Author: Dr. Carlo

Carlo Carandang, MD, is a psychiatrist who has over 15 years experience treating patients with depression and anxiety. In addition, Dr. Carlo has done research and taught students and doctors about depression and anxiety. His other popular website, AnxietyBoss.com, has received over 5 million views to date.
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How Depression Evolves- The Negative Cycle of Depression

Negative Cycle of Depression

 

Depression is a common and serious mental health disorder that can have a negative impact on many aspects of a person’s life. It is characterized by a persistent feeling of sadness and loss of interest in activities that were previously enjoyable. Depression can also cause a range of physical symptoms, such as changes in appetite and sleep patterns, fatigue, and difficulty concentrating.

One of the key ways that depression can evolve is through a negative cycle of thoughts and behaviors. This cycle can be triggered by a stressful life event or a chronic stressor, such as a difficult relationship or financial problems. When a person experiences stress, they may start to have negative thoughts and beliefs about themselves, their situation, and the world around them. These negative thoughts can then lead to symptoms of depression, such as changes in their mood, feeling blue, apathy, and fatigue.

The depression then leads to avoidance, and this leads to negative behaviors, such as isolating themselves from others or engaging in unhealthy behaviors like excessive drinking or drug use.

As the negative cycle continues, they may feel more hopeless and helpless, and their negative thoughts may become even more pervasive. This then leads to more symptoms of depression. This can make it difficult for them to break out of the cycle and seek help.

The good news is that depression is a treatable condition. With the right help and support, a person with depression can break out of the negative cycle and start to feel better. This may involve a combination of treatments, such as therapy, medication, and lifestyle changes, depending on the individual’s needs. It’s important to remember that seeking help is a sign of strength, not weakness, and taking the first step towards treatment can be a powerful step towards recovery.

Here is a visual representation of the negative cycle of depression:

  • A stressful life event or chronic stressor occurs.
  • The person starts to have negative thoughts and beliefs about themselves, their situation, and the world around them.
  • The negative thoughts lead to symptoms of depression, such as changes in mood and apathy.
  • The depression leads to avoidance, manifested by negative behaviors, such as isolating themselves from others or engaging in unhealthy behaviors.
  • The behaviors maintain the thought that all is hopeless.
  • Hence, the negative thoughts become even more pervasive, making it difficult for the person to break out of the cycle and seek help.
  • Without treatment, the negative cycle continues.
For help with depression and mood problems, consider the natural depression supplement KalmPro Mood Support.
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What are the early signs of depression?

Photo by David Besh: https://www.pexels.com/photo/woman-wearing-blue-and-white-plaid-dress-shirt-in-front-of-green-mountain-696208/

The early signs of depression can vary from person to person, but some common ones include feelings of sadness, hopelessness, and a loss of interest in activities that used to be enjoyable. Other signs include changes in appetite and sleep patterns, difficulty concentrating, and feelings of worthlessness or guilt. It’s important to remember that these symptoms can also be caused by other factors, so it’s best to talk to a doctor if you are concerned.

Introduction to the topic of depression and its early signs

Depression is a common and serious mental health condition that can affect people of all ages and backgrounds. It is characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities that used to be enjoyable. These feelings can interfere with a person’s ability to function in daily life and can lead to a variety of physical and emotional problems.

The early signs of depression can be difficult to recognize, as they can vary from person to person and may be similar to symptoms of other conditions. However, it’s important to be aware of these signs so that you can seek help if necessary. Some common early signs of depression include:

  • Feelings of sadness, hopelessness, and worthlessness that persist for an extended period of time
  • Loss of interest in activities that used to be enjoyable, such as hobbies, sports, or social events
  • Changes in appetite and sleep patterns, such as eating more or less than usual or having difficulty falling asleep or staying asleep
  • Difficulty concentrating, remembering things, or making decisions
  • Physical symptoms, such as fatigue, body aches, or stomach problems
  • Feelings of guilt, worthlessness, or helplessness
  • Thoughts of death or suicide.

It’s important to remember that these symptoms can also be caused by other factors, such as a medical condition or a difficult life event. If you are experiencing any of these symptoms, it’s best to talk to a doctor or mental health professional to determine the cause and get the appropriate treatment.

