What is Depression? | Causes, Symptoms, Types, Treatment
1) What is depression
Depression is a serious condition that negatively affects how a person thinks/ feels/acts/ behaves.
Depression invites feelings of sadness/ sorrow/ hopelessness/ loss of interest in activities (engaged earlier)
Conclusively, depression is different from the fluctuations in mood (that people experience as a part of normal life). For instance, temporary emotional responses (to the challenges in everyday life) do not constitute depression. Likewise, even the feeling of grief resulting from the death of near and dear ones cannot be termed ‘depression’ as it is in general not persistent.
Causes of depression are not fully understood. It occurs due to complex combination of factors. The causative factor behind depression is changes in brain chemistry (Clinical depression is thought to be caused by chemical imbalance in the brain. In many cases among the depressed patients, there is found reduction in the amount certain neurotransmitters—such as serotonin).
Issues like depression and mental anxiety can result from the host of factors as stated below.
2.1) Genetic factors
Having near relatives with higher income level and better standard of living, Is found common. This is a great risk factor for causing a feeling depression and discomfiture.
2.2) Biological factors
They bring changes in the neurotransmitter levels.
2.3) Environmental factors
They affect stress/ anxiety leading to depressive disorder. The environmental factors include: air/ water/ food pollution.
Other non-chemical environmental sources include: noise pollution/ electrical pollution/ natural disaster.
2.4) Psychological and psycho-social factors
Psychological factors causing depressive disorder include: loss of parents at an early age/ loss or separation from beloved one
Psycho-social factors contributing to depression are job dissatisfaction, hostility with friends/ office colleagues/business partners.
Those having less competence and coping strategy, are more susceptible to depressive disorder.
2.6) Life events
Bereavement on account of financial loss and problems/ loss of family member/ divorce/ medical concerns can trigger mental stress and depression
2.7) Childhood trauma
Many adverse childhood experiences can overwhelm a child. These are: negligence/ violence/sexual abuses.
2.8) Prescription drugs
Some drugs prescribed by the doctor can cause or aggravate depression. These include: Corticosteroids/ Beta blockers/ Interferon.
2.9) Non-prescription drugs
Abuse of alcohol and drugs like Amphetamines are strongly linked to depression.
2.10) Past head injury
Having experiences of head injuries in the past, may increase the risk of subsequent depression.
2.11) Chronic pain syndrome
Chronic pain syndrome and other chronic conditions (that make depression more likely) include: diabetes/ cardio- vascular disease/ COPD (Chronic Obstructive Pulmonary Disease. It is a type of obstructive lungs disease characterized by long term breathing problem and poor air flow. The damaged lungs can burn 10 times more calories as compared to normal/ healthy lungs even if one has a good appetite. This leads to weight loss).
- a) The cause may also include: taking long time for recovery (from illness/ injury)/ longer time in surgery (than expected).
- b) Additionally, there are many other conditions that rigger the symptoms of depression. These are : reactions (on account of taking anesthesia/ antibiotics/ pain killers) / pain and discomfort during recovery/ physical, mental, emotional stress caused by inadvertent surgical disorder/ risking high probability of death caused by prolonged serious illness.
- C) Various research studies reveal the fact that post operative depression rate are higher in case of some surgeries as listed below.
Heart surgery/ Gastric by pass surgery (it is a surgical procedure in which the stomach is divided into a small upper pouch, and a much larger lower pouch. After that the small intestine is rearranged to connect the both.) /Brain surgery/ Hip replacement (It is a surgical procedure in which the hip joint is replaced by a prosthetic implant)/ Hysterectomy (it is the surgical removal of uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures )/ Cancer resection (The surgical procedure removes all or part of the tumor.)/ Mastectomy (Removing one or both the breasts by surgical procedure)/ Plastic surgery (It is a surgical procedure involving the restoration, alteration and reconstruction of the human body)
The following symptoms are observed in case of the patients having depression.
3.1) Depressed mood
It is a normal temporary reaction to life events (such as, prevention or interference in love affairs). Depressed mood is also a symptom of some physical disease and side effects of some drugs and medical treatments.
3.2) Reduced interest and pleasure (in activities previously enjoyed)
It is known as Anhodonia—one of the major symptoms of depressive disorder. It is the loss of interest in previously enjoyed a activities (such as, loss of interest in hobbies/friend relationship and even food and sex.)
3.3) Unintentional weight loss (without dieting)
It may be an inevitable outcome of depression. This can lead to poor appetite and weight loss.
3.4) Insomnia (difficulty in sleeping)
It is a condition with sleep deprivation or lack of adequate sleep. The underlying causes are : anxiety/ stress/ depression and various emotional and psychological factors (such as, anger/ worrying/grief/trauma)
3.5) Hypersomnia (Excessive sleeping)
It is a condition in which the person, although stays awake during the daytime , but can fall asleep at any time.
