DEPRESSION

“It’s so difficult to describe depression to someone who’s never been there because it’s not sadness.” -J.K. Rowling.

Depression is so common yet so misunderstood. While it is great that more light is being shone on mental health and people are becoming increasingly aware and less stigmatizing of mental health disorders, it is also important to be able to accurately spot someone who is struggling and offer the necessary support. To that end, this article focuses on depression: who can have it, what can cause it, how to spot it, and how to offer necessary help.

What is Depression?

“Depression is being colorblind and constantly told how colourful the world is.” — Atticus, Love Her Wild.

Being unhappy from time to time is a normal life experience. However, being persistently sad to the point where it affects daily human functioning is not normal.

Depression can show up in several ways, but the central features of depression include:

• Persistently low or sad mood
• Constant negative thoughts (for example, thoughts of worthlessness, guilt, pessimism, or suicide)
• Loss of interest or enjoyment in previously enjoyed activities (this may be known as Anhedonia)
• Reduced energy and slowness

Who Can Have Depression?

Everyone is one life event away from a mental illness. We just never know which life event it is. – Unknown

Anybody can have depression. Even people who do not seem to have any “risk factors” can have depression. It isn’t only people who “have it bad” that can suffer from depression. Sometimes, those who seem to have everything going for them can also struggle.

However, while anyone can have depression, it has been found to be more common in women than men (probably because women are more likely to admit depressive symptoms and seek help). Depression has also been noticed to be more common in people who are unemployed, divorced, have high levels of anxiety, and use psychoactive drugs. According to the World Health Organization (WHO), about 280 million people across the world have depression, and suicide is the fourth leading cause of death in 15 to 29-year-olds.

What Can Cause Depression?

Have you ever heard the nature versus nurture argument? Well, in depression, both factors contribute to increasing or decreasing the likelihood of developing depression. Some of these factors include:

• Family History: If a first-degree relative has depression, you are at an increased risk of having depression as well.
• Personality: People who have high levels of anxiety are predisposed to having depression. Those with a strong need for approval may be at a higher risk of developing depression after an unfortunate life event. People with a high level of neuroticism are more likely to develop depression.
• Relationship with Parents: Extreme parenting styles, such as non-caring or overprotective parenting styles, can predispose to depression.
• Other Relationships: Abusive relationships can predispose to depression.
• Recent Life Events: Stressful life events, such as the death of a loved one, huge financial losses or debt, the end of a romantic relationship, bullying, and so on, can trigger a depressive episode.
• Physical Illness: The news of a bad diagnosis, such as a terminal illness, can cause depression in some people. Some physical diseases, like brain diseases or hormonal abnormalities, can temporarily affect the brain and result in depression.

Factors That Affect the Outcome of Depression

There are factors that can improve or worsen a person’s struggle with depression. Some of them include:

• Age of Onset: The earlier in life a person has depression, the more likely they are to have another episode of depression in the future.
• Number of Previous Episodes: The more depressive episodes a person has had in the past, the more likely they are to have another one.
• Social Support: People with a strong sense of social integration, intimacy, or social support are less likely to have recurrent depression.
• Recovery from a Previous Episode: People who recover completely from a previous depressive episode are less likely to have another episode as opposed to people with incomplete recovery from a previous episode.
• Drug Abuse: People who abuse hard drugs are more likely to have depression than people who don’t abuse drugs.

How Can You Spot Depression?

Mood

A depressed person’s mood is extremely and persistently sad, and it can be described as misery. In situations that typically improve moods, such as hearing a joke, some good news, or hanging out with friends, the sad mood does not substantially improve. This mood is different from ordinary sadness; it is sometimes described as pervasive.

In some people, the low mood has a diurnal variation. It is worse early in the morning after just waking up and improves as the day goes on.

Thoughts

“Depression, for me, has been a couple of different things – but the first time I felt it, I felt helpless, hopeless, and things I had never felt before. I lost myself and my will to live.” — Ginger Zee.

Depressive thoughts are negative thoughts, thoughts of worthlessness, hopelessness, pessimism, or guilt. A depressed person may feel like they are failing and that other people can see them as failures. This feeling of worthlessness may persist despite evidence to the contrary.

