Why is depression so hard (7 reasons)

In this writing, we will address the question “ why is depression so hard”, symptom and type of depression, why depression is hard, diagnosis and treatment of depression and some FAQs regarding the subject.

Depression is hard and tough to overcome with because of the following reasons:

• Anhedonia
• A feeling of worthlessness, helplessness, and hopelessness
• Failing to pinpoint the cause of depressed mood
• Others fail to understand their feelings
• Getting through the days requires tremendous energy and will.
• Impaired concentration and focus
• Problematic and Disrupted Sleep Cycle
• Drained out and Low Energy
• Physical pain and symptoms

Depression

Depression is a mood disorder where the individual experiences prolonged sadness, lethargic, worthiness, helplessness and melancholic that interferes or hampers their daily functioning.

The DSM 5 criteria for Depression is depressed mood or loss of interest during the same 2-week period coupled with weight loss, change in appetite, insomnia or hypersomnia, psychomotor agitation, feeling of worthlessness, lack of concentration and suicidal ideation.

Classification of Depression

Based on the severity of the symptoms and their duration, two major types of depression are Major Depressive Disorder or Clinical Depression and Chronic Depressive Disorder/ Dysthymia. Apart from these, there are Bi-Polar Disorder and Seasonal Affective Disorder.

Major Depressive Disorder

To be diagnosed with MDD, there should be five depressive symptoms that last for at least 2 weeks. Adding onto that, there should either be a depressed mood or loss of interest. MDD is a periodic or episodic disorder where the symptoms go on and off over time. Along with it, suicide ideation and thought of death are common. 

The prevalence of depression is 7% with higher prevalence in 60 years or more. 

Persistent Depression Disorder, Dysthymia

One of the essential features of Dysthymia is a depressed mood that lasts throughout the day for at least 2years, in case of children the duration is for 1 year. Along with depressed mood, they should also experience two of the six symptoms (poor appetite, sleep disturbance, low energy, low self-esteem, trouble in concentrating and hopelessness)

 It has an early and insidious onset. It is twice more common in women than in men. Dysthymia is common in general population affecting 5-6% of the population.

Bi-Polar Disorder

Two types of Bi-Polar disorder is, BP-1 and BP-2. The manic symptom is the defining feature of the two and the severity of the two differentiate these. Bi-Polar 1 is known as Manic-Depressive Disorder where there is a single episode of mania during their lifetime however, they may or may not have a depressive episode. While Bi-Polar 2 is characterised by hypomanic (milder version of Manic) episode with Major Depressive Episodes.

 Bipolar 1 Disorder is much rarer than MDD and the prevalence rate is 0.6% and Bi-Polar affects somewhere between 0.4 to 2%.

Cyclothymic Disorder. 

It is also a chronic mood disorder where the proposed symptom (numerous episodes of hypomanic symptoms and depressive symptoms) last for at least 2 years. They experience frequent alternating mild symptoms of Mania and Depression. People with cyclothymia have a high risk of developing Mania and Major Depression. 

About 3-5% of the psychiatric patient is diagnosed with Cyclothymic Disorder.

Seasonal Affective Disorder. 

It is known by recurrent depressive episodes occurring typically in winter.

The severity of the episode ranges from mild to moderate and in the worse case, have the risk of suicide as well. It is more prevalent in people in the northern part of the world than in summer. The change in melatonin is responsible for this episode, they show more change in melatonin than the rest. 

SAD Symptom is similar to those of Depression except that it coincides with seasons.

Postpartum Depression. 

It is a blend of physical, emotional and behavioural changes that a woman undergoes after giving birth. The diagnosis is based on the length of time between their onset and delivery and the severity of depression. Some of the symptoms are difficulty in sleeping, appetite change, fatigue, decreased libido and frequent mood change. It generally begins within the 4 weeks after delivery.

Almost 80% of new mothers are diagnosed with this depression and it follows after 15% of birth.

