What is depression?
Depression is a mood disorder with symptoms that affect a person's thoughts, feelings, behavior, and daily functioning. In some severe cases, it can also lead to thoughts of death or attempts at self-harm or suicide.
Everyone experiences sadness during a period of grief or a stressful situation. In the case of depression these feelings persist over a long period (more than two weeks); can recur frequently; and disrupt a person’s daily life. Its diagnosis is made with careful consideration to commonly experienced feelings like sadness, along with other symptoms that characterize the illness.
Even though it is one of the most well-recognized disorders, it is still widely stigmatized. The national mental health survey estimated that 1 in 20 Indians have depression—despite this, over 85% of the total number of people living with it don’t have access to treatment.
A person can be diagnosed with depression at any point in their life. Treatment for it usually involves medication; psychotherapy; or a combination of the two.
What are its symptoms?
Depression is diagnosed when there are noticeable changes in mood—these are usually characterized by sadness, and psychosocial changes like loss of interest or pleasure in activities that the person usually enjoys. This reflects a shift from their usual behavior or functioning level—the severity of the symptoms may vary from one person to another. While many are self-reported, some symptoms are observed by others.
Some of the symptoms
For a diagnosis of depression, five or more of these symptoms need to be present for over two weeks. These are indicative in nature—a diagnosis can only be made by a trained mental health professional:
Feeling low and sad most of the time.
Loss of interest and difficulty in completing daily activities; an inability to enjoy activities that were enjoyable before.
Tiring quickly and feeling a lack of energy throughout the day.
Difficulty in concentration; thinking; or making decisions.
Loss of self-confidence and self-esteem.
Negative thoughts about self, life, and the future.
Loss of appetite, or overeating.
Feeling guilty and blaming yourself for past failures; feeling unworthy.
Frequent absence from work; being unable to work.
Disrupted sleeping patterns where you end up sleeping excessively, or are unable to get adequate sleep.
Lack of interest in sex/sexual activity as compared to previous levels of interest.
Experiencing frequent headaches or body aches like neck pain, or cramps.
Thoughts about self-harm, suicide or death.
What causes depression?
It can be caused due to a combination of several factors that include—but is not restricted to—genetic factors, life events, stress. Some causes are—
Psychiatric disorders: Depression can coexist as a part of undiagnosed psychiatric disorders, such as obsessive-compulsive disorder (OCD), social phobia, schizophrenia. A detailed assessment by a mental health expert is recommended in such cases.
Life stressors: Common life stressors—like problems relating to work, interpersonal relationships, finances—can contribute to depression.
Physical health problems: Distress experienced by a person because of a physical illness that is hard to cope with can lead to showing signs of depression. It is important to consult a medical professional in such cases.
How is depression diagnosed?
Each disorder has its own diagnosis criteria; consulting a mental health expert to get the correct diagnosis is the first step towards starting treatment. An incorrect diagnosis may lead to complications that might worsen the person’s mental health.
The following criteria is followed while diagnosing depression—
Medical history: Usually, an expert records your medical history to rule out other illnesses that may be causing the symptoms. For example, vitamin D deficiency or other hormonal imbalances can cause depression.
Psychological evaluation: A mental health expert uses different psychometric assessments to collect information about the person's symptoms; thoughts; feelings; 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.
Depression is diagnosed only if there are five or more symptoms of depression during most times of the day, over a period of two weeks. These symptoms must be severe enough to disrupt a person's daily activities either at work, home or other areas of functioning they are usually involved in.
What are the treatment options for depression?
There are multiple treatment options available. The course of treatment is decided based on the severity of the illness and other physiological, cognitive and social factors. In some cases, medication is prescribed. Alternatively, a combination of medication and psychotherapy is employed as a mode of treatment.
In addition, the person is also referred to specialists to be treated for coexisting medical conditions like diabetes or thyroid that may have contributed to the depression. Several psychological therapies have been found to be effective in treating depression. A few examples of the types of therapy used are—
Cognitive behavioral therapy (CBT): CBT is one of the most commonly used treatment methods for depression. It is a structured, conversation-based therapy that helps identify dysfunctional thought patterns and behaviors. Negative thoughts like "I can't do anything right" are identified and replaced with positive thoughts like "I can do this correctly,” leading to more effective and positive behavior. CBT works based on the fact that a change in a person’s behavior can lead to an improvement in thoughts and mood. This can be something as simple as stepping out of the house and taking a 15-minute walk every day. During therapy, the therapist and client set goals and work towards them.
Interpersonal therapy (IPT): This is a structured therapy process that focuses on helping the person improve their interpersonal relationships. The therapist teaches the client to evaluate their interactions with others, and become aware of patterns of self-isolation and difficulties faced in getting along with; relating to; or understanding others. IPT is a time-limited treatment with an initial, middle and final stage.
Dialectical behavior therapy (DBT): DBT is a conversation-based approach that focuses on building skills in many areas, such as distress tolerance, mindfulness, emotional regulation. It helps target specific symptoms of depression and teaches skills to manage them. It is found to be very useful for people who struggle with thoughts of suicide; DBT also helps clients create long-term goals and work towards it.
Electroconvulsive therapy (ECT): This treatment is used for severe forms of psychiatric conditions. ECT is known as ‘shock treatment’ in common parlance. 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. This treatment can be combined with antidepressants and psychotherapy for some individuals.
Alternative therapies: While talk therapies like CBT are the most commonly used forms of treatment for depression, there are many alternative forms of therapy that can be used. Such as animal assisted therapy (AAT); play therapy; yoga therapy; expressive arts therapy which includes music, movement and drama therapy. These are less about a person’s skill level, and more about them using a particular medium as a way to make sense of their problems.
Aside from these, another critical aid in the treatment of depression is psychoeducation. It involves teaching a person about their illness, how it can be treated, and how to recognize signs of relapse to get the treatment they need before a new onset of the illness. Family psychoeducation is an important part of the person’s recovery process—it helps reduce their distress, confusion and anxiety, allowing them to be present to the needs of their loved one struggling with depression.
Similarly, self-help groups, support groups—now becoming more available in urban spaces—are giving people a space to share their experiences and feelings; get information about qualified specialists to approach for treatment and therapy; and learn about helpful community resources.
How do I care for someone with depression?
Many people with depression may not be willing to open up about what they’re going through or seek treatment. This is due to the overwhelming levels of stigma around the illness. As a person caring for someone with depression, you need to be mindful of the number of challenges the other is faced with. As a caregiver, you can—
Educate yourself about the illness—the signs; how they present; treatment options available.
Be sensitive to its symptoms, and don’t respond in a way that is stigmatizing.
Be more understanding, supportive and caring.
Speak and listen in an empathetic and non-judgemental manner.
Encourage open communication between yourself and your loved one with depression.
Be watchful for signs of self-harm or comments contemplating suicide.
Encourage exercise and other activities that can help the person return to their previous functional levels.
Be there, and care for yourself to avoid caregiver burnout.
Know your limits and be realistic about how much time you can dedicate to caregiving.
Join support groups consisting of other caregivers to help cope and manage with the challenges that come with caregiving.