It is normal to occasionally feel sad, hopeless and fatigued. You most likely have experienced these feelings before. For most people, these feelings last a few minutes, hours to days and then subside. But when a person has depression, the feelings may persist for weeks, months or years.
What Is Depression?
Depression is a mood disorder that is characterized by the persistent feelings of sadness, tiredness/loss of strength and loss of interest in pleasurable activities.
These symptoms are experienced for most of the day, nearly every day for at least two weeks.
Other features of depression are:
- loss of confidence and self-esteem
- difficulty in concentrating and making decisions
- undue feelings of guilt and worthlessness
- feelings of hopelessness and helplessness
- sleeping problems-difficulties in getting off to sleep or waking much earlier than usual
- changes in appetite
- loss of sex drive and/or sexual problems
- physical aches and pains
- thoughts of suicide, self-harm and death
In severe cases, delusions (fixed false beliefs) and hallucinations (hearing unseen voices or seeing strange sights) may be present. These symptoms can cause the depressed individual to suffer greatly and function poorly at work, at school and in the family.
At its worst, depression can lead to suicide. Sadly, over 800 000 people die due to suicide every year.
How common is the condition?
Depression is a common mental illness and a major cause of disability worldwide. Globally, it is estimated that 350 million people suffer from depression. Projections indicate that depression will be the leading cause of years lived with disability by 2030. In most countries, the number of people who would suffer from depression during their lives falls within an 8-12% range. Twice as many women are affected by depression than men. Although the illness may occur at any age, affected persons are most likely to have their first depressive episode between the ages of 30 and 40 years, and there is a second, smaller peak of incidence between 50 and 60 years.
What causes depression?
When a person is depressed, she may blame herself, attributing it to a personal weakness or moral failure. However, depression is regarded as a medical condition and most individuals have little or no influence on its onset. You may need to reassure a depressed individual that she is not at fault.
Although, the exact cause of depression is unknown, a number of things have been linked to its development. These include recent events, genetic factors, long-term and personal factors. Rather than one immediate cause or event, a combination of factors may be responsible.
Depression runs in families and some people will be at an increased genetic risk. Some people may be more at risk because of their personality, especially if they have a tendency to worry a lot. Having low self-esteem, high sensitivity to criticism and unusually high expectations may also make an individual susceptible. Furthermore, the evidence suggests that continuing difficulties increase one’s vulnerability to depression. These includes long-term unemployment, living in an abusive or uncaring relationship, long-term isolation, loneliness and prolonged work stress. That is why recent life events such as the loss of a loved one in death and losing one’s job can trigger depression in those already at risk. These factors may cause an imbalance in brain chemicals, which highlights the role of biological factors. Therefore, the presence of some medical conditions such as endocrine diseases (e.g. diabetes mellitus and hypothyroidism) and neurological diseases (for example stroke and Parkinson’s disease) may increase the risk of depression.
Drugs and alcohol use can both lead to and result from depression. Some individuals consume hard drugs to deal with feelings of depression. Rather than help to resolve these negative feelings, drugs may worsen or prolong the symptoms. In some cases, addiction sets in.
Can it be treated?
Yes. There are effective forms of treatment for depression. Mild to moderate cases can be treated on an outpatient basis, but severe cases usually require admission into hospital and inpatient care. Most patients need medications for months.
What treatment options exist?
Medications and psychological therapies are the main treatment modalities. Alleviating unpleasant feelings and thoughts, and preventing self-harm are the most important aspects of treatment. The treatment plan is developed as a collaborative exercise between the patient and the clinician, and the patient’s rights and choices are respected. Treatment plan may involve discussions about the most appropriate level of occupational and social activity for the current circumstances. This is frequently reviewed to allow adjustment to the patient’s changing clinical state. With treatment, each episode lasts 2–3 months on average, but a minority last for much longer and can become chronic (lasting for more than a year).
Psychological treatments help patients to counteract behaviors and negative thoughts associated with the mental disorder. The rationale for treatment is that changing the patient’s thoughts and behaviors will lead to a decline of depressive symptoms and improvement in psychosocial functioning.
Examples of psychological forms of treatment are behavioral activation, cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Different psychological formats include individual, group, family or couple psychological treatments.
Antidepressant medications include the tricyclic antidepressant (TCAs) and selective serotonin re-uptake inhibitors (SSRIs). These drugs work by ensuring appropriate levels of the brain chemical are maintained. They can be an effective form of treatment for moderate-severe cases. However, medications are usually not the first line of treatment for cases of mild depression and are to be used with caution in young children and adolescents.
Unfortunately, up to 50-75% may experience a relapse. To minimize the risk of relapse, health providers usually recommend that patients continue some form of psychotherapy or use medications for several months after remission of symptoms.
- World Health Organization. Depression. Fact sheet. 2016
- Cowen et al. Shorter Oxford Textbook of Psychiatry. 5th 2013