DEPRESSION

What is Depression? 

Depression is a mood disorder that can affect an individual physically and mentally. It may lead to a person’s persistent sadness and loss of interest in things they once enjoyed, and in turn a decrease in one’s overall function in their daily life. Depression can be caused by many different things such as a separate medical illness, genetics and family history, a traumatic event, medication, stress, feeling isolated and more. In 2021, 8.7% of women were reported to have depression, while 5.3% of men were reported to have depression. Among these men and women, depression is most prevalent in young adults aged 18 to 29 years old. Depression commonly coexists with other mental health disorders. 

Associated Features 

Major depressive disorder is associated with high mortality, much of which is accounted for by suicide. As a result, if you think someone you care about may be suffering from depression it is important to know the warning signs of suicide and to take suicidal statements extremely seriously. An active statement by someone with suicidal ideation might be something like, “I’m going to kill myself,” but other passive statements such as, “I wish I could just go to sleep and never wake up,” are equally worrying. If someone with depression exhibits these verbal markers, encourage them to consult a mental health professional immediately. Depressed individuals also present with irritability, brooding, and obsessive rumination, and report anxiety, phobias, excessive worry over physical health, and complain of pain. 

New Specifiers for Depression in DSM-5 

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses: With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode. With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress. 

How is Depression Different from Sadness? 

What is the difference between depression and sadness? Given that the primary symptom associated with depression is sadness it can be hard to know how to make a distinction between the two psychological states. But depression is more than just sadness, and not simply by a measure of degree. The difference doesn’t lie in the extent to which a person feels down, but rather in a combination of factors relating to the duration of these negative feelings, other symptoms, bodily impact, and the effect upon the individual’s ability to function in daily life. Sadness is a normal emotion that everyone will experience at some point in their life. Be it the loss of a job, the end of a relationship, or the death of a loved one, sadness is usually caused by a specific situation, person, or event. When it comes to depression, however, no such trigger is needed. A person suffering from depression feels sad or hopeless about everything. This person may have every reason in the world to be happy and yet they lose the ability to experience joy or pleasure. With sadness, you might feel down in the dumps for a day or two, but you’re still able to enjoy simple things like your favorite TV show, food, or spending time with friends. This isn’t the case when someone is dealing with depression. Even activities that they once enjoyed are no longer interesting or pleasurable. What’s more, when you experience sadness triggered by a certain something you’re still able to sleep as you usually would, remain motivated to do things, and maintain your desire to eat. Depression, on the other hand, is associated with serious disruption of normal eating and sleeping patterns, as well as not wanting to get out of bed all day. In sadness, you might feel regret or remorse for something you said or did, but you won’t experience any permanent sense of worthlessness or guilt as you might with depression. One of the diagnostic features of depression is this kind of self-diminishing, negative thought patterns. Finally, self-harm and suicidal inclinations don’t arise from non-depressive sadness. Those struggling with severe depression may have thoughts of self-harm, death, or suicide, or have a suicide plan. If you’re feeling suicidal or just need to talk, call the National Suicide Prevention Lifeline for free at 1-800-273-8255. 

Depression and Loss 

Although there is a clear distinction to be made between depression and sadness, it is possible for major depressive disorder to occur in addition to sadness resulting from a significant loss, such as bereavement, financial ruin, or a serious medical illness. The decision as to whether a diagnosis of depression should be made will depend on the judgment of the clinician treating the individual.

Symptoms

People with depression experience a wide variety of symptoms, which lead to the decrease in quality of life. Most people will experience an overwhelming sadness and hopelessness, which leads to a loss of interest in normal daily activities. Sometimes people who experience an overwhelming sadness have thoughts of suicide. People with depression also experience trouble sleeping, a lack of focus, and weight loss due to lower appetite, or weight gain due to food cravings. In order to be diagnosed with depression, a medical professional would probably begin by testing the individual’s blood and thyroid levels to ensure that the lack of energy, weight gain, or weight loss is not because of another condition. The medical professional would then complete a psychiatric and physical exam to determine what exactly the patient’s symptoms are and if they align with the DSM-5 manual closely enough for the individual to be diagnosed.

Treatment 

For the treatment of depression, medical professionals usually combine therapy as well as medications. Psychotherapy helps an individual with depression turn negative beliefs into positive ones. It also helps an individual regain control of their emotions and situations, as well as gain coping mechanisms for when they do experience certain feelings. 

For medications, many individuals may be prescribed SSRI’s, SNRI’s, tricyclic antidepressants, MAOI’s, atypical antidepressants, and other medications. SSRIs are selective serotonin reuptake inhibitors. These are usually the antidepressants that a psychiatrist would start with for an individual with depression. Because they are considered safer and usually have less side effects, it is usually a good place for someone to start. SNRI’s are serotonin-norepinephrine reuptake inhibitors, which work almost identically to SSRI’s, except that they not only prevent the reuptake of serotonin, but they also prevent the reuptake of norepinephrine. Tricyclics are a stronger antidepressant and tend to have more side effects. A psychiatrist would not prescribe them to a person with depression unless they have tried SSRI’s and had no improvement. MAOI’s, monoamine oxidase inhibitors, are similar to tricyclic antidepressants in the sense that they are prescribed only after a patient has tried SSRI’s and they have stronger side effects. The difference is that they require a strict diet because they can potentially cause death if they interact with certain foods. Lastly atypical antidepressants are antidepressant medications which do not fit well into any other category of antidepressants. With regard to other medications, some psychiatrists may combine two different medications depending on the individual’s depression diagnosis. In order to find the right medication for an individual, it takes weeks of testing out a medication. Everyone is different, therefore different medications at different dosages work for different people. 

Other treatments for people with depression include a hospital or residential treatment, electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS). Sometimes, an individual with depression has such intense symptoms that residential treatment is the best place to start. The patient will usually remain there until their mood has improved enough to the point that it is safe for them to leave and continue outpatient therapy. ECT is a therapy which consists of electrical currents that get passed through the brain to impact neurotransmitters and in turn relieve depression. TMS is a stimulation which includes coils that go up against your head and send magnetic waves to stimulate nerve cells. These magnetic waves are proven to help with depression, although they are not really used unless other medications are not working.