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Understanding Clinical Depression
Contrary to popular belief, depression is much more than just going through a phase of “feeling low”. It is a severe mood disorder and a mental health condition that impacts the physical, emotional, and mental health of a person. Clinical depression has the power to affect your thoughts, behaviour, feelings, and disrupt your actions, habits, and day-to-day life.
This serious mood disorder affects more than 350 million people across the globe. According to the World Health Organisation (WHO), depression is a leading cause of disability in the world and also one of the foremost “contributors to the overall global burden of disease”.
At its worst, it can compel people to commit suicide.
What causes depression?
To understand depression it is important to understand what causes this disorder in the first place. The World Health Organisation (WHO) states that depression is a complicated combination of various psychological, environmental (connected to social and family environment), and biological factors.
Psychological Factors: An individual’s outlook to life largely depends upon his habitual thoughts.
The habitual thoughts, in turn, have their roots in the upbringing or the childhood experiences of the individual. These experiences coupled with the individual’s reactions to the experiences mould and create his character.
For instance, a child exposed to a very severe and abusive childhood may grow up with little or no self-confidence, and low self-esteem. A child who is repeatedly criticised may find his perspective or views of the world coloured by negativity.
The constant negative thoughts can make an individual act in negative ways, which can create difficult situations in life, causing the individual to suffer emotionally and mentally.
Environmental Factors: A number of situations in the immediate environment of a person can affect his/her mental health and emotional well-being. Situations such as:
- financial problems
- job loss
- stress at workplace
- stressful relationships (either with a spouse, parents, and other family members)
- separations/divorce
- death of a loved one
- unemployment
- chronic health conditions or terminal illnesses
- social isolation
- family violence
- low income
- living alone
- the body not being able to adjust to changing weather conditions, especially during peak summer or winter due to a chemical imbalance in the brain and the hormone melatonin. This condition is known as a seasonal affective disorder (SAD).
Biological Factors: An oft-stated theory is that clinical depression is caused by an imbalance of chemicals in the brain.
The drugs prescribed by doctors are an attempt to bring about a balance in those chemicals. Whether this imbalance of chemicals is a cause of depression or not remains a topic of dispute, but what has been observed is that when a person becomes depressed there is a reduction in the amount of certain neurotransmitters (such as serotonin and norepinephrine) found in the brain. Once the depression lifts from the person, the chemical imbalance returns to normal.
Apart from the above mentioned major factors which contribute to depression, another important factor is family history. Research shows that people whose parents or siblings suffer from depression are three times more likely to suffer from this disorder.
What are the types of depression?
Depression can take many forms and can differ from person to person. Being aware of which type of depression you suffer from can help you to get the most effective form of therapy and treatment and help you to manage your symptoms.
- Major Depressive Disorder: Also known as unipolar depression this condition is characterized by prolonged periods of depression, usually two weeks at a stretch. Different individuals are affected in different ways by this form of depression. For instance, some individuals binge eat, sleep too much, put on a lot of weight and feel worthless, and guilty. Others may have trouble sleeping, eating, socializing, and lose a lot of weight. Yet some other individuals may go about their daily routine in a presumingly normal way while portraying a happy face in front of others, but feel empty and hopeless within.
In general, if you suffer from this condition you may experience severe sadness, constant fatigue, headaches, feelings of hopelessness, lack of focus and interest in all the things they had enjoyed, and recurrent thoughts of suicide. - Dysthymia: is also known as persistent depressive disorder is long-term depression which can linger on for years. People suffering from this form of depression are in general gloomy, irritable, unenthusiastic, sluggish, and unable to have fun. They suffer from sleep difficulties, appetite changes, constant fatigue, lack of focus and concentration, low self-esteem, and feelings of hopelessness.They worry and fret incessantly and have the tendency to complain a lot. This condition differs from major depression, in that the symptoms are felt less acutely by the individual, than in major depression. In major depression, the individual feels the symptoms acutely for a period of two weeks and then return to their normal self when the depression lifts away.
However, in dysthymia, the person can remain chronically mildly depressed for up to a period of two years or more, with a reprieve period of not more than two months in between. Very often, this condition goes unnoticed and the person is simply labelled as a “gloomy and irritable personality.”
