Conclusion depression

Depression is one of the most common conditions in primary care, but is often unrecognized,
undiagnosed, and untreated. Depression has a high rate of morbidity and mortality when left
untreated. Most patients suffering from depression do not complain of feeling depressed, but
rather anhedonia or vague unexplained symptoms. All physicians should remain alert to
effectively screen for depression in their patients. There are several screening tools for
depression that are effective and feasible in primary care settings. An appropriate history,
physical, initial basic lab evaluation, and mental status examination can assist the physician in
diagnosing the patient with the correct depressive spectrum disorder (including bipolar disorder).
Primary care physicians should carefully assess depressed patients for suicide. Depression in the
elderly is not part of the normal aging process. Patients who are elderly when they have their first
episode of depression have a relatively higher likelihood of developing chronic and recurring
depression. The prognosis for recovery is equal in young and old patients, although remission
may take longer to achieve in older patients. Elderly patients usually start antidepressants at
lower doses than their younger counterparts.

Most primary care physician can successfully treat uncomplicated mild or moderate forms of
major depression in their settings with careful psychiatric management (e.g., close monitoring of
symptoms, side effects, etc.); maintaining a therapeutic alliance with their patient;
pharmacotherapy (acute, continuation, and maintenance phases); and / or referral for
psychotherapy. The following situations require referral to psychiatrist: suicide risk, bipolar
disorder or a manic episode, psychotic symptoms, severe decrease in level of functioning,
recurrent depression and chronic depression, depression that is refractory to treatment, cardiac
disease that requires tricyclic antidepressants treatment, need for electroconvulsive therapy
(ECT), lack of available support system, and any diagnostic or treatment questions.

Antidepressant medications’ effectiveness is generally comparable across classes and within

classes of medications.  The medications differ in side effect profiles, drug-drug interactions, and
cost.  The history of a positive response to a particular drug for an individual or a family
member, as well as patient preferences, should also be taken into account.  Most psychiatrists
agree that an SSRI should be the first line choice.  The dual action reuptake inhibitors
venlafaxine and bupropion are generally regarded as second line agents.  Tricyclics and other
mixed or dual action inhibitors are third line, and MAOI’s (monoamine oxidase inhibitors) are
usually medications of last resort for patients who have not responded to other medications, due
to their low tolerability, dietary restrictions, and drug-drug interactions.  Most primary care
physicians would prefer that a psychiatrist manage patients requiring MAOI’s.

Psychotherapy may be a first line therapy choice for mild depression particularly when
associated with psychosocial stress, interpersonal problems, or with concurrent developmental or
personality disorders. Psychotherapy in mild to moderate depression is most effective in the
acute phase, and in preventing relapse during continuation phase treatment. Psychotherapy is not
appropriate alone for severe depression, psychosis, and bipolar disorders. For more severe
depression, psychotherapy may be appropriate in combination with the use of medications. The
most effective forms of psychotherapy are those with structured and brief approaches such as
cognitive behavioral therapy, interpersonal therapy, and certain problem solving therapies.
Regardless of the psychotherapy initiated, “psychiatric management” must be integrated at the
same time.

Patients, who live with depression, and their family and friends, have enormous challenges to
overcome. Primary care physicians can provide compassionate care, important education,
psychiatric monitoring, social support, reassurance, and advocacy for these patients and their
loved ones.

 Depression is a common mental disorder. Globally, more than 264 million people
of all ages suffer from depression.
 Depression is a leading cause of disability worldwide and is a major contributor to
the overall global burden of disease.
 More women are affected by depression than men.
 Depression can lead to suicide.
 There are effective psychological and pharmacological treatments for moderate
and severe depression.
Overview
Depression is a common illness worldwide, with more than 264 million people
affected(1). Depression is different from usual mood fluctuations and short-lived
emotional responses to challenges in everyday life. Especially when long-lasting and
with moderate or severe intensity, depression may become a serious health condition. It
can cause the affected person to suffer greatly and function poorly at work, at school
and in the family. At its worst, depression can lead to suicide. Close to 800 000 people
die due to suicide every year. Suicide is the second leading cause of death in 15-29-
year-olds.

Although there are known, effective treatments for mental disorders, between 76% and
85% of people in low- and middle-income countries receive no treatment for their
disorder(2).  Barriers to effective care include a lack of resources, lack of trained health-
care providers and social stigma associated with mental disorders. Another barrier to
effective care is inaccurate assessment. In countries of all income levels, people who
are depressed are often not correctly diagnosed, and others who do not have the
disorder are too often misdiagnosed and prescribed antidepressants.

The burden of depression and other mental health conditions is on the rise globally. A World Health
Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to
mental disorders at the country level.

Types and symptoms

Depending on the number and severity of symptoms, a depressive episode can be
categorized as mild, moderate or severe.

