THERE is a difference between sadness and depression. Everyone gets sad, low in mood and down at times due to everyday challenges. It’s common to hear someone say “l am feeling depressed” when experiencing sadness, feeling bad or going through some other negative emotional responses to something. Depression and sadness are commonly used interchangeably in everyday language. Depression is a whole lot different from sadness; the former is a medical condition that differs in intensity and duration from sadness. Sadness can be a symptom of depression which is usually accompanied by other intense physical, social and mental changes.
People with sadness can “snap out of it” with minimal support and with time. However, with depression, treatment and other supports are usually necessary. Depression is more than just “the blues”. When it comes to mental health and mental illness, the terms that we use may determine our perception, attitudes and actions towards same. This is especially important considering that stigma, negative attitudes and poor treatment is experienced by those affected by mental illness. These are also barriers to effective treatment.
The World Health Organisation estimates that globally around 350 million are affected by depression. The WHO places depression as the leading cause of disability worldwide and a great “contributor to the overall global burden of disease”. They report more women than men are affected. Depression also leads in the causes of suicide.
When is it depression?
- When the mood state is severe and overwhelming
- When it lasts for two weeks or more and
- It interferes with daily functioning at home, work or school.
What causes depression?
There is no single cause or explanation for what causes depression. It is generally believed that a number of factors listed below, combined with stress, increase the risk of developing depression. The stress can be long-standing or resulting from recent life events.
- Genetic predisposition and vulnerability. This can be inherited. However, depression is likely to occur if there are other stressful life events.
- Physical illness may be associated with low mood and inability to engage in previously enjoyed activities. Pain can also lower one’s mood. Conditions like cancer and compromised immunity have been linked with depression.
- Biochemical factors where the function of the mood regulating neurotransmitters dopamine, serotonin and noradrenaline are disrupted.
- Personality type. For example, worrying or anxious personality, perfectionist, self-critical, high sensitivity or low self-esteem prone personalities may pose a risk to some types of depression.
- Drug and alcohol use also increase the risk of developing depression.
What is important to remember is that there is no single cause or simple explanation for depression. Depression is associated with a combination of stress and the above social, biological and psychological factors and changes.
Signs and symptoms of depression
If you have been feeling sad, miserable, and struggling with normal daily functioning for more than two weeks and also have some of the following, you may need to seek medical help for possible depression.
- Feeling hopeless, negative or pessimistic
- Loss of previously enjoyable activities
- Changes in sleep patterns; oversleeping or under sleeping
- Changes in appetite; overeating or loss of appetite
- Body aches and pains that may not respond to treatment
- Loss of energy, general tiredness and fatigue
- Withdrawing from others
- Use of drugs, alcohol and other substances
- Irritability, crying, anxiety
- Poor concentration, forgetfulness
- Inability or reduced confidence in decision making
- Feelings of guilt and worthlessness
- Thoughts of suicide or suicide attempt
Just as people are different, one does not necessarily have to experience all of the above to be diagnosed and treated for depression. Also, having some of the above symptoms does not automatically mean it’s depression. However, medical treatment should be sought if the symptoms are longer than two weeks, intense and when suicide thoughts or attempts are present. Depression may be mild, moderate or severe depending on the intensity of symptoms as well as the duration and degree to which one is able to engage in usual activities.
In bipolar affective disorder, there are periods of depression and manic episodes. Mania is characterised by overactivity, pressure of speech, grandiose ideas. These are separated by periods of normal mood.
Depression and suicide
Serious depression can lead to suicide. WHO estimates that over 800,000 people die from suicide each year. It’s the second leading cause of death in the 15-29 year old age group. Barriers of care such as stigma, negative attitudes, lack of understanding, lack of trained professionals and resources need to be addressed so that people access treatment and support on time. People with depression need to be properly assessed for suicide ideations. Suicide ideations and/attempts cannot be ignored or dismissed by family and friends due to shame or stigma in the hope that these will go away.
Warning signs of suicide
- Talking about suicide or death
- Making plans or attempts to end one’s life
- Putting affairs in order, changing a will, making peace with others
- A sudden switch from being very sad to calm, peaceful or even happy
- Risk taking behaviour
- Researching ways of ending life
- Giving away possessions
- Talk of the afterlife
- Saying goodbyes or writing suicide notes
- Sometimes there are no evident signs, hence the need to be more vigilant and supportive.
If anyone experiences any of the above, seek medical assistance from professionals immediately.
Treatment for depression
There are effective treatments for depression, although WHO reports that less than half of those affected will seek treatment. This varies from country to country with some countries having fewer than 10% receiving treatment. Recovery may take time and will look different from one person to the other. The medical professional will consider your individual circumstance and advise you on the best treatment options.
These are also called “talking therapies” or commonly referred to as counselling. With the help of a trained professional, the thinking patterns can be changed and the individual equipped with better coping skills to deal with life’s challenges. A safe and supportive environment is provided where unhelpful thoughts, patterns and behaviours can be challenged. This can be delivered in a group or individual setting.
The doctor may prescribe anti-depressant medications to treat depression. In addition, psychological treatments may be used at the same time as medications where appropriate. It may take some time before the effects of medications kicks in. Any concerns about medications should be ideally discussed with the doctor before discontinuing.
Psychosocial treatments and lifestyle changes
There are changes that those recovering from depression can make in order to stay well. These include:
- Regular exercise which is believed to lift the mood.
- Healthy eating for nourishment and energy
- Sleep hygiene; making some adjustments that promote good sleep patterns
- Educating yourself about your condition as well as your loved ones so they are best able to support you
- Joining support groups including online forums to connect with others in similar situations.