Depression

Depression

What is depression?

A loss of interest in things once enjoyed and persistent feelings of sadness are caused by a mood disorder known as depression. Depression is also referred to as clinical depression or major depressive disorder. The condition affects how one feels, behaves and thinks and often results in a number of emotional and even physical issues. Completing daily activities may become problematic as the person feels unmotivated and often hopeless, making everything seem pointless.

It is important to note that someone with depression is not just going through a phase of the ‘blues’, it is also not simply a weakness and one cannot just ‘snap’ out of it. It often requires long-term treatment.

Some of the hallmark symptoms of depression are sadness, anger, loss and even loneliness. The condition can have a negative effect on personal relationships, work, school and may even cause some other chronic health conditions or disorders. Most sufferers feel discouraged and unmotivated to live their lives, this often results in low productivity levels and lost time.

Arthritis, asthma, cancer, diabetes, obesity and cardiovascular diseases are a few examples of chronic conditions that can progress if someone has depression. There is no need, however, to feel discouraged, as most patients are able to lead healthy lives through therapy, medication and other forms of treatment.

It is best to always consult with a doctor or psychologist if you feel as though you or a loved one has depression as the condition can progress over time if left untreated. Those who seek treatment will often see dramatic improvements in their daily lives and symptoms with a matter of weeks.

In the following article, you will find all the information you need to know about depression and how it is treated, diagnosed and dealt with. Please be advised that this information is written as a guideline and should not be seen as a professional opinion.

Depressed man

What are the symptoms of depression?

Depression may only occur at one time in one’s life, however, in some cases, people will suffer from multiple episodes of the condition. Symptoms experienced during these episodes can occur for most of the day and can happen nearly every day. Many people who suffer from depression have symptoms that are serious enough to be noticed as they impact their day-to-day functioning and ability to complete tasks. The social life, school, work, relationships and other activities of someone with the condition will normally take a toll.

In some cases, patients feel depressed without having a reason why. This is not to say that a certain situation isn’t able to spark an episode of depression such as the death of a loved one, although these cases are generally more easily diagnosed, with time often being a key factor in the resolution of depression.

Not all people who experience depression will also experience every single one of the associated symptoms. Some people will experience only a few symptoms, other may experience a number of them. Several of the symptoms of depression, as well as a low mood, are typically required for the patient to be diagnosed with major depression.

However, should someone have only a few of the symptoms but still feel distressed by them, they may be diagnosed with subsyndromal depression. This is known as subsyndromal symptomatic depression, also referred to as SSD. This is a term used to describe a person’s symptoms falling short of the criteria needed to diagnose them with major depressive disorder (MDD).

Major depressive disorder is characterised by persistently feeling depressed and experiencing a loss of interest in daily activities. This results in a significantly negative impact on one’s life.

The dictionary defines depression as a condition of emotional withdrawal and rejection, where the patient expresses emotions of sadness that are significant and not warranted by a specific or objective reason.

The difference between depression and major depression

Major depression, also called clinical depression or major depressive disorder, also known as MDD, is a more severe form of depression. The symptoms of major depression are experienced on most days and will last for at least 14 days in order for the diagnosis to be that of major depression.

For clinical depression or major depression to be diagnosed, the patient must have five or more of the symptoms of depression for most of the duration of their day, with at least one of the symptoms being a loss of pleasure or interest or a depressed mood. Depression is sometimes deemed to be a less severe form of major depressive disorder, however, the two terms are often used interchangeably.

The symptoms of depression include the following:

  • Feeling sad, tearful, empty or hopeless
  • Experiencing outbursts of anger, frustration and irritation over matters that can be large or small
  • Losing interest and pleasure in most activities that were once met with enthusiasm, these include sex, sports and hobbies
  • Not sleeping well, sleeping too much or suffering from insomnia
  • Feeling tired all the time and suffering from a lack of energy, even completing small tasks seems to take up a lot of energy
  • Having a suppressed appetite which can result in weight loss
  • Having an increased appetite and cravings for certain things which may result in weight gain
  • Feeling agitated, anxious or restless
  • Experiencing slow thinking, body movements or speaking
  • Feeling worthless or guilty
  • Fixating on failures of the past or taking responsibility for things that have nothing to do with the sufferer
  • Having issues with concentration, thinking, memory and making decisions
  • Experiencing suicidal thoughts or thinking of death, and even attempting suicide
  • Having inexplicable physical issues such as headaches or backache

Symptoms of depression in children and adolescents

The common symptoms and signs of depression in children and adolescents are very similar to the symptoms found in adults, however, it is beneficial to know the differences.

  • The symptoms seen in children typically include those of irritability, sadness, worry, pains, body aches, being underweight or refusal to attend school.
  • The symptoms seen in adolescents or teenagers often include feelings of negativity, worthlessness, sadness, anger, not performing well at school, feeling extremely sensitive or misunderstood, using alcohol and drugs, wanting to sleep all the time, eating too much, harming themselves, losing interest in their hobbies, avoiding social interaction.

Please note that teenagers expressing some of the above symptoms can often be seen as a normal part of growing up as they learn who they are in the world and what their likes and dislikes are. However, if as a parent or concerned loved one, you notice changes in their behaviour that are destructive or negatively impacting their lives, then it is best that you seek professional help.