3.6) Restlessness (pacing up and down)
3.7) Impaired psychomotor skills
Psychomotor skills occur when the activities of thinking and physical movement are combined. But psychomotor skills are known to be negatively affected by depressive disorder.
Greater impairment relating to psychomotor skills is observed in older people particularly having severe depression.
3.8) Fatigue and loss of energy
Extreme tiredness and feeling less energetic are the outcome of mental as well as physical exertion.
3.9) Feeling of guilt
Feeling guilty (for something wrong done) is quite normal. But problem occurs when one ruminates over the guilt
3.10) Impaired ability (to think/ concentrate/ decide)
It may involve noticeable and conspicuous decline in cognitive abilities (such as, memory and thinking skill)
3.11) Recurrent thought on death and suicide
Frequent suicidal thoughts is one of the major symptoms of depression. In such case, the patients with depressive disorder spend most of the time in wishing death
4) Diagnostic tests
Diagnosis is the procedure to identify the root cause of the disease through applying various tests (to ascertain the signs) /observing the symptoms/ interrogating the patient (about his feelings/ family history/ personal history including the life style)
Diagnostic tests are essential for providing safe/ secure/ effective treatment. Diagnostic tests start only after freely consulting with the doctor/ mental health specialists and other specialists.
In order to attain and assess the diagnostic test results correctly, the medical experts have designed some questionnaires to assess the severity of depression.
The HDRS (Hamilton Depression Rating Scale) is one of the most widely used assessment Instruments in the world. The HDRS contains 21 questions.
The scores indicate the severity of the depressive condition of the patient.
HDRS (Hamilton Depression Rating Scale)
(Patient’s name, addres with date of assessment )
(The score ranges from 0- 4 under varying conditions)
Depressing Symptoms Score
4.1) Depression Mood (gloomy attitude/pessimism/sadness/tendency to weep). Absent (0)
Occasional weeping (2)
Frequent weeping (3)
Extreme weeping (4)
4.2) Feeling of guilt Absent (0)
Self reproach (1)
Feeling guilty (2)
Feeling that frequent illness is a punishment for guilt (3)
Hallucination for guilt (4)
4.3) Suicide Absent (0)
Feeling that life is not worth living (1)
Wishing death (2)
Suicidal ideas/ gestures (3)
Attempt for suicide (4)
4.4) Insomnia (difficulty in falling asleep) Absent (0)
4.5) Insomnia (Feeling disturbed and restless during night) Absent (0)
4.6) Insomnia (waking up during sleep and unable to fall asleep again) Absent (0)
4.7) Interests in work No difficulty (0)
Feeling of incapacity/listlessness to work (1)
Loss of interest in hobbies and work activities (2)
Productivity decreased (3)
Unable to work even after treatment (4)
4.8) Retardation (Slowness in thought/ speech/activity) Absent !0)
Slight retardation observed in interview (1)
Obvious retardation observed in interview (2)
Interview is difficult (3)
Complete stupor (4)
4.9) Agitation (Restlessness associated with anxiety) Absent (0)
4.10) Anxiety (psychic) Absent (0)
Tension and irritability (1)
Worrying about minor matters (2)
Apprehensive attitude (3)
4.11)Anxiety(somatic: urinary, respiratory and gastrointestinal problems/indigestion) Absent(0)
4.12) Gastrointestinal symptom(loss of appetite/heavy abdominal discomfort) Absent (0)
4.13) Somatic symptoms (General: fatigue/headache/backache/loss of energy) Absent (0)
4.14) Genital symptoms (Menstrual disturbance) Absent (0)
4.15)Hypochondriasis(fear of prolonged serious illnesses despite medical assurances)Absent(0)
Self absorption bodily (1)
Preoccupation with health (2)
.Querulous attitude (3)
Hypochondriasial delusion (4)
4.16) Weight loss Absent (0)
4.17) Insight No loss (0)
Partial loss (1)
Loss of insight (2)
4.18) Diurnal variation (Symptoms get worse in morning or evening time) No variation (0)
Mild variation (1)
Severe variation (2)
4.19) Depersonalization and de-regularization (feeling of nihilistic ideas) Absent (0)
4.20) Paranoid symptoms (intense and irrational mistrust/suspicion/fear) None (0)
Ideas of reference (2)
Delusion of reference and persecution(3)
Hallucinations are persecuting (4)
4.21) Obsessive thoughts and compulsions (against which the patient struggles) Absent (0)
5) Health complications
5.1) Depression affects the whole body. Even milder form of depression and mood disorder can affect the quality of life. Serious health complications may arrive in the form of heart disease/ stroke/ diabetes/ cancer.
Additionally, depression dampens the urge for eating / sexual desire/ job performance/ quality of sleep.
