What is Depression (major depressive disorder)?

Life can be like a rocky mountain making it difficult to climb all way to the top and survive. Every step you take forward you feel like someone is pulling you down. Every inch you expand your wings there is something that weighs it down.

Breath

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called a major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living. Depression is something that has the capability to eat you up, but it does not have more power than what you have stored inside yourself. You have that power to fight back with all your mirth and stand out shining like a true star.

Life is all about difficulties and hardships. Sometimes you have great sunny days while sometimes it is pouring as it will never stop. But believe me, it will stop raining one day and you will be able to see a clear bright sunny day with chirping birds flying high giving you the hope and positivity that you need in life.

I always wonder what goes inside every person’s mind. Every mind is unique in its way. It is not necessary that every mind must be alike and genius just like not everyone’s life is the same. Every step you take comes to the challenges. Always be true to yourself and never give up. Try harder every day even when you do not want to. Life has something for each one of us.

Mental health is something that nobody talks about or is not comfortable accepting. Everybody judges that person who is suffering in their life instead of lending a hand to them. Most of the people in our country still suffer all by themselves carrying the remorse inside.

Depression can affect your mood, your feelings, and even your schedule. It can also affect your sleep cycle, eating habits, and your work environment. If a person is affected with depression and it’s just not the mood swings, then the symptoms should be present for more than two weeks. The core symptom of depression is said to be anhedonia, which refers to loss of interest or a loss of feeling of pleasure in certain activities that usually bring joy to people.

Conditions that can get worse due to depression include:

• Arthritis
• Asthma
• Cardiovascular Disease
• Cancer
• Diabetes
• Obesity

It’s important to realize that feeling down at times is a normal part of life. Sad and upsetting events happen to everyone. But, if you are feeling down or hopeless regularly, you could be dealing with depression.

Depression is considered a serious medical condition that can get worse without proper treatment. Improvement can be seen within a few weeks after the treatment started.

Diagnosis

Your doctor may determine a diagnosis of depression based on:

• Physical exam: Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.

• Lab tests: For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it’s functioning properly.

• Psychiatric evaluation: Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.

• DSM-5: Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Disorders that Cause Depression Symptoms

• Persistent depressive disorder (also called dysthymia): It is a case of major depression along with periods of less severe symptoms that should last at least two years. It happens when a person’s depressed state lasts for at least two years to be considered as persistent depressive disorder. Usually, a person affected with PDD can lose interest in normal daily activities, feel hopeless, lack productivity, have low self-esteem

• Postpartum depression: This is more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery). Several women enjoy god’s gift of motherhood but also have to go through postpartum depression during pregnancy or after delivery. It is a full-blown major depression where you get into a hole of extreme sadness, anxiety, and exhaustion. It exhausts the new mother to even go through their life activities for them as well as the baby. General symptoms include feeling hopeless, changes in appetite or eating habits anxiety, losing interest in activities and things you previously enjoyed, persistent sadness, troubles concentrating or remembering, sleep problems, including insomnia or sleeping too much, thoughts of death or suicide

• Psychotic depression: This kind of depression can be associated with delusions of guilt, illness, or poverty. It can seriously affect your brain. It occurs when there is a severe depression plus some form of psychosis that can be disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

• Seasonal affective disorder: yes seasonal depression is a thing and it usually happens winter months due to less natural light. This depression gets away from you during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

• Bipolar disorder: bipolar depression can be seen in certain people experiencing a depressive episode. Although it is different from depression, however, a bipolar affect person experiences an episode of extremely low mood making it a state of depression itself. But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.” The symptoms can be loss of interest or enjoyment from normal activities, feeling sad, worried, anxious, or empty, not having the energy or struggling to complete tasks, difficulty with recall or memory, sleeping too much or insomnia, weight gain or weight loss as a result of increased or decreased appetite, contemplating death, or suicide.

What are the Signs and Symptoms?

If you or someone you know lately has been experiencing some issue most of the day, nearly every day, for at least two weeks, then it might be a sign of depression which can be:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

These symptoms vary from person to person and not everyone faces the same or all symptoms mentioned. Some people experience only a few symptoms while others may experience many.

Depression Symptoms in Children and Teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

• In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
• In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression Symptoms in Older Adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

• Memory difficulties or personality changes
• Physical aches or pain
• Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
• Often wanting to stay at home, rather than going out to socialize or doing new things
• Suicidal thinking or feelings, especially in older men

Depression Is Different From Sadness or Grief/Bereavement

The death of a loved one, loss of a job, or ending a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

• In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.
• In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.
• In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.

Grief and depression can co-exist for some people, the death of a loved one, losing a job, or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.

Distinguishing between grief and depression is important and can assist people in getting the help, support, or treatment they need.

How Is Depression Treated?

