Depression, known as major depressive disorder, is a prevalent and dangerous mental health illness that affects how a person feels, thinks, or acts. It presents with negative thoughts and feelings, pathological sadness, and loss of interest in activities once enjoyed. Depression is treatable and carries an increased risk of early death if left untreated. In this article, we will discuss the essential information regarding depression, its symptoms, risk factors, diagnosis, and treatment with oral medication, therapy, and home remedies, such as weighted blankets.
What is depression
Depression, also known as clinical depression, is a mood disorder that may present with or without psychotic features. Feeling down or being sad may happen to all of us. However, these feelings of sadness may persist in some of us, causing numerous emotional and physical problems and leading to an altered daily functioning, both at home, school, or work. It can affect all age groups and may present differently in children, adolescents, or adults. The trigger for depression may be a significant life event, such as bereavement. Depression is not a problem that passes effortlessly. It may last for years and recur if not treated properly.
How common is depression?
According to the world health organisation (WHO), an estimated 264 million people suffer from depression globally. Depression carries an increased suicide risk, leading to 800 000 people committing suicide each year. These data suggest that suicide is the second leading cause of death among people fifteen to twenty-nine years old. Although treatable, about 76 % and 85 % do not receive any treatment in low and middle-income countries.
Risk factors of depression
Risk factors raise an individual's chance of developing a disease. Depression often presents during a person's twenties or thirties. Statistically, more women present with the disease than men. However, women are more likely to seek help and start on treatment. The following are some of the most well-known risk factors of depression:
- Personality traits. Certain personality traits or disorders might promote the appearance of depression in the future. Some examples might be the ones belonging to cluster C personality disorders. Features that could favour depression are low self-esteem or pessimism.
- Traumatic events during childhood or adolescence, such as sexual or physical abuse, might increase your risk of presenting with depression.
- Family history. A family history of depression, bipolar disorder, alcohol issues, or suicide attempts raises your likelihood of presenting with depression.
- Being lesbian, gay, bisexual, transgender, or intersex might increase your chance of developing depression later in life if living in an unsupportive environment or feeling ashamed or distressed about it.
- A medical history of other mental health disorders such as anxiety, post-traumatic stress disorder (PTSD), or eating disorders might raise your chances of presenting with depression.
- Alcohol abuse and drugs use. Alcohol abuse and drug use might lead to secondary depression or may mask depression.
- Chronic diseases. Chronic diseases such as cardiovascular illnesses or cancer might increase your chance of presenting with depression.
- Some medications may raise your chances of presenting with depression. However, do not start or cut on medication without consulting your doctor.
What causes depression?
Scientists don't know what exactly causes depression. The pathogenesis of the disease involves many factors, some of which are the following:
- Biological changes, brain chemistry, and hormones. Some people with depression appear to have natural differences regarding their brains and their architecture. Others seem to have neurotransmitter imbalances that certainly may play a role in the appearance of depression. Recent data suggest that the way these neurotransmitters function and behaviour have an impact on some neurocircuits, which maintain mood stability. Also, hormones seem to play a significant role in a person's mood alterations. These changes in hormone balance may cause or trigger depression. Some examples include the period after pregnancy or people with thyroid problems.
- Family history and inheritance of particular traits might also play a role in the pathogenesis of depression. People whose blood relatives have a mood disorder have more chances to present with one in the future.
Symptoms and signs of depression
Symptoms may present with heterogeneity, according to the age group and the sex of the patients. Therefore, depression may manifest differently in men, women, adults, adolescents, or children. General symptoms and signs of depression include depressed mood, accompanied by a loss of interest in activities once enjoyed. For example, a young child might stop enjoying football or swimming anymore. Depression generally causes agitation and irritability.
Adults experience decreased sexual libido and changes in appetite and weight. Most people lose weight unintentionally, but others may gain. Depression usually causes sleeping problems. At the initial stages, depression might cause insomnia, which manifests late at night, also called late-night insomnia. As the energy levels of a person with depression drop, they might sleep too much, as they do not find the motivation to wake up and start their day. They usually speak slowly, making long pauses between their sentences. Slowed speech is the result of slow thinking, distraction, and difficulties in making decisions. As the disease progresses, feelings of guilt and worthlessness manifest. More severe cases of depression include suicide thoughts and probably attempts.