A person usually develops dysthymia in their childhood which can go on well into their adulthood. - Atypical Depression: is a subtype of major depressive disorder. This is a form of depression with atypical features, which means, your depressed mood can suddenly vanish in response to happy and positive events. In other words, there is a mood reaction to certain events.
In contrast, a person suffering from major depressive disorder does not have any mood reactivity to happy events. Meaning, the depression does not disappear even temporarily in the face of a positive event.
Atypical depression is characterized by eating disorders such as bulimia, oversleeping or insomnia, the feeling of leaden or heavy arm and legs, and the feeling of being rejected and isolated, thoughts of suicide, panic attacks.
Much like major depressive disorder atypical depression induces suicidal thoughts in a person and leaves him/her feeling incapable of performing day-to-day activities.
Antenatal and Postnatal Depression: Pregnancy can be a very stressful period. It is very normal to experience mood swings during this period, especially since the body is undergoing hormonal changes due to the pregnancy.
Some women though, due to a variety of reasons, experience depression during or even after their pregnancy. Around 7% to 20% of pregnant women are affected by antenatal depression, which occurs during pregnancy.
If not treated on time, antenatal depression can lead to postnatal depression or postpartum depression, which is a condition occurring after the delivery and affects around 15% of the women.
When going through the phases of depression, the women may feel overwhelmed by feelings of sadness, inadequacy, hopelessness, fatigue, suicidal thoughts, insecurity, and fear of becoming a parent.
If you notice any symptoms of antenatal and postnatal depression in yourself, you can manage these by being patient with yourself, by talking to family members or friends for emotional support, taking care of yourself by eating healthy, taking adequate rest, and exercising regularly, and last but not the least joining a mother and baby group, so that you know there are others out there who feel like you and are supporting each other. - Cyclothymic disorder: This disorder is characterized by bouts of emotional ups and downs between mild depression and hypomania. Hypomania is a state of immense excitement, elation, inflated self-esteem, and hyperactivity.
The mood swings, however, are not as severe and do not last for as long a duration as that in bipolar disorder. People with cyclothymic disorder in fact display symptoms, which are much milder than those experienced in bipolar disorder.
The hypomania can last for days on end, or even weeks followed by the depression. The cycle may continue non-stop, or, in between the alternating moods, the person may experience normal moods for a month or more. It has been observed though, that the depressive symptoms in the people affected by cyclothymic disorder are more debilitating than the hypomania symptoms. - Seasonal Affective Disorder (SAD): This disorder has a seasonal pattern. People with this disorder experience emotional disturbances with symptoms, such as, constant fatigue, a craving for carbohydrates, oversleeping, overeating, and weight gain. The emotional disturbances begin and end with a particular season. Usually, it has been observed that depression which starts at the beginning of winter and wanes as the season ends is the most common among people with SAD disorder. This disorder is especially seen among people who stay in the extreme most northern and southern hemispheres.
Less than 1% people experience depression characteristic of SAD when the summer season starts. - Bereavement: It is natural to grieve when a near and dear one passes away. The grieving process may last a few days or even years in some cases. However, if the loss is significant, the grieving can change to depression.
- Bipolar Disorder: is also known as manic depression. It is characterized by extreme mood swings between depression and mania. The manic episodes comprise of feelings of exaggerated self-confidence and grandiosity, anger, decreased need for sleep, extreme talkativeness, feelings of euphoria, racing thoughts, uninhibited risk-taking, recklessness, persistently elevated or irritable mood, extreme indulgence in pleasurable activities such as sex, or over-spending often with painful consequences, and a constant restlessness.
The phases of depression, on the other hand, are ruled by extreme self-loathing, utter hopelessness, extreme fatigue, oversleeping, constant thoughts of suicide, and complete lack of interest in activities that are normally enjoyable.
Sometimes a person with bipolar disorder loses touch with reality and begins to hallucinate, leading to psychosis. The person may start to believe he/she has superpowers.
Very often it is seen that bipolar disorder is linked to family history. A person whose family members have bipolar disorder has a high probability of suffering from bipolar disorder himself.
Who is prone to depression?
According to the World Health Organization (WHO), depression is a leading cause of disability. a major contributor to global disease and it leads to suicide — and some people may be prone to it more than others.