Children who have been diagnosed with ADHD, also known as attention-deficit hyperactivity disorder, may generally demonstrate emotions of irritability without a loss of interest or sadness, however, it is also possible for ADHD to occur simultaneously with major depression.

Symptoms of depression in adults

Depression is not considered a normal part of growing up and the condition should not be taken lightly at any age. In many cases, depression may be overlooked and not diagnosed or treated in older adults, as they often feel reluctant to share their emotions and feelings of depression. The symptoms of the condition can, therefore, be less prominent or obvious in older adults, these include:

  • Suffering from physical aches and pains
  • Having memory issues and changes in personality
  • Loss of appetite, having sleeping issues, loss of sexual drive that is not the result of another condition or medication
  • Wanting to stay home and not socialise
  • Experiencing suicidal thoughts (particularly in men who are older)

When to see a doctor regarding depression

If you or a loved one is feeling depressed or unusually sad for no specific reason over an extended period of time, then it is best that you make an appointment with your doctor or mental healthcare professional.

Admitting to feeling depressed and seeking help is not a sign of weakness but considerable strength, courage and intelligence, as being reluctant to seek medical help can have adverse consequences.

Effective treatment not only helps to alleviate the feelings and symptoms of depression but also the feeling of being a burden on loved ones and others which is often very empowering for the person concerned.

When to seek emergency help regarding depression

If you or a loved one is experiencing suicidal thoughts or has attempted suicide, then you need to seek emergency help, particularly if suicide has been attempted. The following options can be considered if you or a loved one is having thoughts that are suicidal:

  • Calling your doctor or a mental health professional
  • Calling a suicide hotline
  • Reaching out to a loved one or friend

If a loved one of yours has attempted suicide, then the following should be done:

  • Call your local emergency number immediately and follow the instructions of the operator in order to help assess the situation and give first aid where necessary.
  • Ensure that you or someone else stays with the person concerned and provides them with comfort and support until help arrives.
  • In cases where moving the person will not cause further harm, rush them to the nearest emergency room

What causes depression?

Depression is thought to have a number of possible causes. One such cause can be trauma experienced in early childhood. This is due to the body reacting to stressful and fearful situations adversely. Another cause of depression may be genetics and the condition has been known to be inherited, making you more likely to develop depression if a parent or family member has it.

However, the exact cause of the condition it not yet known. As with several mental conditions, the cause may have a number of contributing factors, these include:

  • Biological changes – Those who are diagnosed with depression have been found to have biological and physical differences in their brain. These changes in the brain and their impact on the condition are not yet certain, however, they do aid in pinpointing the cause of the condition later on in the diagnostic process.
  • Brain chemistry – There are neurotransmitters found in the brain that are responsible for relaying messages. These have been found to play a role in the development of depression. Recently, there has been research done that shows that changes in the functioning of these neurotransmitters affecting how they interact with the neurocircuits, which are responsible for maintaining one’s mood stability, have an impact on the development of depression and the treatment thereof.
  • Hormones – If there are changes in the balance of hormones in the body, these may cause or trigger depression. Changes in hormones can often result from being pregnant, having thyroid issues and going through menopause, amongst a number of other health problems and conditions.
  • Inherited traits (genes) – As stated, depression is commonly seen in those who have someone in their family who has been diagnosed with the condition. There is still research being done to find the exact genes responsible for the development of the condition.

The following are more specific causes of depression:

  • Suffering from abuse – This can include emotional, physical or sexual abuse that happened in the past. This has been known to increase one’s vulnerability to depression developing.
  • Taking certain medications – There are a large number of drugs such as the antiviral drug interferon-alpha and isotretinoin (Accutane) that is used for the treatment of acne, that are known to increase the risk of depression.
  • Experiencing personal disputes or conflict – Experiencing these with a friend or loved one may spark depression in someone who is genetically vulnerable to the condition.
  • Suffering from the death or loss of a loved one – Grief and sadness that are associated with the loss or death of someone close to one has been known to increase the risk of depression.
  • Going through a major event – Graduating, starting a new job, getting married, getting divorced, losing a job, retiring or having a baby may be stressful situations for some that can lead to depression. However, to be diagnosed with clinical depression is more than a normal response to situations deemed stressful in life and involves persistent symptoms over an extended period that do not resolve on their own or with time.
  • Having personal issues – Being isolated, having a mental illness or being bullied may contribute to the development of depression.

What are the risk factors for depression?

Depression will often begin during the teens and into the 20s and 30s. However, it can become present at any age in one’s life. Typically, more women are diagnosed with depression than men. Experts argue that this is not actually an indication that more women suffer from depression than men, but this may rather be due to the fact that women are more likely to seek treatment and discuss their emotional state than their male counterparts.

We discussed the causes of depression previously, some of these may be linked to the risk factors of depression.

There are several risk factors that have been identified in the development and triggering of depression, these include the following:

  • Having certain traits in one’s personality such as being overly dependent on others, having low self-esteem, being pessimistic or self-critical.
  • Going through stressful or traumatic events, these include sexual or physical abuse, the loss or death of a friend or loved one, being in a difficult or abusive relationship or having financial problems.
  • Having a history of a traumatic or abusive childhood or depression that began when the patient was a child or teenager.
  • Having family members who have has a history of bipolar disorder, depression, addiction or suicide.
  • Having a history of mental conditions such as anxiety, PTSD (post-traumatic stress disorder) or eating disorders.
  • Having a severe condition or a chronic condition such as cancer, stroke, heart disease or chronic pain.
  • Taking certain medications such as treatment for hypertension (high blood pressure) or sleeping tablets.

