What is depression?

Depression is a common and severe psychological disorder that negatively affects the way you think, feel, and behave. Its symptoms range from persistent feelings of sadness to loss of interest in activities that one used to enjoy, or social withdrawal and isolation. If left untreated, it can have adverse effects on one’s physical health, relationships, and career.

Depression is not just a case of the “blues.” We all have moments in our lives when we struggle to get out of bed or lost interest in activities that we once enjoyed. We will also go through seasons of grief or bereavement when we lose something or someone that we love. Hence, depression is different from the mood fluctuations that everyone experiences as we navigate through the typical challenges in life. However, if the symptoms persist and affect our ability to function in life, then it may be depression.

Fortunately, depression is very much treatable – whether through medical, psychological, or spiritual interventions. The prognosis for recovery differs for individuals and is very much dependent on factors such as the severity of the symptoms, onset of depression, and risk/protective factors.

 

Etiology and Statistics

According to the World Health Organization (WHO), it is estimated that 350 million people worldwide are affected by depression [1]. It is the leading cause of disability, and is one of the main contributors to the “overall global burden of disease.”

At its worst, depression may lead to suicide. The WHO estimates that approximately one million people die from suicide every year, which is equivalent to a global mortality rate of 16 people per 100,000 or one death every 40 seconds [2]. Suicide is now one of the three leading causes of death among individuals aged between 15 – 44, regardless of gender. Of every successful suicide incident, there are up to 20 “unsuccessful” attempts.

Depression affects people of all demographics regardless of race, age, gender, socio-economic background, religion, or geographic location. Over the last five decades, the onset of depression has been cut by half. Depression has seen an increasing start among adolescents and children. This could also be attributed to increased awareness about the illness and treatment options available.

 

Risk factors for depression

Various factors can increase the vulnerability of certain individual groups to depression, often mentioned as the bio-psycho-social factors. These can range from genetics, family environment, adverse childhood experiences (ACE), social factors, etc.

 

  1. Genetics

Depression is more common to be found in people whose blood relatives also suffer from this condition. Though the specific genes responsible for this is not known yet, this could be biological and linked to brain chemistry. Or it could be the nurture and upbringing in which individuals inherit the traits of their primary caregivers.

 

  1. Family Environment

It is widely known that the environment in which a child grows up in can broadly contribute to their mental health. Children who grow up in families where they are affirmed and loved will group up with secure attachment. Whereas the presence of neglect or abuse will often put children at risk of insecure or avoidant attachments. These attachments that are less than ideal could lead to children being more fearful of trying new things or avoid forming relationships. And if it persists, can lead to an onset of depression and anxiety.

 

  1. Adverse Childhood Experiences

Adverse Childhood Experiences (ACE) describes various forms of abuse, neglect, or any other experiences that could be potentially traumatic to individuals under the age of 18. ACEs have been linked to multiple conditions such as an engagement in risky behaviors, chronic illness, low life potential, and even premature deaths.

The presence of ACEs does not mean that the child will experience adverse outcomes, and this will largely depend on the child’s protective and risk factors. Protective factors such as strong family support and access to immediate interventions can help a child who has been through an ACE recover much quicker.

 

  1. Social factors

Humans are social beings, and we live and function within our social circles. Hence, social issues such as bullying and loneliness can have a significant impact on an individual’s mental health. Many people, in particular adolescents, are influenced by peer pressure and in the attempts to fit in, may have gotten themselves involved in social ills and risky behaviors such as drugs & alcohol, unsafe sex, and crime.

There are certain groups of individuals that are more vulnerable to depression due to societal expectation — individuals with disabilities, LGBTQ, minorities, etc. Are generally more susceptible to developing depression as they struggle to “fit in.”

 

Types and Signs of Depression

There are three main types of depression, namely: Major Depressive Disorder (MDD), Bipolar Depression, and Dysthymia.

