While everyone has experienced sadness, not everyone has experienced depression. In fact, if you have never been depressed, chances are that you don’t have a real grasp on what living with this complex mental illness is like.
Depression is insidious. It affects not only your mood, but also your ability to feel, think, and function. It blunts sensations of pleasure, closes off connectedness, stifles creativity, and, at its worst, shuts down hope. It also often causes deep emotional pain not only to the person experiencing it, but to that person’s close family and friends.
It’s not what people think, an act of laziness or a lack of will for change,” says an affected person. “Instead, it’s genuinely believing that change is not possible for you. It’s genuinely believing that you’re stuck in an overwhelming darkness that will never go away.”
How to Identify Depression
If sadness alone isn’t a good gauge of depression, what is? If you have experienced at least five of the following symptoms most of the day, nearly every day, for at least two weeks, you may be diagnosed with major depressive disorder (MDD), also known as clinical depression.
Do you:
• Constantly feel tearful, empty, or worthless?
• Have little interest or pleasure in your work, hobbies, friends, family, and other things you once enjoyed?
• Notice dramatic changes up or down in your appetite or your weight not related to dieting?
• Often feel listless or fatigued for no obvious reason?
• Have trouble concentrating or making decisions?
• Find yourself wringing your hands, pacing or showing other signs of anxious restlessness — or the opposite, moving or speaking more slowly than usual?
• Struggle with insomnia or sleep too much?
• Have recurrent thoughts of suicide or death?
To be diagnosed with MDD, one of your symptoms must be a persistent low mood or a loss of interest or pleasure. Your symptoms must also not be due to substance abuse or a medical condition such as thyroid problems, a brain tumor, or a vitamin deficiency.
Of course, it’s normal to have any or all of these symptoms temporarily (for hours or even days) from time to time. The difference with depression is that the symptoms persist and make it difficult to function normally.
If you suspect you may be depressed, the best first step is to reach out to your primary care doctor, a psychiatrist or a psychotherapist. If you are reluctant to consult a professional, type “depression” or “clinical depression” into Google on your cell phone or computer and you’ll find links to a clinically validated depression test known as the PHQ-9 patient health questionnaire.
Although designed to be administered by a healthcare professional, this test is short and straightforward. Take it and you can immediately see if your score indicates you may have depression.
Important: If you suspect you have depression, or if you’re feeling troubled by your symptoms, have suicidal thoughts, just need to talk, want some advice, or need a referral for treatment, call a helpline.
Nepal Mental Health Toll Free Hotlines:
TPO Nepal Hotline: 16600102005
CMC Nepal Hotline: 16600185080
KCM Nepal Hotline: 16600122322
TUTH Suicide Hotline: 9840021600
TUTH Mental health Hotline: 9849630430
What Are the Different Types of Depression?
In addition to MDD there are several other kinds of depression, including:
• Persistent depressive disorder (PDD) Previously known as dysthymia, PDD is diagnosed in people who have at least two of the symptoms of major depression for at least two years at a time. It’s possible to fluctuate between severe and less-severe symptoms, and to have both PDD and MDD at the same time, a condition called double depression. People with PDD are often perceived as cranky, sullen, changeable, or pessimistic rather than being recognised as having a treatable disorder.
• Bipolar disorder, formerly called manic depressive disease, is characterised by moods that cycle between extreme highs (mania) and lows (depression), often with periods of normal mood in between.
• Seasonal affective disorder (SAD) is depression that occurs at the same time each year, usually beginning in fall and persisting through winter. SAD is associated with changes in sunlight, and is often accompanied by increased sleep, weight gain, and cravings for foods high in carbohydrates.
• Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMDD usually develops a week or two before a woman’s period and passes two or three days after menstruation starts.
• Postpartum (or perinatal) depression (PPD) is diagnosed in mothers who experience symptoms of major depression up to one year after giving birth. PPD is usually related to a combination of factors, including sharp changes in hormone levels following childbirth. Feelings of intense sadness, anxiety, or exhaustion are much stronger, and last longer, than the “baby blues” — the relatively mild symptoms of depression and anxiety that many new mothers experience.