Discussion of common early signs of depression

One of the most common early signs of depression is a persistent feeling of sadness, hopelessness, and worthlessness. These feelings can be accompanied by a general lack of motivation and a loss of interest in activities that used to be enjoyable. For example, a person with depression may stop going to their favorite classes or club meetings, or they may lose interest in hobbies or sports. They may also withdraw from social activities and stop spending time with friends or family.

In addition to these emotional symptoms, depression can also cause changes in a person’s physical and cognitive functioning. For example, a person with depression may experience changes in their appetite and sleep patterns. They may eat more or less than usual, or they may have difficulty falling asleep or staying asleep. They may also have difficulty concentrating, remembering things, or making decisions.

These changes in appetite and sleep patterns can affect a person’s physical health and well-being. For example, they may gain or lose weight, or they may have trouble functioning during the day due to fatigue or lack of sleep. They may also experience physical symptoms, such as body aches, stomach problems, or headaches.

These changes in physical and cognitive functioning can make it difficult for a person with depression to function in daily life. They may have trouble performing at work or school, and they may struggle to maintain relationships or engage in self-care activities. It’s important to recognize these symptoms and seek help if you or someone you know is experiencing them. A doctor or mental health professional can help determine the cause of the symptoms and provide appropriate treatment.

It’s important to be aware of these potential signs of depression so that you can seek help if you or someone you know is experiencing them. A doctor or mental health professional can help determine the cause of the symptoms and provide appropriate treatment. It’s also important to remember that changes in appetite and sleep patterns can be caused by other factors, such as medical conditions or lifestyle factors, so it’s best to talk to a doctor if you are concerned.

Importance of seeking medical advice if you are experiencing symptoms of depression

If you are experiencing symptoms of depression, it’s important to seek medical advice from a doctor or mental health professional. Depression is a serious and common mental health condition that can affect people of all ages and backgrounds. It can interfere with a person’s ability to function in daily life and can lead to a variety of physical and emotional problems if left untreated.

A doctor or mental health professional can help determine the cause of your symptoms and provide appropriate treatment. This may include medication, therapy, or a combination of the two. It’s important to remember that depression is a treatable condition, and with the right treatment, you can improve your symptoms and live a fulfilling life.

It’s also important to seek medical advice if you are experiencing any thoughts of death or suicide. These thoughts can be a sign of a more severe form of depression and require immediate attention. A doctor or mental health professional can help you manage these thoughts and provide support to keep you safe.

In summary, it’s important to seek medical advice if you are experiencing symptoms of depression so that you can get the help you need and improve your symptoms. A doctor or mental health professional can provide you with the support and treatment you need to manage your depression and improve your quality of life.

Conclusion summarizing the key points

In conclusion, depression is a common and serious mental health condition that can affect people of all ages and backgrounds. It is characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities that used to be enjoyable. These feelings can be accompanied by changes in appetite and sleep patterns, difficulty concentrating, and physical symptoms such as fatigue or body aches.

The early signs of depression can be difficult to recognize, as they can vary from person to person and may be similar to symptoms of other conditions. However, it’s important to be aware of these signs so that you can seek help if necessary. A doctor or mental health professional can help determine the cause of your symptoms and provide appropriate treatment.

In summary, the key points of this article are:

  • Depression is a common and serious mental health condition that can affect people of all ages and backgrounds.
  • The early signs of depression can include feelings of sadness, loss of interest in activities, changes in appetite and sleep patterns, and difficulty concentrating.
  • It’s important to seek medical advice if you are experiencing symptoms of depression so that you can get the help you need and improve your symptoms.
  • With the right treatment, you can manage your depression and improve your quality of life.

Additionally, to help with depression and mood problems, consider the natural depression supplement KalmPro Mood Support.

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KalmPro Mood Support for Depression

KalmPro Mood Support

All-new KalmPro Mood Support was developed by a psychiatrist and contains 5-HTP (5-hydroxytryptophan) from all-natural ingredients to help with depression. 5-HTP is an amino acid that the body naturally produces. In KalmPro Mood Support, we extracted the 5-HTP from Griffonia simplicifolia seeds, thereby making this supplement all-natural.

Low serotonin levels in the body can lead to depression, insomnia, and weight gain. 5-HTP can help to alleviate those problems, and helps to improve mood, improve sleep, and induce weight loss.

