Depression

Depression is curable at any age.So if a person is suffering from depression, don't leave them alone,they need yours and our's help. Loneliness may lead to incurable damage to one's life.So be with your loved one's when they really need you.

                                                                                                                        With best regards 

                                                                                  CLINICAL PSYCHOLOGIST                                                                                                                                                                                               SARWAT SHABZEEN KHURSHID

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.

 Depression is also known as mood disorder.

Major depressive disorder (MDD) (also known as recurrent depressive disorder,clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder illustrated by an all-encompassing low mood accompanied by low self esteem, and by loss of interest and pleasure in normally enjoyable activities. This cluster of symptoms  was named, described and classified as one of the mood disorders.

The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors.

Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health.Family and friends may notice that the person's behavior is either agitated or lethargic.

SYMPTOMS:

According to DSM-4 the criteria of Depression is :

• Persistently low mood 
• Lack of interest in daily activities

According to ICD-10 the criteris of depression is :

• Persistently low mood
• Lack of interest in daily activities
• Gernalized weakness.

To lable someone as depression patient,one should have thses symptoms continuosly for two weeks.If these symptoms are for less than two weeks than it is known as BRIEF REACTION DEPRESSION.

Some other biological symptoms are:

• lack of concentration
• low self esteem
• decreased sleep (  Insomnia )
• Hypersomnia
• decreased apatite
• decreased libido ( sex drive )
• loss of weight
• pessimistic thoughts
• guilt feelings.
• hopelessness
• self hatred
• poor memory
• fatigue, 
• headaches, 
• or digestive problems;

In severe cases, depressed people may have symptoms of psychosis.

Its symptoms includes:

• delusions  
• hallucinations
• Suicidal ideation or attempt

CATEGORIES OF DEPRESSION:

There are mainly three different categories of depression.

• Mild
• Moderate
• Severe

Mild Depression

Minimum duration two weeks,

At least two of these  and at least two of other biological symptoms.

• Depressed mood
• loss of interest
• increased fatiguability

Moderate Depression

At least two of the most typical symptoms in addition with three or four other symptoms with the duration of  at least  two weeks.

Severe Depression

• Considerable distress
• loss of self-esteem
• feeling of guilt
• suicidal ideation

Depression vary with the age as this is not an issue just related with adults.An individual of any age can be a victim of depression.

Depressed children may often display an irritable mood rather than a depressed mood, and show varying symptoms depending on age and situation. Most lose interest in school and show a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure.Depression may also coexist with attention-deficit hyperactivity disorder (ADHD).

SUBTYPES OF DEPRESSION:

The DSM-IV-TR recognizes five further subtypes of MDD, called specifiers, in addition to noting the length, severity and presence of psychotic features:

• Melancholic depression is characterized by a loss of pleasure in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt.
• Atypical depression is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite (comfort eating), excessive sleep or sleepiness (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.
• Catatonic depression is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here the person is mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in schizophrenia or in manic episodes, or may be caused by neuroleptic malignant syndrome.
• Postpartum depression, or mental and behavioural disorders associated with the puerperium, not elsewhere classified, refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth. Postpartum depression has an incidence rate of 10–15% among new mothers. The DSM-IV mandates that, in order to qualify as postpartum depression, onset occur within one month of delivery. It has been said that postpartum depression can last as long as three months.
• Seasonal affective disorder (SAD) is a form of depression in which depressive episodes come on in the autumn or winter, and resolve in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times, over a two-year period or longer..

CAUSES:

The biopsychosocial model proposes that 

• biological,
• psychological, 
• and social factors all play a role in causing depression. 
• Thediathesis–stress model specifies that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either genetic, implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.