What are the complications of depression?

Depression should not be deemed a mediocre condition and taken lightly as it can take a toll on families and particularly the individual with the disorder.

It is a serious condition and can progress when left untreated. If depression is not treated it can often result in ill health, behavioural and emotional problems that may affect all areas of the sufferer’s life.

The following are examples of complications that are associated with depression:

  • Gaining excess weight or becoming obese, this may lead to diabetes, heart disease or metabolic syndrome.
  • Experiencing physical illness and pain
  • Misusing drugs or alcohol which in turn has a variety of personal, social and health related consequences.
  • Suffering from panic attacks, social phobia or anxiety
  • Having suicidal thoughts, attempting suicide or committing suicide
  • Mutilating oneself through cutting or other means
  • Suffering from premature death from other medical disorders or conditions

How is depression diagnosed?

Depression can be difficult to diagnose as it is able to manifest in a number of ways that differ from one individual to another, as previously mentioned in the above section on the causes of depression. For example, someone who has clinical depression may show symptoms of social withdrawal or apathy, another person suffering from the same condition may react through agitation or irritability.

The following is a list of tests and exams that are able to assist in ruling out any other issues that may result in the symptoms of depression, provide an accurate diagnosis and check for any related complications:

  • Conducting a physical exam – Here, the doctor will ask questions on the patient’s health and symptoms and conduct a physical exam. In some situations, the patient’s depression can be linked or caused by an underlying health issue that is often physical.
  • Conducting lab tests – In this case, the doctor may conduct a blood test known as a complete blood count (CBC), in addition, the doctor may also check the performance and functioning of the patient’s thyroid so as to ensure that the underlying cause is not related to hormonal issues.
  • Conducting a psychological evaluation – Doctors or a mental healthcare professional such as a psychologist or psychiatrist will most likely ask a series of set questions that help reveal the cause of the condition, these are regarding the patient’s behaviour, past events and present happenings. For example, the patient can report on things such as their behaviours, lifestyle habits and daily moods. In some cases, the patient will be asked to fill out a questionnaire.
  • Utilising the DSM-5 criteria – The doctor or mental healthcare professional may use the DSM-5 criteria, or otherwise known as the Diagnostic and Statistical Manual of Mental Disorders, which was published by the American Psychiatric Association. This is a set of criteria that are used by doctors in the diagnosis of mental conditions such as depression.

What are the different types of depression?

There are a number of different types of depression and symptoms of major depression or clinical depression often vary depending on the patient. In order to clarify the type of depression the patient has, the doctor may add a specifier or two.

Specifiers mean that the depression has specific features or symptoms, these may include:

Anxious distress 

This means that the depression is marked by worry, distress or unusual restlessness about losing control over one’s life or about a possible event that may or may not take place.

Mixed features 

This denotes mania and depression that occur simultaneously. Symptoms include having self-esteem that is elevated, having increased energy and talking more than usual. Symptoms of mania mean the patient is unusually happy or excited for a period, therefore they have bouts of unexplained euphoria and then experience depression at other times.

Melancholic features 

Melancholic features are associated with cases of severe depression that are marked by a lack of excitement, enthusiasm or interest.  Waking up early and negative moods in the mornings (i.e. symptoms of this specifier are often worse in the mornings), acting negatively or not at all to something that was once met with emotions of happiness in the past, losing one’s appetite, or having major changes in appetite or expressing feelings of sluggishness, guilt or agitation are symptoms of depression marked by melancholic features.

This type of depression used to be seen as a distinct disorder, however, it is now no longer recognised as a separate mental condition, but rather a specifier, or subtype of MDD (major depressive disorder). It is defined by intense and persistent emotions of hopelessness and sadness, affecting multiple areas of one’s life. People with melancholic depression may have the below symptoms:

  • Extreme and persistent feelings of sadness over a prolonged period
  • Loss of enthusiasm and interest in things that were once met with excitement
  • Acting anxious and irritable
  • Changes in appetite (eating too little or too much)
  • Changes and twitches in body movement such as shaking one’s leg (something that was not done before)
  • Suicidal thoughts or thoughts of death
  • Loss of pleasure in daily activities
  • Not wanting to wake up in the morning at all

Atypical features 

Atypical depression is referred to as a subtype of depression and can be a specifier for both major depression and dysthymic disorder (aka persistent depressive disorder).

As the name implies, it does not follow typical depression symptoms in that the person suffering from it may be temporarily cheered up by the occurrence of positive events (which is not generally the case with other forms of depression).

 This type of depression consists of the following symptoms:

  • Suffering from hypersomnia, this means sleeping too much and possibly not wanting to wake up
  • Having an increased appetite which leads to weight gain
  • Experiencing feelings of being paralysed or constantly weighed down
  • Having an increased sensitivity to criticism or rejection, this often results in issues at work and in personal relationships.

