Treatment for Depression in Dubai

Treatment for Depression in Dubai. Introduction

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.

Depression can affect anyone, with the risk varying based on triggers. When depression strikes, the reasons are often elusive. Depression symptoms can seemingly appear out of nowhere, leaving many feelings guilty and perplexed, thinking, “Everything is fine, so why do I feel so awful?” Accepting the illness can be challenging initially, 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.

Depression can take a severe toll on one’s life, leading to feelings of persistent sadness, exhaustion, and disinterest in activities and social withdrawal. Untreated depression has devastating impact on people 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.

Therefore, understanding the symptoms, levels of severity, and available treatment for depression in Dubai is essential for effective management and recovery. With proper care and knowledge, therapy of depression can remove the symptoms, leading to a full recovery.

Symptoms of Depression

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 at CHMC in Dubai

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

Diagnostic Criteria of Depression

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 be 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 illnesses.

Depression requires proper diagnosis which can be secured by a psychiatric assessment. Diagnosis of severe depression requiring treatment with medication typically involves few steps: a conversation with the psychiatrist, physical examination of the patient, Laboratory test, ECG and is some case 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 answers “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 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).

Objectives in Treatment for Depression

Depression is a treatable condition. The treatment objectives are:

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

Treatment Options for Depression at CHMC in Dubai

The treatment of depression needs time and requires close cooperation with the psychiatrist and psychologist. The goal of the preliminary visit is to identify the problems and decide which treatment method would be the most suitable.

The therapy of depression consists of two main methods, such as psychotherapy and use of antidepressants, and can be supported by complementary treatment methods.

In case the symptoms are mild, treatment with psychotherapy would be the first choice. However, if the symptoms are more severe, the combination of medication and psychotherapy will be necessary.

Other treatment options are reserved for severe or chronic course of the illness. This could be ECT (electroconvulsive therapy), TMS (Transcranial Magnetic Stimulation) or light therapy.

Older and today rarely used treatments methods are hormonal therapy with L-Thyroxine and using controlled sleep deprivation.

Patient-Therapist Relationship

The warranty of a successful psychiatric and psychotherapeutic treatment is a trustworthy relationship with the psychiatrist and/or psychologist.

The patient should be transparent with the psychiatrist reporting honestly about his worries, work, and private circumstances, as well as possible side effects of the medication. Based on the feedback the psychiatrist can adjust the medication.

One of the common reasons for failing the therapy is changing or discontinuing the medication by the patient himself. Firstly, the risk of uncontrolled stopping the medication can be the reappearance of the depression. Secondly, by sudden discontinuation of the medication will trigger unpleasant symptoms such as mood swings, dizziness, or nausea. Needless to say, that any changes of medication should be discussed and monitored by the psychiatrist.

Treatment for Depression with Psychotherapy at CHMC Dubai

In patients treated only “biologically”, i.e. with medication, the symptoms can appear again despite of 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 behavioral therapy.

Cognitive-Behavioral Therapy in Treatment for Depression

Cognitive behavioral therapy combines two therapeutic approaches:

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 Behavioral 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).

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 empiric research on its effectiveness is less large. Despite the higher number of studies referring to behavioral 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.

EMDR in Treatment of Depression

Francine Shapiro developed and studied EMDR (Eye Movement Desensitization and Reprocessing) which is a form of psychotherapy. This is a technique which 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 row unprocessed shape. Psychologists use the eye movement to facilitate emotional processing of memories to attend to more adaptive information.

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.

Treatment for Depression with Antidepressants at CHMC Dubai

From a neurobiological point of view, depression is caused by an imbalance of certain brain neuromodulators. Antidepressants aim to improve the imbalance, lifting the symptoms of depression.

Modern pharmacological research has developed several antidepressants with different courses of action. The two biggest and most frequently used groups of antidepressants are SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).

Psychiatrists should involve their patients in a dialogue to create an understanding of the effects and potential side effects of the prescribed medications.

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.

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.

Course of Treatment with 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.

Psychiatric Monitoring of the Treatment with Medication

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 tranquilizers, antidepressants need weeks to develop the 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.

Treatment for Depression According to Symptoms’ Severity

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.

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.

Adjusting Treatment to the Phase of Depression

Depression often occurs in phases, called depressive episodes. They can be solitary or recurrent. Prolonged episodes, exceeding two years, are classified as chronic. Approximately two out of ten patients experience chronic depression.

