Depression (A comprehensive Guide)

In this brief guide, depression will be discussed in detail, and its symptoms, diagnostic criteria, types, causes and treatment will be discussed.

Overview of Depression

Depression is a term which is mostly misused by the layman, but the meanings of depression are different in the mental health field.

As per the diagnostic criteria given in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5, 2013), depression is termed as low mood, lack of interest in doing anything, sleep disturbance and emotional dysregulation.

How to know if you have Depression?

Depression is more than sadness and the diagnosis needs a number of symptoms.

Without meeting a mental health professional, a person can take help from the self-assessment tests for depression available online for initial screening.

Symptoms of Depression

The symptoms of depression are massive and affect the person’s functioning in different domains of life.

There different types of symptoms, such as psychological, physical, and social symptoms.

Psychological Symptoms

A person experiencing depression experiences low mood, feelings of worthlessness, guilt, irritability, tearful, unable to focus, having no motivation and a v

Physical Symptoms

Unable to perform required tasks, lack of pleasure in the activities they once enjoyed, disturbed appetite, crying spells, and suicidal intention or suicidal attempt.

Social Symptoms

  • Lack of interest in socialization
  • Neglecting hobbies
  • Difficulty in relationships

Diagnosis of Depression

Diagnosis can only be given by the professionals in the mental health field on the basis of criteria given in DSM-5 (DSM 5, 2013).

Following these criteria the following summary has been extracted:

The condition of a person needs to be monitored or reported by themselves considering the last 2 weeks, and five or more symptoms are required to be diagnosed with Major Depressive Disorder.

a.      Depressed or low mood either reported by the person or observed by others around.

b.      Lack of interest in doing any activity at all, or we can call this anhedonia

c.      Increase or decrease in body weight

d.      Sleep disturbance, either getting overly sleepy or not getting sleepy at all

e.      Decreased physical or motor activity which restricts oneself to bed or to feel slowed down

f.       Overly exhausted, or tired

g.      Excessive feelings of remorse or guilt

h.      Extremely low self-esteem and self-worth

i.       Inability to concentrate or focus on the tasks at hand, as well as unable to make decisions

j.       Continuously or excessively experiencing thoughts of death

B.     These symptoms are disabling the person to work efficiently in their environment

C.      The condition is not because of any medication or substance use

On the basis of above criteria, mental health practitioners diagnose the client with depression.

Types of Depression

There are several types of depression which are recognized:

1.      Clinical Depression

2.      Dysthymia (Persistent Depressive Disorder)

3.      Postpartum Depression

4.      Seasonal Depression

5.      Psychotic Depression

6.      Premenstrual Dysphoric Disorder

7.      Disruptive Mood Dysregulation Disorder

Clinical Depression

The type of depression discussed above is called the clinical depression or major depressive disorder.

The clinical depression is unipolar and characterized by an intense feeling of sadness and lack of interest.

The symptoms are lack of pleasure in the activities they once enjoyed, disturbed appetite, crying spells, low mood, feelings of worthlessness, guilt, irritability, tearful, unable to focus, having no motivation to work and a disturbed sleep pattern.

Dysthymia (Persistent Depressive Disorder)

It is known as persistent because the symptoms of major depression are mild in intensity by the lasts for more than 2 years.

This is also called chronic depression. The person is considered as gloomy, sad and a complainer.

Another main condition is that the person won’t remain without the symptoms for more than 2 months.

Postpartum Depression

This type of depression is linked with the childbirth. This is also known as “baby blues”.

This is quite common and because of hormonal changes, the mother starts feeling down, sad, depressed, anxious for a number of weeks after childbirth.

Seasonal Depression

This is based on the changes in the season, this is experienced at a particular time in the year.

Mostly the symptoms appear at the start of winters and remain there for months.

Person experience fatigue, low mood, hopelessness and progress towards getting severe.

Psychotic Depression

This form of depression is experienced in around 20% of people.

The depression gets so severe that they start experiencing psychotic symptoms and start having hallucinations, delusions and disorganized thinking.

Premenstrual Dysphoric Disorder

This is based on the cyclic hormonal disturbance during the menstrual cycle.

Around 85% of females experience this disorder but only around 5-6% get the diagnosis of the disorder.

The disorder causes low mood, irritability, frustration, mood disturbance, and anxiety.

Disruptive Mood Dysregulation Disorder

DMDD disorder is for the first time introduced in DSM 5.

This diagnosis is specifically for children and symptoms includes the dysregulation of mood expected for their age.

Excessive temper tantrums, behavioural and emotional disturbances are experienced.

Causes of Depression

There are a number of different causes of depression.

There are a number of factors which plays their role in triggering depression.

The causes of depression are multiple, they range from physiological, to psychological, and to environmental.

Brain Structure

The changes in the brain structure and its chemistry can cause depression.

The neurotransmitter dopamine and serotonin are considered to be involved in the levels of depression.

Physiological Causes

The causes can be altered due to the level of hormones due to pregnancy or menstrual cycle, the effect of any medication of substance as well as there can be the genetic causes of depression.

Psychological Causes

These causes include the environmental stresses, traumatic events, and death of loved ones.