A key distinction is also made between depression in people who have or do not have a
history of manic episodes. Both types of depression can be chronic (i.e. over an
extended period) with relapses, especially if they go untreated.

Recurrent depressive disorder: this disorder involves repeated depressive episodes.

During these episodes, the person experiences depressed mood, loss of interest and
enjoyment, and reduced energy leading to diminished activity for at least two weeks.
Many people with depression also suffer from anxiety symptoms, disturbed sleep and
appetite, and may have feelings of guilt or low self-worth, poor concentration and even
symptoms that cannot be explained by a medical diagnosis.

Depending on the number and severity of symptoms, a depressive episode can be

categorized as mild, moderate or severe. An individual with a mild depressive episode
will have some difficulty in continuing with ordinary work and social activities but will
probably not cease to function completely. During a severe depressive episode, it is
unlikely that the sufferer will be able to continue with social, work or domestic activities,
except to a limited extent.

Bipolar affective disorder: this type of depression typically consists of both manic and
depressive episodes separated by periods of normal mood. Manic episodes involve
elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a
decreased need for sleep.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological
factors. People who have gone through adverse life events (unemployment,
bereavement, psychological trauma) are more likely to develop depression. Depression
can, in turn, lead to more stress and dysfunction and worsen the affected person’s life
situation and depression itself.

There are interrelationships between depression and physical health. For example,
cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community approaches to
prevent depression include school-based programmes to enhance a pattern of positive thinking in
children and adolescents. Interventions for parents of children with behavioural problems may reduce
parental depressive symptoms and improve outcomes for their children. Exercise programmes for the
elderly can also be effective in depression prevention.

 
Diagnosis and treatment
There are effective treatments for moderate and severe depression. Health-care providers may offer
psychological treatments such as behavioural activation, cognitive behavioural therapy (CBT) and
interpersonal psychotherapy (IPT), or antidepressant medication such as selective serotonin reuptake
inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Health-care providers should keep in mind the
possible adverse effects associated with antidepressant medication, the ability to deliver either
intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different
psychological treatment formats for consideration include individual and/or group face-to-face
psychological treatments delivered by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be
an effective form of treatment for moderate-severe depression but are not the first line
of treatment for cases of mild depression. They should not be used for treating
depression in children and are not the first line of treatment in adolescents, among
whom they should be used with extra caution.

WHO response
Depression is one of the priority conditions covered by WHO’s mental health Gap Action
Programme (mhGAP). The Programme aims to help countries increase services for
people with mental, neurological and substance use disorders through care provided by
health workers who are not specialists in mental health. WHO has developed brief
psychological intervention manuals for depression that may be delivered by lay workers.
An example is Problem Management Plus, which describes the use of behavioural
activation, relaxation training, problem solving treatment and strengthening social
support. Moreover, the manual Group Interpersonal Therapy (IPT) for Depression
describes group treatment of depression. Finally, Thinking Healthy covers the use of
cognitive-behavioural therapy for perinatal depression.

References
1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018).
Global, regional, and national incidence, prevalence, and years lived with disability for
354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic
analysis for the Global Burden of Disease Study 2017. The Lancet. DOI.
2. Wang et al. Use of mental health services for anxiety, mood, and substance disorders
in 17 countries in the WHO world mental health surveys. The Lancet. 2007;
370(9590):841-50.

Abstract
Numerous studies have outlined similarities and differences between anxiety and
depression, focusing mainly on affect and cognition. The present study aimed to
extend this line of research to include motivation. There are theoretical grounds
(e.g., Gray, 1982) for expecting anxiety to be related primarily to motivational
systems underlying avoidance whereas depression would be expected to include
elements of both high avoidance and low approach motivation. The study &
examined the relationships between approach goals and avoidance goals and
anxiety and depression. A school sample of adolescents (N = 144) completed an
open‐ended task that required participants to write down as many personal
approach and avoidance goals that came to mind within a short time period.
Participants were also asked to describe the most important consequence
associated with either achieving or not achieving each of their goals, which were
then classified as either approach or avoidance consequences. They also
completed a self‐report questionnaire asking about approach and avoidance
achievement goals. The findings were consistent across measures. In line with
predictions, anxiety was associated with measures of avoidance goals but not
approach goals. Depression was related to a deficit in approach goals but,
against prediction, showed no relationship to measures of avoidance goals.
Anxiety and depression can be clearly distinguished in terms of their patterns of
goal motivation.

Depression, in psychology, a mood or emotional state that is marked

by feelings of low self-worth or guilt and a reduced ability to enjoy life.
A person who is depressed usually experiences several of the following
symptoms: feelings of sadness, hopelessness, or pessimism; lowered
self-esteem and heightened self-depreciation; a decrease or loss of
ability to take pleasure in ordinary activities; reduced energy and
vitality; slowness of thought or action; loss of appetite; and
disturbed sleep or insomnia.
BRITANNICA QUIZ

Medical Terms and Pioneers Quiz

Which of these viral diseases is also called variola?

