling of hopelessness and despair. It is normal to feel low occasionally, but if symptoms last for more than a few weeks, one should take medical assistance.
It is likely that one feels sad without any reason once in a while, but if this feeling lingers on for days and months then one should think of a medical management. Feeling hopeless, anxious, angry, and upset for things are generally experienced during the state of sadness, but if these feeling become irreversible then these can be symptoms of depression. Most of the depression symptoms can be self-managed by patients at home; however, some types of depression may require medical management.
Depression cannot directly kill an individual like tuberculosis or cancer, but its negative effects can indirectly increase the risk of death. Suicidal thoughts and self-medication resulting in substance abuse is a common feature of depression. However, this can be prevented with appropriate medical counseling and support from family and friends.
Definite brain areas are responsible for the retrieval and creation of memories. Depression causes irregularities in the functioning of these areas, affecting memory. It also affects ‘pattern separation,’ i.e., the ability to distinguish between similar things, which makes it difficult to remember them. Some antidepressants also have impaired memory as a side-effect.
Yes, insomnia is linked to depression. Insomnia is difficulty in maintaining or initiating normal sleep and is known to be a common symptom of depression. On the other hand, people suffering from chronic sleep disturbance experience loss of pleasure or interest in life, which in turn can be a cause for depression.
Even smallest of the morning routine changes can work wonders in patients with depression. Setting up an activity chart helps with better planning of the day. Mild stretching exercises within the bed as soon as you wake up in the morning help to relax the body muscles. A small session of meditation or a morning stroll can help breathe fresh air, which can be an effective way to provide oxygen to lungs, brain, and body muscles. Having breakfast at a fixed hour every morning would help set up a routine, and a healthy diet will provide effective body nutrition.
In such cases, switching to an antidepressant drug from another class should be taken into consideration. If there is no response to two or more classes of antidepressants, augmentation strategies, and antidepressant combinations can be viable options. These include certain psychosocial and cultural therapies comprising electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, and some other forms of nerve stimulations.
Bupropion, a drug belonging to the class of norepinephrine dopamine reuptake inhibitors, causes long-term weight loss. Hence, it is considered the first-line option for treating depression in overweight and obese individuals. Some studies have also suggested the role of fluoxetine [a selective serotonin reuptake inhibitor (SSRI)—antidepressant] in losing weight. However, its effect is limited to the acute phase of treatment.
Major depressive disorder is deemed the worst form of depression. It is mostly a result of serious psychosocial problems such as discord in interpersonal relationships, unsatisfactory academic achievements, long-term unemployment, and poor work productivity. Studies have shown depressed patients to be at the highest risk for suicidal ideation following a major depressive episode.
People with depression are at a high risk for suicide. Psychological features such as pessimism, guilt, along with negative beliefs and apprehensions about one’s present and future, increase their risk of having suicidal ideation.
The incidence of depression increases remarkably during teenage with one in five adolescents having major depression at some point. An accumulation of negative life experiences and events at this vulnerable age can trigger depression. Usually, family discord, academic incapabilities, and chronic diseases are the common factors that contribute to depression in adolescents.