What is Depression?
The Diagnostic and Statistical Manual -5 defines depressive disorders as types of Mood disorder. The most easily recognized and the most severe depression is a major depressive disorder. It may be described as feelings of extreme sadness, hopelessness, worthlessness and a loss of interest or pleasure which affects an individual’s daily life. It is the experience of a depressed mood for at least 2 weeks. Individual experience with depression differs according to the severity of the disorder which could be mild, moderate to severe depression. It is a very commonly found disorder globally, with more than 264 million people suffering from it. According to WHO reports, 56 million Indians suffer from depression proving it to be a major public health concern and also a leading cause of fatality.
Feeling Depressed vs Clinical Depression
There is a significant difference between feeling depressed and suffering from clinical depression. “Depressed”, synonymous with feeling sad and unhappy, is a feeling that may be felt like a response to a particular situation or event. It may be all-encompassing but it also has moments when one can laugh or be comforted. They may find relief after talking to someone, crying or some other enjoyable activities. Sadness usually passes with time and normal functioning becomes possible. Depression on the other hand is more severe than a temporary feeling of sadness. One may find it hard to find pleasure in anything, even in activities that are usually enjoyable to others. Although sadness is one of the symptoms of depression, these terms are not interchangeable. If a low mood or sadness does not pass for more than 2 weeks, is experienced most of the day, every day and gets worse with time, this could be a sign of depression. It is all-encompassing and debilitating and disrupts the daily functioning of the individual, affects their interpersonal relations, cognitive and emotional well-being.
Symptoms of Depression (As per DSM-5)
A daily depressed mood that lasts for most of the day, almost every day
Marked loss of interest or pleasure in normal activities
Significant weight loss when not dieting or weight gain or increase or decrease in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation (i.e feelings of restlessness or being slowed down)
Fatigue or loss of energy
Feelings of worthlessness or excessive or excessive/inappropriate guilt
Reduced ability to think, concentrate or indecisiveness
Recurrent suicidal thoughts, ideation, attempts or plans
If five or more of these symptoms are present for more than 2 weeks, which have caused a change from previous functioning and also cause significant impairment in the person’s social, occupational and other areas of life, consultation with a mental health professional is advised. The professional would rule out the possibility of any other underlying medical condition or effects of substance use.
There may be multiple reasons that could cause depression and one single cause has not yet been identified. Genetic factors, cytokines, stress hormones, deficiency of GABA, affected circadian rhythms and dysfunctions of glutamate neurotransmitters could be some of the pathophysiological causes of depression. Depression is found to have genetic roots where research, through twin studies, have found that if one twin has depression, the other has a 70% chance of having the disorder sometimes in life. Environmental factors like exposure to violence, neglect, abuse or poverty may make some people more susceptible to depression. Stressful life situations like losing a job, divorce, loss of someone of significance may lead to depression. Personality traits like low self-esteem, negative cognitive style i.e tendency to interpret everyday events negatively may also lead to depression.
Impact of depression
Depression can affect every aspect of daily life which includes the sleep cycle, appetite, education or career, health and even cognitive abilities of the individual. Depression puts the body into a state of emotional and physical stress which could lead to a loss of appetite, weight fluctuations, etc. It can have a severe impact on the digestive system. It may also lead to a cardiovascular anomaly and a compromised immune system. Sleep disorders, anxiety disorders, and substance abuse disorders are found to have high comorbidity with depression. Behaviourally, an individual may feel extremely sad, worthless, hopeless, irritable and even angry. Long term effects of depression can include social isolation, loss of job or school, trouble with interpersonal relationships etc. It also affects the family and friends of those who suffer from depression as it can be difficult to manage the symptoms of the individual. It can also have an impact on the economic status of the individual and the family.
What can others do?
If someone is suffering from depression, their daily functioning may be affected, they may be emotionally distressed. They may be experiencing multiple emotions such as helplessness, frustration, anger, fear, guilt and sadness. Hence the people close to them need to be compassionate and empathetic towards them. Listening to them without judgement is also advised by experts. This listening need not involve advice but just being a patient listener. Actively reaching out to someone who is experiencing depression may also be helpful. As a respondent one is also advised to research more about the disorder. Most importantly, as a respondent, one should encourage them to seek help from a mental health professional. One should not blame the person for the disorder but instead, be compassionate and encourage them to visit a professional. One may even offer support during treatment and also with activities that the individual may find overwhelming.
