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Depression

What Is Depression?

Depression is one of the most common illnesses affecting millions of lives all around the world.

People suffering from depression describe it as an intense, overwhelming feeling of sadness, guilt and worthlessness. Nevertheless, it is completely normal for anyone to experience some degree of sadness, guilt and unworthiness at times. So, what is depression and how do health professionals confirm a diagnosis?

Depression, also known as major depressive disorder, is a mood disorder characterised by persistent low mood, lack of interest, decreased motivation, irritability, and feelings of unworthiness that affect the daily functioning of a person.

What Causes Depression?

Human emotions are controlled by chemicals released by the brain. These brain chemicals are what scientists refer to as neurotransmitters. The brain secretes different kinds of neurotransmitters, each responsible in the regulation of different types of emotions. Happiness is controlled by the brain neurotransmitter serotonin. Motivation, alertness, and pleasure are regulated by the neurotransmitter dopamine.

Unfortunately, sometimes, due to multiple factors, the brain cannot produce enough serotonin and dopamine. When a person’s serotonin and dopamine levels drop to an abnormal range, this imbalance in neurotransmitters may manifest clinically as extreme sadness, lack of motivation, anhedonia, hence giving rise to depression.

Risk Factors Of Depression

Depression can be caused by a number of different factors. Both biological factors and the environment of a person can trigger depression. 

The risk factors include:

Having a family member suffering from depression, or any other type of mood disorder, indicates that a person will have a greater risk of developing depression themselves.

People who have substance use problems are at an increased risk of developing depression.

Stressful life events are one of the biggest culprits in the development of depression. Events associated with losses, such as the loss of a parent, have been identified as potential risk factors.

Any medical condition can affect the mental health of a person. Additionally, organic health problems such as an imbalance in the thyroid levels, Cushing syndrome, among other medical conditions can precipitate depression.

Children who experienced a traumatic childhood are more at risk of developing depression. Studies suggest that parental separation may play a major role in the predisposition of a person’s depression due to the reduction in care.

Diagnosing Depression

To diagnose depression, it is important to be able to differentiate between the normal levels of sadness and “problematic” sadness.

To ensure that depression is rightly diagnosed, standard diagnostic criteria have been established. The ICD-10 and the DSM-5 (Diagnostic and Statistical Manual) provide detailed criteria to identify this condition.

Different healthcare centres use different systems so there may be some variations from one healthcare centre to another. 

A summarised version of the DSM-5 criteria for depression is as follows:

To put a diagnosis of Major Depressive Disorder, at least 5 of the following must be present almost every day for at least 2 weeks:

  • Depressed mood AND/OR anhedonia; AND
  • Significant change in weight (> 5% of body weight in one month)
  • Decreased appetite
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive/inappropriate guilt
  • Diminished concentration or indecisiveness
  • Recurrent thoughts of death or suicidal ideation with or without a plan

Symptoms

The symptoms of depression can vary from person-to-person. The most common symptoms of depression are described below:

  • Feelings of sadness and guilt
  • Feelings of worthlessness
  • Social withdrawal
  • Insomnia or sleeping for longer than normal
  • Agitation or slowed movements
  • Suicidal thoughts or thoughts of self-harm
  • Feeling tired on most days
  • Decreased concentration
  • Anhedonia

Sometimes, depression can present with psychotic symptoms, which clinicians refer to as psychotic depression. Symptoms of psychotic depression include:

  • hallucinations
  • delusions

Important! If you have suicidal thoughts or thoughts of harming yourself associated with the symptoms mentioned above, consult your healthcare professional immediately!

Types

Depression can be classified into the following categories:

Major Depressive Disorder

In major depressive disorder, the patient experiences low mood on most days.

Psychotic Depression

Psychotic depression presents with additional symptoms such as hallucinations and delusions along with the usual symptoms of depression.

Antenatal And Postnatal Depression

Antenatal depression occurs during the period of pregnancy while postnatal depression occurs after birth. This can be attributed to hormonal changes that occur in a woman’s body during and after pregnancy.

Tests

To diagnose depression, your doctor will want to carry out certain tests to rule out other causes of depression. Here are the usual tests that will guide your doctor towards the right diagnosis:

General Blood Tests

Your doctor will request samples of your blood to send for analysis. General blood tests are usually carried out to rule out any organic problem and to ensure the patient’s general health status is good.

Special Blood Tests

Along with routine blood tests, your physician will also order some important tests that can help rule out more important organic causes of depression. Your doctor may send thyroid function tests and liver function tests.

 Living With Depression

Living with depression is hard however, with the right guidance and adequate treatment, the majority of patients slowly heal and eventually get cured of depression. Below are some of the top, expert-recommended tips to help you deal with depression.

