Treatment for Depression in Dubai

Everyone has days of sadness and low mood. These phases usually pass quickly. However, if the low mood persists for more than two weeks, it might indicate depression.

Clinical depression, also known as Major Depressive Disorder (MDD), is a psychiatric condition characterized by persistent feelings of sadness, fatigue, loss of interest in activities, and sleep deprivation.

According to the World Health Organisation (WHO, 2020), depression is, along with anxiety, a highly frequent disorder with more than 300 million people affected globally. Unlike occasional mild mood changes that people experience from time to time, depression may develop into a debilitating, potentially fatal illness.

In Dubai, depression can affect anyone, regardless of age or background, with triggers ranging from personal stressors to unidentified causes. When depression strikes, the reasons are often elusive. Depression symptoms can seemingly appear out of nowhere, leaving many feeling guilty and perplexed, thinking, “Everything is fine, so why do I feel so awful?”

Accepting the illness, because of the still present stigma in Dubai, can be challenging, with sufferers often feeling misunderstood. Well-intentioned advice like “snap out of it” or comforting words like “cheer up, it’ll get better” are unhelpful.

Treatment for depression requires professional help to diagnose the condition and choose the proper therapy.

CHMC, the German Clinic for Psychiatry and Psychology in Dubai provides comprehensive care tailored to cultural and individual needs. For more information call:

Call CHMC

Read more about depression

• Post Partum Depression
• Major Depressive Disorder. Diagnosis and Treatment
• Dysthymia. Diagnosis and Treatment
• Catatonic Depression. Diagnosis and Treatment
• Relaxation Techniques in Therapy for Depression
• Psychotherapy for Older Adults with Depression
• From Early Understanding to Modern Diagnosis of Depression
• Antidepressants. What They Are
• Feeling Depressed? Effects of Loneliness and Social Isolation

Assessing Symptoms of Depression

In Dubai, depression significantly impacts many individuals, leading to persistent sadness, exhaustion, and social withdrawal. Recognizing symptoms early can help access Dubai’s mental health professionals for timely intervention. Untreated depression has devastating impact on individual’s well-being, including decreased quality of life and increased suicide risk. People with depression are mor likely to die on high blood pressure, diabetes, stroke, or heart attack. With proper care and knowledge, therapy for depression can remove the symptoms, leading to a full recovery.

Depressive symptoms include:

Main symptoms:

• persistent low mood
• loss of interests or pleasure
• lack of energy

and

Secondary symptoms:

• Poor concentration and attention
• Low self-esteem and self-confidence
• Feelings of guilt and worthlessness
• Excessive worry about the future
• Thoughts or acts of self-harm or suicide
• Sleep disturbances
• Decreased appetite

Physical Symptoms Caused by Depression

Physical discomfort can also contribute to diagnosis. Headaches, back pain, dizziness, and digestive issues might be the somatic symptoms caused by depression.

Physical complaints that may indicate depression are:

• General physical weakness and fatigue
• Sleep disturbances (difficulty falling asleep and/or staying asleep)
• Appetite changes, gastric discomfort, weight loss, digestive issues like constipation or diarrhoea
• Headaches or other bodily pains such as backaches
• Sensation of pressure in the throat and chest (known as “globus sensation”)
• Shortness of breath and disruptions in heart and circulatory function, like arrhythmias or palpitations
• Dizziness, visual disturbances, and eye fluttering
• Muscle tension and sudden sharp pains
• Loss of sexual interest, absence of menstruation, impotence, sexual dysfunction

Diagnosis of Depression

Depression is one of the most common psychiatric illnesses that affects millions of people. Proper diagnosis and therapy of depression is crucial for an individual’s recovery. However, misdiagnosis is possible. Depression is difficult to diagnose as there are no precise laboratory or neuroimaging tests to confirm the diagnosis.

Depression is diagnosed when there are at least two primary and two secondary symptoms present for a minimum of two weeks. Assessment takes into account not only patient’s current emotional state but also the course of the past few weeks.

Alongside typical emotional stressors, physical complaints can also indicate depression. Such symptoms like shortness of breath or heart rhythm disturbances might have psychological causes.

Making Psychiatric Diagnosis of Depression at CHMC Dubai

The presence of symptoms of depression doesn’t necessarily confirm the diagnosis. Many of such symptoms might align with other mental or physical disorders. Before securing the diagnosis of depression, a thorough assessment should exclude other disorders.

The diagnosis of depression is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5,) mostly used in the US, or the International Classification of Diseases (ICD-10) deployed worldwide, among others in Europe.

Steps in Diagnosing Depression

Depression requires proper diagnosis which can be secured by a psychiatrist or psychologist. The psychiatric interview can start with “Two-Questions Test” giving the physician basic information about patient’s status.

Identifying depression is not always straightforward. Many individuals experiencing depression find it challenging to discuss their emotional state voluntarily. They often struggle to articulate their problems. One reason for this difficulty is that vague physical complaints can be linked to depression. Consequently, some affected individuals mistakenly attribute their symptoms to a physical illness.

Depression requires a proper diagnosis, which can be secured by a psychiatric assessment. Diagnosis of severe depression requiring treatment with medication typically involves a few steps: a conversation with the psychiatrist, a physical examination of the patient, a laboratory test, an ECG, and, in some cases, CT or MRI scans.

The diagnosis of depression at CHMC Dubai is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), mostly used in the US, or the International Classification of Diseases (ICD-10) deployed worldwide, among others in Europe.

The “2 Question Test”

An initial indication of depression can come from a simple test known as the “Two-Question Test”:

• Have you frequently felt down, sad, or hopeless in the past month?
• Did you have noticeably less interest and joy in activities you typically enjoy over the past month?

The answer “yes” to both questions may indicate depression. In that case, the psychiatrist will further assess the signs of depression by engaging in conversation and asking about specific symptoms.

Initial Conversation with the Patient (Anamnesis)

The most crucial tool for determining the diagnosis of depression and assessing its severity through conversation with the patient. The more openly and accurately the exploration, the better the assessment of the depressive state.

The conversation may begin with a more structured interview containing a set of questions or in form of open-ended questions, such as why the person visits the doctor, how he feels, or what are the complaints.

The open approach allows the patient to incorporate better own thoughts and observations into the conversation. However, the patient may also want to discuss entirely different matters initially, such as recent experiences or challenging life situations. The therapist should approach the patient more flexible adjusting the interview to the circumstances.

During the conversation, the psychiatrist or psychologist pay attention to other details such as behaviour, clothing, or language. A soft-spoken tone, a lack of emotional expression, or a slouched and weary posture can provide clues about the individual’s condition.

Diagnosing depression, especially in individuals with severe physical or mental illnesses or in older adults, can be challenging. In such situations, it can be helpful to also interview family members or close caregivers.

Physical Exam

The objective of physical exam, laboratory test and other investigations, described below, is the exclusion of underlying physical illnesses, which can mimic depression.

Physical exam consists of:

• General physical exam: assessment of patient’s general health status (depression may be linked to an underlying physical health problems).

• Neurological exam: allows to roll out major problems of the central nervous system.

Laboratory tests

Evaluating the status of the patient before starting the treatment excluding different health issues. In case of starting treatment with medication the initial result is a benchmark for further controls.

ECG (Electrocardiogram)

By using ECG, we exclude pre-existent heart problems. A “native” ECG is also a point of reference for further controls under medication.

Additional Diagnostics

A more profund investigation will be needed in case of severe mental disorders like psychosis or bipolar disorder. Such diagnostic includes brain scan (CT-scan or MRI) and the record of the brain generated electrical activity EEG (Electroencephalogram).

Treatment Phases of Depression

Modern treatments can often quickly heal or relieve depressive episodes, significantly improving quality of life. However, over 50% of cases are recurrent or chronic, with causes that remain unresolved. Each episode increases the risk of another, and stopping treatment raises the likelihood of recurrence.

Treatment mainly involves antidepressants, psychotherapy, or a combination of both. For mild to moderate depression, psychotherapy is as effective as medication, though it takes longer to show effects. For severe episodes, combined therapy is more effective than either medication or psychotherapy alone. In mild depression (mild episodes, dysthymia), antidepressants are less effective than in severe cases, making psychotherapy the preferred option.

Acute Therapy for Depression

Whether outpatient treatment or a hospital stay is necessary depends on factors like the type and severity of depression and the individual’s suicide risk. For psychotic depression, or for those in suicidal patients, hospitalisation can be the only option. The goals of treatment vary depending on the stage of the illness.