- Health care workers: such as doctors, nurses, therapists can become prone to depression as the well-being and lives of people literally depend on them. The immense work pressure faced by these professionals along with irregular working hours, constant exposure to sickness, trauma, and sometimes death, often takes a toll on them mentally.
- Transgenders: Depression and other mental health issues are very common in the transgender community. This is largely due to the discrimination, and social stigma faced by these people
- Military veterans: Often, some military veterans develop depression or post-traumatic stress syndrome (PTSD) as the experience of warfare and combat often leaves them feeling, guilty, and disillusioned with the world at large. The experience leaves feeling them conflicted with their own value system and shatters the idea that the world can ever be a safe and thriving place.
- Women: especially between the ages of 25 to 40 are twice as likely to experience major depression than men and are up to three times more prone to suffer from anxiety-related disorders or to attempt suicide.
- New mothers: are likely to develop what is known as postpartum depression. It can occur due to hormonal changes, stress, isolation, sleep deprivation and fatigue.
- Artists: Depression is very common among people who are creative by nature and who are drawn to creative professions. Though not much is known about the reasons why depression is so common among the creative professionals, the reasons could include the number of uncertain hours put into their craft, the isolation, and even irregular payment for their work.
Well known writers such as E. Hemingway, J.K. Rowling, Sylvia Plath, Virginia Woolf and many more suffered from severe depression. In fact some of them were known to suffer from bipolar disorder, such as Virginia Woolf. Some well-known actors are known to have suffered from depression, with, Robin Williams and Deepika Padukone being the news recently for this disorder.
Prominent musicians and painters too have suffered from depression, such as Beethoven, and Vincent Van Gogh.
People facing relationship issues: People who face relationship issues or have gone through separation such as divorce, are at an increased risk of depression. - People in stressful occupations: People in stressful occupations such as sales and marketing, food and hospitality, finance, can be prone to depression due to the stressful nature of their work.
- People with traumatic childhoods: A traumatic childhood can give rise to immense depressiveness in life. A number of factors can be responsible such as, parental neglect or parental conflict, mental, physical, or emotional abuse of the child and so on.
- Heredity: People with relatives suffering from clinical depression have a greater chance of developing it themselves. Also, having a close relative who has bipolar disorder may increase a person's chance of developing major depression.
What are the risk factors that can make you vulnerable to depression?
Some of the most common risk factors that can lead one into depression are:
- Loneliness and isolation
- Lack of social support
- Recent stressful life experiences
- Family history of depression
- Marital or relationship problems
- Financial strain
- Early childhood trauma or abuse
- Alcohol or drug abuse
- Unemployment or underemployment
- Health problems or chronic pain
What are the symptoms of depression? How is depression diagnosed?
A depressed person will display some unmistakable signs. If you notice any of these symptoms affecting you or your near and dear ones, you may want to consider seeking help either from your immediate support network which can be your family or from a professional counsellor.
Very often what stops us from seeking help, is the social stigma attached to counselling or psychotherapy. This is a mental block that needs to be overcome. Going for counselling or psychotherapy is not always because of mental instability.
Just as you take medicines when you have a fever, depression too is a problem for which you require mediation if not medication, though, sometimes medication too is prescribed.
Mediation can come from your immediate family members, or friends whom you trust. You can open up to them and ask for their emotional support during your difficult phase.
Alternatively, you can opt for counselling or psychotherapy, which can work wonders for you and help you regain your self-confidence and clarity in life.
Very often, the counsellor or psychotherapist is able to provide you with a viewpoint to move your forward in your life from its stuck position, by virtue of being a complete outsider with no preconceived notions or judgements about your situation.
Some of the symptoms of depression include:
Emotional Symptoms
If you are depressed you will experience immense sadness, and hopelessness, for prolonged periods and may have some of the following repetitive thoughts which cause the emotional disturbance:
- “I feel life is not worth living.”
- “Nobody understands me.”
- “I am so lonely.”
- “I feel helpless.”
- “Nobody needs me.”
- “My life is useless.”
- “I am pulling everyone else down with me.”
- “I don’t deserve happiness.”
- “I don’t enjoy anything anymore.”