In some cases, recovery occurs within weeks or months, while half of patients experience recurring episodes, known as recurrent depression. The interval between episodes can be years or mere weeks.

Acute phase

Quick symptom relief, enabling normal life; usually 6-12 weeks.

Maintenance therapy

When symptoms ease, treatment continues in maintenance therapy. It stabilizes the condition and reduces relapse risk. Medication lasts about four to nine months; psychotherapy, eight to twelve months.

Relapse Prevention of Depression

Untreated depression rarely resolves on its own. However, depression is well treatable condition but requires professional help. An early visit by a psychiatrist and/or psychologist followed by therapy shortens the treatment, reduces the risk of relapses and disrupts the vicious circle of 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 during the recovery process. Discontinuing the medication on one’s own as soon as one feels better often leads to relapses.

Other important factors improving recovery and preventing depression is the involvement of family and friends in the treatment.

International Treatment 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).

A comprehensive approach, considering severity and tailored therapies, is vital in addressing depression. Psychotherapy, when applied appropriately, plays a crucial role in the treatment landscape of depression, offering hope for improved mental health outcomes in the years to come.

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.

Therapy for 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

Recommendations for Combined Treatment for Depression

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.

Key components of long-term MDD treatment encompass psycho

Self-Support in Treatment for Depression

Below are the cornerstones in treatment and prevention from depression:

• The crucial step is consulting a psychiatrist or psychologist to recognize depression.
• In the initial treatment phase, it helps to be assisted by family or friends.
• Practicing patience. Treatment of depression takes time.
• Setting small goals like limited physical activities.
• Socializing, meeting friends and family.
• Accepting their help as the family and friends are the first line of support.
• Connecting with self-help groups.

How Frequent Is Depression?

An estimated 16 to 20 out of 100 people will experience depression at least once in their lifetime. Results from a nationwide health survey show that at any given time, approximately 5% of adults between the ages of 18 and 65 are affected.

The number of people with depressive disorders is rapidly increasing worldwide. According to a study by the World Health Organization (WHO), in 2015 depression affected approximately 322 million people, representing 4.4% of the world population. The WHO sees a particular need for action in young people, women before and after childbirth, and older people.

The causes of the rapid increase of people with depression are still unclear. The most plausible reason is the growing work pressure combined with social and financial instability. Currently depressive disorders became the leading cause of disability.

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.

Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD) is the most prevalent form of depressive disorders. A hallmark of a depressive episode is the persistence of depressive symptoms for at least two weeks. The core features of the depressive syndrome include a low, sad, or depressive mood and a loss of joy and interest in almost all activities that typically bring pleasure.

Simultaneously, in Major Depressive Disorder, a critical number of other, individually variable symptoms emerge, such as appetite and/or weight loss, sleep disturbances, loss of energy, difficulty concentrating, diminished self-esteem, suicidal thoughts, or actions.

The diagnosis of MDD can be secured by using the diagnostic criteria of ICD 10 or DSM 5 which require the existence of at least 5 of the above mentioned symptoms persisting continuously for a minimum of 2 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.

MDD with delusions or delusional thinking is described as Major Depressive Disorder with Psychotic Features.

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 extreme sadness, emotional numbness and anxiety. Their sleep is disturbed, the energy level 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. Researchers found that the children of mothers who suffered of depression during pregnancy or after delivery are at much higher risk of developing mental conditions. Also, the mature offspring of mothers with peripartum depression is at much higher risk to develop depressive disorders or anxiety in their later stages of life.   

Peripartum depression is a serious, but treatable medical condition. The treatment requires the use of medication or psychotherapy, or ideally the combination of both.

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

Catatonia is characterized by severe motor disturbances, such as rigidity and withdrawal. During catatonic episodes, individuals exhibit immobility and mutism, along with stupor.

Catatonia is relatively common in psychiatric conditions, but its occurrence in major depressive disorder is rare. It is predominantly associated with bipolar depression. Bipolar disorder is the most frequently observed psychiatric condition associated with symptoms of catatonia, followed by schizophrenia.

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.

Unlike other atypical features, pathological sensitivity to perceived interpersonal rejection is a trait that emerges early and persists throughout most of adult life. Rejection sensitivity occurs both during and outside of depressive periods, though it may worsen during depressive episodes.