The cause of this specifier of depression is believed to be due to issues with the functionality of brain circuits that are responsible for regulating one’s mood and allowing one area of the brain to communicate with another through the use of neurotransmitters, which are chemicals in the brain that allow for the brain to transmit signals and tell the body how to function properly.

Nerve cells in these communication circuits use neurotransmitters (chemicals which include serotonin, norepinephrine and dopamine) as the communicators and when issues arise with regard to the functioning of these systems, changes emerge in the brain that may lead to depression.

Psychotic features

This is also known as psychotic depression, and it is marked by psychotic features such as delusions, paranoia or hallucinations experienced by the patient. Delusions are false perceptions of, or false beliefs regarding reality wherein the deluded person cannot distinguish between what is real and imagined. Hallucinations, on the other hand, are a sensory experience wherein the patient may hear, see or feel something that does not exist. Hallucinations are generated by one's mind, as opposed to external stimuli. 

For example, someone may believe that their partner is trying to murder them, this is a delusion, a hallucination is seeing something that is not there, such as seeing wolves attacking them when in actual fact, there are no wolves. This can be a very stressful situation for someone to go through and terrifying for both themselves and those around them.

Catatonia 

Catatonia, which is also known as catatonic depression, is defined as a state of stupor, stupor meaning a state of near-unconscious or being dazed.

This type of depression results from motor (muscle movement) activity and involves either purposeless or uncontrollable movements, being in an inflexible posture or a rigid position being held for a long period of time. The patient may feel leaden, this is a state of paralysis where the body will feel heavy in the arms and legs, feeling as though they are unable to move.

Peripartum onset 

Also known as postpartum depression, this specifier of depression usually occurs within the first four months after giving birth but can present itself at any time within the first year after birth (thus being termed postpartum or postnatal depression.) It may also occur during a pregnancy in some cases.

It is defined by symptoms of a loss of appetite, feelings of shame, finding it difficult to bond with one’s baby, feeling guilty or inadequate as a parent. Roughly 10 to 13 percent of women who have recently had a baby will suffer from this type of depression after their baby has been delivered, however, as mentioned, the symptoms can begin before the baby is delivered This condition is not restricted to women only and can affect both the mother and father, being particularly prevalent in first time parents.

Many women who have had a natural birth do not have as high of a risk of developing this type of depression as their body will naturally release oxytocin, which is a ‘happy’ hormone that is released during the birthing process.

It is also important to note that suffering from “baby blues”, a normal, short-term period (lasting up to two weeks) which is thought to affect up to 80 percent of new mothers, making them feel sad and weepy or irritable and moody, due to changing hormone levels after giving birth, is not the same thing as peripartum onset depression whose symptoms are persistent and longer lasting.

Seasonal pattern 

This type of depression is related to the changes in the seasons as well as being exposed to sunlight, or more specifically, the lack thereof. This is also known as seasonal affective disorder, abbreviated as SAD. It can often result in patients becoming depressed in the colder, darker months. However, it is important to note that there is no hard evidence to suggest that this type of depression is real, although it is a specifier of depression.  

Other disorders that cause the symptoms of depression

There are a number of other disorders, most of which are listed below, that include depression as one of the symptoms. It is vital to always acquire a diagnosis that is accurate from a trained and certified medical or mental health professional so as to be treated correctly.

If one is simply treated for depression and the doctor is unable to find the underlying cause or condition, then one may be given medication that is not suitable for the actual disorder.

The following are conditions that have depression as a symptom:

Bipolar I and II disorders

These are mood disorders that are marked by episodes of mania and depression. The patient will suffer from bouts of extreme elation, followed by feeling unhappy and depressed. Depression is one of the hallmark symptoms of bipolar disorder, the others being mania or hypomania. It can often be difficult to distinguish between bipolar and depression.

Cyclothymic disorder

Cyclothymic, which is pronounced “sy-kloe-THIE-mik”, involves moods that consist of mania and depression that are often milder than episodes of bipolar disorder. People with this condition tend to function normally in their daily lives, although it can often be difficult to do so. The psychological highs and lows are intermittent and can often progress to become more pronounced in time when left untreated.

Disruptive mood dysregulation disorder

This disorder is known as DMDD, and is a mental condition in adolescents and children that is characterised by having a persistently angry or irritable mood with temper outbursts, or tantrums that are considered inappropriate to the situation and appear to be more severe than the moods of their peers of the same age.

Persistent depressive disorder

This condition also known as dysthymia, pronounced dis-THIE-me-uh, is defined by a low mood that occurs for a period of at least two years, as well as at least two of the other depression symptoms.

It is a more chronic, yet less severe form of clinical depression. It is not disabling to the patient, however, being persistent it can prevent them from living a normal life and enjoying their daily activities.

Some of the symptoms include:

  • Feeling hopeless
  • Decreased appetite
  • Having constantly low energy
  • Experiencing changes in sleeping patterns
  • Suffering from poor concentration
  • Losing interest in activities
  • Feeling like you are not living life to the fullest

Premenstrual dysphoric disorder

This condition which is often referred to as PMDD, can be seen as a disabling form or rather, extension of PMS, being premenstrual syndrome. It includes behavioural and physical symptoms that are normally resolved with the onset of the patient’s menstruation. PMDD results in extreme mood swings that often disrupt productivity and impact relationships. The symptoms often include:

  • Feeling hopeless
  • Breast tenderness
  • Anger
  • Irritability
  • Bloating

This form of depression has symptoms that are associated with the hormone changes that start one week before the onset of a menstrual period and will improve once the period over.