- “I am feeling overwhelmed.”
- “Nothing seems to make me happy.”
- “I feel like crying all the time.”
- “I feel like dying.”
- “I am useless.”
- “I am all alone.”
- “Nobody cares for me.”
- “ I give up.”
Behavioural Symptoms
When you are depressed you will behave in a way which is not normal for you, for instance:
- “I just want to sleep all the time.”
- “I don’t want to do anything.”
- “I am not interested in anything.”
- “I do not want to be with my friends.”
- “I just want to be alone.”
- “I am worried.”
- “I am anxious.”
- “I feel restless.”
- “I don’t know what to do.”
- “I am not interested in sex anymore.”
Cognitive Symptoms
Depression can make you feel confused and impair your ability to think clearly and even affect your memory. You may feel like:
- “I feel I keep forgetting things.”
- “I am confused.”
- “I can’t seem to take decisions.”
- “I am not able to concentrate.”
Physical Symptoms:
Your depression will also show physical symptoms and you may complain to yourself in the following ways:
- “ I do not feel like eating anything.”
- “ I feel like eating all the time.”
- “I am just tired, all the time.”
- “I have no energy.”
- “I am hungry all the time.”
- “I have no appetite.”
- “I wake up suddenly in the middle of the night.”
- “I am unable to sleep.”
- “I’m getting fatter and I cannot control it.”
- “My joints ache for no reason.”
- “I feel lethargic.”
- “I have a headache.”
- “ I don’t feel like doing anything.”
A few other noticeable symptoms include:
- Irritability, agitation or restlessness
- insomnia or sleeping excessively
- Change in appetite such as eating too much or too little
- Significant weight loss when not dieting or weight gain due to sudden overeating tendencies
- No interest or pleasure in almost all activities nearly every day
- Recurrent thoughts of suicide, making plans for suicide or suicide attempt
Diagnosis
Firstly, your family doctor may ask you to undergo a blood test to rule out the possibility of health conditions, which can give rise to symptoms mimicking depression, such as diabetes, or thyroid disorder. Once physical ailments are ruled out, you will be referred to a psychologist, psychotherapist, counsellor, or a psychiatrist for therapy who will ask you questions to find out about your symptoms. The questions can be about your lifestyle and habits, your daily behaviour, and your current situation in life.
Once the symptoms are established, the doctor will use a standard set of questions to find out whether what you are suffering from is depression.
Based on the level of your depression you may be prescribed antidepressants and therapies.
What are the complications of depression?
If left untreated, depression can get worse and can result in complications which will affect every area of your life such as emotional, mental, behavioural, and physical.
The complications include:
- panic attacks
- social anxiety or phobia leading to social isolation
- losing weight or putting on weight excessively
- physical pains and illnesses
- suicidal thoughts and attempts
- substance abuse such as drugs and alcohol
- the immune system can be affected
- prone to heart disease and may even die from it
What is the treatment for depression?
Psychological treatments
Psychological treatments are also known as talk therapy, which can help you identify self-sabotaging thinking patterns and behaviour. The therapies can work wonders to bring about positive transformations in different areas of your life. The different forms of talk therapy include:
- Cognitive Behavioural Therapy
- Interpersonal Therapy
- Behaviour Therapy
- Mindfulness-Based Cognitive Therapy
- Dialectic Behaviour Therapy
- Counselling
- Couples Counselling
- Drama Therapy
- Gestalt Therapy
- Relationship Counselling
- Family therapy
- Cognitive Analytic Therapy
- Bereavement Therapy
Exercise
Regular exercising can vastly reduce the symptoms of depression.
Exercising will not only make your immune system stronger but will also release feel-good chemicals in the brain. Exercises such as swimming, cycling, jogging, can boost your activity level and make you feel fresh and energized. Activities such as gardening, washing your car, a walk around a park with your pet, too can uplift your mood. Yoga and Tai Chi too are well- known for great mental and emotional benefits, apart from physical.
Exercising can, in fact, prevent depression from recurring.
Medical Treatments
If your depression level is moderate you may be prescribed antidepressants along with psychological counselling.
If you suffer from very severe forms of depression such as bipolar disorder, or psychosis, you may be prescribed mood stabilizers and anti-psychotic drugs.