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    Depression Treatment and Management : Symptoms, Causes, Types and more

    It’s perfectly natural to feel sad at certain times in your life. Sadness can be brought on by the loss of a loved one, a breakup, moving away from friends and family, struggling financially or working in a job you don’t enjoy.

    Sadness comes in waves and usually passes with time. However, if it does not pass or if sadness leaves you struggling to cope with everyday life; you could be suffering from depression. Understanding the difference between sadness and depression as well as types of depression, symptoms and how to treat depression is important. It can help you get the support or treatment you need before the condition becomes severe.

    Sadness

    How depression is different from sadness or grief

    Depression is a mood disorder that causes an unrelenting feeling of sadness and loss of interest. It’s more than just a bout of the blues and it’s not something you can simply “snap out of”. Depression tends to be a long-term condition and may require treatment in the form of medication, psychotherapy or both.

    Sadness is just one element of depression. It’s a human emotion that can leave you feeling upset or in emotional pain. You get varying degrees of sadness but like any other emotion, it’s temporary and passes with time. Between bouts of sadness, you should also have moments of being able to laugh and experience joy.

    Depression is different in that it is not an emotion, it is a mental illness. If left untreated, depression symptoms may last a long time and will impair many aspects of your life; from socialising, working, developing relationships and coping with everyday tasks and activities you usually enjoy.

    Depression is one of the most common mental disorders in the world but the good news is that most people respond well to therapy and medical treatment. Even the most severe cases of major depression can be treated.

    The earlier that treatment can begin, the more effective it is.

    What causes depression?

    There is no number one cause of depression. It’s a mental disorder that is so complex, even the science on depression is incomplete; despite the fact that depression is the most common mental disorder in the world.

    Similarly, no two people will experience depression in the same way. This is because depression is a convoluted combination of brain chemicals, genetic makeup, life stress, early trauma and medical problems. All these forces interact to bring on depression.

    Common wisdom says emotions reside in the heart. But, as mentioned, depression is not an emotion. It’s an illness. Therefore, scientists have looked at human biological makeup to find the causes of depression and it’s now common knowledge that brain chemicals are involved in depression. Billions of chemical reactions make up the dynamic system that is responsible for our moods, thoughts, perceptions and how we experience life.

    Scientists have also identified genes that make certain people vulnerable to low moods and erratic emotions. They’ve found that nerve cell connections, nerve cell growth and the functioning of nerve circuits have a major impact on depression.

    4 theories on what causes depression

    The science behind what causes depression is ongoing and there are many theories of how the mental illness develops. Here are four key factors that researchers have uncovered in their search for the root cause of depression.

    1. Your genetic code

    According to a Stanford Medicine study on Major depression and Genetics, “Heritability is probably 40-50% and might be higher for severe depression. This could mean that in most cases of depression, around 50% of the cause is genetic and around 50% is unrelated to genes (psychological or physical factors).  Or it could mean that in some cases, the tendency to become depressed is almost completely genetic, and in other cases it is not really genetic at all.”

    Therefore, the study notes, “If someone has a parent or sibling with major depression, that person probably has a 2 or 3 times greater risk of developing depression compared with the average person (or around 20-30% instead of 10%).”

    Two people with two different sets of genes could experience the same traumatic life event, yet one develops depression and the other doesn’t. Different types of depression – bipolar disorder, psychotic depression and dysthymia – may involve different genes.

    2. Early childhood experiences

    A large number of people who suffer from major depression can link it back to negative experiences in early childhood. This may be a traumatic event like the death of a parent or sibling, neglect, abandonment or physical or sexual abuse.

    These experiences in early childhood create changes in the brain that are hard to “rewire” but it is possible. Therapies such as cognitive behaviour therapy, psychodynamic therapy and transcranial magnetic stimulation have proven to be successful in reframing how one views these childhood experiences and what impact they have on one’s life.