Other depression conditions and disorders

These include depression that is a result of prescribed medications, a medical condition or the abuse of recreational drugs.

How is depression treated?

Psychotherapy, which is known as psychological counselling, and medications are regarded as effective in most cases of depression. Medication may be prescribed by the psychiatrist or doctor to help relieve the symptoms. Keep in mind that a lot of people who suffer from depression will benefit from sessions with a mental health professional such as a psychologist or psychiatrist.

In some more severe cases, a hospital stay may be necessary or joining an outpatient program is advisable until the symptoms improve. The following are the treatment options for depression:

    Medication for depression

Medications

There are a number of types of medications, known as antidepressants, available for the treatment of depression, it is advised that the possible side effects be discussed with the prescribing doctor.

What are the side effects of antidepressants?

A very effective means of treatment for depression is the use of antidepressants. These can be used to treat both anxiety and depression. However, they do unfortunately come with some adverse side effects. These side effects include:

  • Fatigue
  • Weight loss
  • Weight gain
  • Insomnia
  • Memory loss
  • Loss of libido
  • Nausea

How do antidepressants work?

Antidepressants such as SSRIs, the abbreviation for selective serotonin reuptake inhibitors, also known as happy pills or happy tablets, work through increasing the serotonin levels of the brain. Serotonin is one of the brain’s chemical messengers, also known as a neurotransmitter, and is responsible for carrying signals between the brain cells. Neurotransmitters basically allow for the brain to communicate and tell the body what to do. SSRIs stop the brain from reabsorbing the serotonin, or rather, block the reuptake of it, and therefore make it possible for more serotonin to be present in the brain, this helps improve the patient’s mood.

The list below are some antidepressants that are normally prescribed to treat depression:

  • SSRIs (Selective serotonin reuptake inhibitors) – An SSRI is normally prescribed first by doctors. These kinds of medications tend to be safer to use as they have less side effects than others. Types of SSRIs include:
    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)
    • Paroxetine (Paxil, Pexeva)
  • SNRIs (Serotonin-norepinephrine reuptake inhibitors) – These types of medications help in easing symptoms of depression that include sadness and irritability. Types of these medications include:
    • Duloxetine (Cymbalta)
    • Desvenlafaxine (Pristiq, Khedezla)
    • Venlafaxine (Effexor XR)
    • Levomilnacipran (Fetzima)
  • NDRIs (Norepinephrine-dopamine reuptake inhibitors) – These are a popular type of medication as they are not associated with any sexual side effects and are used to treat chronic pain and menopausal symptoms. The most common medication is Bupropion (Wellbutrin, Aplenzin, Forfivo XL).
  • Atypical antidepressants – There are nerve cells that transmit signals in the brain using chemicals known as neurotransmitters, such as serotonin, norepinephrine and dopamine. Antidepressants are believed to change or alter these chemicals to improve their efficiency and help regulate someone’s mood. Atypical antidepressants do not fit into the same categories as other antidepressants and each has a unique effect and way of working. Mirtazapine (Remeron), trazodone, vilazodone (Viibryd) and vortioxetine (Brintellix) are some examples of these.
  • Tricyclic antidepressants – These types of antidepressants are normally very effective in treating the symptoms of depression but have more severe side effects than others. Because of this, tricyclics are not normally prescribed unless an SSRI has first been tried. These include:
    • Imipramine (Tofranil)
    • Trimipramine (Surmontil)
    • Doxepin
    • Protriptyline (Vivactil)
    • Amitriptyline
    • Nortriptyline (Pamelor)
  • MAOIs (Monoamine oxidase inhibitors) – These kinds of medications also have more serious side effects and are generally only prescribed once other antidepressants have been tried and deemed ineffective. These medications also require a very strict diet as they can be extremely dangerous when taken with certain foods and other medications. Dangerous interactions occur with some wines, pickles, birth control pills and decongestants. These types of medications cannot be combined with SSRIs. MAOIs include:
    • Tranylcypromine (Parnate)
    • Isocarboxazid (Marplan)
    • Phenelzine (Nardil)
    • Selegiline (Emsam) – This is a newer kind of MAOI that comes in the form of a skin patch and causes fewer side effects than other forms of MAOIs.

Other medications 

It is possible to mix other medications with antidepressants that have been prescribed. In some cases, a doctor may prescribe the combination of two antidepressants such as antipsychotics and mood stabilisers. Stimulant medications and anti-anxiety medications are also able to be prescribed for short-term use. 

Finding the right medication for depression

Doctors can sometimes judge the efficacy of a medication and how it will work for the patient according to how a family member with depression may have responded to the same type of drug.

In other situations, the patient may have to try a variety of drugs and combinations thereof before finding the right kind of treatment. Patience is required from both the doctor and patient as the medications often need a number of weeks to achieve their full effect and show results, this is also the amount of time it will take for the side effects to become prominent if there are any.  

Risks of abruptly stopping antidepressant medication

It is advised that patients do not stop their medication without first talking to their doctor. Antidepressants have not been deemed addictive, however, in some cases, a physical dependence on them can occur.

