Chapter II

REVIEW OF RELATED LITERATURE

This chapter represents a review of different insights and definitions relevant to

this research study.

Related Literature

Depression is a constant feeling of sadness where the loss of interest

occurs. This stops you from doing your normal activities and affects your daily

life. According to Zhang et al. (2018), it is a major health problem and has an

especially large effect on health when co morbid with a chronic medical condition

such as hypertension, coronary heart disease, and diabetes are accompanied by

a high incidence of depression and can affect the treatment and prognosis.

This is a major human blight and is responsible for more years lost to

disability than any other condition. Since many people suffer from this illness and

the fact that this can last for years. In ranking for disability and death combined,

depression could come in the ninth behind prolific killers (Smith & Torres 2014).

Depression has a detrimental effect on all aspects of social functioning.

This includes self-care, family, household, marital, kinship, and parental roles.

Many individuals that suffer from depression experience life-long challenges due

to the chronic and episodic nature of this illness (Trivedi, 2020).

Some individuals suffer from the recurrence for the rest of their lives

whereas half or more never face such recurrences (Monroe et al, 2022).
 This is associated with alterations in the regional brain volumes,

particularly the hippocampus, and with functional changes in brain circuits, such

as the cognitive control network and the affective salience network (Otte et al.,

2016).

Major Depressive Disorder (MDD) is a common mental disorder generally

characterized by symptoms associated with mood, pleasure, and effectiveness in

daily life experiences (Muhammad Kamran et al., 2022).

According to Uher et al., (2014), major depressive disorder is now a part

of the new “Depressive Disorders” section, which is separate from “bipolar

disorders”, marking a division in what had been known as “Mood Disorders”. The

replacement of an operationalized bereavement exclusion with a call for clinical

judgement in distinguishing normal reactions to significant loss of hope.

Some symptoms of Major Depressive Order (MDD) that an individual may

experience is the loss of interest or pleasure in your activities. The feeling of

restlessness and agitation, you would feel very sluggish and slowed down both

physically and mentally. The trouble of concentrating or making decisions, feeling

worthless and having guilt leading to suicidal thoughts (Bhandari, 2023).

As cited by Schramm et al., (2020), Persistent Depressive Disorder is a

chronic mood disorder that is common and often more disabling than episodic

major depression. This subsumes several chronic depressive presentations,

including dysthymia with or without superimposed major depressive disorder

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episodes, chronic major depression, and recurrent major depression without

recovery.

This is difficult to detect in the psychiatric and primary care settings until it

intensifies into the form of a superimposed major depressive disorder. Although

information is scarce concerning the cause of persistent depressive disorder, this

causation is likely to be multifunctional.

Also called as Dysthymia this is a recurrent depressive disorder with no

clearly demarcated episodes. This is insidious and can occur on both

adolescence or adulthood and remains unrecognized and undiagnosed

frequently for years, while the sufferers experience such significant functional

impairment and are putting their lives on the line by suicide (Melrose, 2019).

Depressive disorders were traditionally conceptualized as episodic,

remitting conditions. In recent years, this has shifted to viewing depression as

recurrent and chronic. However, some individuals with depression have only one

episode, while others have recurrent episodes with periods of full remission in

between, and others have chronic conditions (Monroe & Harkness, 2012).

According to Melrose (2015), Seasonal Affective Disorder (SAD) is a

recurrent major depressive disorder with a seasonal pattern. This usually begins

at fall and continues into the winter months giving it the name “winter blues’’.

However, this may also occur during spring or early summer. The symptoms of

Seasonal Affective Disorder on sad mood and low energy and those most at risk

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are female, adolescence, those who live far from the equator, and those who

have family histories of depression.

As cited by Galima et al., (2020), Seasonal Affective Disorder is a sub type or

qualifier of major depressive disorder or bipolar disorder. It is characterized by

depressive symptoms that occur only at a specific time of the year. The possible

risk factors of this disorder include family history, female sex, and living at a more

northern latitude. With the temporal nature of the mood episodes, diagnosis

requires full remission when the specified season ends and the two consecutive

years of episodes in the same season.

Psychotic Depression was initially considered to be one of a continuum of

severity of major depression. Psychosis is an independent that may accompany

mood disorders, while much has been learned about the impact of severe mood

congruent delusions and hallucinations on the course and treatment response to

depression (Dubovsky et al., 2021).

Those who are suffering from Psychotic Depression could be involved in

performing potentially fatal actions, feeling hounded to death, becoming trapped

in an inescapable darkness, and being left bereft of mental control. This disorder

directs a person to hallucination and delusions that results to their unpredictable

actions with only moments from decision to conduct.

Psychotic Major Depression (PMD) is found to be relatively common in

psychiatric conditions that affects patients with major depression. The symptoms

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of this disorder lead to double the risk of suicides over and above the risk that

was associated with severe depression (Tiihonen et al., 2023).

Postpartum Depression is prevalent and concerns a serious mental health

problem for women especially for their families. It is also from major depressive

disorder and is largely affected by how the postpartum period is defined. The

most common complication of childbirth is associated with immediate and

enduring adverse effects on maternal and offspring morbidity and morality (Batt

et al., 2020).