 

  1. Major Depressive Disorder (MDD)

For many people with depression, it is debilitating and severe enough to cause problems in daily activities such as work and school, social events, or relationships with others. Some of the symptoms of depression include:

– persistent feelings of sadness, weariness, hopelessness, or emptiness

– anger outbursts or irritability over seemingly insignificant matters

– Lost of pleasure or interests in activities such as sex, hobbies, or sports

– Sleep disturbances; either insomnia or sleeping too much

– Lack of appetite or eating too much

– Fatigue and lack of energy that even small tasks require a lot of effort

– delayed thinking and slow body movements

– agitation, anxiety, and restlessness

– disrupted cognitive functioning and issues with concentration, memory and decision making

– frequent thoughts and pre-occupation with suicidal thoughts

– Unexplained physical problems such as back and headaches.

 

Even though most people will experience some symptoms in our lives, generally, if five or more symptoms persist for two weeks, it could signify the onset of depression.

 

  1. Dysthymia

Dysthymia – sometimes referred to as mild, chronic depression is generally less severe and has fewer symptoms than major depression. For persons with dysthymia, the symptoms can persist for a more extended period, usually two years or more.

 

  1. Bipolar Disorder or Manic-Depression

Bipolar disorder is an illness that causes abnormal shifts in mood, energy, and activity levels. These moods range from periods of elation or high energy to depressive episodes with symptoms similar to that of MDD.

Symptoms of mania include:

– Feeling very upbeat and happy

– Feeling very energetic

– Increase in activity levels

– Have difficulty “slowing down.”

– Difficulty in sleeping

– Talking very fast about different things

– Extremely agitated or irritable

– Feeling as though their thoughts are going at a rapid pace

– Having grandiose ideas and feeling as though they can do a lot of things at once

– participating in risky behaviors, problems with impulse control

 

Depression in Men

Depression can manifest in different ways with different people, and there are notable gender differences between men and women. One of the reasons is because men are more unwilling to talk about their emotions as compared to women. As a result, they may be more inclined to come across as angry, irritable, or aggressive; while women more often express sadness. Men suffering from depression are also more likely to see a physician for physically-manifested symptoms such as heart issues, headaches, or digestive problems. Men are also more inclined to place the blame or responsibility on those around them.

Men tend to cope with depression in more tangible ways, from engaging in sports or turning to substance abuse and even violence. While women have a higher tendency to attempt suicide, men are more likely to complete it using more lethal methods.

 

Depression in Women

Depression tends to affect women twice as much as it does men and different contributing factors. Some of the causes of depression among women range from biological (hormones), psychological (responses to stress or body image issues), to social factors (relationship issues). Besides that, incidences of sexual abuse, whether during childhood or adulthood, are also risk factors for depression among women.

Women are more inclined to cope with depression through an expression of emotions and are less reserved in showing sadness or processing their feelings with a friend or therapist. By seeking help, this can be a robust protective factor that mitigates the impact of depression on women.

Unlike men, women tend to internalize the blame and engage in more self-destructive behaviors. While men may blame those around them and react in violence, women will turn their anger and frustration inwards through emotional eating or self-injury.

 

Depression in children and adolescents

There is an increasing prevalence of depression among children and adolescents below the age of 18. as with adults, childhood depression is more than just blues. It is a persistent sadness that interferes with family and social life, school work, and activities that a child used to enjoy.

Depression in children is often dismissed as part of growing up or puberty. While it is common for children to express tantrums, children with depression are more likely to suffer noticeable changes in their mood swings, academic performance, and social functioning.

Among the variety of reasons that predispose children to depression – among them, childhood abuse and neglect, family issues and divorce, loss of loved one, bullying, and the increasing societal expectations to perform.

Children are often unable to express their emotions, especially when there is a lack of communication about how they feel. Hence, children may turn to more self-destructive methods to cope with difficult emotions – such as disordered eating, self-injury. Other children may appear to be more angry or irritable.