    3. Major life events

    Immediate or prolonged major life events can trigger depression in someone who is at risk of the mental illness.

    Immediate major life eventsDivorce or marital strife
    Breakup of a relationship
    Death of a loved one
    Retrenchment or fired from a job
    Business failure
    Loss of home or income due to a natural disaster
    Serious physical injury
    Childbirth (postpartum depression) 
    Prolonged stressful life events Unemployment
    Homelessness
    Chronic illness or pain
    Abusive or unhealthy relationship
    Executive burnout

    4. Substance abuse

    Depression and substance abuse – alcohol and drugs – often go hand-in-hand with major depression. Therapists that treat drug and alcohol addiction refer to this as co-occurring disorders. About one in four depressed people (25%) also struggle with substance abuse. Likewise, one in five (20%) of alcoholics and drug addicts suffer from depression.

    Substance abuse can trigger or intensify feelings of guilt, isolation, loneliness, sadness and hopelessness which are symptoms of depression. Similarly, the symptoms of depression can drive some people toward substance abuse as a way of coping with their mental illness.

    Consuming drugs or alcohol to self-medicate depression symptoms can increase your risk of addiction. This is because regularly drinking or using drugs can make you feel euphoric and provides temporary relief from the debilitating symptoms of chronic depression.

    9 types of depression

    There are many types of depression. Chemicals in your brain cause some types of depression while events in your life causes other types. It’s important that you speak to your doctor for a proper diagnosis of the type of depression you may be suffering from and the best depression treatment for you.

    1. Major depressive disorder

    Major depressive disorder or major depression is when you feel depressed most of the time for most days of the week.

    You may have major depression if you have five or more of these symptoms on most days for 2 weeks or longer. At least one of the symptoms must be a depressed mood or loss of interest in activities.


    Symptoms of major depressive disorder

    Most commonPoor appetite or repeatedly going over thoughts 
    MoodAnxiety, apathy, general discontent, guilt, hopelessness, loss of interest, loss of interest or pleasure in activities, mood swings or sadness 
    Whole bodyExcessive hunger, loss of appetite or fatigue 
    BehaviorAgitation, excessive crying, irritability, restlessness or social isolation 
    SleepEarly awakening, excess sleepiness, insomnia or restless sleep 
    CognitiveLack of concentration, slowness in activities or thoughts of suicide 
    WeightWeight gain or weight loss
    Source: Mayo Clinic

    Treatment for major depressive disorder

    The mainstay of treatment for major depressive disorder is usually medication, talk therapy or a combination of the two. Research suggests that these treatments may normalise brain changes associated with depression.

    TherapiesCognitive behavioral therapy
    Talk therapy focused on modifying negative thoughts, behaviour and emotional responses associated with psychological distress

    Behaviour therapy
    Therapy focused on modifying harmful behaviours associated with psychological distress

    Psychotherapy
    Treatment of mental or behavioural disorders through talk therapy 
    MedicationSSRIs
    Eases symptoms of depressed mood and anxiety

    Antidepressant
    Medication designed to help relieve symptoms of depression; some antidepressants have other uses such as treating chronic pain and certain anxiety disorders

    Anxiolytic
    Relieves anxiety and tension; may help with sleep problems

    Antipsychotic
    Reduces or improves the symptoms of certain psychiatric conditions 
    Medical procedures Electroconvulsive therapy (ECT)
    Treating mental illness by sending electric currents through the brain to trigger a seizure; also known as shock treatment

    Transcranial magnetic stimulation (TMS)
    A non-invasive form of brain stimulation in which a changing magnetic field is used to cause electric current at a specific area of the brain through electromagnetic induction

    Vagus Nerve Stimulation (VNS)
    Sends regular, mild pulses of electrical energy to the brain via the vagus nerve, through a device that is similar to a pacemaker; there is no physical involvement of the brain in this surgery and patients cannot generally feel the pulses
    Source: Mayo Clinic

    2. Persistent depressive disorder

    Persistent depressive disorder is depression that lasts for two years or longer. It’s a term used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.

