Everyone experiences periods in life when there seems to be nothing to look forward to and the world appears bleak. Usually, such phases last a few hours or a few days.
The casual use of the term “depression” can be misleading when used to describe these temporary mood swings. However, if these symptoms persist for at least two weeks, a diagnosis of depression is likely.
Depression, in a medical sense, is a serious condition that deeply affects a person’s thinking, feelings, and actions. Persistent low mood, low motivation, loss of interest, sleeplessness, and various physical symptoms are possible signs of depression. Some people with depression might experience suicidal thoughts at some point.
An estimated 16 to 20 out of 100 people will experience depression at least once in their lifetime. Results from a nationwide health survey show that at any given time, approximately 5% of adults between the ages of 18 and 65 are affected.
The number of people with depressive disorders is rapidly increasing worldwide. According to a study by the World Health Organisation (WHO), in 2015 depression affected approximately 322 million people, representing 4.4% of the world population. The WHO sees a particular need for action in young people, women before and after childbirth, and older people.
The causes of the rapid increase of people with depression are still unclear. The most plausible reason is the growing work pressure combined with social and financial instability. Currently, depressive disorders are the leading cause of disability.
Symptoms of Depression
People with depression rarely find relief from their low mood, lack of energy, and negative thoughts on their own. Unfortunately, many sufferers don’t seek medical help, often due to lack of knowledge, denial, or shame.
Depression can strike once or several times over a person’s life; many people go through repeated episodes. Symptoms during these episodes last over a period longer than 2 weeks, for most of the day, practically every day. These symptoms can include:
Persistent Sadness
The often-experienced symptoms of persistent sadness are emptiness and hopelessness. One can feel overwhelmed and trapped in this emotional condition.
Irritability and Anger
People may have angry outbursts or feel irritable and frustrated, even over small problems. This impatience can cause extra stress and harm personal relationships.
Anxiety and Restlessness
Depression frequently coexists with anxiety, restlessness, and agitation.
Loss of Interest
Another sign is a reduced enthusiasm or pleasure in daily activities. Things like sex, hobbies, or sports might not bring happiness or gratification anymore. In effect, sufferers from depression tend to withdraw socially.
Sleeplessness
Depression frequently throws off sleep patterns, leading to either insomnia or too much sleep. These disruptions can cause tiredness and trouble functioning during the day.
Fatigue and Low Energy
Depression sufferers often feel tired and low in energy; thus, even little chores seem to them to be enormous difficulties. This tiredness can lower daily living motivation and involvement even more.
Changes in Appetite and Weight
Depression influences the appetite, increasing or decreasing weight depending on the severity of depressive symptoms. In moderate depression, people tend to overeat; those suffering from severe depression lose appetite and, in consequence, their weight.
Disturbed Memory, Concentration, and Thinking
Common cognitive complaints of depression are trouble focusing, making decisions, and remembering events. This disability affects daily chores as well as social and professional duties.
Feelings of Worthlessness
People with depression often battle emotions of worthlessness or guilt, fixating on past mistakes or engaging in self-blame. These negative ideas can seriously lower self-worth and confidence.
Suicidal Thoughts
Serious symptoms include frequent or recurring thoughts of death, suicide, or even suicide attempts themselves.
Physical Symptoms
Depression is also linked to physical ailments such as headaches, stomach pain, or back pain.
Many people find these symptoms severe enough to interfere clearly with their daily activities, including social and professional duties. Understanding that physical symptoms can overlap with depression is essential to recognising them in the right context.
Treatment for Depression
Millions of people around the world suffer from depression. In treatment for depression, medication and psychotherapy, alone or in combination, are the options. In mild or moderate cases of depression, the treatment can be provided in an outpatient setting. However, patients with severe depression, especially those with suicidal thoughts, should be hospitalised.
Treatments for depression involving psychiatrists and psychologists require time and teamwork. The degree of symptoms determines the treatment choices. A psychologist can help patients with milder depression; however, patients with severe depression require treatment with medication and, after stabilising the patient’s condition, also psychotherapy.
Psychotherapy is often used in combination with medication. Medications balance brain chemicals to help reduce symptoms; psychotherapy tackles underlying emotional and psychological problems. Such combined therapy offers a more all-encompassing treatment plan, decreasing the treatment time and increasing the possibility of a full recovery.
Treatment for Depression with Medication
Transparency and a trusting relationship with the psychiatrist are the guarantees of a successful treatment with medication. Before starting any treatment with medication, the patient should be informed about the possible treatment outcome, including side effects.
Patients should refrain from changing or stopping their medication on their own. Sudden discontinuation of the medication can cause unpleasant side effects or relapses.
There are several varieties of drugs available, each with unique mechanisms.
Antidepressants
Antidepressants refer to a group of medications used primarily for the treatment of depression. They can also be successfully used for the treatment of anxiety disorders, OCD, and chronic pain. In treatment for depression, they address such symptoms as a low mood, a low level of energy, sleeplessness, and anxiety.
Antidepressants work by balancing the metabolism of the brain’s neurotransmitters, like norepinephrine, serotonin, dopamine, and others. Neurotransmitters are important for nerve signal transmission in the brain, which is disrupted in depression.
However, antidepressants don’t work immediately. While motivational effects can appear relatively quickly, a noticeable improvement in mood and anxiety usually takes a few weeks. Even with long-term use, antidepressants do not cause dependency.
