What is Depression ?
Depression is a mood disorder involving disturbances in one’s mood, concentration, activity level, interest, appetite, social behaviour and physical health. Persons who are clinically depressed have trouble with daily life, that is, they experience a loss of functioning in life arenas (occupation, family, social, educational, spiritual) and the symptoms are distressing to him or her.
Although depression is treatable, oftentimes it is a lifelong disorder with periods of wellness alternating with depressive recurrences (remitting and relapsing nature of the disorder).
Depression affects approximately one (1) in ten (10) adults in the general population and about twice (x2) as many females as males, suffer with the disorder. It is not unusual for persons to have depression co-occurring with another physical disorder/illness/ailment. In fact, 80% of persons diagnosed with depression, often are diagnosed with a co-occurring physical disorder/illness/ailment e.g. diabetes mellitus type 2; hypertension; cancers; thyroid gland disorders; HIV/AIDs.
What are the causes of Depression ?
Depression does not have a single cause. There are several factors or a combination of factors that may contribute to the onset of depression. These include, a person’s life experience, genetic influence, age, sex, brain chemistry imbalance, hormonal changes, substance usage and other illnesses all may play significant roles in the development of depression
Genetics: Persons with a biological (family) history of depression may be more likely to develop it than those families who do not
Brain Chemistry: Persons with depression are thought to have a different brain chemistry than those without the disorder
Attitude: Persons with a pessimistic outlook on life and low self-esteem who are easily overwhelmed by stress are more likely to develop depression
Gender: Women experience depression twice (x2) as often as men. While a specific explanation of this remains unclear, hormonal changes in women that occur during menstruation, pregnancy, childbirth and menopause are thought to be possible explanations for the onset of depressive symptoms.
Life Situations: Difficult life events or traumas such as emotional, physical, sexual, or verbal abuse; continuous exposure to violence; financial problems or poverty; inappropriate or unclear expectations; maternal separation; family addiction; death of a loved one; neglect; divorce; illness; or racism may all contribute to depression.
During or After Pregnancy: Depression may be associated with pregnancy or the delivery of a child. Studies show that approximately 15%-20% of new mothers and 10% of new fathers experience some form of perinatal mood disorder which occurs during pregnancy, until up to two (2) years after a baby is born and includes depression, anxiety, psychosis, bipolar disorder, obsessive compulsive disorder (OCD) and Post Traumatic Stress Disorder.
Postpartum Depression is different from the “baby blues”, both by its duration and intensity of distressing symptoms.
Illnesses: Depression often coexists with other illnesses that precede, follow, cause or are a consequence of the depression. These include mental health conditions, substance use/misuse and serious medical illnesses e.g. cancer; diabetes mellitus Type 2; HIV/AIDs; thyroid gland disorders
What are the symptoms of Depression?
--->Require at least five (5) out of the nine (9) symptoms below, occurring every day, for at least two (2) weeks
Feeling persistent sadness throughout the day, for days back to back
Having little interest and pleasure in doing things once normally enjoyed
Experiencing a change in appetite with weight loss or weight gain
Trouble falling or staying asleep or sleeping too much
Being tired, fatigued and having no energy
Feeling worthless or guilty that you have let yourself or your family down
Moving slowly or the opposite-being overly fidgety and restless
Having difficulty thinking or concentrating on things such as reading the newspaper or watching TV
Letting personal hygiene go-not bathing or not dressing well
Recurring thoughts that one would be better off dead or hurting yourself
What are suicidal warning signs ?
Some suicidal warning signs include:
-person talks about wanting to die or committing suicide
-seems preoccupied with death and dying
-is looking for a way to kill himself/herself e.g. searching for a weapon- gun/knife/rope/box cutter
-prepares for death by writing a will and making final arrangements
-gives away prized possessions
-talks about feeling hopeless or having no reason to live
-talks about feeling trapped or unbearable pain
--talks about being a burden to others
--increases the use of alcohol and other drugs
-sleeps too little or too much
-acts recklessly e.g. driving whilst under the influence of alcohol; spending excessive amounts of money; spending frivolously
-withdraws from activities
-isolates from friends and families
-visits or calls people to say goodbye
What are the types of Depression?
Major Depression: persons have at least one major depressive episode (five or more symptoms for at least a two (2) week period). For some persons the disorder is recurrent.
Dysthymia: Is a low-level state of depression that lasts a longtime. It is not as severe as major depression but can be just as disabling.
Postpartum Depression: Depression occurring during pregnancy or in new patients up to two (2) years after a baby is born.
Seasonal Affective Disorder: A major depressive episode occurring regularly in seasons with little sunlight. Persons with SAD reside in North America and Europe (onset of symptoms and episodes, during winter months of November to April).
What are the treatments for Depression?
Medication: antidepressant medication works well for many persons diagnosed with moderate to severe depression.
Of note, it can take two (2) to four (4) weeks before the medication starts to work and about six (6) to twelve (12) weeks before an individual sees the full effect of antidepressants.
Psychotherapy: also known as “talk therapy” and it is an effective tool in treating depression and can include cognitive behavioural therapy (CBT) and interpersonal therapy (IPT). These types of therapy help by teaching a depressed individual different ways of thinking and behaving and further, changing one’s habits that may contribute to depression.
CBT helps to change the negative thinking and behaviour associated with depression while also teaching persons how to unlearn specific behaviours that contribute to their depression. Oftentimes, changing one’s behaviour can lead to an improvement in thoughts and moods.
Light Therapy: For those who suffer seasonal affective disorder (SAD) or “winter depression”, daily exposure to bright light is often effective. Light therapy can be used alone or together with other treatments such as “talk therapy” or medications.
Address Suicidal Behaviour as an Emergency: Must be seen as an emergency and do call for help that is, other family members or supportive friends of the person; the emergency medical system-EMS (ambulance services or call 911 for assistance)
Of significance, a person who is displaying suicidal warning signs must not be left alone by a family member or by a friend or by a coworker.
Do show sympathy to the individual and listen to the person without passing judgement (empathic listening).
Be supportive of the person and accompany him/her to the emergency department for a comprehensive medical and psychiatric assessment.
Religion: Clinical experts have long wondered if there is a connection between religion and depression. Research is finally catching up with this question and the findings are promising. Adults at risk for developing depression may actually benefit from a deep connection to their faith.
This is particularly true in reducing the risk of recurring episodes of depression. The empirical data is showing that individuals who highly value their religion, had about one quarter (1/4) the risk of other study participants in experiencing a major depressive episode (AJP, August, 2011).
Recognizing depression as soon as it occurs and seeking help from your primary physician (first contact of care) is extremely important. With prompt treatment a persons with depression can return to a happier life and a healthier outlook.
If you or a loved one is experiencing depression symptoms, do not be dismissive of the symptoms but schedule an urgent appointment with your primary physician i.e. family medicine practitioner; general physician; internal medicine specialist. They will complete the initial assessment and then refer you on to a mental health physician if it is indicated (psychologist, psychiatrist)
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