Depression

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What is Depression?

Depression is a mood disorder presenting with extreme sadness, hopelessness, and lack of interest in daily activities leading to loss of appetite, weakness, worthlessness, and suicidal thoughts.

Is Depression a Medical emergency?

Depression is not a medical emergency.

Types

There are different types of Depression, which are as follows:

  • Clinical Depression or Major Depression
  • Manic Depression
  • Persistent depressive disorder
  • Postpartum Depression
  • Seasonal Depression
  • Psychotic Depression or seasonal affective disorder
  • Atypical Depression
  • Situational Depression

Causes

There are multiple causes  that are as listed below:

  • Childhood life events: Children experiencing events like neglect, bereavement, unequal parental treatment of siblings, mental and physical abuse, and sexual abuse can develop in adulthood.
  • Stress and other life events: Stress from work, family, education, living condition, financial difficulties, unemployment, bullying, relationship troubles, social isolation, peer pressure, etc. Stressful life events such as loss of loved one, catastrophic injury, natural disasters, rape, etc.
  • Personality changes: Personality changes like having low self-esteem, loss of interest in activities, poor sleep patterns, and feelings of hopelessness.
  • Medical conditions: Chronic medical illnesses like cancer, HIV, diabetes, chronic pain, stroke, etc.
  • Medications: Certain medications like beta-blockers, anticonvulsants, contraceptives, etc.
  • Substance abuse: Use of substances like alcohol, sedatives, opioids, pain killers, and stimulants such as cocaine.
  • Psychiatric disorders: Psychiatric disorders like bipolar disorder, borderline personality disorder, posttraumatic stress disorder, and mood disorders.
  • Hormonal imbalance: Imbalance of hormones in the body.
  • biological changes and brain chemistry: Biological changes in the brain. Neurotransmitters are chemical messengers in the body. Changes in the function of these neurotransmitters in the brain.
  • Genetics: It can be inherited. People having blood relatives are most likely to develop Depression.

Risk factors

Individuals who are subjected to any of the following factors are at a higher risk of developing Depression:

  • Experiencing traumatic stressful life events like death of loved ones, physical or sexual abuse, financial problems, separation, motor vehicle accidents, and natural disasters.
  • Having certain personality characteristics like low self-esteem, low confidence, being too dependent on others, being pessimistic, and staying single.
  • Having a family history and other mental disorders.
  • Having a personal history of other mental disorders like eating disorders, anxiety disorders, bipolar disorder, or post-traumatic mood disorder.
  • Abusing alcohol and drugs like cocaine, heroin, marijuana, etc.
  • Having chronic medical illnesses like chronic pain, cancer, HIV, stroke, heart disease, and sleeping problems.
  • Taking certain medications like high blood pressure medications and sleeping pills.
  • Being a lesbian, gay, or transgender and experiencing social isolation or other relationship problems.
  • Being a woman and undergoing stressful life events like childbirth, miscarriage, pregnancy, postpartum period, menopause, single parenthood, and caring for children and aging elders.
  • Elderly people are more prone to develop Depression.

Signs & symptoms

Signs and symptoms in adults are as follows:

  • Feeling sad, tearful, empty, disappointed, and hopeless
  • Feeling irritable, aggressive, restless, and frustrated
  • Feeling worthless, guilty, thinking of past failures, and self-criticizing
  • Loss of interest and pleasure in activities like hobbies, sports, or sex
  • Withdrawing from friends, family, and social life
  • Unable to concentrate, remember things, make decisions, and complete simple tasks
  • Sleep problems like being unable to sleep or sleeping too much
  • Appetite problems like not eating at all or eating too much
  • Unexplained weight loss or weight gain
  • Consuming excessive alcohol and using drugs
  • Feeling tired and weak all the time
  • Unexplained muscle pains and headaches
  • Frequent and recurrent thoughts of death and suicide

Signs and symptoms of Depression in children are as follows:

  • Feeling unhappy and crying
  • Avoiding friends and siblings, and staying alone most of the time
  • Feeling irritable, angry, and aggressive
  • Frequently refusing to go to school
  • Poorly performing in studies and at school
  • Unable to sleep or sleeping too much
  • Change in appetite
  • Weight loss or weight gain
  • Having thoughts of self-harm

Investigations

Investigation tests include the following:

Psychiatric evaluation: This evaluation consists of reviewing the symptoms, thoughts, feelings, and behavior patterns of an individual.

Blood tests: A complete blood count (CBC) is performed to check for any abnormality that can cause Depression. Other psychological tests are performed to measure the severity of Depression. A Depression rating questionnaire is used to determine the level of Depression. Each questionnaire contains a set of questions that are needed to be answered by the individual.

They include the following:

  • Beck Depression Inventory (BDI)
  • Hamilton Depression rating scale (HDRS)
  • Zung scale
  • IWP multi-affect indicator

Diagnosis

A diagnosis is made based on medical history, clinical evaluation, psychiatric evaluation, and results of investigations if any.

Treatment options

In all cases, it does not require professional treatment. However, a prolonged Depression associated with other symptoms may benefit from treatment. Treatment consists of medications, therapy, and lifestyle modifications.

Medical treatment

Medical management may include the following:

  • Antidepressants
  • Anti-anxiety medications.
  • Anti-psychotic medications.

Interventional treatment including surgery and indications for surgery/ Surgical treatment.

Some treatment options include:

  • Electroconvulsive therapy (ECT): This therapy is used when Depression is not cured with antidepressants, and the individual is at a higher risk of suicide.
  • Transcranial magnetic stimulation (TMS): This therapy is used when symptoms of Depression do not respond to antidepressants.
  • Psychotherapy: Psychotherapy or talk therapy is used to treat Depression. The benefits of psychotherapy are:
    • It helps to identify negative thoughts and replace them with positive ones.
    • It helps to identify and change behaviors that are causing Depression.
    • It helps to ease stress.
    • It provides counseling sessions and support groups to improve self-esteem, self-confidence, and social interactions.
    • It provides strength to cope with stressful life events.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Lifestyle modifications to treat the condition include:

  • Being compliant with the treatment plan
  • Physical activity and exercise
  • Eating a diet rich in vitamins B and D
  • Avoiding alcohol and drugs
  • Social interactions
  • Managing stress
  • Getting plenty of sleep

Complications

Complications include the following:

  • Unexplained physical illness
  • Social isolation
  • Relationship issues
  • Problems at work or school
  • Anxiety
  • Suicidal thoughts
  • Worsening of conditions like heart diseases, obesity, cancer, diabetes, asthma, and arthritis

Prognosis

The prognosis depends upon the severity of the symptoms and the duration of the Depression episode. The prognosis of short-term Depression is good. However, long-term Depression may not go away completely.

When to contact the doctor? / How to identify the complications?

A consultation with a mental health provider is recommended after observing symptoms.

Indications for hospitalization if required

If symptoms persist despite treatment, hospitalization might be necessary for a short period of time.

Suggested clinical specialists/ Departments to consult for this condition

  • Psychiatry
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