DEPRESSION, Causes and How to control and prevent yourself from depression?

DEPRESSION

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depression, major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and depression may make you feel as if life is not worth living.

Depression can be a part of several mental health problems:

• Bipolar disorder
• Borderline personality disorder (BPD) and other personality disorders
• Schizoaffective disorders

DIFFERENT TYPES OF DEPRESSION

Two of the most common forms pf depression are:

• Major depression having symptoms of depression most of the day, nearly every day for at least 2 weeks that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once person lifetime, but more often, a person has several episodes.
• persistent depression disorder having symptoms of depression that last for at least 2 years. A person diagnosed with this form of depression may have episodes of major depression along with periods of less severe symptoms.

Some form of depression are slightly different, or they may develop under unique circumstances, such as

• Perinatal depression: Women with perinatal depression experience full-blown major depression during pregnancy or after delivery(postpartum depression)
• Seasonal affective depression (SAD): SAD is type of depression that come and goes with the seasons, typically starting in the late fall and early winter and away during the spring and summer.
• Psychotic depression: This type of depression occurs when a person severe depression plus some from of phychosis, such as having disturbing false fixed beliefs (delusion)

Depression level based on gender and age

• Women have depression more often than men. Biological, lifecycle, and hormonal factors that are unique to women may be linked to their higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
• Men with depression are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognize their depression and fail to seek help.
• Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.
• Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.
• Older children and teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse.

Risk Factors for depression include:

• Prior episode(s)
• Family history of depressive disorder
• Female gender
• Postpartum period
• Peri/postmenopausal period
• Medical co-morbidity
• Lack of social support
• Major life stressor (loss of loved one or other members of social network)
• Substance abuse
• History of adverse childhood events 
• Negative cognitive style

Causes of depression

The exact cause of depression is not known. Many researchers believe it is caused by chemical changes in the brain. This may be due to a problem with your genes, or triggered by certain stressful events. More likely, it’s a combination of both.

Some types of depression run in families. But depression can also occur if you have no family history of the illness. Anyone can develop depression, even kids. The following may play a role in depression:

• Alcohol or drug abuse
• Certain medical conditions, including underactive thyroid, cancer, or long term pain
• Certain medications such as steroids
• Sleeping problems
• Stressful life events, such as:
• Breaking up with a boyfriend or girlfriend

• Failing a class
• Death or illness of someone close to you
• Divorce
• Childhood abuse or neglect
• Job loss
• Social isolation (common in the elderly)

What are the signs and symptoms of depression?

Sadness is only one small part of depression and some people with depression may not feel sadness at all. Different people have different symptoms. Some symptoms of depression include:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies or activities
• Decreased energy, fatigue, or being “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide or suicide attempts
• Restlessness or irritability
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Tests and diagnosis of depression

Diagnosis of depression starts with a consultation with a doctor or mental health specialist. It is important to seek the help of a health professional to rule out different causes of depression, ensure an accurate differential diagnosis, and secure safe and effective treatment.

Screening

Screen patients who present with symptoms for MDD.3 Note that some patients present with somatic symptoms. Use the ‘two quick question’ screening method.

In the past month:

• Have you lost interest or pleasure in things you usually like to do?
• Have you felt sad, low, down, depressed or hopeless? An answer of yes to either question requires a more detailed assessment
• An answer of yes to either question requires a more detailed assessment

Assessment

The detailed assessment includes: • Clinical interview to determine if the patient meets the Diagnostic and Statistical Manual of Mental Disorders criteria to diagnose MDD by using SSIGECAPS and focusing on functional status.