Assessment of Depression

When an assessment is being done, then there are a number of ways to do it.

Such as mental health professionals who carry out the assessment on the basis of a clinical interview, and standardized tools.

Similarly, self-assessment tools are available as well which helps the person to understand their condition and its severity.

Some of the self-assessment tools are available here.

While the tools mental health professionals use are based on their preference and expertise.

There are few standardized and validated mostly used in the clinical settings are:

Beck Depression Inventory

This tool was developed by Beck, and this is the most popularly used tool among practitioners.

The tool has 21 question items and it has been revised several times after it was developed in 1961.

This tool was developed according to the diagnostic and statistical manual of mental disorder depression criteria.

The tool is based on the cognitive triad concept used by Cognitive behaviour therapist and developed by Aaron T. Beck.

This theory says that the thoughts are affected by negativity about self, others and the world.

Hamilton Depression Rating Scale

This HAM-D scale (Hamilton Depression Rating Scale ) is the oldest scale for depression.

This scale is time consuming but is validated as BDI(Beck depression inventory).

There is a shorter version of the HAM-D( Hamilton Depression Rating Scale ) as well, but the validity and reliability of that version is not yet fully developed.

Patient Health Questionnaire

The PHQ scale is quite long and takes a lot of time, as it includes the five psychiatric conditions (depression, anxiety, somatoform, alcohol and eating disorders).

The shorter version of PHQ is available which is called PHQ-9, this scale takes only about 3-5 minute of the practitioner.

Treatment of Depression

There two different types of evidence-based treatments:

Medication

Antidepressants are commonly prescribed by the psychiatrist as a treatment for depression. 

There are about thirty different types, among which if the client doesn’t respond to one medication the other one is given.

When a person uses medication there are chances of side effects and psychiatric medication usually has adverse side effects.

A person needs to take medication for several months so their effect starts to get visible.

Apart from Antidepressants, the modern medication of SSRIs can be used.

They help the brain to naturally increase the levels of serotonin required for good mood regulation.

Then another type of antidepressants available is Tricyclic Antidepressants (TCAs), they are used to treat the moderate to severe depression.

These help the person to lift their mood by increasing the level of hormones required for mood regulation.

Psychotherapy

Talk therapy can be beneficial and researches have been conducted where psychotherapy gives equally effective results to medication or sometimes more efficient and long-lasting results.

In psychotherapy, Cognitive behaviour therapy is the evidence-based therapy which improves the condition of the person.

The focus of CBT is on the present and identification of thinking patterns.

Because according to CBT, the faulty thinking patterns makes one person sad or depressed.

The negative automatic thoughts are considered to be the cause of depression.

There are a number of different psychotherapy which can be used along with the improvements in the lifestyle of the person which are required.

Yoga, appropriate diet, exercise, and getting enough sleep also helps in the symptoms of depression.

Recommended foods for Depression

Antioxidants prevent cells from damage, and vitamin C and E enriched foods are beneficial for depression.

Fruits such as blueberries, grapefruit, kiwi, peaches, carrots, spinach, sweet potato, as well as nuts, seeds, margarine, and wheat germ are effective in the condition of depression.

Smart carbohydrates also give a calming and relaxing effect, these include limited sugar foods such as whole grains, fruits, and healthy fibre.

A protein-rich diet is also healthy and beneficial for the alertness and gives the boost of energy.

This includes turkey, tuna, chicken, meat and poultry.

Vitamin D is also the essential ingredient and particularly effective especially for seasonal affective disorder.

Side Note: I have tried and tested various products and services to help with my anxiety and depression. See my top recommendations here, as well as a full list of all products and services our team has tested for various mental health conditions and general wellness.

Frequently Asked Questions

What is the major depressive episode?

The major depressive episode is two weeks long, and the person experiences extreme sadness, low mood, lack of interest, disturbed sleep and disturbed appetite, fatigue, lack of socialization, crying spells, hopelessness, low self-esteem and suicidal thoughts.

Is Major depression curable?

There is no yes or no answer to whether major depression is curable.

As major depression but comes and goes around the lifetime, but the treatment improves the quality of a person’s life.

What is the best treatment for depression?

The best treatment for depression is CBT as well medication, but in a number of researches conducted CBT gave promising results without giving any side effects which is the case with medication as well.

What is double depression?

Double depression is actually the severe form dysthymia.

The worsening of dysthymia symptoms replicates the major depressive episode and this condition is called double depression.

Can seasonal depression happen in summer?

Yes, seasonal depression can occur around 9-10% of people report that the symptoms emerge in the summer months.

What we recommend for depression

Professional counselling

If you are suffering from depression then ongoing professional counselling may be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.

Please feel free to give your feedback and ask questions in the comments section below, we will be pleased to respond.

References

NHS

Mind.org.uk

Rethink.org

Psycom.com

 Recommended Readings:

The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness

Overcoming Depression – Get Happy Again: The Self-Help Workbook for Understanding Depression, Anxiety and Panic Attacks

Reasons to Stay Alive

Overcoming Depression: A self- help guide using Cognitive Behavioural Techniques

Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions

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