What Is Depression?

 

Depression is a mood disorder, and it represents one of society's most costly and challenging health burdens (Robinson, 2018). According to the American Psychiatric Association, depression is one of the most common mental disorders in the world. Although Depression is a common disorder it is one of the poorly understood psychiatric conditions (Robinson & Roiser, 2016). In depression, the body, mood, and thoughts are affected. Depression is characterized by persistent low mood, loss of interest and enjoyment, and reduced energy.  Depression is frequently taking a chronic course (Cladder-Micus et al., 2015).

A major depressive episode is characterized by a low mood or an inability to experience pleasure (anhedonia), or both, for more than 2 weeks, combined with several cognitive and vegetative symptoms and the occurrence of distress or impairment (APA, 1994). Major depressive disorder is caused by the cumulative impact of genetics, adverse events in childhood, and ongoing or recent stress (Marije et al., 2009). Major depressive disorder affects more than 10% of the population (Hales et al., 2014) and with a lifetime prevalence of over 15% (Irwin& Miller, 2007).  It is associated with significant costs in quality of life and lost work productivity (Culpepper et al., 2015), and high relapse rates (Cladder-Micus et al., 2017).

Depression has many negative consequences. Self-harm and suicidal behavior exist at all times during major depressive episodes. Depression is the cause of over two-thirds of the 30,000 reported suicides in the U.S. each year (White House Conference on Mental Health, 1999). Sometimes depressed individuals experience psychotic symptoms.  The World Health Organization (WHO) predicts that by the year 2030 depression will be the leading cause of disability worldwide (World Federation for Mental Health, 2012).

Depression and Risk of Suicide 

People with depressive disorder have an increased risk of experiencing suicidal thoughts, planning suicide, carrying it out and even dying from suicide. About one-half to two-thirds of all suicides are by people who suffer from mood disorders (Isometsä, 2014). Depressive thoughts and loneliness are potential risk factors associated with depression and suicidal ideation. Moreover, a history of self-injurious thoughts and behaviors is consistently cited as one of the strongest predictors of future suicidal behavior( Ribeiro et al., 2016). In the majority of patients with mood disorders, suicidal behavior is predictable and preventable. Successful, acute, and long-term treatment of these patients substantially reduces suicidal behavior even in high-risk populations (Rihmer, 2007).

Post-Partum Depression (PPD) 

Postpartum depression refers to non-psychotic depression that occurs shortly after childbirth and it is often unrecognized and untreated.  Postpartum depression has been associated with disruptions in maternal–infant interactions. Postpartum depression can manifest with symptoms of mood lability, tearfulness, anxiety, insomnia, and irritability.  In some cases, a woman will not disclose that she has psychological problems but will instead focus on physical symptoms.  Women with PPD may lose interest or no longer enjoy activities that used to give them pleasure.  Sleep disturbance is a common symptom of depression. Psychomotor retardation ( physical feelings of being slowed down, moving slowly, experiencing sluggishness) or Psychomotor agitation ( refers to feelings of restlessness, jumpy, and on edge) is often noticed.  Some individuals have excessive and inappropriate feelings of guilt or worthlessness. 

 

Treatment of Depression 

The treatment of depression is important because people with untreated depression have a lower quality of life, a higher risk of suicide, and worse physical outcomes Medications and psychotherapy are effective for most people with depression. Antidepressants are the most effective medication for treating depression symptoms. Stopping treatment abruptly can cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression.

Drug Therapy in Depression

There are various medications for the treatment of depression.  Antidepressant medications are most commonly used to help relieve the distress of depression. The most commonly used antidepressants:  Tricyclic antidepressants (TCAs) Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin noradrenaline reuptake inhibitors (SNRIs). Antidepressants aim to increase the availability of neurotransmitters like serotonin.  Antidepressants can take up to several weeks to be fully effective.

Psychotherapeutic Interventions in Depression

Psychotherapy is the process of treating psychological disorders with verbal and psychological techniques. Various psychotherapeutic interventions have been developed to treat depression, including cognitive-behavioral, interpersonal, humanistic, and psychodynamic approaches.  Most types of psychotherapy foster a relationship between therapist and client to help individuals identify and overcome negative thoughts or behavioral patterns. 

