All About DEPRESSION- Can it be self-managed?

Worldwide, over 970 million individuals belonging to all ages suffer from a mental illness. Out of this, more than 264 million people suffer from depression. Yes! It is that common but it is extremely dreadful at the same time. Depression has become the leading cause of disability and can lead to suicide too. People today use the term ‘depression’ very loosely and have blurred the lines between feeling low and actually suffering from a mental illness.

It is okay to feel sad after a bad day or grieve after the death of a loved one. These mood fluctuations and transient emotional responses to the hardships of everyday life cannot be labelled as depression. It is depression only when you feel sad persistently for a long period of time and it starts hampering your everyday activities.

By definition, Depression is a mood disorder which includes a persistent feeling of sadness and loss of activity level and interest. It is not quite the same as the mood swings that individuals routinely experience as a part of life. Depression is an ongoing issue, not a passing one. It comprises of episodes where the symptoms last for at least 2 weeks.  Depression can persist for several weeks, months, or years. (Goldman, 2019)

The COVID-19 pandemic has marked its effect on depression by doubling the depression rates. According to a meta-literature review published in JAMA Pediatrics, the rate of depression increased from 8.5% to 25% within the last two years. One in four children has depression. (McLernon, 2021). Currently in India, more than 65% of those aged 18-24 years in India suffer from depression. (Roy, 2021). The pandemic-induced unemployment, lack of social settings- isolation, monetary struggles and loss of near ones have highly contributed to the lower mental well-being of people.

 

There are several causes of depression which can range from biological to situational factors. The most common causes of depression are (Higuera, 2020) -

1. Early Childhood Trauma: Your childhood environment can affect the way your body responds to stressful and fear-oriented situations

2. Family History: Hereditary can be a major cause of developing depression.

3. Medical Condition: Chronic Illness such as insomnia, Down syndrome, or Attention-Deficit Hyperactivity Disorder (ADHD) can expose you to a greater risk of depression.

4. Brain Structure: Scientists are still unsure, but they say that if the frontal lobe of the brain is less active, the chances of depression increase. In addition, changes in the brain’s neurotransmitter levels too can cause depression.

5. Drug use: Alcohol misuse or a history of drugs can lead to higher risks of depression. 

6. Situational Factors: Death of a loved one, Loss of job, etc.

 

Depression can be divided into several categories based on the severity of symptoms. It can range from mild and temporary to severe and ongoing depressive episodes. The most common types of depression are-

1. Major Depressive Disorder:  This is the most severe form and is characterized by continuous feelings of hopelessness, sadness and worthlessness which interfere with everyday life. The symptoms should last for a minimum of over a 2-week period to be diagnosed.

2. Persistent Depressive Disorder: Also known as dysthymia, this is a chronic, but milder form. To be diagnosed, the symptoms should last for at least 2 years.

3. Seasonal Affective Disorder: This type of depression can be treated with light therapy as it is caused due to reduction in daylight during the winter seasons.

4. Postpartum Depression: This depression occurs in females, after the delivery of a child when the levels of hormones readjust.

                                                                     

The symptoms of Depression can vary greatly and can be different for different people and age groups. Depending on these symptoms and their severity, different treatments can be suggested. For a better and clear understanding, I have divided it into the following three groups-

 

1. When the behaviour includes negative feelings such as sadness but is normal behaviour to the abnormal situation: This step into understanding the difference between depression and depressed mood. As mentioned earlier, depression is not the same as feeling down or being in a bad mood for a few days. It is normal for a person to feel low after a hard day at work. Negative feelings such as sadness or helplessness when someone loses a job, shifts into a new city, or a loved one dies are normal reaction behaviour to an abnormal situation. During these abnormal situations, the signs and symptoms can include-

• ·         ·Loss of appetite
• ·         ·Disrupted Sleep cycle
• ·         ·Feeling of grief
• ·         ·Increase in self-doubt
• ·         ·Lack of motivation
• ·         ·Reduced energy
• ·         ·Difficulty in concentrating, and other similar symptoms

·         It can only be diagnosed as depression if you feel this way for more than 2 weeks.