Based on diverse mechanisms of action, antidepressants are divided into several groups.
Tricyclic Antidepressants
Tricyclic antidepressants were one of the first on the market. The most common tricyclic antidepressants are imipramine, amitriptyline, doxepin, and clomipramine. Tricyclics are generally not prescribed unless an SSRI has been tried first without improvement. Tricyclic antidepressants cause more side effects than SSRIs and SNRIs; however, they can still be used for certain indications.
SSRIs (Selective Serotonin Reuptake Inhibitors)
SSRIs raise serotonin concentration in particular areas of the brain, enhancing emotional balance and mood. They are considered safer and generally cause fewer side effects than, for example, tricyclics or MAOIs. Fluoxetine was the first SSRI introduced to the market. Later, other SSRIs are paroxetine, sertraline, and escitalopram.
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
Another class of antidepressants used for the treatment of depression are SNRIs. They boost in certain areas of the brain the concentration of serotonin and norepinephrine, both of which are crucial for controlling mood and energy. The first SNRI developed in 1993 was venlafaxine, followed by duloxetine, levomilnacipran, and desvenlafaxine.
Atypical Antidepressants
Atypical antidepressants do not fit neatly into other categories but can be effective for some individuals. Among them are mirtazapine, nefazodone, and bupropion. Others are trazodone and vortioxetine.
MAOIs (Monoamine Oxidase Inhibitors)
MAOIs, such as tranylcypromine, phenelzine, and isocarboxazid, are usually recommended as “reserve” antidepressants when other medications have not worked. Because of harmful interactions with some foods, like cheeses and wines, MAOIs require a rigorous diet. A more recent MAOI patch, selegiline, could produce fewer side effects.
Other Medications in Treatment for Depression
Sometimes other drugs are added to an antidepressant to boost its effects. Physicians might advise combining two antidepressants or including drugs like antipsychotics or mood stabilizers. In cases of depression combined with anxiety, short-term use of an anti-anxiety medication called benzodiazepines might be required.
Psychotherapy in Treatment for Depression
Commonly referred to as “talk therapy,” psychotherapy is a pillar of treatment for depression and other mental health illnesses. Speaking with a trained therapist helps one find and handle depression.
For people suffering from depression, psychotherapy has many advantages. It offers a safe and encouraging space free from judgement where people might freely express their ideas and emotions. Talking to a therapist can teach people techniques for controlling stress and help them acquire the abilities to deal with unpleasant emotions. These abilities help one to improve general well-being and emotional resilience in daily life.
Each of the several forms of psychotherapy has special methods and approaches. Finding the appropriate fit is crucial since some people react better to one kind of therapy than another.
Cognitive Behavior Therapy (CBT)
CBT is an often-used type of psychotherapy that emphasises spotting and modifying negative patterns of thinking. Working with you, a therapist helps you find how these patterns might be generating destructive behaviours, reactions, and self-perceptions. Through recognition and challenge of negative ideas, CBT replaces them with more positive and helpful ones. Your therapist might assign “homework” to practice these new abilities as part of the treatment, helping to reinforce the changes outside of sessions.
Dialectical Behavior Therapy (DBT)
In DBT, the focus is on validation and acceptance. Instead of battling difficult ideas, feelings, and behaviours, this therapy promotes acceptance of them. According to the theory, people can accept that change is possible and build a recovery plan by recognising negative ideas and emotions. For those who battle strong emotions and self-destructive habits, DBT is especially successful.
Psychodynamic Therapy
Psychodynamic psychotherapy has its roots in Freudian psychoanalysis. This type of psychotherapy concentrates on unconscious memories and feelings. Some shameful or painful experiences, mostly from childhood, shape our behaviour. Psychodynamic psychotherapy tries to uncover the unconscious conflicts that cause symptoms. Through exploration and understanding between present contraproductive behaviour patterns or inexplicable symptoms and earlier events, the therapy resolves the conflicts and, through emotional challenges, heals the symptoms.
The Role of Family and Group Therapy
Apart from personal counselling, family or group therapy sessions have great value. Family therapy is a therapeutic process that includes the family members of the individual, illuminating family dynamics and communication styles. It can help the person with depression live in better surroundings and strengthen understanding and support within the family.
Moreover, group therapy involves a small group of individuals with similar experiences or challenges. Group therapy, under the direction of a therapist, offers a supportive setting where members may exchange experiences and grow personally. For those with depression, it provides a sense of community and helps to lower isolation’s effects.
Therapy Strategies for Depression
Depressive disorders are on the rise, projected to be the most common illness by 2030, emphasising their significance in prevention and treatment. These disorders severely impact mental and physical well-being, social connections, work, and functionality.
Following the international guidelines set by the World Federation of Societies of Biological Psychiatry (WFSBP) and, in particular, the S3 guidelines summarising evidence-based therapeutic strategies, a thorough diagnostic assessment by a specialised medical professional is crucial.
These guidelines systematically assess evidence for treating major depression. They offer meaningful clinical recommendations. Physicians treating these conditions should use them. Data come from treatment guidelines, metaanalyses, and Cochrane Library searches. Literature is evaluated for efficacy and categorised into evidence and recommendation levels. Part two of the WFSBP guidelines focuses on maintenance phase treatment, especially biological approaches.
Criteria used in the guidelines
This assessment is based on four fundamental elements in the overall treatment of depressive episodes, taking into account clinical factors like symptom severity, disease progression, and patient preferences (watchful waiting, medication, psychotherapeutic treatments, combination therapy).
