Depression

What is depression?

Ever wondered why someone you know, a friend or a relative, seems very sad and looks tired or dull for a long time? You may have noticed that the person has become very quiet, has lost interest in daily activities, does not eat properly or is frequently absent from work. Such signs indicate that the person may be suffering from depression.
 
Depression is a common mental disorder with a set of symptoms that affect a person's thoughts, feelings, behavior, relationships, performance at work, and in very severe cases, may also lead to thoughts of suicide and death. 
 
It is alright to feel sad or upset over some unhappy events or circumstances. However, if this feeling persists for a long time (more than two weeks) or recurs frequently and disrupts normal life and health, then it could be a sign of clinical depression, which requires treatment. 
 
Note: 
  • Depression is not a sign of weakness or mental instability; it is an illness like diabetes or heart problems. Depression can affect anyone at any juncture in their lifetime. 
  • Depression is treatable.

What are the symptoms of depression?

"I don't feel hungry nowadays. I feel like sleeping through the day, but at night I tend to stay awake with restless thoughts in my mind. I don’t want to work or speak to anyone, I'd rather stay in my room all day long. Whatever I do seems to be wrong. I feel I am worthless and useless. Nobody understands me..." 
 
Such thoughts and feelings indicate that the person may be suffering from depression. However, the severity and the symptoms may vary from one person to another. Also, not all depression symptoms are seen in one person. Depression can affect every aspect of life. 
 
Note: These symptoms are a broad classification to indicate the possibility of the condition. It is important to consult a mental health professional and get the correct diagnosis, which will then help determine the type of treatment.

Some of the symptoms are:
  • Feeling low and sad most of the time
  • Loss of interest and difficulty in completing daily activities. Tiring easily and feeling a lack of energy throughout the day. Inability to enjoy things that you found interesting earlier.
  • Difficulty in concentration, thinking or making decisions (example: hobbies, focusing on studies, etc.).
  • Loss of self-confidence and self-esteem
  • Negative thought about self, life and future
  • Loss of appetite or overeating
  • Feeling guilty and blaming oneself for past failures; feeling unworthy
  • Frequently absent from work or being unable to work
  • Feeling hopeless about the future
  • Disturbed sleep or being unable to sleep
  • Lack of interest in sex/sexual activity
  • Experiencing body aches such as headaches, neck pain, or cramps
  • Thoughts about self-harm, suicide or death
In case you observe any of these depression symptoms in someone you know, you can encourage them to consult a mental health expert.

What causes depression?

Depression can be caused due to a combination of several factors that include genetics, life events, or stress.

  • Psychiatric disorders: Depression can co-exist as a part of undiagnosed psychiatric disorders such  as obsessive compulsive disorder, social phobia and schizophrenia. A detailed assessment by a mental health expert is recommended in such cases. 
  • Life stressors: Common stressors in adults could be work-related, interpersonal (either familial or marital), financial problems and others. 
  • Physical health problems: Uncontrolled medical illnesses such as diabetes and thyroid problems can lead to depression. Hence, consultation with a psychiatrist would also involve investigating for previously undiagnosed medical illnesses. People suffering from major medical illnesses such as heart disease, cancer, or HIV, may have difficulty in coping with or adapting to the illness, leading to depression. 
  • Personality: Having problems with personality or body image (being too fat or too thin, too short or tall), perfectionism, low self-confidence, unhealthy competition and peer pressure in school, college, and at work. Most research indicates that all or a combination of these factors can trigger depression.
  • Addiction to alcohol or drugs: Alcohol is a depressant and excessive consumption may cause depression. Addiction to drugs and other harmful substances isolates a person from family and friends. Prolonged use or inability to gain access to drugs may lead to withdrawal symptoms, behavioral issues and depression.

Depression can manifest itself across age groups due to various psychosocial factors. The following sections contain information about how depression affects children, women, and the elderly.

How is depression diagnosed?

Each disorder has its own set of diagnosis and it is important to consult a mental health expert and get the correct diagnosis before starting the treatment. Incorrect diagnosis may lead to complications and may further worsen the condition. 
 
Medical history: Usually, an expert records your medical history to rule out other illnesses that may be causing the symptoms.
 
Psychological evaluation: A mental health expert uses a questionnaire to collect information about the person's symptoms, thoughts, feelings and behavioral patterns. The expert will also evaluate the duration of symptoms, how and when they started, their severity and how these symptoms have affected the person's thoughts and behavior.
 
The person is diagnosed as suffering from depression only if they have more than five symptoms of depression during most times of the day over a two-week period. These symptoms must be severe enough to disrupt a person's daily activities either at work or at home.

Getting treatment for depression

Depression remains hidden most of the time because people hesitate to speak about it. Many of us just smile and refuse to share the problem for fear of being ridiculed or considered weak. The stigma associated with depression is a major obstacle that prevents people from seeking help. Without treatment, a person may suffer unnecessarily for a long time, and also cause suffering to their family.

Due to lack of knowledge, many people are unable to identify the signs or know how to overcome depression. This results in a huge time-lapse before they even seek treatment, which could aggravate the condition. For mild and moderate depression, self-help techniques, counseling or any therapy may be sufficient for recovery. It is only in severe depression that one would need treatment and medication.

 
The World Health Organization (WHO) ranks depression as one of the world’s most disabling diseases. Yet, anyone suffering from depression can recover and lead a normal and happy life.
 
