Depression

 Symptoms Of Depression

Depression can develop gradually or suddenly and may affect emotions, thinking, physical health, and daily functioning. Common symptoms can include:

• Persistent low mood, like sadness and emptiness
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite or weight
• Sleep disturbances like insomnia or hypersomnia
• Fatigue or tiredness
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating, thinking, or making decisions
• Increased irritability or anger
• Physical aches and pains without a clear cause
• Hopelessness or persistent negative thinking 
• Anxiety 
• Social withdrawal
• Loss of libido

Severe or urgent warning signs:

• Recurrent thoughts of death or suicide
• Suicide attempt 
• Psychotic symptoms like hallucinations and delusions
• Inability to move or speak

Symptoms in children and adolescents:

• Irritability instead of sadness
• Decline in school performance
• Social withdrawal 
• Low self-esteem or excessive self-criticism.

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Causes Of Depression

The exact cause of depression is not fully understood. It can develop spontaneously, without an obvious trigger, or in response to life events. Current research suggests that depression arises from a combination of biological, psychological, and social factors, often called the biopsychosocial model.

What happens in depression?

• The brain contains billions of nerve cells (neurons) that communicate via chemical messengers known as neurotransmitters.

• These help regulate mood, thoughts, and emotions, and are crucial for mental well-being.

• In depression, certain parts of the brain that control mood don’t work together as they should

• The balance of brain chemicals like serotonin, norepinephrine, and dopamine is disturbed

• Also, in some people, brain scans show a smaller hippocampus, the part linked to memory and emotions, which may happen when long-term stress or other factors slow down the growth of new brain cells.

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Types Of Depression

Depressive disorders, including depression, are mood conditions marked by persistent sadness, loss of interest, and impaired daily functioning. They vary in duration, severity, and triggers, but all involve disruptions in mood regulation. Some common types include:

Major depressive disorder (MDD)

• This is characterized by a persistent low mood that lasts at least two weeks and causes significant impairment in daily functioning. 

• MDD can occur as a single episode or recur multiple times in a lifetime.

Persistent depressive disorder (PDD or dysthymia)

• A chronic form of depression with a low mood lasting at least 2 years and 1 year in children or adolescents. 

• People with PDD may experience episodes of major depression called “double depression.

Other specified or unspecified depressive disorder

• Used when depressive symptoms cause significant distress, with fewer symptoms and a short duration.

Adjustment disorder with depressed mood

• Depressive symptoms that develop within 3 months of a major life stressor like loss of a loved one, divorce, or job loss, and improve within 6 months after the stressor or its consequences end.

Bipolar disorder with depressive episodes

• A mood disorder with alternating episodes of mania or hypomania, elevated or irritable mood, increased activity, decreased need for sleep, and symptoms of depression.

• Depressive episodes in bipolar disorder can resemble MDD but require different treatment approaches.

Seasonal affective disorder (SAD)

• A form of depression with a seasonal pattern, typically occurring during winter months due to reduced sunlight exposure.

• SAD is considered a specifier for MDD or PDD rather than a separate disorder.
  
  

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Risk Factors For Depression

Anyone can suffer from depression, even a person who appears to live in relatively ideal circumstances. However, many potential factors can trigger or influence depression:

Biological factors

• Family history and genetics: Depression, especially bipolar disorder, can run in families, but requires environmental triggers.

• Inflammation: Chronic disease or stress-related inflammation may alter brain chemistry, increasing depression risk and affecting treatment response.

• Traumatic brain injury (TBI): Concussions or head injuries from falls, accidents, or sports.

• Medications: Certain drugs for high blood pressure, seizures, cancer, anxiety, sleep, or alcohol dependence can lead to depression.

• Circadian rhythm disruption: Shift work, irregular sleep, reduced sunlight exposure.

• Poor diet: Deficiency in omega-3 fatty acids, vitamin D, imbalanced omega-6/omega-3 ratio, and high sugar intake are also related to depression.

Psychological or social factors

• History of abuse (physical, emotional, or sexual)
• Loneliness or social isolation
• Low socioeconomic status
• Stressful life events like loss of a loved one, divorce, job loss, or financial crises
• Positive but disruptive changes like marriage, moving house, graduation, and retirement
• Personality traits like low self-esteem, pessimism, self-criticism, and poor coping skills

Mental health conditions

• Anxiety disorders
• Post traumatic stress disorder (PTSD)
• Eating disorders
• Substance use disorders
• Learning disabilities

Medical conditions

• Chronic pain
• Thyroid disorders
• Diabetes
• Multiple sclerosis
• Parkinson’s disease
• Cancer
• Addison’s disease
• Liver disease
• Sleep disorders

Factors associated with depression in children and adolescents

• Stress at school
• Lower academic performance
• Failure in the examination
• Stress in the family
• Change of house/residence
• Death of a family member
• Prolonged absence or death of a parent
• Serious illness
• End of a relationship.
  