Dysthymia

Dysthymia is the old term describing conditions with chronic depressive mood lasting for several years. The symptoms of dysthymia are not severe or persistent enough to meet the criteria for major, moderate, or mild recurrent depressive disorder. In DSM 5 the old diagnosis chronic depressive disorder and dysthymic disorder have ben unified under one diagnosis called “Persistent Depressive Disorder” (PDD).

Individuals with dysthymia feel low, unmotivated, and inadequate on most days. They tend to doubt themselves and feel inferior. They rarely feel happy experiencing non-specific physical symptoms such as fatigue, sleep disturbances, loss of appetite, or headaches. Even minor tasks are exhausting. Despite the difficulties, individuals with dysthymia can generally manage their daily lives.

In contrast, Major Depressive Disorder is characterized by more severe symptoms and often occurs in phases (episodes). A depressive episode can be a one-time occurrence or recur at intervals. In dysthymia, the symptoms persist more or less constantly but with lower intensity.

Despite the lower symptoms’ intensity, 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 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.

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.

Organic Depression

This type of depression is the result of a physical illness. Some physical illnesses, such as hypothyroidism, diabetes or certain neurological disorders can cause depression. Evaluation by an experienced psychiatrist and thorough examination are critical for diagnostic differentiation and effective treatment.

Severity Levels 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:

Mild

Two main and two secondary symptoms for over two weeks.

Moderate

Two main and three to four secondary symptoms for over two weeks.

Severe

Three main and four or more secondary symptoms for over two weeks.

The therapy of depression should be adjusted to the level of severity. While mild depression can be treated only with psychotherapy, the higher grades require the use of medication.

Treatment for Depression According to Symptoms’ Severity

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

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.

Causes of Depression

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.

The origins of depression are in the center of psychiatric and psychological research. 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.

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.)

Medication-Gene Interaction

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.

Endogenous versus Reactive Depression

The category “endogenous” or “reactive” depression has been used in the ICD 9 diagnostic manual. In ICD 10, the diagnosis is based on descriptive characteristics, taking in consideration the multi factorial cause of depression. Depression can have internal (endogenous) or external (reactive) causes. The endogenous influence relates mostly to the above described genetic and neurobiological factors. The reactive aspect of depression is influenced by a variety of external circumstances.

Reactive Depression

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.

Endogenous Depression

Determining the cause of depression is always difficult. Depression can develop at any age, with or without major external events. 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 supported by psychotherapy.

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.

History of depression

Melancholy, now called depression, has accompanied humans since the beginning of history. Its symptoms found their resonance in art, literature, and philosophy, which tried to interpret, explain and to cope with the mental despair.

In the following chapters, we shed light on how the understanding of the condition evolved over the past millennia.

Ancient Egypt

The ancient Egyptian document, known as the Ebers papyrus, from circa 1550 BC, contains the first description of depression. Some notes in this papyrus describe a status of disordered concentration and emotional distress of the mind. Such symptoms are typical for depression.

Ancient Greece

The foundation for the modern medicine has been created in ancient Greece. In the 4th and 5th centuries B.C.E., the Greek philosopher and the father of modern medicine, Hippocrates separated medicine from religion crating, what we call today an “evidence based” science.

The term “melancholia”, the older description of today’s depression, derives from the Ancient Greek words “melas” (black) and “kholé” (bile). Hippocrates argued that mental illnesses have biological origins. His viewpoint contradicted the popular custom of attributing mental health disorders to supernatural or magical sources. He described “melancholia” as a manifestation of a brain dysfunction.

Humoral hypothesis

According to the humoral hypothesis, humans needed a balance of four “humors” (blood, black bile, and yellow bile) and three elements such as fire, water, and earth. Melancholy was understood as an excess of black bile, while mania was believed to be caused by overproduction of yellow bile.

In ancient and later in medieval times, the treatment aimed to restore the balance of humours, using dietary measures, baths, and activities such as movement, music, and stimulating conversations. The ancient physicians also used bloodletting, purgatives, cautery, or medication. These methods were still in used until the end of the early XIX century.

In that time melancholy was considered not only as a disease, but also as a specific human constitution. Its occurrence was related to the logic of the parallelism between microcosm (individual) and macrocosm (nature) with the afternoon, autumn, or higher age to which a melancholic character was assigned.

Plato, the “psychological” hypothesis

The Greek philosopher Plato (427-347 BC) believed that the cause of madness was in the mind. He saw mental illness as the result of a person’s ignorance about his psyche leading to self-deception. Even today the division of psyche and body reflects such past concept, marking the barrier between psychiatry and psychology.