Also called as Peripartum Depression or PPD, this is a public health problem

which has been widely studied. It is a critical period in a woman’s life as during

this period women experience several and significant normal or pathological

physiological, hormonal, emotional, and social changes. This is now a very well

known to be vulnerable to mental disorders and is hypothesized that this is due

to both biological (hormonal), psychological and environmental (social) aspects.

The early development and children’s health and mental health are at heightened

risk of negative outcome in part due to the lack of timely responses to infant

needs and the lack of inadequate bonding. While in most severe cases, women

can commit suicide and/or infanticide (Valadares et al., 2020).

Postpartum Depression (PPD) is one of most common complications of

childbirth, it is vital to identify best treatments for optimal maternal, infant, and

family outcomes (Stewart et al., 2019).

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 According to Schimelpfening (2024), atypical Depression which now also

referred to as major depressive disorder with atypical features is quite common.

This is a type of depression that does not follow what was thought to be the

typical presentation of the disorder as those who suffers from this disorder

experience mood reactivity.

Unlike those with typical depression, atypical depression can respond to

positive events with an improvement in mood, albeit temporarily. The symptoms

of this can include low mood, difficulty in concentrating, fatigue, and short-lived

improvements in mood when positive evens occur.

According to Villines (2021), atypical depression is distinct from

melancholic depression as this is a form of depression that most people might

identify as depression which includes a very sad mood and having the trouble of

finding pleasure. Atypical depression can also make people deeply sad however,

it is more tied to a person’s situation and environment. Symptoms could be that

the patients are experiencing excessive sleeping, feeling slow or sluggish, feeling

like the arms or legs are heavy, overeating and gaining excessive wight, and that

symptoms may improve when the person has something to feel happy about.

This suggest that atypical depression may correlate with a higher risk of

developing cardiovascular disease. This also emphasizes that depression is both

a physical and mental health condition.

As stated by Gascon (2022), there are many coping strategies for

managing depression and sometimes even a laugh from watching a movie or

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hanging out with a friend is a possible way to cope with your depression. Doing

these coping strategies may help in healing your mental health like doing one

self-care activity, talking to your support network, getting active, exploring your

new snack options, journal your thoughts, tap into your senses, have a laugh,

starting a gratitude journal, encouraging others, and practicing mindfulness or

meditation.

Here are the types of coping mechanisms Gascon (2022) has sorted.

When a person has depression, doing daily tasks is much of a challenge

with their lack of interest for anything even the duties that gives them pleasure

before would be too tiring to accomplish. However, doing the one self-care

activity helps you to slowly become more productive even in just brushing your

teeth, taking a bath even if you may not feel like bathing, putting on fresh clothes.

Taking care of yourself may boost your mood even if you feel too down.

Having depression, the patient might feel that they are a burden to others.

However, friends and family will be there the same as how the patient would

want if the roles were revised. It is suggested to talk to trusted loved ones instead

of isolation. It could be anywhere from the patients’ own home, video chat, or

phone calls. As long as communication is present instead of putting the patient

away from others.

Exercise is a natural mood booster when a patient feels trapped or

emotionally paralyzed. Depression makes a person lack energy with the feeling

of hopelessness and even making someone lose their interest in their desires in

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life. However, instead of laying all day getting a little movement can help a

patient feel better.

Depression can lead a patient to lack of appetite or overeating which gives

an effect to their mood. However, exploring and considering having foods that

boost the mood of a patient should be given attention to. The food a patient

intake can lead to even worse scenarios like drinking caffeinated drinks such as

coffee and sodas that can raise anxiety levels.

Observing and giving attention in choosing the right snacks or meals can give

an impact to the mood of those suffering from depression. Considering eating

nuts or seeds, fresh fruits, fruit cups, yogurt, decaffeinated coffee or caffeine free

tea, whole grain breads and pastas, and eating salmon fillets, a tasty way in

getting protein and omega-3 fatty acids.

A person with depression usually suffers from negative thinking which can

sometimes worsen symptoms. It is advised that if a patient is losing hope in

having a good future, writing down thoughts and looking for distortions as these

are irrational or are negative thoughts that are not based on facts or reality.

Some distorted thoughts are catastrophic thoughts, making unfounded

predictions, unfairly labeling own self, mind reading, and turning something

positive into negative.

Challenging these thoughts by questioning if these distortions truly are valid,

accurate, or fair and thinking about how to respond to a friend if they had these

thoughts. Journaling may help in making a patient see things more clearly.

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 To stabilize the emotion of those suffering from depression during those

“roller coaster” moments, the patient must try to engage in multiple senses. This

means doing things that stimulate more than one of the five senses, like sight,

touch, or hearing. Watching movies or looking at nature while listening to

meditative music can help. However, a patient could also do a five-senses

exercise, the five things you can see, four things you can touch, three things you

can hear, two things you can smell, one thing you can taste.

Laughter has been liked by researchers to reduce stress and depression.