  

Diagnosis Of Depression

The diagnosis of depression is based on history and physical findings. No diagnostic laboratory tests are available to diagnose major depressive disorder. 

1. Psychiatric evaluation 

• It is a comprehensive evaluation needed to diagnose emotional, behavioral, or developmental disorders. 

• The evaluation may include a description of behaviors like how long the changed behavior lasts, and what the conditions are in which the behaviors most often happen

• A complete medical history, including description of the person's overall physical health, list of any other illnesses or conditions present, and any current ongoing treatments.

DSM-5 guidelines

These are the 9 symptoms listed in the DSM-5. Five must be present to make the diagnosis of major depressive disorder (one of the symptoms should be depressed mood or loss of interest or pleasure):

• Sleep disturbance

• Interest/pleasure reduction

• Guilt feelings or thoughts of worthlessness

• Energy changes/fatigue

• Concentration/attention impairment

• Appetite/weight changes

• Psychomotor disturbances

• Suicidal thoughts

• Depressed mood

2. Blood tests 

Blood tests can help in the exclusion of any underlying medical conditions that can manifest as depression. These include:

• Complete blood cell (CBC) count: Detects anemia or infections that can mimic or worsen depressive symptoms.

• Thyroid-stimulating hormone (TSH): Screens for hypothyroidism, a common reversible cause of low mood and fatigue.

• Vitamin B-12: Identifies deficiencies that can cause depression, cognitive changes, and fatigue.

• Rapid plasma reagin (RPR): This test is done to screen for syphilis, since untreated syphilis (especially neurosyphilis) can cause mood changes, cognitive issues, or depression-like symptoms.

• Toxic screening: To rule out active substance abuse.

• HIV test: Detects infections that can present with neuropsychiatric symptoms, including depression.

• Serum electrolytes: This test finds imbalances that may affect brain function and mood regulation.

• LFT and KFT (Liver and kidney function test): Checks for chronic organ disease that can cause fatigue, cognitive slowing, and mood changes.

• Blood and urine toxicology screen: Identifies substance use that can trigger or worsen depressive symptoms.

Note: Arterial blood gas (ABG), dexamethasone suppression test, and ACTH stimulation test are not routine; only indicated for specific suspected conditions like Cushing's disease or Addison's disease.

3. Imaging tests

Just like blood tests, imaging tests can help rule out other medical causes and conditions. These include:

• CT scan: Detects structural brain abnormalities, strokes, or tumors that can cause depressive symptoms.

• MRI brain: Provides detailed imaging to identify lesions, demyelination, or neurodegenerative changes linked to mood disorders.

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Specialist To Visit 

Specialists that can help you diagnose and treat depression include:

• General physician
• Psychiatrist
• Clinical psychologist

A general physician identifies possible medical causes of depression and coordinates referrals for specialized care.

A psychiatrist diagnoses depression, prescribes medication, and manages complex psychiatric symptoms.

A clinical psychologist provides psychotherapy to address emotional, behavioral, and cognitive aspects of depression.

When to see a doctor?

Seek medical attention if you experience: 

• Persistent sadness, hopelessness, or loss of interest lasting more than 2 weeks
• Thoughts of self-harm or suicide
• Severe changes in sleep, appetite, or energy levels
• Difficulty functioning at work, school, or in daily life
• Depression symptoms interfering with relationships or caregiving
• Worsening mood despite self-care efforts
• New psychiatric or physical symptoms after starting a medication.

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Prevention Of Depression

While not all cases of depression can be prevented, certain lifestyle choices and proactive mental health strategies can reduce the risk or delay the onset. These include:

1. Take care of your lifestyle

• Being physically active can improve mood

• Eat a balanced diet rich in omega-3s, vitamins, and minerals

• Get adequate rest with a consistent sleep schedule

2. Build emotional resilience

• Practice stress-management techniques like mindfulness, meditation, and deep breathing

• Develop problem-solving and coping skills

• Set realistic goals and break large tasks into smaller steps

3. Strengthen social connections

• Stay engaged with friends, family, and community

• Seek support groups or counseling during stressful times

• Avoid social isolation

4. Manage risk factors early

• Treat chronic medical conditions promptly

• Seek early help for anxiety, substance misuse, or other mental health concerns

• Avoid alcohol and recreational drugs

5. Promote positive mental habits

• Keep a gratitude journal or focus on daily positives

• Engage in enjoyable hobbies and creative activities

• Limit exposure to excessive negative news, excessive social media scrolls, online negativity etc.