There are different ways in which depression can be treated. This depends on the severity of depression, health condition, and the patient's determination to recover soon.
  • Doctors usually prescribe antidepressants.
  • Detection and treatment of co-existing medical conditions such as diabetes or thyroid disorders would help the person recover faster from depression.
  • Various psychological therapies have also been found effective in treating depression. The patient can be taught relaxation techniques to increase positive thinking and improve coping skills. This can also be done through a host of therapies such as cognitive behavioral therapy, supportive therapy, mindfulness-based cognitive therapy and others.

Caring for someone with depression

You can always help a person suffering from depression. However, it may be difficult to convince the person to accept the fact and seek help. Nevertheless, if you observe any of the depression symptoms mentioned above in someone you know, it is always good to encourage the person to consult a mental health expert.
 
As a caregiver, you can:
  • Be more understanding, supportive and caring.
  • Speak to the person or listen with empathy.
  • Encourage the person to speak up and share their feelings.
  • Help the person get involved in activities because being active is the antidote to depression.
  • Be watchful for comments on suicide and immediately inform the psychiatrist.

Coping with depression

Depression is an illness and you need support to recover from it. Speak to family and friends, and as a first step, consult a mental health expert for correct diagnosis and treatment.
 
Along with treatment or therapy, you need to take care of yourself. It may not be easy but small changes in your routine can have a positive outcome.
 
Break the cycle of negativity: One of the symptoms of depression is the constant feeling of guilt, worthlessness and being useless. Such thoughts need to be controlled and you need to be aware when such thoughts and feelings emerge. Try to recognize this pattern of negative thinking and replace it with positive or constructive thinking. If possible, make notes of such thoughts and see how you can replace them with happier thoughts and feelings.
 
Be active: Daily tasks and activities can be therapeutic. Try to complete the daily tasks as much as possible. Set small and achievable goals and work on them. Take up some form of exercise. Research has proven that exercise helps the body and mind.
 
Face your fears: Usually, when people feel sad or anxious, they avoid talking to others or avoid tasks such as traveling, gardening, cooking, etc. It is best to face your fears and slowly continue with these tasks.
 
Plan your activities and daily routine: Since depression affects sleep patterns, try to get up at your normal time and sleep at the same time every night. Stick to the routine as much as possible. 
 
Family support: Seek support from family members and friends. Take the required treatment or therapy regularly as prescribed by the doctor, which will help you recover sooner. Motivation and self-determination are the key factors to recover from depression.

Caring for the caregiver

Caring for someone with depression can make you feel exhausted and stressed. It is crucial that you take care of your health so that you can look after your loved one. Getting support from family and friends, and other professional support or advice can be helpful. You can also speak to other caregivers, who know what you are going through and who will be able to understand your situation better.
 
You can do certain things that will make you feel better.
  • Learn about the disorder, as it reduces your anxiety and helps you become more effective as a caregiver.
  • Take care of your physical health with proper nutrition and sufficient sleep.
  • Go for a walk or get involved in a hobby or any activity that you are interested in.
  • Speak to a friend or confidant and share your thoughts and feelings. This will help you overcome your own inhibitions.
  • Know your limits and be realistic about how much time you can spend in caregiving. Communicate these limits to the 'patient', your family and the doctor so that everyone is aware of it and they do not expect undue commitment from you.
  • Take a break to be away (for a short time) from the situation, if it becomes overwhelming.

Types of treatment for depression

Psychotherapy of several types have shown to be effective for depression, including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). In general, these two therapies are of short term, with treatments usually lasting about 10-20 weeks. Research has shown that mild to moderate depression can be treated successfully with either medication or psychotherapy alone. However, a person with severe depression is likely to respond to a combination of these two treatments.
 
Cognitive behavioral therapy (CBT) is an effective and evidence-based therapy that is beneficial in treating depression. It helps in changing the negative thinking pattern and behavior associated with depression, while teaching the person how to understand, control and stop this negative thinking pattern that triggers depression. Negative thought process (for example: "I can't do anything right") is identified and replaced with positive thoughts (for example: "I can do this correctly"), leading to a more effective and positive behavior. It is also observed that simply changing one's behavior can lead to an improvement in thoughts and mood. This can be as simple as stepping out of the house and taking a 15-minute walk every day.
 
Interpersonal therapy (IPT) focuses on improving personal relationships. The therapist teaches people how to evaluate their interactions with others and become aware of self-isolation and difficulties getting along with, relating to, or understanding others.
 
Psychoeducation involves teaching a person about their illness, how it can be treated, and how to recognize signs of relapse so they can get necessary treatment before the illness worsens or recurs.
 
Family psychoeducation helps to reduce distress, confusion and anxiety within the family and help them cope with the situation, so that they are able to provide care and support to their loved one who is affected with depression.
 
Self-help and support groups for people and families dealing with mental illnesses are becoming more widely available. People can share their experiences, feelings, and also get referrals to qualified specialists; they also learn about community resources and gain information about what treatment or therapy works best for their recovery. 
 
Electroconvulsive therapy (ECT): This is a highly effective treatment for severe depressive episodes and severe depression with psychosis. When medication or psychotherapy is not effective in treating severe symptoms such as acute psychosis or thoughts of suicide, or if a person cannot take antidepressants, then ECT may be considered. ECT can be combined with antidepressants for some individuals. Memory problems can follow ECT treatments, so a careful risk-benefit assessment needs to be made for this important and effective intervention.

Did you know?

WHO has estimated that:

Depressive disorders affect around 5 percent of the adult population during any phase in their lives.

Depression is going to be the second biggest mental illness by 2020.

India has the highest rate of depression in the world.


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