Depression

Depression is a common mental disorder, characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks.

In addition, people with depression normally have several of the following:

• a loss of energy
• a change in appetite
• sleeping more or less
• anxiety
• reduced concentration
• indecisiveness
• restlessness
• feelings of worthlessness, guilt or hopelessness; and
• thoughts of self-harm or suicide.

Depression is now the world’s most wide-spread illness and most common mental disorder. Depression is the leading cause of disability worldwide. It is a major contributor to the over-all global burden of diseases. At its worst, can lead to suicide.

Types and symptoms

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.

A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period of time) with relapses, especially if they go untreated.

Recurrent depressive disorder

This disorder involves repeated depressive episodes. During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.

Bipolar affective disorder

This type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.ETIOLOGY: Depression is a multi-factorial clinical phenomenon. It results from social, psychological and biological factors. Stressful life events are one of common precedents in the first episode of depression and may leave a person more vulnerable to develop subsequent episodes.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.

Diagnosis and treatment

There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy (CBT), and interpersonal psychotherapy (IPT)) or antidepressant medication (such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)). Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.

What you can do if you think you are depressed

• Talk to someone you trust about your feelings. Most people feel better after talking to someone who cares about them.
• Seek professional help. Your local health-care worker or doctor is a good place to start.
• Remember that with the right help, you can get better.
• Keep up with activities that you used to enjoy when you were well.
• Stay connected. Keep in contact with family and friends.
• Exercise regularly, even if it’s just a short walk.
• Stick to regular eating and sleeping habits.
• Accept that you might have depression and adjust your expectations. You may not be able to accomplish as much as you do usually.
• Avoid or restrict alcohol intake and refrain from using illicit drugs; they can worsen depression.
• If you feel suicidal, contact someone for help immediately.

Source : WHO