Depression (major depressive disorder or clinical
depression)
Depression is a very common yet serious mood disorder. It causes a ongoing
feeling of sadness and loss of interest in anything. It can lead to a variety of
emotional and physical problems and can impacts normal day-to-day activities.
Sometimes one may even that life isn't worth living. Typically for someone to be
diagnosed as depressed, the symptoms must be present for at least two weeks.
Usually depression is caused by a combination of biological, environmental,
genetic and psychological factors and can happen at any age. As per WHO(
[Link] Globally, it is
estimated that 5.0% of adults or approximately 280M people in world suffer
from depression. One should watch for the risk factors for depression like
family history, trauma, stress and certain physical illnesses and medications
As per Mayo clinic ( [Link]
causes/syc-20356007), typica symptoms of depression are as follows.
● Feelings of sadness, tearfulness, emptiness or hopelessness
● Angry outbursts, irritability or frustration, even over small matters
● Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or
sports
● Sleep disturbances, including insomnia or sleeping too much
● Tiredness and lack of energy, so even small tasks take extra effort
● Reduced appetite and weight loss or increased cravings for food and weight gain
● Anxiety, agitation or restlessness
● Slowed thinking, speaking or body movements
● Feelings of worthlessness or guilt, fixating on past failures or self-blame
● Trouble thinking, concentrating, making decisions and remembering things
● Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
● Unexplained physical problems, such as back pain or headaches
Depression takes many forms and some of types of depression features are listed below
● In Anxious distress, depression is combined with restlessness and worry about some
possible events or loss of control etc.
● Mixed features depression includes simultaneous depression and mania. It brings in
elevated self-esteem, talkativeness and increased energy levels.
● Melancholic features come with lack of pleasure and is associated with
worsened mood in the morning, feelings of guilt, agitation or
sluggishness, change in appetite etc,
Also note that some forms of depression may develop under special circumstances,
● In Persistent depressive disorder or dysthymia , depressed mood t lasts for two or
more years,
● Postpartum depression or Baby Blues happen after giving birth and typically clear
within two weeks after delivery.
● In Psychotic depression severe depression and some form of psychosis ( delusion,
hallucinations etc,) happens together.
● Winter depression or Seasonal affective disorder happens during winter months.
Refer DSM5 for details and various other features ( [Link]
Please note that there are multiple other mental disorders which present depression as a
symptom. Some of those are Bipolar I and II disorders, Cyclothymic disorder, Disruptive
mood dysregulation disorder.
Typically a diagnosis of depression includes Physical exam, Lab test & Psychiatric
evaluation and finally mental health professional uses criteria as listed in DSM-5 to classify
a condition as depression.
Treatment of depression include Medications and psychotherapy. There are several types of
antidepressants available and choosing a right one sometimes can be a long process. One
may need to try several medications or a combination of medications before firming up on
one.
Some of the antidepressants are listed below.
Source : ([Link]
drc-20356013 )
● Selective serotonin reuptake inhibitors (SSRIs) : citalopram, escitalopram,
fluoxetine, paroxetine , sertraline and vilazodone
● Serotonin-norepinephrine reuptake inhibitors (SNRIs) : duloxetine (Cymbalta),
venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran
(Fetzima).
● Atypical antidepressants. : bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin,
Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine
(Trintellix).
● Tricyclic antidepressants : imipramine (Tofranil), nortriptyline (Pamelor),
amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and
protriptyline (Vivactil)
● Monoamine oxidase inhibitors (MAOIs). tranylcypromine (Parnate), phenelzine
(Nardil) and isocarboxazid (Marplan)
Antidepressants and increased suicide risk : In some cases, children, teenagers and adult
<25 years may find increase in suicidal thoughts or behavior when taking antidepressants. It
is typically associated with change in dosages or during first few weeks of treatment.