Depression: Symptoms, Diagnosis, Causes & Treatment

Last modified on December 2021
With inputs from Dr. Sreelekha Daruvuri

What is depression?

Depression is a common and serious mental health disorder. There are different types of depression, each of which has its own set of causes and triggers. Depression can be incapacitating for some individuals due to the amount of physical and emotional symptoms it is associated with. It may negatively affect the way an individual feels, thinks, and acts. However, depression is treatable through pharmaceutical and behavioral interventions by mental health professionals. This comprehensive guide on depression will not only bring awareness to the mental health stigma surrounding the condition but also helps equip those diagnosed with depression to understand the condition better.

Last modified on December 2021
With inputs from Dr. Sreelekha Daruvuri

What is depression?

Depression is a common and serious mental health disorder. There are different types of depression, each of which has its own set of causes and triggers. Depression can be incapacitating for some individuals due to the amount of physical and emotional symptoms it is associated with. It may negatively affect the way an individual feels, thinks, and acts. However, depression is treatable through pharmaceutical and behavioral interventions by mental health professionals. This comprehensive guide on depression will not only bring awareness to the mental health stigma surrounding the condition but also helps equip those diagnosed with depression to understand the condition better.

Chapter 1: Causes of Depression

Depression can occur at any time in an individual’s lifespan. There are different causes of depression, the following are the most common.

– Genetic predisposition: A family history of depression can be a major cause of depression. The risk of depression increases with children, siblings, and parents that have family members diagnosed with depression. Gender plays a significant role too. Women are two times more vulnerable to depression to men, however, the rate of suicide is higher in men as compared to women.

– Biochemical Causes: Depression is often associated with functional and molecular alterations in several areas of the brain. Serotonin, dopamine, and norepinephrine are some of the common neurotransmitters known to play a role in depression.

– Psychosocial causes: Psychosocial factors contributing to depression can range across age groups. Starting from early childhood experiences of trauma and abuse to significant life events such as, personal conflicts, loss of job, relationship difficulties, relocating to a new place, financial constraints, loss of loved one, bereavement, and grief can lead to depression. Physical, mental, and/or sexual abuse can also play a contributing role in developing depression or making an individual vulnerable to depression.

– Chronic illness: Illnesses such as diabetes, PCOD, hypertension can increase the risk of depression as it is not only debilitating but also leads to an unwillingness to live and results in feelings of hopelessness and despair.

Chapter 2: Symptoms of Depression

The symptoms of depression can vary from mild to severe. The following are the most common symptoms of depression.

Depression physical symptoms
– Lack of energy
– Increased fatigue
– Changes in appetite leading to weight gain or weight loss
– Changes in sleep patterns: Insomnia or oversleeping
– Slowness in activity

Depression emotional symptoms

– Felt sad for the majority of the day
– Loss of interest in activities that once brought joy and pleasure
– Feeling of worthlessness, hopelessness, and guilt
– Difficulty in concentrating
– Persistent thoughts of self-harm and suicide
– Increased episode of anxiety
– Mood swings
– Rapid and uncontrollable thoughts

Chapter 3: Diagnosing Depression

Depression testing

There are no lab tests that help in diagnosing depression. However, there are psychological assessments and tests that can be conducted for the diagnosis. There are also additional tests that can be conducted to rule out depression. This is primarily because of certain medical conditions like thyroid disorders and hormonal conditions such as PCOD that can mimic depression. After ruling out the medical conditions, a physician refers the person to mental health professionals for further evaluation of depressive symptoms.

How is depression diagnosed?

A mental health professional will most commonly ask detailed questions about the patient’s mood, daily activities, symptoms, psychological history, family history, and medical history. This will help them comprehend the severity of depression, should they suspect it.

To be diagnosed with depression, a person must present with five of the following symptoms for at least 14 days or two weeks:

– Sadness or depressed mood for the majority of the day
– Loss of interest in activities that once brought joy and pleasure
– Changes in sleep patterns: Insomnia or oversleeping
– Changes in appetite leading to weight gain or weight loss
– Feeling of worthlessness, hopelessness, and guilt
– Difficulty in concentrating
– Slow-moving or slowness in activity
– Rapid and uncontrollable thoughts
– Lack of energy and increased fatigue
– Persistent thoughts of self-harm or suicide

Chapter 4: Types of Depression

Major depressive disorder/ MDD

Major depressive disorder or MDD ranges from low to severe depending on the severity of the symptoms. In MDD, clients usually feel depressed, low, or sad most of the time during most days of the week. It requires the symptoms to last for a minimum of two weeks to reach a diagnostic criterion.

– Persistent mood disorders
In persistent mood disorder, the symptoms are persistent and usually fluctuate from mild to severe depression and last for at least a year or more. Persistent mood disorder describes two conditions known as cyclothymia and dysthymia. In cyclothymia, the clients show mild to moderate symptoms of depression which persistently lasts for a couple of weeks to months, although at times the mood may become normal and stable for months at a time. It takes a prolonged period of observation to make a diagnosis. In dysthymia, the symptoms are of mild intensity for a prolonged duration of time, however, don’t match with the criteria of recurrent depressive disorder.

