What is depression?
Everyone has days of sadness and low mood. These phases usually pass quickly. However, if the low mood persists for more than two weeks, it might indicate a depression.
Globally, by 2030, depression is expected to be a major health burden. Yet, many sufferers don’t seek help, leading to a high estimate.
Symptoms of depression
Depressive symptoms include main symptoms such as:
- persistent low mood
- loss of interests or pleasure
- lack of energy
and secondary symptoms of varying severity:
- Poor concentration and attention
- Low self-esteem and self-confidence
- Feelings of guilt and worthlessness
- Excessive worry about the future
- Thoughts or acts of self-harm or suicide
- Sleep disturbances
- Decreased appetite
Severity levels of depression
Each depression is unique. It differs in intensity and course. Severity levels can be mild, moderate, or severe, based on the number and duration of main and secondary symptoms:
- Mild: Two main and two secondary symptoms for over two weeks.
- Moderate: Two main and three to four secondary symptoms for over two weeks.
- Severe: Three main and four or more secondary symptoms for over two weeks.
Course of depression
Depression often occurs in phases, called depressive episodes. They can be solitary or recurrent. Prolonged episodes, exceeding two years, are classified as chronic. Approximately two out of ten patients experience chronic depression.
In some cases, recovery occurs within weeks or months, while half of patients experience recurring episodes, known as recurrent depression. The interval between episodes can be years or mere weeks.
How does depression occur?
Depression causes aren’t fully understood. We know that depression is caused by interaction of several contributing factors.
Genetics
One of the main factors contributing factors is the genetic predisposition.
Gender
Women are twice as likely as men to get depressed.
Psychosocial factors
Life circumstances and social environment impact the child development. Children who experience early traumatic events like abuse are more susceptible.
A disrupted mother-child relationship in early childhood contributes as well. Triggers often involve negative life events like loss, divorce, chronic stress, suggesting a protective role of supportive parenting and favorable social circumstances.
Physical aspects
Depression might be also triggered by physical illnesses. For example, cancer, diabetes, heart conditions, hormonal changes (for example hypothyroidism) can trigger its onset due to neurobiological changes caused by such conditions.
Diagnosing depression
Distinguishing between low moods and depression can be challenging. Diagnosis begins with questions about symptoms. The “Two-Question Test” assesses:
- Did you often feel down, sad, or hopeless last month?
- Did you have significantly less interest or pleasure in things you usually enjoy last month?
If both are “Yes,” medical professionals determine the diagnosis via conversation and questionnaires. This, open, detailed responses aid to identify symptoms of depression and its severity.
Physical discomfort can contribute to diagnosis. Headaches, back pain, breathing difficulties, dizziness, and digestive issues might be the somatic symptoms resulting from depression.
How is depression treated?
Depression is a treatable condition. The treatment objectives are:
- symptom reduction
- daily functioning
- preventing relapse
The treatment consists of two main methods such as psychotherapy and use of antidepressants, and can be supported by complementary treatment methods.
Other treatment options are reserved for severe or chronic course of the illness. This could be ECT (electroconvulsive therapy), TMS (Transcranial Magnetic Stimulation) or light therapy.
Older and today rarely used treatments methods are hormonal therapy with L-Thyroxine and using controlled sleep deprivation in the acute phase.
Choosing the right treatment
Psychiatrist and patient decide together, which therapy method can be used considering personal wishes and preferences, medical history, and the illness severity:
- Mild depression: Education, support, self-management, psychotherapy; cautious antidepressant use.
- Moderate depression: Psychotherapy or medication.
- Severe depression: Medication combined with psychotherapy.
Treatment phases
Acute phase: Quick symptom relief, enabling normal life; usually 6-12 weeks.
Maintenance therapy: when symptoms ease, treatment continues in maintenance therapy. It stabilizes the condition and reduces relapse risk. Medication lasts about four to nine months; psychotherapy, eight to twelve months.
Relapse prevention
Prevention for those with past relapse or severe episode aims to prevent recurrence. Such therapy lasts often one year or more.
Untreated depression may resolve on its own, but therapy shortens episodes and reduces recurrence risk.
Self-blame worsens patient’s condition, leading to social withdrawal, substance abuse.
Treatment for suicidal patients. Suicidal thoughts can appear in severe episodes of depression. Such patients should be immediately hospitalized and treated under close supervision by a psychiatrist and nurses.
Suicidal ideations can appear at every age but the most vulnerable group are older adults facing isolation, physical ailments and partner loss.
Successful treatment is key to suicide prevention.
What to do for yourself during depression?
Remember: Depression is a treatable illness.
- The most crucial step is consulting a psychiatrist or psychologist.
- Overcome shame. Be open and honest for accurate assessment.
- Seek support. Take a trusted person to appointments. Their perspective aids symptom communication.
- Practice patience. You’re in treatment; remember progress takes time and the symptoms improve first after few weeks.
- Stay active. Set small goals like limited physical activities for positive impact.
- Engage in activities. Meet a friend, visit a stylist, cook; small steps toward success.
- Accept help. Family and friends are you first line of support. Discuss with them what helps and bothers you.
- Connect with peers. Self-help groups offer understanding. Embrace conversations to ease crises.