Depression differs from simple grief or mourning, which are
appropriate emotional responses to the loss of loved persons or
objects. Where there are clear grounds for a person’s unhappiness,
depression is considered to be present if the depressed mood is
disproportionately long or severe vis-à-vis the precipitating event. The
distinctions between the duration of depression, the circumstances
under which it arises, and certain other characteristics underlie the
classification of depression into different types. Examples of different
types of depression include bipolar disorder, major depressive
disorder (clinical depression), persistent depressive disorder,
and seasonal affective disorder.

Characteristics And Causes Of

Depression
Depression is probably the most common psychiatric complaint and
has been described by physicians since before the time of ancient
Greek physician Hippocrates, who called it melancholia. The course of
the disorder is extremely variable from person to person; it may be
mild or severe, acute or chronic. Untreated, depression may last an
average of four months or longer. Depression is twice as prevalent in
women than in men. The typical age of onset is in the 20s, but it may
occur at any age.

Depression can have many causes. Unfavourable life events can

increase a person’s vulnerability to depression or trigger a depressive
episode. Negative thoughts about oneself and the world are also
important in producing and maintaining depressive symptoms.
However, both psychosocial and biochemical mechanisms seem to be
important causes; the chief biochemical cause appears to be the
defective regulation of the release of one or more naturally
occurring neurotransmitters in the brain,
particularly norepinephrine and serotonin. Reduced quantities or
reduced activity of these chemicals in the brain is thought to cause the
depressed mood in some sufferers.
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Depression is also associated with disordered rapid eye movement

(REM) sleep. A region of the brain known as
the amygdala contains neurons that project into the brainstem and
appear to be involved in modulating REM sleep. The amygdala is also
associated with processing negative thoughts and may be enlarged,
hyperactive, or otherwise dysfunctional in some depressed persons.
Although the significance of these associations is yet to be defined, the
link between depression, disordered REM sleep, and abnormalities of
the amygdala has led to new avenues of research into the neurobiology
and treatment of depression.

Research suggests that depression is also linked to physical activity,

whereby physical activity may lower a person’s risk of developing
depression. Individuals who exercise typically report better mental
health and are less likely to be depressed, compared with individuals
who do not exercise.

Types Of Depression
Bipolar disorder, major depressive disorder, and persistent depressive
disorder are the primary types of depression. A person who
experiences alternating states of depression and mania (abnormal
elevation of mood) or hypomania (distinct, though not necessarily
abnormal, elevation of mood) is said to suffer from bipolar
disorder. Major depressive disorder is characterized by severe
symptoms that disrupt the individual’s daily life, typically with effects
on appetite, sleep, work, or the ability to enjoy life. Episodes of major
depression can occur at any age and may occur once or multiple times
in an affected person’s life. Persistent depressive disorder involves
symptoms that last two or more years, sometimes marked by episodes
of major depression.

Other types of depression include postpartum depression, psychotic

depression, and seasonal affective disorder, each of which develops
under specific circumstances. Postpartum depression develops in
women in the period following childbirth. Symptoms include anxiety,
a lack of interest in caring for the infant, and feelings of sadness,
hopelessness, or inadequacy. Postpartum depression is longer-lasting
and more severe than the “baby blues,” a common condition among
women after childbirth that typically involves mood swings, feelings of
sadness, and crying spells. Psychotic depression arises against a
background of psychosis, which may involve symptoms of delusions,
hallucinations, or paranoia. Seasonal affective disorder is
characterized by the onset of depressive symptoms in autumn and
winter, which are alleviated with increased exposure to natural light in
spring and summer.

Treatments For Depression

There are three main treatments for depression. The two most
important—and widespread by far—are psychotherapy and
psychotropic medication, specifically antidepressants. Psychotherapy
aims to alter the patient’s maladaptive cognitive and behavioral
responses to stressful life events while also giving emotional support
to the patient. Antidepressant medications, by contrast, directly affect
the chemistry of the brain and presumably achieve their therapeutic
effects by correcting the chemical dysregulation that is causing the
depression. Two types of medications, tricyclic
antidepressants and selective serotonin reuptake inhibitors (SSRIs;
e.g., fluoxetine [Prozac]), though chemically different, both serve to
prevent the presynaptic reuptake of serotonin (and in the case of
tricyclic antidepressants, norepinephrine as well). This results in the
buildup or accumulation of neurotransmitters in the brain and allows
them to remain in contact with the nerve cell receptors longer, thus
helping to elevate the patient’s mood. By contrast, the antidepressants
known as monoamine oxidase inhibitors (MAOIs) interfere with the
activity of monoamine oxidase, an enzyme that is known to be
involved in the breakdown of norepinephrine and serotonin.
 Prozac
Prozac pills.
Tom Varco
In cases of severe depression in which therapeutic results are needed
quickly, electroconvulsive therapy (ECT) has sometimes proved
helpful. In this procedure, a convulsion is produced by passing
an electric current through the person’s brain. For most persons with
depression, however, the best therapeutic results are obtained by
using a combination of psychotherapy and antidepressant medication.
(See also therapeutics.)

