What is Depression?

What is depression? Introduction

Depression counting to mood disorders is one of the most common and most underestimated illnesses with debilitating impact on people’s life. It’s not just sadness, but a state with 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, silent and can spend days in bet. Others, in opposite, feel restless and driven getting easy irritable.

In the below text we describe different forms of depressive disorders, their symptoms, and impact on individual’s life.

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 in the diagnostic procedures guidelines helping to identify a particular type of depressive disorders. 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.

Symptoms, effects and causes of PPD

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 to develop 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.   

PPD does not have a single trigger. Similar to other psychiatric disorders it’s caused by a combination of multiple factors such hormonal changes, genetic and environmental factors, the physical and emotional demands of childbearing and caring for a new baby.

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

“Baby blues”

Up to 2/3 of mothers after the delivery of their first child experience “baby blues,” a short-lasting and self-limiting condition which doesn’t impact severely their daily activities and does not require medical attention.

Symptoms of “baby blues” are emotional lability such as crying for no reason, irritability, and anxiety. These symptoms last for few days to maximum few weeks and disappear spontaneously without treatment.

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.

Conclusion

Everyone experiences phases in life when there seems to be nothing to look forward to, everything appears grey, and one feels “depressed.” The weather, work, or personal disappointments can be perceived as depressing. However, medically speaking, depression is different from a temporary feeling of sadness, lack of interest, or a mood dip that nearly everyone experiences at some point in life.

From psychiatric perspective, depression is a serious condition that profoundly affects individual’s thoughts, feelings, and actions. People suffering from depression rarely can overcome their low mood, lack of motivation, and negative thoughts on their own.

Consequences of Depression

Depressed individuals who do not seek therapy quickly find themselves caught in a vicious cycle. The symptoms of depressive disorder strain family relationships, friendships, affecting also the 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 resort to alcohol, or drugs as a coping mechanism.

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.

Read More

The effects of loneliness and social isolation

How to treat depression?

What are antidepressants and how they work

What is the integrative treatment for depression?

Misdiagnosing depression with other psychiatric illnesses

What is post-partum depression?

Important facts about depression

What is dysthymia?

How to prevent depression?

What is causing depression?

History of depression

How to find if I’m depressed?

Useful sources providing reliable informations

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