Depression, clinical depression, or Major depressive disorder is a serious mood disorder that exceeds the limits of just feeling sad, or low for a few days. Depression is very common and affects around 350 million people of all ages complicating their lives, in addition to life threatening consequences that may lead to suicide. It has many forms or subtypes, including: atypical depression, melancholic depression, dysthymia, seasonal affective disorder, and psychotic depression. Genes, life events, childhood experiences, substance abuse, medical conditions and other mental health problems are considered to be risk factors and possible causes of depression. When it comes to treatments, there are many treatment options for depression like medications, psychological therapies, electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation. 

Depression, also known as clinical depression, Major depressive disorder, Dysthymic disorder, and unipolar depression, is a serious mood disorder that exceeds the limits of just feeling sad, or low for a few days. Depression is considered so serious because it is common, can affect people of all ages complicating their lives, in addition to life threatening consequences that may lead to committing suicide.

Depression is well known with its forms that differ from each other slightly such as:

Atypical depression

It is a subtype of depression, called depression with atypical features. Atypical depression shares some features of major depression on one hand but it is characterized by improved mood when exposed to positive or good events, on the other hand.  

Melancholic depression

It is a severe form of depression characterized by melancholic features, such as: intense and persistent feelings of hopelessness and sadness, in addition to deep feelings of guilt, helpless and worthlessness. Symptoms of melancholic depression are regularly worse in the morning and accompanied by lack of appetite and weight loss.

Dysthymia

It is known also as persistent depressive disorder, or dysthymic disorder characterized by depressed mood most of the days for 2 years at least.

Bipolar disorder

If someone has bipolar disorder, they experience severe low mood episodes called depressive episodes that meet major depression criteria in addition to episodes of feeling high, and euphoric called manic episodes if they are sever or hypomanic episodes if they are not severe.

Seasonal affective disorder

Seasonal affective disorder abbreviated as SAD is considered to be a mood disorder with a seasonal pattern that starts in winter months where there is less natural sunlight. This form of depression is usually accompanied by some symptoms like over sleeping, weight gaining and social withdrawal. Though seasonal affective disorder tends to disappear during spring and summer months, it may recur every year. 

Psychotic depression

People with psychotic depression usually lose touch with reality and experience delusions represented in false beliefs and hallucinations such hearing or seeing things that other people cannot hear or see. Furthermore, psychotic depression patients feel like everyone in the world is against them which is called paranoia.

Prenatal depression

Prenatal depression, also called antenatal depression, occurs during pregnancy causing symptoms such as irritation, guilty and worthless feelings, loss of appetite, etc.  

According to The American Congress of Obstetricians and Gynecologists estimation, 14 to 23% of women will suffer from depression bouts during pregnancy.

Postnatal depression

Postnatal depression has alternative names like postpartum depression and it is a common problem that affects women after giving birth. Though postnatal depression affects women mostly, it can affect fathers as well but it is less common.

Depression is thought to be the result of several risk factors, such as genetics and life events.

In the following, you can find a number of risk factors and causes of depression:

Genetics. Depression can be hereditary though researchers have never identified one single gene responsible for having depression. However, some research results have shown that if there is a person with depression in a family, other members of the same family have higher risks of getting depression.

Life events. Some tragic and stressful events like the loss of a beloved person, being unemployed for a long time after losing a job, or getting divorced, can trigger depression.

Medical conditions. Coping with a serious or chronic disease such as diabetes or cancer can lead to depression due to the stress and anxiety caused by the long term management of such conditions.

On the other hand, some medical conditions like thyroid problems and nutrient deficiencies contribute to getting depression.

Mental health problems. Struggling with a mental problem such as, anxiety, eating disorders or post-traumatic stress disorder can trigger experiencing depression.

Drugs, alcohol and some medications. Certain medications like those used to treat high blood pressure, such as beta-blockers may cause depression as a side effect. In addition, abusing alcohol or drugs can also lead to depression.

Experiences of childhood

Childhood is a sensitive stage of any person’s life. So any difficult experiences that a child has, such as emotional, physical, or sexual abuse, neglect, traumatic events, family problems can increase the chances of getting depression later in life

Depression affects many areas in the brain as the following:

Amygdala, responsible for facilitating emotional responses like fear, anger and sorrow, becomes activated when someone remembers emotional memories like a scary situation. Amygdala becomes larger and more active in people with depression which contributes along with abnormal activity of other parts of the brain to sleep and activity patterns problems.

 Thalamus, is referred to as the secretary of the cerebral cortex controlling important functions such as talking, seeing, thinking, and memory. In one study, researchers at UT Southwestern Medical Center have found that people suffering from severe depression have more nerve cells in the thalamus which is larger in size comparing to other people.

Hippocampus plays an important role in recalling and processing long-term memory. According to Harvard university publications, continuous exposure to stress impairs the growth of nerve cells in hippocampus which explains the smaller hippocampus in people with depression.