Some persons with depression are affected by treatment-resistant

depression (TRD), meaning that they are refractory to existing
therapies. For those individuals, scientists have been
investigating alternative therapeutic approaches, including deep brain
stimulation (DBS) and gene therapy. In DBS, experimental research
has focused on the implantation of an electrode in a region of the brain
known as the nucleus accumbens, which is located in the striatum
(neostriatum) deep within the cerebral hemispheres and is associated
with emotions and feelings such as fear, pleasure, and reward. Studies
of depressed animals and postmortem studies of the brains of patients
with depression have revealed that reduced levels of a protein known
as p11 in cells of the nucleus accumbens are associated with
depression. In depressed animals, increasing p11 levels in the nucleus
accumbens using gene therapy has been found to relieve depression-
like symptoms. Both DBS and gene therapy, however, are associated
with potentially dangerous side effects.

The Editors of Encyclopaedia BritannicaThis article was most recently revised and
updated by Kara Rogers, Senior Editor.
LEARN MORE in these related Britannica articles:

mental disorder: Mood disorders

…disorders include characteristics of either depression or mania or both, often in a

fluctuating pattern. In their severer forms, these disorders include the bipolar disorders and
major depressive disorder.…


 human disease: Psychiatric diseases

…of mood, ranging from severe depression to manic behaviour, are common forms of mental
illnesses. Severe depression is characterized by despondency, diminished interest in most or
all activities, weight fluctuation not due to dieting, disruption in sleep patterns, psychomotor
agitation or retardation, feelings of worthlessness, excessive quiet, and recurrent thoughts…

therapeutics: Mental disorders

anxiety disorders and depression. The benzodiazepines were the mainstay of treatment for
anxiety disorders beginning in the 1960s, although their prolonged use incurs the risk of mild
dependence. The azapirones (e.g., buspirone) have little potential for producing dependency
and are not affected by alcohol intake. Newer and safer…

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Depression
QUICK FACTS

KEY PEOPLE

 Viktor Frankl
 Joseph Jacob Schildkraut

RELATED TOPICS
 Emotion
 Neurosis
 Postpartum depression
 Antidepressant
 Seasonal affective disorder
 Bipolar disorder
 Affective disorder
 Zung Self-Rating Depression Scale
 Beck Depression Inventory
 Major depressive disorder
ANTIDEPRESSANT
ArticleMediaAdditional Info

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Antidepressant
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WRITTEN BY
Floyd E. Bloom
Chairman, Department of Neuropharmacology, Scripps Research
Institute, La Jolla, California. Editor in Chief, Science magazine.
Coauthor of Biochemical Basis of Neuropharmacology and others.
See Article History
Alternative Titles: antidepressant drug, psychic energizer
Antidepressant, any member of a class of drugs prescribed to
relieve depression. There are several major classes of antidepressant
drugs, the best known of which include the tricyclic
antidepressants, monoamine oxidase inhibitors (MAOIs), and
selective serotonin reuptake inhibitors (SSRIs). Other important
groups include the norepinephrine reuptake inhibitors (NRIs), the
serotonin-norepinephrine reuptake inhibitors (SNRIs), and
the atypical antidepressants, a disparate group of agents that possess
unique structural features and mechanisms of action.
 Prozac
Prozac pills.
Tom Varco
 READ MORE ON THIS TOPIC

therapeutics: Antidepressant drugs

Depression, a common mental disorder, is classified as an affective disorder (also

called mood disorders). Many drugs are available to treat...

Chemically speaking, depression is apparently caused by reduced

quantities or reduced activity of the
monoamine neurotransmitters (e.g., serotonin, norepinephrine,
and dopamine) within the brain. This etiology is supported by
evidence that drugs that restore chemical imbalances in the levels of
neurotransmitters in the brain effectively mitigate symptoms of
depression. All antidepressants, in fact, achieve their effects
by inhibiting the body’s reabsorption or inactivation of monoamine
neurotransmitters, thus allowing the neurotransmitters to accumulate
and remain in contact with their receptors for prolonged periods of
time; these changes seem to be important in elevating mood and
relieving depression.
One of the first antidepressants to demonstrate success clinically
was iproniazid, a drug developed originally for
the treatment of tuberculosis. In the 1950s scientists discovered that
the extreme euphoria and hyperactivity experienced by some patients
who were taking iproniazid was caused by the drug’s inhibition of
monoamine oxidase, an enzyme in the liver and brain that normally
breaks down the monoamine neurotransmitters. Drugs that were
better at blocking the activity of this enzyme were even more effective
in evoking euphoria. As a group, these drugs came to be known as
MAOIs.