Treatment Of Depression

Depression is among the most treatable of mental disorders. The treatment of depression involves both pharmacological (medical) and psychological approaches.

1. Medical therapy

a. SSRIs (Selective serotonin reuptake inhibitors): These medicines help increase “feel-good” brain chemicals to improve mood and reduce anxiety. Examples of this class of drugs include: 

• Escitalopram
• Fluoxetine
• Sertraline
• Paroxetine

b. SNRIs (Serotonin and nor-adrenaline reuptake inhibitors): These lift mood and also help reduce certain types of body pain by balancing brain chemicals. Common drugs include:

• Duloxetine
• Milnacipran
• Venlafaxine

c. MAO (Monoamine oxidase) inhibitors: These are older antidepressants that improve mood but require strict diet and drug precautions. Examples include:

• Phenelzine 
• Isocarboxazid 
• Tranylcypromine

d. TCA (Tricyclic antidepressants): These are older medicines that boost mood but may cause more side effects like dry mouth (xerostomia) and drowsiness. Examples of these drugs include: 

• Nortriptyline
• Amitriptyline
• Imipramine

Note: Selegiline, a newer MAOI that sticks on the skin as a patch, may cause fewer side effects than other MAOIs do.

e. Atypical depressants: These work in unique ways to improve mood when standard treatments aren’t enough.  Some of the common examples of these medications are: 

• Mirtazapine
• Agomelatine
• Bupropion
• Atomoxetine
  

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2. Psychotherapy

Also known as talk therapy or psychological therapy, it is a common approach used for treating depression by talking about your condition and related issues in the form of counseling sessions with a mental health professional. These include:

• Cognitive behavioral therapy (CBT): This type of psychological therapy helps teach the person coping skills to manage their difficult conditions. The therapy focuses on the cognitive component. This helps the person to change their thinking about a particular situation and the behavioral component, which further helps them to change their reactions to any situation.

• Interpersonal therapy (IPT): This is a time-limited approach that focuses on improving the symptoms of depression and treating mood disorders. In this, a therapist emphatically engages with the person with depression to improve their communication with others and solve the problem.

3. Surgical and other interventions

• Electro-convulsive therapy (ECT): Also known as shock therapy, this mode of treatment is the best for acute depression. It is also useful for people who do not respond to drug therapy, are psychotic, or are suicidal or dangerous to themselves. 

• Transcranial magnetic stimulation (TMS): It is usually reserved for those who haven't responded to antidepressants. During TMS, a treatment coil is placed against your scalp, which sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.

• Vagus nerve stimulation (VNS): This approach is also used in refractory cases. Like ECT, it uses electrical stimulation to relieve the symptoms of depression. The difference is that the device is surgically implanted in your body. VNS is FDA-approved for the long-term (not acute) depression of chronic depression that does not respond to at least two antidepressant trials.
  
  

Complications Of Depression

If left untreated, depression can lead to serious emotional, physical, and social problems that affect every area of life. These can include:

• Substance use disorders: Some individuals may turn to alcohol or drugs as a coping mechanism.

• Relationship difficulties: Depression can strain personal and professional relationships due to withdrawal, irritability, or loss of interest.

• Chronic physical illnesses: These are associated with worsened outcomes in heart disease, diabetes, and chronic pain conditions.

• Poor work or academic performance: Reduced concentration and motivation can lead to job loss or poor grades.

• Anxiety disorders: Depression frequently co-occurs with generalized anxiety, panic disorder, or Post-traumatic stress disorder (PTSD).

• Weakened immune function: Chronic stress and low mood can impair immune response, making illness more likely.

• Social isolation: Withdrawal from friends and family can deepen feelings of loneliness and worsen depression.

• Suicidal thoughts or behaviors: Persistent feelings of hopelessness can increase the risk of self-harm or suicide.
  
  

Alternative Therapies For Depression

Some alternate approaches may help support emotional well-being, but they should be considered adjuncts and not replacements for evidence-based medical treatments like medication or psychotherapy. Always consult a qualified healthcare provider before starting any alternative therapy. The recipes that can help include:

Acupuncture

An ancient Chinese practice involving the insertion of fine needles at specific points on the body to restore energy balance. Some studies suggest it may help improve mood by modulating neurotransmitter activity, though high-quality evidence is still limited.

Aromatherapy

Uses essential oils such as lavender, bergamot, or rose through inhalation or massage to promote relaxation and reduce anxiety. While pleasant and soothing, its antidepressant effects are generally mild and best used alongside other therapies.

Yoga

It combines physical postures, breathing exercises, and meditation to improve flexibility, reduce stress hormones, and promote mindfulness. Regular practice may help ease depressive symptoms and improve sleep.

