General overview
Depression is a mood disorder leading to persistent low moods, loss of energy and a loss of interest. These symptoms can show periodically or chronically (over a prolonged period). Professionals call this condition a Major Depressive Disorder or Clinical Depression. What sets depression apart from regular sadness is the persistence of symptoms for more than several weeks and their interference with your usual level of functioning. As a result, depression may lead you to struggle with day-to-day activities and to see purpose in life.
Depression is not a weakness or something you can just “snap out of” by “pulling yourself together”.
Depression may require (long-term) treatment. But don’t get discouraged. The good news is that with the right treatment and support, most people with depression can make a full recovery.
Causes and risk factors of depression
The exact cause of depression is not known. A variety of factors may be involved that increase the risk, such as:
- Genetic vulnerability: depression cmay be passed on among blood relatives.
- Environmental: various or repeated adverse and stressful life events (abuse, violence, loss, unemployment). In the absence of supportive structures, this feeling can be enhanced.
- Certain personality traits: such as difficulty to cope with change, or low self-esteem.
- Hormonal: Changes in the body’s balance of hormones may be involved in causing or triggering depression. Puberty, pregnancy and during the period after delivery (postpartum), thyroid problems, menopause or a number of other conditions.
- Immunological: there is emerging evidence that immunological reactions in the body, for instance after a physical illness such as coronary heart disease or auto-immune diseases may be involved in triggering depression.
- LGBT or gender dysphoria in an unsupportive environment.
- Abuse of drugs or alcohol
- Chronic or serious illnesses as heart disease, diabetes, chronic pain, cancer etc.
- As side effect of certain medications, such as high blood pressure medications, sleeping pills, stimulants, or corticosteroids (do not stop any maintenance medication on your own, consult your doctor first).
Symptoms
During a depression episode, typical symptoms occur most part of the day, and most days of the week. These may include:
- Sad feelings, tearfulness, emptiness or hopelessness
- Agitation, anger outbursts, irritability or frustration, even over small matters
- Decreased or complete loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
- Sleep disturbances, including insomnia (typical depression) or sleeping too much (atypical depressive symptoms)
- Tiredness and lack of energy, so even small tasks take extra effort
- Appetite and weight fluctuations. Reduced appetite and weight loss (typical depression) or the other way around increased cravings for food and weight gain (atypical depressive symptoms)
- Anxiety, restlessness
- Slowed thinking, speaking or body movements
- sensations of worthlessness or guilt, fixating on past failures or self-blame
- Trouble thinking, concentrating, making decisions and remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
Complications
- Possible difficulty to attend to self, neglecting basic self-care needs
- Anxiety
- Rumination
- Psychomotor changes
- Social isolation and difficulties
- Sleep dysregulation which on the longer run can lead to physical illness with more chance of heart disease and diabetes.
- Substance abuse
- Shift in weight due to changes in appetite. Excess weight can lead to physical illness like heart disease or diabetes.
- Suicidal ideation or suicide
- Unexplainable physical symptoms (e.g., aches, back pains)
- Self-harming such as cutting
Treatment
- Cognitive behavioral Therapy, Interpersonal Therapy, Schema Focused Therapy or other psychotherapy depending on the depressive episode
- Depending on the severity or recurrent depression: psychotherapy in combination with pharmacotherapy as antidepressants (e.g. SSRI, SNRI, TCA, Lithium, MAOi)
- In some individuals repetitive-Trans Magnetic Stimulation (r-TMS) can render very good results.
- Recently there is emerging evidence that Ketamine might help for treatment resistant depression.
- In Seasonal Affective Disorder and Atypical Depression Bright Light Therapy can be a helpful treatment.
Treatment for depression is severity dependent and dependent on the type of depression.
Responses to treatment is individual and therefore varies. Speak to your general practitioner or psychiatrist about the different treatment options and which treatment might fit your condition best.
Types of depression:
Atypical Depression
Atypical features can come about in depression such as heavy feelings in your arms or legs, long-standing pattern of sensitivity to interpersonal rejection (not limited to episodes) that lead to social/occupational impairments, increased appetite, and hypersomnia.
Seasonal Affective Depression (SAD)
This what we call typically a Winter Depression, occurring especially in regions far from the equator where the sun light hours are significancy reduced in the wintertime. Typical symptoms of a Winter Depression are physical tiredness, lack of energy, heavy feelings in the body, increased appetite for carbohydrates and too much need for sleep
Major Depressive Disorder (MDD)
includes a major depressive episode characterized by persistent or recurring low mood, inability to anticipate happiness or pleasure and pessimistic ruminations, feelings of hopelessness.
Dysthymia
The essential feature of dysthymia is a moderate low mood that persists for most of the day, most of the days in the week for at least a few years.