Suddenly stopping one’s treatment or missing a number of doses can result in the symptoms of withdrawal or worsen depression. It is best to always work with a doctor to decrease or increase the dosage safely.

Pregnancy and antidepressants

If one happens to be pregnant or is breastfeeding, then some types of antidepressants may pose a risk for both the mother and baby. If a woman is diagnosed with depression, then it is best to speak to a doctor about medications that are safe for both herself and her baby preferably before falling pregnant or as soon she finds out that she has conceived.  

Increased suicide risk and antidepressants

Doctors say that most types of antidepressants are safe to take, however, all of them have warnings against taking them without extreme caution and care. There are some cases where patients under the age of 25 have experienced increased suicidal thoughts when taking prescribed antidepressants. This is particularly seen the in the first couple of weeks after the medication has been started or if the dosage has been changed.

Any patient who is taking antidepressants should be monitored for unusual behaviour, particularly in the first few weeks. Bear in mind, antidepressants are meant to reduce the risk of suicide and are usually effective in doing so over a period of time through improving the patient’s mood. That said, not all medication has the desired effect and often types and dosages need to be altered in order to find the best one to treat the person concerned.

Psychotherapy

This refers to the patient attending sessions with a mental health professional where they can discuss their symptoms and learn how to deal with them. This is normally done with the help and guidance of a psychologist or a psychiatrist.

Psychiatrists are trained medical professionals who are able to prescribe medications such as antidepressants as well as offer psychotherapy. Psychologists, on the other hand, offer psychotherapy exclusively. Psychotherapy refers to treating mental and emotional issues through the means of behavioural intervention. This is also known as psychological therapy or talk therapy.

There are a number of different types of psychotherapy available, these include interpersonal therapy and cognitive behavioural therapy. IPT, which is interpersonal therapy, is a kind of therapy that focuses on resolving interpersonal issues, as well as facilitating symptomatic recovery. It follows a time-limited approach that is highly structured, intended to be completed with 12 to 16 weeks.

Cognitive behavioural therapy is a kind of psychotherapy that involves challenging negative thought patterns in order to alter them and treat certain mood disorders.

Psychotherapy is able to assist patients in the following ways:

  • Helping them to adjust to a difficult current crisis
  • Identifying negative behaviours and beliefs and replacing these with positive ones
  • Exploring experiences and relationships and then helping to create positive interactions on social and personal levels
  • Finding more effective ways to solve problems and deal with current issues
  • Identifying problems that are contributing to depression and changing behaviours that make the condition worse
  • Teaching the patient to develop goals for their life
  • Developing the ability to accept and tolerate distressing situations through practicing healthier behaviours

Residential and hospital treatment

Some cases of depression are extremely serious and require a hospital stay in order for the patient to be closely monitored. This is sometimes needed when the patient is unable to care for themselves or is in danger of inflicting self-harm. This hospital stay will involve psychiatric care that helps the patient remain calm and not attempt to hurt themselves until their mood and psychological state has improved.

In other cases, the patient may only need partial hospitalisation or a day treatment program in order to get the help they need. These kinds of programs provide outpatient support as well as the counselling that is required to manage symptoms and get them and the patient’s mental health under control.

Other treatment options

In some cases, doctors may recommend the treatments listed below:

  • ECT (Electroconvulsive Therapy) – This kind of treatment involves passing electrical currents through the patient’s brain. This procedure is performed under anaesthetic and is said to impact the ability of the neurotransmitters in the brain to allow for immediate relief of symptoms associated with even severe depression, this is done when other means of treatment are seen to be unsuccessful. The side effects are normally tolerable, a headache being the most common. Memory loss may also be one of the temporary side effects. Patients who typically undergo ECT do not respond to medications or cannot take antidepressants due to other health concerns.
  • TMS (Transcranial Magnetic Stimulation) – This kind of treatment is often an option for patients who do not respond to antidepressant medications. During this procedure, the patient will sit in a recliner chair, and whilst the patient is awake, the doctor will place a treatment coil against their scalp. This coil will send brief pulses of magnetic frequencies to stimulate the nerve cells in the brain that are involved in depression and regulating mood. This treatment is usually done over a period of six weeks, five times a week.  

**My Med Memo: In the majority of cases, depression can be effectively treated. The earlier the treatment begins, the better the outcome. Always keep in mind that no two cases of depression are the same. There is no such thing as a ‘one-size-fits-all’ approach when it comes to treating depression. It often takes patience and trial and error to find the best treatment plan.

Alternative medicine

This is an unconventional means of treatment. These include complementary medications such as herbal supplements, acupuncture, nutritional therapy and even light-therapy. It is best not to replace conventional medications and prescriptions with unconventional ones.

In the case of depression, unconventional means of treatment cannot be viewed as medical care. It is best to always understand the benefits as well as the risks associated with alternative medicine options and speak to a doctor before exploring unconventional routes as many of these supplements can interact with prescription medications and have adverse effects.

