Depression

Definition

Depression is characterized by sustained and recurrent periods of sadness that go beyond typical emotional responses. According to the World Health Organization, depression is currently the leading cause of disability worldwide. Emerging research suggests that depression may function as a biological defense mechanism—a response designed to conserve energy in the face of perceived defeat or danger, often manifesting as emotional and physical withdrawal.

Although highly treatable, depression is considered a cyclical disorder, marked by recurring episodes even after successful intervention. It is crucial to understand that depression is not simply a natural outcome of adversity. Rather, it becomes a clinical concern when it involves persistent negative thinking patterns and ruminative tendencies over an extended duration.

Types of Depression 

1. Major Depressive Disorder (MDD):

Major Depressive Disorder is diagnosed when an individual experiences a consistently low mood for at least two weeks. It is a serious condition, with the risk of suicide present across all age groups. 

Diagnostic Criteria:

According to the DSM-5, a diagnosis requires the presence of at least five of the following symptoms:

  • Depressed mood for most of the day
  • Noticeable loss of interest or pleasure in usual activities
  • Significant weight loss or gain, or changes in appetite
  • Insomnia or hypersomnia nearly every day
  • Marked decrease in energy
  • Feelings of worthlessness or excessive guilt
  • Difficulty concentrating or indecisiveness
  • Recurrent thoughts of death or suicidal ideation

Symptoms:

  • Denial of sadness initially, though it may be revealed during clinical interviews
  • Emotional numbness
  • Sudden outbursts of anger
  • Irritability, particularly in children

Gender-Related Diagnostic Considerations:

Women often present with changes in appetite, sleep disturbances, and gastrointestinal discomfort. In contrast, men are more likely to display difficulties in emotional regulation, often manifesting through poor impulse control.

2. Persistent Depressive Disorder (PDD):

Persistent Depressive Disorder involves a chronic form of depression, where symptoms last for at least two years in adults (or one year in children). This diagnosis often applies to individuals whose Major Depressive Disorder continues without significant remission for two years. It combines features of chronic major depression and dysthymic disorder.

Diagnostic criteria:

  • Depressed mood for most of the day, more days than not
  • Criteria for MDD continuously met over a two-year period
  • No history of manic episodes
  • Symptoms not better accounted for by other psychotic disorders
  • Symptoms cause clinically significant distress or impairment
  • No attribution to physiological effects of a substance or medical condition

Symptoms:

  • Persistent low mood that becomes a part of daily functioning
  • A pervasive feeling of being “down in the dumps”
  • Irritability

Gender-Related Diagnostic Considerations:

PDD is reported to be twice as prevalent in women compared to men.

3. Premenstrual Dysphoric Disorder (PMDD):

PMDD refers to a cluster of emotional and behavioral symptoms that occur in the luteal phase of the menstrual cycle and resolve with the onset or conclusion of menstruation. This condition can significantly impact functioning and has been linked to increased suicide risk.

Diagnostic criteria:

An individual requires the presence of at least five symptoms, appearing during most menstrual cycles over the past year. Symptoms typically improve within a few days of menstruation and resolve in the postmenstrual phase.

I. At least one emotional or behavioral symptom must be present:

  • Persistent self-critical thoughts
  • Irritability or frequent anger
  • Mood swings or heightened emotional sensitivity
  • Anxiety or tension

II. Additional symptoms includes:

  • Feelings of being overwhelmed or out of control
  • Fatigue or low energy
  • Appetite changes
  • Physical symptoms such as bloating or weight fluctuations
  • Decreased interest in daily activities
  • Sleep disruptions
  • Difficulty concentrating

III. Other symptoms:

  • Symptoms must significantly interfere with social, academic, or occupational functioning
  • They must not be an exacerbation of another mental health disorder
  • Symptoms must occur in at least two menstrual cycles
  • No substance use should be responsible for the symptoms

4. Substance/Medication-Induced Depressive Disorder:

This form of depression is triggered either during the active use of a substance or following withdrawal. The symptoms are often similar to other depressive disorders but are clearly associated with substance use, such as alcohol, drugs, or certain medications. This subtype carries a heightened risk of suicide due to the physiological toll of substance dependence. Symptoms typically persist for about one month after cessation of the substance

Diagnostic criteria include:

  • A disturbance in mood that is not better explained by another depressive disorder
  • Significant distress across major areas of functioning
  • Lack of interest in almost all daily activities
  • Symptoms must follow use or withdrawal from a substance
  • Depressive symptoms should not occur exclusively during delirium.

Gender-Related Considerations: There is no significant difference in prevalence between men and women for this subtype.

Causes

While depression may emerge due to complex interactions between biological, psychological, and social factors, the following are commonly observed triggers:

  • Bereavement or loss of a loved one
  • Breakup or end of a significant relationship
  • Chronic illness (in oneself or a close family member)
  • Social isolation or loneliness
  • Exposure to domestic violence or abuse

Treatment

Effective management of depression typically involves a combination of pharmacological and psychotherapeutic interventions. Treatment plans are tailored to the individual's specific symptoms, underlying causes, and preferences.

1. Pharmacological Treatment: Common classes of medications used include:

  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Atypical Antidepressants
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

It is essential for individuals to be well-informed about the potential side effects of these medications and to use them under medical supervision.

2. Psychotherapeutic Interventions

  • Cognitive Behavioural Therapy (CBT): CBT is widely recognized for its effectiveness in treating depression. It involves identifying negative thought patterns and replacing them with healthier, more constructive ways of thinking. Therapists also assist clients in developing coping skills and behavioral strategies.
  • Acceptance and Commitment Therapy (ACT): ACT encourages individuals to acknowledge and accept their thoughts and emotions without assigning negative value to them. This approach helps individuals distance themselves from distressing thoughts and respond in more adaptive ways.

Conclusion: Understanding the type and severity of your depression is an important first step toward healing. By seeking help in the form of therapy or self-care tools, you can begin to manage your symptoms and improve your overall well-being.

Related Resources: If you are experiencing the negative effects of depression, access these resources for help:

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