Depression: A Complete Guide to Its Symptoms, Risk Factors, and Treatment

Depression is a common mental health problem marked by negative emotions or low moods that affect every aspect of one’s life. Depression causes severe symptoms that negatively influence one's way of feeling, thinking, and attitude towards managing day-to-day activities, such as working, sleeping, exercising, and eating.

Depression causes feelings of sadness, loneliness, or loss of interest in the activities you used to enjoy. Fortunately, depression is treatable.

People who are diagnosed with depression show symptoms for at least two weeks.

Types of depression:

Some of the unique forms of depression that may develop under unusual circumstances are:

Persistent depressive disorder (also called dysthymia) is a chronic form of depression whose symptoms may last for at least 2 years.

An individual diagnosed with dysthymia (PDD) may also experience alternating periods of major depression and less severe symptoms. However, to diagnose this condition, an adult must have a depressed mood with feelings of hopelessness, fatigue, and low self-esteem for at least 2 years.

Postpartum depression is a type of childbirth depression experienced by new moms. Postpartum depression can last for months compared to maternity blues which typically goes away two weeks after childbirth.

However, women with postpartum depression experience full-blown major depression symptoms such as mood swings, crying spells, and difficulty sleeping during pregnancy or after delivery.  The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to take care of themselves and their newborns.

Psychotic depression is another serious form of depression that involves severe depression plus some form of psychosis, such as delusions, hallucinations, or some other break with reality.

This type of depression affects roughly one out of every four people admitted to the hospital with a history of depression.

The seasonal affective disorder is related to changes in the season. This health problem begins and ends at about the same time in the year. This depression generally begins during the onset of winter seasons due to less exposure to natural sunlight. The symptoms of seasonal affective disorder are loss of interest in activities, feeling hopeless, having low energy, and gaining weight. These symptoms however lift during the spring or summer seasons.

Bipolar disorder, sometimes called a manic disorder, is different from depression. However, it is considered a type of depression because of symptoms which include episodes of extreme mood swings that meet the criteria for depression. But the moods of a person with bipolar disorder often fluctuate between extreme high (euphoric or irritable) moods called “mania” or a less severe form called “hypomania.”

Other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (in children and adolescents) and premenstrual dysphoric disorder (in women able to get pregnant).

Signs and Symptoms:

Depression is now becoming a common problem. Therefore, a good knowledge of its signs and symptoms can help you get diagnosed earlier. If you are experiencing any of the following signs and symptoms constantly for at least 14 days, you may be suffering from major depressive disorder:

If you are experiencing any of the following signs and symptoms constantly for at least 14 days, you may be suffering from major depressive disorder:

• Persistent feelings of sadness, hopelessness, or emptiness
• Angry outbursts or irritability over small matters
• Feelings of guilt, worthlessness, or helplessness
• Complete loss of interest in all daily activities and hobbies
• Tiredness and lack of energy or fatigue
•  Weight loss due to a reduced desire for food or increased cravings for food causing weight gain
• Trouble concentrating, remembering, or making decisions
• Slowed speaking or other body movements
• Anxiety, agitation, exhaustion, or restlessness
• Sleep disturbances such as insomnia and waking early in the morning or oversleeping
• Uncontrolled thoughts of death, suicide, or suicidal attempts
• Unexplained physical health issues such as headaches, cramps, or digestive problems that do not ease even with treatment.

Not everyone suffering from depression experiences every symptom. Some people experience only a few symptoms of depression while others experience many symptoms.

 The severity and frequency of symptoms and how long they last will vary depending on the individual depending upon the stage of illness.

Risk Factors:

There is no single factor responsible for causing depression. Current research suggests that depression is caused by a combination of factors such as:

• Genetic factors
• Environmental factors
• Biological factors
• Psychological factors
• No age group is resistant to experiencing depression.

However, the most vulnerable group to suffer from depression is the adult group.

In older adults, depression is related to some serious physical illnesses such as hypertension, diabetes, cancer, heart disease, and Parkinson’s disease.

However, the medications used to treat these medical illnesses can cause depression as a side effect.

Common risk factors for depression include:

• A strong family history of depression
• Significant changes in life such as  loss of health, the death of a loved one, or stress
• Conflict with friends or family members
• History of physical, sexual, or emotional abuse

Treatment and Therapies:

Fortunately, every type of depression is treatable.

Standard treatment options for depression are:

• Psychotherapy
• Medications
• Combination of the two

These treatments are effective in most cases. However, if these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be the alternative options.

It should be noted here that no two people are affected the same way by depression and there is no single treatment that helps everyone. It may take some trial and error to find the best treatment for an individual.

