Written By Sreekriti Sista
DISORDER OVERVIEW
Depression, often referred to as Major Depressive Disorder or even Clinical Depression, is a disorder that affects the mood of an individual, causing feelings of sadness and loss of interest that persist for an extended period of time. Depression is a severe mental disorder as it can affect not only the way an individual behaves emotionally and physically but also affects normal day-to-day activities. Often mistaken for situational depression or even simple feelings of sadness and grief, clinical depression represents one of the most common mental disorders across the world, particularly in the United States, with approximately 21 million cases (8% of the United States population) of the disorder occurring in 2021 alone, with 14.5 million of them being U.S. adults aged 18 and older. The disorder primarily manifests in women, with cases being around 10.3% of the female population compared to 6.2% of males. Other factors for being more prone to depression include being between the ages of 18-25 and being of more than one race. Though MDD is the primary form of depression, different types of depression do occur, developing due to many circumstances. While there is no cure for depression, this disorder is treatable, with generally positive results and success, being among the most treatable of mental disorders; between 80 to 90 percent of treated patients respond favorably to treatment, and almost all patients gain some form of relief from the treatments. As such, it is essential to understand the history behind this disorder: its causes, effects, and treatments.
TYPES of DEPRESSION
Depression can be of many types. Though, generally, major depression or major depressive disorder is the most common form of depression occurring around the world, there are many other types of depression that can occur, both long-lasting and those that occur once in an individual's lifetime.
According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, individuals with Major Depression or Major Depressive Disorder show symptoms of low, depressed mood and loss of interest for a period of 2 weeks that may or may not interfere with daily activities. Individuals may also display a majority of symptoms, including problems with sleep, energy, concentration, feelings of low self-worth and life value, and more. MDD also has milder forms—regular depression or just depressive disorder—that can occur among the population.
Persistent depressive disorder, also known as dysthymia or dysthymic disorder, includes less severe symptoms of depression that tend to last much longer, usually for periods of time that are greater than two years.
While those are the more common forms of depression, perinatal depression, seasonal affective disorder, and depression with psychosis can also occur.
Perinatal depression, consisting of depression during pregnancy and before birth (pre-natal depression), and the more well-known post-partum depression, which occurs after pregnancy, is depression that occurs during or after pregnancy. Many mothers go through this during their lives.
Some people are affected not so much by regular factors of depression but by the seasons. Seasonal affective disorder occurs with the changing and passing of seasons, with symptoms typically showing during the colder months of fall and winter and disappearing during the spring and summer.
Individuals experiencing depression may also show signs of psychosis. This is a highly severe form of depression where a person experiences many symptoms of psychosis, including delusions and hallucinations.
Individuals with bipolar disorder may also experience depression. Still, as they do have bipolar disorder, they also experience the other side of the “manic-depressive illness,” which is mania or unusually high moods.
Some people may also experience PMDD or premenstrual dysphoric disorder, a type of depression that results in extreme irritability, anxiety, or depression during the days after their period.
CAUSES and RISK FACTORS of DEPRESSION
There is no actual cause of depression. It can occur in anyone, regardless of circumstances, race, gender, and more, even if the person lives a relatively everyday life. But, many believe it to be a result of chemical imbalances in the brain. This is a state that doesn’t fully capture the wholeness of the causes and risk factors of depression because while chemicals are involved in causing depression, there are many factors involved in an individual's life that may cause them to be affected by depression. However, researchers believe that nerve connections and neural circuits, after the use of various forms of brain imaging, play a part in depression. Some studies even have a smaller hippocampus in individuals with depression, and stress plays a significant part in depression because it can suppress the production of new nerves, among other factors.
So, while there are no official causes, it is known that there are many risk factors associated with depression, including genetic, biological, environmental, and psychological factors. Depression can also occur at any age.
Risk factors:
Biochemistry: Differences in how certain parts of your brain, primarily your hippocampus and your amygdala, work and how certain chemicals in the brain alter its chemistry may influence symptoms of depression.
Genetics: If a family member, especially a close one like a sibling or a parent, has depression, you are more likely to have this disorder at some point in your life.
Personality: If you tend to have low self-esteem and are usually in a low mood, you are more likely to experience depression.
Environmental factors: If you have been continuously exposed to traumatic incidents like violence, neglect, abuse, or poverty, you are more likely to have depression. Significant negative life changes, trauma, or stress can also induce depression.
Personal history: if you have had depression before in your lifetime, you are more vulnerable to depression in the future.
It is also widespread to see one disorder or disease occur when an individual experiences another disorder or disease, including diabetes, cancer, chronic pain and conditions, and Parkinson’s disease; other diseases can also play a part. These individuals may show more severe symptoms of both disorders.
SIGNS/SYMPTOMS
Most signs and symptoms are related to mental and emotional changes, while some can also be physical. Individuals who experience depression show specific signs and symptoms for most of the period of at least two weeks. However, not all individuals experience every single one of the listed symptoms and may experience symptoms that may not have been mentioned. Additionally, other medical conditions, including thyroid problems, tumors, and vitamin deficiencies, can mimic symptoms of depression, so seeing a medical professional and ruling out other medical causes is essential.