Acute therapy should begin as soon as an acute phase of the depression appears. It continues until the acute symptoms have significantly improved. The acute therapy typically lasts four to eight weeks. In this phase, the focus is on educating the patient about the illness, the treatment plan, and the importance of taking medications.

This “psychoeducation” is essential, along with maintaining close contact with the psychiatrist, who is available to answer questions and encourage patients to take prescribed medications regularly. It’s important for patients to know that antidepressants often take a few days to weeks to show effects.

Maintenance Therapy for Depression

Maintenance therapy follows acute therapy and aims to stabilize the patient to prevent a relapse. Relapse means the return of symptoms before full recovery has been achieved. If symptoms reappear after the person has returned to their original state of health, it’s considered a recurrence. The goal of maintenance therapy is to stabilize patient’s state for at least four to six months. It’s crucial to recognize early warning signs of a relapse and know strategies to prevent it.

Relapse Prevention for Depressive Disorders

Prevention of recurrence begins once the patient’s mood has stabilized. Its goal is to prevent another acute episode in long term. The duration of the relapse prevention depends on the number and severity of past depressive episodes. Generally, patients should not stop the prescribed therapy on their own, and a regular daily rhythm of rest and activity should be established and maintained.

Involving a partner or family members is important in treating depression. Relatives should be informed about the symptoms, treatment options, and prognosis (psychoeducation). Equiped with such knowledge they can support the patient, encourage continuation of treatment, and protect against relapse.

Adjusting Treatment to Severity of Depression

Treatment options vary for each severity level. Hence, it’s crucial to identify all signs of the illness through thorough questioning. Each depression is unique. It differs in intensity and course. Severity levels can be mild, moderate, or severe, based on the number and duration of main and secondary symptoms.

Psychiatrist and patient decide together which therapy method can be used considering personal wishes and preferences, medical history, and the illness severity:

• Mild depression: education, support, self-management, psychotherapy; cautious antidepressant use.
• Moderate depression: psychotherapy or medication.
• Severe depression: medication combined with psychotherapy.

Consequences of Untreated Depression

The treatment of depression is not a “quick fix.” The process of healing takes time. The patients should be careful while judging the therapeutic progress without overestimating the temporary improvement. It’s not uncommon to experience setbacks even after a full recovery.

Depressed individuals who do not seek therapy quickly find themselves caught in a vicious cycle. The symptoms of depression strain family relationships and friendships, affecting also work performance. These illness-related social impairments are substantial and appear to persist in many patients even after the depressive episode have subsided. Consequently, individuals with depression tend to drink alcohol or take drugs as a coping mechanism.

Treatment for Depression with Medication

Medication is the fastest method of treatment of depression. However, the best long-term effect can be achieved by combining medication with psychotherapy.

Brain nerve cells use various neurotransmitters to transmit signals. While not all details are known, experts believe that in depression, the balance of certain neurotransmitters, such as serotonin, noradrenaline, dopamine or, glutamate are altered and some nerve connections are inhibited. They are different groups of medication influencing the neurotransmitters and used in treatment of depression. However, the main medication used in the treatment are antidepressants.

For mild depression, herbal alternatives like St. John’s Wort may be used, but it has side effects and interacts strongly with other medications.

Treatment for Depression with Antidepressants at CHMC in Dubai

From a neurobiological point of view, depression is caused by an imbalance of certain brain neuromodulators. Antidepressants are a group of medication improving the imbalance of neurotransmitters which elevates the mood, increases the energy levels, and reduces physical symptoms of depression. Modern pharmacological research has developed several antidepressants with different courses of action. They work by balancing the neurotransmitters, such as serotonin, noradrenaline, dopamin, and others. Antidepressants belong to distinct groups including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), NaSSA, MAO inhibitors, tricyclic and tetracyclic antidepressants.

Antidepressants are taken daily. In the first weeks and months, the goal is to alleviate symptoms and ideally make the depression disappear. Once this goal is achieved, the treatment is continued for at least 6 to 9 months. This so-called maintenance therapy is important to prevent relapses. Sometimes the medications are taken for even longer to avoid relapses (relapse prevention). The duration of intake depends, among other things, on how the symptoms develop and whether there is an increased risk of relapse. Some people make need antidepressants for many years. Antidepressants are not addictive, even with long-term use.

Course of Treatment for Depression with Antidepressants

While there are many different antidepressants, it is difficult to predict how well a specific medication will help in a particular case. Therefore, at the beginning of treatment, psychiatrists suggest a medication that they consider most effective and well-tolerated. If the medication does not work as expected, it is possible to switch to another one. Sometimes, various trials with medications are necessary to find the most suitable substance. 

Maintaining the course of antidepressant medication is crucial even when a patient experiences an improvement in their condition. In fact, continuing treatment for a minimum of four to nine months, even after symptoms have abated, can substantially reduce the likelihood of a relapse. When discontinuing antidepressants, it is essential to do so gradually to manage potential side effects that may arise during this phase.

When to Use Antidepressants

Studies have shown that the benefit of treatment with antidepressants depends on the severity of depression: the more severe the depression, the more the benefits outweigh the drawbacks. This means that antidepressants are effective for chronic, moderate, and severe depression. They use is less successful for treatment of mild depression or dysthymia.

However, even in cases of mild depression, where the efficacy of antidepressants is somewhat diminished, they might still prove valuable. This is particularly true if the individual has experienced more severe depressive episodes in the past or has responded positively to antidepressant medication previously.

Psychiatric Monitoring During Treatment with Antidepressants

Regular psychiatric visits are important during the treatment with medication. The psychiatrist will ask whether the symptoms have improved and if any side effects have occurred. If necessary, the medication type and dosage will be adjusted.

Under no circumstances the patient should medicate himself. This can result in insufficient effectiveness, more side effects or even in overdosing. Unlike many sleep aids and antidepressants need weeks to develop full efficacy. Abruptly discontinuation of antidepressants leads often to sleep disturbances, nausea, or restlessness. It can also happen, that few days later the patient might feel better. This leads him to the conclusion that he is healed and/or that the medication wasn’t effective. However, days or weeks later the depression can reoccur even more pronounced then at the beginning.

Towards the end of the treatment, the medication dosage should be gradually reduced over several weeks under strict psychiatric monitoring.

Advantages of Antidepressants

It’s essential to recognize that antidepressants are non-addictive, dispelling concerns of dependence or the need for escalating doses to achieve the desired therapeutic effect. However, to minimize the risk of unwanted side effects, it is imperative to adhere to a consistent medication regimen. Any adjustments to the dosage should only occur under the guidance and approval of a psychiatrist.

Antidepressants offer several advantages in the treatment of depression. They demonstrate remarkable efficacy, particularly for individuals grappling with moderate to severe forms of the condition. Furthermore, they typically manifest their therapeutic effects relatively quickly, typically within approximately two weeks. Importantly, the treatment regimen is relatively undemanding in terms of time commitment. Additionally, a variety of antidepressant formulations exist, each tailored to address specific symptoms, allowing for a personalized approach to treatment.

Disadvantages of Antidepressants

However, it’s essential to acknowledge the potential drawbacks associated with antidepressants. Depending on the specific medication, individuals may experience side effects such as nausea, weight gain, digestive disturbances, drowsiness, or sexual problems. These side effects are most common at the onset of treatment, with roughly half of all patients reporting transient discomfort. In some cases, the side effects can be so burdensome that treatment must be discontinued. Moreover, it’s essential to recognize that antidepressants do not address the underlying life issues that may have contributed to the development of depression, such as work-related stress or relationship difficulties. Finally, individuals who have undergone antidepressant treatment are at a higher risk of experiencing a relapse compared to those who have received psychotherapy.

Predictability of Genetic Testing for Antidepressant’s Efficacy

Antidepressants remain the first-line treatment for major depressive disorder (MDD), but responses to antidepressants vary widely between individuals. There is still a lack of predictive treatment response, which means that the choice of the most effective antidepressant for a specific patient can be identified only by trial and error.

The currently available genetic tests trying to predict the effectiveness of a particular antidepressant are not showing the expected accuracy. The lack of predictability of those tests is explicable not only by the interaction of a variety of different genes but also by the role of an external stressor. Such evidence leads to the conclusion that the onset of depression is a complex and heterogeneous process combining genetics and environmental factors.

Treatment for Depression with Psychotherapy

In patients treated only “biologically,” i.e. with medication, the symptoms can appear again despite using the same dosage of the medication. Consequently, adding the psychotherapy is a necessary part of an effective treatment, improving by several times the chance for a full recovery.