5-HTP is a natural antidepressant, and there are studies showing its preliminary effectiveness and safety for depression.

If you are tired of the side effects and expensive cost of prescription antidepressant medications, then consider this all-natural supplement for depression- KalmPro Mood Support.

To get the most out of KalmPro Mood Support, it is recommended you take two capsules daily with a meal. Before taking KalmPro Mood Support, it is advisable to let your doctor know that your are considering this supplement for improved mood, better sleep, and better weight control.

Take control of your moods and get KalmPro Mood Support now!

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Adjustment Disorder with Depressed Mood: A General Overview

Adjustment Disorder with Depressed Mood, also known as Situational Depression, is another subtype of depression. Adjustment Disorder with Depressed Mood is where depressive symptoms mainly consist of low mood, tearfulness, and feelings of hopelessness. These depressive symptoms occur in response to a stressor, such as losing a job, financial problems, relationship problems, and losing a loved one, just to name a few.

The depressive symptoms of sadness, tearfulness, and hopelessness present in Adjustment Disorder with Depressed Mood do not meet the criteria for a major depressive episode. However, during the course of an Adjustment Disorder, one may develop more depressive symptoms, in which case the diagnosis of major depressive disorder may be more appropriate, or if manic or mixed episodes were present, then bipolar depression may be more appropriate.

So the depressive symptoms only occur in association with a recent stressor, and the depressive symptoms that are mainly present are low mood, tearfulness, and feelings of hopelessness. Again, if five or more depressive symptoms are present, then this is not an Adjustment Disorder with Depressed Mood, and one needs to look at the other subtypes of depression. In addition, the depressive symptoms from Adjustment Disorder with Depression Mood resolves when the stressor is no longer there, and does not last longer than 6 months from when the stressor ended.

However, if the depressive symptoms continue despite the stressor being removed, then the person may have developed Major Depressive Disorder, and the treatment plan needs to be switched to accommodate the new diagnosis.

The treatment for Adjustment Disorder with Depressed Mood is focused on addressing the stressor, and how to cope with it. Stay tuned for upcoming articles to get help and treatment for Depressive Disorders, such as Adjustment Disorder with Depressed Mood.

photo credit: Aaron Stidwell Face full of tears via photopin (license)

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KalmPro Reformulated: Natural Anxiety and Depression Supplement

KalmPro, a natural anxiety and depression supplement, has been reformulated to relieve both anxiety and depression. It was important to include even more ingredients than the original KalmPro formulation, as many people with anxiety also have depression. On the other hand, many people with depression also have anxiety. So the reformulated KalmPro was designed to address both anxiety and depressive symptoms, as both go hand-in-hand. Insomnia, or difficulty sleeping, is also a common problem that goes along with anxiety and depression. So it was important for KalmPro to address insomnia as well.

This is why KalmPro was reformulated, to address the symptoms of anxiety, depression, and insomnia. The original KalmPro formulation only had 5 ingredients to help for anxiety. The new, reformulated KalmPro now has 14 ingredients to help for anxiety, depression, and insomnia. As an added bonus, there are ingredients in KalmPro which also help for improving concentration, as concentration problems also go along with anxiety and depression.

If you look at what is available on the market now, there is only one natural anxiety and depression supplement- KalmPro.

The reformulated KalmPro contains the following ingredients:

