Depression

c. Treatment options range from counseling to medications to brain stimulation and complementary therapies.

OVERVIEW

What is depression?

Depression is a medical condition that affects your mood and ability to function.

Depressive symptoms include feeling sad, anxious or hopeless. The condition can also cause difficulty with thinking, memory, eating and sleeping. A diagnosis of major depressive disorder (clinical depression) means you have felt sad, low or worthless most days for at least two weeks while also having other symptoms such as sleep problems, loss of interest in activities, or change in appetite.

Without treatment, depression can get worse and last longer. In severe cases, it can lead to self-harm or death. Fortunately, treatments can be very effective in improving symptoms of depression.

How common is depression?

Globally, the total number of people with depression was estimated to exceed 300 million in 2015, equivalent to 4.3% of the world’s population. In India, the National Mental Health Survey 2015-16 revealed that nearly 15% Indian adults need active intervention for one or more mental health issues and one in 20 Indians suffers from depression. It is estimated that in 2012, India had over 258 000 suicides, with the age-group of 15-49 years being most affected.

Depression is ranked as the single largest contributor to global disability (7.5% of all years lived with disability in 2015). At its worst, depression can lead to suicide; over 800 000 people die due to suicide every year. It is the second leading cause of death in 15-29-year-olds.

What are the types of depression?

Healthcare providers name depression types according to symptoms and causes. These episodes often have no obvious cause. In some people, they can linger much longer than in others for no clear reason.

Types of depression include:

• Major depressive disorder (MDD): Major depression (clinical depression) has intense or overwhelming symptoms that last longer than two weeks. These symptoms interfere with everyday life.
• Bipolar depression: People with bipolar disorder have alternating periods of low mood and extremely high-energy (manic) periods. During the low period, they may have depression symptoms such as feeling sad or hopeless or lacking energy.
• Perinatal and postpartum depression: “Perinatal” means around birth. Many people refer to this type as postpartum depression. Perinatal depression can occur during pregnancy and up to one year after having a baby. Symptoms go beyond “the baby blues,” which causes minor sadness, worry or stress.
• Persistent depressive disorder (PDD): PDD is also known as dysthymia. Symptoms of PDD are less severe than major depression. But people experience PDD symptoms for two years or longer.
• Premenstrual dysphoric disorder (PMDD): Premenstrual dysphoric disorder is a severe form of premenstrual disorder (PMS). It affects women in the days or weeks leading up to their menstrual period.
• Psychotic depression: People with psychotic depression have severe depressive symptoms and delusions or hallucinations. Delusions are beliefs in things that are not based in reality, while hallucinations involve seeing, hearing, or feeling touched by things that aren’t actually there.
• Seasonal affective disorder (SAD): Seasonal depression, or seasonal affective disorder, usually starts in late fall and early winter. It often goes away during the spring and summer.

What are the symptoms of depression?

Depression can affect your emotions, mind and body. Depression symptoms include:

• Feeling very sad, hopeless or worried.
• Not enjoying things that used to give you joy.
• Being easily irritated or frustrated.
• Eating too much or too little.
• Changes in how much you sleep.
• Having a difficult time concentrating or remembering things.
• Experiencing physical problems like headache, stomachache or sexual dysfunction.
• Thinking about hurting or killing yourself.

If you or someone you know has thoughts of hurting themselves, please call the National Suicide Prevention Lifeline (https://suicidepreventionlifeline.org/)at 988. This national network of local crisis centers provides free, private emotional support to people in suicidal crisis or emotional distress 24 hours a day, seven days a week.

CAUSES AND RISK FACTORS

What causes depression?

Various factors can cause depression:

• Brain chemistry: Abnormalities in brain chemical levels may lead to depression.
• Genetics: If you have a relative with depression, you may be more likely to become depressed.
• Life events: Stress, the death of a loved one, upsetting events (trauma), isolation and lack of support can cause depression.
• Medical conditions: Ongoing physical pain and illnesses can cause depression. People often have depression along with conditions like diabetes, cancer and Parkinson’s disease.
• Medication: Some medications have depression as a side effect. Recreational drugs and alcohol can also cause depression or make it worse.
• Personality: People who are easily overwhelmed or have trouble coping may be prone to depression.

DIAGNOSIS AND TESTS

How is depression syndrome diagnosed?

Everyone may feel sad or down from time to time. However, clinical depression has more intense symptoms that last two weeks or longer.

To determine whether you have clinical depression, your healthcare provider will ask questions. You may complete a questionnaire and provide a family history. Your healthcare provider may also perform an exam or order lab tests to see if you have another medical condition.

MANAGEMENT AND TREATMENT

How is depression syndrome treated?

• Self-help: Regular exercise, getting enough sleep, and spending time with people you care about can improve depression symptoms.
• Counseling: Counseling or psychotherapy is talking with a mental health professional. Your counselor helps you address your problems and develop coping skills. Sometimes brief therapy is all you need. Other people continue therapy longer.
• Alternative medicine: People with mild depression or ongoing symptoms can improve their well-being with complementary therapy. Therapy may include massage, acupuncture, hypnosis and biofeedback.
• Medication: Prescription medicine called antidepressants can help change brain chemistry that causes depression. Antidepressants can take a few weeks to have an effect. Some antidepressants have side effects, which often improve with time. If they don’t, talk to your provider. A different medications may work better for you.
• Brain stimulation therapy: Brain stimulation therapy can help people who have severe depression or depression with psychosis. Types of brain stimulation therapy include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS).

PREVENTION

Who is at risk for depression?

Depression can affect anyone, no matter their age, gender or circumstances. About 16 million Indian experience depression each year.

Women may experience depression more often than men. And your genetics or other health conditions can increase the likelihood that you’ll have at least one depressive episode in your lifetime.

Can depression be prevented?

You can help prevent depression by getting enough sleep, eating a healthy diet and practicing regular self-care activities such as exercise, meditation and yoga.

If you’ve had depression before, you may be more likely to experience it again. If you have depression symptoms, get help. Care can help you feel better sooner.

OUTLOOK / PROGNOSIS

What’s the outlook for people with depression?

Depression can be mild or severe. And it can be brief or long-lasting. It’s important to get help right away.

Without treatment, depression can:

• Become worse.
• Increase your chance of other health conditions, like dementia.
• Lead to self-harm or death.
• Return, even after you start to feel better.

LIVING WITH

What can I do if I have depression?

If you have symptoms of depression, see your healthcare provider. They can give you an accurate diagnosis, refer you to a specialist or suggest treatment options.

If you or someone you know is thinking of hurting themselves or taking their own life:

• Call 988 or the National Suicide Prevention Lifeline.
• Go to the emergency department of your  nearest hospital.
• Contact a healthcare provider.
• Speak to a trusted friend, family member or spiritual leader.

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Depression is a common condition that affects millions of Indians every year. Anyone can experience depression. even if there doesn’t seem to be a reason for it. Causes of depression include difficulties in life, brain chemistry abnormalities, some medications and physical conditions. The good news is that depression is treatable. If you have symptoms of depression, talk to your healthcare provider. The sooner you get help, the sooner you can feel better.

REFERENCES:

•  "This is Depression" by Dr. Diane McIntosh, because it explains the intricacies of the illness in an accessible and compassionate voice and discusses available treatment options.

• "Feeling Great" by Dr. David D. Burns for a unique perspective on how to manage depression and anxiety.

•  Who (https://www.who.int/india/health-topics/depression).

• Wikipedia (https://en.m.wikipedia.org/wiki/Depression_(mood)).