5.2) The brain stores memories and regulates the production of hormones called cortisols . The body releases cortisols during time of physical and mental stress including depression. This can lead to memory problem (such as, forgetfulness/ concentration).
Over and above,, depression makes it difficult to concentrate and focus on the tasks/ make correct decisions/ think clearly/ behave rationally
5.3) Depression can cause mental sufferings greatly and uncontrollably. At its worst, depression can lead to suicide
Identifying the type is quite important. Because, treatment procedure largely depends on the type of the disease. Various types of depressive disorders are stated below
6.1) Unipolar depression
Unipolar depression can involve anxiety and other symptoms, but no manic episodes. In case of unipolar depression , predominant feature is depressed mood (it is a normal temporary reaction to life events, such as prevention in romance and love affairs. Depressed mood is also a symptom of some physical disease as well as side effects of some drugs and medical treatments).
6.2) Bipolar depression
It is a mental health condition that involves changes in moods and other mental conditions.
There may be different types of bipolar depression depending on the patterns of mood swings. The condition is characterized by both manic as well as depressive episodes (manic episode includes clinical depression as part of diagnosis. On the other hand depressive episode is characterized by feeling sad and unhappy at least for 2 weeks continuously ). Bipolar depression is separated by periods of normal moods.
Conclusively, It is important to seek timely treatment as the impact of bipolar depression on health and quality of life can be severe.
6.3) Major depressive disorder with psychotic features
The condition is characterized by depression accompanied with psychosis (it is a severe mental disorder in which emotions are so impaired that contact is lost with external realty).
Psychosis can involve false belief /detachment from reality/ sensing things that do not exist/ delusion and hallucination ( Delusion is a symptom of mental disorder with impression maintained despite being contradicted by rational argument. And
hallucination is an experience involving apparent perception of something not present).
6.4) Post partum depression
It is also known as post natal depression which may be severe. Women having this condition experience baby blues with new born babies.
Post partum or postnatal period begins immediately after the birth of a child.
‘Baby blues’ refer to the babies that are born with blue eyes. The condition occurs due to lack of ‘melanin pigment’ .
6.5) Major depressive disorder with seasonal pattern
The condition is related to reduced daylight of winter. The depression occurs during the season and is responsive to light therapy (it is also known as photo therapy. It is a method to treat the seasonally affected disorder by exposure to artificial light).
Conclusively, the patients in countries with long or severe winter, are affected more.
6.6) Agitated Depression
It is characterized by low mood involving uneasiness and anxiety.
6.7) Mild depression
It is a condition with frequent changes in moods and behavior. The fluctuating emotions occur displaying regularity.
6.8) Post Surgery depression
After surgery, it is quite common to lose hope and feel mentally depressed.
The surgery may also be invasive (It is a surgical procedure which is carried out by entering the body through the skin or anatomical opening allowing the smallest possible damage to the structures. Most of the surgical procedures administered, are minimally invasive).
The cost of surgery ( in terms of worries caused by not having in good health) may aggravate the feelings of depression and despair.
Depression is a treatable mental illness. There are 3 main components in treatment plan. In addition, other treatments are also applied as stated below.
The treatment procedure ranges from discussing the problems with solution, to educating the family members
7.2) Psychotherapy (or talking therapy)
The treatment procedure includes interpersonal therapy and CBT (Cognitive Behavioral Therapy is a form of psychotherapy that treats the problem affecting mental stability. The treatment is done by modifying the dysfunctional emotions, behaviors etc).
In mild cases psychotherapies are the 1st option for treatment. CBT may be effectively delivered to the patient in several ways as stated below :
7.2.1) Face to face
7.2.2) In a group
7.2.3) Over telephone
7.2.4) Through computer
Interpersonal therapy is used to identify the problems that affect relationships and communication.
7.3) Drug treatment (antidepressant medications)
Antidepressants are drugs used for the treatment of major depressive disorder. These are prescribed by the doctor only for the adolescent (and not for the children).
A number of medications are used for the treatment which are stated below.
7.3.1) SSRI (Selective Serotonin Reuptake Inhibitors)
7.3.2) MAOI (Monoamine Oxidase Inhibitors)
7.3.3) Tri-cyclic antidepressants
7.3.4) Atypical antidepressants
7.3.5) SSNRI (Selective Serotonin Norepinephrine Reuptake Inhibitors)
Conclusively, each class of antidepressants acts as a different neurotransmitter. The drugs prescribed, should be continued even after the symptoms have improved.
7.4) Other treatments (Exercise and therapies)
7.4.1) Aerobic exercise
Aerobic exercise help against mild depression.. Because it stimulates the neurotransmitters which is related to mood. Aerobic exercise is also known as cardio exercise of low to high intensity. The exercise primarily depends on aerobic energy generating process.