Clinical psychologists offer psychotherapy, or “talk therapy”, and have degrees in psychology and significant postgraduate training. Psychologists avail themselves of evidence based psychotherapeutic treatment methods.

There are variety of psychotherapeutic methods. The majority of them belong to two psychotherapeutic branches: psychodynamic and behavioural therapy.

Cognitive-Behavioral Therapy in Treatment for Depression

Cognitive behavioral therapy combines two therapeutic approaches:

• initially symptom reduction and then their full disappearance
• improving and then restoring daily routine
• preventing relapse after patient’s full recovery

Cognitive Therapy

According to cognitive therapy, it is often not the things and situations themselves that cause problems, but rather the meaning we attach to them. Our personal perspective can be a crucial starting point for change.

Behavioral Therapy

Behavioral therapy is based on the assumption that behaviours can be learned and unlearned. The therapeutic goal is to identify problematic behavioral patterns, work with them, and bring about change.

The core approach of CBT (Cognitive Behavioural Therapy) is based on the idea that problems are the result of the way people interpret situations, thoughts, and feelings. CBT addresses the symptoms, giving the patient insight about the triggers in “her and now.” This allows the patient to control the patterns of his thinking and behaviour causing the symptoms. It helps the individual identify thoughts that make them feel bad (e.g., I am not good enough).

Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a synthesis of interpersonal, cognitive, behavioral and psychodynamic therapies developed by James P. McCullough Jr. of Virginia Commonwealth University. CBASP is the only psychotherapy method specifically developed for treating chronic depression.

People with chronic depression often lack a sense of safety in their relationships with others. This can stem from past traumas or ongoing experiences of emotional harm, like rejection, harsh criticism, or neglect by significant people in their earlier stages of life. As a result, they develop a deep fear of relationships, seeing other people as a source of pain or threat. To cope, they tend to avoid social interactions at home, work, or elsewhere, which becomes a key challenge in therapy. Addressing this avoidance pattern is crucial for helping them improve their mood and relationships.

The CBASP technique

CBASP focus primarily on social and interpersonal learning by combines three techniques: 1) Situational Analysis, a technique helping patients comprehend the consequences of their behavior on others and modify it, 2) Interpersonal Discrimination Exercises, examins the past traumatic experiences with others and differentiation of those from healthier relationships, and 3) Behavioral Skill Training/Rehearsal, such as assertiveness training, to help depressed individuals correct their maladaptive behavior. 

Unlike traditional psychodynamic therapy, the transference analysis in CBASP helps patients recognising transference in “here and now” during their interaction with the therapist. Transference analysis alows the patient consciously differentiate the therapist from influential figures in their past.

The goals of CBASP therapy are to help patients:

1. Reconnect patients with their social enviroment.
2. Learn how to improve their emotional well-being and maintain control over their feelings.
3. Develop skills to successfully navigate relationships and achieve their interpersonal goals.
4. Understand the importance of maintaining progress after therapy by practicing what they’ve learned. This ongoing practice helps prevent relapse and ensures lasting change by replacing old, harmful patterns with healthier behaviors.

Effectivness of CBASP

Studies have shown that the combination of CBASP and pharmacotherapy with antidepressants proved to be the most successful treatment method for chronic depression.

Treatment with Psychodynamic Psychotherapy

Psychodynamic psychotherapy relates to several methods of in-depth psychotherapy. These are classical psychoanalysis, psychoanalytical psychotherapy, and different modifications of this methods.

Despite the different approach, just as cognitive-behavioral therapy, psychodynamic therapy also wants to bring about changes in behaviour. Unlike CBT, psychodynamic psychotherapy places a large emphasis on the psychic layer not accessible to the consciousness, especially on the unresolved conflicts. Conflicts are upsetting contents such as aggressive impulses and anti-social desires “stored” in the unconscious. However, even though they are not accessible to our conscious perception, they influence our feelings and behaviour.

A key requirement for psychoanalytic-based therapy is a willingness to engage deeply with past, such as early childhood experiences, current relationships and current defence mechanisms.

Reducing the intensity of the conflict, creating the underlying tension, leads to symptom reduction. Making unbearable feelings conscious and employing the Ego (the conscious part of the psyche) in understanding cause and effect brings about healing.

Efficacy of Psychodynamic Treatment for Depression

Psychodynamic psychotherapy has not been studied as extensively as behavioural therapy in the treatment for depression. Even though psychodynamic psychotherapy, including the eldest technique called “psychoanalysis”, has a long-standing history, the empirical research on its effectiveness is less large. Despite the higher number of studies referring to behavioural methods, those done for psychodynamic psychotherapy prove its efficacy. The main reason for the lower volume of research related to psychodynamic methods is explicable by the therapy setting. The psychodynamic psychotherapy done by an analyst in his private practice is less accessible for empiric evaluation.

Depression Treatment with Interpersonal Psychotherapy

Interpersonal Psychotherapy involves meeting with a group of other people who have been through the same or a similar traumatic event. It can be easier to talk about what happened if you are with other people who have been through a similar experience. An open trial of interpersonal psychotherapy reported high rates of remission from symptoms.

Treatment with Systemic Therapy

Systemic therapy places great importance on social relationships, such as those within the family, circle of friends, or workplace, as they can contribute to the development of depression. During therapy, efforts are made to improve communication within a family, for example. This is intended to help alleviate depressive symptoms.

Treatment for Depression with EMDR

Francine Shapiro developed and studied EMDR (Eye Movement Desensitisation and Reprocessing), which is a form of psychotherapy. This is a technique that uses eye movements to help the brain access and integrate the traumatic events “pushed” by sudden trauma (for example, by war trauma or accidents) in the unconscious in their raw, unprocessed shape. Psychologists use the eye movement to facilitate emotional processing of memories to attend to more adaptive information.

Suicide Risk in Depression

The most severe consequence of depression is suicide. Between 10% to 15% of patients with recurrent severe depressive episodes die by suicide. Those at the highest risk include individuals in challenging psychosocial circumstances, such as divorced or solitary individuals, those who abuse alcohol or drugs, older adults, and those with a history of suicide attempts. Suicides often occur at the beginning or end of an episode when mood is low but motivation remains high, providing ample energy for dangerous actions.

Recognizing and addressing the profound impact and potential consequences of depression is crucial for effective intervention, treatment and support for those affected by this debilitating condition.

Treatment for Depression of Suicidal Patients

Suicidal thoughts can appear in severe episodes of depression. Such patients should be immediately hospitalized and treated under close supervision by a psychiatrist and nurses.

Suicidal ideations can appear at every age but the most vulnerable group are older adults facing isolation, physical ailments and partner loss. Successful treatment is key to suicide prevention.

Therapy Recommendations for Depression

Following the international therapy recommendations for depression therapy set by the World Federation of Societies of Biological Psychiatry (WFSBP) summarizing evidence-based therapeutic strategies, a thorough diagnostic assessment by a specialized medical professional is crucial.

These therapy recommendations systematically assess evidence for treating major depression. They offer meaningful clinical recommendations. Physicians treating these conditions should use them. Data come from treatment recommendations, meta-analyses, and Cochrane Library searches.  

This assessment is based on four fundamental elements in the overall treatment of depressive episodes, taking into account clinical factors like symptom severity, disease progression, and patient preferences (watchful waiting, medication, psychotherapeutic treatments, combination therapy).

Maintaining medication adherence is crucial for the success of maintenance therapy for depression. Therefore, establishing a strong therapeutic alliance and providing education to both patients and their families are fundamental aspects of psychiatric care. These educational efforts should cover various topics, including the typical course of the illness, treatment options, medication effects and potential side effects, the use of daily self-report instruments to monitor mood and early signs of relapse, long-term expectations, and the eventual conclusion of treatment.

When a person is struggling with depression, it can be challenging for their family to know how to provide the right support. Well-intentioned advice may not always be helpful, and it’s crucial to approach the situation with sensitivity and understanding.

Watchful Waiting

For mild depression, the “watchful waiting” approach is suitable. Treatment begins only if the condition worsens. Patients are supervised by their doctor, typically a general practitioner. The doctor assesses symptom changes during regular check-ups. If no improvement or deterioration occurs after two weeks, treatment should commence. Supportive conversations, general counselling, education about the condition, guided self-help, such as through self-help books or online programs, and problem-solving approaches can be offered initially before considering medication or psychotherapy.

IMPORTANT: Watchful waiting is only suitable for patients with mild depression. Prompt treatment initiation is necessary for moderate or severe depression!