When you feel low as an outcome of normal behaviour in an abnormal situation, the following treatments are seen to be useful-

• ·         ·Take things slow and don’t be hard on yourself
• ·         ·Meditate and indulge in mindful activities
• ·         ·Take morning or evening walks
• ·         ·Indulge in games or sports
• ·         ·Try to think positive by remembering the good things that happened to you lately, or the things that you are grateful for in your life, or your achievements.
• ·         ·Try putting yourself in a good mood by watching a movie, talking to a friend, spending time with family or listening to your favourite music.

 

2. When the symptoms are prolonged but can be self-managed: This is the condition where the individual shows depressive symptoms but does not fulfil the criteria of having a depressive disorder. (Cuijpers & Smit, 2008). This includes the symptoms which persist but are yet mild and can be overcome through self-management. This refers to the subclinical level of symptoms. This group includes a mild reaction to a situation that is not considered normal. This can be also considered as the starting phase, where if the symptoms are not controlled and checked it might lead to something more serious. In this scenario, taking adequate preventive measures is highly important. (Ji, 2012). The symptoms here are the same as in the previous group, but are higher in intensity and involve other signs as well. The symptoms are-

• ·         Loss or increase in appetite
• ·         Weight loss or weight gain
• ·         Lack of sleep or increase in sleep
• ·         Rapid heart rate or breathing
• ·         Restlessness
• ·         Feelings of anxiety
• ·         Irritability
• ·         Emotional outburst
• ·         Panic in normal situations
• ·         Lost Interest in things which you once enjoyed
• ·         Increased fatigue

If these symptoms persist even longer, or the intensity changes from mild to intensive, it might be surfaced as Clinical Depression. This diagnosis can only be led by mental health professionals.

When the behaviour is considered to be not normal but mild enough, then self-management tips can be helpful. These are –

• ·         Set small and achievable goals in the morning. Try to complete those small goals each day.
• ·         Reward yourself for your efforts and for completing those goals
• ·         Make a schedule and try to stick to it
• ·         Do things that you enjoy- watching a movie, listening to music, dancing, etc
• ·         Assess your emotions part by part and not generalize it
• ·         Don’t dismiss your feelings
• ·         Practice gratitude
• ·         Try meditation and mindfulness techniques
• ·         Eat healthily
• ·         Take evening or morning walks. Even better, start exercising.
• ·         Acknowledge your feeling and understand where your feeling is stemming from
• ·         Give yourself a constructive space to channel your feelings
• ·         Don’t push yourself too hard. Instead, meet yourself where you are
• ·         Accept your feelings and your shortcomings
• ·         Use essential oils- it is proven that using essential oils such as chamomile or lavender can help you relax and sleep better.

‘The key to self-treatment for depression is to be open, accepting, and loving toward yourself and what you’re going through.’ (Holland, 2018)

                                                               

                                          

3. When the symptoms persist and the behaviour is significant to warrant a clinical intervention: This category includes dealing with cases where the behaviour is serious enough to be guided by professionals. If you are feeling hopeless and anxious continuously on a regular basis over prolonged weeks and months, then you might be facing clinical depression. Clinical depression is an ongoing process, which might last weeks, months and even years. It can be as detrimental as causing the patient to even indulge in self-harm. At this stage, the situation could get worse without adequate clinical intervention. When the behaviour and signs become intense that it is adversely affecting the everyday life and performance of the individual, then a clinical intervention becomes urgent. Major depression witnesses a variety of signs and symptoms affecting your mood and body. These symptoms are maybe irregular or ongoing. Signs and symptoms of clinical depression are-

