Although sometimes there are no physical manifestations of it, depression can be difficult to recognize but should be taken very seriously. The truth is, it affects an estimated one in 15 adults in any given year, and one in six people will experience depression at some time in their life. It is a leading cause of disability in the United States among people aged 15-44. In some extreme cases, depression will drive people to commit suicide, a tragic outcome that must be acknowledged and taken very seriously in order for better prevention to be achieved. Women are generally more prone to depression, but more men die from attempted suicide caused by depression. Although depression and suicide rates have been climbing over the last two decades, it is important to know that depression is treatable and that help is out there. The most important thing is to start the discussion about it in order to recognize it and get help.
Major Depressive Disorder (MDD), commonly referred to as depression, is a common but serious mood disorder that is typically characterized by a persistent feeling of sadness and/or loss of interest in activities you usually enjoy. Symptoms typically vary from mild to severe, and can include: low mood or feelings of sadness, hopelessness, or emptiness, frustration, loss of interest or pleasure in activities you normally enjoy, insomnia (lack of sleep) or sleeping too much, anxiety, loss of appetite, feelings of worthlessness, confusion, self-harm and/or suicidal thoughts. Depression can affect anyone, even those who appear on the surface to have a normal mood. It is not always clear what causes depression, but current research has suggested that it is caused by a combination of genetic, biological, environmental, and psychological factors. Furthermore, there are a number of known risk factors for depression including personal or family history of depression, major life changes, trauma or stress, certain physical illnesses (such as diabetes, cancer, heart disease, and Parkinson’s disease), and medications.
Just as the factors for depression vary, the types of depression also vary:
Dysthymia’, or persistent depressive disorder, is a long-term (chronic) type of depression that lasts for at least two years. In this case, periods of major depression may occur along with periods of less severe symptoms. Dysthymia may have a significant and debilitating impact on relationships, work, school, and daily activities
Another form of depression is psychotic depression, which occurs in a person suffering from severe depression in combination with psychotic features, for example delusions or hallucinations. In other words, this condition causes people to hear, see, or believe things that are not real. The suicide risk for this depressive type can be particularly high because hallucinations and delusions can be frightening. An early diagnosis and adapted treatment is very important to prevent serious harm.
After giving birth, some women can experience mood changes, feelings of helplessness, extreme sadness, anxiety, and exhaustion. This depressive condition is known as postpartum depression, and may interfere with the new mother’s ability to accomplish daily tasks and caring for themselves and/or their babies. Postpartum depression can occur during pregnancy or after delivery.
Seasonal affective disorder, commonly known as “winter depression”, is a form of depression that typically occurs during the winter months when there is less natural sunlight. This depression is often characterized by symptoms such as social withdrawal, persistent low mood, irritability, lethargy (lack of energy), fatigue, increased sleep, and weight gain. These symptoms typically improve with the onset of spring and summer.
Bipolar disorder is a mood disorder characterized by both episodes of depression and ‘mania’ (euphoric, overactive, or irritable feelings). It differs from the above forms of depression because the mood swings between high and low can vary a lot. However, part of it still involves episodes of extreme depression (“bipolar depression”).
Depression can be difficult to overcome, but it is important to keep in mind that it is treatable! Indeed, between 80% and 90% of people with depression eventually respond favorably to treatment, and experience significant improvements.
Before setting up an adequate treatment, health professionals should evaluate the patient thoroughly to deliver an adequate diagnostic. This may involve one-on-one conversations to identify the symptoms, medical and family history, as well as environmental and cultural factors. Often, physical examinations such as blood tests are also conducted to check if the depressive mood is not related to a physical condition such as a thyroid problem.
Usually, depression is treated with medications (anti-depressants), psychotherapy, or a combination of both. Antidepressants are used to improve the chemicals in your brain, which control mood and stress. An imbalance in your brain chemistry may contribute to depression. There are many different types of anti-depressants, therefore, if your symptoms do not improve right away, or if your anti-depressant causes unpleasant side-effects, do not give up, and seek to figure out with the help of your doctor which drug would suit you better.
Psychotherapy, also known as “talk therapy”, can be an effective way to help you cope with your depressive symptoms, and deal with everyday life stress factors and triggers. One of the most common approaches to treat depression is called cognitive-behavioral therapy (CBT), and involves examining how your own behavior may be contributing to your depression. This problem solving approach focuses on your present, and offers you practical tools to recognize and change negative thinking and behavioral patterns in order to improve how you feel. Other types of psychotherapy used to treat depression include cognitive therapy (how your thoughts affect our emotions), behavioral therapy (how to turn unwanted behaviors into wanted behaviors), dialectical behavior therapy (type of CBT that incorporated mindfulness to improve stress and our relationship with others), psychodynamic therapy (involves analyzing unconscious behavior and emotions that may have originated from childhood), interpersonal therapy (focuses on you and your relationship with other people, and how this may contribute to your depression).
Some patients with severe major depression or bipolar disorder do not respond to medication or psychotherapy. This is known as ‘treatment-resistant depression’. In this case, electroconvulsive therapy (ECT) can be an option. ECT is done under general anesthesia, and involves a brief electrical stimulation of the brain (electric currents) to intentionally trigger a seizure, which causes a change in brain chemistry and reverses symptoms. This practice is often used as an emergency treatment in patients who are suicidal, or refuse to eat, for example in the case of psychotic depression.
Finally, there are a number of self-help tricks that patients can incorporate into their daily routines in order to manage the symptoms of their depression. Try to follow a healthy life-style by exercising regularly to improve your mood, getting enough and good quality sleep, eating healthily, and avoid drinking alcohol. Try to stick to a routine as much as possible in order to give your days some structure, and help you avoid poor sleeping patterns. Also, try not to isolate yourself, and stay in touch with your loved ones by spending time with friends and family. If they want to help you, acknowledge this! Depression can become a very lonely place to be in, but you are not alone in this.
There are many treatment options available to explore. If you suspect that you are suffering from depression, talk about it with a friend, and do not hesitate to get a checkup with a health professional. If you are worried that someone you know is at risk of committing suicide, you can find help and prevention resources on the National Suicide Prevention Lifeline, which provides 24/7, free, and confidential support (https://suicidepreventionlifeline.org/).