Also in the 1950s the first tricyclic antidepressants were discovered.

These agents, so called because they are composed chemically of
three carbon rings, inhibit the active reuptake, to varying degrees, of
norepinephrine, serotonin, and dopamine in the brain. The tricyclics
include imipramine, amitriptyline, desipramine, nortriptyline, and a
number of other compounds. These drugs relieve symptoms in a high
proportion (more than 70 percent) of depressed patients. As with the
MAOIs, the antidepressant action of tricyclic drugs may not become
apparent until two to four weeks after treatment begins.

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today

SSRIs were introduced in the 1980s, and shortly thereafter they

became some of the most commonly used antidepressants, primarily
because they have fewer side effects than tricyclics or MAOIs. SSRIs
include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
SSRIs are also used in the treatment of anxiety, eating disorders, panic
disorder, obsessive-compulsive disorder, and borderline personality
disorder.

Other antidepressants inhibit the reuptake of monoamine

neurotransmitters in variable amounts. For example, the
SNRI venlafaxine blocks both serotonin and norepinephrine reuptake;
therapeutic doses of the drug, however, also weakly inhibit dopamine
reuptake. Nefazodone, an atypical antidepressant, inhibits serotonin
and norepinephrine reuptake and is an antagonist at certain serotonin
receptors and at α1-adrenoceptors.
Three to four weeks are typically required to produce significant
improvement in individuals who are taking antidepressant
medications. Most physicians recommend that patients continue to
take antidepressants for at least six months to prevent a relapse. The
type of antidepressant that a physician prescribes depends largely on
symptoms and severity of the condition and on the patient’s tolerance
of side effects. For instance, the MAOIs—
chiefly isocarboxazid, phenelzine, and tranylcypromine—in general are
used only after treatment with tricyclic drugs has proved
unsatisfactory, because these drugs’ side effects are unpredictable and
their complex interactions are incompletely understood. Fluoxetine
often relieves cases of depression that have failed to yield to tricyclics
or MAOIs.

Side effects vary among the types of antidepressants and may include
sleepiness, tremors, anxiety, loss of sexual desire, and nausea. The
possible side effects of tricyclics specifically include dry mouth,
blurred vision, constipation, dizziness, and difficulty
in urination. Cerebral and cardiac toxicity have been observed in some
individuals. In rare instances, antidepressants may cause life-
threatening side effects. For instance, nefazodone is associated with a
low risk of death from hepatic (liver) failure; the discovery of this risk
association resulted in the drug’s discontinuation in the United States.
Many antidepressants also have the potential to produce dangerous
drug interactions. This is especially true of MAOIs; the interaction of
these drugs with tyramine, which is found in many foods as well as
in wine and certain types of beer, can cause hypertension (high blood
pressure) and severe headache.

epression (major depressive disorder) is a common and serious medical illness that
negatively affects how you feel, the way you think and how you act. Fortunately, it is
also treatable. Depression causes feelings of sadness and/or a loss of interest in
activities you once enjoyed. It can lead to a variety of emotional and physical problems
and can decrease your ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:
 o Feeling sad or having a depressed mood
o Loss of interest or pleasure in activities once enjoyed
o Changes in appetite — weight loss or gain unrelated to dieting
o Trouble sleeping or sleeping too much
o Loss of energy or increased fatigue
o Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing)
or slowed movements or speech (these actions must be severe enough to be
observable by others)
o Feeling worthless or guilty
o Difficulty thinking, concentrating or making decisions
o Thoughts of death or suicide

Symptoms must last at least two weeks and must represent a change in your previous
level of functioning for a diagnosis of depression.

Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can
mimic symptoms of depression so it is important to rule out general medical causes.

Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in
six people (16.6%) will experience depression at some time in their life. Depression can
occur at any time, but on average, first appears during the late teens to mid-20s.
Women are more likely than men to experience depression. Some studies show that
one-third of women will experience a major depressive episode in their lifetime. There is
a high degree of heritability (approximately 40%) when first-degree relatives
(parents/children/siblings) have depression.

Depression Is Different From Sadness or Grief/Bereavement

The death of a loved one, loss of a job or the ending of a relationship are difficult
experiences for a person to endure. It is normal for feelings of sadness or grief to
develop in response to such situations. Those experiencing loss often might describe
themselves as being “depressed.”

But being sad is not the same as having depression. The grieving process is natural
and unique to each individual and shares some of the same features of depression.
Both grief and depression may involve intense sadness and withdrawal from usual
activities. They are also different in important ways:

o In grief, painful feelings come in waves, often intermixed with positive memories of the
deceased. In major depression, mood and/or interest (pleasure) are decreased for most
of two weeks.
o In grief, self-esteem is usually maintained. In major depression, feelings of
worthlessness and self-loathing are common.
o In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the
deceased loved one. In major depression, thoughts are focused on ending one’s life due
to feeling worthless or undeserving of living or being unable to cope with the pain of
depression.
Grief and depression can co-exist For some people, the death of a loved one, losing a
job or being a victim of a physical assault or a major disaster can lead to depression.
When grief and depression co-occur, the grief is more severe and lasts longer than grief
without depression. 

