What Depression Can Become

Having experienced first-hand what depression feels like, I couldn’t help but frown upon the information that’s out there. Sure, we all know what depression is since it’s become such a significant phenomenon in recent times, but what I’m not sure whether people truly understand what it can become. I feel that the understanding of depressions scope is one dimensional. When you ask people about what depression feels like, their response is going to be somewhat similar. You would hear things like it feels like having butterflies in your stomach, panic attacks, mood swings, headaches, and other related symptoms. Though all this information is more or less correct for most people, it does in many ways diminish what depression can become.

Depression, a Physical Condition?

Having gone through several mental health problems including depression, my response to the above question is simply that it’s highly subjective. In the summer of 2006, during my summer break, I felt symptoms that mimicked an acute sinus problem. Having never had any problems with my sinus, it was naturally quite puzzling for me to accept. However, the symptoms were as clear as they could be, and the next step was to get a paranasal test to confirm the symptoms.  Surprisingly, the test results were clear, and the physician was as surprised as I was. I left the physicians room more confused about my health than ever, and my mom soon exited the room along with the prescription paper. I was curious to know what was written on that piece of paper because as far as I knew he wasn’t sure what it was. I opened the paper, and the drug that he prescribed was Fluoxetine. I Googled the medicine and read about how it was prescribed to depression patients. It was the first time I have ever heard of the term depression, and I when I asked my mom about it, she simply dismissed the possibility of it happening to me. She was never a fan of doctors or the pharmaceutical industry, due to her past experiences and simply told me to forget about it. She was unaware of how to converse with someone with depression, as she had never experienced it in her life. Nevertheless, I did what I knew best which was to endure whatever the condition was and hope it got better. It, unfortunately, did not get better, but I was able to adapt to the pain and felt like I had to live with it. A couple of years later, I felt a sharp pain in my chest and cramping all over my body. The next day I felt a burning sensation in my chest, had trouble swallowing food, chest pains, pain in my eyes, muscular cramps, and acidity. I told my parents about it who scheduled an appointment with a gastroenterologist who asked me to get some tests done to ascertain the issue. He was convinced that this was a case of peptic ulceration and that the tests would confirm this. Shockingly, again the test results came out clear though to my amazement the doctor was not at all surprised. He told me that the problem was not with my stomach but with my head. On his advice, I consulted a psychologist and began my long road to recovery.

The biggest take away though from the story is that if you feel that depression cannot translate into a physical condition, then you’re sadly mistaken. It is one of the most varied conditions and can result in things that you would never have imagined. At the same time you also need to understand that you are not alone in your battles either; therefore you should never shy away from seeking the proper treatment to try and revive the will to live again.

photo credit: Gaia Li Mandri If only via photopin (license)

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)

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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