This lowers the body’s stress chemicals, such as cortisol and epinephrine. This

can also raise the chemicals that elevate a person’s mood, such as dopamine

and serotonin. A patient suffering from depression can have a laugh by watching

comedy shows, reading comics, spending time with a funny friend, and also

catching up on your favorite internet memes.

On days when a person suffering from depression is feeling particularly

low, jotting down things they are grateful for can lower the levels of depression.

This can help them focus on the things no matter how small that can mean to life.

Keeping a notebook on a night sand or a coffee table and thinking about the

people or experiences that make them feel good and they can focus on those

positive feelings.

One of the ways to get a person out of their depressed mood is to turn

their attention to someone else. Studies suggest that supporting others by

making statements using “you” rather than “I” can regulate their emotion.

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Reaching out to a friend or a family member who is going through a difficult time

and asking about their needs can uplift a person with depression as they uplift

someone else.

When experiencing a low mood, mindfulness can be a powerful tool. This

can help those suffering from depression to pull their focus away from all the

negativities. Meditation exercises, especially the kind that calm worrying and

ruminating thoughts. Often, people who are depressed feel the worst when

getting up and praying or meditating can help them start the day with a clean

slate. Calming and relaxing can be in a way of grabbing a cup of coffee, sitting on

a comfortable chair, praying, meditating, or even reading something inspirational.

As cited by Gautam et al., (2020), Cognitive Behavioral Therapy is one of

the most evidence-based psychological interventions for the treatment of several

psychiatric disorders such as depression and anxiety disorders. Several studies

have been conducted and shown the effectiveness of CBT in depressive

disorders. Treatment guidelines for depression treatment suggest that

psychological interventions are effective and acceptable strategy for treatment.

Depression has many possible causes. It can occur for a variety of

reasons, and it has many triggers. For some people, it could be an upsetting or

stressful life event or illness. However, different causes can often combine to

trigger depression. Here are some common factors that cause depression among

teenagers.

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 Bullying is a common type of aggressive conduct that involves the

subjugation and manipulation of those who are viewed as inferior. This

phenomenon leaves its victims with severe emotional scars in addition to

physical brutality and psychological manipulation. Bullying has far-reaching

effects that go beyond the initial act and frequently result in a chain reaction of

unfavorable outcomes.

As cited by Hidayati (2021), it emphasizes the serious effects of bullying and

links it to several medical and mental health conditions. Depression stands out

among them and casts a pall over the victim's welfare. Depression is a sneaky

illness that throws off a person's emotional balance as well as their mental

abilities. This disturbance has the potential to seriously impair learning, impeding

both intellectual development and academic achievement.

According to Schimelpfening (2023), major life pressures that surpass a

person's capacity for coping are frequently the cause of depression. Even the

most tough among us may be overwhelmed by these stressful experiences,

which can range from trauma and bereavement to ongoing adversity and have a

significant negative effect on mental health.

According to this study, when stress levels are high, the body's stress

response system goes into overdrive, causing the release of cortisol, a hormone

linked to the fight-or-flight reaction. Long-term exposure to high cortisol levels

can upset the brain's delicate neurotransmitter balance, especially serotonin,

which is essential for mood regulation and emotional stability.

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 Substance use and depressive disorders have a relationship that includes

both direct and indirect ways in which drugs and alcohol can trigger depressed

symptoms. It is common information that abusing substances can greatly raise

one's chance of acquiring depression, but it's also critical to note that some

prescribed drugs may have the ability to set off depressive episodes.

As stated by Schimelpfening (2023), several prescription medication types

have been connected to the aggravation of depressive symptoms. These include

stimulants, anticonvulsants, statins, and beta-blockers, which are frequently

taken for a variety of illnesses, such as hypertension, epilepsy, excessive

cholesterol, and attention deficit hyperactivity disorder (ADHD). Although the

purpose of these drugs is to treat medical conditions, their actions might

unintentionally interfere with neurochemical circuits related to mood control that

could be a cause of depression.

According to Nova et al., (2020), family can be a factor causing depression in

adolescents through being able to adapt to the environment. A harmonious family

makes a child mentally healthy while a family that is not harmonious can trigger

depression because conditions are not as expected, coupled with burden of

schoolwork and stressors from teachers and peers.

It was also confirmed by Deng (2022) that academic and family stress leads

to depression among students, negatively affecting their academic performance

and learning outcomes.

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 As cited by Yang (2022), students claimed that academic-related

pressures such as ongoing study, writing papers, and preparation for tests were

the most important daily problems. On the other hand, the parents’ attitudes,

understanding, and perspective can reflect on the physical, emotional, and

mental behavior of a teenager.

According to Schimelpfening (2023), there is a curiosity surrounding the

contribution of genetics to depression. Genetics and depression are not causally

related; however, it is generally accepted that genetics can provide a

susceptibility to this common mental illness. Genetic predisposition, on the other

hand, is just one of several factors that influence an individual's vulnerability to

depression.

In fact, genes may not always determine how an illness develops, even if

some genetic variants may make a person more susceptible to depressed

symptoms. Genetic predisposition, on the other hand, is a risk factor that

increases a person's chance of developing depression in specific scenarios.

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