Mindfulness meditation 

Involves focusing on the present moment without judgment, which can reduce rumination and negative thinking patterns. Mindfulness-Based Cognitive Therapy (MBCT) is a structured program that has shown benefits in preventing depression relapse.

Music therapy

A therapeutic approach where listening to or creating music is used to improve mood, reduce stress, and enhance emotional expression. Particularly useful for individuals who find verbal expression challenging.

Living With Depression

Living with depression can feel overwhelming, but with the right support and strategies, it is possible to manage symptoms and lead a fulfilling life. Here is a list of practical ways that will  help you cope with depression effectively:

1. Speak up

• To effectively fight depression, you need to seek social help

• Connect with your friends and family. Try to talk as much and share your problems

• Talking about your worries will help to lessen the burden of your problem. 

2. Engage in activities that make you happy

• Depression wipes you out of the energy and the zeal to engage yourself in activities that once were your passion. Not trying to pull yourself out of this state will only worsen your depression

• Engage yourself in activities that keep you happy to fight depression effectively

• Stay active by opting for activities that relax and energize you

3. Don’t be harsh on yourself

• Depression puts you at an increased risk of self-hate and embarrassment. It makes you think negatively and very critically about all issues

• You must remain compassionate towards yourself and not demean or discourage yourself from connecting with others

• Research suggests that supporting others has been found to boost one’s mood and make one feel happy

• To overcome this condition, it is important for you to love yourself

4. Get moving

• Depression tends to keep you in bed or glued to your couch. The less you move around, the worse it may get

• Go for a 20-minute walk every day with a friend or alone. You could also pick a sport that interests you or any other physical activity that would keep you moving

• Exercise has been found to increase the production of neurochemicals such as endorphins that elevate the mood and make you happy

5. Get some sunshine

• Studies suggest that sunlight has a therapeutic effect on those suffering from depression. Sunlight has been found to boost depressed mood and serve as a therapy.

• Take short walks outdoors in the sunlight. Instead of opting to have coffee/ tea in a dark room, try doing the same in the sun

• If you practice yoga, do it during the early morning hours and enjoy the benefits of sunlight as well

6. Have mood-enhancing foods

• While fighting depression, include foods that are rich in B complex, Vitamin C, and Omega-3 Fatty acids

• Omega-3 rich foods (rich in EPA and DHA) have been found to stabilize mood swings. Include foods such as fatty fish or fish oil supplements in your diet.

• Do not skip your meals. Make sure you eat after regular hours (2-3 hours).

• Minimize the intake of sugars and refined carbs, such as bakery items, pasta, as they may lead to an energy crash.

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7. Seek medical help 

• In severe cases, where nothing seems to work, it is better that you seek help from a therapist.

• Medical help will help you combat the situation and keep your symptoms in check.

Depression and related conditions

• Diabetes: The prevalence rates of depression could be up to three times higher in people with type 1 diabetes and twice as high in people with type 2 diabetes compared with the general population worldwide. The common cause could be stress and inflammation, as both promote depression and DM2, giving a feasible common link between them.   

• Heart disease: Depression is known to be associated with poorer outcomes of chronic heart disease (CHD). Depression can act as a risk factor for a poor prognosis after a heart attack or unstable angina (chest pain at rest due to reduced blood flow to the heart). 

Depression and other mental disorders

• Anxiety disorders:. Studies have shown that more than 70% of individuals with depressive disorders also have anxiety symptoms, and 40 to 70% simultaneously met criteria for at least one type of anxiety disorder. The concurrent presence of anxiety symptoms or anxiety disorders often complicates the treatment of depressive disorders. 

• Schizophrenia: Although technically, depression and schizophrenia are different, it is seen that depressed mood is commonly associated with first-episode schizophrenia. Schizophrenia is a chronic mental disorder that affects how a person thinks, feels, behaves, and interacts with his/her surroundings. Moreover, it is reported that these symptoms impair the everyday life of the patient as well as the quality of life, which requires medical treatment as well as hospitalization, in some cases.

• Eating disorders: Both depressive disorders and eating disorders are complex and varied, often occurring together. They are more common in women and girls, though men and boys are also significantly affected.

• Substance abuse: It’s no secret that there is a strong connection between substance use and mental illness. A strong link between depression with substance use, and impairment would suggest that depressed substance users may require enhanced treatment interventions. 
  

• Phobias: Phobias are a form of anxiety disorder, wherein a person will have an irrational, all-encompassing fear of a person, place, thing, or a specific situation. Unfortunately, depression and anxiety are closely linked. Some of the common phobias include:
  • Aviophobia/aerophobia (fear of flying)
  • Emetophobia (fear of vomiting)
  • Amaxophobia (fear of driving)