Depression: Causes, symptoms and treatment

Depression a mental health condition characterized by an overwhelming feeling of sadness, isolation and despair that affects how a person thinks, feels and functions. Also known as mental depressive disorder, it is a mood disorder which causes a persistent feeling of low mood or sadness and the often-profound loss of interest in things that usually bring you pleasure, or aversion to activity. It can affect a person’s thoughts, behaviour, motivation, feelings, and sense of well-being. 

People experiencing depression may have feelings of dejection, hopelessness and, may significantly interfere with a person’s daily life, sometimes promptings suicidal thoughts. It can either be short term or long term.  Depression can affect people of all ages, races and socioeconomic classes, and can strike at any time. The condition is found in twice as many women as men.

Types of depression

There are different types of depression that may vary in presumed cases, timing, duration, or may involve different types of symptoms. The treatment for different types of depression varies too.

1. Major Depressive Disorder (MDD): Also known as clinical depression, is a mood disorder that involves a two-week period of intense sadness or loss of interest in almost all activities. It’s characterized by; depressed mood, fatigue, changes in sleep, changes in weight, difficulty concentrating, feelings of worthlessness and guilt, lack of interest in activities normally enjoyed, and thoughts of death and suicide.
2. Persistent Depressive Disorder: Also known as dysthymia, is a type of chronic depression present for at least two years. It can be mild, moderate or severe.
3. Bipolar Disorder: Also known as maniac depression, is a mood disorder characterized by; periods of abnormally elevated mood. It’s characterized by fatigue, insomnia, lethargy, unexplained aches, pains, psychomotor agitation, hopelessness, diminished interest in activities, loss of self-esteem, irritability, anxiety, indecision, disorganization, suicide thoughts, and psychosis (including hallucinations and delusions) in extreme cases. Also, in extreme cases, it can cause impairment in a person’s life, require hospitalization, or affect a person’s sense of reality.
4. Postpartum Depression: Occurs as a result of pregnancy or childbirth in women, due to significant hormonal shifts. It can range from a persistent lethargy and sadness that requires medical treatment all the way up to postpartum psychosis, a condition in which the mood episode is accompanied by confusion, hallucinations or delusions.
5. Premenstrual Dysphoric Disorder (PMDD): Involves depressive symptoms that begin shortly before the onset of menses in the majority of menstrual cycles. It’s characterized by; irritability, extreme fatigue, anxiety, moodiness, bloating, increased appetite, food cravings, aches, breast tenderness, feeling sad, hopeless, self-critical, severe feelings of stress, mood swings, inability to concentrate, food cravings, and binging.
6. Seasonal Affective Disorder (SAD): Also called winter depression, is a major depressive disorder, with seasonal pattern. It’s depression that is related to weather, usually winter, so it happens seasonally. SAD is believed to be triggered by a disturbance in the normal circadian rhythm of the body. It’s more common in far northern or far southern regions of the planet and can often be treated with light therapy to offset the seasonal loss the daylight.
7. Atypical Depression: Is a depressive disorder with atypical features) a type of depression which does not follow what was thought to be the “typical” presentation of the disorder. It’s characterized by; excessive eating, weight gain, excessive sleep, fatigue, weakness, feeling “weighed down”, intense sensitivity to rejection, and strongly reactive moods.
8. Disruptive mood dysregulation disorder: Is diagnosed in children and involves temper outbursts, anger, and irritability.

Causes of depression

It’s believed that depression is caused by an imbalance in the brain’s signalling chemicals, and a number of distressing life situations, for instance; abuse, loss of a loved one, job loss, financial troubles or a divorce. Also, depression arises from a combination of genetic, biological, environmental, and psychological factors. Additionally, certain medical conditions, some sedatives and induction of hormones may trigger depression.

a. Grief and loss

Losing a loved is very hard on every person. Grieving people may experience many symptoms of depression, like trouble sleeping, poor appetite and losing interest in activities. Some grieving people, if not advised, supported or given professional help, may end up being depressed.

b. Poor nutrition

Poor diet, for instance deficiencies in a variety of vitamin and minerals, can cause symptoms of depression. Diets either low in omega-3 fatty acids or with an imbalanced ratio of omega-6 to omega-3, and those diets high in sugar are associated with increased rates of depression.

c. Illness

Certain illnesses, such as thyroid disorders, Addison’s disease, chronic illness, insomnia, chronic pain, attention-deficit hyperactivity disorder (ADHD), cancer or coronary heart disease, liver disease and severe head injury, can cause depression symptoms. Also, the stress of having a chronic illness may trigger an episode of major depression.