In summary, mild depression can resolve without intervention, but consulting a healthcare professional is wise. Various treatments, including psychotherapy and medication, are available for more severe cases. Watchful waiting is an option for mild depression, but prompt treatment is crucial for moderate or severe depression. Each individual’s journey to recovery is unique, and seeking help is the first step towards healing.

When to Treat Depression with Psychotherapy?

In the recommendation “Unipolar Depression,” the general recommendation of psychotherapy stands out, depending on the severity, either as monotherapy or combination therapy. Psychotherapy plays a highly valued role in the acute treatment of unipolar depression. A closer examination of criteria and circumstances for practical application is essential.

Numerous Cochrane reviews confirm the effectiveness of psychotherapy. Following psychotherapeutic approaches are validated in depression treatment:

• Cognitive Behavioral Therapy (CBT)
• Interpersonal Psychotherapy (IPT)
• Cognitive Behavioral Analysis System of Psychotherapy (CBASP)
• Psychodynamic short-term psychotherapies

When to Combine Medication with Psychotherapy?

Combination therapy involves using both antidepressants and psychotherapy simultaneously. This approach is employed when a single treatment alone isn’t effective or when severe depression hinders participation in psychotherapy until medication has improved symptoms.

The combination treatment is most effective for severe episodes and for severe, long-lasting depression. This approach harnesses the advantages of both methods – fast medication effects and improved understanding of symptoms and life management.

For individuals with moderately severe depression (2 main symptoms and 3-4 additional symptoms), either psychotherapy or antidepressant treatment is suitable.

In cases of severe depression (3 main symptoms and at least 4 additional symptoms) or prolonged illness, a combination of psychotherapy and antidepressants is usually prudent. If symptoms persist or worsen, or if suicidal thoughts arise, hospitalization may be necessary. In inpatient settings, combination treatment should be initiated from the beginning.

Recommendations for Long-Term Treatment for Depression

Unipolar Major Depressive Disorder (MDD) often follows a recurrent and persistent course, posing significant challenges. Maintenance or prophylactic treatment aims to achieve three primary objectives: prevent depressive episode recurrence, reduce the risk of suicide, and mitigate the development of chronicity.

To implement effective maintenance-phase treatment, clinicians must consider each patient’s unique illness trajectory and treatment history. A key recommendation is the continuation of successful treatment for 6 to 9 months following the remission of an acute depressive episode.

While no definitive timeline exists for prophylactic therapy beyond this initial period, it becomes essential in high-risk situations. For individuals who have experienced three or more major depression episodes or have a history of frequent recurrence (e.g., two episodes within 5 years), longer-term maintenance therapy is warranted.

Several adverse prognostic indicators can predict recurrence, including residual symptoms at remission, prior longer episodes, chronicity, severe past episodes, early-onset depression, concurrent dysthymic disorder (referred to as “double depression”), relapse after medication withdrawal, recent episodes, comorbid substance abuse or anxiety disorders, and a family history of MDD in first-degree relatives.

Types of Depression

The types and symptoms of depressive disorders vary. Psychiatrists use the diagnostic procedures’ guidelines to help identify a particular type of depressive disorder. The guidelines specify criteria such as anxious distress, mixed features, melancholic features, atypical features, psychotic features, catatonia, peripartum onset, and seasonal patterns.

The description “Clinical Depression” is not a proper psychiatric diagnosis. The term is used for depression with more severe symptoms which require treatment.

Endogenous versus Reactive Depression

The category “endogenous” or “reactive” depression has been used in the ICD 9 diagnostic manual. Depression can have internal (endogenous) or external (reactive) causes.

Endogenous depression refers to a type of depression that has no apparent external cause such as stress, trauma, or grief. This suggests that genetic or biological factors are the main root cause for this type of depression. Unexpectedly, people who are successful, live active lives, have intact families, and have no obvious reasons for being sad become depressed. This type responds well to the treatment with medication.

External circumstances can cause the onset of depression, called “reactive depression.” The triggering factors might be social isolation, hostile environments, personal losses, or personal misgivings. The symptoms caused by the reactive depression usually disappear after solving the external problems.

Determining the cause of depression is always difficult. Depression can develop at any age, with or without major external events. Therefore, in ICD 10, the diagnosis is based on descriptive characteristics (mild, moderat, sever episodes), taking in consideration the multi multifactoriafactorial cause of depression.

Major Depressive Disorder (MDD)

One of the most commonly diagnosed forms of depression is Major Depressive Disorder (MDD). MDD differs from other types of depression in several ways. This condition can occur at any age but most commonly begins in late adolescence to the mid-20s. Women are more likely than men to experience depressive symptoms.

The main symptoms in Major Depressive Disorder, is a deep, persistent low mood, followed by fatique and sleep deprivation. To be diagnosed with MDD, symptoms must persist for at least two weeks. ,

Major Depressive Disorder has episodic course and can continue for months, sometimes for years. It can be further categorized based on the symptom’s severity in mild, moderate, or severe episodes. A form with frequent episodes is called Recurrent Depressive Disorder.

Untreated MDD can have dire consequences, affecting people’s overall quality of life. The depressive symptoms can persist for months or even years. In the worst cases, MDD can lead to suicide.

Read more about diagnosis and treatment for Major Depressive Disorder

Atypical Depression

Atypical depression is a sub-type of Major Depressive Disorder with atypical features. The main characteristic is the emotional reactivity with moods reacting strongly to environmental circumstances. The individuals suffering of atypical depression feel extremely sensitive. They experience profound fatigue, crave for food and face interpersonal difficulties. The patients feel leaden heaviness in arms or legs.

Unlike classic melancholic depression, atypical depression lacks features like insomnia, weight loss, and loss of reactivity of mood. The positive events don’t have any mood enhancing effect. Increased appetite can be observed through a noticeable increase in food intake or weight gain. Hypersomnia may manifest as either an extended period of nighttime sleep or daytime napping.

Catatonic Depression

Catatonic depression, is a combination of catatonia and depression. The condition is categorized under the DSM-5 as Major Depressive Disorder with Catatonic Features. Catatonia is relatively common in psychiatric conditions, but its occurrence in major depressive disorder is rare. The exact cause of catatonia is not yet fully understood. It is often associated with various psychiatric or neurological disorders. It is predominantly associated with bipolar depression in Bipolar disorder.

Catatonia is characterized by a clinical picture including stupor, psychomotor agitation, postural stereotypes, negativism, catalepsy, varying flexibility, and other symptoms like command automatism and speech stereotypes.

Read more about catatonic depression

Dysthymia or Persistent Depressive Disorder (PDD)

The old term “Dysthymia” called in the new nomenclature “Persistent Depressive Disorder” (PDD), is a form of long-lasting depression. It has similar symptoms as the clinical depression (Major Depressive Disorder (MDD), but their last longer. Additionally, the depressive symptoms in dysthymia are far less severe than in a depressive episode.

Despite the less pronounced symptoms, dysthymia is associated with a high level of distress, primarily because the symptoms persist nearly continuously over an extended period with little variation in intensity. Women are diagnosed more often than men. The condition usually appears in adolescence or early adulthood, although people of all ages can be affected.

The causes of dysthymia, similar as in Major Depressive Disorder, are multifactorial. The best researched are the influence of genetic factors, dependence due to an overprotective upbringing and subsequent self-devaluation, and psychosocial influences such as social isolation.

The lifetime prevalence of dysthymia is approximately 4–6%, and it typically manifests in early adulthood. In 50% of cases, dysthymia begins before the age of 25. Women are more frequently affected and also tend to develop the condition earlier than men. Clinical evaluation should always include diagnostic testing. Tools such as the Beck Depression Inventory (BDI) and the Hamilton Depression Scale (HAMD-Score) can provide insights into the severity of the depressive mood.

In dysthymia, the depressive symptoms persist more or less constantly over years but with a lower intensity.

Read more about diagnosis and treatment for dysthymia

Peripartum Depression (Former Postpartum Depression)

Pregnancy and the period after delivery is a particularly vulnerable time for women. During this time mothers are exposed to major biological, emotional, and social changes causing high risk for developing depression or anxiety.

The change from DSM-4 “postpartum depression” to DSM-5’s “peripartum depression” reflects evidence that around half of depressive episodes related to pregnancy actually occur prior to delivery.

The term “perinatal” refers to the period before and after the birth of a child. Perinatal depression includes depression that begins during pregnancy, called prenatal depression, and depression that begins after the delivery, called postpartum depression.

Mothers affected with peripartum depression experience symptoms such as sadness, emotional numbness and anxiety. Their sleep is disturbed, and the energy level is reduced, limiting their abilities to carry for themselves and the child.

