Major Depressive Disorder- Know it all! 

 'Depression' is a word we have all heard, experienced and felt in our day to day living. The World Health Organisation (WHO) estimates that more than 264 million people all over the world experience 'Depression'. WHO suggest that rising rate of diagnosis' of depression in itself explain that depression is a common mental condition that affects people from all walks of life.  It is the leading cause of disability worldwide and is a major contributor to the global burden of disease. In India, 56 million people experience depression yet many people are living in the dark, not even fully understanding what it is. This article will provide an overview of depression and sub-types of depression, the common signs and symptoms, severity of symptoms - severe to moderate to mild symptoms, causes, and treatment options that are available.

If I have successfully peaked your interest with the statistics establishing a dominant prevalence of depression in this world (p.s: pops confetti: mission accomplished),  then let's break down what this complex mental health condition is. 

Depression is a type of Mood Disorder that affects our our mood, affect and perception of world around us. People who experience depression reported an overwhelming and persistent feeling of sadness. This feeling of sadness differs from just 'feeling down'  The symptoms and causes include continuous low moods over a significant period of time, prolonged feeling of sadness, worthlessness and hopelessness. Majority of people with depression among adults include increased fatigue and a continued loss of interest in activities that were once enjoyable to them - including meeting friends, reading, having sex and intimate relationships. Symptoms may also cause difficulty concentrating/focusing on task.

In saying that - it is natural to feel down or low on mood and energy from time to time, however - if you are feeling 'low' and 'sad' that has persisted for an extended period, chances are that you could be struggling with 'depression.'

Signs and symptoms of depression

Some common symptoms of depression include:

1. Persistent feelings of sadness, anxiety, or emptiness

2. Loss of interest or pleasure in activities once enjoyed

3. Feelings of hopelessness, helplessness, or worthlessness

4. Changes in appetite or weight

5. Changes in sleep patterns (insomnia or oversleeping)

6. Fatigue or lack of energy

7. Difficulty concentrating or making decisions

8. Physical symptoms such as headaches, stomach problems, or muscle aches

9. Isolation from friends, family and other social networks 

10. Thoughts of committing suicide or ending life

However, it is important to note that not everyone experiences depression in the same way. Depression is different for every individual while some people may only have a few of these symptoms, others may have many of these in combination.  

Admittedly though for the longest time I didn’t know that there are many different types of depression. No, these are actually not categorised on the scale of Arijit Singh to Nusrat Fateh Ali Khan songs- as you might think (confession: I did) but the main source of classification are depressive symptoms and the severity of symptoms. 

Types of Depression

Some of the most common types of depression include:

1. Major Depressive Disorder: Depression also called Major Depressive Disorder or Clinical Depression - is the clinical term of 'Depression'. It impacts the way we feel, think and behave due to prolonged sense of feeling sad and characteristic of loss of interest in pleasurable activities. This is the most common and severe type of depression that starts to impact our day functioning and survival.

2. Persistent Depressive Disorder (PDD): It is also known as 'Dysthymia' which is mild to moderate chronic depression. This condition differentiates from MDD is that it is mild depression but long lasting, unto at least two years. For PDD to be diagnosed, a persisent mood impairment must last for 2 years including symptoms such as overeating, insomnia or excessive sleeping in, low self-esteem and increased fatigued. 

3. Bipolar Disorder: This type of depression is a chronic mood disorder that causes extreme shifts in mood, energy, and activity levels. People with bipolar disorder experience periods of intense highs (mania or hypomania) and lows (depression).

4. Seasonal affective disorder: This is a type of depression that is triggered by changes in the seasons, particularly in the fall and winter months when there is less sunlight. It is believed that Seasonal depression can cause disruption in the body's natural circadian rhythm and affect the production of certain hormones, such as melatonin and serotonin depending on the changes in the amount of sunlight that a person is exposed to during the fall and winter months.

5. Antenatal depression: also known as depression during pregnancy, can occur at any time during the pregnancy and can have significant effects on both the mother and the baby. Pregnant individuals with depression may have difficulty bonding with their baby and may experience difficulty breastfeeding. Additionally, depression during pregnancy is associated with an increased risk of preterm birth, low birth weight, and developmental delays in the baby. 

6. Postpartum depression (PPD): This is a type of depression that affects women after giving birth. It is thought to be caused by hormonal changes, stress, and lack of sleep. PPD is caused by a combination of physical, emotional, and environmental factors. Hormonal changes after giving birth, such as a sudden drop in oestrogen and progesterone levels, can contribute to the development of PPD. Additionally, sleep deprivation, a lack of social support, and stress related to parenting and adjusting to a new role can all contribute to the development of PPD.

7. Psychotic depression: This is a severe form of depression that is characterised by the presence of psychosis symptoms, such as delusions or hallucinations. Delusions are false beliefs that are not based in reality, while hallucinations are perceptions that occur without any external stimulus. Depression with psychosis can be a serious and potentially life-threatening condition, as individuals may be at an heightened risk of suicide or self-harm.

8. Atypical depression: This is a subtype of depression that is characterised by symptoms that do not fit the usual pattern of depression. For example, people with atypical depression may experience increased appetite, weight gain, and increased sensitivity to rejection.

