Depression: Causes, Symptoms, and Treatments..... physician Rokinuzzaman
## Introduction
Depression—often referred to as *clinical depression* or a *depressive disorder*—is a common but serious mood disorder. It causes persistent feelings of sadness and loss of interest, interfering with daily activities such as sleep, work, eating, and relationships. While everyone experiences sadness from time to time, depression is more severe and long-lasting.
Depression can also occur as part of other mental health conditions, including:
* Bipolar disorder
* Other personality disorders in addition to borderline personality disorder (BPD) * Disorder of schizophrenia ## Types of Depression
There are various manifestations of depression. The two most common types are:
1. **Major Depression** – Symptoms last most of the day, nearly every day, for at least two weeks. They significantly affect daily functioning such as work, sleep, study, and relationships. Some people may have only one episode, while others experience multiple episodes over a lifetime.
2. **Persistent Depressive Disorder (Dysthymia)** – A chronic form of depression lasting for at least two years. Symptoms may fluctuate between less severe depression and episodes of major depression.
Other types include:
* **Perinatal Depression**: Occurs during pregnancy or after childbirth (postpartum depression). Symptoms can be managed with counseling and medication.
* **Seasonal Affective Disorder (SAD)**: Depression linked to seasonal changes, usually worsening in late fall or winter.
* **Psychotic Depression**: Severe depression accompanied by psychosis, such as hallucinations or delusions.
* **Bipolar Disorder**: Although not depression itself, bipolar disorder involves episodes of extreme low moods (depression) alternating with periods of mania (high energy and mood).
## Depression by Gender and Age
* **Women**: Hormonal, biological, and life-cycle factors increase the risk of developing depression. Symptoms often include sadness, guilt, and feelings of worthlessness.
* **Men**: Symptoms may include irritability, fatigue, reckless behavior, substance misuse, or loss of interest in work and hobbies. Many men don't know they're depressed and don't get help. * **Older Adults**: More likely to have medical conditions that contribute to depression and may have subtle symptoms. * **Children**: Young children may pretend to be sick, refuse school, or show separation anxiety. Teens often exhibit irritability, academic problems, or risk-taking behavior. Depression in adolescents can coexist with anxiety, eating disorders, or substance abuse.
## Historical Perspective
Since ancient Mesopotamia, depression, also known as "melancholia," has been described. Early civilizations attributed mental illness to demonic possession and used exorcism rituals as treatment.
* **Greek and Roman Era**: Some physicians recognized depression as both biological and psychological. Diet, exercise, baths, massage, and herbal remedies were some of the treatments. * **17th Century**: Robert Burton’s *Anatomy of Melancholy* described psychological and social causes of depression, recommending remedies such as diet, exercise, music, and travel.
* **18th–19th Century**: Depression was often viewed as a hereditary weakness. Patients were stigmatized, institutionalized, or left homeless.
## Epidemiology
People of all ages and cultures are affected by depression: * In **India**, about 9% experience depression at some point, while 36% suffer from a major depressive episode.
* In **Canada**, 11% of people meet criteria for major depressive disorder in their lifetime, with 4% affected in any given year.
* In **China**, the prevalence of MDE is about 12%, one of the lowest worldwide.
* Globally, **women are nearly twice as likely** as men to be affected.
According to the World Health Organization (WHO), depression is the **fourth leading cause of disability** worldwide and is projected to become the **second leading cause** in the near future.
## Risk Factors
Depression can affect anyone, but certain factors increase risk:
* Previous episodes of depression
* A history of mood disorders in the family * Female gender
* Postpartum and menopausal stages
* Conditions that persist * Major life stressors (loss, divorce, job loss)
* Lack of social support
* Substance abuse
* Trauma from childhood * Negative thought patterns
## Causes
The exact cause of depression is not fully understood. Most experts believe it results from a combination of genetic, biological, psychological, and environmental factors.
Some potential participants include: * Chemical imbalances in the brain * Genetics (depression in the family) * Chronic illnesses (e.g., thyroid disease, cancer, chronic pain)
* Certain medications (e.g., steroids)
* Abuse of drugs * Stressful life events (relationship breakups, bereavement, financial stress, job loss)
* Problems falling asleep * Neglect or abuse of a child ---
## Signs and Symptoms
Depression can manifest in many ways, and not everyone experiences sadness. Common symptoms include:
* Constant sadness or feeling empty * Loss of interest in hobbies or activities
* Despair, guilt, or a sense of worthlessness * Fatigue or lack of energy
* A lack of focus or memory * Sleep disturbances (insomnia or oversleeping)
* Appetite or weight changes
* Restlessness or irritability
* Physical symptoms like stomach problems, cramps, or headaches * Suicidal thoughts or behaviors
## Findings Diagnosis involves clinical evaluation by a physician or mental health professional.
### Screening Questions
* Have you lost interest or pleasure in activities you usually enjoy?
* Have you felt sad, hopeless, or depressed in the past month?
If yes, further assessment is required.
### Assessment Tools
**SSIGECAP** criteria (Sadness, Sleep disturbance, Interest reduction, Guilt, Energy loss, Concentration problems, Appetite changes, Psychomotor changes, Suicidal thoughts)
**PHQ-9 questionnaire** to determine severity
* Review of medical conditions and medications
* Differential diagnosis to rule out bipolar disorder, anxiety disorders, substance abuse, and thyroid dysfunction
### Assessment of Suicide Danger Patients are evaluated for suicidal thoughts, plans, previous attempts, and family history. Those at high risk may require emergency psychiatric intervention.
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## Treatments
### Medications
Antidepressants are often the first line of treatment. Common classes include:
* **SSRIs** (e.g., fluoxetine, sertraline, escitalopram.
* **SNRIs**
* **Tricyclic antidepressants**
* **MAOIs**
They usually take 2–4 weeks to show effect and may cause temporary side effects.
### Psychotherapy
Talk therapy (e.g., cognitive-behavioral therapy, interpersonal therapy) helps patients change negative thought patterns, improve coping skills, and address relationship issues.
### Brain Stimulation Therapies
* **Electroconvulsive therapy (ECT)** for severe, treatment-resistant cases
* **Transcranial magnetic stimulation (TMS)** for mood regulation
* **Light therapy** for seasonal affective disorder
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## Prevention and Self-Help
* Stay physically active and exercise regularly
* Break large tasks into manageable steps
* Maintain social connections and supportive relationships
* Avoid alcohol and drugs
* Delay major decisions until symptoms improve
* Engage in enjoyable and relaxing activities
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## Supporting Someone with Depression
* Inspire them to seek professional assistance. * Show patience, empathy, and understanding
* Never ignore suicidal comments—report them immediately
* Invite them to participate in activities and outings
* Help them follow their treatment plan
* Remind them that recovery is possible with time and treatment
Disclaimer:
This blog's health-related content is for general informational purposes only. It should not be used in place of professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare professional regarding any medical condition or health concerns.