Peripartum depression carries risks not only for the mothers but also for their children. Children of mothers who suffered from depression during pregnancy or after delivery are at much higher risk of developing mental conditions. Also, the mature offspring of mothers with peripartum depression are at much higher risk of developing depressive disorders or anxiety in their later stages of life. 

Read more about diagnosis and treatment for post-partum depression

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder (PMDD) is the most severe phorm of Premenstrual Syndrome (PMS). PMDD significantly affects daily life, including work, social interactions, and relationships. In extreme cases, it can lead to suicidal feelings. While premenstrual symptoms have been recognized for centuries, diagnostic criteria have only recently been clearly defined. The terminology for premenstrual disorders has evolved over time. In the 18th century, it was referred to as “menses moodiness,” changing to “premenstrual tension” in the early 19th century, and finally to “premenstrual syndrome” (PMS) in the 1950s. Although some level of discomfort before menstruation is common, PMS refers specifically to cases where symptoms are severe enough to disrupt daily activities and overall functioning.

Currently, PMDD is recognized as a distinct condition under the “Depressive Disorders” category in the DSM-5. Premenstrual Dysphoric Disorder symptoms encompass a range of mood, behavioral, and physical changes that follow a cyclical pattern. These symptoms typically emerge during the luteal phase of the menstrual cycle, typically one to two weeks before menstruation, and subside once the menstrual period begins.

Read more about Premenstrual Dysphoric Disorder (PMDD)

Agitated or Anxious Depression

This type of depression involves worry, restlessness and anger. It can be easily mistaken for anxiety disorder. People with agitated depression usually do not feel depressed in the sense of feeling fatigued. They experience psychomotor restlessness. The affected individual might move around, feel angry, talk constantly, having shaky hands and racing thoughts. While being externally hyperactive, on the inside they feel confused and helpless.

Seasonal Depression

The symptoms of seasonal depression are different from MDD that occurs year-round. They are less severe. This type occurs only in the dark part of the year, typically in winter. This form has similar diagnostic criteria to MDD, with two differences: in typical depression, there is a loss of appetite, and the sufferer loses weight. In winter depression, the opposite happens: there is increased appetite and weight gain.

The other difference is in sleep: both forms can cause sleep disturbances, but in typical depression, the sleep is deprived (problems to fall and to maintain sleep), whereas in winter depression, people tend to sleep too much. Nonetheless, most depressions in winter are not winter depressions. The seasonal depression is very rare with prevalence in the general population of about one to two percent.

Masked Depression

A Masked (hidden) depression isn’t used as a diagnosis anymore, but some psychiatrist still use the term to describe reduced wellbeing with mostly physical symptoms without obvious depressive symptoms. The symptoms can only be identified on closer inspection. The focus is on physical symptoms of psychogenic (emotional) origin. Psychogenic pain appears real to those affected. Pain can occur in any part of the body. Patients may experience this as back pain, skin tingling, migraines, persistent headaches, chest pain, abdominal pain, etc.

Depression in Neurological Disorders

Depression is a complex mental health condition that can manifest in various forms and often co-occurs with other neurological conditions. The treatment often requires a multidisciplinary approach involving psychiatrists, neurologists, psychotherapists, and social workers. A combination of psychotherapy, pharmacotherapy, and medical interventions must be tailored to the specific needs of the patient.

Depression in Alzheimer’s Disease

Depression is a common comorbidity in patients with Alzheimer’s Dementia (AD), with prevalence rates reaching up to 50%. Moreover, research suggests that depression may act as a risk factor for the development of cognitive impairments or dementia later in life.

One potential link between depression and dementia lies in the observation that depression can contribute to hippocampal atrophy. Conversely, depression ranks as the third most common psychiatric symptom in Alzheimer’s Dementia, following apathy and psychotic symptoms. High rates of depression comorbidity also corelates with fronto-temporal dementias and Lewy Body dementia.

The neuropsychological assessment for distinguishing depression from dementia is challenging during the acute phase of depression. Making accurate differential diagnosis is possible first after severe depression subsides. These diagnostic tests are comprehensive, evaluating verbal episodic and non-episodic memory, executive functions, attention, language, visual processing, and processing speed.

Depression in Parkinson’s Disease

In functional imaging studies, depressed patients with Parkinson’s Disease exhibit significantly reduced metabolic activity in limbic areas and the basal ganglia. Similar to Alzheimer’s Disease, prior depressive episodes may elevate the risk of developing Parkinson’s dementia.

It is crucial to exercise caution when selecting antidepressant treatments for these patients, as they often respond with blood pressure and motor side effects.

Huntington’s Chorea and Depression

Depression is also highly prevalent in Huntington’s Chorea, with reported rates of up to 75%.

Depression in Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is frequently comorbid with depression., with a prevalence ranging from 25% to 50% of MS patients suffer of depression. Multiple sclerosis patients often display poor therapy adherence and a high propensity for suicidal ideation. However, also the immunomodulatory medications used in MS treatment also has a depression-triggering effect.

Amyotrophic Lateral Sclerosis (ALS) and Depression

Depression’s occurrence is also frequent in in Amyotrophic Lateral Sclerosis (ALS). The diagnosis of depression in ALS is difficult because of the overlapping symptoms like anorexia, insomnia, or fatigue, occurring independently of depression. Whether the prevalent depression in supranuclear gaze palsy or corticobasal syndrome represents prodromal syndromes remains uncertain.

Vascular Depression (Subcortical Ischemic Depression)

The concept of vascular depression emerged in the late 1990s, defining it as a cerebrovascular condition that predisposes, causes, or sustains depression in older individuals. The late-life depression and cerebrovascular changes are intertwined. The genesis of cerebrovascular depression depends on the extent and distribution of vascular damage of affected networks.

The pathologies in fronto-striatal and fronto-limbic connections also contribute to depression. Clinical presentation primarily includes executive function problems, psychomotor retardation/inhibition, and apathy. Cognitive deficits take centre stage, and affected individuals are often unaware of their illness and exhibit suspicion.

Besides executive dysfunction, these patients may struggle with visual naming difficulties and reduced verbal fluency. There is an increased risk of treatment resistance, incomplete remission, and dementia development.

Imaging changes are detectable as hyperintensities in the subcortical white matter, reflecting the organic basis of vascular depression. The severity of depression often correlates with the extent, location, and volume of these defects, with temporal and frontal lesions most strongly associated with depression.

Depression in Substance Use Disorders

There is a high comorbidity between depression and substance use disorders, especially among older individuals.

Alcohol Use and Depression

Notably, alcohol dependence is significantly higher among older depressed patients compared to non-depressed counterparts. This comorbidity is associated with a high risk of suicide, with around 60% increase compared to depressed individuals without alcohol issues.

Opiat/Opioids Use and Depression

Depression is also common among those with opiat/opioid dependence, often accompanied by anxiety and personality changes. This comorbidity is particularly evident in patients with chronic pain syndromes. Moreover, the number of individuals aged 65 and older who consume opioids doubled in Western countries due to the COVID pandemic and socio-economical changes.

Misuse of Stimulants and Depression

In younger patients, high comorbidity between depression and anxiety correlates with dependence from stimulants such as cocaine, amphetamine and methamphetamine.

Tobacco Dependence and Depression

In the case of nicotine dependence, withdrawal is associated with an increased risk of depression, whereas sustained smoking cessation is linked to a significant reduction in depressive symptoms.

Depression Caused by Cardiovascular Diseases

A close relationship exists between late-life depression and cardiovascular diseases. This connection appears to be reciprocal: cardiovascular events increase the risk of depression, and depression, in turn, acts as a risk factor for cardiovascular diseases. The risk of ischemic heart disease is increased by 1.5 to 2 times in older individuals with depression. Conversely, approximately 20% of patients experience depression following a myocardial infarction, which, in turn, raises mortality rates in these individuals by 3.5 times in the first six months after the event.

Depressive symptoms lead to a worse disease course, frequent hospitalisations, and reduced benefits from cardiovascular surgeries. Various pathophysiological mechanisms are discussed regarding this comorbidity, including an imbalance between sympathetic hyperactivity and parasympathetic underactivity, reduced heart rate variability, changes in the beta-adrenergic system, and overactivity of the hypothalamic-pituitary-adrenal axis.

Causes of Depression

Causes of depression are complex and not entirely identified. They involve multiple sources, including highly heterogeneous genetic and biological factors as well as psychosocial and environmental influences. Thus, no single cause can explain the onset of depression. There is a scientific consensus that depression originates from an interaction of biological, genetic, psychological, and social factors.

