All we need to know about Depression

What is depression?

Depression as illness is considered to be a serious Psychiatric illness with feelings of persistent sadness and loss of interest in activities severe enough to interfere with daily activities and work. It is different from common experience of unhappiness or dissatisfaction which is a short lasting emotional reaction in response to stress or loss.

About one in ten people experience depression at some point in life. It is about twice as common in women than in men. It is usually seen in age group of 20 – 50 years. Depression can also be seen in chronic medical illnesses like hypertension, diabetes mellitus, heart diseases.


What are the common signs and symptoms of Depression?

Depression often present as

  • feeling low and sad most of the times

  • little interest in social activities

  • trouble sleeping and/or anxiety

  • trouble concentrating or remembering things

  • unexplained aches and pains

  • change in appetite and weight

  • feeling hopeless about the future

  • feelings helpless

  • low self esteem

  • easily irritated and/or listless

  • feelings of guilt

  • death wishes/ suicidal ideas


What are the causes and risk factors for depression?

There is no single cause for depression but many factors can act as triggers. Many factors like stressful life events, isolation, lack of support, poverty, unemployment, chronic medical illness, hormonal disturbances including Hypothyroidism, diabetes, relationship difficulties often trigger depression. The family history of depression, alcohol or drug abuse can also increase the risk of depression. Post-partum depression seen immediately after delivery is also common variants of depression.


How to recognize Depression?

It may take time to recognize the symptoms as depression as often these may develop gradually and may be ignored as just an emotional reaction. When any of these symptoms are present for a substantial period and have an impact on individual’s functioning, it can be Depression. Particularly sadness of mood and loss of interest lasting for more than two weeks and interfering with the functioning are considered the key symptoms of depression.

If the person has severe symptoms, he/ she cannot care for himself or herself or if the person is threatening to harm himself or herself, then, seek immediate treatment in a hospital . Some of the behaviors like talking about killing or harming one’s self, hopelessness, reckless behavior, preoccupation with death, preparing will, saying goodbye to people etc can serve as warning signs of suicide.


What are the Treatment options?


There are various types of antidepressant medications available which are safe and effective in treating depression. Antidepressants are neither addictive nor meant to be used as sedatives.

The drug most suitable in a particular patient is chosen in consultation with the patient/care giver. Antidepressants take about 3 – 4 weeks to act. Treatment is continued for at least 2 years and may be longer in some cases. The decision to stop taking the medication should be made together with the doctor


Psychotherapy/Counselling i.e. talking to the patient about their problems and understanding the reason for the same is equally effective. Psychotherapy is provided by the trained counsellors and is used along with medicines. The techniques commonly practiced are Cognitive Behaviour Therapy (CBT) or Interpersonal Therapy (IPT).  Multiple sessions need to be taken each usually lasting for 30 – 40 minutes.


Is Self-Care at Home possible?

Lifestyle changes are proven to be effective in patients with depression. Regular exercise, adequate rest, periodic de-stressing, healthy eating habits and social support help beating depression. Avoiding alcohol or drug use, regular follow-up with Psychiatrist and completing medication course are also important factors.

When is urgent medical attention required?

 You (or your family) may need to contact your family doctor, psychiatrist, counselor if any of these events occur:

  1. You are experiencing any unexpected or serious medication side effects.

  2. You develop additional symptoms of depression, particularly if those symptoms are severe or develop rapidly.

  3. You feel that you are having setbacks and your present therapy is ineffective.

  4. You continue to suffer from bouts of anxiety and depression.

  5. You have trouble coping with your feelings and are starting to feel as if you are losing control.

What is chronic depression?

Dysthymia is a chronic state of mild depression that lasts for years. It is believed to affect about 3 percent of the population at any time.  In dysthymia, the mood never seems to better for more than a day or two, draining all pleasure from life. Some people grow so used to being depressed that they think it is part and parcel of their nature rather than an illness that can be treated. Because symptoms are not as severe as in major depression, sufferers are able to carry out work. In the long run, however, because their symptoms are chronic, their relationships and work suffer.


Does depression recover completely?


The response to treatment in an individual patient may vary with some patients responding very well to treatment while in others it may be more challenging with patients requiring more than one medicine trial or need for a combination of medicines. The recurrence of symptoms after successful treatment can be seen in nearly half the patients. Drug treatment usually needs to be continued for a longer period. Lifelong maintenance therapy may be required in some patients to prevent recurrence.


Can Depression be prevented?

There are no known ways to prevent the development of the disorder. However early recognition of the illness and prompt and adequate treatment is helpful.


What is the role of family?

The understanding and attitude of the family towards illness also influence the course and outcome. The family thus need to understand the illness, understand the ways of coping with the illness, need for medications and continuation of treatment. The family also need to be alert for possible complications or crisis situations like self-harming or suicidal ideas or behavior. In such case, family should immediately report it to the doctor as this requires emergency intervention and/or hospitalization. 


What are the Rehabilitation options for patients with chronic depression?


 Rehabilitation involves the use of psychosocial therapies which include a variety of methods to increase social abilities, self-sufficiency, practical skills, and interpersonal communication in depressive patients. The goal is to enable persons who are severely ill to develop social and vocational skills for independent living. The following techniques are often useful


1.      Social Skills Training: Involves techniques for correcting anomalies in  behavioural skills

2.      Family-Oriented Therapies: Involves psycho-education of family members about the illness and ways to deal with the patient and minimising expressed emotions

3.      Cognitive Behavioural Therapy: to improve cognitive distortions, reduce distractibility, and correct errors in judgment