  • B Complex Vitamins– Research shows that B complex vitamins, which include B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine),  and B7 (biotin),  are effective for reducing anxiety and depressive symptoms (1).
  • Magnesium–  Magnesium is known be a treatment for anxiety and can help depression as an augmenting agent. When vitamin B6 is combined with magnesium, it is especially effective for anxiety (2).
  • Rhodiola Extract– Multiple studies show that Rhodiola can reduce anxiety symptoms in Generalized Anxiety Disorder (GAD), but recently has also been found to be effective for mild to moderate depression (3, 4).
  • Ashwagandha– Several studies show that Ashwagandha can relieve anxiety symptoms by stabilizing the body’s response to stress (5).
  • Chamomile– Research shows that Chamomile can reduce anxiety in Generalized Anxiety Disorder (GAD) by enhancing GABA  and serotonin (6).
  • GABA– GABA is an inhibitory neurotransmitter in the brain which reduces hyperactive fear circuits, and is effective for phobic anxiety (7).
  • Lemon Balm– Lemon Balm enhances GABA and reduces stress-induced corticosteroids to help with anxiety and insomnia (8, 9).
  • Skullcap–  Skullcap enhances GABA and is a GABA receptor agonist, which helps to decrease anxiety symptoms (10).
  • Bacopa– Bacopa helps to reduce anxiety symptoms and has been known to improve memory and concentration (11).
  • Passion Flower– Passionflower is a GABA reuptake inhibitor and enhances GABA, which research shows to be effective for Generalized Anxiety Disorder (GAD) and anxiety before surgery (12, 13).
  • Valerian– Valerian enhances GABA activity and is used to treat Obsessive Compulsive Disorder (OCD) (8).
  • L-Theanine– L-Theanine is an amino acid found in green tea, and is effective at reducing anxiety. It enhances GABA and serotonin in the brain (8).
  • St. John’s Wort– St. John’s Wort is an herbal supplement that is effective for depression, and its effect is similar to antidepressant medications. It modulates the neurotransmitters serotonin, dopamine, noradrenaline, GABA, and glutamate in brain areas that are affected in depression (14).
  • 5-HTP– 5-HTP is the precursor to 5-HT, also known as serotonin, which is effective for depression (15).

As you can see, the new and reformulated KalmPro has many natural ingredients that studies show to be effective for anxiety and depression, with an added benefit of helping to improve sleep and concentration. KalmPro is the best natural anxiety and depression supplement, formulated by a psychiatrist.

References

  1. Lewis JE, Tiozzo E, Melillo AB, Leonard S, Chen L, Mendez A, Woolger JM, Konefal J. The effect of methylated vitamin B complex on depressive and anxiety symptoms and quality of life in adults with depression. ISRN Psychiatry. 2013 Jan 21;2013:621453. doi: 10.1155/2013/621453. Print 2013. PubMed PMID: 23738221; PubMed Central PMCID: PMC3658370.
  2. Boyle NB, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review.Nutrients. 2017 Apr 26;9(5). pii: E429. doi: 10.3390/nu9050429. Review. PubMed PMID: 28445426; PubMed Central PMCID: PMC5452159.
  3. Bystritsky A, Kerwin L, Feusner JD. A pilot study of Rhodiola rosea (Rhodax) for generalized anxiety disorder (GAD). J Altern Complement Med. 2008 Mar;14(2):175-80. doi: 10.1089/acm.2007.7117. PubMed PMID: 18307390.
  4. Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014 Dec;20(12):901-8. doi: 10.1089/acm.2014.0177. Review. PubMed PMID: 25405876; PubMed Central PMCID: PMC4270108.
  5. Bangratz M, Ait Abdellah S, Berlin A, Blondeau C, Guilbot A, Dubourdeaux M, Lemoine P. A preliminary assessment of a combination of rhodiola and saffron in the management of mild-moderate depression. Neuropsychiatr Dis Treat. 2018 Jul 13;14:1821-1829. doi: 10.2147/NDT.S169575. eCollection 2018. PubMed PMID: 30034237; PubMed Central PMCID: PMC6049049.
  6. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009 Aug;29(4):378-82. doi: 10.1097/JCP.0b013e3181ac935c. PubMed PMID: 19593179; PubMed Central PMCID: PMC3600416.
  7. Abdou AM, Higashiguchi S, Horie K, Kim M, Hatta H, Yokogoshi H. Relaxation and immunity enhancement effects of gamma-aminobutyric acid (GABA) administration in humans. Biofactors. 2006;26(3):201-8. PubMed PMID: 16971751.
  8. “Chapter 14- Natural Supplements for Anxiety Disorders.” Anxiety Protocol. Carandang C. 2014. Healthy Mind Research Corporation.
  9. Yoo DY, Choi JH, Kim W, Yoo KY, Lee CH, Yoon YS, Won MH, Hwang IK. Effects of Melissa officinalis L. (lemon balm) extract on neurogenesis associated with serum corticosterone and GABA in the mouse dentate gyrus. Neurochem Res. 2011 Feb;36(2):250-7. doi: 10.1007/s11064-010-0312-2. Epub 2010 Nov 13. PubMed PMID: 21076869.
  10. Alramadhan E, Hanna MS, Hanna MS, Goldstein TA, Avila SM, Weeks BS. Dietary and botanical anxiolytics. Med Sci Monit. 2012 Apr;18(4):RA40-8. Review. PubMed PMID: 22460105; PubMed Central PMCID: PMC3560823.
  11. Sathyanarayanan V, Thomas T, Einöther SJ, Dobriyal R, Joshi MK, Krishnamachari S. Brahmi for the better? New findings challenging cognition and anti-anxiety effects of Brahmi (Bacopa monniera) in healthy adults. Psychopharmacology (Berl). 2013 May;227(2):299-306. doi: 10.1007/s00213-013-2978-z. Epub 2013 Jan 26. PubMed PMID: 23354535.
  12. “Passionflower.” Retrieved from https://nccih.nih.gov/health/passionflower. National Center for Complementary and Integrative Health (NCCIH). 2014.
  13. Modulation of the γ-aminobutyric acid (GABA) system by Passiflora incarnata L. Appel K, Rose T, Fiebich B, Kammler T, Hoffmann C, Weiss G. Phytother Res. 2011 Jun;25(6):838-43.
  14. Maher AR, Hempel S, Apaydin E, Shanman RM, Booth M, Miles JN, Sorbero ME. St. John’s Wort for Major Depressive Disorder: A Systematic Review. Rand Health Q. 2016 May 9;5(4):12. eCollection 2016 May 9. PubMed PMID: 28083422; PubMed Central PMCID: PMC5158227.
  15. van Praag HM. In search of the mode of action of antidepressants: 5-HTP/tyrosine mixtures in depression. Adv Biochem Psychopharmacol. 1984;39:301-14. PubMed PMID: 6380226.