Cognitive-Behavioral Therapy (CBT)

CBT focuses on addressing both the negative thought patterns and the behaviors that contribute to depression. CBT is based on cognitive theory and was developed by Aaron Beck for anxiety and depression. Beck developed specific procedures to help challenge a depressive client's assumptions and beliefs and help patients learn how to change their thinking to be more realistic and thus leading to feeling better. CBT targets current problems and symptoms and focuses on recognizing the relationship between behaviors, thoughts, and feelings and changing patterns that reduce pleasure and interfere with a person’s ability to function at their best.

Interpersonal Psychotherapy (IPT) 

Research has demonstrated that depression often follows a disturbing change in one's interpersonal environment such as the death of a loved one (complicated bereavement), a struggle with a significant other (role dispute), or some other life upheaval: a geographic or career move, the beginning or ending of a marriage or other relationship, or becoming physically ill (a role transition). Interpersonal psychotherapy focuses on improving problematic relationships and circumstances that are most closely linked to the current depressive episode. The central idea of IPT is that psychological symptoms can be understood as a response to current difficulties in everyday relationships with other people.

Psychodynamic Therapy 

Psychodynamic therapy for depression refers to a type of therapy that involves examining a person's past in order to fix their present situation. This type of therapy has its origin in Freudian psychoanalysis. Psychodynamic therapy focuses on unconscious thoughts, early experiences, and the therapeutic relationship to understand current challenges, improve self-awareness and support the patient in developing more adaptive patterns of functioning.  Psychodynamic therapy is designed to help patients explore the full range of their emotions, including feelings they may not be aware of. By making the unconscious elements of their life a part of their present experience, psychodynamic therapy helps people understand how their behavior and mood are affected by unresolved issues and unconscious feelings.

Dialectical Behavior Therapy   

DBT was developed by Marsha Linehan, Ph.D., a cognitive behavioral psychologist. In her work with patients who had chronically suicidal tendencies or self-harming behavior. Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). Its main goals are to teach people how to live in the moment, develop healthy ways to cope DBT teaches tangible skills to regulate and tolerate mood, and modify ineffective behaviors to reduce crises with stress, regulate their emotions, and improve their relationships with others. DBT is effective in the treatment of common symptoms of depressive disorders. DBT helps in Increasing interpersonal effectiveness, Regulating painful emotions, Tolerating emotional distress, and Developing mindfulness skills to help to become fully aware and accepting of the present moment

EMDR

Eye movement desensitization and reprocessing (EMDR) is an evidence-based, highly effective intervention for treating depression. In the studies investigating EMDR as a treatment for depression, results showed the practice to be very effective, especially in cases of trauma-induced depression. This variation of depression is specifically induced by a life-changing event, such as a bereavement, and although trauma-induced depression shares many of the same symptoms as other depressive disorders.  EMDR as a therapy treatment for depression has proven results in tackling the root of the traumatizing memories which enable these negative thoughts. 

Clinical Meditation to Treat Depression 

Meditation is a non-pharmacological intervention and an effective cognitive technique for treating depression. It can change the way that depressed people think and feel about their experiences.

Meditation brings awareness to thoughts and feelings, without making judgments, allowing the individual to become less trapped in his depressive thoughts. Through meditation emotional and cognitive symptoms of depression can be restored. Meditation helps to change the negative core beliefs connected with depression.  Meditation augments emotion regulation.  Practicing mindfulness and self-compassion helps the depressed person to recover efficiently. Meditation helps to reduce depressive rumination and worry. Also, it improves sleep and functionality.

Growing research literature has documented the effectiveness of mindfulness-based interventions for depressive disorders (Hazlett-Stevens, 2012). Mindfulness meditation has been shown to be effective in relieving the suffering of depression (Sanders, 2010). Strauss and colleagues (2014) recommend mindfulness-based interventions for people diagnosed with depressive disorder.  

Written and compiled by Dr. Ruwan M Jayatunge