Distinguishing between grief and depression is important and can assist peopoel in
getting the help, support or treatment they need.

Risk Factors for Depression

Depression can affect anyone—even a person who appears to live in relatively ideal
circumstances.

Several factors can play a role in depression:

o Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms

of depression.
o Genetics: Depression can run in families. For example, if one identical twin has
depression, the other has a 70 percent chance of having the illness sometime in life.
o Personality: People with low self-esteem, who are easily overwhelmed by stress, or who
are generally pessimistic appear to be more likely to experience depression.
o Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may
make some people more vulnerable to depression.

How Is Depression Treated?

Depression is among the most treatable of mental disorders. Between 80% and 90%
percent of people with depression eventually respond well to treatment. Almost all
patients gain some relief from their symptoms.

Before a diagnosis or treatment, a health professional should conduct a thorough

diagnostic evaluation, including an interview and a physical examination. In some
cases, a blood test might be done to make sure the depression is not due to a medical
condition like a thyroid problem or a vitamin deficiency (reversing the medical cause
would alleviate the depression-like symptoms). The evaluation will identify specific
symptoms and explore medical and family histories as well as cultural and
environmental factors with the goal of arriving at a diagnosis and planning a course of
action.

Medication: Brain chemistry may contribute to an individual’s depression and may factor

into their treatment. For this reason, antidepressants might be prescribed to help modify
one’s brain chemistry. These medications are not sedatives, “uppers” or tranquilizers.
They are not habit-forming. Generally antidepressant medications have no stimulating
effect on people not experiencing depression.

Antidepressants may produce some improvement within the first week or two of use yet
full benefits may not be seen for two to three months. If a patient feels little or no
improvement after several weeks, his or her psychiatrist can alter the dose of the
medication or add or substitute another antidepressant. In some situations other
psychotropic medications may be helpful. It is important to let your doctor know if a
medication does not work or if you experience side effects.

Psychiatrists usually recommend that patients continue to take medication for six or
more months after the symptoms have improved. Longer-term maintenance treatment
may be suggested to decrease the risk of future episodes for certain people at high risk.

Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment

of mild depression; for moderate to severe depression, psychotherapy is often used 
along with antidepressant medications. Cognitive behavioral therapy (CBT) has been
found to be effective in treating depression. CBT is a form of therapy focused on the
problem solving in the present. CBT helps a person to recognize distorted/negative
thinking with the goal of changing thoughts and behaviors to respond to challenges in a
more positive manner.

Psychotherapy may involve only the individual, but it can include others. For example,
family or couples therapy can help address issues within these close relationships.
Group therapy ibrings people with similar illnesses together in a supportive
environment, and can assist the participant to learn how others cope in similar situations
.

.Depending on the severity of the depression, treatment can take a few weeks or much
longer. In many cases, significant improvement can be made in 10 to 15 sessions.

Electroconvulsive Therapy (ECT) is a medical treatment that has been most commonly
reserved for patients with severe major depression who have not responded to other
treatments. It involves a brief electrical stimulation of the brain while the patient is under
anesthesia. A patient typically receives ECT two to three times a week for a total of six
to 12 treatments. It is usually managed by a team of trained medical professionals
including a psychiatrist, an anesthesiologist and a nurse or physician assistant. ECT
has been used since the 1940s, and many years of research have led to major
improvements and the recognition of its effectiveness as a mainstream rather than a
"last resort" treatment. . 

Self-help and Coping

There are a number of things people can do to help reduce the symptoms of
depression. For many people, regular exercise helps create positive feeling and
improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet
and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

Depression is a real illness and help is available. With proper diagnosis and treatment,
the vast majority of people with depression will overcome it. If you are experiencing
symptoms of depression, a first step is to see your family physician or psychiatrist. Talk
about your concerns and request a thorough evaluation. This is a start to addressing
your mental health needs.
Related Conditions

o Peripartum depression (previously postpartum depression)

o Seasonal depression (Also called seasonal affective disorder)
o Bipolar disorders
o Persistent depressive disorder (previously dysthymia) (description below)
o Premenstrual dysphoric disorder (description below)
o Disruptive mood dysregulation disorder (description below)

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) was added to the Diagnostic and Statistical

Manual of Mental Disorders (DSM-5) in 2013. A woman with PMDD has severe
symptoms of depression, irritability, and tension about a week before menstruation
begins.

Common symptoms include mood swings, irritability or anger, depressed mood,  and
marked anxiety or tension. Other symptoms may include decreased interest in usual
activities, difficulty concentrating, lack of energy or easy fatigue, changes in appetite
with specific food cravings, trouble sleeping or sleeping too much, or a sense of being
overwhelmed or out of control. Physical symptoms may include breast tenderness or
swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.

