depression - causes, symptoms, diagnosis and treatment
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Depression is a serious mood disorder that generates impressions of sadness, lack of interest and tiredness. It is often termed as clinical depression or major depressive disorder. It influences a person’s thinking, feelings, memory, eating and sleeping patterns leading to numerous physical and emotional problems. As stated by the World Health Organisation, this is the prime cause of disability worldwide.
It is estimates that globally more than 300 million people of all ages suffer from this disorder. Women experience higher rates due to hormonal changes that occur throughout the woman’s life.
Episodes of depression should be supported and treated at the right time, if untreated, lasts about 6 months but sometimes lasts for 2 years or more. Often, episodes may recur several times during their lifetime.
Causes of depression
Factors that brings about this condition include
- Genetics
- Brain chemistry
- Specific medical conditions
- Stress
- Poor nutrition
- Drugs usage
1. Genetic factors and family history
If any close family members are affected with this issue, then the chances are more likely to developing this mood disorder. Specific genes responsible for developing this have to be identified. It is estimated that 40% of cases are due to genetics. So genes are one factor, but they are not the only cause.
2. Neurotransmitter imbalances
Neurotransmitters are chemical messengers by which nerve cells of the brain communicate with each other. Especially neurotransmitters like dopamine, serotonin and norepinephrine take part in a key role in building up mood. When these neurotransmitter levels drop, it contributes to developing this situation.
3. Medical conditions
Specific conditions like chronic illness, sleep disorder or thyroid condition, chronic pain, multiple sclerosis, liver disorder and cancer causes this state of illness.
4. Hormonal changes
Women are more likely to suffer from this condition majorly, because of the hormonal changes occurring gradually during their lifetime like menstruation, pregnancy, childbirth and menopause. More often, postpartum depression is noticed in many cases due to hormonal swift after delivery.
5. Lifestyle changes
Many lifestyle factors bring about this situation. By controlling lifestyle factors, this can be reversed.
6. Disruption of Biological rhythm
Interruption of biorhythm clock in the body is also closely associated in causing Depression. Light falling on the eyes shows an impact on this rhythm. People living in cold climatic conditions experience this condition as they spend less time in the sunlight. This declines serotonin and melatonin levels resulting in sleep disturbances and mood alterations. However, this can be overcome by walking or sitting in the sunlight.
7. Poor diet
A 2017 study showed, people with moderate to severe symptoms benefited when they ate a healthy diet for 12 weeks which included mainly a diet containing selenium, vitamin D,B, omega-3-fatty acids, zinc, protein and probiotics.
8. Stress
Many researchers proposed that cortisol released during stressful conditions is capable of altering serotonin and gives rise to this.
9. Grief and loss
Loss of a loved one experiences symptoms like trouble sleeping, poor appetite and loss of pleasure or interest. When these symptoms of grief get worse without subsiding, it turns to this type of mental disorder.
10. Drugs and alcohol
Drugs and alcohol contribute to this mood disorder. Sometimes prescribed drugs are also linked to this. Some of them are anticonvulsants, benzodiazepines, corticosteroids, beta blockers, statins, stimulants, beta blockers.
11. Family and social environment
In a few cases, people with unhappy families or negative, stressful lives with poverty, homelessness, harassment or violence can lead to this disorder. Facing these situations without support can make it easier to depress.
Major types of depression
1.Clinical depression/major depressive disorder
Characterized by key features:
- Lack of interest
- Changes in sleep, weight
- Fatigue
- Depressive mood
2. Persistent depressive disorder
Symptomsinclude :
- Feeling of sadness
- Anger
- Irritation
- Loss of interest and pleasure
- Change in appetite
- Feeling of guilt
- Difficulty falling or staying asleep
- Sleeping too much
3. Disruptive mood dysregulation disorder
It causes:
- Chronic, intense irritation
- Frequent anger outbursts in children
4. Premenstrual dysphoric disorder
These symptoms include :
- Irritation
- Breast tenderness
- Mood swings with bouts of crying
- Food cravings
- Inability to concentrate
5. Bipolar disorder
It shows a range of physical and emotional symptoms :
- Fatigue, insomnia and lethargy
- Unexplained aches
- Irritability
- Anxiety
- Indecision and disorganization
6. Prenatal and postpartum depression
Significant hormonal shift during pregnancy brings about this. Such symptoms include :
- Low mood
- Social withdrawal
- Appetite changes
- Severe mood swings
- Suicidal intention
- Anxiety and panic attacks
- Feeling inadequate and worthless
7. Atypical depression
It shows :
- Excessive sleep
- Excessive eating and weight gain
- Strongly reactive moods
Signs and symptoms of depression
The signs and symptoms are different and vary from person to person. They include :
1. Behavioural symptoms
- Irritability and restlessness
- Angry outbursts
- Sleeping for more time
- Loss of interest
- Self-harm
- Suicidal attempts
2. Physical symptoms
- Insomnia or hypersomnia
- Fatigue
- Changes in eating patterns
- Aches and pains
- Digestive problems
3. Cognitive symptoms
- Increased depressive feelings
- Decreased ability to make decisions
- Decreased concentration
- Slowed thinking and speaking
4. Psychological symptoms
- Worthlessness
- Overwhelming sadness
- Anxiety
- Feeling of guilt
- Helplessness
- Low self-esteem
- Poor self-image
- Preoccupation with death, dying and suicide
Depression diagnosis
1. Physical exam
The doctor performs a diagnosis by physical examination and asks questions about health.
2. Lab tests
Blood tests help in screening anemia, thyroid, other hormones, calcium and vitamin D levels. By this, they rule out problems causing these symptoms.
3. Psychiatric evaluation
Mental health professional asks about symptoms, thoughts, feelings and behavioural patterns. The doctor asks the patient to fill out the questionnaire by the patient in this screening procedure for better insight of the patient’s mood. By this the doctor diagnoses with more certainty.
4. DSM-5
Mental health practitioners use the criteria for this diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders {DSM-5} published by the American Psychiatric Association. The patient should experience five or more symptoms for a continuous period of 2 weeks. In that one should be either depressed in mood or lack of interest or pleasure.
Treatment for depression
Medications and psychotherapy are more effective in treating this condition.
1. Medications
Include antidepressants, mood stabilizers and antipsychotic medications. They include Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, atypical antidepressants, tricyclic antidepressants, monoamine oxidase inhibitors, and other medications.
2. Psychotherapy
It includes cognitive behavioural therapy, family-focused therapy and interpersonal therapy.
3. Exercise
It helps in preventing mild to moderate symptoms.
4. Brain stimulation therapies
This can be tried if psychotherapy and medication are ineffective. These include electroconvulsive therapy for depressive disorder with psychosis or repetitive transcranial magnetic stimulation for treatment of severe depression.
5. Light therapy
A person is exposed to full spectrum light by using a lightbox to regulate the hormone melatonin
6. Alternative approaches
Include acupuncture, meditation, spending time with people you care about, avoiding alcohol, getting quality sleep, faith and nutrition.
Conclusion
Depression is a common disorder that affects millions of people every year. As it is curable, seeking the doctor’s advice at the correct time makes the patient feel better. Currently, effective treatment is available, when it occurs alone or when accompanied with other medical illness.