What is Depression?
Depression is a condition characterized by ongoing feelings of sadness and a lack of interest in activities. The American Psychiatric Association has a list it uses for diagnosing mental disorders, and it breaks down depression into five types:
1. Disruptive mood dysregulation disorder
2. Major depression
3. Constant depression (also known as dysthymia)
4. Pre-period severe depression
5. Depression due to another medical problem.
Common signs across all these types of depression are feelings of sadness or emptiness, or being easily irritated. They’re paired with physical and mental changes that seriously affect an individual’s ability to go about their daily life.
One issue is that misperceptions often stop nearly 60% of people with depression from seeking medical help. Many are afraid that having a mental health disorder would be seen negatively and could affect their personal and professional lives. However, evidence shows that most antidepressants do help, although the effectiveness can vary from person to person.
What Causes Depression?
The cause of major depressive disorder isn’t a straightforward one; it involves both genetics and environmental factors. For instance, people who have a family member with depression are approximately 3 times more likely to also get depression compared to the average person. However, it’s also true that depression can affect people with no history of the disorder in their families.
Some clues suggest that genes might not play as big a role in depression that starts later in life compared to when it begins at a younger age. There are also certain biological risk factors that have been linked to increased chances of depression in older people. These can include conditions like Alzheimer’s, Parkinson’s disease, stroke, multiple sclerosis, seizure disorders, cancer, and chronic pain.
Experiences in life, as well, can act as triggers to set off depression. Stressful events, like the death or loss of someone close, limited or no social support, the strain of caring for others, financial troubles, difficulties in relationships, and conflicts can all serve as triggers for depression.
Risk Factors and Frequency for Depression
Major depressive disorder, or simply known as depression, affects about 7% of people over a year. However, it is more prevalent in certain age groups and genders. Young adults who are 18 to 29 years old are three times more likely to experience depression compared to those who are 60 years or older. Also, from early adolescence, females are 1.5 to 3 times more likely to suffer from depression than males. In the US alone, nearly 17 million adults are affected by depression. However, this number is likely significantly higher as many people have never sought medical attention for their symptoms.
- Major depressive disorder affects around 7% of people over the span of a year.
- Those aged 18 to 29 are three times more likely to have depression than those aged 60 or older.
- Females are 1.5 to 3 times more likely to suffer from depression than males starting from early adolescence.
- In the US, nearly 17 million adults have depression.
- The actual number of people with depression is likely higher as many people have not sought medical help.
Signs and Symptoms of Depression
When examining an individual for signs of depression, the first step is to ask about changes in sleep, appetite, and energy levels. If these signs are present, then more specific symptoms of major depression are explored. According to the DSM-5, there are nine key symptoms of major depression:
- Difficulty with sleep
- Loss of interest or pleasure
- Feelings of guilt or worthlessness
- Changes in energy or feeling excessively tired
- Difficulty concentrating
- Changes in appetite or weight
- Disturbance in physical movements
- Thoughts of suicide
- Feeling down or depressed
A diagnosis of major depression can be made if five or more of these symptoms are present, and at least one of them needs to be either a depressed mood or a loss of interest or pleasure. It’s very important to assess anyone with depression to see if they’re at risk of suicide. This can be so serious it requires hospitalization or frequent monitoring to ensure safety.
In addition, doctors will investigate other areas such as:
- Past medical history, family medical history, and current medications
- Individual’s social circumstances, including potential stressors, and use of drugs or alcohol
- Physical health examination to rule out other potential causes of these symptoms
Minimizing the symptoms and understanding how severe they are can be aided by tools like the Beck’s Depression Inventory (BDI), Hamilton Depression Scale (Ham-D), and Zung Self Rating Depression Scale.
Testing for Depression
Depression is diagnosed mainly through a patient’s history and physical symptoms. Currently, there are no specific lab tests that can diagnose depression. However, lab tests can be useful in ruling out other medical conditions that might display similar symptoms to depression. Some common lab tests your doctor might order include:
- A complete blood count
- Thyroid-stimulating hormone test
- Vitamin B-12 levels
- Rapid plasma reagin test
- HIV test
- Tests for various electrolytes including calcium, phosphate, and magnesium
- Tests to check the functionality of your kidneys via blood urea nitrogen and creatinine levels
- Liver function tests
- Tests to measure your blood alcohol level
- Screening your blood and urine for toxic substances
In addition, two hormone tests, the dexamethasone suppression test and cosyntropin stimulation test, might be performed. These usually check for Cushing’s disease and Addison’s disease, but can also indicate depression.
