Depression Explained

UNDERSTANDING DEPRESSION

Depression is a natural, human response to events that occur within our environment. We have all felt sad, blue, low, or ‘depressed’ from time-to-time. This mood can be triggered for a variety of reasons, usually short-lived. For most individuals, depression does not interfere with one’s daily life.

However, for many individuals, depression is a serious debilitating health concern that affects both the mind and body.

THE WORLD HEALTH ORGANISATION ( W.H.O. )

• Depression is a common brain function disorder. Globally, more than 350 million people of all ages suffer from depression.
• Depression is the leading cause of disability worldwide and is a major contributor to the global burden of disease.
• One in five people will suffer depression during their lifetime.
• Although there are known, effective treatments for depression, fewer than half of those affected in the world ( in some countries, fewer than 10% ) receive such treatments.
• Barriers to effective care include a lack of resources, lack of trained health care providers, lack of understanding and support from one’s community, friends and family members, and social stigma associated with mental disorders.
• Another barrier to effective care is an inaccurate assessment. Even in some high-income countries, people who are depressed are not always correctly diagnosed, and others who do not have the disorder are occasionally misdiagnosed and prescribed antidepressants.
• More women are affected by depression than men.
• At its worst, depression can lead to suicide.
• There are effective treatments for depression.

The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution in May 2012 called for a comprehensive, coordinated response to mental disorders at a country level.

If you, or someone you know, has a severe depressive mood state that lasts for 2-weeks or more, and this state interferes with one’s ability to function, then this may indicate that a major depressive disorder is present. Do not take any risk. Seek professional help by talking to a doctor. If the symptoms are extreme, go to a hospital or medical clinic’s emergency room.

TYPES OF DEPRESSION / SYMPTOMS

• Major Depression ( Also known as Major Depressive Disorder, Chronic Major Depression or Unipolar Depression )
• Dysthymia
• Bipolar I Disorder
• Persistent Depressive Disorder
• Seasonal Affective Disorder ( SAD )
• Psychotic Depression
• Postpartum Depression
• Substance-Induced Mood Disorder ( abuse or dependence )
• Comorbidity

Major Depression

Major Depression is manifested by a combination of symptoms that interferes with the ability to work, study, sleep, eat and enjoy once-pleasurable activities. A Major Depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic Major Depression may require a person to continue treatment and monitor lifestyle habits on an ongoing basis.  This disorder is characterised by the presence of the majority of these symptoms:

Symptoms of Major Depression include:

• Persistent sad mood
• Varying emotions throughout the day, for example, feeling worse in the morning and better as the day progresses
• Less ability to control emotions such as pessimism, helplessness, anger, guilt,  ( In children and adolescents, this may be characterised as an irritable mood )
• Restlessness irritability, anxiety, and/or angry outbursts
• Feelings of hopelessness, pessimism
• Lowered self-esteem ( or self-worth )
• Reduced capacity to experience pleasure: you can’t enjoy what’s happening now, nor look forward to anything with pleasure. Hobbies and interests once enjoyed drop off
• Changed sex drive: absent or reduced
• Reduced motivation or energy levels, fatigue, being “slowed down”: it doesn’t seem worth the effort to do anything, things seem meaningless
• Poor concentration, challenged memory or have increased difficulty in making decisions: some people are so impaired that they think that they are becoming demented
• Change in sleep patterns, that is, insomnia or broken sleep ( Trouble sleeping, early-morning awakening, or oversleeping )
• Changes in appetite or weight
• Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain, which do not respond to routine
• Reduced pain tolerance: you are less able to tolerate aches and pains and may have a host of new ailments
• Thoughts of death or suicide, or suicide attempts

Having one of these above features, by themselves, is unlikely to indicate depression; however, there could be other causes which may warrant medical assessment.

Dysthymia

Dysthymia is characterised by an overwhelming yet chronic state of depression, exhibited by a depressed mood for most of the days, for more days than not, for at least 2-years.  (In children and adolescents mood can be irritable and duration must be at least 1-year.)  The person who suffers from this disorder must not have gone for more than 2-months without experiencing two or more of the following symptoms:

Symptoms of Dysthymia

• Appetite and/or weight changes
• Trouble sleeping, early-morning awakening, or oversleeping
• Decreased energy, fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

In addition, no Major Depressive Episode has been present during the first two years ( or one year in children and adolescents ) and there has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.  Further, the symptoms cannot be due to the direct physiological effects of use or abuse of a substance such as alcohol, drugs or medication or general medical condition.  The symptoms must also cause significant distress or impairment in social, occupational, educational, or other important areas of functioning.