d. Abuse or stressful life events

If someone has experienced physical, sexual, emotional abuse or stressful life events, the chances of developing depression are high. These experiences may also increase the vulnerability to clinical depression later in life.

e. Certain medical drugs

Some drugs, such as corticosteroids, anticonvulsants, statins, stimulants, benzodiazepines, beta-blockers, antiviral drug interferon-alpha and isotretinoin (used to treat acne), can increase your risk of depression.

f. Genetic disposition

Family history of depression can be a contributing factor in the depression of a person. Like some diseases, depression can run in genes, a person may develop depression without a particular trigger coming into play. A person is at a higher risk or developing depression if they have a family history of depression or another mood disorder.

g. Dysfunctional families

Families are key pillars to every person’s life. When a person comes from a dysfunctional family; domestic violence, lack of love and appreciation, may lead to depression. Parents should get the basics right, make the home environment peaceful and avoid causing stress to their children. Families and homes should enhance love, care and support, lack of that may make someone feel unloved and unappreciated, which may lead to habouring self-harm or suicidal thoughts.

h. Financial stress

Financial constraints, high cost of living and poverty, contributes greatly to the number of cases of depression. When a person loses his/her job and unable to provide for their family, is often a catalyst for depression. Life can be tough, not only for people from poor backgrounds but also rich ones and high social set-ups, when even the relatively well-off have to take up two or three jobs to make ends meet. Financial stress and lack of job security, may make a person see like the world is coming to an end and that life was not meant for them.

i. Exposure to adversity

Being exposed to traumatizing scenes, for instances; witnessing murder or suicide, mass killings, gun shooting or war zone, can expose a person to a lot of emotional and psychological trauma. Take for example, the police personnel who see macabre killings, doctors or nurses in hospitals, a person exposed to suicidal behavior by family or friends, or even a person who has served jail term, they are often prone to depression.

j. Lifestyle

Getting some sort of fame, can expose an individual to extreme levels of anxiety, stress and pressure. This often leads to misuse of alcohol and drugs, disrupted sleeping patterns, physical distance from friends and family, thus affecting the physical and mental health of the person.

k. Fame

Getting some sort of fame, can expose an individual to extreme levels of anxiety, stress and pressure. This often leads to misuse of alcohol and drugs, disrupted sleeping patterns, physical distance from friends and family, thus affecting the physical and mental health of the person.

l. Cultural beliefs

Certain cultural beliefs may put people in peculiar positions. Take for instance; culture that prohibit expression, show of feeling, emotions (men are not supposed to cry) and even those that overlook LGBTQI rights, space and reality. They conditioned that they are not supposed to do certain things, even when those things seem pretty normal. Thus, you find people being predisposed based on cultural imposed conditions, and as they try to repress those emotions, the higher the chances of them having worse symptomatology or experience of depressive state.

m. Adolescence

Adolescence is a stage, when prevalence rates of emotional and behavioural problems are high. This is the stage when most teens are rude, violent, and engage in alcohol and substance abuse. With poor or lack of advice in handling traumatic life experiences, may end up engaging in violent acts like school riots, burning school properties, bullying and molesting others, murder and even suicide.

n. College life

When a person joins college/university, they get some sort of freedom, which they didn’t have in high school or at home. This new-found freedom comes with bad influence, peer pressure, drugs, alcohol and sex. If the student is not strong enough and backed with good advice, then he/she will be consumed. Campus life contributes greatly to the life of a student, with breakups in friendships and romantic relationships, and the purpose and meaning of life lost. Campuses are now breeding grounds for depression, and without help, suicidal thoughts will come into play, when life becomes unbearable and relationships go south.

o. Personality

Some personality traits can put people at a higher risk of developing depression. These include low self-esteem or a habit of criticizing oneself too much. These personality traits can come from the person’s genes, which they get from their parents, or they can be as a result of experiences in their early life.

p. Loneliness

The risk of depression gets higher if someone isn’t in contact or spending time with family and friends.

q. Giving birth

Pregnancy and child delivery can make some women vulnerable to depression. Postpartum (postnatal) depression can happen as the result of physical changes, hormonal changes, and the responsibility of taking care of a new baby.

