Depression refers to a group of conditions associated with the elevation or lowering of a person’s mood as described by WHO. In technical terms, depression is referred to as major depressive disorder(MDD) or unipolar depression.
To understand MDD, it is firstly important to understand what a major depressive episode is. It involves a period of time, typically at least 2 weeks, where an individual experiences sad or empty moods most of the day, nearly every day (APA, 2000).
Major Depressive Episode (MDD)
As per DSM-5, the features or criteria of a major depressive episode are:
A major depressive episode may take place with specifiers which are “different patterns of symptoms that characterize major depressive episodes which may help predict the course and preferred treatments for the condition”. They are additional symptoms that help to understand depression better. The specifiers are of following types:
MAJOR DEPRESSIVE EPISODE WITH MELANCHOLIC FEATURES: It is applied when an individual loses interest or pleasure in almost all activities or stops reacting to pleasurable stimuli or desired events.
MAJOR DEPRESSIVE EPISODES WITH PSYCHOTIC FEATURES: It is characterized by loss of contact with reality and delusions or hallucinations which are mood-congruent i.e they seem in some sense appropriate to serious depression because the content is negative in tone, such as themes of personal inadequacy, guilt, deserved punishment, death, or disease
MAJOR DEPRESSIVE EPISODE WITH ATYPICAL FEATURES: It has a pattern of symptoms characterized by mood reactivity i.e the person’s mood brightens in response to potential positive events.
MAJOR DEPRESSIVE EPISODE WITH CATATONIC FEATURES: It includes a range of psychomotor symptoms from motoric immobility(catalepsy-a stuporous state) to extensive psychomotor activity(mutism and rigidity).
MAJOR DEPRESSIVE EPISODE WITH A SEASONAL PATTERN OR SEASONAL AFFECTIVE DISORDER: Here, the individual must have at least two episodes of depression in the past 2 years occurring at the same time of the year(commonly fall or winter) and full remission must have also occurred at the same time of the year(commonly spring).
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition or mood-incongruent delusions or hallucinations.
Depressed mood most of the day or nearly every day.
Diminished interest in almost all the activities of the day.
Significant increase or decrease in appetite.
Insomnia or hypersomnia.
Psychomotor agitation or retardation nearly every day.
Fatigue or loss of energy.
Feelings of worthlessness or excessive or inappropriate guilt.
Diminished ability to think or concentrate or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
Types of Depression
After understanding what a major depressive disorder is, let us now proceed to other categories of depression. They usually involve a longer period during which an individual experiences multiple instances of major depressive episodes. For the episodes to be considered different from each other, a 2-month interval of normal mood must occur. All the symptoms of a major depressive episode are found in MDD as well. MDD can be mild, moderate, or severe or may occur with or without psychotic features such as hallucinations or delusions. Depending upon the symptoms, MDD or unipolar depression is further of three types which are explained below:
A. Dysthymic disorder or persistent depressive disorder: It is a chronic feeling of depression that lasts for at least 2 years. All severe symptoms of major depression are not present in it rather individuals show ‘low-grade’ symptoms which persist for much of their life. As per DSM-5, the symptoms of dysthymia are:
Depressed mood for most of the day, more days than not, for at least 2 years.
No presence of manic, mixed, or hypomanic episode nor of cyclothymia.
No major depressive episode has occurred during the first 2 years of the disorder
Symptoms are not due to a substance or medical condition.
Symptoms cause significant distress or impairment in social, occupational, or other areas of functioning.
During the 2-year period of the symptoms listed above, the person has never been without these symptoms for more than 2 months at a time.
The disorder does not occur during a chronic psychotic disorder
Presence of two or more of the following:
Poor appetite or overeating.
Insomnia or hypersomnia.
Trouble concentrating or difficulty making decisions.
Feelings of hopelessness.
To be diagnosed with dysthymia, the person should have had a full-blown major depressive episode during the first 2 years of her dysthymia. When individuals have both major depressive episodes and persistent depression with fewer symptoms, then it is called as double depression.
B. Recurrent depressive disorder: When two or more depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed, then it is referred to as recurrent depressive disorder.
C. Post-partum depression: It occurs in women after the birth of a child and is also referred to as ‘baby blues’. The symptoms include changeable mood, sadness, irritability often intermixed with feelings of happiness. It occurs if the mother lacks social support or has difficulty adjusting to her new identity and responsibilities. As per studies, if there has been a history of depression in the family, then new mothers are more prone to it. Studies also show that hormonal changes are also responsible for it.
D. Seasonal Affective Disorder(SAD): It is related to changes that occur in seasons. It begins and ends at about the same time every year. It occurs mostly in the fall and winter season but can occur in spring and summer as well. People with SAD, often experience reduced energy, poor motivation, and anxiety with depressed mood. Symptoms of SAD typical to fall and winter are:
Appetite changes especially high consumption of carbohydrates.
Tiredness or low energy.
Symptoms of SAD typical to spring and summer are:
Agitation or anxiety.
Studies show the secretion of hormones like melatonin causes SAD. An increase or decrease of melatonin leads to it in either of the two seasons.
CAUSE AND RISK FACTORS :
Biological risk factors: As per studies, families which have a history of depression can have the coming generations being prone to it. Apart from that, there are differences in brain areas. people with depression have a reduced activity and size changes in prefrontal and other cortical areas. Neurotransmitters like serotonin, epinephrine, and dopamine are also responsible for it. Decreased secretion of serotonin, increased dopamine and epinephrine have been found in individuals who have depression.
Environmental risk factors: Stressful life events like loss of loved ones, inability to attain life goals, and cognitive factors like cognitive distortions reading to negative thoughts, and an individual’s own coping mechanisms are related to it. Impaired attachment styles in childhood lead to the development of feelings of loneliness and helplessness making children prone to depression in the future.
PREVENTION AND TREATMENT :
The earlier it is diagnosed the better. As people with depression isolate themselves, therapists focus on behavioral activation by focusing on activities like:
Educational and creative activities such as learning a musical instrument or engaging in photography
Domestic activities such as housecleaning or cooking
Health and appearance activities such as going to the dentist and shopping for new clothes
Leisure activities such as walking in the park and increased exercise
Religious activities such as going to church on, including making eye contact, smiling more, and discussing topics other than depression.
Coping or problem-solving skills training may also be used to help people find effective solutions for problems instead of avoiding them.
The goal of behavioral activation is to help a person get involved with daily social activities, and to help them exercise positive feelings of self-esteem. Apart from this, cognitive therapy is also used where the goal is to increase a person’s ability to challenge the automatic negative thoughts and alter them to have a hassle-free life ahead.