Depression also called major depressive disorder or clinical depression is a clinical disorder in which low mood persists for at least 2 weeks, it is usually a combined manifestation of genetic, environmental, biological and psychological factors. Much research has been done to identify the causative agents but one thing alone can never be pinpointed; chemically there is a decrease in the levels of dopamine and serotonin which affect a persons functioning in a number of ways. The cause is known but all researchers agree that it is a combination of negative life events, a pre-existing genetic liability and negative coping techniques in life. Childhood trauma and abuse is a leading cause of depression and concurrent drug abuse in adolescents. In addition depression occurs in a lot of other diseases such as:
- Generalized anxiety disorder;
- Social phobia;
- Social anxiety disorder;
- Post traumatic stress disorder;
- Obsessive compulsive disorder;
- Panic disorder;
- Anorexia nervos;
- Borderline personality disorder;
- Bipolar disorder;
- Attention deficit disorder;
- Depersonalization disorder;
- Parkinson disease;
- Most systemic illnesses like hypertension, diabetes, ischemic heart disease, irritable bowel syndrome, insomnia, narcolepsy.
- Melancholic depression (as the name suggests a state of melancholy is prevalent. One loses interest in all day to day activities, excess guilt, excess weight loss, early waking, dullness of the mind and worsening of mood and other symptoms in the morning);
- Atypical depression (paradoxical anhedonia (mood reactivity), positivity, increase in appetite and weight gain, excess sleep, social impairment, heaviness in the limbs and increased perception of interpersonal rejection;
- Catatonic depression (severe form, disturbance of motor behavior, either immobile or shows bizarre movements, remains silent almost all the time. Are a part of schizophrenia, bipolar disorder. Symptoms may be caused by neuroleptic malignant syndrome);
- Postpartum depression (continuous depressed state of the mother after child birth. Involves crying spells, amenity towards self and the child. It is usually seen from 2 weeks after birth till 3 months, episodes lasting longer than 6 months are classified as postpartum psychosis);
- Seasonal affective disorder (depressive episodes in tandem with autumn and winter, which resolve during summer and spring, 2 episodes in colder seasons over a 2 year period and resolution in summer seasons is diagnostic).
Depression has a wide array of symptoms which engulf most body organs as a whole, they include:
- sad or empty mood;
- feeling hopeless;
- feelings of guilt;
- loss of interest in day to day life;
- low energy level;
- feeling monotonous;
- difficulty sleeping;
- decreased concentration;
- changes in appetite;
- generalized body pain;
- in severe cases suicidal thoughts and attempts.
Depression is managed by a multi therapy approach given the severity.
- Psychotherapy is an essential for all kinds of depression, wherein the patient sits with a qualified 'shrink' to get through and manage the negative bits in their lives. It helps a lot of patients and is probably the most important step in the management of depression. Counselling is employed and newer techniques like cognitive behavioral therapy (CBT) are used. In CBT patients are taught to challenge their existing beliefs and advised behavioral modifications, it relies on the principle that negative thoughts and notions are because of negative beliefs and if one is changed so will the other, it is used in conjunction with interpersonal and family therapy.
- Antidepressants are medicines used to treat the symptoms of depression. They work by acting on different parts of the brain but eventually they are responsible for bringing the neurochemical levels in the brain to the optimum level. They are highly effective and therapy lasts for a few months but to the enlightened ones the improvement may seem as 'fake happiness' as the underlying depressive cause never gets resolved. They include:,
- Tricyclic antidepressants (TCA's) one of the oldest medication, first discovered in the 1950s, they increase the levels of serotonin and norepinephrine. Being old and due to its side effects they have been replaced by SSRI's and SNRI's in clinical use;
- Selective serotonin reuptake inhibitors (SSRI) one of the most widely used antidepressant nowadays, it has a good response in people of all ages. As the name suggests they block the uptake of serotonin which in turn increases its quantity, it also increases dopamine and norepinephrine to a lesser degree. In addition to this SSRIs are highly effective in treating the physical symptoms of depression such as headache, body pains and appetite issues;
- Serotonin-norepinephrine reuptake inhibitors (SNRI) almost identical to the SSRIs it is chemically different as in it blocks the norepinephrine transporters as well. Theoretically they are superior to SSRIs;
- Serotonin modulators and stimulators;
- Serotonin antagonists and reuptake inhibitors;
- Norepinephrine reuptake inhibitors;
- Monoamine oxidase inhibitors (usually the last line of treatment after SSRIs and SNRIs, is highly effective in the treatment of atypical depression);
- Electro-convulsive therapy (ECT) used for patients with severe depression which do not respond to medication or therapy. ECT needs to be done on a weekly basis until there is a difference.
- Transcranial magnetic stimulation (small areas of the brain are stimulated instead of the whole brain like in ECT).
- multi therapeutic approach is necessary to fight depression. It is one of the most prevalent disease in all age groups throughout the world. Any condition in which quality of life is affected can lead to depression. It's a tough battle but with expert treatment it is quite manageable; belief in a higher power and spirituality has given new hope to many patients and is employed in therapy as well. Meditation has also proven very helpful in the treatment of depression. Getting depressed is not a choice but getting better usually is a choice and with help it can be achieved, everyone deserves to live life to its full and in light, away from the darkness of depression.