The symptoms of depression appear as the following:

• Persistent feelings of sadness, anxiety or depressed mood.
• Loss of interest or pleasure in activities used to be enjoyable.
• Significant weight changes or changes in appetite.
• Pessimistic, hopeless feelings.
• Feelings of worthlessness, guilt or helplessness.
• Fatigue or decreased energy.
• Sleeping difficulty or oversleeping.
• Difficulties concentrating, paying attention, or remembering.
• Restlessness, or irritability
• Unexplained pains and aches, cramps or digestive problems that do not get better with treatment.
• Social withdrawal.
• Low performance at school or work.
• Substance abuse.
• Thoughts of death, suicide, or suicide attempts.

Psychiatrists diagnose depression according to the criteria of DSM-5:

• Loss of pleasure or interest in daily activities or depressed mood for a period of time that exceeds two weeks.
• Changes in mood that represent a deviation from the person’s usual mood.
• Troubled or impaired occupational, social or educational functions.
• At least 5 out of the following symptoms present almost every day:
  • Loss of interest or pleasure in activities used to be enjoyable.
  • Depressed mood or irritable most of the day, nearly every day.
  • Significant weight changes or changes in appetite.
  • Insomnia or hypersomnia.
  • Feelings of worthlessness, guilt or helplessness.
  • Fatigue or Decreased energy.
  • Activity change, meaning agitation or retardation of Psychomotor.
  • Difficulties concentrating, paying attention, or remembering.
  • Thoughts of death or suicide, or suicide attempts.

On the other hand, the doctor may ask the patient to do some screens and tests for conditions that mimic or co-exist with depression such as:

Substance abuse, such as alcohol, drugs and some medications.

Medical illnesses that may cause depression or depressed mood like diabetes, heart disease and hypothyroidism 

Psychiatric disorder other than depression such as bipolar, schizophrenia, etc.

Bereavement: The diagnosis of depression is generally not given unless the symptoms are still present 2 months after the loss or there are suicidal thoughts, morbid preoccupation with worthlessness, psychotic symptoms, or psychomotor retardation.

Medications

There are several types of medications available in order to treat depression such as:

• Antidepressants

Antidepressants represent a group of medications that include:

• Selective Serotonin Reuptake Inhibitors. This class of drugs is widely used to treat depression and some mental health condition like panic disorder, obsessive compulsive disorder, bulimia, etc.

 SSRIs are considered to be safer and have less number of side effects than most other classes of antidepressants. Examples of SSRIs include citalopram, escitalopram, fluoxetine, fluvoxamine, fluvoxamine CR, paroxetine, and sertraline.

• Serotonin-norepinephrine reuptake inhibitors.  SNRIs are prescribed to treat depression, and anxiety disorders in addition to chronic pain such as nerve pain. So, they are helpful for depression patients who have chronic pain. SNRIs include desvenlafaxine, duloxetine, venlafaxine, and milnacipran.
• Tricyclic antidepressants. This class of medications is used to treat depression and some other conditions like migraine and bedwetting. Examples of Tricyclic antidepressants, known also as cyclic antidepressants, include mitriptyline, clomipramine, doxepin, imipramine, trimipramine, desipramine and protriptylin.
• Monoamine oxidase inhibitors. MAOIs represent the first class of medications developed for treating depression. Though they are well known with their interactions and side effects, they are still good for some patients. Examples of MAOIs can include isocarboxazid, phenelzine, selegiline and tranylcypromine.
• Atypical antidepressants. Their name suggests that they are not typical, meaning they do not fit into any other antidepressant classes and each drug of them works in ways that differ from other medications. Best examples of atypical antidepressants are bupropion, mirtazapine, nefazodone, trazodone, and vortioxetine.

• Tranquillizers. They are a class of drugs that depresses the central nervous system and induces a state of relaxation. Tranquillizers can be divided into two categories: Minor and major. Alprazolam, clonazepam, flurazepam, and diazepam are examples of minor tranquillizers while haloperidol, chlorpromazine and fluphenazine are examples of major tranquilizers.
• Mood stabilizers. These drugs are usually used to treat mood disorders characterized by a serious change or shift in mood such as bipolar disorder. Mood stabilizers, such as lithium, carbamazepine, and valproic acid, may help with acute episodes of depression and mania and prevent them from recurring.

The doctor may recommend a combination of two antidepressants or adding drugs such as mood stabilizers to help treating depression.

Psychological Treatments

Cognitive behavior therapy

CBT is considered to be one of the best treatments for people suffering from depression. It helps patients identify thoughts making them depressed or the ones that prevent them from getting better. So, the patient becomes more likely able to think rationally and turn negative thoughts and reactions to more realistic and positive ones.

Interpersonal therapy

IPT is a structured and time limited approach that is complete usually within 12 to 16 weeks. IPT focuses on relationships of a patient with family members, and peers in addition to exploring relationship issues in order to help patients identify and deal effectively with their interpersonal problems.