A depressed person may constantly expect failure or misfortune in their endeavours. They may feel deeply hopeless. They may also feel an immense and irrational sense of guilt and may unreasonably blame themselves for trivial or minor matters, including things that are long gone and forgotten.

Appearance

Depression can affect a person’s appearance negatively. The person may not care for grooming and hygiene as much. They may also appear characteristically sad with a sad demeanour.

Loss of Interest and Enjoyment

“People who have never dealt with depression think it’s just being sad or being in a bad mood. That’s not what depression is for me; it’s falling into a state of grayness and numbness.” — Dan Reynolds.

A depressed person may lose interest in and show no enthusiasm for activities and hobbies they used to enjoy. They feel no zest for life and lose pleasure in everyday activities, withdraw from social interactions, and may have reduced physical energy. In some uncommon cases, they become restless. They may feel lethargic, find everything stressful, and leave tasks uncompleted, which can result in a decline in academic or career achievements.

Other Changes

There could be changes in sleep patterns. Some people repeatedly wake up hours earlier than usual, some may find it difficult to fall asleep, some may constantly wake up in the middle of the night to brood, and, in some cases, oversleep.

There could be a reduction in appetite and consequent weight loss. Some other people may also experience overeating instead.

Sexual changes such as loss of libido may also be noticed.

Sometimes, a person with depression may not realize it but will have more physical health complaints, especially if they already have a pre-existing health condition.

How Can Depression Be Diagnosed?

If there is something that the above list of symptoms proves, it is that depression is not black and white. There is a wide range of symptoms, and different people can present with varying cocktails of symptoms. This then begs the question: “How is depression diagnosed?”

The International Classification of Diseases (ICD-10) provides a simple guideline for it. This guideline splits depressive signs and symptoms into two groups: A and B.

Group A

• Persistently low or sad mood
• Loss of interest and enjoyment
• Reduced energy and decreased activity

Group B

• Reduced Concentration
• Low self-esteem and confidence
• Feelings of guilt and unworthiness
• Pessimistic thoughts
• Ideas of self-harm
• Changes in sleep pattern
• Reduced appetite

Using the above grouping, depression can be can be categorized based on severity.

Mild Depression: Depression is said to be mild when a person has at least two symptoms from Group A and at least two symptoms from Group B.

Moderate Depression: In moderate depression, a person has at least two symptoms from Group A and at least three symptoms from Group B.

Severe Depression: Here, all three signs and symptoms from Group A must be present, along with at least four signs and symptoms from Group B.

Some Types of Depression

• Seasonal Affective Disorder (SAD): This is when a person has recurrent depressive symptoms at the same time of the year. Usually, once that season passes, the depression ends, only to come back again the next year.
• Unipolar and Bipolar Disorder: The “opposite” of depression is mania. In mania, the person is excessively happy and energetic or angry for no obvious reason. If a person has experienced both mania and depression before, he/she is said to have bipolar disorder. If they have never had mania, the depression is said to be unipolar.

How To Cope with Depression

Do you or a loved one have depression?

If yes, the first thing to keep at the forefront of your mind is that no matter how dark, gloomy, and numb things may be, depression can be successfully managed. Management options for depression include Psychotherapy and Medications.

Psychotherapy is a type of treatment that involves helping the affected person to identify and actively change their mental state through their emotions, thoughts, behaviours, and interactions. It often involves talking to a mental health practitioner.

Medications can also be offered exclusively or alongside psychotherapy. There are different groups of antidepressants available, so it is important to work with a specialist to determine which medication is most suitable and what dosage is best.

Family and social support play a pivotal role in dealing with depression. If you are battling depression, it is helpful to speak up and seek help from the right people. Like Dwayne “The Rock” Johnson once said, “I found that with depression, one of the most important things you could realize is that you’re not alone.” If you have a loved one who is dealing with depression, it is important that you are present and attentive to them. This will help you catch any change in their symptoms – good or bad – and get them the help they need. Like Stephen Fry said, “Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.”