What do you know about the “common cold of psychiatry” (i.e. Depression)?
By Ahmed Mujtaba Owaisi
We all feel changes in our mood from day to day. Many people say that they are feeling depressed, but what does depression means in real sense? What is the difference between every day depression and the clinical depression? What are the major causes of depression and how much dangerous it can be? Do children get depression? These are a few of many questions which everyone wants to know about depression.
What is Depression?
Depression is a severe mental disorder with a very high rate of prevalence in the whole world. Fortunately it is a treatable mental illness which can be successfully treated through treatment. Depression is diagnosed by its specific symptoms which should be present for a specific time duration.
What are the symptoms of Depression?
According to DSM-5, five (or more) of the following symptoms should have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. These symptoms cause significant impairment in social, occupational, and other areas of daily life functioning.
i. Depressed mood
ii. Diminished interest or pleasure
iii. Significant weight loss (when not dieting) or weight gain
iv. Insomnia or hypersomnia
v. Psychomotor agitation or retardation
vi. Fatigue or loss of energy
vii. Feelings of worthlessness or excessive or inappropriate guilt
viii. Diminished ability to think or concentrate
ix. Recurrent thoughts of death
How Depression is diagnosed?
There are many standardized psychological tests which are developed to measure the severity level of depression. One most commonly used test is known as “Beck Depression Inventory” which was developed by Aaron T. Beck in 1961. The revised version came in 1978 as the BDI-1A. BDI consists of 21 items. Each item is rated on a 4-point scale ranging from 0 to 3. The maximum total score is 63. These scored are interpreted as:
0-10 = these ups and downs are considered normal
11-16 = Mild mood disturbance
17-20 = Borderline clinical depression
21-30 = Moderate depression
31-40 = Severe depression
Over 40 = Extreme depression
How common is depression?
Depression is among the most common psychological disorders. Its prevalence rate is so high that it is also known as “The common cold of Psychiatry”. Statistics vary about the prevalence rate of depression. The World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression in the previous year. Depressive disorders often start at a young age; they reduce people’s functioning and often are recurring (WHO, 2012). Twelve-month prevalence of major depressive disorder in the United States is approximately 7%, with marked differences by age group such that the prevalence in 18- to 29-year-old individuals is threefold higher than the prevalence in individual’s age 60 years or older. Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence (American Psychiatric Association, 2013).
Who are at great risk of Depression?
Depression can happen to anyone including young, old, poor, or rich. There are many factors which cause depression but according to different researches the most common factors include:
- Unemployment: Those individuals which are unemployed for a long duration of time are more vulnerable to depression.
- Women: Researches show that the prevalence of depression among women is twice as compared to men. The chances further increase in those women who are caring for children without proper support.
- Genetic factors: Those people whose parents have depression have greater chances to develop depression during their life time.
- Social support: Those people who do not have proper social support from family and friends are also vulnerable to depression.
- Family loss: Those individuals became orphan before adolescence are also at high vulnerability of depression.
- Negative life events: Those individuals who have many negative life events like loss of job, divorce, loss of love ones are also at great risk of depression.
- People living in Cities: Modern researches show that those people who live in cities are at greater risk of depression as compared to the people living in villages (Peen et al., 2010)
How long depression lasts?
The duration of depression mostly varies according to the severity level. Among the majority of people the symptoms of depressive episode lasts for about three to six months and in most of cases people recover even without treatment (Moncrieff, & Kirsch, 2005). But for some people the duration of depression is more than six months and even it changes to dysthymia (another form of depression) (Furukawa et al, 2000).
Another dangerous risk factor of depression is that it is a recurrent problem. About 50% of people with depression face and other episode at some time in their life time. Fortunately both of these forms of depression are curable and can be treated by medication, psychotherapy or both of these (NIHCE, 2004).
What are the causes of depression?
Genetic factors play very important topic in the occurrence of depression. These are the genetic causes due to which the people whose parents have depression are at high risk of depression. Researches also show that in identical twins if one person have depression then there are 37% (percentage varies in different studies) that the other will also develop depression (Wender, et al., 1986) A Finnish community-based twin sample that used structured interviews to verify diagnoses obtained a heritability estimate of 93 percent (Kieseppa, et al., 2004).
There are three most important neurotransmitters associated with depression which are norepinephrine, dopamine, and serotonin. The levels of norepinephrine and dopamine are found to be low in the people with depressive disorder while the levels are high among the people with Mania. While the level of serotonin was found to be low among the people with depression and mania (Thase, Jindal, & Howland, 2002).