Behavioral therapy

It is a component of cognitive behavior therapy that emphasizes the correction of unpleasant, destructing, maladaptive behavior patterns and encouraging the pleasant and satisfying ones.

Mindfulness meditation

 It is delivered in groups usually and teaches patients how to focus on the present moment whether it is good or not without any try to change it. Mindfulness meditation gives the patients the ability to notice negative emotions and thinking patterns before they become fixed which will make it easier for the patient to detect and deal with warning signs effectively.

Other treatment options

Electroconvulsive therapy. ECT is a procedure in which electrical currents are passed through the brain to relieve severe symptoms of depression if a patient has not had good results of other therapies and treatments. Though it has some side effects like headaches and temporary loss of memory for some people, ECT is considered safe and effective.

Transcranial magnetic stimulation. Unlike Electroconvulsive Therapy, TMS doesn’t require general anesthesia, it uses smaller electric current on a region of the brain that controls mood, and it does not cause consciousness loss or seizures.

Though FDA has approved the procedure for depression, research has not proved that it is as effective as electroconvulsive therapy for depression.

Vagus nerve stimulation. It is surgical procedure involving implantation of a pacemaker-like device in the chest to stimulate electrical impulses of the vagus nerve. Vagus nerve stimulation is used to treat epilepsy and depression cases that have not responded to other therapies.

If left untreated, depression can have serious and long term consequences:

 Health issues: Symptoms of depression prevent the patients from taking care of themselves because they are not interested in doing anything, And find it hard to sleep, eat well, etc. if not treated, and depression worsens and becomes a vicious circle of bad health making the patients defenseless against disease like influenza in addition to worsening health problem they already have like diabetes. 

Relationship issues: if a person ignores treating their depression, the symptoms will be severe which drains them physically, mentally and even emotionally affecting negatively their relationships with other people. So, they become more isolated and lonely which adds more negativity on their state of mind.

Sexual Issues: neurotransmitters expand communications of brain cells and play a role in increasing blood flow to sex organs in both men and women. But, those communications are not as effective as they should be if someone has depression causing low or no sexual desire.

Self-harm: Symptoms of depression and negative patterns of thoughts and feelings force some patients to try anything to cope with what they feel such deliberately harming themselves which may lead to serious injuries and accidental death in some cases.

 Committing suicide: When depression is not treated, suicidal thoughts buildup and get worse with time giving the patient a feeling that death is the only way out of the pain caused by depression which leads to suicidal attempts that may be successful somehow.

Substance abuse and addiction: Ignoring depression treatment leads to more complications in thoughts and feelings which makes some patients try alcohol or drugs in an attempt to relieve the severity of depression. Doing so increases the chances of getting used or addicted to such substances and magnifying suicidal thoughts as well.

Though there is no one hundred percent sure way to prevent depression, the following steps enhance your general mental health in the long run:

Staying connected: Getting involved in social activities, such as visiting friends and relatives, keeps the mind occupied and away from negative thinking patterns and prevents people from withdrawing from social life and suffering from loneliness which may lead to depression.

Staying active: Any type of physical activities for at least 30 minutes, three to five times a week is good for both mental and physical health in addition it improves mood in general.

Healthy diet: There are some kinds of food known with their benefits to mental health, such as:

Beans: They are rich in folic acid, and B vitamin that are important to the brain health.

Oily fish: Salmon, tuna, and sardines are great sources of omega-3 fatty acids that help building serotonin neurotransmitter regulating mood which is also called happiness hormone.

 Vitamin D: Researchers at University of Texas Southwestern Medical Center has found a strong relation between adults who have a history with depression and Vitamin D deficiency. Vitamin D is available in dairy products, and fish but the human body requires sunlight to be able to create it.

Relieving stress: having a joyful hoppy or activity like reading, writing, drawing, or yoga is very effective in terms of relieving stress and its effects.

Planning in advance: planning for life challenges and difficulties can set the mind free of future uncertainty reducing stress and anxiety as well.

While some people with depression experience no symptoms after having one or two depression episodes, other patients suffer from recurring depression for years.

Symptoms of depression can be relieved over a period of time when a patient finally is able to adjust with their new circumstances only if the depression was triggered by events such as financial problems, unemployment or loss. On the other hand, if Symptoms of depression have not been addressed fully in a treatment course, the risks of depression recurring are higher.

Depression does not disappear by its own and it gets worse and worse with time if left untreated. It is important to know that depression with alcohol and some drugs is a very dangerous mix. In spite of the fact that taking steps towards depression treatment is very hard, patients should recognize and acknowledge their condition.

Depression is very common among people across the globe and it affects women more than men. According to the world health organization estimation in 2016, there are around 350 million people of all ages who suffer from depression. Also, depression is considered a major reason for the overall disease burden worldwide and the leading cause of disability in the world.