• ·         Panic attacks
• ·         Social Isolation
• ·         Recurring Suicidal thoughts
• ·         Self-harm tendencies
• ·         Physical pain
• ·         Fatigue and low energy throughout the day
• ·         Trouble maintaining relationships
• ·         Significant Weight gain or loss
• ·         Slowed thinking or movement
• ·         Indecisiveness and loss of concentration
• ·         Loss of interest even in regular activities
• ·         Feeling of guilt and hopelessness
• ·         Excessive intrusive thoughts
• ·         Sleeping too less or sleeping a lot
• ·         Out-of-control emotive outburst
• ·         Reduction is activity level
• ·         Excessive sweating and breathlessness
• ·         Rapid heartbeat
• ·         Excessive mood swings
• ·         Substance use problems

The diagnosis of depression can only be carried out by mental health professionals. Self-diagnosis and treatment of depression are absolutely not recommended as they will only make the situation worse. Mental Health professionals have different means of diagnosis and treatment which is imperative to treat depression adequately. Guidance on seeking the right mental health intervention for those with clinical symptoms are-

·         The primary is to choose the right therapist according to your needs and consult them

1. ·         Psychotherapy- Also known as talk therapy. It includes one-to-one counselling where the therapist tries to regulate the patient.
2. ·         Antidepressants- These are the medications prescribed by professional therapists that help balance brain chemicals. These antidepressants should only be taken under the guidance of a mental health expert and can include a number of side effects such as nausea, constipation, low blood sugar, etc.
3. ·         Brain stimulation therapies- It is used in extreme cases when people don’t respond to psychotherapy and antidepressants. Here, doctors use electrical pulses to alter the activity of the brain.
4. ·         Electroconvulsive Therapy- This is used for severe depression. In this case, the doctor puts the patient to sleep and sends electrical currents through the brain in order to cause a short seizure. This treatment is proven to ease the intensity and symptoms of depression.

·         Other than these, individuals should also keep trying to improve their lives at a personal level by the means described in earlier groups.

 

Lately, with the emergence of social media and artificial intelligence, there are several apps (such as 21 days challenge, inner hour) and Instagram pages (such as @hereforyour_mind, @therapy.india) that are suggesting viable ways to enhance mental-well being in the most fundamental manners. Something as serious ad depression needs adequate awareness and people should opt for the right kind of treatment. There are many government initiatives too which aim to help individuals with depression. Depression is serious, don’t take it lightly!

 

References- 

1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. DOI.

2. Wang et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet. 2007; 370(9590):841-50.

3. Depression. (2020). World Health Organisation. Retrieved from- https://www.who.int/news-room/fact-sheets/detail/depression

4. McLernon, L. M. (2021). Depression and anxiety doubled in children, pandemic study says. Retrieved from- https://www.cidrap.umn.edu/news-perspective/2021/08/depression-and-anxiety-doubled-children-pandemic-study-says

5. Lastoe, S. (2021). Depression Treatment Is Different for Everyone. Retrieved from- https://www.webmd.com/depression/features/depression-treatment-different-everyone

6. Goldman, L. (2019). What is depression and what can I do about it? Retrieved from- https://www.medicalnewstoday.com/articles/8933#treatment

7. Fava G. A. (1999). Subclinical symptoms in mood disorders: pathophysiological and therapeutic implications. Psychological medicine, 29(1), 47–61. https://doi.org/10.1017/s0033291798007429

8. Ji J. (2012). Distinguishing subclinical (subthreshold) depression from the residual symptoms of major depression. Shanghai archives of psychiatry, 24(5), 288–289. https://doi.org/10.3969/j.issn.1002-0829.2012.05.007

9. Roy, P. (2021). The COVID-19 Outbreak Has Been Draining Young India’s Mental Health Capital. Retrieved from- https://science.thewire.in/health/the-covid-19-outbreak-has-been-draining-young-indias-mental-health-capital/

10. Holland, K. (2018). How to Fight Depression: 20 Things to Try. Retrieved from- https://www.healthline.com/health/depression/how-to-fight-depression

11. Higuera, V. (2020). Everything You Want to Know About Depression. Retrieved from- https://www.healthline.com/health/depression