The role of genetic and environmental factors varies from person to person. Most models explaining depression are based on genetic predisposition, neurobiological imbalances, and certain developmental and personality factors (psychosocial factors).

People affected by depression generally have a lower tolerance for emotional, physical, and life stressors than healthy individuals. This particular vulnerability also plays a significant role in triggering and sustaining depression.

Neurobiological Causes

The immense progress in the neurosciences, which started in the mid-20th century, showed that depressed people have in their brain an imbalance of the neurotransmitters. The neurotransmitters allow the nerve cells to communicate with each other. The neurotransmitters can be influenced by variety of factors, such as genetics, social circumstances, or physical illnesses. Treatment with anti-depressants helps to restore the balance of neurotransmitters and as its effect to remove the symptoms of depression.

Genetic Influences

A large body of evidence from family and twin studies points to genetic contributions for causing depression. The twin studies compare disease frequencies in identical twins. Only half of the identical twins gets ill if the sibling developed depression. It means that other factors than genetics contribute to the onset of depression in the second half. The family history puts their offspring at an increased risk of depression. As a result, a child with one depressed parent is 10-15% more likely to develop depression than the average. If both parents suffer of depression, the risk for their children increases to 20-40%. Such results prove the multi-factorial genesis of depression.

The exploration of numerous genes and their influence on depression didn’t show one particular gene causing the illness. This means that an interaction of several genes is necessary to trigger the onset of depression. So even the genetic component of depression requires synchronized action of various genes.

Psychosocial Causes of Depression

Many studies have confirmed that among the psychosocial factors, stressful severe life events, such as breakups, loss of a loved one, or job loss, are likely to contribute to the onset of depression.

Wang et al. (2016) highlight that socioeconomic status, and the severity of depression are negatively related. The scientists claim that a fourfold increased risk of depression is the attribute of sexually or physically abused women in childhood compared with women without such experiences.

Certain physical illnesses (e.g., thyroid disorders), medications (e.g., birth control pills, antibiotics), or substance abuse can trigger depression.

In addition, the attachment theory of Bowlby (1977) claims that disrupted affectional bonds between children and caregivers have been the key contributors to psychopathology, including depression and anxiety.

Similarly, the developmental pathway from early conduct problems to adult depression explains another possible cause of depression.

Environmental Effects

Converging evidence indicates that environmental exposures can contribute to the onset of depression. Air pollution, use of herbicides, food preservatives and other chemicals in every area of urban life can affect the activity of certain brain cells (i.e. serotonergic and dopaminergic neurons.)

Cultural Background and Depression

The cultural factors may influence symptoms of depression. For instance, in some cultural contexts, mental distress is primarily expressed through physical symptoms. This can sometimes make it challenging for doctors and psychologists to identify depression. Therefore, while diagnosing depression it’s essential to consider culture-specific factors and its nuances.

Frequency, Ethnic and Gender Differences

• This condition occurs in people of all cultures, all social classes, and nationalities
• Race or an ethnic origin has no influence on the development of depression.
• Currently, there are mathematically 340 million cases of depression existing worldwide.
• While approximately 25% of adult women develop depression only about 10 % of all men affected.
• 20% of all Germans develop depression once in their life. Worldwide figures vary between 8-20%.
• The average age of manifestation of a depressive disorder lies between the ages of 20 – 40.

Internal and external factors causing depression

Depression is caused by internal and external factors. The internal factors are the genetic predisposition and changes of the concentration of the neuromodulators in certain brain areas. The external factors are environmental factors and changing live circumstances.

The internal factors respond well to the treatment with medication. However, the external factors can be mastered only by your action. The first step before acting is the understanding the nature of your problems. In the second step you will create the “course of action plan”, helping you to resolve the problems. The difficulties at work or in the partnership can’t be solved in days or weeks. You will need months or even years to find the way out of the crisis.

Preventing Depression

Depressed individuals who do not seek therapy quickly find themselves caught in a vicious cycle. Depression strain family relationships and friendships, affecting also work performance. These illness-related social impairments are substantial and appear to persist in many patients even after the depressive episode have subsided. Consequently, individuals with depression tend to drink alcohol or take drugs as a coping mechanism. The way to recovery is not linear.

There are several ways to reduce the risk of a relapse.

Treatment setting in therapy for depression

Depression isn’t a disorder that patients can treat on their own. Depression must be diagnosed and treated by psychiatrists. The effect of uncontrolled stopping of medication can result in a depressive relapse. Therefore, any changes to the medication should be discussed with the psychiatrist. Apart of the relapse risk, a sudden discontinuation of medication can trigger unpleasant physical symptoms (drossiness, nausea) and mood swings. Such symptoms can be avoided if the adjustment, reduction, or discontinuation of the medication happens gradually under psychiatric supervision.

The patients should be careful while judging the therapeutic progress without overestimating the temporary improvement. It’s not uncommon to experience setbacks even after a full recovery.

Combined use of medication and psychotherapy

The treatment of depression is not a “quick fix.” The process of healing takes time. The most sucessful treatment modality for depression is the combination of medication with psychotherapy. In patients treated only “biologically”, i.e. with medication, the symptoms can appear again despite of using the same dosage of an antidepressant. The psychotherapy as a stand-alone method can be used only for treatment of mild depressive episodes.

Family support in preventing depression

The knowledge of the nature of depression is substantial for patient’s family and friends. People often think that patients suffering from depression were able to overcome the symptoms using their willpower. Such negative “encouragement” can lead to aggravation of the depressive symptoms. The lack of awareness about the nature of depression by laypeople around can amplify feelings of guilt, worsening a person’s psychological status.

Recomendations for patients how to avoid a relapse:

• Don’t expect a “quick fix” of the depression. Be patient with yourself and your recovery process. The process of healing takes time.
• Be careful while judging your progress. Don’t overestimate a temporary improvement. It’s not uncommon to experience setbacks during the recovery process.
• Pay attention to warning signs working with your psychiatrist and psychotherapist to learn what might trigger your depressive symptoms.
• Set realistic goals. Set achievable goals and fragment the process into smaller tasks. Accomplishing your goals will boost your self-esteem and motivation helping to overcome feelings of isolation and hopelessness.
• Be open and honest with your psychiatrist about how do you feel. Report any adverse affects caused by the medication; itcan be replaced by such without side effects.
• Enhance your social network spending time with your loved ones and friends. Talk to them about your problems. Remember that it’s not a sign of weakness to ask for help.
• Participate in the support groups. This helps you to understand the nature of your illness. You will not feel alienate meeting people who share the same problems.
• Take care of your physical fitness. Exercising will help you to lift your mood and reduce symptoms of depression.
• Get enough sleep. The duration of a refreshing sleep should be at least 7 hours.
• Avoiding alcohol and recreational drugs. Alcohol and drugs can be used by depressive people giving them a short-term release. However, in the long run they lead to addiction worsening the symptoms and making depression harder to treat.

Helping People with Depression

Depression is a life-threatening illness with destructive potential. It can turn a once lively partner or friend into someone who is lethargic, burdened by guilt, inner emptiness, and hopelessness.

One of the core symptoms of depression is the social withdrawal. The person affected may cut relationships and friendships due to the lost ability to interact socially.

Helping a family member or friend through their battle with depression requires patience, empathy, and an understanding of the complex emotions they face. Transitioning from despair to hope and recovery is a journey that is manageable with unwavering support.

It’s crucial to remember that a person with depression may sometimes respond with rejection or withdrawal. This behaviour is a manifestation of the illness they are battling. Understanding this and respecting their ability to accept or decline external suggestions without taking offence can be immensely helpful.

Above all, family and friends should not try to downplay the severity of the illness or offer well-meaning advice. These actions may inadvertently convey a lack of acceptance. It’s extremely helpful to reassuring them that depression is an illness similar to physical disorders and that it can be cured.

Be Informed about Depression

Gather information about depression and let the affected person understand the importance of treatment. You can also refer them to online depression forums, such as Depression and Bipolar Support Alliance (DBSA) or support groups. Talking to people who have dealt with depression provides easy access to the “first hand” information and shared experiences. Sometimes, it’s more convincing when someone who has experienced or recovered from depression reports that treatment was helpful.

You can also find information on family support groups through the regional associations and family self-help groups. Sometimes, just sharing your experiences with other family members can provide relief. Family members and friends of individuals with depression can find an online program with various exercises and videos. It demonstrates how to support the affected person and handle crises without overwhelming yourself.