Plato was convinced, of the connection between melancholy and genius: “Why do all exceptional men in philosophy or politics or poetry or the arts prove to be melancholic?” (Phaedrus, c. 360 BC).

Middle Ages

In the Middle Ages retained the humoral pathology approach of the ancient world. However, the humoral theory representing four temperaments, as well as the corresponding diseases, were given a religious meaning. In the philosophy of the Middle Ages earthly life was necessarily connected with illness and suffering, while the true healing could only lie in the resurrection, in the afterlife.

The beginning of modern era

In the modern age, the ancient-medieval views continued, but with the secular orientation towards nature and the individual. This mindset emphasized the glorification of youth, beauty, and health, and the suppression of death. Such perception is exemplified in the painting “The Fountain of Youth” (1546) by Lucas Cranach (1515-1586).

In the modern era, melancholy was increasingly interpreted empirically. The Oxford theologian Robert Burton (1577-1640) derived this mental state from biological, psychological, and socio-cultural conditions. In his “Anatomy of Melancholy” (1621) he wrote:

“Those who have an unfavourable position of the Moon, Saturn, or Mercury in their horoscope; those who live in overly cold or hot climates; those who come from melancholic parents or who have suffered from illness for a long time; people who live a naturally solitary life, wholly given over to contemplative and withdrawn from active life – they are all most susceptible to melancholy. Both genders are affected by it, but when women fall ill, they are far worse and more violently tormented.” 

Reflecting on such statement we must admit, that apart of the astrological admixture, the description of factors causing depression corresponds to the modern view about depression.

Enlightenment

During the Age of Enlightenment, new experiences, theoretical interpretations, and social initiatives emerged. They led physicians to attribute melancholy to the nervous system. The materialistic perspective made them believe that melancholy could be treated with mechanical methods. They used in the treatment of mental illnesses showers, rotational machines, cold and warm stimuli, and chemical means like arsenic, mercury, bloodletting, and enemas. Enlightenment was also the age where the first psychological techniques such as manipulating emotions were introduced.

Enlightenment was also the era with humanistic attempts in medicine and psychiatry. In the field of psychiatry, the patients were liberated from chains through institutional reforms. In France, psychiatrists Philippe Pinel and Jean Etienne Dominique Esquirol, and in Germany, physician Johann Christian Reil were associated with these reforms. 

Metaphysics of suffering

Georg Wilhelm Friedrich Hegel (1770-1831), who dealt with the disturbances and illnesses of the soul in his philosophical system, emphasized the anthropological dimension of melancholy and saw it as a fundamental developmental stage of humans.

The Danish philosopher Søren Kierkegaard (1813-1855) gives melancholy an existential meaning, which shaped psychopathology into the 20th century. He wrote:

“As immediate spirit, human beings are connected to all earthly life, and now the spirit wants to collect itself out of this dispersion and explain itself within itself; personality wants to become aware of itself in its eternal validity. If this does not happen, if the movement is interrupted or pushed back, then melancholy sets in.”

Depression. The evolution of diagnosis

Despite the symptoms of depression are known to humans since millennia, the scientific research on depression started first at the end of the 19th century.

Emil Kraepelin’s, classification

Emil Kraepelin, (15.02.1856 – 07.10.1926) was a German psychiatrist, and founder of modern scientific psychiatry. He was the first who systemized the mood disorders creating for these conditions a term called “manic depression”. This term today would cover a range of mood disorders, such as depression and bipolar disorder.

Sigmund Freud, mourning and melancholia

Sigmund Freud, (06.05.1856 – 23.09.1939) was Austrian neurologist and the founder of the psychodynamic approach in psychology. he developed the first effective psychotherapeutic method for treatment of mental illnesses.

In his essay, “Mourning and Melancholia” (1917) he linked the state of melancholia to mourning. Both conditions are often triggered by the same circumstances. Freud discusses what conditions need to be present for the two states to progress along their varying paths. He theorized that the depressed individual has identified with the object of affection through an unconscious, narcissistic process. He wrote: “Mourning is regularly the reaction to the loss of a loved person or to the loss of some abstraction which had taken the place of one, such as one`s country, liberty, an ideal, and so on.”

Mourning

Mourning is not considered a psychiatric disorder. Morning is a normal reaction accompanied by depressive symptoms to traumatizing events. Over time reality wins out and slowly the person returns to normal state of emotions.