Severity classification is particularly important. For instance, the 2009 NICE guideline recommends medication primarily for moderate to severe depression, while recommending active monitoring for two weeks followed by psychosocial interventions for mild depression. There is a broad clinical and scientific consensus on the necessity of treating moderate and severe depression with antidepressants combined with psychosocial interventions in the guidelines of WFSBP and APA.
A comprehensive approach, considering severity and tailored therapies, is vital in addressing this growing public health concern. Psychotherapy, when applied appropriately, plays a crucial role in the treatment landscape of depression, offering hope for improved mental health outcomes in the years to come.
Here’s an overview of depression treatment options:
1. Watchful Waiting
For mild depression, the “watchful waiting” approach is suitable. Treatment begins only if the condition worsens. Patients are supervised by their doctor, typically a general practitioner. The doctor assesses symptom changes during regular check-ups. If no improvement or deterioration occurs after two weeks, treatment should commence. Supportive conversations, general counselling, education about the condition, guided self-help, such as through self-help books or online programs, and problem-solving approaches can be offered initially before considering medication or psychotherapy.
Important: Watchful waiting is only suitable for patients with mild depression. Prompt treatment initiation is necessary for moderate or severe depression!
In summary, mild depression can resolve without intervention, but consulting a healthcare professional is wise. Various treatments, including psychotherapy and medication, are available for more severe cases. Watchful waiting is an option for mild depression, but prompt treatment is crucial for moderate or severe depression. Each individual’s journey to recovery is unique, and seeking help is the first step towards healing.
2. Treatment for depression with psychotherapy
In the S3 guideline “Unipolar Depression,” the general recommendation of psychotherapy stands out, depending on the severity, either as monotherapy or combination therapy. Psychotherapy plays a highly valued role in the acute treatment of unipolar depression. A closer examination of criteria and circumstances for practical application is essential.
Numerous Cochrane reviews confirm the effectiveness of psychotherapy. Furthermore, the following psychotherapeutic approaches are validated in depression treatment: cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), cognitive behavioural analysis system of psychotherapy (CBASP), and psychodynamic short-term psychotherapies.
3. Antidepressants in Treatment for Depression
Antidepressant treatment is most beneficial for individuals grappling with severe or persistent forms of depression. Furthermore, it can be effective for those who have endured depression for an extended period, surpassing two years. Even in cases of mild depression, where the efficacy of antidepressants is somewhat diminished, they might still prove valuable. This is particularly true if the individual has experienced more severe depressive episodes in the past or has responded positively to antidepressant medication previously.
It’s essential to recognise that antidepressants are non-addictive, dispelling concerns of dependence or the need for escalating doses to achieve the desired therapeutic effect. However, to minimise the risk of unwanted side effects, it is imperative to adhere to a consistent medication regimen. Any adjustments to the dosage should only occur under the guidance and approval of a healthcare professional.
3.1 Maintaining the Course of Treatment with Antidepressant
Maintaining the course of antidepressant medication is crucial even when a patient experiences an improvement in their condition. In fact, continuing treatment for a minimum of four to nine months, even after symptoms have abated, can substantially reduce the likelihood of a relapse. When discontinuing antidepressants, it is essential to do so gradually to manage potential side effects that may arise during this phase.
Patients should engage in open dialogue with their healthcare provider to gain a comprehensive understanding of the effects and potential side effects of the prescribed medications, as well as any interactions they may have with other drugs.
3.2 Advantages of Antidepressants
Antidepressants offer several advantages in the treatment of depression. They demonstrate remarkable efficacy, particularly for individuals grappling with moderate to severe forms of the condition. Furthermore, they typically manifest their therapeutic effects relatively quickly, typically within approximately two weeks. Importantly, the treatment regimen is relatively undemanding in terms of time commitment. Additionally, a variety of antidepressant formulations exist, each tailored to address specific symptoms, allowing for a personalised approach to treatment.
However, it’s essential to acknowledge the potential drawbacks associated with antidepressants. Depending on the specific medication, individuals may experience side effects such as nausea, weight gain, digestive disturbances, drowsiness, or sexual problems. These side effects are most common at the onset of treatment, with roughly half of all patients reporting transient discomfort. In some cases, the side effects can be so burdensome that treatment must be discontinued. Moreover, it’s essential to recognise that antidepressants do not address the underlying life issues that may have contributed to the development of depression, such as work-related stress or relationship difficulties. Finally, individuals who have undergone antidepressant treatment are at a higher risk of experiencing a relapse compared to those who have received psychotherapy.
4. Combination of Medication and Psychotherapy in Treatment for Depression
Combination treatment involves using both antidepressants and psychotherapy simultaneously. This approach is employed when a single treatment alone isn’t effective or when severe depression hinders participation in psychotherapy until medication has improved symptoms. In inpatient settings, combination treatment is typically initiated promptly.
4.1 Treatment Options for Severe and Recurrent Depression
In cases of severe depression (3 main symptoms and at least 4 additional symptoms) or prolonged illness, a combination of psychotherapy and antidepressants is usually prudent. If symptoms persist or worsen, or if suicidal thoughts arise, hospitalisation may be necessary. This approach harnesses the advantages of both methods—fast medication effects and improved understanding of symptoms and life management.