Exercise Patience with Depressed People

Many people suffering from depression express complaints and despair, withdrawing from their surroundings. Be patient with them. Remind them that depression is a treatable illness and will pass. Do not try to convince them that their feelings of guilt are baseless. Avoid arguing about whether their negative perspective is “objectively” justified or not. Both approaches will not yield success.

It’s not easy to understand the subjective feeling of a person suffering of depression. Do not dismiss the affected person’s physical discomfort and health anxieties as exaggerated or “merely psychological.” because depressed individuals do not dramatize their experiences. It is depression that amplifies even mild pain or discomfort to unbearable levels.

Avoid Well-Intentioned Advices to People with Depression

It is futile to advise a depressed person to “take a break” or go on a trip for a few days. Being in an unfamiliar environment can deepen patient’s depression even further.  Do not tell the affected person to “pull themselves together” because someone with depression cannot fulfil this demand. Such advice may even intensify feelings of guilt. The same applies to attempts to cheer them up. Instead, support your family member whenever they show initiative.

Understand Your Limits

If your family member is depressed for months, his illness will certainly affect you and the entire family. Therefore, it is crucial to recognize your own limits without feeling guilty. Patients suffering of clinical depression require professional treatment provided by psychiatrist or psychotherapist.

Being a helper, do not lose sight of your own mental help. Keep your interests and maintain your social connections. Be prepared that your family member will need your help for months, if not years.

Facilitating Professional Help for People with Depression

Depressed individuals often attribute their condition to themselves and do not consider seeking medical help. Due to the lack of motivation and hopelessness, people with depression believe that they cannot be helped. They also lack the energy to muster the strength for a doctor’s visit.

Always bear in mind that individuals with depression perceive reality through a “depressive lens,” which distorts their perspective. This may lead to decisions they may reconsider once they have recovered. Consider this, whenever possible, in all matters related to the person’s personal or professional future. In such situation, motivate the patient to seek medical advice as soon as possible.

Take the initiative and schedule an appointment by a psychiatrist or psychologist for your family member or friend suffering of depression. Even if he might initially reject offers of help, let him know you are there for him. Therefore, do not give up after the first attempt. Reiterate your concern and offer your assistance periodically.

Sometimes, it takes time to convince the person of depression to look for medical advice as the feel to be “beyond repair”.  You don’t necessarily have to disclose your suspicion of depression. Saying, “You don’t seem well. I’m concerned. Let’s get you checked by a doctor; I’ll accompany you if needed,” can make that first step easier.

Critical Concern: Suicidal Thoughts

Individuals with depression not only endure immense suffering but also lose all hope due to the illness. They doubt that help is possible and that their condition will ever improve. Perceiving their situation as hopeless, the suicide might appear to them as only a relief from the suffering. Suicidal thoughts and impulses are a very common symptom of depression. They turn depression into a life-threatening condition. If your family member or friend would experience suicidal thoughts, take action and seek medical help immediately.

Take Seriously Suicidal Thoughts

Suicidal threats and announcements

The misconception that a person who talks about suicide won’t act on it is false. Profound hopelessness and statements such as, “It all makes no sense anymore…,” “Eventually, it has to end…,” “Something has to happen now…” are indications of severe danger in individuals with depression.

Settling affairs and saying goodbye

Many people want to organize their affairs before suicide. They may give away valuable items, write their wills, or bid farewell to friends and family. Someone determined to commit suicide often appears calmer, more composed, and less desperate. Onlookers may mistakenly believe that the person is finally improving.

What Can I Do for Suicidal Person?

The most crucial aspect of acute suicidality is not to let alone the sufferer in the seemingly hopeless situation.

Initiate Conversation

If you suspect that a friend or family member is at risk of suicide, calmly and objectively address the issue with him. In most cases, talking about the distressing thoughts is a relief for the suicidal individual.

Care for the Person

The key is to buy time, as the desire to die is almost always a temporary state, and even in challenging life situations, the will to live usually returns. Show that you are there for them. Take responsibility for the individual during the acute situation. Accompany the person to the doctor or clinic. At night, this may be the psychiatric emergency department or the medical on-call service.

Seek Medical Emergency

Do not attempt to act as a therapist. Instead, support the individual in seeking professional help. You can seek assistance from a general practitioner or psychiatrist or visit a hospital if the patient is cooperative.

However, take immediate action when a person is immediately threatened by suicide but is unresponsive and unwilling to seek help.  Call for emergency medical assistance to ensure his safety. Provide the paramedics with a detailed account of the situation, and do not leave the affected person alone until the paramedics arrive.

Psychotherapy for Depression

Psychotherapeutic methods used today for treatment of depression are:

1. Behavioral Therapy – Focuses on learning and unlearning behaviors, particularly helpful for depression where positive actions are encouraged, often using cognitive techniques and relaxation.
2. Cognitive Therapy – Targets negative thought patterns, teaching patients to reframe their thinking, enhancing self-control and realistic perceptions of their issues.
3. Interpersonal Therapy (IPT) – Addresses social conflicts and life transitions, focusing on areas like grief, role changes, and social skills to support patients’ relationships.
4. Psychodynamic Therapy – Explores unconscious conflicts from past experiences to resolve depression symptoms, especially useful in short-term formats for mild to moderate cases.
5. Person-Centered Therapy – Based on self-image and self-acceptance, encouraging patients to recognize and articulate their own feelings and needs.
6. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a synthesis of interpersonal, cognitive, behavioral and psychodynamic therapies and the only psychotherapy method specifically developed for treating chronic depression.

Group therapies are also effective, particularly for depression tied to chronic illness, offering peer support and shared experience.

Key Points in Treatment for Depression

1. The first step prior to treatment is the correct diagnosis distinguishing MDD from other mental disorders.
2. Recognizing correctly depression is the “bottle neck” in the diagnostic and treatment process. Thus, only half of the depressive disorders are diagnosed properly.
3. From those accurately diagnosed only half are treated. This means that only every fourth person suffering from depression receives treatment.
4. Among the sufferers 10% -15% commit suicide.
5. Men are three times more likely to commit suicide than women.
6. A professional team consisting of a psychiatrist and psychologist can cure depression.

FAQ about Depression

In the below FAQs section we provide the answers to the most common concerns of our patients about depression.

What are the common symptoms of depression in Dubai?

Depression symptoms in Dubai are similar to global patterns and include persistent sadness, fatigue, loss of interest in activities, sleep disturbances, difficulty concentrating, and physical issues like headaches or digestive problems. Recognizing these signs early is crucial for seeking timely help.

Where can I seek treatment for depression in Dubai?

Dubai offers a range of options for depression treatment, including private clinics and government hospitals specialized in mental health care. For severe cases of depression you can seek help Al Amal Psychiatric Hospital or rashid Hospital in Dubai. Mild and moderate depression can be treated in private clinics such as CHMC.

Is depression treatment in Dubai covered by insurance?

Most insurance plans in Dubai now cover mental health services, including depression treatment. Check with your provider to confirm the extent of coverage for psychiatric consultations, therapy sessions, and medications.

What types of depression treatments are available in Dubai?

Treatments for depression in Dubai include:

• Psychotherapy (e.g., Cognitive Behavioral Therapy, psychodynamic therapy).
• Medication (e.g., antidepressants such as SSRIs or SNRIs).
• Holistic Approaches (e.g., mindfulness, yoga, or lifestyle adjustments).
• Hospitalization for severe cases requiring intensive care.

I am feeling really depressed. Can you tell me if I should see the psychologist or the psychiatrist?

If you are having trouble functioning in daily life, eg. working, parenting, grooming, etc., or you have lost your ability to sleep, seek psychiatric care.  For milder or more moderate feelings of depression psychotherapy from a psychologist will help you.  If you are uncertain, our psychologists are qualified to assess your level of depression and will make a referral for a psychiatric assessment if needed.

How can I help someone with depression in Dubai?

Encourage them to seek professional help and provide emotional support. You can also connect them with local resources such as mental health clinics, or hospitals for crisis support, or reputable psychiatrists or psychologists specializing in depression treatment in Dubai.

I feel fatigued, anxious, and demotivated and not enjoy things as I used to. Do you think the counselling can help me get rid of the symptoms?

You obviously suffer of depression. You can visit one of our psychologists. After an interview and short test, the severity of the symptoms can be assessed. If the symptoms are not severe and don’t last long, counseling would be the method of choice. In some cases, the medication can be indicated at the beginning to increase the energy, motivation, and mood. Combined with counseling, the medication can be gradually removed.

What types of depression treatments are available in Dubai?