Some common signs and symptoms include:
Feeling sad or anxious for long periods of time. This may also result in a feeling of emptiness. General low mood persists, including feelings of guilt, hopelessness, pessimism, worthlessness, and more.
Feel irritable and frustrated with what you are doing or going through.
Being restless and showing increased signs of purposeless activity, including observable nervous tics, slowed movements, or speech
Losing interest or pleasure in activities that you once enjoyed
Losing energy and having increased feelings of fatigue
Having difficulty concentrating, thinking, or making decisions
Having difficulty controlling sleep, having excess, too little, or having fluctuating sleep patterns.
Feeling changes in appetite or finding unprecedented weight gain or loss
Having thoughts of death or suicide or suicide attempts
Symptoms from depression may interfere with day-to-day life and cause significant distress for both the individual affected and all their close/loved ones.
While these are the main signs and symptoms of depression, this disorder can also involve other mood and behavioral changes, from increased anger and impulsivity to detachment and isolation from loved ones to even problems with sexual drive and alcohol consumption.
Finally, as mentioned before, depression affects men and women differently, and as such, reactions to depression for men and women are expressed differently. It is important to recognize these differences when attempting to help someone you know or recognize symptoms of depression in others. In some cases, symptoms of depression can appear as physical problems, including tightened chests, headaches, and digestive issues.
As NIH kindly says, “If you experience signs or symptoms of depression and they persist or do not go away, talk to a health care provider. If you see signs or symptoms of depression in someone you know, encourage them to seek help from a mental health professional.”
DIAGNOSIS/TREATMENTS
Several persistent symptoms, in addition to low mood, are needed to diagnose depression. Still, even individuals who do not show the full extent of depressive symptoms may be receptive to the treatments.
There are many ways to treat and alleviate the symptoms of depression since depression is uncurable. The most common methods of treatment are medications, psychotherapy, and brain stimulation therapy.
Medication
The primary medications used for treating depression are called antidepressants, which are used to change brain chemistry. There are many forms of antidepressants, but the most common ones are called SSRIs or selective serotonin reuptake inhibitors, which use a hormone called serotonin to help control mood. These medications take between 4 and 8 weeks of continuous usage before effects start to show, starting with symptoms like sleep and concentration before mood. However, caution is required as antidepressants may cause adverse side effects such as suicidal thoughts and behavior in individuals.
If an individual doesn’t show the effects of the treatments after at least two antidepressants, their disorder would be classified as treatment-resistant depression, which has fewer treatments available, most of which are in clinical trials or are a mix of different types of medication. Esketamine is one such treatment.
Psychotherapy
Psychotherapy is essentially counseling or talking with a licensed, trained mental health professional. During individual and group sessions, individuals learn to consider thoughts and behaviors in new, different ways, helping change habits that may be contributing to depression. The two most common forms of psychotherapies for depression are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). CBT helps people change unhealthy patterns in their lifestyles, including thoughts and behavior, to improve their feelings by using techniques such as mindfulness. IPT focuses on improving personal and professional connections, developing skills to establish a support group, and dealing with interpersonal events impacting an individual’s depression.
Brain Stimulation Therapy
This form of treatment is more extreme than the rest, helping individuals with more severe forms of depression, including those with signs of psychosis who have not responded to other treatments. Brain stimulation therapy involves the direct, electrical, or magnetic stimulation of the nerves and brain activity. Some forms include electroconvulsive therapy, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. Particularly, electroconvulsive therapy involves multiple rounds of electrical brain stimulation of a patient while they are under anesthesia.
In addition to the treatments, individuals should find ways to take care of themselves during the treatment and afterward to improve their general mood by maintaining regular physical activity, having a proper schedule with enough sleep, eating healthy and regularly, connecting with others, working on hobbies and doing what they can, among others. Avoiding alcohol is also important.
Works Cited
Depression statistics. Depression and Bipolar Support Alliance. (2019, July 12). https://www.dbsalliance.org/education/depression/statistics/
Harvard Health Publishing. (2022, January 10). What causes depression?. Harvard Health. https://www.health.harvard.edu/mind-and-mood/what-causes-depression
Mayo Clinic Staff. (2022, October 14). Depression (major depressive disorder). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
professional, C. C. medical. (n.d.-a). Antidepressants. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/9301-antidepressants-depression-medication
professional, C. C. medical. (n.d.-b). Depression: Causes, symptoms, types & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9290-depression
Torres, F. (2020, October). What is depression?. Psychiatry.org - What Is Depression? https://www.psychiatry.org/patients-families/depression/what-is-depression
U.S. Department of Health and Human Services. (n.d.-a). Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression
U.S. Department of Health and Human Services. (n.d.-b). Major depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression
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