4.2 Treatment Options for Moderate Depression
For individuals with moderately severe depression (2 main symptoms and 3-4 additional symptoms), either psychotherapy or antidepressant treatment is suitable.
Different Types of Depression
The types and symptoms of depressive disorders vary. Psychiatrists use in the diagnostic procedures guidelines helping to identify a particular type of depression. The guidelines specify criteria such as anxious distress, mixed features, melancholic features, atypical features, psychotic features, catatonia, peripartum onset, and seasonal patterns.
The description “clinical depression” is not a proper psychiatric diagnosis. The term is used for depression with more severe symptoms, which requires treatment.
Major Depressive Disorder (MDD)
Major Depressive Disorder (MDD) is the most prevalent form of depressive disorders. A hallmark of a depressive episode is the persistence of depressive symptoms for at least two weeks. The core features of the depressive syndrome include a low, sad, or depressive mood and a loss of joy and interest in almost all activities that typically bring pleasure.
Simultaneously, in major depressive disorder, a critical number of other, individually variable symptoms emerge, such as appetite and/or weight loss, sleep disturbances, loss of energy, difficulty concentrating, diminished self-esteem, suicidal thoughts, or actions.
The diagnosis of MDD can be secured by using the diagnostic criteria of ICD 10 or DSM 5, which require the existence of at least 5 of the above-mentioned symptoms persisting continuously for a minimum of 2 weeks.
Major Depressive Disorder has an episodic course and can continue for months, sometimes for years. It can be further categorised based on the symptom’s severity into mild, moderate, or severe episodes.
A form with frequent episodes is called recurrent depressive disorder.
MDD with delusions or delusional thinking is described as Major Depressive Disorder with Psychotic Features.
Dysthymia
Dysthymia is the old term describing conditions with chronic depressive mood lasting for several years. The symptoms of dysthymia are not severe or persistent enough to meet the criteria for major, moderate, or mild recurrent depressive disorder. In DSM 5, the old diagnoses of chronic depressive disorder and dysthymic disorder have been unified under one diagnosis called “persistent depressive disorder” (PDD).
Individuals with dysthymia feel low, unmotivated, and inadequate on most days. They tend to doubt themselves and feel inferior. They rarely feel happy experiencing non-specific physical symptoms such as fatigue, sleep disturbances, loss of appetite, or headaches. Even minor tasks are exhausting. Despite the difficulties, individuals with dysthymia can generally manage their daily lives.
In contrast, major depressive disorder is characterised by more severe symptoms and often occurs in phases (episodes). A depressive episode can be a one-time occurrence or recur at intervals. In dysthymia, the symptoms persist more or less constantly but with lower intensity.
Despite the lower symptoms intensity, dysthymia is associated with a high level of distress, primarily because the symptoms persist nearly continuously over an extended period with little variation in intensity. Women are diagnosed more often than men. The condition usually appears in adolescence or early adulthood, although people of all ages can be affected.
The causes of dysthymia are multifactorial. The best researched are the influences of genetic factors, dependence due to an overprotective upbringing and subsequent self-devaluation, and psychosocial influences such as social isolation.
Peripartum Depression (formerly Postpartum Depression)
Pregnancy and the period after delivery are particularly vulnerable times for women. During this time, mothers are exposed to major biological, emotional, and social changes, causing a high risk of developing depression or anxiety.
The change from DSM-4 “postpartum depression” to DSM-5’s “peripartum depression” reflects evidence that around half of depressive episodes related to pregnancy actually occur prior to delivery.
The term “perinatal” refers to the period before and after the birth of a child. Perinatal depression includes depression that begins during pregnancy, called prenatal depression, and depression that begins after the delivery, called postpartum depression.
Symptoms, effects and causes of PPD
Mothers affected with peripartum depression experience symptoms such as extreme sadness, emotional numbness, and anxiety. Their sleep is disturbed, the energy level is reduced limiting their abilities to carry for themselves and the child.
Peripartum depression carries risks not only for the mothers but also for their children. Researchers found that the children of mothers who suffered from depression during pregnancy or after delivery are at much higher risk of developing mental conditions. Also, the mature offspring of mothers with peripartum depression are at much higher risk of developing depressive disorders or anxiety in their later stages of life.
PPD does not have a single trigger. Similar to other psychiatric disorders, it’s caused by a combination of multiple factors, such as hormonal changes, genetic and environmental factors, and the physical and emotional demands of childbearing and caring for a new baby.
Peripartum depression is a serious but treatable medical condition. The treatment requires the use of medication or psychotherapy, or ideally the combination of both.
“Baby blues”
Up to 2/3 of mothers after the delivery of their first child experience “baby blues,” a short-lasting and self-limiting condition that doesn’t impact severely their daily activities and does not require medical attention.
Symptoms of “baby blues” are emotional lability such as crying for no reason, irritability, and anxiety. These symptoms last for a few days to a maximum of a few weeks and disappear spontaneously without treatment.
Catatonic Depression
Catatonic depression is a combination of catatonia and depression. The condition is categorised under the DSM-5 as Major Depressive Disorder with Catatonic Features.
Catatonia
Catatonia is characterised by severe motor disturbances, such as rigidity and withdrawal. During catatonic episodes, individuals exhibit immobility and mutism, along with stupor.
Catatonia is relatively common in psychiatric conditions, but its occurrence in major depressive disorder is rare. It is predominantly associated with bipolar depression. Bipolar disorder is the most frequently observed psychiatric condition associated with symptoms of catatonia, followed by schizophrenia.