Alternative supplements

Examples of alternative supplements that are often used for depression when following an alternative route include:

  • St. John's wort – This is a herbal supplement that is yet to be approved as a means of treatment for depression in the U.S. by the FDA (Food and Drug Administration). However, it is a very popular treatment in Europe. Effective results are often seen in those who have a mild case of depression. This supplement has been known to interfere with several medications, and because of this, the use of it should be done with caution. Interferences with other medications include those used in chemotherapy, birth control pills, AIDS/HIV drugs, and drugs used to aid the body in not rejecting an organ transplant. The combination of St. John’s wort with antidepressant is also known to have various side effects.
  • SAMe – This is a dietary supplement and is pronounced ‘sam-E’. It is a synthetic or artificial form of the chemical S-adenosylmethionine that is naturally found in every tissue in the body and is pronounced “es-uh-den-o-sul-muh-THIE-o-neen”. This chemical is a methyl donating compound circulating in the blood and provides methyl groups that help maintain metabolic reactions. A metabolic reaction is a chemical reaction that occurs in all living organisms and includes processes such as digestion and the transport of nutrients. A methyl group is known as a molecule containing one carbon atom that is surrounded by three atoms made of hydrogen. SAMe is also not approved by the FDA as a means of treatment for depression. This supplement requires more research to determine the positive effects of it as it has been known to trigger mania in some patients who have bipolar disorder.
  • Omega-3 fatty acids – These are known as healthy fats that are found in flax oil, flaxseed, cold-water fish, walnuts and several other foods. These are considered to be safe, however, when taken in high doses these supplements have been known to adversely interact with other medications. The effect of Omega-3 fatty acids on depression is yet to be proven.

Dietary and nutritional products are not monitored and researched in the same way that conventional medications are. Therefore, their side effects and safety is not documented thoroughly. Because of this, it is best to always speak to the healthcare professional or doctor involved in the treatment of depression in order to ensure that all the risks have been taken into account for the specific case.

Mind and body connections

Some practitioners of alternative treatments for depression believe that the mind and the body need to be in harmony in order for the body to be healthy. Relying on these therapies as the only means of treatment is not generally advised in the treatment of depression. However, many of these treatments can often help conventional medications to work well and serve as a complementary form of treatment.

The following are examples of mind and body techniques that can be performed:

  • Yoga, tai chi and other relaxation techniques
  • Acupuncture
  • Guided imagery – This is a mind-body intervention where a trained professional will generate and evoke certain mental images that are able to re-create or stimulate sensory perceptions of sounds, tastes, movements, and imagery that create a state of relaxation for the patient and help them to focus on their mental experience associated with certain senses.
  • Meditation
  • Light therapy – This kind of therapy is often used to treat SAD (seasonal affective disorder) through exposing the patient to artificial light by using light therapy boxes that contain a light brighter than natural light. This is said to help boost the patient’s mood and brain activity.
  • Aerobic exercise
  • Art or music therapy
  • Massage therapy

 Exercise for depression

Home and lifestyle means of treatment

It is not advised that depression be treated through lifestyle and home remedies as the sole means of treatments. However, it can complement professional and conventional means of treatment and help improve the experience of depression for the patient. The following are a set of lifestyle adjustment steps that can be done at home to assist with depression:

  • Sticking to the treatment plan – It is advised that the patient does not skip their psychotherapy sessions or other appointments with their doctor/s. It is often the case when the patient is feeling better that they skip their medications. If this happens, their depression can often come back or they will go through withdrawal-like symptoms. When one is feeling better, it means that the medication is working, not that it should be stopped.
  • Learning about depression – As a patient or loved one of a depression sufferer, educating yourself on the condition can motivate and empower you, giving you knowledge about treatment and what is to be expected. Encouragement from friends and family can also provide a strong base of support for the person concerned.
  • Paying attention to the warning signs – It is advised that the patient, and in some cases, their loved ones, work with the psychologist or mental health professional to help identify the triggers of the symptoms of depression. If any adverse changes in symptoms are noticed, then it is best to discuss these with the doctor.
  • Avoiding the use of recreational drugs and alcohol – In some situations, the symptoms of depression may appear to disappear when the patient is taking drugs or drinking alcohol. However, the symptoms will actually progress over time and, in turn, be harder to treat. Substance abuse should not be taken lightly and the patient should speak to their doctor if they suffer with it.
  • Taking care of oneself – Eating healthy and nutritional foods, getting at least 30 minutes of physical exercise a day and getting enough sleep is important for both one’s mental and physical well-being. Consider swimming, gardening or jogging as exercise, as this can also help one to sleep better and have more energy during the day for other tasks. If sleeping tablets are needed, then the patient is advised to speak to their doctor.

Coping with or supporting someone with depression

It is always advised that a depression sufferer speaks to their mental healthcare professional in order to develop coping techniques to help them to manage the condition more effectively, these include:

  • Simplifying one’s life – The patient should try to set attainable goals for themselves and not feel guilty for feeling down. It is alright to cut back on obligations when need be. If someone has too many responsibilities on their plate, it may impact them adversely and contribute to their depression.
  • Writing in a daily journal – Journaling can often assist in monitoring symptoms, identifying triggers and allow for the patient to express their emotions of anger, pain, fear or sadness.
  • Reading self-help books and websites that are reputable – The therapist or doctor may recommend sites or books that can be very helpful for the patient.
  • Attending support groups – There are a number of organisations and community support groups that are able to help those with depression and offer support and education regarding the condition. These can also be found in the form of online communities on websites.
  • Avoiding complete isolation – It is best that the sufferer partakes in social get-togethers and activities with friends or loved ones on a regular basis. This helps them to feel supported and loved in what can be a very lonely time in one’s life.
  • Learning ways to manage stress and relax – Meditation, breathing techniques and yoga are some of the techniques that can be used in combating depression and in easing the symptoms.
  • Structuring times – Planning each day and making lists of daily tasks can often aid in not allowing for the sufferer to feel overwhelmed or stressed.
  • Not making important decisions when down – It is not advised that the patient make important decisions when they are feeling down as they may not be thinking straight and could regret passing something up or doing something.

