All About Depression

Dr Akhlaq AhmadBSc, MBBS, MA, LLB

DPM, DFMH, Dip.L&M

Mental Health Facts• According to one study (by the National Institute of Mental

Health), 1in 5 adults in America suffer from mental illness in any given year.

In most countries, the percentage of people suffering from depression during their lifetime is 8-12%.

People are most likely to suffer their first depressive episode between their 30th and 40th birthday.

Future projections show that depression may become the 2nd leading cause of mortality (after cardiovascular disease) by 2020.

Epidemiology of Depression

It's natural to feel down sometimes, but if that low mood lingers day after day, it could signal depression.

Major depression is an episode of sadness or apathy along with other symptoms that lasts at least two consecutive weeks and is severe enough to interrupt daily activities.

Depression is not a sign of weakness or a negative personality. It is a major public health problem and a treatable medical condition.

What is depression?

The primary symptoms of depression are a sad mood and/or loss of interest in life. Activities that were once pleasurable, lose their appeal.

Patients may also be haunted by a sense of guilt or worthlessness, lack of hope, and recurring thoughts of death or suicide.

Depression Symptoms: Emotional

Hallucinations◦ Hearing voices

Delusions◦ Firmly held false beliefs

Both are mostly mood congruent

Depression Symptoms: Psychotic

Depression is sometimes linked to physical symptoms:◦ Fatigue and decreased energy◦ Insomnia, especially early-morning waking◦ Excessive sleep

Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

Depression can make other health problems feel worse, particularly chronic pain.

Treating depression has been shown to improve co-existing illnesses, e.g. memory problems.

Depression Symptoms: Physical

Changes in appetite or weight are another hallmark of depression. Some patients develop increased appetite, while others lose their appetite altogether.

Depressed people may experience serious weight loss or weight gain.

Depression Symptom: Appetite

Without treatment, the physical and emotional turmoil brought on by depression can derail careers, hobbies, and relationships.

Depressed people often find it difficult to concentrate and make decisions. They turn away from previously enjoyable activities, including sex.

In severe cases, depression can become life-threatening.

Impact on Daily Life

People who are depressed are more likely to attempt suicide.

Anyone who appears suicidal should be taken very seriously.

Warning signs include:◦ Talking about death or suicide◦ Threatening to hurt people◦ Engaging in aggressive or risky behaviour.

Suicide Warning Signs

Anyone can become depressed, but many experts believe genetics play a role.

Having a parent or sibling with depression increases your risk of developing the disorder.

Women are twice as likely as men to become depressed.

Depression: Who is at Risk?

We aren't sure what causes depression, but a prominent theory is altered brain structure and chemical function.

Brain circuits that regulate mood may work less efficiently during depression. Drugs are believed to improve communication between nerve cells.

Experts also think that while life events - such as losing a loved one.

Other triggers could include certain medications, alcohol or substance abuse, hormonal changes, or even the season.

Causes of Depression

If your mood matches the season -- sunny in the summer, gloomy in the winter -- you may have a form of depression called seasonal affective disorder (SAD).

The onset of SAD usually occurs in the late fall and early winter, as the daylight hours grow shorter.

Experts say SAD affects from 3% to 20% of all people, depending upon where they live.

Seasonal Depression

The "baby blues" strikes as many as 3 out of 4 new mothers. But nearly 12% develop a more intense dark mood that lingers even as their baby thrives.

This is known as postpartum depression, and the symptoms are the same as those of major depression.

An important difference is that the baby's well-being is also at stake.

Postpartum Depression

In the USA, depression affects 2% of grade school kids and about 1 in 10 teenagers.

It interferes with the ability to play, make friends, and complete schoolwork.

Symptoms are similar to depression in adults, but some children may appear angry or engage in risky behaviour, called "acting out."

Depression can be difficult to diagnose in children.

Depression in Children

As of yet, there is no lab test for depression. To make an accurate diagnosis, doctors rely on a patient's description of the symptoms.

Doctors ask about your medical history and medication use since these can contribute to symptoms of depression.

Discussing moods, behaviours, and daily activities can help reveal the severity and type of depression. This is a critical step in determining the most effective treatment.

Diagnosing Depression

Studies suggest different types of talk therapy can fight mild to moderate depression. CBT aims to change thoughts and behaviours that contribute to depression.

Interpersonal therapy identifies how your relationships impact your mood.

Psychodynamic psychotherapy helps people understand how their behaviour and mood are affected by unresolved issues and unconscious feelings.

Some patients find a few months of therapy are all they need, while others continue long term.

Treatment: Talk Therapy for Depression

Antidepressants affect the levels of brain chemicals, such as serotonin and norepinephrine. There are many options. Give antidepressants a few weeks of use to take effect.

Good follow-up is important to evaluate their effectiveness and make dosage adjustments. If the first medication tried doesn't help, there's a good chance another will.

The combination of talk therapy and medication appears particularly effective.

Treatment: Medications for Depression

Research suggests exercise is a potent weapon against mild to moderate depression.

Physical activity releases endorphins that can help boost mood. Regular exercise is also linked to higher self-esteem, better sleep, less stress, and more energy.

Any type of moderate activity, like walking or housework, can help. Choose something you enjoy and aim for 20 to 30 minutes daily.

Treatment: Exercise for Depression

Researchers say pets can ease the symptoms of mild to moderate depression in many people.

Pets provide unconditional love, relieve loneliness, and give patients a sense of purpose.

Studies have found pet owners have less trouble sleeping and better overall health.

Treatment: Pets for Depression

Because loneliness goes hand-in-hand with depression, developing a social support network can be an important part of treatment.

This may include joining a support group, or making a genuine effort to see friends and family more often.

Treatment: The Role of Social Support

Another option for patients with treatment-resistant or severe melancholic depression is electroconvulsive therapy (ECT).

This treatment uses electric charges to create a controlled seizure. Patients are not conscious for the procedure.

ECT helps 80% to 90% of patients who receive it, giving new hope to those who don't improve with medication.

Electroconvulsive Therapy (ECT)

In the midst of major depression, you may feel hopeless and helpless. But the fact is, this condition is highly treatable.

More than 80% of people get better with medication, talk therapy or a combination of the two.

Even when these therapies fail to help, there are further strategies which can be applied.

Good Outlook

Thank-you for listening.

Any Questions?