There are many different psychological factors may play a role in depressive disorders. According to psychoanalytic theory childhood experiences play very important role in the development of depression. For example, if a child loses his mother in the age of 13 then there are greater chances for him to develop depression in his later life.
Personality factors also play a vital role in the development of depressive disorder. Among the most important personality traits is the Neuroticism. Studies suggest that neuroticism, a personality trait in which the person reacts to events in more negative way. This trait makes him vulnerable to depression (Jorm, et al., 2000). A large study of twins found that neuroticism is a major cause of depression among the identical twins (Fanous, Prescott, & Kendler, 2004). Neuroticism is also associated with anxiety and dysthymia (Kotov, et al., 2010).
Cognitive Theories: According to the cognitive theories, negative thoughts and beliefs are found to be among the major causes of depression. Pessimistic and self-critical thoughts can lead the person to depression.
Beck’s Theory: According to Aaron T. Beck (1967) depression is associated with a negative view of the self, the world, and the future. The “world” part of the depressive triad refers to the person’s own corner of the world—the situations he or she faces. For example, the individual might think “I cannot possibly cope with all these demands and responsibilities” because he is worrying about problems in the broader world outside of his life.
How depression is treated?
The purpose of treatment of depression have two objectives, the first is to speed up the recovery from depression now and the second is to minimize the risks of depression in the future.
Antidepressants are very much effective for the treatment of depression. Different types of drugs are used according to their own advantages.
- The first category of antidepressants used for the treatment of depression is called “tricyclic”. These include amitryptiline (Tryptizol), imipramine (Tryptizol), lofepramine (Gamanil), clomipramine (Anafranil), dothiepin (Prothiaden) and others.
- The second category of antidepressant drugs is known as Monoamine Oxidase Inhibitors (MOAIs) which include phenelzine (Nardil), moclobemide (Manerix) and tranylcypromine (Parnate). This category of drugs is less prescribed to the clients because the client needs special care of food and other items while using these drugs.
- The most common category of antidepressants is known as Selective Serotonin Reuptake Inhibitor (SSRI) which include paroxetine (Seroxat), sertraline (Lustral), fluoxetine (Prozac) and others.
- Lithium carbonate (Priadel, Camcolit) and trazodone (Molipaxin) are also used for the treatment of depression but only in some cases.
Electroconvulsive Therapy (ECT):
When no medicine is proving useful for the treatment of depression then Electroconvulsive Therapy (ECT) is used. It is not used much frequently and is only given to the clients who are admitted in the hospital.
Psychological Treatment for Depression:
Interpersonal psychotherapy (IPT) is a psychological treatment for depression which is commonly used in clinical practice. The theory behind the interpersonal psychotherapy says that depression and many other psychological disturbances mostly occur due to interpersonal problems (Klerman, et al., 1984). The goal of this psychotherapy is to identify the major interpersonal issues like interpersonal conflicts, role transitions, interpersonal isolation, and bereavement. IPT is a brief psychotherapy which usually takes 16 sessions. The techniques used in this therapy includes discussing interpersonal problems, exploring negative feelings and encouraging their expression, problem solving, suggesting new and more satisfying modes, and improving the ways of communication. Several researches found IPT to be very much effective for the treatment of Depression (Mufson, et al., 1999).
The theory behind the cognitive therapy states that depression is caused by negative schema and cognitive biases. Cognitive therapy was developed by Aaron Beck and his associates with the aim of altering the maladaptive thought patterns. The therapist helps the person to change his cognition pattern which lead him to change his view about self. In this way the person views himself in a positive way rather than being worthless.
Cognitive Behavior Therapy (CBT)
CBT was developed by Aaron T. Beck which is a problem-oriented approach consisting of six to twenty sessions. This therapy is developed to be effective in less time and goal oriented. The goal is to provide long term skills to people to keep them healthy. The goal of CBT is to educate people about their perceptions and their impact on their emotions and behavior. It do not focus on childhood experiences which are the focus of psychoanalysis. This therapy guides the individuals about their emotional experience and its effect on their behavior.
According to CBT, the way people feel is associated to the pattern of their thinking about a situation and not simply to the nature of the situation itself. Beck described the negative thinking patterns related with depression in his early writings. He developed this approach to target and reduce negative thoughts to improve mood. He focused on content and thinking pattern which is related to anxiety and depression. CBT is currently the most common and effective psychotherapy used throughout the world by psychologists to treat depression, OCD, anxiety, somatoform disorders, post-traumatic stress disorder (PTSD) and anger problems (Mor & Haran, 2009).
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