Although awareness is rising about mental illnesses, depression, like many other mental disorders is still heavily stigmatized. It is difficult to note physical manifestation of depression as is seen with other physical ailments like diabetes, hypo/hyperthyroidism etc. Lack of knowledge or misinformation could also be an important reason for the stigma. The traditional education system does not include education about mental health and related problems. Society still refutes the impact of depression by calling it a cry for attention or ridiculing genuine concerns. Instead of professional help, many still seek the help of superstitious rituals or even ignore the problems. This societal stigma towards individuals suffering from depression may lead to them being discouraged from seeking help and may even worsen the mental health of the individual.
Depression is found to be the most treatable mental disorders with about 80% to 90% responding well to the treatment. Before diagnosis, the mental health professional conducts a thorough diagnostic evaluation and a physical examination. Treatment for depression can include medication i.e pharmacological treatment, psychotherapy and social support. The treatment differs based on the severity of the disorder.
Brain chemistry can be a cause of depression and may also factor into treatment. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) and psychotropic drugs might be prescribed by a qualified professional. These drugs need to be administered under the guidance and evaluation of a medical professional The pharmacological treatment may also be accompanied by psychotherapy. Psychotherapy may involve the individual and also the family or friends of the individual. Depending on the severity of the disorder, the duration of treatment may differ.
Types of depressive disorders:
Several types of depressive disorder are categorised based on the severity of the depressive episode i.e an extremely depressed mood state lasting for more than 2 weeks and also involves cognitive and physical difficulties.
Recurrent major depressive disorder: It is defined by the presence of 2 or more depressive episodes with the separation of at least 2 months where the individual is not depressed
Premenstrual dysphoric disorder (PMDD): A woman with PMDD experiences severe symptoms of depression, irritability and tension about a week before menstruation begins. It is characterised by severe mood swings, irritability, anger, depressed mood and marked anxiety. It may also include decreased interest in usual activities, lack of concentration, fatigue, too much or too less sleeping, excessive appetite and various physical symptoms like swelling, joint pains, weight gain etc.
Persistent Depressive Disorder (Dysthymia): it is defined as a depressed mood that continues at least 2 years during which the individual is not symptom-free for more than 2 months at a time.
Disruptive Mood Dysregulation Disorder: it is a condition that occurs in children and youth between the age of 6-18. It involves chronic and severe anger/irritability that may lead to temper outbursts in verbal or physical form. These outbursts are significantly out of proportion to the situation. For diagnosis, the child/adolescent the symptoms must be present for at least one year in at least two settings (home, school, with peers etc).
Gender Differences in Depression
It has been found that women have a higher prevalence rate for depression, twice as higher as men. Understanding gender differences becomes important as it is reflective of the social structure of a community and also to understand future risks and prevent them. It was found that women were at five times higher risk of depression if they have suffered from a crisis involving children, housing and reproduction. These gender differences may be a result of social factors such as societal expectations of women, gender-based division of roles, lack of access to resources, etc. There may also be some biological roots to this. There is a possibility that women may be at risk due to pregnancy and childbirth. Another possibility is that hormonal changes due to puberty and the onset of the menstrual cycle may lead to depression.
Given the fact that there is a huge population suffering from depression, multiple initiatives are being taken at a global level and national level to make treatment accessible to people. At a global level, WHO’s mental health Gap Action Programme (mhGAP) aims to help countries increase services for people with mental, neurological and substance use disorders through care provided by health workers who are not specialists in mental health. WHO has also developed psychological intervention manuals for depression for example Problem Management Plus, which describes the use of behavioural activation, relaxation training, problem-solving treatment and strengthening social support. At a national level, under the National Mental Health Program, India is taking steps towards making mental healthcare accessible to people. Popular culture is also trying to spread awareness about the illness. Movies like Perks of being a wallflower, Melancholia, little Miss Sunshine and Indian movies like Dear Zindagi are trying to portray how Depression is affecting individuals. We as a nation have a long way to go in terms of fund allocation towards mental healthcare, mental health institutions and also education in the field, along with the social outlook towards it but we are certainly making progress every day with increasing awareness.
This article on 'All You Need to Know About Depression' has been contributed by Smruti Pusalkar, who is a Psychology student from Fergusson College. She is part of the Global Internship Research Program (GIRP), which is under the leadership and guidance of Anil Thomas. GIRP is an Umang Foundation Trust initiative to encourage young adults across our globe to showcase their research skills in psychology and to present it in creative content expression.
Smruti wishes to develop herself to be a more patient listener and a sharp observer to understand the happenings of the world and grow increasingly empathetic. She is passionate about mental health and well being and plans to pursue a career in this field. She is extremely curious about psychology and wants to spread awareness about mental health problems to help those in need.