9. Treatment-resistant depression (TRD) is a type of depression that does not improve with standard treatments, such as antidepressant medication or psychotherapy. It is estimated that approximately one-third of people with depression may experience TRD. In general, a person with TRD will have tried at least two different antidepressant medications with little or no benefit. They may have also undergone several rounds of psychotherapy or other types of treatment without success. TRD can be particularly challenging for those experiencing it, as it can cause significant distress and impair their ability to function in daily life.

Although we are now aware of the various diagnosis of depression in which this complex disorder manifests itself, yet we don't quite know the reason behind it's manifestation. Here, the sad news is that the causes of depression are not fully understood, though we have listed a variety factors that are believe to cause depression.

Factors that cause depression

1. Genetics: There is evidence suggesting that depression can tend to run in families; family history of depression is one of the key underlying cause of depression suggesting that genetics may play a big role in its development.

2. Brain chemistry: Changes in the levels of certain chemicals in the brain, such as serotonin and dopamine, can contribute to depression.

3. Environmental factors: Traumatic life events, such as the loss of a loved one, a major illness, or a difficult relationship, can play a role in depression.

4. Hormonal imbalances: Changes in hormones, such as those that occur during pregnancy or menopause, can trigger depression.

5. Medical conditions: Chronic illnesses, such as cancer or heart disease, can increase the risk of depression.

6. Substance abuse: Alcohol and drug abuse can lead to depression.

7. Chronic stress: Chronic stress from work, finances, or other life circumstances can also contribute to the development of depression.

Again, I can not stress enough on the fact that not everyone who experiences above listed causes will end up developing depression perhaps due to varied styles of coping mechanisms, so to say. While similarly, depression can also arise without any obvious cause. However, the good news above it all is that depression is treatable and there are multiple treatment options available to choose from.  An effective treatment of depression typically involves a combination of medication and psychotherapy. Medication can help to correct any chemical imbalances that may be contributing to the depression. While psychotherapy, the most common treatment of depression treatment, can help to address any underlying issues that may be contributing to the development of depression. 

Diagnosis and Treatment for depression

Here are some of the top treatments to reduce the symptoms of depression:

1. Psychotherapy: Also known as talk therapy or counselling, is a type of treatment that is used to help individuals manage and overcome emotional and psychological issues. It involves talking with a qualified therapist, such as a psychologist, psychiatrist, or licensed therapist, in a safe and supportive environment. A therapist can help you to understand and manage your depression, as well as provide you with coping strategies. There are different types of treatment within psychotherapy itself, including-

1. Cognitive-behavioral therapy (CBT): CBT is a type of psychotherapy that focuses on the relationship between an individual's thoughts, behaviors, and emotions. This therapy is based on the idea that negative thoughts and beliefs can lead to negative behaviours and emotions. CBT aims to help individuals identify and challenge negative thought patterns and develop more positive coping skills.

2. Psychodynamic therapy: It focuses on the relationship between an individual's unconscious thoughts and behaviours. This type of therapy is based on the idea that early childhood experiences can shape an individual's thoughts, behaviours, and relationships. Psychodynamic therapy aims to help individuals gain insight into their unconscious thoughts and behaviours and make positive changes.

3. Interpersonal therapy (IPT): IPT focuses on the relationship between an individual's interpersonal relationships and their mental health. This type of therapy is based on the idea that difficult life events, such as a death or divorce, can lead to depression and other mental health issues. It aims to help individuals improve their relationships and communication skills, and develop more positive coping skills.

4. Acceptance and Commitment Therapy (ACT): ACT focuses on helping individuals accept their thoughts and feelings rather than trying to suppress them. This type of therapy is based on the idea that avoiding negative emotions can lead to greater suffering. It aims to help individuals develop greater psychological flexibility and make positive changes in their lives.

5. Dialectical Behavior Therapy (DBT): DBT combines behavioural therapy with mindfulness techniques. This type of therapy is often used to treat individuals with borderline personality disorder and other mental health conditions that involve difficulty regulating emotions. It aims to help individuals learn how to manage their emotions, improve their relationships, and develop more positive coping skills.

2. Medication: Antidepressant medications can be effective in treating depression. These medications work by altering the levels of certain chemicals in the brain, such as serotonin and norepinephrine. There are several different types of antidepressants available, and the best choice will depend on the individual's symptoms and medical history. It's important to work closely with a healthcare provider to determine the most appropriate medication and dosage.

3. Brain Stimulation Therapy: Brain stimulation therapy involves using electrical currents to stimulate specific areas of the brain. This includes electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagus nerve stimulation (VNS). These therapies are typically used in cases where other treatments have not been effective.

4. Lifestyle Changes: Making lifestyle changes can also be an effective way to manage depression. This includes getting regular exercise, eating a healthy diet, getting enough sleep, and reducing stress. Engaging in activities that bring joy and fulfilment can also be helpful in order to reduce symptoms of depression.

5. Complementary Therapies: There are several complementary therapies that can be used in conjunction with other treatments for depression. These therapies include acupuncture, massage therapy, and meditation. While there is limited scientific evidence to support the effectiveness of these therapies, people with severe depression find them helpful in managing depression.

 It is important to remember that if you are feeling depressed, you are not alone. There are many resources available to help you, such as support groups and online communities such as our YouMatter Community. Depression is a serious mental health issue but with the right treatment it can be managed. If you are struggling with depression, we can not stress enough on how important it is to reach out and seek help. We are here for you!