If your doctor thinks your depressive symptoms might be caused by a physical change in your brain, they might order imaging tests such as a CT scan or MRI. These can help rule out conditions like organic brain syndrome or a condition that affects the pituitary gland (hypopituitarism).
Treatment Options for Depression
Depression can be relieved by medication or short-term psychotherapy methods like cognitive-behavioral therapy and interpersonal therapy. These treatments can also work well together, improving depressive symptoms, quality of life, and treatment adherence. Therapies like cognitive-behavioral therapy have even been shown to help prevent depression from returning.
For those who don’t respond well to medications or are feeling suicidal, Electroconvulsive therapy (ECT) can be useful.
Medications used for treating depression include Selective serotonin reuptake inhibitors (SSRIs), Serotonin/norepinephrine reuptake inhibitors (SNRIs), Atypical antidepressants, Serotonin-Dopamine Activity Modulators (SDAMs), Tricyclic antidepressants (TCAs), and Monoamine oxidase inhibitors (MAOIs).
SSRIs are often employed first and are easy to dose with low toxicity if taken in larger amounts. SNRIs can also serve as first-line agents, especially if a patient experiences extreme tiredness or pain with their depression. Atypical antidepressants are proven effective for major depressive disorders and can be paired with other therapies for tougher cases.
SDAMs, including brexpiprazole and aripiprazole, can sometimes be added in with other depression treatments. TCAs have a history of being effective but are less commonly used due to their side effects and risk in overdose. MAOIs are effective for a range of depression and anxiety disorders, but they come with certain risks and side effects. Thus, patients on this medication must follow a specific diet.
In terms of electroconvulsive therapy (ECT), it’s a highly effective treatment for depression. In fact, the benefits can often be seen within a week of starting treatment. ECT is best for those patients who don’t respond to other treatments, or if they’re a danger to themselves or potentially suicidal.
The psychotherapy methods of Cognitive Behavior Therapy and Interpersonal Therapy are also scientifically proven to be effective in treating depression.
Cognitive-behavioral therapy focuses on helping individuals identify and change damaging thought and behavior patterns. This therapy has been effective across all ages and can prevent depression relapse, especially benefiting elderly patients who can’t tolerate medication side effects.
Mindfulness-based cognitive therapy is made to reduce relapse in individuals previously treated for recurrent major depressive disorder with a focus on thought processes as a risk factor for relapse.
Interpersonal therapy emphasizes the role of interpersonal relationships and focuses on current interpersonal difficulties. This short-term treatment (typically over 16 sessions) helps address specific areas like grief, disputes, role transitions, and interpersonal deficits.
What else can Depression be?
- Conditions dealing with difficulty coping with stress, also known as adjustment disorders.
- Anemia, a condition where your body lacks enough healthy red blood cells.
- Chronic Fatigue Syndrome, a disorder characterized by extreme tiredness that can’t be fully explained by an underlying medical condition.
- Dissociative disorders, conditions that involve experiencing a disconnection between thoughts, memories, surroundings, actions, and identity.
- Illness Anxiety Disorders, previously known as hypochondriasis, where a person is excessively worried about having a serious illness.
- Hypoglycemia, a condition characterized by an abnormally low level of sugar (glucose) in the blood.
- Hypopituitarism, a condition where the pituitary gland doesn’t produce one or more of its hormones or not enough of them.
- Schizoaffective Disorders, a blend of symptoms of schizophrenia and mood disorder, such as depression or bipolar disorder.
- Schizophrenia, a severe mental disorder affecting how a person thinks, feels, and behaves.
- Somatic Symptom Disorders, conditions in which the primary symptoms are physical, causing significant emotional distress and difficulty functioning.
What to expect with Depression
Major depression is a serious condition that significantly impacts people’s health and can lead to suicide. Despite the availability of effective medications, almost half of the patients might not see improvement initially. While complete restoration to normal mood is not always achieved, at least 40% of patients experience some level of improvement within the first year.
However, it’s important to note that recovery is often challenging, with relapses being quite frequent. Many patients need different types of treatments to manage the symptoms. Unfortunately, the overall quality of life for most people suffering from depression is poor.
Depression is a major contributing factor to suicide, accounting for nearly 40,000 cases in the U.S. each year. The highest suicide rates due to depression are found among older men.