Melancholia

In melancholia the depressive symptoms persist over longer period. Quoting Freud: “In mourning it is the world which has become poor and empty; in melancholia it is the ego (patients’ personality) itself.”

Freud assumed that the melancholic individuals may know that they have lost something. However, the person is not aware of the underlying psychological mechanism. In melancholia essence of the loss is inaccessible to consciousness. So, in mourning the libido (life energy) slowly withdraws from the lost object and replaces it with other one. In contrary in melancholia, the libido withdraws into the Ego and identifies with the lost object.

Karl Abraham, libidinal hatred

Karl Abraham, (03.05.1877 – 25.12.1925) was a German psychoanalyst, and a collaborator of Freud. He also analyzed the relationship between mourning and melancholia. For him, the structure of melancholia was closer to that of obsessive neurosis rooted in the intense hostility toward the outside world. In both illnesses, hostility reduces the ability to love.

Abraham assumed that in melancholia, the hostile drives are projected and suppressed. Based on the Freudian theory he proposed a psychopathological model of depression. Abraham’s idea was, that libidinal hatred projected onto the outside world, reverts back onto the subject. The subject (patient) suppressing the aggressive impulses, develops depressive symptoms. The process of suppression consumes the “libidinal energy” and in consequence the patient develops depressive symptoms.

Depression, contemporary diagnostic

Today’s psychiatric diagnostic is based on the so called phenomenological (descriptive) psychopathology. It examines and describes the basic structures of subjective experience and their modifications in mental illnesses using empirical methodology.

The ICD-10 (International Statistical Classification of Diseases) is a medical coding system developed by the WHO (World Health Organization) which includes criteria for mental and behavioral disorders. ICD 10 is similar to the American statistic manual DSM (Diagnostic and Statistical Manual of Mental Disorders).

Today depression is categorized based on symptoms severity in mild, moderate, and severe episodes. The additional criteria are the presence of additional psychotic symptoms. Such condition is called depression with psychotic features. The second important criteria is the symptoms distribution in time: single episodes or, in case of long-lasting symptoms: recurring depression.

Preventing Depression

Depression isn’t a disorder that you can treat on your own. It’s a serious condition triggered by multiple factors. The condition must be diagnosed and treated by a professional.

There is no warranty how to prevent the onset of depression or how to avoid a depressive relapse. However, there are several ways how you can reduce the risk of the next depressive episode.

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.

Relationship with your therapist

The prerequisite of a successful psychiatric treatment including the therapy for depression is a trustworthy relationship with your psychiatrist and/or psychologist. You have to be transparent with your healthcare provider reporting honestly about your worries, work and private circumstances, as well as possible side effects of the medication.

Based on your feedback the psychiatrist can adjust your medication. The psychotherapist may change the therapy goals or even refer you to other psychologist who’s training could be a better match for your particular problems. 

Follow your treatment plan

First of all, you must follow your treatment plan. Don’t skip your regular visit by the psychiatrist and your psychologist.

Even if you’re feeling well, don’t discontinue or change the medication on your own. Any changes of the medication should be discussed with your psychiatrist.  

Firstly, the risk of uncontrolled stopping the medication can be the reappearance of the depression. Secondly, by sudden discontinuation of the medication you will develop unpleasant symptoms such as mood swings, dizziness, or nausea. Such symptoms can be avoided if you reduce or stop the medication under the supervision of your psychiatrist.

To reach the full recovery the treatment of depression needs time and requires a close cooperation with your psychiatrist and psychologist.

Only mild depressive episodes can be treated only with psychotherapy. In the more serious cases the most effective treatment of depression consists of medication and psychotherapy. In patients treated only “biologically”, i.e. with medication, the symptoms can appear again despite of using the same dosage of an antidepressant.

Things to remember

• Depression is well treatable condition but requires professional help. Don’t hesitate to reach for support visiting your psychiatrist or psychologist and accept the support from loved ones and friends.

• Be open and honest with your healthcare provider about how you’re feelings. Report any side affects you are experiencing taking the medication. They may need to adjust your treatment plan or medication.

• Depression is not a sign of weakness. It’s a human condition which happens to everyone throughout the life spam. 

• Be patient with yourself and your recovery process. It takes time to see improvement but stick to your treatment plan.

• Even during the therapy, you might experience drawbacks and periods of sadness. The way to recovery is not linear.