These symptoms begin a week to 10 days before the start of menstruation and improve
or stop around the onset of menses. The symptoms lead to significant distress and
problems with regular functioning or social interactions.

For a diagnosis of PMDD, symptoms must have occurred in most of the menstrual
cycles during the past year and must have an adverse effect on work or social
functioning. Premenstrual dysphoric disorder is estimated to affect between 1.8% to
5.8% of menstruating women every year.

PMDD can be treated with antidepressants, birth control pills, or nutritional

supplements. Diet and lifestyle changes, such as reducing caffeine and alcohol, getting
enough sleep and exercise, and practicing relaxations techniques, can help. 

Premenstrual syndrome (PMS) is similar to PMDD in that symptoms occur seven to 10

days before a woman’s period begins. However, PMS involves fewer and less severe
symptoms than PMDD.

Disruptive Mood Dysregulation Disorder

Disruptive mood dysregulation disorder is a condition that occurs in children and youth
ages 6 to 18. It involves a chronic and severe irritability resulting in severe and frequent
temper outbursts. The temper outbursts can be verbal or can involve behavior such as
physical aggression toward people or property. These outbursts are significantly out of
proportion to the situation and are not consistent with the child’s developmental age.
They must occur frequently (three or more times per week on average) and typically in
response to frustration. In between the outbursts, the child’s mood is persistently
irritable or angry most of the day, nearly every day. This mood is noticeable by others,
such as parents, teachers, and peers.

In order for a diagnosis of disruptive mood dysregulation disorder to be made,

symptoms must be present for at least one year in at least two settings (such as at
home, at school, with peers) and the condition must begin before age 10.  Disruptive
mood dysregulation disorder is much more common in males than females. It may
occur along with other disorders, including major depressive, attention-
deficit/hyperactivity, anxiety, and conduct disorders.

Disruptive mood dysregulation disorder can have a significant impact on the child’s
ability to function and a significant impact on the family. Chronic, severe irritability and
temper outbursts can disrupt family life, make it difficult for the child/youth to make or
keep friendships, and cause difficulties at school.

Treatment typically involves psychotherapy (cognitive behavior therapy) and/or

medications. 

Persistent Depressive Disorder

A person with persistent depressive disorder (previously referred to as dysthymic

disorder) has a depressed mood for most of the day, for more days than not, for at least
two years. In children and adolescents, the mood can be irritable or depressed, and
must continue for at least one year.

In addition to depressed mood, symptoms include:

o Poor appetite or overeating

o Insomnia or hypersomnia
o Low energy or fatigue
o Low self-esteem
o Poor concentration or difficulty making decisions
o Feelings of hopelessness

Persistent depressive disorder often begins in childhood, adolescence, or early

adulthood and affects an estimated 0.5% of adults in the United States every year.
Individuals with persistent depressive disorder often describe their mood as sad or
“down in the dumps.” Because these symptoms have become a part of the individual’s
day-to-day experience, they may not seek help, just assuming that “I’ve always been
this way.”
The symptoms cause significant distress or difficulty in work, social activities, or other
important areas of functioning. While the impact of persistent depressive disorder on
work, relationships and daily life can vary widely, its effects can be as great as or
greater than those of major depressive disorder.

A major depressive episode may precede the onset of persistent depressive disorder
but may also arise during (and be superimposed on) a previous diagnosis of persistent
depressive disorder.

Depression is a common mental disorder affecting more than 264 million people
worldwide. It is characterized by persistent sadness and a lack of interest or pleasure in
previously rewarding or enjoyable activities.  It can also disturb sleep and appetite;
tiredness and poor concentration are common. Depression is a leading cause of
disability around the world and contributes greatly to the global burden of disease. The
effects of depression can be long-lasting or recurrent and can dramatically affect a
person’s ability to function and live a rewarding life.

The causes of depression include complex interactions between social, psychological

and biological factors. Life events such as childhood adversity, loss and unemployment
contribute to and may catalyse the development of depression.

Psychological and pharmacological treatments exist for moderate and severe

depression. However, in low- and middle-income countries, treatment and support
services for depression are often absent or underdeveloped. An estimated 76–85% of
people suffering from mental disorders in these countries lack access to the treatment
they need. 

Definition
Depression in its clinical form, is a mood disorder in which the individual may feel sad,
helpless, hopeless, as if life is just too overwhelming and burdensome. Every one of us
experiences depressed feelings from time to time; no one can escape the hurtful things in
life. It’s how we react that matters in the face of adversity and the state of being depressed
cuts your health down, also.

Question that often arises is- Can I overcome depression? Yes,

you can.
Treatment Options

There are a wide variety of treatment options for dealing with depression. Each case is
different and the prescribed treatment varies from person to person. Some treatment
options include:

 Psychotherapy
 Support groups
 Medication/antidepressants
 Natural remedies
 Hypnosis
 Meditation
 Exercise
 Any combination of the above.

