What is depression? Signs, symptoms and treatment options

It can be natural for our mood to fluctuate and even for us to feel down sometimes, but how can we tell if what we are experiencing is depression or not?

Depression (also known as major depressive disorder or clinical depression) is a common, yet serious mood disorder. Individuals who suffer from depression can experience significant impacts on their physical, emotional, and psychological well being. Symptoms of depression can cause significant distress or impairment in social, occupational, or other important areas of functioning. This can include affecting how you think and tackle daily activities like eating, sleeping, and working, as well as impacting your daily mood.

Symptoms of Depression

Below are some of the common symptoms of depression that can vary in frequency and intensity from mild to severe:

• Persistent sad, despairing mood
• Feelings of hopelessness, or pessimism
• Anger, irritability, or agitation
• Feelings of guilt, worthlessness, or helplessness
• Difficulty concentrating, making decisions, or completing daily tasks
• Loss of interest or pleasure in activities that were previously enjoyable
• Decreased energy or fatigue
• Difficulty sleeping (too much or too little)
• Appetite and/or weight changes
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Engaging in high-risk activities
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

The severity, frequency and duration of symptoms can vary depending on the individual and their particular illness, as well as the stage of the illness.

In order for an individual to be diagnosed with depression, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) indicates that the individual must be experiencing the at least 5 of the following symptoms during the same 2-week period.

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Many individuals do experience the symptoms of depression without receiving a diagnosis, or do not meet all of the criteria listed above for a diagnosis to be made. It is important to note that regardless of if a diagnosis is made, symptoms of depression should be taken seriously and treatment can still help to prevent symptoms from being exacerbated further.

Causes and Risk Factors

Depression and the appearance of symptoms can materialize at any age, but commonly appear in adulthood. Depression does not discriminate on age, gender, culture, or even socio-economic status, as even those who appear to live in relatively ideal circumstances can experience its effects.

While it might not always be easy to pinpoint exactly when symptoms begin to appear or how they came to be, there are some possible causes and risk factors of depression to consider which are outlined below:

• Genetics– some individuals may be at a higher risk for developing depression if they have a family history of depression or another mood disorder.
• Significant Events, Trauma, or Stress – Some events affect the way your body reacts to fear and stressful situations (i.e. fight or flight responses). In many cases early childhood trauma, especially if not processed effectively can contribute to the onset of depression symptoms later in life.
• Biochemistry and brain structure – specific chemicals in the brain or lack of activity in one’s frontal lobe of their brain may be contributors to an individual’s vulnerability in developing symptoms of depression.
• Medical conditions– some medical conditions may put individuals at higher risk for developing symptoms of depression, such as chronic pain or illness, insomnia, or attention-deficit hyperactivity disorder (ADHD).
• Personality– Individuals with low self-esteem or who are easily overwhelmed by stress, may be more susceptible to experience symptoms of depression.
• Substance Use – Individuals with a history of drug or alcohol misuse may have a higher risk of developing symptoms of depression.
• Environmental factors– for individuals who experience or witness ongoing exposure to violence, neglect, abuse or poverty that may be at a higher risk for developing symptoms of depression.

Treatment  

Even in the most severe cases, depression can be treated. If you or someone you know is experiencing symptoms of depression, the best course of action can be to seek help immediately to prevent things from worsening. Depression is usually treated with medications, psychotherapy, or a combination of the two.

Before treatment begins, it is always a good idea to talk to your family doctor for a thorough diagnostic evaluation, including an interview and a physical examination that may include blood testing.  The benefits of additional screening and performing a blood test can be done to ensure the symptoms experienced are not due to a medical condition like a thyroid problem or a vitamin deficiency. This information can help a qualified practitioner make an accurate diagnosis to ensure the appropriate course of action for treatment can be provided.

Medications

Antidepressants are commonly prescribed medications used to help modify one’s brain chemistry and treat symptoms of depression. These types of medication serve the purpose of trying to help improve the way your brain uses certain chemicals that control mood or stress. It is important to note that there is not a one-size-fits-all approach and you may need to work with your family doctor or Psychiatrist to find the right medication to improve your symptoms. Additionally, it is always important to consult with your doctor or pharmacist about any possible side effects the prescribed medication offers.

Antidepressants may provide some positive improvement within the first week or two of use, yet the full impacts or benefits may not be experienced for weeks or even months. Therefore, if you are not noticing any changes in symptoms after several weeks, then it would be beneficial to talk with your doctor or psychiatrist about altering the dosage or prescribing a different medication. It is also recommended that an individual does not stop taking their prescribed medication without the approval of their doctor or psychiatrist. Stopping abruptly can cause withdrawal symptoms, so it is very important to work collaboratively with your doctor or psychiatrist to slowly and safely decrease your dose.

Psychotherapy

Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression, whereas it may be more commonly used in combination with antidepressant medications for moderate to severe depression.

There are a number of evidence-based therapeutic frameworks that have been demonstrated to help improve symptoms of depression, such as cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and solution-focused therapy.  Cognitive behavioural therapy (CBT) is one of the most well-know and widely utilized approaches in treating depression. It has been know to help individuals recognize distorted or maladaptive thinking and its impact on behaviours, with the goal of changing thoughts and behaviours to respond to challenges in a more positive manner. The aim of psychotherapy as a form of treatment can be to help raise awareness to the source or cause of symptoms, as well as developing an understanding of certain triggers and learning more effective ways to cope and manage symptoms if they arise.

It can be difficult to place a timeline on length of treatment as individuals may experience depression differently, but in many situations significant improvement can be made in 10 to 15 sessions. Additionally, in some cases alternate forms of therapy such as electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore if an individual is not experiencing any change in symptoms.

Things You Can Do

There are a number of things people can do themselves to help reduce or manage their symptoms of depression.

• Be active and exercise more regularly
• Prioritize sleep and develop healthy sleep hygiene habits
• Focus on eating well and fuelling your body with nutrients
• Reduce or avoid alcohol consumption
• Try not to isolate yourself – spend time with individuals you feel comfortable and safe with
• Set realistic goals for yourself and expect gradual changes
• Postpone important decisions or discuss your potential decisions with other individuals who you trust and may have a more objective view of your situation
• Continue to educate yourself about depression

Depression is an actual illness, but there are treatment options available. With proper diagnosis and treatment, the vast majority of people with depression can better manage, cope, and even overcome it. If you or someone you love is experiencing symptoms of depression, then I recommend contacting your family doctor to discuss your concerns. Additionally, if you are looking for a safe place and someone to talk to, then I invite you to reach out today and book a free 15-minute consultation.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition.

National Institute of Mental Health. (2013). Depression. https://www.nimh.nih.gov/health/topics/depression/index.shtml