    Causes of dysthymia/PDD Chemical imbalance in the brain
    Family history of the condition
    History of other mental health conditions, such as anxiety or bipolar disorder
    Stressful or traumatic life events, such as the loss of a loved one or financial problems
    Chronic physical illness, such as heart disease or diabetes
    Physical brain trauma, such as a concussion 
    SymptomsChange in your appetite (not eating enough or overeating)
    Sleep too much or too little
    Lack of energy or fatigue
    Low self-esteem
    Trouble concentrating or making decisions
    Feel hopeless 
    TreatmentPsychotherapy, medication or a combination of the two

    3. Bipolar disorder

    A person with bipolar disorder has mood episodes or “mood swings” that range from extreme high energy to very low depressive periods. The old-fashion term for bipolar disorder is manic depression.

    Bipolar mood episodes last from a few days to months at a time and may also be associated with suicidal thoughts.

    When you’re in a low phase, you have symptoms of major depressive disorder. When you’re in a high phase, you experience manic symptoms.


    Symptoms of bipolar disorder

    Depressive symptomsLack of energy
    Feeling worthless
    Low self-esteem
    Suicidal thoughts 
    Manic symptomsIncreased energy
    Excitement
    Impulsive behavior
    Agitation
    Restlessness

    Treatment for bipolar disorder

    A formal diagnosis of bipolar disorder is required and then you will be prescribed medication that will bring your mood swings under control. These are mood stabilisers which will help you regardless of whether you’re in a high or low episode.

    FDA-approved medicine Lithium
    Seroquel
    Latuda
    Olanzapine-fluoxetine combination 
    Off-label medication Lamotrigine; anti-convulsion
    Vraylar; anti-psychotic
    Therapy Psychotherapy for individuals and family members

    Note

    Traditional antidepressants used for major depression are not typically prescribed or recommended as first-line treatment for bipolar disorder. In addition to not being proven efficient, a small percentage of people with bipolar disorder experience adverse side-effects or increased frequency of bipolar episodes when taking anti-depressants.

    4. Seasonal affective disorder (SAD)

    Seasonal affective disorder (SAD) is a form of major depression that is triggered by the autumn and winter season, when days grow short and you get less and less sunlight. SAD should go away in spring and summer, as soon as the weather improves, the sun comes out and the days warms up.

    Reduced sunlight or lack of sunlight can cause a drop in serotonin and melatonin levels which may trigger depression. Serotonin is a brain chemical (neurotransmitter) that affects our moods. Melatonin plays a role in sleep patterns and stabilising moods.

    Symptoms and treatment for SAD

    SAD symptomsSocial withdrawal
    School or work problems
    Substance abuse
    Other mental health disorders such as anxiety or eating disorders
    Suicidal thoughts or behavior
    Trouble sleeping (insomnia)
    Poor appetite
    Weight loss
    Agitation or anxiety 
    SAD treatment Anti-depressants work well for SAD as well as light therapy. This is where you sit in a special bright light box for between 15 to 30 minutes each day.

    5. Psychotic depression

    Psychotic depression involves symptoms of major depression along with psychotic symptoms. It is a subtype of major depression and it’s a severe depressive illness which includes some form of psychosis.

    Psychosis is a mental disorder characterised by a disconnection from reality. It may occur as a result of a psychiatric illness such as schizophrenia or may be caused by a health condition, medication or drug use.