You can benefit greatly from relaxation techniques if you are currently struggling with depression. Some of the most effective relaxation techniques to fight depression include:

  • Progressive muscle relaxation training
  • Deep breathing exercises
  • Music intervention
  • Yoga

Massage is a stress-relieving technique that has been used for thousands of years. Massage therapists believe that massage stimulates the release of certain hormones that can help a person feel an emotional connection.

Chinese massage also targets special massage points that are known to trigger relaxation.

You can try soothing massages to relieve tension, calm your mind and focus on the “now” to detach from the constant flow of negative thoughts through your mind.

Improve Your Sleep Hygiene

Depression can greatly impact the quality of your sleep. Fortunately, there are numerous strategies you can use to improve your sleep patterns and enjoy a good night’s sleep.

Health experts recommend switching off all electronic devices a few hours before sleep, as blue light emitted from phones and tablets can affect the release of the sleep hormone melatonin.

Caffeine found in coffee is a stimulant. Taking any stimulant a few hours before bedtime can stimulate the brain when it is supposed to be ‘‘shutting down’’ and preparing for sleep, so experts advise not to drink caffeine based drinks, like coffee, for several hours before you go to bed. 

Health experts also recommend having your last meal of the day 3 to 4 hours before bedtime to ensure that your digestive system enters a state of relaxation before sleep.

Additionally, the NHS recommends going to bed and waking up at the same time every day to help your internal sleep-wake clock accommodate your sleep patterns to a specific time of the day so that your body automatically shifts into a state of relaxation at bedtime.

Talk To Someone

Depression makes it more difficult to reach out for help, open up to someone, and even leaving your bed. Unfortunately, withdrawing yourself can not only make it more difficult to deal with depression, but it can also aggravate it.

The best thing to do when suffering from depression is to open up to someone you can trust, such as a parent or grandparent.

You can view the whole range of handy mental health apps from the NHS library by clicking on the following link: Mental Health Apps NHS Library

Get Moving

Even if you feel like staying in bed and being alone all day long, try getting out of bed and get moving. Exercise is one of the best depression fighters.

Studies show that practising three sessions of exercise a week for at least 12 weeks can reduce the severity of depression. Research also reveals a 22% increase in the chance of remitting from depression.

Seek Professional support

You should seek support from a medical professional if you find yourself struggling with depression. Do not delay in seeking treatment, as untreated depression can lead to serious complications such as substance abuse, suicidal thoughts, and even self-harm. The treatment strategies used to manage depression vary according to the severity of the condition.

Psychological interventions like problem-solving techniques and Cognitive Behavioral Therapy (CBT) are the treatment of choice for patients suffering from mild depression. 

Moderate depression requires a combination of medications such as a Selective Serotonin Reuptake Inhibitor, SSRI with a psychological therapy such as Cognitive Behavioral Therapy.

Patients with severe depression are managed by adding or changing the class of antidepressants.

People living in England can refer themselves for an NHS psychological therapy service such as CBT without the need for a referral from a general practitioner. You can learn more about IAPT services here.

Support

Depression UK

Mind: For Better Mental Health

Mental Health Foundation UK 

Young Minds UK

Glossary

Medical terminology can sometimes be difficult to understand. Below are some key terms that you’ll find in this article to try and help you have a better understanding of the condition.

Abnormal

Anhedonia – anhedonia is defined as the loss of interest in once pleasurable activities.

Antenatal

Antidepressants

Biological

Caffeine

Chemicals

Clinicians

Cognitive Behavioral Therapy (CBT)

Cushing syndrome

Delusions – delusions are irrational, fixed false beliefs that cannot be changed. Patients suffering from psychotic depression may experience delusions.

Diagnosis / diagnose

Digestive

Dopamine

DSM-5

Fatigue

Hallucinations – hallucinations are sensory experiences that appear real, but are inexistent in reality, such as a person hearing voices despite complete silence.

Hormonal / hormones

Hypersomnia

ICD-10

Insomnia

Irritability

Melatonin

Neurotransmitters – neurotransmitters are special chemicals released at the end of nerves. Neurotransmitters carry impulses or a message from one nerve to another or from a nerve to a muscle. Examples of neurotransmitters involved in emotions include dopamine, gamma-aminobutyric acid (GABA) and serotonin.

Neurotransmitter dopamine

Neurotransmitter serotonin

Organic

Organic health problems

Physician

Postnatal

Psychological

Psychomotor agitation

Psychomotor retardation

Psychotic

Secretes

Selective Serotonin Reuptake inhibitor (SSRI) – SSRIs are the most commonly prescribed antidepressants. Selective Serotonin Reuptake Inhibitor, as its name suggests, works by inhibiting the reuptake of serotonin, hence making more serotonin available to create proper messages to regulate emotions.

Serotonin – serotonin is an inhibitory neurotransmitter that is responsible for the regulation of mood, hunger and sleep. A deficit in serotonin causes depression.

SSRI

Stimulant

Substance abuse

Thyroid

Trigger