Depression or depressive disorder is an issue that influences many aspects of one’s life: it has an impact on thoughts, on the body and behaviours, on relationships and social life, work and achievement, as well as on the way one looks at their future.

If left untreated, depression can be permanent and pervasive, and can cause a lot of upset to both the person struggling with the disorder and the people around him/her.

According to the DSM-5, we can identify a range of symptoms that describe the depressive disorder (a duration of at least 2 weeks is usually required for diagnosis):

  • Depressed mood
  • Loss of interest and enjoyment (anhedonia, usually worse in the morning)
  • Reduced energy leading to increased fatigue
  • Diminished/increased activity (definite psychomotor retardation or agitation)
  • Reduced concentration and attention
  • Reduced self-esteem and self-confidence
  • Sleeping problems (waking in the morning 2 hours or more before the usual time; insomnia)
  • Eating problems (marked loss of appetite; weight loss 5% or more of body weight in the past month)
  • Marked loss of libido
  • Ideas of guilt and unworthiness
  • Bleak and pessimistic views of the future
  • Ideas or acts of self-harm or suicide.

Depression appears to affect 4-10% of the population (worldwide). The average age of the first episode of major depression occurs in the mid-20s, and the WHO study of mental disorders in 14 countries across the world found that 50% of patients still had a diagnosis of depression 1 year later (Simon et al., 2002) and at least 10% had persistent or chronic depression.

 The variation in the presentation, course and outcomes of depressive illness is reflected in the breadth of theoretical explanations for their aetiology, including genetic, biochemical, endocrine and neurophysiological, psychological, and social (processes and/or factors). One of the most consistent findings in depression (especially psychotic depression) is a marked elevation in cortisol levels, a hormone that can have effects on mood and memory.

So, what causes depression? It is partly to do with biochemical factors, like hormone imbalances (increased levels of stress hormones such as adrenaline and cortisol), as well as neurotransmitters (reduction in the amount of monoamines such as serotonin and norepinephrine). Also, the environment that surrounds us could be a risk factor, such as highly stressful situations (loss of job, death/separation of a loved one or financial difficulties), that have been shown to trigger periods of depression. Finally, there are genetic factors involved: depression is more common in those with biological family members who also suffer from some form of the disorder.

When depression is accompanied by symptoms of anxiety, the first priority should usually be to treat the depression, although when the person has an anxiety disorder and comorbid depression or depressive symptoms, it is advised to consider treating the anxiety disorder first (since effective treatment of the anxiety disorder will often improve the depression or the depressive symptoms).

If you or a friend is having an experience that includes some of the feelings described above, there is some advice that could help (although the only way to really treat depression is by consulting an expert):

Improve sleep hygiene: establishing regular sleep and wake times, and creating a proper environment for sleep can be really helpful.

– Avoid excessive eating, smoking or drinking alcohol in general, but mostly before sleep.

– Exercise regularly (even a walk in the park could help).

– Do not isolate yourself: try to keep contact with relatives and friends, and to talk about your feelings.

– Take care of yourself: have a bath, wear nice and confortable clothes, clean your house, treat yourself to something you enjoy.

– Make plans (is not important to do it, just write it down): whether it’s for today, tomorrow, for the years to come… Try to think about activities and things that you like.

– Keep a personal diary (possibly daily): write your thoughts, feeling, day-events, hopes and fear.

Remember: a lot of people can go through periods of depression, the important thing is to recognise your feelings and not to be ashamed of them, and most importantly not to be afraid of asking for help.

 

 

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Floriana Bua
Psychologist
Mental Health Worker (C&I Mental Health Foundation Trust, NHS)
London