Clinical depression is common
In the UK, one in four adults is diagnosed with a mental health condition at some point during their lives, and the self-reported figure is even higher.
Depression is one of the most well-known conditions, yet, many people have a poor understanding of this debilitating condition.
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What is depression?
Depression can occur in many different ways. The common way of describing depression is a persistent subdued mood. Symptoms may vary between individuals, and include the following:
• Subdued mood (feeling ”low”)
• Lack of initiative
• Low energy
• Feeling weepy
• Changes in sleep patterns
• Changes in appetite
• Increased irritability and anger
• Lack of focus
• Suicidal thoughts or thinking a lot about death in general
• Self-harming behaviour
• Low self-esteem
A depressed individual doesn’t have to exhibit all of the above signs. For example, sleep and appetite issues can manifest differently in different people. One person may experience insomnia and poor appetite, while another may suffer from the opposite: being overly sleepy and eating too much.
Subtypes of depression
Clinical depression is the most common form. This refers to a state of subdued mood lasting for two consecutive weeks or more.
Dysthymia is a chronic low-grade depression lasting for two years or more.
Exhaustion syndrome is often called “burnout” and can cause many symptoms of depression. The condition is most often linked to symptoms of tiredness and difficulty coping.
SAD (Seasonal Affective Disorder) is a form of depression linked to a specific time of year, most commonly winter. A lack of natural daylight exposure is thought to play a part in this condition, during the colder and darker months of the year.
Bipolar depression means that the patient shifts back and forth between periods of mania (abnormally elevated mood) and depression.
Depression and pregnancy
Depression during pregnancy and following childbirth is sometimes considered a taboo subject to talk about. Women are often expected to be happy and “blissful” when they are having a child and therefore the subject is not often discussed, although depression is not uncommon during this time.
Depression during pregnancy
Pregnancy leads to many changes – not just in your body, but there can be big changes to your life in general.
Your body is subject to a lot of stress and hormone levels can fluctuate greatly. These changes can contribute to depression.
Women who are previously already sensitive to hormone changes, for example linked to their menstrual cycle, or who have experienced depression in the past, can have an increased risk of depression during pregnancy.
Depression after childbirth is more commonly discussed and is known as postpartum (or postnatal) depression.
Childbirth and the time afterwards can cause a lot of new stresses and changes in a person’s life, which can lead to depression.
It is very common for people suffering from postpartum depression to not seek help, for example because they have an expectation on themselves that they should be able to cope, otherwise they are a poor parent.
It is very important that you talk to your GP if you are experiencing negative feelings during pregnancy or after birth, so you can get the right support.
It should also be noted that it is common for partners to experience depression after childbirth, and they should also not hesitate to seek help.
Depression in elderly people
It is common to experience depression as we get older due to a large number of changes in our body and our surroundings.
As we age, levels of some neurotransmitters (brain messenger substances) often decline, which can have a negative effect on mood and cognition.
Older people are also generally more prone to physical disease, which weakens the entire body—mind system and makes you more susceptible to depression.
Nutritional deficiencies—either due to poor appetite, irregular meal habits, or malabsorption—can also play a part.
The existential challenges that come with old age is another factor. Losing loved ones for example can be deeply saddening, for example the loss of a long-term partner and the feeling of being alone for the first time in many years. Or your financial situation upon retirement may not be as good as expected. These factors can all contribute to depression. If it is hard to go to your GP, you may wish to consider booking a video call with a psychologist to get support.
Depression in young people
Growing up can present many challenges with so many physical and psychological changes in your life, and sometimes things can go wrong.
Childhood trauma can cause depression, even in infants. There can be a long delay (several years, in some cases) in symptom manifestation, making it difficult to link the traumatic event to the subsequent depression.
Adolescence is an intense period of development for most people. Puberty induces rapid physical transformations, and your social life—school, peer groups, finding romantic partners—can change almost overnight. It’s not surprising that adolescents are prone to mood swings which sometimes may lead to clinical depression.
Symptoms of depression in young people can differ slightly from its presentation in adults:
• Overt anger and irritability. The child or adolescent may act out aggressively.
• Social withdrawal.
• The child may become excessively dependent on their caretaker(s) and experience abnormal separation anxiety.
• Self-harming behaviour.
• Difficulties focusing, e.g. in school.
• Psychosomatic pain (mental suffering manifesting as physical pain). This is especially common among small children, who may not be able to verbalize their emotions.
Causes of depression
Low levels of certain neurotransmitters—especially monoamines: serotonin, dopamine, and norepinephrine—are thought to contribute to clinical depression. Neurotransmitters are chemical substances that affect mood, cognition, and even physiology (e.g. gut function; muscle tone).
Nutritional deficiencies can also cause depression, since many vitamins, minerals, and amino acids are essential for the manufacturing and synthesis of the above mentioned neurotransmittors.
Inflammation—especially of some distinct brain regions—as well as gut flora (microbiome) health can also influence your mood, according to some researchers.
Trauma can lead to depression, if the sufferer has failed to integrate (make sense of and/or let go of) the experience. Physical assault, automobile accidents, childhood neglect, or sexual violence are common causes of trauma.
Negative thought patterns and/or improductive rumination may also contribute to depression. A feeling of helplessness means that the individual experiences a lack of control over their own destiny. Although this may be true to some extent for a given individual, questioning and challenging these perceptions can be empowering and reduce symptoms of depression.
Testing for depression
There are many online questionnaires claiming to assess and even diagnose depression. However, most of these are not scientifically valid. If you think you may be depressed, it is better to consult a licensed clinical psychologist or psychiatrist.
CBT, cognitive behavioural therapy, is proven to be an effective treatment for many cases of clinical depression. The treatment is based on identifying and correcting negative ideas and thought patterns, and actively changing your behaviour on a day-to-day basis. When you make an effort to change your thoughts and behaviour in a more positive direction, your mood is likely to follow suit.
Drugs can give some relief if administered properly. SSRIs, which increase brain serotonin levels, are the most common. They may have undesired side effects and be difficult to wean off, so some caution is warranted. A combination of talking therapy and medication can sometimes yield better results than a stand-alone intervention.
ECT, electroconvulsive therapy, may be effective in severe cases of depression. During anaesthesia, the patient receives electrical shocks to the brain. For some unknown reason, this therapy ”resets” the central nervous system and may bring on great symptom relief.