Treatments for depression in Dubai include:

• Psychotherapy (e.g., Cognitive Behavioral Therapy, psychodynamic therapy).
• Medication (e.g., antidepressants such as SSRIs or SNRIs).
• Holistic Approaches (e.g., mindfulness, yoga, or lifestyle adjustments).
• Hospitalization for severe cases requiring intensive care.

Is depression curable or just treatable with medication?

Depression is a curable condition. However, untreated, it can develop into chronic, lifelong suffering. Therefore, it is critical for individuals with depression to engage in therapy as soon as possible. The state-of-the-art treatment for depression combines medication and psychotherapy. Medication can suppress the symptoms within a few weeks creating a sound foundation for the psychotherapy. However, medication alone will lose eventually its efficacy. On the other hand, psychotherapy used without medication wouldn’t be able to “unwind” severe depressive symptoms.

Are drugs the best treatment for depression?

Medications helps to quickly restore person’s functioning but it’s not healing depression per se. The purpose of treatment with antidepressants is to alleviate symptoms of severe depression, such as feeling down and not being capable to deal with social and professional obligations. They help to restore the sleep, lift the mood, and suppress the anxiety. In most of the cases depression is the effect of psychological malfunction due to accumulation of conflicts the individual is not aware of or feels incapable to solve. However, using only medication will not solve such problems by default. The individual needs time and guidance to find a suitable solution. Once such solution is found and implemented in individual’s life, the medication would be obsolete.

Is there a stigma around seeking help for depression in Dubai?

While awareness of mental health has improved in Dubai, some stigma remains. However, mental health professionals in Dubai prioritize patient confidentiality, and more people are becoming open to seeking help due to increased education and acceptance.

Are depression and anxiety related?

Yes, depression and anxiety are often related. While they are distinct mental health disorders, they frequently coexist and share common symptoms, such as excessive worry, irritability, and difficulty concentrating. Additionally, experiencing one disorder can increase the risk of developing the other, and they often respond to similar treatment approaches.

What is the treatment for depression?

The treatment for depression typically includes a combination of therapy, medication, and lifestyle changes. Therapy, such as cognitive-behavioral therapy (CBT), helps individuals identify and change negative thought patterns and behaviors. Medications, such as antidepressants, can help rebalance brain chemicals. Lifestyle changes, like exercise, adequate sleep, and stress management, also play a crucial role in managing depression.

Are depression rates in Dubai increasing?

Depression rates in Dubai as well as globally have been increasing over recent years. Factors such as societal pressures, economic stressors, and lifestyle changes contribute to this rise. Additionally, increased awareness and recognition of mental health issues may also play a role in the reported increase in depression rates.

Can depression be genetic?

Yes, depression can have a genetic component. Research suggests that individuals with a family history of depression are at a higher risk of developing the disorder themselves. Genetic factors can influence a person’s susceptibility to depression, but environmental and psychological factors also play significant roles in its development.

Will depression go away on its own?

The duration of depression varies widely among individuals, making it challenging to determine an average timeframe. However, it’s unlikely for depression to resolve without treatment. Addressing chronic depression typically involves a multifaceted approach, including medication, therapy, self-care practices, and adopting healthy lifestyle habits such as maintaining a balanced diet and regular exercise.

Self-Assessment for Depression (Beck Inventory)

Beck Depression Inventory is psychometric evaluation of the depressive symptoms in adults with social anxiety disorder. (BDI) is used to assess levels of depressive symptoms in socially anxious adults.

BDI is a self-assessment for depression helping to identify the severity of an individual’s depressive symptoms. Beck Depression Inventory was developed in 1961 by psychologist Aaron Beck. Since then, BDI has been widely used in clinical and research settings to diagnose and measure the severity of depression. The questionnaire contains 21 questions that assess various symptoms of depression, including mood, cognitive symptoms, and physical symptoms. Total scores range from 0 to 63, with higher scores indicating more severe depression.

This Beck’s Depression Assessment helps to identify a clinical depression. However, the test doesn’t replace a thorough psychiatric and psychological evaluation, necessary to secure the diagnosis.

Beck’s Self-Assessment Test for depression

This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.

1. Question

I do not feel sad 1 I feel sad; 2 I am sad all the time and I can’t snap out of it; 3 I am so sad and unhappy that I can’t stand it

2. Question

0 I am not particularly discouraged about the future 1 I feel discouraged about the future; 2 I feel I have nothing to look forward to; 3 I feel the future is hopeless and that things cannot improve

3. Question

0 I do not feel like a failure 1 I feel I have failed more than the average person. 2 As I look back on my life, all I can see is a lot of failures 3 I feel I am a complete failure as a person

4. Question

I get as much satisfaction out of things as I used to. I don’t enjoy things the way I used to. 2: I don’t get real satisfaction out of anything anymore. I am dissatisfied or bored with everything

5. Question

I don’t feel particularly guilty 1 I feel guilty a good part of the time; 2 I feel quite guilty most of the time; 3 I feel guilty all of the time

6. Question

0 I don’t feel I am being punished 1: I feel I may be punished; 2: I expect to be punished; 3: I feel I am being punished

7. Question

0 I don’t feel disappointed in myself 1 I am disappointed in myself 2 I am disgusted with myself 3 I hate myself

8. Question

0 I don’t feel I am any worse than anybody else 1 I am critical of myself for my weaknesses or mistakes; 2 I blame myself all the time for my faults; 3 I blame myself for everything bad that happens

9. Question

I don’t have any thoughts of killing myself. 1 I have thoughts of killing myself, but I would not carry them out. 2 I would like to kill myself. 3 I would kill myself if I had the chance

10. Question

I don’t cry any more than usual. I cry more now than I used to. 2: I cry all the time now. 3: I used to be able to cry, but now I can’t cry even though I want to

11. Question

0 I am no more irritated by things than I ever was 1 I am slightly more irritated now than usual 2 I am quite annoyed or irritated a good deal of the time 3 I feel irritated all the time

12. Question

I have not lost interest in other people I am less interested in other people than I used to be. 2: I have lost most of my interest in other people I have lost all of my interest in other people

13. Question

0 I make decisions about as well as I ever could 1 I put off making decisions more than I used to 2 I have greater difficulty in making decisions more than I used to 3 I can’t make decisions at all anymore

14. Question

0 I don’t feel that I look any worse than I used to. I am worried that I am looking old or unattractive 2: I feel there are permanent changes in my appearance that make me look unattractive I believe that I look ugly

15. Question

0 I can work about as well as before 1: It takes an extra effort to get started at doing something. 2. I have to push myself very hard to do anything. I can’t do any work at all

16. Question

0 I can sleep as well as usual 1 I don’t sleep as well as I used to 2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep 3 I wake up several hours earlier than I used to and cannot get back to sleep

17. Question

0 I don’t get more tired than usual 1 I get tired more easily than I used to 2 I get tired from doing almost anything 3 I am too tired to do anything

18. Question

0 My appetite is no worse than usual 1. My appetite is not as good as it used to be. 2 My appetite is much worse now. I have no appetite at all anymore

19. Question

0 I haven’t lost much weight, if any, lately. I have lost more than five pounds I have lost more than ten pounds I have lost more than fifteen pounds

20. Question

I am no more worried about my health than usual 1: I am worried about physical problems like aches, pains, upset stomach, or constipation. 2: I am very worried about physical problems, and it’s hard to think of much else I am so worried about my physical problems that I cannot think of anything else

21. Question

I have not noticed any recent change in my interest in sex. I am less interested in sex than I used to be. 2 I have almost no interest in sex. I have lost interest in sex completely.

Interpreting the Beck Depression Inventory

Now that you have completed the Self-Assessment questionnaire, add up the score for each of the twenty-one questions by counting the number to the right of each question you marked. The highest possible total for the whole test would be sixty-three. This would mean you circled number three on all twenty-one questions. Since the lowest possible score for each question is zero, the lowest possible score for the test would be zero. This would mean you circle zero on each question.

You can evaluate your depression according to the table below:

Total Score__________ Levels of Depression

1-10________________ These ups and downs are considered normal

11-16_______________ Mild mood disturbance

17-20_______________ Borderline clinical depression

21-30_______________ Moderate depression

31-40_______________Severe depression

over 40_____________Extreme depression

Famous people diagnosed with depression:

• Abraham Lincoln
• Georgia O’Keeffe
• Theodore Roosevelt
• Robert Schumann
• Emily Dickinson
• Ludwig van Beethoven
• Edgar Allan Poe
• Marie Curie
• Mark Twain
• Vincent van Gogh
• Virginia Woolf

Looking for experts treating depression in Dubai? Contact CHMC:

Call CHMC