Understanding Depression

 “Depression” is, as of today, one of the most common mental illnesses in the world, with statistics showing that today depression affects 3.8% of the total world’s population¹. And since the pandemic has hit our lives, an observed increase in uncertainty and stress levels could be related to a further increase in this prevalence. A study conducted just months into the first wave found that 46 percent of individuals residing in India may actually be dealing with depression and related symptoms. As common as it is, the term also has a casual connotation to it – so lets first try to understand what makes a mood disparate enough to be deemed a diagnosis, or an illness.

Depression as a mood tends to last for a specific and possibly shorter duration; may be for a few hours or days, and be associated with.an unfavorable or undesirable situation. Here being “depressed” can simply mean feeling sad and low, and activities like talking to a friend, going out or listening to your favorite music might help feel you better.

Now Depression as an illness is considered as a type of ‘mood disorder’, that are related to distress and/or dysfunction in more than one aspect of an individual’s life experience (work, relationships, family, etc.), that generally persist for a longer time. A person experiencing feelings of sadness (along with few other symptoms mentioned below) for at least two weeks is said to have a depression. Mood disorders are considered to be spread out over a spectrum with sadness at one end and ‘hypomania/mania’ at the other end (redirect: blog on bipolar disorder).

The diagnosis of ‘depression’ may be related to the severity of observed symptoms, ranging from mild, to moderate to severe. What we refer to most readily as this illness could be what is technically called as Chronic Major Depressive Disorder, or CMDD. However, mood disturbances may be seen within a lower but generally more persistent grade of symptoms, wherein an individual would likely be diagnosed as living with Dysthymic Disorder (DD).

Severe or not, depressive symptoms are likely to affect the day to day life of a person, straining their personal as well as professional relationships. But as the symptoms appear more severe, depression may become more obvious.

The Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM-5), a publication by The American Psychiatry Association (APA) is known to provide a standard criterion for the categorization of mental disorders in adults. The criteria for depression in DSM-5 are mentioned as follows:

Five (or more) of the symptoms mentioned below must be present for a duration of at least two weeks:

• Depressed mood most of the day,
• Loss of interest in pleasurable activities (anhedonia),
• Significant weight loss or gain,
• Insomnia or hypersomnia (sleep disturbance),
• Low psycho-motor (conscious movement) activity,
• Feelings of worthlessness, hopeless and helplessness,
• Fatigue or loss of energy,
• Inability to concentrate,
• Suicidal attempts or suicidal ideation.

It is important to note that these symptoms can come up, or present, differently for different persons, cultures, ages, genders, etc. Sometimes the symptoms last for a few weeks or a month and deteriorate at a point – this is what an episode of depression looks like. These episodes might occur once or more times throughout the lifetime of a person. Alternatively, symptoms might also be present for a more continuous time.

Sometimes symptoms of depression may present itself differently from what we are generally aware of. It can be increased appetite, weight gain, hypersomnia (increased sleep), leaden paralysis (arms and legs feels as heavy as lead). This is termed as Atypical Depression. The key differential here is that the mood brightens when a positive event presents itself.

Mental Health Professionals, such as psychiatrists, psychologists, clinical psychologists, etc. would use diagnostic criteria (such as those mentioned above), along with their clinical expertise to accurately diagnose the experienced symptoms, and may use the same to frame a plan of management for the illness. Without the proper intervention, symptoms may be likely to worsen, and in time it may be increasingly difficult to bring a person’s condition towards life as it was experienced before the illness set in. 

The occurrence of expression is also sometimes linked positively with the occurrence of other mental and general health conditions; this linkage is called as a ‘comorbidity’.

Listed below are a few comorbidities of depression with other illnesses:

• Depression with Anxiety disorder: Research has shown that more than 50% of people suffering from anxiety or panic disorder experience at least one depressive episode in their lifetime.
• Depression with OCD: Common biological markers of OCD and depression.
• Depression with alcoholism
• Depression with personality disorders.
• Depressive episodes are often seen with psychotic conditions such as Schizophrenia.
• Heart diseases and diabetes
• Parkinson’s disease
• Multiple sclerosis
• Stroke
• Cancer

Depression is estimated to be one of the most common complications of a chronic illness, as with the presence of such an illness come many changes in a person’s daily routine, which can be stressful and can cause despair and sadness in the long run. It has been suggested that one-third of people with a serious medical condition may show symptoms related to depression.

Certain medications can also alter levels of brain chemicals (such as neurotransmitters and hormones) that may also be a cause for depression. For instance, drugs used to treat acne and high blood pressure have been known to have depression as a common side effect.

Understanding what causes depression is still a topic of discussion among mental health professionals all around the world; multiple theories exist, each also related to a treatment method for presenting symptoms.

As an example, let’s talk about a theory by Aaron Beck which suggests that depression is caused by a pattern of negative automatic thoughts which are rigid in nature. These thoughts basically center around three themes i.e., the self, the world and the future which is known as the cognitive triad.

The self (“I’m worthless!”)

The world (“No one loves me because I am worthless!”)

The future (“I’ll never be good at anything because everyone hates me!”)  

Numerous strides have been made in the field of mental all around the world to help people with depression. Psychotherapy and medications have proven to be affective in its treatment. Today, it has become an extremely crucial message to put forward in our society that depression is real but so is its treatment.

This article was written by a trainee psychologist. But we were humans long before we began our training, and so are always looking to learn better! If you found that any of the above is inaccurate, irrelevant or unhelpful, or would like to suggest ways to make this article more helpful in any way, please let us know in the comments below.