Depression

Definition

Depression is a chronic medical condition characterized by persistent low mood, sadness and diminished interest in activities enjoyed previously. It can affect a person’s thinking, behavior, interaction with other people, day-to-day activities and even their physical well-being. Severe depression may result in suicidal tendencies, excessive or loss of sleep, appetite, weight loss, fatigue and physical problems that are resistant to treatment. Depression is not always a psychiatric disorder, it may occur in response to stressful events of life (death of beloved, loss of job), associated with some medical illness or as side-effect of some drugs. The main treatment options are psychotherapy and drugs.

Symptoms

The symptoms of depression include :

  • Persistent low feeling and unhappiness.
  • Irritability, frustration, angry outbursts and tearfulness.
  • Loss of interest in activities enjoyed previously.
  • Excessive or loss of sleep.
  • Poor appetite (more common) leading to drastic weight loss but sometimes excessive eating occurs with rapid weight gain.
  • Restlessness.
  • Reduced attention span, poor performance at work place and poor social interaction.
  • Slowness of thought processes, movement and activities.
  • Lethargy and fatigue.
  • Increased feeling of anxiety, emptiness, hopelessness, worthlessness, guilt, hurt, rejected, loneliness or helplessness.
  • Indecisiveness.
  • Decreased libido (sexual drive).
  • Generalized body ache, digestive problems poorly responding to medical treatment

Symptoms of depression vary from person-to-person depending upon inherited genetic make-up, socioeconomic background, education, culture, age and gender. Severe depression may lead to suicidal thoughts, drug addiction, smoking, alcoholism), relationship and social problems and social isolation.

Causes

The exact cause of depression is not known. Actually depression occurs due to a complex interplay of various factors. Some people are at a greater risk of depression, including :

  • History of depression in biological relatives
  • Childhood trauma
  • Previous history of depression
  • After delivery of baby (postpartum depression)
  • Intake of certain drugs like anti hepatitis C drugs, blood pressure lowering drugs (beta blockers, reserpine)
  • Having certain type of personality (pessimistic, low self respect, dependent)

Life events

  • Loss of job and unemployment.
  • Menopause.
  • Financial crisis.
  • Relationship crisis (break-ups, divorce, death of dear ones).
  • Work and study-related stress.
  • Abuse (mental, physical, sexual)

Medical illness

  • Paralysis (due to brain stroke, trauma)
  • Hormonal problem (like hypoandrogenism in men, hypothyroidism, menopause, after delivery of baby)
  • Chronic pain
  • Cancer
  • Alzheimer’s disease
  • Sleep apnea (intermittent wakefulness during sleep due to breathing problems).

Psychiatric illness

  • Major depressive disorder (MDD) (depression lasting for more than 2 weeks or loss of interest in all activities)
  • Dysthymia (chronic depressive status less severe than MDD)
  • Bipolar disorder (alternate mood swing between mania and depression)
  • Borderline personality disorder
  • Post traumatic stress disorder (an anxiety disorder occurring after exposure to any kind of traumatic condition like accident, rape, natural calamity and so on).

Treatment

Depression needs to be addressed medically. Family and/or group support, counseling and medication work jointly to assist the patient. Sometimes depression can pass on its own without any medical treatment. However, there is a risk of severe and even fatal outcomes if depression is left untreated.

  • Psychotherapy most commonly cognitive behavior therapy is employed.
  • Drugs for depression :
    – Antidepressants
    – Selective serotonin reuptake inhibitors (SSRI)
    – Atypical antidepressants
    – Tricyclic antidepressants
    – Monoamine oxidase inhibitors (MAOIs)
  • Other drugs :
    – Anti-anxiety
    – Mood stabilizers
  • Electroconvulsive therapy used in poor response to drugs and high suicidal risk.
  • Transcranial magnetic stimulation and vagal nerve stimulation may be used in resistant cases.

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