Symptoms (signs) of depression

The symptoms of depression may vary from one person to another, but there are common signs that tend to show in most people. For instance, feeling empty, sad and hopeless. Often people will notice changes in your family life, social life and work. These symptoms may persist for weeks and even months, they in some cases be seasonal (they come and go). Depression affects men, women and children differently, and the symptoms of depression in men vary from those in women and in children, and vice versa.

a. Symptoms of depression in men

Symptoms of depression in men may include:

• Mood: Anger, aggressiveness, irritability, anxiousness, restlessness, agitation.
• Emotional: Feeling empty, sad, hopeless, self-loathing or guilt.
• Behavioral: Loss of interest in activities, no longer finding pleasure in favorite activities, feeling tired easily, thoughts of suicide, drinking excessively, using drugs, engaging in high-risk activities, recklessness.
• Sexual: Reduced sexual desire, lack of sexual performance.
• Cognitive: Inability to concentrate, difficulty completing tasks, delayed responses during conversations.
• Sleep: Insomnia, restless sleep, excessive sleepiness, not sleeping through the night.
• Physical: Fatigue, pains, headache, digestive problems.

b. Symptoms of depression in women

Symptoms of depression in women may include:

• Mood: Irritability.
• Emotional: Feeling sad or empty, anxious or hopeless, self-loathing or guilt.
• Behavioral: Loss of interest in activities, withdrawing from social engagements, thoughts of suicide.
• Cognitive: Thinking or talking more slowly.
• Sleep: Difficulty sleeping through the night, waking early, sleeping too much.
• Physical: Decreased energy, greater fatigue, changes in appetite, weight changes, aches, pain, headaches, increased cramps.

c. Symptoms of depression in children

Symptoms of depression in children may include:

• Mood: Irritability, anger, mood swings, crying.
• Emotional: Feelings of incompetence, despair, crying, intense sadness.
• Behavioral: Getting into trouble at school or refusing to go to school, avoiding friends or siblings, thoughts of death or suicide.
• Cognitive: Difficulty concentrating, decline in school performance, changes in grades.
• Sleep: Difficulty sleeping or sleeping too much.
• Physical: Loss of energy, digestive problems, changes in appetite, weight loss or gain.

How to cope with depression

Depression is something that can eat you up and end up destroying you. While depression can affect virtually everybody, some people might end up being consumed by it, while others cope up with it and come out strong. Some of the activities that someone engages in while feeling depressed can help accelerate the effects of depression. There are many things depressed people can do to lift and stabilize their moods.

• Reach out to family/friends: Isolation fuels depression. Create time and spend it with your loved ones, and people you can count one. Develop strong social support, forging stronger ties with friends or family or join a depression support group, that can help go a long way toward improving your depression.
• Regular exercise: Get out of bed and start exercising. Doing exercises can be as effective as antidepressant medication in countering the symptoms of depression.
• Eat a mood boosting diet: Increase intake of foods with mood-enhancing nutrients such as Omega-3 fatty acids. Reduce your intake of foods that can adversely affect your mood, such as caffeine, alcohol, trans fats, sugar and refined carbs.
• Pick a hobby: Find ways to engage again with the world by doing something that you enjoy most and one that can lift your spirits. For instance, spend some time in nature, care for a pet, volunteer, pick up a hobby you used to enjoy (or take up a new one) and make it a habit.
• Reduce your stress: Getting too stressed can gear you up for depression. You can reduce stress, by talking to someone you trust, doing exercises or hobbies and engaging in other activities that light up your moods.
• Improve your sleep hygiene: Good sleep hygiene can help you improve the quality and quantity of your sleep, as sleep and mood are intimately related. Always ensure you get enough sleep. Only use your bed for sleep and sexual activity. Doing work in bed, or even in your bedroom, can cause you to associate your bed with stress, rather than relaxation.
• Stop negative thoughts: Depression can make you have negative thoughts that can lead to irritational or reckless behavior. Changing those negative thoughts, can improve your mood.

Diagnosis of depression

In order to diagnose if a person has depression, doctors may ask a variety of questions, for instance; family health history, mood and behaviour patterns (such as eating and sleeping), and thoughts of suicide. They may also ask patients to report their depression symptoms on a printed questionnaire. The person must also exhibit a depressed mood, or loss of interest or pleasure for a period of 2 weeks or so.

The doctor may also do a blood test so as to rule out that the symptoms are not caused by another medical condition, such as a thyroid problem, or due to the direct effects of a drug or medication. Doctors will then look at whether the symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. Doctors describe depression in one of three ways, depending on how serious it is:

• Mild depression: It has some impact on daily life.
• Moderate depression: It has a significant impact on your daily life.
• Severe depression: This makes it nearly impossible to get through your life day to day.