Sign and symptoms of Depression

Some of the sign and symptoms associated with Depression are:

• Depressed and Low mood
• Anhedonia
• Feeling of hopelessness
• Worthlessness and Helplessness
• Lack of concentration
• Thoughts on ending life
• Difficulty in sleep
• Irritability and Agitation
• Fluctuation in appetite
• Difficulty in decision making.
• Diurnal Mood
• Significant weight loss
• Lost motivation
• Loss of energy
• Recurrent thoughts on death
• Excessive guilt

Depression is hard and difficult because of the following reasons:

Anhedonia

It is the loss of pleasure or interest in those activities that one find pleasurable in normal days such as spending time with friends, travelling, playing and etc. Anhedonia is a significant symptom of mental illnesses. 

Anhedonia hampers our functioning, especially with our reward system and we lose interest in all activities. 

A feeling of worthlessness, helplessness, and hopelessness

The dominance of these thoughts and feeling over a prolonged period time makes it hard for an individual to cope up with it. The constant battle with these thoughts results in gloominess and eventually suicidal thoughts.

Failing to pinpoint the cause of depressed mood

A depressed patient finds it hard to understand the underlying reason behind their low and depressed mood. They feel that something is bothering them but are unable to understand the reason behind it.

Others fail to understand their feelings

Those who have never undergone the feeling of depression, they fail to understand people who are actually battling with it. It thus a daunting task for such people to convince and let others understand the emotions and feeling that they are undergoing.

Getting through the days requires tremendous energy and will.

Each day is a battle for an individual going through depression and to get over with it, it requires lots of guts and energy from the patient. 

And at times, they find too hard to actually wake up in the morning and to interact with others.

Impaired concentration and focus

Individual going through depression find it very taxing and strenuous to take initiative in doing any kind of activity such as reading, cooking and et. they feel they are always demotivated and loss of energy. 

Problematic and Disrupted Sleep Cycle

Insomnia and Hyposomnia are the two major problems in their sleep cycle. Depressed patient experience problem in falling asleep due to overdominance of feeling of worthless and failure while waking up in the morning also takes a lot of energy from them.

Drained out and Low Energy

People find it tiring to get out of bed and are exhausted throughout time. They feel exhausted and find it wearying to take up even the simple task. 

Physical pain and symptoms

Adding on to the low and depressed mood, there are underlying physical pain and symptoms such as headaches, nausea, body pain and etc. 

Diagnosing Depression.

There are different ways through which we can assess depression in an individual. It can be a physical test, psychological test and medical screenings.

Some of the most commonly used tests to assess depressive episode or diagnosis are:

Patient Health Questionnaire 

It is a 9-item questionnaire which is self-administered. It is usually used to screen the severity and diagnosis of Depression.

Beck Depression Inventory

Beck Depression Inventory is one of the most widely used tests in measuring and studying the symptoms of depression. It contains a 21-item self-report inventory that measures the symptoms of depression in an individual with four choices.

Hamilton Rating Scale of Depression

It is multiple choce quesrtionnanire.

Some of the treatment that can be used for Depression are:

Medication/ Pharmacotherapy: 

Medicines like Anti-Depressants, Mood-Stabilizer, or Anti-Psychotic drugs are used to treat Depression. 

• MAOIs, Monoamine Oxidase Inhibitors 

It works by inhibiting the action of Monoamine oxidize, which is an enzyme that breaks down Norepinephrine and Serotonin when they are released. 

• Tricyclic

It is another medicine that has shown a significant effect in reducing depressive symptoms, unfortunately, have severe side effects like weight loss, dry mouth, sexual dysfunction, etc. 

• SSRI, Selective Serotonin Reuptake inhibitors 

These are an effective treatment for those with severe depression and it is better tolerated by people with Depression. It is also used for those with Mild Depression. 

Electroconvulsive Therapy:

Another alternative for the treatment of Depression is Electroconvulsive Therapy which is used most frequently for severely depressed patients who also have a serious risk of suicides. 