Depression: Recognising Unusual Symptoms
One reason depression can be hard to identify is that its signs can vary widely from person to person and sometimes be masked by atypical symptoms. For example, some people who are depressed may show it by acting disgruntled, resentful, or irritable. In fact, aggression — including outright acts of violence — can be indicative of “hidden” depression.
Depression masquerading as anger may seem surprising at first, but not when you consider that several underlying factors, including alcohol or substance abuse and childhood trauma, have been linked to both.
Similarly, although it’s not clear why, a person who experiences anxiety is at high risk for developing depression, and vice versa.
Reports state that as many as 60 % of people with anxiety will also have symptoms of depression; the same goes for people with depression having symptoms of anxiety. Some researchers even suspect that depression and anxiety are, in fact, inexorably intertwined expressions of the same underlying psychological disorder.
Depression may also manifest psychosomatically, meaning that instead of presenting first and foremost as a mood disorder, the dominant symptom may be things like vague aches, dizziness, headaches, digestive problems, or back pain. Complicating matters is that it’s often hard to know whether depression is causing the physical symptoms, or if the physical symptoms are causing depression.
What Causes Depression?
No one knows for sure why some people become depressed. As with other brain diseases, such as Alzheimer’s, the precise cause remains elusive. Depression can occur spontaneously, without any obvious cause. And it’s well documented that once you’ve had one depressive episode your risk of having another later in life increases.
Psychiatrists today generally look at depression in “bio-psycho-social” terms, meaning that they see it as a complex disorder most likely triggered by overlapping biological, psychological, and social (also referred to as environmental) factors.
Among the potential contributors to depression are:
• Genetics Many studies suggest that depression can spring from a genetic predisposition, including one international study involving more than 2 million people that linked 269 genes to depression. Genes alone are not believed to write your destiny, however. Scientists think that while some genes may increase risk, other factors are needed to trigger symptoms.
• Neurotransmitters The long-held idea that depression is caused by low levels of certain neurotransmitters (chemicals messengers that communicate between neurons) has been debunked. And yet it’s clear that neurotransmitters do play a role. The new thinking is that depression can sometimes be activated by nerve cell connections in the brain, nerve cell growth, or when the functioning of nerve circuits goes awry.
• Inflammation Multiple studies indicate that disease-related or stress-related inflammation may create chemical changes in the brain that can trigger or worsen depression in certain people and influence how a person responds to drug therapy.
• Hardship There’s growing evidence, according to the World Health Organisation, that psychological and social factors like a history of abuse, poor health and nutrition, unemployment, social isolation or loneliness, low socioeconomic status, or stressful life events (divorce or money worries, for example) can play a decisive role in the onset of depression.
• Traumatic brain injury (TBI) Another all-too-common cause of depression is traumatic brain injury (TBI). Millions of people each year are treated in emergency rooms for TBIs (aka concussions) following a bump or blow to the head from things like falls, assaults, car accidents, and workplace and sports-related injuries. And more than half of those patients will meet the criteria for major depression three months after their injury, suggests a study.
Depression and Gender: Is It Different in Men and Women?
When it comes to depression, there is a distinct gender gap. Depression is nearly twice as common in women as in men, according to data. Hormonal and other biological factors play a role in this disparity. After all, only women can have premenstrual or postpartum depression. The same is true of antenatal (or prenatal) depression — depression during pregnancy. But women also have higher rates of seasonal affective disorder, depressive symptoms in bipolar disorder, and persistent depressive disorder, note experts. The reasons for this are cause for speculation. Some researchers believe that environmental factors, such as the different stressors and expectations that society places on women, are an important factor. Others theorise that men and women actually have depression at similar rates, but that women are more likely to talk about their feelings and seek help.
Treatment
Although there is no one-size-fits-all cure for depression, there are many effective treatment options, one of which is bound to help you heal if you are struggling with the illness. This cannot be emphasised enough, given that roughly a majority of people living with depression do not receive the care they need.