Atypical Depression
is a sub-type of major depressive disorder with atypical features. The main characteristic is the emotional reactivity, with moods reacting strongly to environmental circumstances. The individuals suffering from atypical depression feel extremely sensitive. They experience profound fatigue, crave food, and face interpersonal difficulties. The patients feel leaden heaviness in arms or legs.
Unlike classic melancholic depression, atypical depression lacks features like insomnia, weight loss, and loss of reactivity of mood. The positive events don’t have any mood-enhancing effect. Increased appetite can be observed through a noticeable increase in food intake or weight gain. Hypersomnia may manifest as either an extended period of nighttime sleep or daytime napping.
Unlike other atypical features, pathological sensitivity to perceived interpersonal rejection is a trait that emerges early and persists throughout most of adult life. Rejection sensitivity occurs both during and outside of depressive periods, though it may worsen during depressive episodes.
Agitated or Anxious Depression
People with agitated depression might have a normal mood and energy level. However, the depression causes restlessness, anger, and psychomotor restlessness. It might resemble an anxiety disorder.
Seasonal Depression
The symptoms of seasonal depression are different from MDD that occurs year-round. They are less severe. This type occurs only in the dark part of the year, typically in winter. This form has similar diagnostic criteria to MDD, with two differences: in typical depression, there is a loss of appetite, and the sufferer loses weight. In winter depression, the opposite happens: there is increased appetite and weight gain.
The other difference is in sleep: both forms can cause sleep disturbances, but in typical depression, the sleep is deprived (problems to fall and to maintain sleep), whereas in winter depression, people tend to sleep too much. Nonetheless, most depressions in winter are not winter depressions. The seasonal depression is very rare, with a prevalence in the general population of about one to two percent.
Masked Depression
Masked (hidden) depression isn’t an ICD-10 diagnosis anymore, but some psychiatrists still use the term to describe reduced wellbeing with mostly physical symptoms without obvious depressive symptoms. The symptoms can only be identified on closer inspection. The focus is on physical symptoms of psychogenic (emotional) origin. Psychogenic pain appears real to those affected. Pain can occur in any part of the body. Patients may experience this as back pain, skin tingling, migraines, persistent headaches, chest pain, abdominal pain, etc.
Organic Depression
This type of depression is the result of a physical illness. Some physical illnesses, such as hypothyroidism, diabetes, or certain neurological disorders, can cause depression. Evaluation by an experienced psychiatrist and thorough examination are critical for diagnostic differentiation and effective treatment.
Causes of Depression
Depression is a mental illness afflicting millions of people worldwide. Knowing the causes of depression helps one identify risk factors and create appropriate treatment and preventive plans. The onset of depression is the result of several factors affecting a person’s mental well-being. Depression is not a personal weakness or a character flaw.
Brain Chemistry
Brain chemistry is among the main factors triggering depression. Chemical imbalances in neurotransmitters, which are molecules that allow communication between various parts of the brain, have a significant impact on mood control. Our feelings, thoughts, and actions are all influenced by neurotransmitters, including serotonin, dopamine, and norepinephrine. Depression can result from an imbalance of these chemicals. Knowing how brain chemistry contributes to depression will help one choose treatment, including drugs meant to restore balance.
Hormonal Changes
Hormonal changes can influence emotional stability and mood, causing depression. Menstruation, the postpartum period, perimenopause, and menopause all mark such changes. Some women find themselves more prone to depression during these periods.
Family History
Studies suggest that there is a hereditary component to depression. Your chances of acquiring depression if you have a close relative suffering from this condition are higher. While this genetic inclination does not ensure depression, it emphasises for those with a family history the need for awareness and early intervention.
Early Life Trauma
Early childhood trauma events can affect mental health for a lifetime. Traumatic events—such as loss, abuse, or neglect—can influence the body’s reaction to stress and fear. These events can change the development and operation of the brain, raising its susceptibility to depression in later life. For people with depression, a crucial first step in management is addressing and processing past traumas through therapy.
Brain Structure
Depression risk also varies in part with the structure of the brain. Studies have indicated that a less active frontal lobe increases one’s risk of depression. Emotional expression, problem-solving, and judgement—all of which the frontal lobe handles—are under its purview. Less activity in this field can affect cognitive ability and mood control. It is unclear, though, whether depression causes this lowered activity or results from it. Ongoing studies in this field might offer a better understanding of the function of brain structure in depression.
Medical Conditions
Some medical disorders raise a person’s chance of becoming depressed. Illnesses, including diabetes or cardiovascular disease, can cause hopelessness and feelings of powerlessness. By disturbing sleep and raising stress, insomnia and chronic pain disorders also increase the risk of depression. Higher depression rates also correspond with neurological disorders, including cancer, stroke, and Parkinson’s disease. Reducing the risk of depression depends on efficient management of these disorders.
Substance Use
The risk of depression can significantly change if you use alcohol or other drugs. The use of substances changes brain chemistry, aggravating or triggering depression. While drugs and alcohol offer temporary relief, they eventually worsen emotional well-being. Long-term drug abuse can cause dependency, which makes it difficult to break the cycle of depression and addiction. Depression treatment for those with past drug use calls for addressing both problems at once.