Medications:

You may have heard of “antidepressants”. These are the clinically approved medicines that treat depression. They help balance the levels of certain chemicals such as dopamine in your brain. This helps your brain control mood or stress.

First, you need to try several different antidepressant medicines to find out the one that improves your symptoms and has manageable side effects. Family history of using a particular medicine for treating depression can also be considered. Usually, antidepressants take 2 to 4 weeks to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts. Therefore, the right approach is to try a medication before concluding its effectiveness.

Sometimes, people taking antidepressants feel improvement in their symptoms and then stop taking the medication on their own. This is not the right approach. According to experts, once you have begun taking antidepressants, don’t stop using them without consulting your doctor otherwise your depression might return.

After a course of approximately 6 to 12 months, when your symptoms have been improved to a great extent, you should consult your doctor about decreasing your dose slowly but safely.

This is because stopping the medicines abruptly can cause withdrawal symptoms that can worsen your condition.

Note: The Food and Drug Administration U.S. recommends watching closely the patients taking antidepressants, especially during the first few weeks of the treatment. This is because in some cases children, teens, and young adults under 25 taking antidepressants are at risk of experiencing an increase in suicidal thoughts, especially in the initial days of treatment.

Pregnant women or those breastfeeding should talk to their doctor about any increased health risks to them or their child.

An herbal medicine called St. John's wort is a top-selling botanical product. However, the FDA has not yet approved its use as a prescription medicine for depression because of some serious concerns about its safety and effectiveness.

People with depression should never use St. John’s wort before talking to their health care provider. Other dietary supplements such as S-adenosylmethionine and omega-3 fatty acids also have not yet been proven safe and effective for routine use.

Psychotherapies:

Psychotherapy often called counseling or talk therapy is a popularly practiced treatment for depression. This treatment helps the patient find out some easy ways to deal with everyday stressors. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), Psychodynamic therapy, Dialectical Behavior Therapy, and problem-solving therapy.

Many online platforms now offer online and virtual counseling sessions for the treatment of depression. Various virtual tools have been introduced that help you determine your degree of depression and then consult with a psychologist for treatment. Virtual counseling can help you get quicker results due to any time access to your therapist and 24/7 monitoring of your daily activities.

Brain Stimulation Therapies:

If your medicines don’t help reduce the symptoms of depression, brain stimulation therapies such as electroconvulsive therapy (ECT) may be an option to explore.

According to the latest research:

• Electroconvulsive therapy can help people with severe depression who have not been able to feel better with other treatments.
• Electroconvulsive therapy can be an effective method for treating depression. In cases where a rapid response is necessary but medications can’t be used safely, this therapy can even be a first-line intervention.
• Electroconvulsive therapy was once strictly an inpatient procedure, but today it is often performed on an outpatient basis. The treatment consists of a series of sessions typically three times a week, for a period of two to four weeks.
• ECT may cause some potential side effects such as disorientation, fatigue, nausea, confusion, headache,  and slight memory loss. Usually, these side effects last from minutes to hours, but, sometimes memory problems can persist for months.

Advancements in ECT devices and methods have made modern electroconvulsive therapy safe and effective for mental health patients. Before giving your consent to undergo ECT, make sure to consult with your specialist and get all information regarding the potential benefits and risks of this treatment.

• ECT is not painful as you cannot feel any electrical impulses. Before starting the treatment, a patient is put under brief anesthesia and given a muscle relaxant. Then the treatment session is started which usually takes only a few minutes, and after one hour the patient is conscious and alert.

Other recently introduced types of brain stimulation therapies that have been proven effective for the treatment of depression (medicine-resistant) include:

• Repetitive transcranial
• Magnetic stimulation (rTMS)
• Vagus nerve stimulation (VNS)

Other things you can do:

Following are the some effective tips you or your loved can try to deal with the symptoms of depression:

• Stay active or exercise regularly
• Set some realistic goals for yourself
• Try to spend more quality time with others and confide in a trusted friend or relative
• Say no to loneliness and let others help you
• Give yourself some time and expect your mood to improve gradually, not immediately.
• Postpone major changes in your life such as getting married or divorced, or changing jobs until you feel better. Share your decisions with others who know you well.
• Stay on track and continue to educate yourself about depression.

The bottom line:

Depression is a common mental health problem that affects your everyday life. There are many types of depression and not every type has the same treatment. Medications and counseling are effective treatments for reducing symptoms of depression. In some severe cases where medications don’t work, ECT can also be used.

All information in this article is written based on the publication of The National Institute of Mental Health, a U.S based federal agency that researches mental disorders. The experts of NIMH provide information on mental health problems and the latest mental health research.

https://www.nimh.nih.gov/