Dealing with Depression: Everything you need to know

What is depression?

Feeling sad or depressed at times is a normal reaction to loss or life's struggles. However, when intense sadness envelops a person, involving feelings of hopelessness, worthlessness and helplessness, which last from days to weeks and keep a person from functioning normally, it is referred to as depression. Different forms of depression include:

1. Major depression, which is characterised by the inability of a person to function normally. It interferes with their ability to work, sleep, eat or enjoy fun activities.
2. Dysthymia or dysthymic disorder refers to a long-term (two years or more) depressive disorder in which the person is hindered from performing normal activities but is not severe enough to cause disability. One or more episodes of depression are common in the lifetime.
3. Minor depression is characterised by symptoms for two weeks or more, but that which do not meet all criteria for major depression. However, without treatment, it can progress to major depression.

Some other forms of depression that may develop under unique circumstances:

1. Postpartum depression - Hormonal and physical changes after giving birth and the new responsibility of caring for a newborn can cause postpartum depression in new mothers. Read more about postpartum depression.

1. Psychotic depression - Some patients may have psychosis along with severe depression.
2. Seasonal affective disorder (SAD) - Treatable with light therapy and medication, this form of depression takes place during winter months, when there is less natural sunlight.
3. Bipolar disorder (Manic-depressive illness) - This is characterised by changing moods, ranging from extreme highs (mania) to extreme lows (depression).  

What are the causes of the disorder?

Depression is caused by a combination of psychological, biological, genetic and environmental factors.

1. Genetics - While some forms of depression runs in families, it can also occur in people with no family record of depression. Certain genes are being studied for making people prone to depression.
2. Environment - The role of a combination of genes acting together under certain environmental conditions is also being researched.
3. Psychological factors - Trauma, loss of a loved one or stressful life situations can also trigger depression.

What one needs to know about symptoms or signs?

A person with depression may show one or more of the following symptoms:

• Fatigue and loss of energy
• Depressed mood that lasts whole day, and more during morning
• Worthless feeling or feeling of guilt
• Poor concentration, indecisiveness
• Loss of interest in daily activities
• Sense of restlessness
• Weight gain or weight loss in short time
• Insomnia (inability to sleep) or hypersomnia (excessive sleeping)

A person is diagnosed with depression if one or more of the above signs are present throughout the day, either daily or almost every day for a minimum period of two weeks. Further, depression is considered as the main cause of the above symptoms if there is no other indication of effects of substance use (drug or medication) or signs of a medical condition (hypothyroidism).

Which specialist should be consulted in case of signs and symptoms?

A person showing signs of depression is referred to a psychologist or psychiatrist, who specialise in treating mental health conditions.

What are the screening tests and investigations done to confirm or rule out the disorder?

Depression is difficult to diagnose as it is manifested in multiple ways in different patients. It may be diagnosed in the following manner:

1. Physical examination - A physical exam throws light on a person's overall state of health.
2. Interview and questions - A doctor learns more about a patient's mental state by talking with him/her. The doctor makes notes of things relevant to making a depression diagnosis, like daily mood behaviour, lifestyle habits, etc.
3. Laboratory tests - The doctor may conduct a blood test to determine the complete blood count (CBC) or test thyroid function to rule out underlying physical ailments that could be causing the depression-like symptoms.

What treatment modalities are available for management of the disorder?

Once diagnosed with depression, a patient can be treated either through medication or psychotherapy, or both.

1. Anti-Depressant medication - Many types of medication are available. These include:
   • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
   • Selective serotonin reuptake inhibitors (SSRIs)
   • Norepinephrine and dopamine reuptake inhibitors (NDRIs)
   • Atypical antidepressants
   • Tricyclic antidepressants
   • Monoamine oxidase inhibitors (MAOIs)
2. Psychotherapy - It is the most widely used treatment form for mild to moderate depression. Psychotherapies allow a patient to gain insight into their issues and resolve them through a verbal dialogue with the therapist.
   • Interpersonal and cognitive/behavioural therapy - These are short-term therapies that are useful in treating some forms of depression. Patients learn to unlearn certain behavioural patterns that could be contributing to their depression.
   • Psychodynamic therapy - These focus on treating a patient's internal psychological conflicts, typically rooted in the childhood.
3. Electroconvulsive therapy (ECT) - Formerly known as shock therapy, ECT is used when medication and psychotherapy does not provide relief from depression.
4. Trans cranial magnetic stimulation (TMS) - Patients who do not respond to antidepressants may opt for TMS. A treatment coil placed on the scalp passes brief magnetic pulses to stimulate nerve cells in the brain that are involved in regulating moods and depression.

What are the known complications in management of the disorder?

Depression can take a serious toll on not only patients but also their families. Left untreated, it can cause behavioural, emotional and health problems like the following:

• Alcohol or substance abuse
• Excess weight, obesity, heart disease, diabetes
• Anxiety, social phobia
• Suicidal tendencies, suicide attempts
• Self-mutilation
• Premature death from other medical conditions

How can the disorder be prevented from happening or recurring?

Though there are no sure ways to prevent the onset of depression, some habits and strategies can help:

• Taking charge of stress
• Reaching out to family and friends for timely support
• Seeking treatment at the earliest signs of depression
• Completing treatment as outlined by the doctor to prevent relapse

How can a caregiver give support and help the patient cope with the disorder?

Knowing a family member or friend who is suffering from depression can affect the other person too. A patient with depression may not be able to recognise the problem or seek help himself/herself - a friend or relative can help the patient to seek diagnosis and treatment, schedule appointments and accompany the patient to the doctor. A depressed patient requires the love and support of his/her loved ones and a near one can encourage the patient to stick to the treatment and motivate them through the process.