– Bipolar disorder: 

In bipolar disorder, the clients usually report recurrent episodes of hypomania, mania, and depression. It involves extreme and sudden changes in mood. In hypomania, clients usually experience a persistent elevation of mood, increased energy and activity, increased sexual urges, and decreased need for sleep. In mania, the symptoms are usually much heightened than that of hypomania and often the clients lose the normal social inhibitions. In bipolar disorder, client can experience both manic as well as depressive symptoms, and usually, the symptoms oscillate within a few weeks of time.

– Postnatal or Postpartum depression
Postpartum depression can affect both males and females and occurs in the weeks or months after a child is born.

– Seasonal Affective Disorder
SAD, now known as major depressive disorder with seasonal patterns, is a type of major depression that is experienced during the winter months where there is a reduction of sunlight. It most commonly alleviates during the spring and summer months. Light therapy is one of the main ways that SAD can be treated.

Severe depressive episode with psychotic symptoms
This type of depression involves symptoms of major depression but also includes symptoms of psychosis. These symptoms include hallucinations, paranoia, and delusions. Individuals that are diagnosed with psychotic depression often hear and see things that are not there, have false beliefs or conspiracy theories, and/or believe that people are trying to harm them. This type of depression is treated with antidepressants and antipsychotic drugs.

– Premenstrual Dysphoric Disorder (PMDD)

PMDD is experienced in women at the start of their period. They experience the common symptoms of depression that are alleviated through antidepressants or oral contraceptives.

– Atypical depression

This type of depression is often referred to as depression with atypical features. This includes symptoms where a patient’s depressed mood can brighten in response to good news or positive events. Other key symptoms include increased appetite or hyperphagia, sleeping too much, feeling that your arms or legs are heavy, and feeling rejected.

– Treatment-Resistant Depression
This type of depression is diagnosed after several methods of treatment fail to alleviate the symptoms and cure the illness.

Chapter 5: Depression Treatment

Treatment for depression should solely be followed under the supervision of psychiatrists and clinical psychologists. Pharmaceutical and alternative (psychotherapy and counseling) treatments are suggested only after a thorough evaluation. It is advised to avoid self-medication or self-diagnosis as mental health conditions can be serious and the medications can have serious side effects and drug interactions if taken unsupervised.

Pharmaceutical Treatment
– SSRIs
Selective serotonin reuptake inhibitors are the most commonly prescribed depression medications. They are ideal because they have very few side effects. The mechanism in which they help treat depression is that they increase the availability of serotonin in your brain.

– SNRIs
Serotonin and norepinephrine reuptake inhibitors’ mechanism in treating depression involves increasing the amount of serotonin and norepinephrine in the brain.

– TCAs and TECAs
Tricyclic and tetracyclic antidepressants increase the amount of serotonin and norepinephrine in the brain as well. However, they have more side effects than SSRIs and SNRIs.
– Atypical antidepressants
– NDRIs
Noradrenaline and dopamine reuptake inhibitors increase the levels of dopamine and
Noradrenaline to treat depression.

– MAOIs
Monoamine oxidase inhibitors increase norepinephrine, serotonin, dopamine, and
tyramine to help treat depression. MAOIs have significant side effects and are not
commonly the first-line treatment of mental health conditions. They are used as a
last resort if symptoms of depressions are not alleviated through other depression
medications.
– NMDAs
N-methyl-D-aspartate increases levels of glutamate – a neurotransmitter  involved
in depression – to help treat depression. These are most commonly prescribed to
patients that have not been helped with other antidepressant medications.

Alternate Treatment
Alternate treatment for Depression includes Psychotherapy that involves psychoeducation and behavioral interventions with trained mental health professionals. They assist in teaching tools and skills to cope with negative thoughts and feelings. Some of the commonly used therapeutic intervention in depression are:

– CBT
Cognitive Behavioral Therapy (CBT) is considered to be an effective evidence-based intervention to treat mental health disorders. It is a widely practiced intervention to treat anxiety and depression that helps one become aware of their inaccurate or negative thinking so that they can view challenging situations more clearly and respond to them in an effective manner. They learn skills to change thinking and behavior in order to achieve lasting improvement in mood and functioning and sense of well-being.

– REBT

Rational emotive behavior therapy (REBT) is another approach for the treatment of depression. In this approach, the clients are helped in identifying irrational beliefs and negative thought patterns that may lead to emotional or behavioral issues.

– DBT
Dialectical behavior therapy (DBT) is a modified type of CBT and is considered to be highly effective evidence-based psychotherapy which was primarily developed for the management of personality disorders, however, shows effective results in depression as well. Its main goals are to teach clients how to live in the moment using mindfulness, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.