Meditation:
Meditation can calm the mind and reduce stress, making dealing with depression easier.
This technique brings you in contact with the present moment and creates awareness of
what is around you.

Inhale slowly and deeply. Imagine your breath beginning at your head and traveling down
to your feet, then coming back up again. Feel your breath travel through your body. How
long you spend in this meditation it all depends on your tolerance for it. If you're new to
meditation, ten minutes might be as much as you can handle. If you can last for or
gradually increase your time to thirty minutes that would be ideal.

Realistic goal setting

Goal setting fights depression by helping women regain a sense of control over their lives.
Regaining control over life also boosts self esteem and helps with positive thinking.
Remember that regardless of age, a one-week goal is a manageable way to begin with.
Goals should be “SMART”: Specific, Measurable, Attainable, Realistic and Timely, to build
self-confidence.

Relaxation Techniques

Learning relaxation techniques can ease stress, muscle tension and anxiety. Progressive
relaxation teaches- how to relax at will. This way of relaxation allows you to regain control
over your body's involuntary muscle tension, and trains your body to release that tension.
Basically, you focus your attention on one group of muscles at a time (the left arm, for
instance, or the lower back muscles). Which in turn helps you, to become aware of the
tension and tightness in that group of muscles, examining where the tension occurs and
how it feels. Now exaggerate the tension, tightening the muscles and then releasing. By
making the muscle even tighter than usual, you train your body to recognize how a relaxing
muscle feels. Over time, the muscles relax more easily, and you become more aware of
your body's tension trouble spots.

Breathing techniques can help you remain grounded and calm. Breath counting is one of the
more commonly used techniques. Sit comfortably, close your eyes, and concentrate on your
breathing. As you exhale, count each breath. When you reach five, start back at one. If your
mind wanders, return your mind gently but firmly back to breathe counting.

Exercise
Exercise is a great tension-fighter. It can improve body image, confidence and self-
awareness. Exercise also increases the level of certain neurotransmitters (endorphins) that
are known to elevate mood. Summoning the energy to go to aerobics class can be very
difficult especially when you are feeling down and out. Start off slowly—even ten minutes a
day is better than nothing. Exercise with a friend if possible, to help keep your motivation
up. Even a simple walk around the block is better than nothing and is a great way to start
exercising. Twenty to thirty minutes of bicycling, swimming, dancing, running, or brisk
walking can relieve most common, mild depressions. Yoga exercises combined with some
deep breathing and meditation each morning will leave you feeling refreshed and better able
to face the day.

Nutritional therapy

Correcting nutritional deficiencies, balancing blood sugar levels, and improving the overall
diet can significantly help to lift depression. The role of certain amino acids, tryptophan and
D, L-phenylalanine (DLPA) may also be significant.

As a result, victims of depression may often suffer form nutritional deficiencies or

imbalances – particularly a lack of B vitamins and vitamin C, and of the minerals calcium,
copper, iron, magnesium and potassium. The precise relationship between different
nutrients and the brain’s chemistry is still unclear but malnourishment or weight problems
clearly contribute to morale spiraling downwards.

Eat plenty of:

Whole grains, peas, lentils and other types of pulses

Fresh fruit and vegetables
Learn meat, poultry and offal
Fish and shellfish

Cut down on:

1. Alcohol

2. Caffeine, in tea, coffee or colas

If you are taking certain antidepressants, avoid:

 1. Canned and processed meats

 2. Calves or chicken liver
 3. Beer, red wine and liqueurs
 4. Processed or ripe cheese
 5. Sugar, honey, sweets

Plenty of whole grains and pulses, and regular amounts of lean meat, offal, oily fish,
shellfish and eggs, will supply B vitamins, iron, potassium, magnesium, copper and zinc. A
high intake of fresh fruit and vegetables (such as asparagus, broccoli, cabbage, melon,
oranges and berries) will supply ample Vitamin C. Dark green leafy vegetables will improve
levels of calcium, magnesium and iron; while dairy produce (preferably low fat) will boost
reserves of calcium.

Too much caffeine (more than four cups of coffee or six cups of tea a day) can exacerbate
depression. Since caffeine also contributes to sleeplessness, and insomnia is one of the
symptoms of depression, sufferers should avoid drinking tea of coffee before going to bed.

Acupuncture

Traditional acupuncture treatment or electro-acupuncture can ease depression. Some

studies found it superior to anti-depressant drugs and with less side-effects. Research has
shown that acupuncture triggers the release of endorphins in the brain. These chemicals
affect various body systems, reduce pain and make you feel good. Traditionally it is thought
that acupuncture removes blockages and promotes the flow of Qi energy on the meridians.
This is believed to improve the functioning of the internal organs.