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Dysthymic Disorder: A General Overview

The 3rd subtype of Depression is Dysthymic Disorder, also known as Dysthymia. Dysthymia is a chronic, smoldering form of Major Depressive Disorder. While not as severe and dramatic as Major Depression, Dysthymia lasts a long time, greater than two years in adults, and greater than one year in adolescents. Dysthymia affects 3% to 6% of people. It is one of the 7 subtypes of Depression.

For Dysthymia, you need to experience depressed mood, and at least two of the following symptoms:

  • Sleep: insomnia or hypersomnia
  • Esteem: low self esteem
  • Hopelessness: feelings of hopelessness
  • Energy: low energy or fatigue
  • Concentration: poor concentration or difficulty making decisions
  • Appetite: poor appetite or overeating

People who have Dysthymia experience these symptoms most of the day, most days of the week. In Dysthymic Disorder, if you feel any periods of normal mood, these do not last for more than two months, and there are no major depressive episodes.

You’ll notice that there is a difference for the symptoms of Dysthymia versus a major depressive episode. For Dysthymia, you will use the mnemonic SEHECA, versus the mnemonic SIGECAPS for a Depressive Episode. In Dysthymia, you will see more soft symptoms such as low self-esteem, feelings of hopelessness, and accompanying neurovegetative symptoms with insomnia, low energy, poor concentration, and poor appetite. Major Depressive Disorder (MDD) is more dramatic, and it is easier to pick out the Depressive Episode symptoms such as suicidal ideations, anhedonia, feelings of guilt, and psychomotor agitation/retardation.

The difference is that Dysthymic Disorder is more subtle and exhibits the soft symptoms of SEHECA, while MDD is more dramatic and the depressive symptoms of SIGECAPS are more defined and therefore easier to identify.

Doctors often overlook the diagnosis of Dysthymic Disorder, as they are well-trained to pick out the dramatic neurovegetative symptoms of Major Depressive Disorder, while overlooking the more subtle and covert symptoms of Dysthymic Disorder. Using the mnemonic SEHECA can help to uncover and diagnose Dysthymic Disorder.

The treatments for MDD, which include psychotherapy and antidepressant medications, also work for Dysthymic Disorder. Please review the rest of Depression Boss to learn about the identification and treatment of Dysthymic Disorder and other Depression subtypes.

References:

Sansone, R. A., & Sansone, L. A. (2009). Dysthymic Disorder: Forlorn and Overlooked? Psychiatry (Edgmont), 6(5), 46–51.