In contrast, anaerobic i.e. ‘without oxygen’ exercise is a physical activity that causes one to be quickly out of breath, such a lifting a heavy weight.
Examples of aerobic exercises include running/swimming/walking/ hiking/ climbing/dancing/skating.
And neurotransmitters are endogenous chemicals that enable the neurotransmissions. It is a type of chemical messenger which transmits signals across a chemical synapse ( such as neuromuscular junctions-- from one neuron to another).
7.4.2) Brain stimulation therapy
It can play a key role in treating certain mental disorder. The treatment procedure involves activating or inhibiting the brain directly with the use of electricity. The electricity can be given directly by electrode implanted in the brain.
7.4.3) RTMS (Repetitive Trans-cranial Magnetic Stimulation)
Till date, several randomized controlled trials have shown the efficacy of RTMS in the treatment of major depressions. The treatment procedure has been proved effective in patients with resistant unipolar depression.
7.4.4) Electro-cardiovascular therapy
It is one of the safest, cheapest and yet effective therapeutic treatment in psychiatry. It is the most consistently effective treatment for severe depression.
7.4.5) Sticking to sleep schedule
Sleep is important for every living being (including man and animal) to stay healthy and energetic. For an adult, daily 7- 9 hour sleep is essential to stay active and energetic. However, it does not mean that one should sleep longer than needed. Neither under sleep nor oversleep is good for health.
It is essential to set a sleep schedule and adhere to it . Maintaining a regular schedule (for bed time and waking up) may help the patient to feel better and free of stress and anxieties. More importantly, it is recommended to follow a healthy life style through consuming healthy foods and drinks (in addition to avoiding the unhealthy foods as well as expensive bad habits like smoking and alcohol)
8) Key global information
8.1) Globally, 350 million people are affected by depression.
8.2) Depression is twice as common among women (as compared to men)
8.3) About 20% of women will experience at least one episode of depression across their life time.
8.4) Suicidal thoughts result mostly from depression. Suicide is the 2nd leading cause of death among the youths (15- 29 years)
8.5) Depression is the most common illness worldwide . It is the leading cause of disability (according to the report of the World Health Organization).
9) Popular questions and answers on depression (Q = A = Answer)
9.1) Q (What is the most important symptom of depression)
A (A patient is diagnosed with depression if at lest 5 symptom are experienced for 2 consecutive weeks. Of the 5 symptoms, 1 must be either depressed mood or loss of interest and pleasure )
9.2) Q (Why is depression more prevalent in women than men)
A ( After attaining puberty, girls become more likely to experience depression than boys. Biological/ psychological / hormonal factors operate uniquely in girls during puberty. This leads to increasing rate of depression in women )
9.3) Q (What happens concerning depression during menopause)
A (Menopause is the time in most women’s lives when menstrual period stops permanently. Women with menopause are no longer able to bear children. Menopause occurs in 49- 52 years of age. Such women experience increased risks of depression)
9.4) Q (What is about depression in old people)
A (Old people suffer from restricted blood flow called ischemia . At this stage, the changes in brain/ body may occur. Overtime blood vessels become less flexible. This may harden and prevent blood from flowing normally to the body organs including brain. The condition may result in vascular depression in old people).
9.5) Q (Can brain condition guide treatment for depression)
A (Brain imaging has confirmed the biological nature of many psychiatric illnesses over the past 30 years. In mid 1990s, Functional Magnetic Resonance Imaging was used to identify structural brain changes in depressed people).
10) Concluding remarks
10.1) To be called ‘depression’, the symptoms must be persistent (lasting 6-8 months)
10.2) Depression can’t be dealt with overnight. In addition to applying all treatment procedures, the family members need to play a key role to understand and help the patient to stay motivated and mentally strong till the full recovery.
10.3) Though depression mostly affects mind, it can also lead to physical illness. Again physical health is an important foundation of mental health. People lacking in physical fitness are at increasing risk for developing depression.
10.4) It is also essential for the patients to keep record of all questions coming to mind and regularly consult the doctor. This can greatly reduce the stress.
- D = DEPRESSION (is more common in women than men)
- E =ENVIRONMENTAL (factors like air/water/food pollution cause depressive disorder)
- P= PSYCHOTHERAPY (is the 1st option for treatment of mild depression)
- R=RISK(of developing depression is high in people lacking in physical fitness)
5)E=EVENTS(like financial loss/divorce/lack of adjustment with family may cause depression)
6)S=SLEEP(for 7-9 hours daily is essential to stay away from depressive effects)
7)S=SUICIDAL (thoughts result mostly from depression)
8)I=INTERPERSONAL(therapy is used to identify and treat problems affecting relationships)
9)O=OBSTRUCTIVE(lungs disease with diseased lungs trigger depression/cause weight loss)
10)N= NEGATIVE(impact on feelings /thoughts/ behavior patterns result from depression)