    Symptoms of psychotic depression

    Common symptoms Agitation
    Anxiety
    Constipation
    Hypochondria
    Insomnia
    Intellectual impairment
    Physical immobility 
    PsychosisHallucinations
    Hearing a voice telling you that you are no good or worthless

    Delusions
    Intense feelings of worthlessness, failure or having committed a sin

    Paranoia
    Wrongly believing that others are trying to harm you

    Treatment for psychotic depression

    Hospitalisation Psychotic depression is usually treated on an inpatient basis in hospital. The patient can be closely monitored by health professionals and prescribed medication to stabilise their moods. 
    Anti-depressants Same as for major depressive disorder
    Anti-psychotic drugs Aripiprazole (Abilify)
    Asenapine (Saphris)
    Cariprazine (Vraylar)
    Olanzapine (Zyprexa)
    Quetiapine (Seroquel)
    Risperidone (Risperdal) 
    Therapy Psychotherapy for individuals and family members

    6. Peripartum or postpartum depression

    Peripartum or postpartum depression is a severe case of the ‘baby blues’ that women can experience after childbirth. If you develop postpartum depression, you are at greater risk of developing major depression later in life. That’s why it’s important to speak to your doctor and get help for this type of depression early rather than later.

    Postpartum depression if left untreated can lead to thoughts of suicide and suicide itself.

    SymptomsInsomnia
    Loss of appetite
    Intense irritability
    Difficulty bonding with the baby
    Suicidal thoughts 
    Treatment Counselling
    Anti-depressants
    Hormone therapy
    Hospitalisation

    7. Premenstrual dysphoric disorder (PMDD)

    Premenstrual dysphoric disorder (PMDD) is a form of depression many women experience at the start of their menstrual period, along with other symptoms. It’s a much more severe form of ‘pre-menstrual tension’ (PMS) and can morph into a chronic medical condition.

    Symptoms of PMDD appear during the week before menstruation and end within a few days after your period starts. These symptoms often disrupt everyday tasks and how well you cope with your home and work environment.

    SymptomsDepressed mood
    Anger or irritability
    Trouble concentrating
    Lack of interest in activities once enjoyed
    Moodiness
    Increased appetite
    Insomnia or the need for more sleep
    Feeling overwhelmed or out of control
    Physical symptoms such as belly bloating, breast tenderness and headaches 
    TreatmentChanges in diet to increase protein and carbohydrates
    Decrease intake of sugar, salt, caffeine and alcohol
    Regular exercise
    Stress management
    Vitamin supplements (such as vitamin B6, calcium, and magnesium)
    Anti-inflammatory medicines
    Selective serotonin reuptake inhibitors (SSRI)Birth control pills

    8. Situational depression

    Situational depression is a term used to describe a mental illness brought on when a person is having trouble managing or adapting to a stressful event in their life. This could be the death of a loved one, a divorce or marital problems, losing your job or relocating.

    Doctors also call situational depression “stress response syndrome”. It is usually short-term depression that can be treated successfully with medication, therapy, exercise or diet.

    Causes of situational depression

    Stressful eventsRelationship or marital problems, such as constant fighting or divorce
    Situational changes, such as retirement, leaving home or having a baby
    Negative financial situations, such as money problems or losing a job
    The death of a loved one
    Social issues at school or work, including bullying and low self-confidence
    Life-or-death experiences such as physical assault, combat or a natural disaster
    Medical illness such as cancer, loss of limb or a brain injury
    Living in dangerous times or an unsafe location 
    Biological factorsAbnormalities in brain structure and chemistry
    Hormonal abnormalities
    Changes in genetics

    Treatment for situational depression

    Medicine Selective serotonin uptake inhibitors (SSRIs), such as sertraline (Zoloft) and citalopram (Celexa) Dopamine reuptake blockers, such as bupropion 
    Lifestyle changes/support Cognitive behavioral therapy (CBT).
    Getting exercise
    Establishing healthy sleeping habits
    Getting more rest and relaxation
    Eating more healthfully
    Strengthening your social support system

    9. Atypical depression

    Atypical depression describes a pattern of depressive symptoms. If you have atypical depression, a positive event can temporarily improve your mood. Atypical depression is one of the most common types of depression and someone living with it does respond well to medication and therapy.