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Bipolar Depression: A General Overview

Bipolar Depression is the depressive phase of Bipolar Disorder, where there is cycling between mania, depression, and sometimes mixed episodes. This is in contrast to Unipolar Depression (Major Depressive Disorder), where there is only depressive episodes, with no manic episodes. Bipolar Depression is just one of the 7 subtypes of Depression, as discussed in a previous article entitled “What is Depression?”

Alas, it can be difficult to tell the difference between Bipolar Depression and Unipolar Depression. You can still use the SIGECAPS mnemonic to determine the presence of a depressive episode, but there are some differences in the presentation of a Bipolar Depression versus a Unipolar Depression:

Bipolar Depression: increased need for sleep (hypersomnia), rejection hypersensitivity (increased sensitivity to rejection), increased appetite, weight gain, and leaden paralysis

Unipolar Depression: multiple early morning awakenings (insomnia), decreased appetite, weight loss, and agitation.

The other main difference between Unipolar and Bipolar Depression is the history of manic episodes in Bipolar Disorder. As with SIGECAPS for a depressive episode, you can use the mnemonic DIGFAST for a manic episode. In addition to expansive, elevated moods, a manic episode needs at least 2 more of the following symptoms:

  • Distractibility (inability to focus)
  • Insomnia (decreased need for sleep)
  • Grandiosity (grandiose delusions)
  • Flight of ideas (racing thoughts)
  • Activity (hyperactivity)
  • Speech (pressured speech)
  • Thoughtlessness (reckless and impulsive behaviors)

So in Bipolar Disorder, there is cycling between manic episodes, depressive episodes, and sometimes mixed episodes (mix of manic and depressive symptoms). And when not in any of those episodes, then there is euthymia, or normal moods. Contrast this with Unipolar Depression, where there is only cycling between depressive episodes and euthymia, with no manic episodes.

It’s important to tell the difference between Bipolar Depression and Unipolar Depression, as the treatment plan for each differs dramatically, and the wrong treatment can lead to worsening of the illness and mood episodes.

photo credit: Risager Valencia via photopin (license)

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Major Depressive Disorder: A General Overview

Major Depressive Disorder is the prototypical depressive disorder. When you talk about depression, many people are thinking about Major Depressive Disorder. It is also known as Major Depression and Clinical Depression. Major Depression is just one of the 7 types of depression.

Prevalence

Major Depressive Disorder affects about 7% of adults and 13% of teenagers, making it a common mental illness. It also affects a person’s functioning at home, work, and school. Major Depression also disrupts relationships and self-care. In other words, Major Depressive Disorder can be devastating and life-altering. In some cases, Major Depression can lead to completed suicide, and is a serious consequence of this mental disorder.

Major Depressive Episode

To meet the criteria for Major Depressive Disorder, you must have a Major Depressive Episode lasting for at least 2 weeks. In addition, you must have poor functioning at work, school, relationships, and self-care.

To meet the criteria for a Major Depressive Episode, the episode lasts most of the day and most days of the week, and the episode must include either depressed mood or anhedonia (loss of pleasure and interest in things). In addition, the episode must have at least 5 of the following 9 symptoms for at least 2 weeks:

  • Depressed mood
  • Problems Sleeping (multiple early morning awakenings)
  • Loss of Interest (anhedonia)
  • Feelings of Guilt or hopelessless
  • Low Energy
  • Poor Concentration
  • Poor Appetite
  • Psychomotor agitation (revved-up) or retardation (slowed-down)
  • Suicidal thoughts

SIGECAPS

The easy way to memorize the symptoms of depression is to use to the following mnemonic:

SIGECAPS

  • S: stands for sleep
  • I: stands for interest
  • G: stands for guilt or hopelessness
  • E: stands for energy
  • C: stands for concentration
  • A: stands for appetite
  • P: stands for psychomotor agitation or retardation
  • S: stands for suicidal thoughts

So when you have to consider a Major Depressive Episode, use the mnemonic SIGECAPS, where you have at least 5 of the 9 symptoms. In addition, one of the symptoms must include either depressed mood or anhedonia.

Treatment

The treatment for Major Depressive Disorder begins with psychotherapy. Specifically, interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are the most-researched treatment approaches for mild to moderate depression. For mild to moderate depression that does not respond to psychotherapy, then antidepressant medication treatment may be necessary. These include treatment with SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin Norepinephrine Reuptake Inhibitors).