Anxiety
Both emotional and persistent physical pain have a significant impact on depression. Ongoing pain can cause emotions of frustration, hopelessness, and despair. Arthritis or fibromyalgia are among the chronic pain disorders that might seriously affect quality of life and raise the risk of depression. By addressing emotional as well as physical components of pain using combined therapy approaches, one can lower their chances of developing depression.
Risk Factors for Depression
Depression is a complicated mental illness that has many risk factors. These elements can be circumstantial, medical, social, genetic, or biochemical. Knowing these risk factors will enable one to spot those more vulnerable and direct therapy and preventive initiatives. Depression is often the outcome of several factors influencing mental health, not only of personal weakness or a character defect.
Biochemical Factors
Mood control depends on the brain’s chemistry. An imbalance in serotonin, epinephrine, dopamine, and other neurotransmitters can increase the risk of depression. The use of antidepressants helps to bring the chemical balance back.
Gender
Major depression strikes twice as often in women as in men. Menstruation, pregnancy, and menopause’s hormonal changes can all add to this higher risk. The higher frequency of depression among women could be related to social and cultural factors, including gender roles and expectations.
Genetics
Genetics is a major risk factor for depression. Your chance of acquiring depression rises if you have a close relative who suffers from the condition.
Use of Drugs for Physical Illnesses
Particular drugs, especially corticosteroids, beta-blockers, and hormonal birth control drugs, can trigger depression. Therefore, starting a new medication calls for a discussion on possible side effects with a healthcare provider.
Social Risk Factors
Low socioeconomic status, including financial difficulties, can increase the risk of depression. Feelings of hopelessness and despair can result from both financial strain and lack of resources. Access to community resources and social support help reduce these risks.
Substance Abuse
About 21 percent of those suffering from substance use disorders develop depression. The misuse of substances can also aggravate an existing depression. Breaking the cycle of depression and addiction can be difficult; thus, combined treatment approaches addressing both problems at once are necessary.
Medical Illnesses
Depression is sometimes linked to long-standing medical illnesses. Those without heart diseases are roughly twice as likely to develop depression. Depression may also strike one in four cancer sufferers. The stress and uncertainty linked to chronic conditions can exacerbate depressive symptoms.
Treatment for Depression at CHMC
Depressive disorders are on the rise, projected to be the most common illnesses by 2030, emphasising their significance in prevention and treatment.
Depression is not just sadness, but a state with a wide reduction of all emotions described as a “feeling of emotional numbness.” The affected individuals suffer from low mood, lack of interest or pleasure, reduced energy level, and sleeplessness. In some people, the “life energy” (libido) seems to implode. They get immobile and silent spending days in bet. Others, on the other hand, feel restless and driven, getting easily irritable.
Depression severely impacts mental and physical well-being, social connections, work, and functionality, leading in extreme cases to full invalidism and often to suicide. Therefore, it’s important to understand that depression is a treatable illness, and seeking help early improves the chances of full recovery. Early diagnoses and therapy of depression can restore an individual’s performance, their general health condition, and their life quality.
Diagnostic Steps Prior to the Treatment
Depression requires a proper diagnosis, which can be secured by a psychiatric assessment prior to the treatment. The assessment consists of:
Anamnesis (Medical History Review): collecting the patient’s personal and family medical history to rule out any possible genetic or environmental factors contributing to depression. In the second step, the severity and duration of symptoms should be assessed.
A physical exam evaluates the patient’s general health status (depression may be linked to an underlying physical health problem).
Laboratory tests create a “screen shot” of the patient’s health condition based on examining distinct blood and coagulation parameters. Later, under the medication, the initial result serves as a benchmark for further controls.
ECG (Electrocardiogram): By using ECG, we exclude pre-existing heart problems. A “native” ECG is also a point of reference for further controls under medication.
Additional Diagnostics: in more severe psychiatric conditions like psychosis or bipolar disorder, neuroimaging diagnostics (EEG, CT, MRI) can be required.
Treatment Plan
The recommendation for treatment of depression has been established based on evidence-based research, including meta-analyses and Cochrane Library data. The recommendations should be a guideline for therapy for depression used by psychiatrists.
A qualified therapy for depression can restore the overall psychological functioning with full mental and psychosocial recovery. Evidence demonstrates that combining pharmacological treatment and psychotherapy is more effective than either program alone. Therefore, depression treatment at CHMC in Dubai includes psychotherapy, medication, or a combination of both.
The effect of medication appears after a few days to a few weeks. On the contrary, the benefits of psychotherapy unfold over a longer period of time and have a much deeper impact on people’s lives. Thus, it’s crucial to start the treatment as early as possible, seeking help from an experienced psychiatrist and psychologist.
Preventing Depression
Depression is a complicated disorder that requires expert diagnosis and treatment.
Follow your treatment plan: Treatment consistency is absolutely vital. Make appointments; never change your medication without first seeing your psychiatrist.
Understanding depression causes: Knowing the causes of depression will help one both inside and outside. Medication addresses external factors; internal factors are addressed with time and planning.
Building trust with your therapist: Effective treatment depends on a close relationship between you and your therapist, whereby trust can be developed.
Learning about depression: Education is vital for managing depression, both for you and those around you.
Setting realistic treatment goals: Break down goals into achievable steps to boost self-esteem and motivation.
Social networks and support groups: Improving your social network and spending time with friends and loved ones helps reduce isolation. Participating in support groups helps you to learn about your illness and interact with others going through similar circumstances.