Within 6-12 treatments, complete remissions of the symptoms occur in many of the patients. The treatment induces Seizures thus, the patient is given anaesthesia along with muscle relaxants.

Transcranial Magnetic Stimulation:

TMS is an alternative biological treatment for Depression which is a Non-Invasive Technique.  A brief yet intense magnetic stimulation is or field induces electrical activity in the cortex area of the brain. It is a painless procedure and the treatment is provided 5 times a  week and wrapped up within 5-6 weeks. There is no post-effect observed on memory and cognition of the patient.

Brightlight Therapy:

This therapy is an alternative nonpharmacological bio method that has received increasing attention over the last decades. Initially, it was Seasonal Affective Disorder that was treated by this therapy however, it has also shown effectiveness in Depression as well.

Psychotherapies:

Since the 1970’s Psyhchotherapies are also used for the treatment purpose of Depression along with the existing medication and biological treatments. Therapies had a notable effect on the treatment of Depression when carried froward alone or supplementing with medication.

• Cognitive Behavioural Therapy:

The therapy is designed and formulated by Aeron Beck, which is a brief treatment that stresses the here and now of the problem rather than the past or deeper level of it. 

The basic idea or the crust of the therapy is that the thinking pattern or the belief of the patient is assumed to be a hypothesis that can be tested or evaluated through behavioural experiments. 

• Mindfulness-based Cognitive Therapy:

It is developed only in recent years for those with recurrent episodes of Depression.  In this therapy, the patients are taught about mindfulness-based meditation techniques so that their awareness about the distorted thoughts are raised and thus can accept it rather than avoid it.

• Interpersonal Therapy: 

The therapy is as effective as medication and CBT. It stresses the relationship issues and help the person change and modify the maladaptive pattern in relation. For those with severe and recurrent episodes of Depression, the therapy is often used with follow-up. 

Lifestyle changes:

This domain of modification comprises behavioural change, change in diet, daily routine, and our social circle.

It can be a gradual change starting with a change in diet and then progressing further that will uplift one’s mood and brighten up the day.

For the treatment of Depression, some lifestyle changes include

• Getting rid of all the negative energies and activities.

• Self Journalling or Keeping a Gratitude Journal
• Healthy Eating
• Meditation and Calming Activities
• Taking time out for friends, family, and social events.
• Balancing out things
• Getting extra sleep
• Staying hydrated
• Stress Management
• Asking for support and seeking professional help

FAQs: Why is Depression hard?

BetterHelp: A Better Alternative

Those who are seeking therapy online may also be interested in BetterHelp. BetterHelp offers plenty of formats of therapy, ranging from live chats, live audio sessions and live video sessions. In addition, unlimited messaging through texting, audio messages and even video messages are available here.

BetterHelp also offers couples therapy and therapy for teenagers in its platform. Furthermore, group sessions can also be found in this platform, covering more than twenty different topics related to mental health and mental illness. The pricing of BetterHelp is also pretty cost-effective, especially considering the fact that the platform offers financial aid to most users.

Conclusion

In this article, the question, “ Is Depression hard” is addressed along with symptoms of depression, type, diagnosis and treatment of depression and some FAQs regarding the subject.

Some sites for more information

https://www.medicalnewstoday.com/articles/314071#feels

https://young.scot/get-informed/national/10-things-people-with-depression-want-you-to-know

https://www.healthline.com/health/mental-health/what-major-depression-is-really-like

Bibliography

Berry, J. (2018, 07 11). How do I know I am feeling depressed? Medicalnews today. https://www.medicalnewstoday.com/articles/314071

Drillinger, M. (2019, 04 18). 8 Things People with High-Functioning Depression Want You to Know. healthline. https://www.healthline.com/health/what-you-should-know-high-functioning-depression

Fabian, R. (2018, 08 24). Why Does Depression Make it Difficult to Function? The Talkspace Voice. https://www.talkspace.com/blog/depression-makes-functioning-difficult/

Saddook, B. J., & Saddock, V. A. (2017). Synopsis of Psychiatry. Wolters Kluwer.