Depression is very common and in fact, one of the most common mental illnesses worldwide, with more than 264 million people affected. It is more common in people between the ages of 18 and older. Depression is treatable. It can affect our thoughts, feelings, and judgment. This will eventually lead to a decrease in function, loss of interest, and poor performance. Depression can eventually lead to suicide. About 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.
Depression can be classified into:
1) Major depressive disorder (MDD): which includes depressed mood, reduced interest, and pleasure (considered “core” symptoms), and other symptoms that affect daily life and functioning.
2) Seasonal affective depression(SAD): As the days get shorter, people feel sad. This improves with spring when there are longer daylight hours. People may start to feel “down” when the days get shorter in the fall and winter (also called “winter blues”) and begin to feel better in the spring, with longer daylight hours.
3) Premenstrual Dysphoric Disorder (PMDD): Premenstrual dysphoric disorder (PMDD) is severe, and can occur due to the extension of premenstrual syndrome (PMS). Symptoms of premenstrual syndrome (PMS) are irritability, tiredness, anxiety, mood changes, bloating, increased appetite/cravings, aches, and breast tenderness. It starts 7-10 days before menstruation begins.
5) Dysthymia: This is a milder form of depression that can progress to MDD.
6) Postpartum depression: Pregnancy can cause changes in hormone levels, leading to depression. It occurs weeks after giving birth. It is usually characterized by depressed mood, anxiety, and difficulty concentrating.
Causes of depression
- Medical conditions: Some medical conditions can increase the likelihood of depression, such as insomnia (lack of adequate sleep), severe pain, chronic illnesses.
- Drug/ Alcohol abuse
- Traumatic events: Some life events can make us respond to situations differently.
- Hormonal changes: Changes in hormone levels might cause or trigger depression. This occurs mostly with pregnancy, menopause, thyroid problems, menstruation, etc.
- Biological differences: People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
- Family history: A family history of depression or any other mood disorder can increase the likelihood of developing depression.
- Brain chemistry: Chemical imbalances in the brain can also contribute to depression. These chemicals are called neurotransmitters (naturally occurring brain chemicals). Researchers suggest that depression occurs when there is a decrease in norepinephrine, serotonin, and dopamine in some centers of the brain. Also, the risk of depression is high if the frontal lobe is less functional.
Symptoms of depression
- Sadness, tearfulness, and hopelessness.
- Anger and irritability.
- Decreased energy, tiredness, and fatigue.
- Loss of interest in activities you enjoy such as sex, exercise, etc.
- Sleep disturbances, including insomnia or sleeping too much.
- Changes in appetite causing weight loss or weight gain.
- Anxiety, agitation, or restlessness.
- Slowed thinking, speaking, or body movements.
- Guilt or Feelings of worthlessness.
- Difficulty concentrating and recalling things.
- Unexplained physical problems, such as back pain or headaches.
- Suicidal thoughts and attempts.
Treatment of depression
1). Light therapy: This has helped me in several ways. Usually, when I feel sad, depressed, or gloomy, I go out or open the windows to let the light come in and it makes me feel better. This can helps mostly in seasonal affective disorder. Exposure to doses of white light can help regulate your mood and improve the symptoms of depression
2). Psychotherapy: Seeing a therapist can help you learn ways to cope with symptoms of depression when they occur.
3). Antidepressant medications:
- Selective serotonin reuptake inhibitors (SSRIs): This is usually the first-line drug for depression. They cause fewer and less severe side effects compared to other antidepressants. Some examples include Citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): A few examples of SNRIs are duloxetine (Cymbalta), venlafaxine (Effexor XR), and desvenlafaxine (Pristiq, Khedezla).
- Tricyclic antidepressants: These drugs although helpful can cause some serious side effects compared to other antidepressants. Hence, they are usually prescribed when SSRIs are not helpful. Examples are imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), and desipramine (Norpramin).
- Monoamine oxidase inhibitors (MAOIs): Some MAOI prescribed are tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan), selegiline (Emsam). MAOIs may be prescribed, typically when other drugs fail because they can have serious side effects. To use MAOIs, the patient’s diet must be watched and strictly monitored because of interactions with certain types of food such as certain cheeses, pickles, wines, some medications, and herbal supplements which can be deadly. Also, selegiline (Emsam) may cause fewer side effects. Do not combine with an SSRI.
- Atypical antidepressants: They don’t completely fit into any of the categories mentioned above. Examples include bupropion (Wellbutrin XL, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).
- Your doctor may recommend combining two antidepressants or adding medications like mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications might be added for short-term use.
4). Electroconvulsive therapy (ECT): This is done under general anesthesia. Small electric currents are passed through the brain, intentionally causing a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. It is used for people who do not get better with medication.
Ways to prevent depression,
- Avoid drugs and alcohol
- Exercise regularly
- Get enough rest and sleep
- Communicate and build strong relationships with others
- Get regular exposure to light.
- Medical checkup
- Reach out to friends and family when you need help.