Depression can be life-threatening where you need to struggle every day to survive. However, it is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.

Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms). The evaluation will identify specific symptoms and explore medical and family histories and cultural and environmental factors to arrive at a diagnosis and plan a course of action.

Doctors usually use a medication approach for the treatment or psychotherapy or amalgamation of both. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies are explored further. Every person has a different kind of depression, and the same treatment cannot be the solution, always stick to the process that works best for you.

Medications

Antidepressants are medicines that are used to treat depression. It can function as improving your certain chemical present in the brain that affects your mood or stress. They may help improve the way your brain uses certain chemicals that control mood or stress. It usually takes 2-4 weeks where symptoms like sleep, appetite, and concentration problems to improve before mood lifts, so it is important to give medication a chance before concluding its effectiveness. The medication should only be taken under the guidance of a doctor and should only be stopped when your doctor says so. Any person taking antidepressants should be observed closely as they might have suicidal thoughts or can harm themselves.

An herbal medicine called St. John’s wort is a quite famous product that is still not approved by the FDA and has serious safety concerns. Products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study due to their safety and effectiveness.

Psychotherapies

Depression cannot be only healed through medication, sometimes talking to someone or going for counseling helps a lot. These evidence-based approaches for depression can include treatment like cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy.

Brain Stimulation Therapies/ Electroconvulsive Therapy (ECT)

Medication may not be the only solution for the treatment of depression and if does not reduce the symptoms then electroconvulsive therapy (ECT) may be an option to explore. ECT can provide better results to those who are still going through severe depression after all the other options. The session includes treatment three times a week, for two to four weeks.

Like any other treatment, ECT contains some side effects, which are confusion, disorientation, and memory loss. These are short-term side effects, but memory issues can stay for longer during the period of treatment. ECT is not painful, and you cannot feel the electrical impulses.

Some of the newly introduced brain stimulation therapies are repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS) used for medicine-resistant depression.

Self-Help and Coping

There are several things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feelings and improves mood. Getting enough quality sleep regularly, eating a healthy diet, and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

What Causes Depression?

Depression can happen to anyone at any point in time and it is nothing to be insecure or ashamed about. The cause of depression can vary from person to person ranging from biological to circumstances. Some causes include:

• Family history- Our genes define who we are and how our body works. Having a family history of depression can put you at stake and there is a possibility to suffer from it.

• Early childhood trauma- Not everyone’s childhood has those cheerful and ecstatic memories; some go through major mental trauma that can bring back all the stress and fear even after growing up making it hard to ever overcome it.

• Brain structure- Keeping your brain active can sometimes be challenging. If the frontal lobe of your brain is less active, then the risk gets higher. Although scientists are not fully aware of this happens before or after the onset of depression.

• Medical conditions- Chronic illness, insomnia, chronic pain, or attention-deficit hyperactivity disorder (ADHD) can increase the chances to be affected by depression.

• Drug use- Drugs and alcohol come with several risks, one of which includes depression.

• Low Self-Esteem or Being Self-Critical
• Personal History of Mental Illness
• Certain Medications
• Stressful events, such as the loss of a loved one, economic problems, or a divorce.

How Can You Fight Against Depression?

Well, here are some dos and don’ts for coping with depression that may help you or your dear ones:

• There is nothing more effective than keeping your body in Zen. Try to be active and exercise.
• Always absorb positivity and keep smiling.
• Set realistic goals for yourself. You do not need to compare your life with anybody. You are the king/queen of your own life.
• Try to spend time with other people and confide in a trusted friend or relative.
• Try not to isolate yourself, sometimes all you need is a hand to hold and a shoulder to lean on.
• Remember things take time. Therefore, don’t burden yourself and expect your mood to improve gradually, not immediately.
• Life is a journey, and it should be how you want it to be. If you are not up to something, learn to say no for your peace of mind. Postpone important decisions if you are not ready for it, which can be getting married or divorced, or changing jobs, or not working for a while. Have a conversation with someone who knows you inside and out and can give you an honest opinion about your decisions.
• Get enlighten about depression so that you can work on it and climb on top of the rocky mountain.

When to See a Doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you’re reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

Many people avoid a psychiatrist due to social pressure and they do not want their friends and family to know about their mental issues. In some part of India depression, anxiety, mental health is considered a disease. Often people put a nametag of psycho or mad person who has lost their mind hurting their sentiments. To avoid publicity, one can schedule an appointment through the Telehealth platform for Mental Health which can be done with complete secrecy from a doctor located in a different state or different country

When to Get Emergency Help

If you think you may hurt yourself or attempt suicide, call your local emergency number immediately.

Also, consider these options if you’re having suicidal thoughts:

• Call your doctor or mental health professional.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Remember who you are and do not let anyone convince you otherwise.