– Light Therapy
White light therapy has been researched to help regulate mood and alleviate symptoms of depression. It is ideally used in SAD or seasonal affective disorder, which is now known as major depressive disorder with seasonal patterns.

-Lifestyle modifications

 Healthy lifestyle choices such as a consistent sleep schedule, maintaining a healthy and balanced diet, regular physical activity and exercises such as yoga and meditation, and using the right supplements for physical and mental health also contribute to the long-term treatment of depression.

Chapter 6: Depression Risk Factors

Depression can affect anyone at any age. However, some factors make an individual more at risk or more vulnerable to developing depression. Risk factors to depression include:

– Age: the elderly are at a higher risk of going through depression and there are various factors that contribute to this. These include chronic illness, empty nests, loneliness, lack of emotional and social support, etc.

– Gender: Women are two times more vulnerable to depression than men, however, men are seen to be more prone to suicide as compared to women.

– Abuse: Physical, mental, emotional, and/or sexual abuse is one of the most common causes of depression. Feeling trapped in an abusive situation, or being abused in any way for long-durations chips away at an individual’s mental health.

– Significant life events: Life events such as the loss of a job, a breakup, loss of a friendship, family conflicts, divorce, etc increase the risk of developing depression.

– Medications: Some drugs make individuals more vulnerable to depression. Some examples include isotretinoin, corticosteroids, and interferon-alpha.

– Death and grief: The loss of a loved one can trigger a depressive episode, and although natural, is very debilitating to some individuals and can further increase the risk of depression.

– Chronic illness: Illness such as diabetes, rheumatoid arthritis, PCOD, and hypertension can increase the risk of depression. This is because suffering from chronic illness can not only be debilitating and isolating but in some cases the lack of cure results in feelings of hopelessness and lack of will to live.

– Substance abuse/misuse: Those who are dependent on drugs that help in temporary relief of their pain or depression are more vulnerable to recurrence and aggravation of depression.

Chapter 7: Depression and COVID-19 management

The COVID-19 pandemic has been a huge part of everyday life since 2020, and for now, shows no signs of ending soon. During this almost two-year time period, many have lost their loved ones, have battled the viral illness themselves, have become caregivers of those that have tested positive, have worked from home, raised children at home, and many more life-altering activities. This isolation and quarantine to a certain extent have taken a huge toll on mental health.

However, there are healthy ways to cope with anxiety, stress, and grief during the COVID-19 pandemic:
– Learn how to manage depression and anxiety during COVID-19 by reading this easy-to-understand blog.

– Some tips and tools can be learned to keep your mind at ease and calm if the pandemic has increased your anxiety levels.
– Coping with mental health complications post a COVID19 infection can be hard – physical and mental recovery are both important. Here are some easy ways that you can cope with and heal.

Chapter 8: FAQ’s

Q. What is the difference between depression and feeling sad?
Being sad is not the same as having depression. While both involve intense and overwhelming emotions, there are key differences between them. Major depression has symptoms that last for over two weeks while feeling sad is a temporary feeling which does not last long and usually subsides as and when the situation improves. Major depression also takes a hit on an individual’s self-esteem and can bring about devastatingly negative thoughts on suicide, sadness does not. You can learn more about this here.

Q. Can depression cause weight loss?
Yes, one of the symptoms of depression is a persistent change or disturbance in eating patterns. While some individuals tend to overeat, some others diagnosed with depression eat significantly less than they used to. Hence, depression can cause weight loss as well as weight gain or lead to obesity


Q. Can depression be prevented?

Depression can be prevented by following a treatment plan by mental health professionals and by attempting to avoid potential triggers. This will help in alleviating any changes of recurrence of depressive episodes.

 

Q. Can depression cause high blood pressure?

There is no direct correlation between blood pressure or hypertension and depression. However, emotional turmoil can cause a rise in blood pressure and anxiety that can increase the risks of developing hypertension.

 

Q. Can depression cause heart attacks?

For those diagnosed with heart disease, depression can increase the risk of cardiac abnormalities such as a heart attack. For those that are not diagnosed with heart disease, depression can increase the risk of a heart attack and coronary heart disease (CAD).

 

Q. Can depression cause memory loss?
As per research, depression has been linked to memory issues such as memory loss or confusion. Lack of concentration and the ability to think clearly is also a symptom of depression. Depression is associated with short-term memory loss.

Mental health disorders are often stigmatized and that can further lead to those going through them feeling isolated. There is no reason that someone should not seek help for a mental health condition – it’s the same as having a physical condition. If you or a family member are showing signs of depression, early detection can help save lives.

Talking to a psychotherapist can greatly help. They will be able to help you not only identify your triggers but also teach you how to cope with them, along with tailoring a treatment plan that will work for you. Your mental health should also be of equal priority as your physical health. MFine’s 2-Month Mental Health Care Plan gives you the ease of flexibility and quality treatment quickly. The customized program designed for you will help you access advice on daily care along with therapy sessions. The plan also includes daily supervision and assessments so you know your progress.

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