KATHMANDU: Depression, also known as major depressive disorder, is a mood disorder that causes persistent sadness or a lack of interest in daily activities.

It affects the body, mood, and thoughts, influencing how individuals eat, sleep, and function.

Although it’s common to experience occasional sadness, persistent or extreme feelings of depression can signal a more serious underlying condition that requires attention.

Often overlooked, the silent warning signs of depression, such as irritability, trouble sleeping, feelings of hopelessness, and lack of interest in daily activities, can signal a need for intervention.

While depression can stem from various factors like genetics, life events, or medical conditions, early detection and treatment through therapy, medication, and lifestyle changes are crucial in preventing its long-term effects, including severe complications such as suicide or chronic illness.

Types of Depression

1. Major Depression: Characterized by a depressed mood or loss of interest for at least two weeks, disrupting daily activities.
2. Persistent Depressive Disorder (PDD): Previously known as dysthymia, this chronic form of depression can last longer and may impact life more significantly than major depression. Symptoms include hopelessness, loss of interest, and reduced productivity.
3. Prenatal Depression: Occurs during pregnancy, leading to ongoing or extreme sadness.
4. Seasonal Affective Disorder (SAD): Depression that typically starts in late fall or early winter and fades in spring or summer.
5. Postpartum Depression (PPD): Affects individuals assigned female at birth following childbirth, causing major depressive episodes in the weeks or months after delivery.

Causes of Depression

Depression can be triggered by various factors, including:

• Genetics: Family history of depression increases risk.
• Brain Structure: Differences in brain chemistry and structure may contribute.
• Head Injuries: Past injuries may impact mood regulation.
• Drug or Alcohol Abuse: Substance misuse can lead to depression.
• Life Events: Stressful events like the loss of a loved one or financial struggles.
• Hormonal Changes: Fluctuations in hormone levels can influence mood.
• Early Childhood Trauma: Negative experiences early in life can increase vulnerability.
• Medical Conditions: Chronic illnesses such as cancer may contribute to depression.

Risk Factors

Several factors can increase the likelihood of depression:

• Medical illnesses
• Substance abuse
• Vitamin deficiency
• Certain medications
• Socioeconomic factors
• Family history of depression
• Gender (more common in females)

Symptoms of Depression

Recognizing the signs of depression early is crucial for effective treatment. Symptoms may include:

• Persistent sadness or low mood
• Loss of interest in hobbies or activities
• Difficulty concentrating or making decisions
• Loss of sexual desire
• Excessive feelings of guilt, helplessness, or worthlessness
• Feelings of restlessness or agitation
• Aches, pains, and headaches with no physical cause
• Changes in appetite or sleep patterns
• Fatigue or low energy
• Hopelessness or anxiety
• Suicidal thoughts or attempts

Diagnosis of Depression

To diagnose depression, healthcare professionals may perform:

1. Medical History and Physical Examination: Assess appetite, sleep patterns, activity levels, thoughts, and moods.
2. Lab Tests: Blood tests may be done to rule out other conditions.
3. Psychiatric Evaluation: A comprehensive evaluation of thoughts, behaviors, and symptoms.
4. DSM-5: The Diagnostic and Statistical Manual of Mental Disorders helps professionals classify and diagnose depression.

Treatment for Depression

Depression is often treated with a combination of medication and lifestyle therapies. Common treatments include:

• Medications: These include SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), tricyclic and tetracyclic antidepressants, and atypical antidepressants.
• Psychotherapy: Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are commonly used.
• Light Therapy: Especially for Seasonal Affective Disorder (SAD), exposure to light can be effective.
• Electroconvulsive Therapy (ECT): A treatment option for severe depression.

Natural Remedies and Lifestyle Tips

Lifestyle changes can also support mental health, including:

• Avoiding alcohol and substances
• Regular exercise
• Taking supplements such as SAMe, 5-HTP, and omega-3 fatty acids
• Ensuring adequate intake of vitamins B and D

Prevention

Taking steps to prevent depression can significantly improve mental well-being:

• Regular physical activity
• Managing stress
• Building strong relationships with family and friends
• Getting enough sleep
• Eating a healthy diet
• Avoiding drugs and alcohol

Psychological interventions such as systemic therapy, cognitive-behavioral therapy, and psychodynamic psychotherapy may help in managing symptoms and preventing relapse.

Complications of Depression

If untreated, depression can lead to severe complications, including:

• Stroke
• Heart attack
• Cancer
• Suicide
• Substance misuse
• Physical illnesses
• Work or school-related problems
• Premature death

Severe Depression Warning Signs

In severe cases, depression may manifest with alarming signs:

1. Loss of Interest in Activities: Known as anhedonia, this is a hallmark symptom of severe depression.
2. Irritability: Irritability, particularly in children and teens, can be a key symptom.
3. Hopelessness: Feeling a lack of hope can increase the risk of suicide.
4. Trouble Sleeping: Insomnia is common, as is excessive sleep.
5. Inability to Care for Oneself: Depression can make it difficult to perform daily activities, like bathing or eating.
6. Persistent Negative Thoughts: An overwhelming sense of dread or worrying about bad things happening may occur.
7. Suicidal Thoughts or Attempts: Feelings of worthlessness and sadness can lead some individuals to contemplate suicide.
8. Psychotic Symptoms: In rare cases, individuals may experience hallucinations or delusions.

Conclusion

Depression is a serious, treatable condition, but many individuals suffer in silence. Recognizing the silent warning signs of depression is essential in ensuring timely intervention and appropriate care. If you or someone you know is experiencing any of the symptoms listed, it’s crucial to seek professional help immediately to prevent the condition from worsening and to improve quality of life.