For severe depression, psychotherapy is often not effective initially. This is because the severe depressive symptoms prevent active participation in therapy due to social isolation, low energy, poor concentration, and poor decision-making. Therefore, antidepressant medication is the treatment of choice for severe depression. Once the antidepressant medication reduces the depressive symptoms, then psychotherapy may be added to help further decrease the symptoms and improve functioning.

So how do you determine the severity of a Major Depressive Episode, and how do you measure it? The answer will be published in an upcoming article on Depression Boss.

photo credit: Send me adrift. Empty via photopin (license)

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What Is Depression?

Depression is another term for Depressive Disorders, which are brain disorders based on abnormal brain circuit functioning, maladaptive thinking and behaviors, maladaptive coping to stressors, and mood dysregulation.

Depressive Disorders

Depressive Disorders include the following DSM-IV diagnoses:

All these Depressive Disorders are characterized by the presence of a depressive episode. A depressive episode is highlighted by either depressed mood or lack of interest in pleasurable things (anhedonia). In addition to depressed mood or anhedonia, you also need to have 4 more symptoms of the following to meet the criteria for a depressive episode:

  • Problems sleeping and multiple early morning awakenings
  • Feelings of guilt or hopelessness
  • Low energy level
  • Poor concentration
  • Poor appetite
  • Being revved-up or slowed-down
  • Thoughts of suicide or self-harm

Major Depressive Disorder

The prototypical Depressive Disorder is Major Depressive Disorder (Major Depression). It is characterized by the presence of a depressive episode for at least 2 weeks, and disrupts a person’s normal functioning at home and work, and disrupts relationships, jobs, and self-care. Mild to moderate cases require psychotherapy with a therapist, and moderate to severe cases often require antidepressant medication treatment, then psychotherapy once the depressive symptoms are under control.

Bipolar Depression

Bipolar Disorder is characterized by mood swings, where the sufferer alternates between manic episodes, depressive episodes, or mixed episodes. When a person with bipolar disorder is in a depressive episode, it is difficult to distinguish it from depression associated with Major Depression (or Unipolar Depression). Some caveats: Bipolar Depression tends to be on the opposite spectrum of the manic episode, where a person with Bipolar Depression tends to experience more sleeping (hypersomnia), increased appetite, weight gain, extreme low energy, extreme moodiness to stressors, and rejection hypersensitivity. These symptoms of Bipolar Depression look like what is called Atypical Depression. Treatment of Bipolar Depression requires addressing the manic or mixed episode which will come or has previously occurred. Treatment with mood stabilizers is the standard of treatment, and antidepressants can make the mood swings more unstable.

Dysthymic Disorder

Dysthymic Disorder is basically a depressive episode that lasts for at least 2 years, and is more chronic but less severe than Major Depression. Treatment is similar to the treatment for Major Depression.

Adjustment Disorder with Depressed Mood

People with Adjustment Disorder with Depressed Mood, also known as Situational Depression, experience a depressive episode in response to a known stressor, such as the loss of a loved one, or the breakup of a relationship. The depressive episode only occurs in association with a stressor, and the depressive episode resolves when the stressor is no longer there. Treatment is focused on addressing the stressor, and/or how to cope with it. However, if the depressive symptoms continue despite the stressor being removed, then the person may have developed Major Depressive Disorder.

Substance-Induced Depression

Drugs of abuse, such as cannabis, alcohol, and cocaine, can cause a depressive episode. In addition, prescription drugs and chemicals, such as isotretinoin (Accutane), can cause depression. The depressive episode continues until the offending drug is removed- then the depressive episode lifts. Treatment is focused on addressing the drug abuse or removing the offending substance. However, with continued drug use, the sufferer may go on to develop a Major Depressive Disorder.

Depression Secondary to a General Medical Condition

A general medical condition, such as hypothyroidism, can cause a depressive episode. Treatment is geared towards addressing the underlying general medical disorder, and the depression lifts as a result.

Grief and Bereavement

Grief and bereavement can present as a depressive episode, after the loss of a loved-one. Treatment is focused on supporting the sufferer through their grief process. If depressive symptoms worsen, or if they continue way past the date of the loss, then Major Depression may develop.

Summary

So as you can see, depression is not so simple- it includes multiple depressive disorders as discussed above. When you have depression, look for which type you have listed above.

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