Various aspects of personality and its development appear to be essential to the occurrence and persistence of depression with negative emotionality as a common predecessor. Although depressive episodes are strongly associated with unpleasant events, a person's characteristic style of coping may be correlated with his or her buoyancy. In addition, low self-esteem and self-defeating or vague thinking are related to depression. Depression is less likely to occur, as well as quicker to remit, among those who are religious. It is not always clear which factors are causes and which are effects of depression; however, depressed persons who are able to reflect upon and challenge their thinking patterns often show improved mood and self-esteem.

Depression may be secondary to a specific medical condition — for example,

 metabolic disturbances, such as hypoxia and hypercalcemia; endocrine disorders, such as diabetes and Cushing’s syndrome; neurologic diseases, such as Parkinson’s and Alzheimer’s diseases; cancer (especially of the pancreas); viral and bacterial infections, such as influenza and pneumonia; cardiovascular disorders, such as heart failure; pulmonary disorders, such as chronic obstructive lung disease; musculoskeletal disorders, such as degenerative arthritis; GI disorders, such as irritable bowel syndrome; genitourinary problems, such as incontinence; collagen vascular diseases, such as lupus; and anemia.

. Depressed individuals often blame themselves for negative events.

• Poverty and 
• social isolation are associated with increased risk of mental health problems in general. 
• Child abuse (physical,emotional, sexual, or neglect) is also associated with increased risk of developing depressive disorders later in life.
• Abuse of the child by the caregiver is bound to distort the developing personality and create a much greater risk for depression and many other debilitating mental and emotional states. 
• Disturbances in family functioning, such as parental (particularly maternal) depression, severe marital conflict or divorce, death of a parent, or other disturbances in parenting are additional risk factors.
• In adulthood, stressful life events are strongly associated with the onset of major depressive episodes. In this context, life events connected to social rejection appear to be particularly related to depression.
• The relationship between stressful life events and social support has been a matter of some debate; the lack of social support may increase the likelihood that life stress will lead to depression, or the absence of social support may constitute a form of strain that leads to depression directly.
• Adverse conditions at work, particularly demanding jobs with little scope for decision-making, are associated with depression.
•  Alcoholism or excessive alcohol consumption significantly increases the risk of developing major depression.

PSYCHOLOGICAL TESTING :

A diagnostic assessment may be conducted by a suitably trained  psychologist, who records the person's current circumstances, biographical history, current symptoms and family history. The broad clinical aim is to formulate the relevant biological, psychological and social factors that may be impacting on the individual's mood. The assessor may also discuss the person's current ways of regulating their mood (healthy or otherwise) such as alcohol and drug use. The assessment also includes a mental state examination, which is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism, self harm or suicide, and an absence of positive thoughts or plans.
Different psychological tests are used during psychological sessions to evaluate the level of depression in patients.
Some of them that are :

• BDI --- BECKS DEPRESSIVE INVENTRY
• HAMD---HAMILTON DEPRESSIVE SCALE
• HADS--HOSPITAL ANXIETY AND DEPRESSION SCALE
• MADS---MONTGOMERY ASBERG DEPRESSIVE RATING SCALE
• DEPRESSION SELF-RATING SCALE
• ZUNG SELF-RATING DEPRESSION SCALE

TREATMENT :

There are three ways of treating depression :

Psychotherapy done by Psychologists

Antidepressants prescribed by Psychiatrist

ElectroConvulsive Therapy (ECT) performed by Psychaitrist.

Psychotherapies:

Different psychotherapies are used in treatment of depression.Some of them are as follows

• Cognitive behavioral therapy 
• interpersonal therapy, or family therapy
• rational emotive behavior therapy, 
• and more recently mindfulness-based cognitive therapy.
•  psychodynamic psychotherapy,
• Logotherapy

Antidepressants:

Mostly recommended antidepressants are

• Selective serotonin reuptake inhibitors (SSRIs)
• bupropion
•  Venlafaxine,
• mirtazapine
• COX-2 inhibitors

ECT (ELECTROCONVULSIVE THERAPY):

Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are sent through the brain via two electrodes, usually one on each temple, to induce a seizure while the patient is under a brief period of general anesthesia.