Depression is a common psychiatric illness that is characterized by depressed mood, loss of pleasure and interest in usual activities, feeling of guilt, low self esteem, loss of energy, disturbed sleep and eating, poor concentration and decision making and in some cases motor agitation. When severe it badly affects the patient’s activity. According to an estimate 1 in 15 people suffers from depressive episode at sometimes in life. It is a potentially treatable disease but majority of people never seek medical advice regarding treatment of this disorder.
Different forms of depression
Depression has got following forms
- Major depression
- Minor depression
- Dysthemic disorder
- Depressive episode under specific circumstances these include
- Psychotic depression
- Seasonal affective disorder
- Postpartum depression
Major depression
Major depression is defined as severely depressed mood on daily basis for a minimum of two weeks duration along with other symptoms of depression that incapacitate the individual for routine activities. An episode of major depression is characterized by sadness, indifference, apathy, and irritability.
Minor depression
Minor depression is one which doesn’t meet the criteria for major depressive illness. Symptoms of depression should be there for more than 2 weeks to label it as depressive illness. If minor depressive illness is not treated, chances of major depression increase.
Dysthemic disorder
In dysthemic disorder, symptoms of depression are persistent for long time even years but these symptoms are not so severe. Symptoms make difficult the normal functioning of the patient and depressive patient feels unwell all the times. Patient with such condition may have major depressive illness in later life.
Depressive episodes under specific circumstances
These forms of depressive illness occur in following circumstances
Psychotic depression:
this form of depressive illness is present in patients who also have features of psychosis. Feature of psychosis include hallucination (patient sees objects, feels things and hear voices or perceive smells in the absence of any thing), delusion (patients have false belief about things or other people) and loss of touch with reality.
Post-partum depression:
women after childbirth suffer this depressive illness, hormonal changes are thought to be responsible. It occurs almost in 15% of females after childbirth.
Seasonal affective disorder:
Seasonal affective disorder is a unique form of depression which occurs during winter months and improves in spring and summer season. It is said that decrease in daylight during winter season is responsible for this form of depression. Light therapy along with antidepressant and psychotherapy is used in its treatment.
Symptoms of depression
There are a variety of symptoms that are present in patient with depressive illness. Every patient has some of these symptoms, everyone having depressive disease don’t experience same type of symptoms. These symptoms include:
- Sadness which is persistent
- Hopelessness
- Feelings of guilt, helplessness or worthlessness
- Restlessness
- Irritability
- Anhydonia, which mean loss of interest and pleasure in enjoyable activities even some depressive patient disinterest in sex
- Decreased energy
- Fatigue
- Poor concentration
- Inability to make decision
- Disturbed sleep pattern, sometimes insomnia which is loss of sleep or early morning awakening
- Changing eating behavior, either patient eats too much or too little
- Suicidal thoughts sometimes suicidal attempts
- Body pains which don’t improve with painkillers
- Digestive problems difficult to treat
Causes of depression
Depression result from combination of different factors like genetic, environmental, psychological and biological. It is thought that some neurotransmitters in the brain are out of balance resulting in depression. Environmental factor that can trigger depressive illness include:
- Some life trauma
- Loss of a near and dear one
- Relationship issues
- Stressful conditions at work place or home
- Morbid disease
- Sometimes no triggering factor for depression is identified
Diagnosis of depression
Depression is diagnosed clinically, a criteria is used called DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDER (DSM-IV). Symptoms should be present for at least two weeks to diagnose depression.
Treatment of depression
Treatment for depression includes medical therapy along with psychotherapy. In some special situations, electroconvulsive therapy is also used.
Medication
Antidepressants
Antidepressant medication alleviate the condition by primarily working on neurotransmitters in the brain mainly serotonin, norepinephrine and dopamine. These neurotransmitters are thought to be involved in mood regulation. Antidepressants have following group.
Tricyclic antidepressants
These are the older medications approved for depression. Now days their use is limited due to their side effect profile. They can cause drowsiness, dry mouth weight gain and augmenting coronary artery disease. This group includes imapramine, nortriptyline, amitriptyline and others.
Monoamine oxidase inhibitors (MAOIs)
These are oldest medication approved for treatment of depression, this class of antidepressant is particularly effective in atypical depression, in which patient has increased appetite and increased sleep instead of being reduced. Patient should be advised to avoid some food like cheese and red wine while taking MAOIs. Patient should avoid SSRIs while taking MAOIs, otherwise life-threatening serotonin syndrome may arise.
Newest antidepressants
SSRIs are selective serotonine reuptake inhibitors, new class of medication that has little side effect as compared to the older antidepressants. This group includes sertraline or Zoloft, escitaloplram, paroxitine and other meidications.
SNRIs, selective norepinephrine reuptake inhibitors are similar to SSRIs and include venalfaxamine and duloxetine.
SSRIs are most commonly used medications these days due to their safety profile.
Psychotherapy
Psychotherapy is useful treatment option in cases of depression. When combined with medicine, results are very good. The important types of psychotherapy for depression are
- Cognitive behaviour therapy: helpful for depressive patient who have negative thinking
- Interpersonal therapy: used for those patients who have difficulties in maintaining relations
Electroconvulsive therapy
Electroconvulsive therapy is an option for those depressive patients who
- Fail to respond medical therapy and psychotherapy
- Resistant depression with suicidal thoughts
Vagus nerve stimulation (VNS) and repetitive Tran cranial magnetic stimulation (rTMS) are brain stimulation technique not commonly used, but they are reported to have efficacy in treatment of depression.
Prognosis
Depression is a potentially treatable disease. If treatment is commenced in time, prognosis is excellent. Some patients with major depression don’t respond to treatment and continue having symptoms, in these patients risk of suicide increases.