Treatment of depression

Depression is treatable, though it might take time before the person sees any improvement. Most depressed people feel better when treated with medication, psychotherapy, or a combination of the two. Treatment should be individualized, as it various from one person to another, what works for one person might not necessarily work for another.

a. Psychotherapy

There are many different types of therapies that are effective in reducing depression.

1. Interpersonal therapy: It aims at improving skills, such as communication skills and conflict-resolution skills. It’s relatively short in duration. Sessions are highly structured.
2. Cognitive behavioral therapy: It aims at helping depressed people identify and replace cognitive distortions and behavioral patterns that reinforce depressive feelings. It is usually short-term, and it focuses on present problems and skills teaching.
3. Social skills therapy: Focuses on establishing healthy relationships by improving communication and building strong social networks.
4. Psychodynamic therapy: Helps patients explore their unconscious and unhealed emotional wounds from the past.
5. Supportive counseling: Is unstructured and focuses on listening to the patient.
6. Behavioral activation: Raises awareness of pleasant and more pleasurable activities.
7. Problem-solving therapy: Aims to define a patient’s problems and offer multiple solutions.
8. Family or couple therapy: In cases where depression affects other people in the household and focuses on the interpersonal relationships.

b. Medications

There are many different medications that can help reduce the symptoms of depression. Medications are most effective when used in conjunction with therapy. Here are some classes of medication that are commonly used to treat depression.

1. Selective serotonin reuptake inhibitors (SSRIs): They are the most commonly prescribed medication for depression today. They include: Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) Celexa (citalopram) and Luvox (fluvoxamine).
2. Tricyclic antidepressants (TCAs): They include: Elavil (amitriptyline), Tofranil (imipramine) and Pamelor (nortriptyline).
3. Monoamine oxidase inhibitors (MAOIs): They include: Marplan (isocarboxazid), Nardil (phenelzine) and Parnate (tranylcypromine).
4. Serotonin and norepinephrine reuptake inhibitors (SNRIs): They include: Effexor (venlafaxine), Cymbalta (duloxetine) and Pristiq (deslavenfaxine).
5. Norepinephrine and dopamine reuptake inhibitors (NDRIs): They include: Wellbutrin (bupropion).
6. Esketamine: It works within hours and is approved for adults with treatment-resistant depression, who other medication options have not worked for them, and needs to be prescribed together with an oral antidepressant.

c. Supplements

Several types of supplements are thought to have some positive impact on depression symptoms.

1. St. John’s wort: Is a natural treatment is used in Europe as an antidepressant medication.
2. S-adenosyl-L-methionine (SAMe): Is a traditional antidepressant that can ease symptoms of depression.
3. 5-hydroxytryptophan (5-HTP): May raise serotonin levels in the brain, which could ease depression symptoms.
4. Omega-3 fatty acids: Adding omega-3 supplements to your diet may help reduce depression symptoms.

d. Essential oils

People with depression may find symptom relief with some essential oils.

1. Wild ginger: Inhaling this strong scent may activate serotonin receptors in the brain slowing the release of stress-inducing hormones.
2. Bergamot: This citrusy essential oil has been shown to reduce anxiety as a result of depression.
3. Chamomile or rose oil: May when inhaled ease depression symptoms.

e. Vitamins

Two vitamins are very useful for easing symptoms of depression.

1. Vitamin B: B-12 and B-6 are vital to brain health. Low levels of vitamin B, raises the risk for developing depression.
2. Vitamin D: Often called sunshine vitamin because exposure to the sun supplies it to your body, Vitamin D is important for brain, heart and bone health. People who are depressed are more likely to have low levels of vitamin D.

f. Other treatments

If other medications or therapy have been tried and still no improvement, more extreme treatment measures may be recommended.

1. Lithium: If you’ve tried several different antidepressants and had no improvement, lithium may be recommended. There are two types of lithium; lithium carbonate and lithium citrate.
2. Electroconvulsive therapy (ECT): It’s used in cases of severe depression and other treatments, like medication, haven’t worked. Electrodes are placed on the head of the patient that give an electrical shock to the brain.
3. Hospitalization: It may involve medication, individual therapy, family therapy, and group therapy. It may become necessary when it is deemed that a patient has become a danger to himself or others. A patient who is seriously considering suicide, for example, may require inpatient hospitalization. Once a patient is safe to leave the hospital, an intensive outpatient program, such as a partial hospital may be recommended.