Depression in women
Depression is twice more prevalent in women than in men. However, scientists believe that women are more likely to report their problems and seek help. Females with depression often seem irritated, anxious, and tired. They have frequent mood swings and keep ruminating all the time. Postpartum depression and premenstrual dysphoric disorder are two distinct types of depression that appear only in women.
Depression in men
Men are less likely to report their depression and more likely to mask it with certain behaviours, such as alcohol abuse, recreational drug use, or anger outbursts. An estimated 9 % of males have depression or anxiety in the US. Men with depression might also avoid social situations, work a lot, show difficulties keeping up with responsibilities, or display an abusive or manipulative behaviour in relationships.
Depression in young adults and college students
For some young adults, the transition to college life might be a trigger for depression and anxiety. As a result, they might find it hard keeping up with the university curriculum. Sleeping problems are quite prevalent in college students with depression, as many experience insomnia, or they sleep too much. They might also face appetite or weight imbalances. Finally, college students may stop enjoying activities they used to in the past.
Depression in children and adolescents
In teens and children, depression mostly affects schoolwork and family or social interaction. The transition from childhood to adolescence might be challenging and work as a trigger for depression. Teens might find it hard to concentrate on school and homework, and they might isolate themselves from friends and family. They usually feel worthless and experience guilt. Children with depression might cry a lot and seem like they have low energy levels. They might also present with clinginess or defiant behaviour. Finally, they might have vocal outbursts or difficulties expressing or talking about their feelings.
What are the types of depression?
Depression might be a distinct disorder or part of another mental health illness. The following are some of the most prevalent types of depression or diseases which have depression in their phenotype:
- Major depression
- Persistent depressive disorder
- Bipolar disorder
- Seasonal affective disorder
- Psychotic depression
- Peripartum or postpartum depression
- Premenstrual dysphoric disorder
- Situational depression
- Atypical depression
Depression and sleep disorders
Depression and sleep have an interactive relationship. Although lack of sleep caused by other conditions may contribute to the appearance and manifestation of depression, the latter can also cause insomnia or hypersomnia. Sometimes, depression begins with no other symptoms than sleep problems. Other times, insomnia manifests later in the course of the disease. Doctors associate sleep disorders with a more severe version of depression. The sleep disorder that is quite prevalent among people with depression is insomnia. On the other hand, individuals with insomnia are ten times more likely to present with depressive symptoms. Insomnia caused by depression might present in various forms, such as sleep-onset, maintenance, or late-night. Some other sleep disorders correlated with depression and insomnia are obstructive sleep apnoea, narcolepsy, or restless leg syndrome.
Insomnia, depression, and the risk of misdiagnosis
Symptoms of insomnia and depression might overlap. For example, both lead to daytime sleepiness, low energy, and cognitive disturbances. Therefore, the risk of misdiagnosis is high. Doctors have to distinguish between primary and secondary depression. Sometimes, depressive symptoms are the result of a mood disorder or a sleep disorder. Restless leg syndrome, for example, might present with symptoms that suggest depression. However, depressive symptoms are due to the sleep disorder. Therefore, incorrect assessment of the symptoms and signs might lead to misdiagnosis and unnecessary medication.
How to diagnose depression?
To make a diagnosis of depression, your doctor might ask you several questions regarding your family and personal medical history. He or she might perform a physical examination to exclude other underlying conditions that may be responsible for your depression. Lab tests might include a blood exam, and a hormonal panel, to assess the function, and concentration of some of your hormones. Excluding all medical causes, you will have to undergo a psychiatric evaluation, during which your doctor asks you about your symptoms and signs. She or he might ask you how you feel and what your thoughts are, to establish your behavioural pattern. A questionnaire might also be helpful. Your doctor might use the criteria of depression listed in ICD-10 or DSM-5.
Depression and suicide risk
Suicide accounts for 1.4 % of all deaths worldwide. Most cases of suicide have to do with psychiatric disorders, such as depression and psychosis. The most relevant risk factors for suicide are the following:
- Substance use disorders
- Anxiety and traumatic disorders
- Personality and eating disorders
- Organic mental health disorders
The general risk for suicide for several mental health illnesses is about 5 % to 8 %, including depression, schizophrenia, or alcohol abuse. Scientists correlate depression strongly with thoughts of suicide and attempt. Keep in mind that the two most prevalent diagnoses among suicide victims are alcoholism and depression.