Avoiding Depressive Relapse
- Be patient and cautious in judging your progress.
- Keep an emergency plan and pay attention to warning signals.
- Have loved ones check on your health.-Maintaining physical fitness, a balanced diet, and enough sleep will help one be in general good health and improve mood.
- Avoiding Alcohol and Drugs: Though they provide short-term comfort, drugs and alcohol aggravate depression and eventually cause addiction.
The Importance of Self-Care in Treatment for Depression
Managing depression symptoms and encouraging general well-being depend critically on self-care. It entails choosing deliberately to participate in activities bolstering mental, emotional, and physical health. Although professional treatment is vital, including self-care activities into daily life will greatly improve resilience and recovery.
Maintaining Energy and Involvement
One of the main components of self-care is keeping up activities you used to enjoy. Depression often drains people of their will to engage in leisure activities or social events. Still, pushing yourself to participate in these pursuits can be quite good. It breaks the cycle of isolation and withdrawal that depression can bring about. Little actions like reading a book or showing up for a favourite class can add up.
Maintaining Social Connections
Another crucial self-care tactic is keeping close to friends and relatives. Although isolating oneself can be tempting in depression, keeping social ties is absolutely vital. Tell loved ones how you’re feeling; reach out to them. Under difficult circumstances, they can offer emotional support and understanding. Whether by phone, text, or in-person visits, regular communication—from calls to texts—helps reduce loneliness and gives one a sense of community.
Regular Exercise
One very effective self-care tool that can greatly affect energy level and mood is regular exercise. Natural mood boosters, endorphins, can be released even from a brief stroll around the block. Exercise also helps lower anxiety and stress, facilitating the management of depressive symptoms. Whether it’s yoga, swimming, or dancing, discovering an activity you enjoy will help you more easily fit exercise into your schedule.
Healthy Habits
Managing depression requires maintaining consistent eating and sleeping patterns. Depression often throws off appetite and sleep patterns, which causes tiredness and inadequate nutrition. Aim for a balanced diet and try to create a regular sleep schedule. Regularly eating wholesome meals will help regulate mood and energy levels. Furthermore, important for mental and emotional health is enough sleep, which lets the body heal and rejuvenate itself.
Avoiding Harmful Substances
A major component of self-care is avoiding or reducing alcohol and illegal drugs. These drugs can disrupt treatment and aggravate depression symptoms. Since alcohol is a depressant, overuse of it might aggravate hopelessness and sadness. Analogous effects on mood and mental health can come from illegal drugs as well. Choose better coping strategies, like talking to a friend or using leisure activities.
Expressing Emotions
A basic component of self-care is talking about your emotions to someone you trust. While sharing emotions can offer relief and perspective, bottled-up ones can aggravate depression. Finding a safe place to communicate your ideas can be quite therapeutic—that of a friend, relative, therapist, or other person. Understanding and handling your emotions starts with an acknowledgement of them.
Early Professional Help
Effective management of depression requires consulting a healthcare provider. A doctor or mental health professional can provide direction, encouragement, and treatment choices catered to your needs. In treating depression, therapy, drugs, or a mix of both can help. A professional can also assist in the creation of reasonable recovery goals and coping mechanisms.
Joining Support Groups
Another quite useful activity is joining a support group. Participating in a community of people who know what you are going through might be comforting and motivating. Support groups provide a safe environment for people to share events, grow networks of support, and learn from one another. They can give one a sense of belonging and help to lessen isolation.
Emergency Help
Call any accessible crisis line or emergency services if you believe you are at immediate risk of hurting yourself. These materials exist to offer instant help and direction. Recall that getting help is a sign of strength rather than weakness.
Recognizing Depression
Depression is a psychiatric disorder characterised by persistent feelings of sadness, hopelessness, and loss of interest in activities.
The first step in opening the treatment process is recognising the particular type of depression, each with their own specific symptoms and causes.
Treatment options include psychotherapy, medication, and sometimes also use of alternative methods.
The most effective treatment method varies depending on the individuals and the type of depression they suffer from.
Recognizing symptoms of depression
Depression is the most common psychiatric disorder worldwide. It counts to the affective disorders impairing emotions. The negative emotions, such as low mood, influence the reasoning and the physical wellbeing.
Every person experiences depression differently. The depressive symptoms vary individually in severity and duration.
Common symptoms of depression affecting a person’s psychological wellbeing are sadness (low mood, sometimes thoughts of suicide), fatigue (low drive), negativistic thinking, social withdrawal, and sleep deprivation (insomnia). Thoughts of suicide are hallmarks of depression. Other symptoms include physical symptoms such as headaches, stomach aches, changes in appetite, and physical.
Prevalence of depression
Depression is a common condition that affects people of all ages, genders, and cultures worldwide. It is a serious mental illness that can cause a wide range of emotional and physical symptoms.
The estimated rate of Americans experiencing depression in a given year is around 7%. According to the National Institute of Mental Health (NIMH), in 2020, an estimated 17.3 million adults in the United States had at least one major depressive episode in the past year, which corresponds to 6.8% of all U.S. adults.
More than 16% of U.S. adults, or about 1 in 6 people, will experience depression in their lifetime, as you mentioned. Women may be more likely to get depressed than men, and people with a family history or other mental health conditions may be at an increased risk of developing depression.
Recognizing and treating depression
It’s important to consult a mental health professional to get a proper diagnosis and develop an appropriate treatment plan.
