One in every six people experiences depression at least once in a lifetime. Females are more prone to major depressive disorders as compared to males. Symptoms of depression include sleep disturbance, loss of interest in different activities, guilt, loss of energy and concentration, appetite changes, psychomotor agitation, and Suicidality. Cognitive behavioral therapy and Interpersonal psychotherapy along with medication help to improve the symptoms. It is, however, important to rule out mimicking conditions like hypothyroidism, CNS lesions, and anemia.
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Overview and Definition

Depression is a chronic and recurrent mood disorder characterized by reduced functioning in more than one major area of life i.e. academic, familial, and peer relationships. According to the World Health Organization statistics, 350 million people across the globe suffer from depression.

3 million teenagers in the United States had at least one major depressive episode in the year 2015. One in every 6 people experiences depression at least once in a lifetime. Women are more likely to suffer depression as compared to men.

Major depressive episode

The presence of 5 or more symptoms of depression during same two weeks.

Major depressive disorder

2 or more major depressive episodes are an indication of the major depressive disorder.

Risk Factors for Depression

Even though depression can affect anyone, people who have the following factors are, particularly, at risk:

  • The family history of depression (Individuals whose parents have depression are 3 to 4 times more likely to suffer depression as compared to offsprings of health parents.)
  • Pessimistic personality and low self-esteem
  • Exposure to violence and abuse
  • Poor socioeconomic status
  • Parental neglect
  • Bullying in school
  • Physical illness
  • Issues related to family relationships
  • Negative life events
  • Peer rejection

Low brain levels of serotonin (monoamine) can cause depression.

Resilience

Two individuals under similar condition may react to a situation differently. One may develop depression while other may not. Even in the presence of risk factors, some people cope well and escape depression. This ability is termed as resilience. High intelligence, emotionally stable personalities, better coping mechanisms, healthy relationships with family, and peer support are positive resilience factors.

SIGECAPS — Symptoms of depression

S — Sleep disturbance

I — Loss of interest in different activities

G — Guilt

E — Loss of energy

C — Loss of concentration

A — Appetite changes

P — Psychomotor agitation

S — Suicidality

Other symptoms

  • Rebellious behavior
  • Use of alcohol or drugs
  • Promiscuous sexual activities
  • Crying episodes
  • Sadness and tearfulness
  • Hopelessness
  • Persistent boredom
  • Social isolation
  • Poor communication
  • Low self-esteem
  • Sensitivity to failure or rejection
  • Irritability
  • Frequent headaches, back pain, and stomachaches
  • Decline in academic performance
  • Apathy
  • Difficulty with relationships
  • Forgetfulness
  • Weight loss or weight gain
  • Changes in eating habits
  • Efforts to run away from home
  • Self-destructive behavior
  • Substance abuse

Physical findings

  • Change in body weight
  • Signs of self-injury

 

Diagnosis

Diagnosis is based on interview questions. Symptoms that last at least two weeks are more likely to be due to depression.

  • Different questionnaires are used for screening depression in adolescents
  • Two-item patient health questionnaire (PHQ-2)
  • Short mood and feelings questionnaire
  • Children’s depression inventory

Medical conditions like thyroid problems, CNS lesions, anemia, vitamin deficiency, and obstructive sleep apnea should be ruled out as these conditions are likely to mimic depression.

Differential diagnosis

  • Adjustment disorder
  • Dysthymic disorder
  • Bipolar disorder
  • Schizophrenia

Comorbidities

Around two third of individuals with depression have at least one comorbid psychological condition. 10 to 15 percent of the individuals have 2 or more comorbid psychological conditions. There are 3 to 6 times more chances of substance abuse in patients with depression.

  • Syndrome of severe mood dysregulation
  • Generalized anxiety disorder
  • Moreover, autistic spectrum disorders, eating disorders, and ADHD is likely to get more complicated in the presence of depression.

Individuals with depression are more at risk of developing disruptive behavior disorder and anxiety issues.

Treatment

  • Cognitive behavioral therapy (CBT)
  • Interpersonal psychotherapy (IPT)
  • Antidepressants (medicines are continued for at least 6 months after the symptoms have improved)
  • SSRIs are a preferred treatment
  • Electroconvulsive Therapy (ECT): It is the brief electrical stimulation of the brain. The patient is under anesthesia during this procedure. ECT is typically reserved for severe depression cases which fail to respond to other treatment options.
  • Patient Health Questionnaire (PHQ-9) is used to monitor the response to treatment.
  • Comorbidities like anxiety, eating disorders, and substance abuse is treated separately.

Self-help

Following activities can help improve depression:

  • Regular exercise
  • Healthy diet
  • Abstinence from alcohol
  • Quality sleep

Suicide

People attempt suicide when they are hopeless and depressed. The 10th leading cause of death in the US is suicide. Suicide attempts by females are two to four times more than males. Males complete suicide three to four times more than females.

Methods used in suicides

  1. Firearms
  2. Suffocation
  3. Poisoning

Risk factors

Some of the risk factors identified by researchers are as follows:

  • Previous attempts to suicide
  • History of substance abuse
  • Stressful life event
  • Loss of a loved one
  • Ease of access to lethal drugs
  • History of interpersonal violence
  • Mental illness
  • Family history of suicide

 

Protective factors

  • Reflective and deep thinking skills
  • Effective community programs for mental illness and substance abuse disorders
  • Ease of access to psychiatric help
  • Support from friends and family
  • Cultural that discourages suicide
  • Religious beliefs
National Suicide Prevention Lifeline
Call 1-800-273-8255
Available 24 hours everyday
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