Preventing depression trough learning

• The education about the depression is crucial for you to move forward and to maintain your psychological balance.

• The knowledge of the nature of depression is also important for your family and friends. People often think that patients suffering of depression were able to overcome the symptoms of depression using their will power. Such negative “encouragement” can lead to aggravation of the depressive symptoms. The lack of awareness about the nature of depression by people around you can amplify your feelings of guilt worsening your wellbeing.

• 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.

• 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 for people with depression. This helps you to understand the nature of your illness. You will not feel alienate meeting people who share the same problems.

How to avoid depressive relapse?

• Be patient. Don’t expect a “quick fix” of the depressive symptoms. 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.

• Make an “emergency plan” so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms.

• Ask relatives or friends to help watch for warning signs.

Preventing depression trough lifestyle changes

• Take care of your physical fitness. Exercising will help you to lift your mood and reduce symptoms of depression.

• Eat a healthy food. A balanced diet will help improve your physical and mental health.

• Get enough sleep. The duration of a refreshing sleep should be at least 7 hours.

Preventing depression trough selfcare

• Keep in mind that recovery from depression is possible, and that treatment and self-care can help you overcome the symptoms and improve your well-being.

• Practice self-compassion. Instead of criticizing or judging yourself be more easy going and forgiving with yourself. Don’t dwarf your self-esteem trough self-criticism. No one is perfect so the imperfection is a part of the human nature.

• Take time to slow down, to reflect on yourself and your life. Enjoy the moment.

• You can cope with stress and negative emotions using the complementary treatment such as art therapy, music therapy, meditation technics and physical activity.

Avoid 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. In such situation you will suffer of depression and additionally deal with the demon of addiction.

Treatment for Depression at CHMC in Dubai. Summary

Depressive disorders are on the rise, projected to be the most common illnesses by 2030, emphasizing their significance in prevention and treatment.

Depression is not just sadness, but a state with a wide reduction of all emotions described as a “feeling of emotional numbness.” The affected individuals suffer of low mood, lack of interest or pleasure, reduced energy level and sleeplessness. In some people, the “life energy” (libido) seems to implode. They get immobile and silent spending days in bet. Others, on the other hand, feel restless and driven, getting easily irritable.

Depression severely impacts mental and physical well-being, social connections, work, and functionality leading in extreme cases to full invalidism and often to suicide. Therefore, it’s important to understand that depression is a treatable illness and seeking help early improves the chances of full recovery. Early diagnoses and therapy of depression can restore individual’s performance, their general health condition, and their life quality.

Diagnostic Steps Prior to the Treatment

Depression requires proper diagnosis which can be secured by a psychiatric assessment prior to the treatment. The assessment consists of:

Anamnesis (Medical History Review) collecting patient’s personal and family medical history to rule out any possible genetic or environmental factors contributing to depression. In the second step the severity and duration of symptoms should be assessed.

Physical Exam evaluates patient’s general health status (depression may be linked to an underlying physical health problems).

Laboratory tests creates a “screen shot” of patient’s health condition based on examining distinct blood and ruine parameters. Later, under the medication the initial result serves as a benchmark for further controls.

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

Additional Diagnostics: in more severe psychiatric conditions like psychosis or bipolar disorder neuroimaging diagnostics (EEG, CT, MRI) can be required.

Treatment Plan

The recommendation for treatment of depression has been established based on evidence-based research including meta-analyses, and Cochrane Library data. The recommendations should be a guidline for therapy of depression used by psychiatrists.

A qualified therapy for depression can restore the overall psychological functioning with full mental and psychosocial recovery. Evidence demonstrates that combining pharmacological treatment and psychotherapy is more effective than either program alone. Therefore, depression treatment at CHMC in Dubai includes psychotherapy, medication, or a combination of both.

The effect of medication appears after a few days to a few weeks. On the contrary, the benefits of psychotherapy unfold over a longer period of time and have a much deeper impact on people’s lives. Thus, it’s crucial to start the treatment as early as possible, seeking help from an experienced psychiatrist and psychologist.

Useful sources providing reliable information

National Institute of Mental Health www.nimh.nih.gov

American Psychiatric Association www.psych.org

American Psychological Association www.apa.org

Depression and Bipolar Support Alliance (DBSA) www.DBSAlliance.org

National Alliance on Mental Illness www.nami.org

National Library of Medicine www.medlineplus.gov/healthtopics.html