How can depression be prevented?

Depression does not have a sure-fire means of prevention. However, there are certain strategies that may be able to assist with the condition, these are:

  • Taking steps that help to control stress and also aid in boosting self-esteem
  • Reaching out to friends and family in order for them to provide a platform of support
  • Getting treatment as early as possible to prevent the condition from worsening
  • Considering long-term forms of treatment, known as maintenance treatment, to help prevent the symptoms relapsing

What is the outlook for depression?

Depression often ranges from being temporary to being a long-term issue. Forms of treatment do not make the symptoms disappear entirely. However, medications and treatment often allow for the symptoms to be managed.

It is advised that the patient always adheres to their doctor’s treatment plan and discusses any issues or changes in symptoms or side effects with their doctor on a regular basis. In order for the symptoms of depression to be effectively controlled, a combination and testing of therapies and medications will be involved.

Keep in mind that depression is a difficult condition to deal with, for both the patient and those close to him or her. Early detection, the right treatment and monitoring can often lead to patients living happy and successful lives.

Some more information on depression

Can depression result in anxiety?

Anxiety disorders and depression are separate conditions. However, some people who have depression have said that they often have similar symptoms to those associated with an anxiety disorder. Keep in mind that each disorder has its own symptoms and causes.

There are a number of different kinds of anxiety disorders, just as there are a number of different forms or types of depression. However, symptoms that are experienced in both can be:

  • Irritability
  • Sleeping issues
  • Issues with concentrating
  • Nervousness

Therefore, anxiety and depression are often seen as the fraternal twins of mood conditions and disorders. It is possible to suffer from depression and anxiety at the same time. Anxiety will typically come first and can then lead to the development of depression.

What is a depressive disorder?

Having a depressive disorder is more than simply feeling down, it involves having feelings of worthlessness and sadness that are persistent. A depressive disorder is also known as clinical depression, major depression, and in some cases, refers to another mood disorder, the most common being bipolar disorder.

Can depression result in mental confusion?

Anxiety, stress or depression can often result in confusion, forgetfulness, memory issues, difficulty concentrating, as well as a number of other issues that interfere with daily activities. In some cases, the medication used to treat depression can result in mental confusion.

Can depression result in memory loss?

Memory problems have been linked to depression, as mentioned above, these include confusion and forgetfulness. These can cause difficulties in trying to focus at work, completing tasks, thinking clearly or making decisions. Depression has been associated with memory loss that is short-term, but as stated, this may also be a result of certain medications.

How does exercise help with the symptoms of depression?

Getting regular exercise will help ease depression as exercising allows for the brain to release certain chemicals that can boost the mood of the person concerned. The main chemicals released during exercise are endorphins. The effect of these can be felt for a number of hours after exercising and when physical exercise is done on a regular basis, this can help depression sufferers to see positive results in their condition and a significant ease of their symptoms. Exercise also helps the body release any agitation or irritation and can help alleviate stress.

What does a low mood mean?

To be sad and have a low mood, which means to feel down or unhappy for some reason, are absolutely normal emotions to go through from time to time. However, it can be seen as a cause for concern when this low mood is persistent and does not go away, this is normally the first sign of depression. When a low mood lasts for longer than two weeks, it is best to get professional help and allow for a trained healthcare professional to diagnose the issue. There is often an underlying cause, for example, the death of a loved one may result in a low mood for a number of weeks, it is when this mood impacts the functioning ability of the person’s daily life that help must be sought.

Is major depressive disorder the same as bipolar disorder?

Bipolar disorder is known as a type of specifier of major depressive disorder. Bipolar was previously known as manic-depressive illness and is characterised by severe ups and downs of one’s mood, going through severe mania (being elated and unusually happy), followed by an episode of depression (feeling sad and unhappy). There are also periods of a normal mood in between. Depression consists of a prominent low mood without the episodes of mania.

Is there a cure for clinical depression?

Clinical or major depression is a severe and serious condition, but it is treatable. The treatment of the condition is dependent on the symptoms the patient is experiencing as well as upon the doctor or mental healthcare professional prescribing the medication and creating the treatment plan.

Through various means of treatment such as talk therapy, which allows for the patient to voice their feelings and emotions and learn how to cope with them, as well as the administration of antidepressants, many patients have stated that they have noticed a significant improvement in their symptoms. In this regard, there is a cure for depression. However, some patients never seek professional diagnosis and treatment and the results can often be fatal as the patient may attempt or commit suicide.

Disclaimer - MyMed.com is for informational purposes only. It is not intended to diagnose or treat any condition or illness or act as a substitute for professional medical advice.