S – Sadness (depressed mood)

S – Sleep disturbance (insomnia, hypersomnia)

I – Interest reduced (anhedonia)

G – Guilt and self-blame

E – Energy loss and fatigue

C – Concentration problems

A – Appetite changes (low/increased appetite or weight loss/gain)

P – Psychomotor changes (retardation, agitation)

S – Suicidal thoughts

Review PHQ-9 score and responses.* The PHQ-9 is a patient administered questionnaire that aids in the diagnosis and assesses the severity (e.g., mild, moderate, severe) of depression.6-9

Consider:

• Differential diagnosis, particularly screening for Bipolar I and II;
• Past history of depression and its treatment;
• Family history of a mood disorder;
• Psychosocial stressors;
• Any medical conditions associated with depression (e.g., chronic obstructive pulmonary disease, migraine, multiple sclerosis, back problems, cancer, epilepsy, asthma, stroke, thyroid disease, diabetes and heart disease); and Collateral information from family or friends

Differential Diagnosis

When arriving at the differential diagnosis, consider the following:

• Ruling out medical conditions that require laboratory tests (e.g., thyroid stimulating hormone, Vitamin B12);
• Other psychiatric syndrome (e.g., adjustment disorder, anxiety disorder, bipolar disorder I or II, psychosis, alcohol and/or substance abuse);and
• Medications that mimic mood disorders (see Appendix A: Medications that Mimic Mood Disorders).

Suicide Risk Assessment

Once patient has met MDD criteria, conduct a suicide risk assessment.

• Ask the patient if they have thoughts of death or suicide, feel life is not worth living, have made a previous suicide attempt and if there is a family history of suicide.
• If the answer is yes to any of the above, ask about their plans for suicide (e.g., have they considered a method, do they have access to material required for suicide and if they have written a note).
• Consider emergency psychiatric consultation and in-patient treatment if the patient has: persistent suicidal thoughts; a previous suicide attempt; or a current plan.
• If the patient is considered low risk, discuss and/or create a safety plan with the patient, detailing steps the patient will take if their situation deteriorates.

Treatment and medications for depressed person

The first step in getting the right treatment is to visit a health care provider or mental health professional, such as a psychiatrist or psychologist. Your health care provider can do an exam, interview, and lab tests to rule out other health conditions that may have the same symptoms as depression.

Once diagnosed, depression can be treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, brain stimulation therapy may be another treatment option to explore

Medications

• Medications called antidepressants can work well to treat depression.
• Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of the neurochemical serotonin in the brain. SSRIs are often the first-line treatment for depression. Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil), ser traline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Tricyclics and tricyclic-related drugs
• Monoamine oxidase inhibitors (MAOIs)

They can take 2 to 4 weeks to work. Antidepressants can have side effects, but many side effects may lessen over time. Talk to your health care provider about any side effects that you have. Do not stop taking your antidepressant without first talking to your health care provider.

Psychotherapy

Psychotherapy helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to depression. Therapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse.

Brain stimulation therapies

• Electroconvulsive therapy (ECT) and other brain stimulation therapies may be an option for people with severe depression who do not respond to antidepressant medications. ECT is the best studied brain stimulation therapy and has the longest history of use.
• Transcranial magnetic stimulation (TMS) uses pulses of energy to stimulate nerve cells in the brain that are believe to affect mood. There is some research to suggest that it can help relieve depression.
• Light therapy may relieve depression symptoms in the winter time. However, it is usually not considered a first-line treatment.

How to control and prevent yourself from depression?

As you continue treatment, you may start to feel better gradually. Remember that if you are taking an antidepressant, it may take 2 to 4 weeks to start working. Try to do things that you used to enjoy. Go easy on yourself. Other things that may help include:

• Trying to be active and exercise
• Breaking up large tasks into small ones, set priorities, and do what you can as you can
• Spending time with other people and confide in a trusted friend or relative
• Postponing important life decisions until you feel better. Discuss decisions with others who know you well
• Avoiding self-medication with alcohol or with drugs not prescribed for you

How to support a person who is depressed?

If you know someone who has depression, first help him or her see a health care provider or mental health professional. You can also:

• Offer support, understanding, patience, and encouragement
• Never ignore comments about suicide, and report them to your loved one’s health care provider or therapist
• Invite him or her out for walks, outings, and other activities
• Help him or her adhere to the treatment plan, such as setting reminders to take prescribed medications
• Help him or her by ensuring that he or she has transportation to therapy appointments
• Remind him or her that, with time and treatment, the depression will lift