    Atypical depression is different to sadness because many people who suffer from it also complain of having uncomfortable physical symptoms; the most common being a feeling of heaviness in their arms and legs. They tend to oversleep and overeat, feel worse in the evenings, experience phobias and paranoia and are highly sensitive to rejection or any form of criticism.

    Someone with atypical depression does not feel sad or hopeless all the time; they do cheer up momentarily in response to sympathy, compliments or visits with family and friends.

    SymptomsSadness or depressed mood most of the day or almost every day
    Loss of enjoyment in things that were once pleasurable
    Major change in weight
    Insomnia or excessive sleep almost every day
    A state of physical restlessness or being rundown that is noticeable by others
    Fatigue or loss of energy almost every day
    Feelings of hopelessness or worthlessness or excessive guilt almost every day
    Problems with concentration or making decisions almost every day
    Recurring thoughts of death or suicide, suicide plan or suicide attempt 
    TreatmentAnti-depressants
    Cognitive behavioral therapy
    Counselling

    Is depression hereditary?

    Yes, depression is known to run in families and can be passed down from your parents or grandparents. Genetic factors do contribute to the risk of developing depression but it does not mean you will get depression even if the mental illness is prevalent in your family.

    According to the US National Library of Medicine, people who have a first-degree relative – a parent or sibling – with depression appear to have a two to three times greater risk of developing the condition than the general public. However, many people who develop depression do not have a family history of the mental disorder, and many people with an affected relative never develop depression.

    Talk therapy

    How is depression diagnosed

    If you suspect you are living with depression, it’s important that you speak to your doctor or a licensed mental health expert for an evaluation and proper diagnosis. This involves a depression screening where you will complete a battery of questions.

    Your doctor may also do a general physical exam and take blood to rule out if you have any other medical issues that are causing depression symptoms. Certain illnesses, hormonal changes and medications can produce symptoms similar to depression.

    What is DSM?

    The Diagnostic and Statistical Manual of Mental Disorders (DSM) is one of the most popular evaluations used by mental health professionals to diagnose depression. DSM contains descriptions, symptoms and other criteria for diagnosing mental disorders.

    DSM provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders. It also provides a common language for researchers to study the criteria for potential future revisions and to aid in the development of medications and other interventions.

    DSM has been periodically reviewed and revised since it was first published in 1952. The previous version of DSM was completed nearly two decades ago and since that time, there has been a wealth of new research and knowledge about mental disorders.

    There are 5 DSM categories; the most recent update is DSM-5. The criteria listed in the DSM-5 will help your doctor determine whether or not you have depression and it’s used by your insurance company to reimburse your or a family member for therapy and medicine required to treat your type of depression.

    What is the DSM-5 definition of depression?

    The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five (5) or more symptoms during the same 2-week period and at least one of the symptoms should be either a depressed mood or loss of interest or pleasure.

    • depressed mood most of the day, nearly every day.
    • markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
    • significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
    • a slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
    • fatigue or loss of energy nearly every day.
    • feelings of worthlessness or excessive or inappropriate guilt nearly every day.
    • diminished ability to think or concentrate, or indecisiveness, nearly every day.
    • recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

    To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

    When to seek help?

    Only a doctor or a mental health professional such as a psychologist or psychotherapist can make an accurate diagnosis of depression and recommend the best treatment for your type of depression. It’s important that you seek professional help for depression earlier rather than later because the symptoms may worsen and leave you feeling hopeless and helpless with thoughts of suicide.

    Certain illnesses and certain medication can cause symptoms that mimic depression. It’s a good idea to have a complete medical examination as part of the process of diagnosing and treating depression and deciding on the right depression treatment protocol for you.

    Disclaimer

    The information in this article is only meant to be used as a tool to help you recognise depression symptoms and help you talk to your doctor or loved ones. It does not substitute medical intervention for an accurate diagnosis of depression.