Risk factors for suicide in people with depression
Depression is the most common mental health illness among those who die from suicide. The following are some of the most well-established risk factors for suicide in people with depression:
- Being a man
- Family history of psychiatric disorder
- Previously attempted suicide
- More severe depression
- Comorbid disorders, such as anxiety or substance abuse
Suicide warning signs
Depression and suicidal ideation might possess some warning signs which family or friends might miss or misinterpret. Individuals that think of taking their lives away by committing suicide might talk about death or how it would be if they were dead. Another warning sign would be seeking for lethal means, such as pills or arms, that they could use to take their life away. They usually preoccupy their minds with death, sometimes being creative about it, writing songs or poems. Suicidal people often feel helpless and express hopelessness. They feel worthless and guilty, sometimes referring to themselves as being a burden. Other unusual acts that may indicate suicidal ideation or a potential attempt are when people make arrangements out of the blue, or call family or friends to say goodbye. Social isolation is common, and individuals usually present with self-destructive behaviour. Finally, some people might appear suddenly calm. This feeling of calmness may represent the acceptance of the suicidal ideation and the intention to attempt suicide. Usually, the person seems happy about his or her decision.
Treatment of depression
People with depression benefit from medication, psychotherapy, and lifestyle changes. Severe depression might require hospitalisation. Other forms of therapy might include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
Many classes of antidepressants might benefit a person with depression. Doctors often start treatment with a selective serotonin reuptake inhibitor (SSRI). Keep in mind that choosing the correct medication for you is a multifactorial decision. Some people might present with side effects caused by a specific class of antidepressants. Special populations, such as pregnant women, may benefit from a different regimen. Other classes of antidepressants include the following:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs
- Atypical antidepressants
- Tricyclic antidepressants.
- Monoamine oxidase inhibitors (MAOIs)
Sometimes, patients might need other types of medication, additional to their antidepressants, such as antipsychotics, mood stabilisers, or anxiolytics. Sometimes, you might need to try several types of antidepressants to find the correct one for you. Other people require a combination of drugs. Generally, antidepressants are not addictive. However, if you stop taking an antidepressant abruptly, physical dependence might occur. Talk to your doctor before deciding to make any changes regarding your treatment. It is essential to consult your doctor about antidepressants and the risk of suicide. Sometimes, especially during the first weeks of treatment, patients might experience an increase in suicidal thoughts. These first weeks of treatment are crucial as the person starts feeling more energetic and has more chances to stick to a final suicidal plan and attempt suicide. However, long-term antidepressant treatment will most probably improve mood and decrease the risk of suicide.
Psychotherapy may be quite helpful for some people with depression, especially when the trigger for their condition is exogenous, meaning it comes from their environment. There are various types of psychotherapy, such as cognitive-behavioural therapy or interpersonal therapy, that could improve the symptoms and signs of depression in an individual. Individuals with mild depression might benefit from psychotherapy as a monotherapy.
There are some things you can achieve alone to help you prevent depressive episodes and understand when something is likely to trigger your depression. Firstly, you have to stick to your treatment plan and follow it in the long-term. Depression treatment might not be a short-term goal, like treating a sore throat, for example. It might take months to fight the disease and start feeling strong and independent again. Learn more about depression and educate yourself about how depression affects you and what impact it has on your life. Also, try and understand the warning signs when they occur. Do not try to ignore or mask depression using alcohol or drugs. Instead, seek help and take care of yourself.
Weighted blankets and depression
Improving your sleeping habits alongside treatment for depression will help you break this negative feedback loop between insomnia and depression. You can fight onset, maintenance, or early-night insomnia using a weighted blanket. Weighted blankets provide you with deep pressure stimulation (DPS), also known as deep touch pressure or deep touch pressure therapy (DTP), which allows you to relax and fall or stay asleep effortlessly. Fighting sleeplessness will give you daytime energy and better cognitive skills. Weighted blankets also decrease agitation and irritability associated both with depression and lack of sleep. They are appropriate for anxiety, which often coexists with depression. Weighted blankets are proper for all ages, including children, adolescents, or adults suffering from depression and insomnia. They have an even weight distribution that has a therapeutic and calming effect, promotes a better mood, and improves sleep quality by applying DPS.
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