Both medication and psychotherapy can have their own benefits. The most appropriate treatment plan depends on a variety of factors.
The treatment should be tailored, taking into consideration the severity of the symptoms, the patient’s personal preferences, and any co-occurring medical or psychological conditions. It is essential that individuals with depression work closely with their psychiatrist and/or psychologist to determine the best course of treatment for their specific needs.
The main medications used in the treatment of depression are the antidepressants. They work by altering the levels of certain chemicals in the brain, which can help to improve mood and other symptoms.
Treatment for depression. Summary
Everyone experiences phases in life when there seems to be nothing to look forward to, everything appears grey, and one feels “depressed.” The weather, work, or personal disappointments can be perceived as depressing. However, medically speaking, depression is different from a temporary feeling of sadness, lack of interest, or a mood dip that nearly everyone experiences at some point in life.
From a psychiatric perspective, depression is a serious condition that profoundly affects an individual’s thoughts, feelings, and actions. People suffering from depression rarely can overcome their low mood, lack of motivation, and negative thoughts without therapy.
Because depressive symptoms are so varied, an accurate diagnosis requires not only general medical expertise but also significant psychiatric experience. Once a correct diagnosis is made, the situation is far from hopeless. In recent decades, treatment for depression has greatly improved, with full recovery in more than 80% of patients.
Combining medication and psychotherapy
Depression is a well-treatable condition, and there are many different treatment options available, including therapy, medication, and lifestyle changes. It is essential to seek help from a healthcare professional as soon as possible. The earlier treatment is sought, the better the chances for recovery.
The main pillars of treatment for depression are medication (the use of antidepressants) and psychotherapy. Treatment with medication is considered an essential and effective therapy method.
Psychotherapeutic methods, like cognitive behavioural therapy, also play a crucial role in treating depression. Often, both types of therapy are combined. Additional therapeutic options can help improve symptoms, daily coping, and quality of life.
Treatment efficacy depends on the severity of the illness and the patient’s medical history. Also, patient’s needs and life circumstances are important factors to consider. In any case, the psychiatrist should carefully weigh the benefits and risks of the available methods. Treatment for depression aims for several goals:
The symptoms of depression should be suppressed as quickly as possible to restore the patient’s emotional balance, making him fully functional in social and work life. The likelihood of a relapse or future recurrence should be minimised by adjusting the treatment duration and possibly a longer use of relapse-preventing medication and/or psychotherapy.
Treatment for depression consists of three phases:
1. Acute Therapy
The goal is to treat the current symptoms of depression as quickly and effectively as possible until they are largely gone, allowing patient’s as quick as possible social and professional reintegration. This phase typically lasts six to twelve weeks.
2. Maintenance Therapy
When symptoms have almost completely subsided, maintenance therapy begins. This involves continuing treatment for an extended period of time to stabilise the patient’s condition. This phase lasts about 6 months up to 2 years. It reduces the risk of an early relapse. It’s important not to stop treatment prematurely as soon as symptoms improve.
3. Relapse Prevention
After maintenance therapy, further treatment may follow to prevent a new depressive episode. This phase, called “relapse prevention,” can last for a year or longer. This phase is not necessary for everyone with depression, only for:
- People with multiple relapses
- Those who were severely limited during the depressive phase
Treatment for depression requires professional guidance. Early intervention by a psychologist or psychiatrist improves therapy efficacy and long-term results. Depression treatment takes time; it is not a quick fix. Early stopping of medications increases the likelihood of depression recurrence. Preventing recurrence depends critically on psychiatric monitoring, psychotherapy, family support, self-education, and self-care.
Causes of depression
The common factors causing depression:
- Brain Chemistry: Abnormal brain chemical levels can trigger depressive symptoms.
- Genetics: If you have a depressed relative, you are more likely to become depressed.
- Life events: stress, the death of a loved one, trauma, isolation, and lack of support contribute to the onset of the condition.
- Physical disease: persistent physical pain and illness can lead to depression.
Other factors that can cause depression include:
- Hormonal changes: hormonal imbalances, such as those that occur during pregnancy or menopause.
- Social and environmental factors: social isolation, poverty, unemployment, and other environmental factors.
- Medications: certain medications, such as blood pressure medications and others, can cause depressive symptoms as a side effect.
- Substance abuse: Alcohol and drug use can increase the risk of depression.
Family Support for People with Depression
Accepting the illness can be challenging initially, with sufferers often feeling misunderstood. Well-intentioned advice like “snap out of it” or comforting words like “cheer up, it’ll get better” are unhelpful. Depression symptoms can seemingly appear out of nowhere, leaving many feeling guilty and perplexed, thinking, “Everything is fine, so why do I feel so awful?”
No one is to blame for their depression. It can affect anyone, with the risk varying based on triggers. When depression strikes, the reasons are often elusive, and understanding why it occurred at that moment can be perplexing. Support from family members and friends is crucial for successful treatment and healing of depression.
FAQs about Depression
Who treats depression?
A psychiatrist is a medical doctor who specialises in the treatment of mental health conditions, including depression. He can prescribe medications, such as antidepressants, helping to alleviate the symptoms. However, many depressed people also benefit from seeing a psychologist or other mental health professional, such as a licensed clinical social worker or licensed professional counsellor. These mental health professionals can provide different types of psychotherapy, which can help individuals learn new ways of thinking and behaving that can help to reduce the symptoms.