Bipolar Disorder

Another type of depressive illness is ‘bipolar disorder’ ( in the past described as manic-depressive illness ). Bipolar disorder is characterised by cycling mood changes: severe highs ( mania ) and lows (depression), often with periods of normal mood in between. Sometimes the mood switches are dramatic and rapid, but usually, they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy.

Bipolar disorder is characterised by more than one bipolar episode.  There are four basic types of bipolar disorder.

1.  Bipolar I Disorder

The primary symptom presentation is manic, or rapid (daily) cycling episodes of mania and depression that last at least seven days.  Manic episodes may be so severe that the individual may require hospitalisation.  Depressive episodes typically last at least two weeks.

2.  Bipolar II Disorder

The primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalisation but are sufficient to be observable by others).

3.  Bipolar Disorder Not Otherwise Specified

Symptoms of the disorder exist, but do not meet diagnostic criteria for either Bipolar I or II.   However, symptoms are well out of normal range for the individual.

4.  Cyclothymic Disorder

A chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder but have been present for at least two years.

Mania often affects thinking, judgment, and social behaviour in ways that cause serious problems.   For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees and unsafe sex. Mania left untreated may worsen to a psychotic state.  Manic episodes are characterised by:

A.  A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalisation is necessary)).

B.  During the period of mood disturbance, three or more of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

Symptoms of Mania

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• Grandiose notions or increased self-esteem
• Increased talking or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained purchasing sprees, sexual indiscretions, or foolish business investments).
• Markedly increased energy
• Poor judgment
• Inappropriate social behaviour
• Distractibility (i.e., attention is easily drawn toward unimportant or irrelevant external stimuli)

Depressive episodes are characterised by symptoms described above for Major Depressive Episode.

Persistent Depressive Disorder

A depression that lasts over 2 years, involving symptoms that come and go in severity.  The key is that the symptoms must be present at least two years

Seasonal Affective Disorder ( SAD )

A depression starting in the winter months, usually stemming from low natural sunlight and often lifting in the summer months.  Sad may be effectively treated with light therapy (Full Spectrum Lighting), but about half do not respond to treatment and benefit from a combination of therapy and medication.

Psychotic Depression

A severe depression where the person has some form of psychosis along with other symptoms.  This psychosis can include having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

Postpartum Depression

This depression occurs right after giving birth.  It is much more than the “baby blues” that many women experience after giving birth when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It seriously interferes with the woman’s daily activities.  It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Substance-Induced Mood Disorder ( abuse or dependence )

Substance-Induced Mood Disorder is a common depressive illness of clients in substance abuse treatment.  It is defined in DSM-V-TR as “a prominent and persistent disturbance of mood…that is judged to be due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or somatic treatment for depression, or toxin exposure).  The mood can manifest as manic (expansive, grandiose, irritable), depressed, or a mixture of mania and depression.

Generally, substance-induced mood disorders will only present either during intoxication from the substance or on withdrawal from the substance and therefore do not have as lengthy a course as other depressive illnesses.  However, substance use disorders also frequently co-occur with other depressive disorders. Research has revealed that people with alcoholism are almost twice as likely as those without alcoholism to also suffer from major depression. In addition, more than half of people with bipolar disorder type I (with severe mania) have a co-occurring substance use disorder.

Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a “symptom” of underlying depression or a co-occurring condition that more commonly develops in men. Nevertheless, a substance use can mask depression, making it harder to recognise depression as a separate illness that needs treatment.

Comorbidity

When a disease or disorder occurs at the same time as another but is unrelated to it, it is considered to be comorbid.  Among those suffering depression, 92% also reported meeting the criteria for at least one additional mental illness.  The most common mental illnesses are:

• Behavioural disorders ( ADD/ADHD, Conduct disorder )
• Substance abuse disorders
• Anxiety

Seek Help

If you or someone you know is suffering from any of these symptoms, and they persist for most of the day for more days than not over a two-week period of time, and they interfere with your ability to manage at home and at work, then you might benefit from getting an assessment by a skilled professional.

Sources:

• National Institute of Mental Health
• World Health Organization
• American Psychiatric Association (2013).  Diagnostic and statistical manual of mental disorders.  5th edition.  Washington, DC:  American Psychiatric Association.
• Depression and Suicide in Children and Adolescents.  Surgeon General’s Health Report.

If you are feeling suicidal, it is very important to seek immediate help, preferably by a mental health practitioner. Click Get Help for further helpful information.

Disclaimer

Please note that the information on this page ( or anywhere on this site ) is not intended as a substitute for professional medical advice, so please see a qualified health provider if you have any health concerns.