Depression


Depression is a psychiatric illness associated with both psychological suffering and potentially life threatening changes in normal physiology.

The World Health Organization (WHO) ranks depression as the third leading cause of global disease burden and projects that by 2030, it will be the first leading cause worldwide.

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Signs and symptoms of depression include:

  • Persistent feelings of sadness, anxiety or worthlessness

  • Irritability

  • Feelings of pessimism, hopelessness or guilt

  • Loss of pleasure in things you used to enjoy

  • Reduced energy or increased fatigue

  • Speaking or moving slower than you used to

  • Difficulty focusing or concentrating, or having trouble making decisions

  • Appetite or weight changes

  • Suicidal thoughts or attempts

  • Physical pain (e.g. stomach pain) that does not have a clear cause

Risk factors for depression

Depression is a multi-factorial disease. Risk factors include family history, early stage emotional neglect, emotional/sexual abuse as a child, trauma, chronic stress, rigid parenting and alcohol/substance abuse.

Recent research also indicates a link with altered gut bacteria (microbiota). It has been shown that a diet characterized by nutrient-poor, energy-dense processed foods can influence and modulate several brain processes impacting both appetite and mood.

Diagnosis

Diagnostic criteria are based on both self-reported symptoms (e.g., changes in normal day-to-day behaviour, cognitive, affective or physical disturbances) and interview-based clinical assessments.

However, this diagnostic approach can be prone to patient and expert bias, suggesting the need for more objective and reliable ways to inform clinical diagnosis and treatment.

Treatment

Depression is managed with psychological, pharmacological interventions or combination of both. All treatments however, have limitations, and medications have side effects (including increased risk for suicide), reduced response or frequent relapse. Even patients who show symptom alleviation after antidepressant treatment are often reluctant to regularly take medication and thus are at risk for relapse.

What if I think I have depression?

If you are experiencing one of more of the symptoms listed above, or think you have depression, you should you speak to your GP or a mental health professional. You will then be invited for an interview with the aim of formulating a diagnosis and decide on the treatment that best suits your situation.


What can I do to cope with depression?

If you think you are depressed or if you are diagnosed with depression, you first need to look into your lifestyle and see what you can change immediately to start feeling better.

Below is some advice (based on published research) that you can put into practice even before seeing a doctor of mental health professional:

  • Start exercising regularly. More and more research indicates that regular exercise reduces the risk of depression and also has therapeutic effects.

  • Avoid exposure to violent/anxiogenic content (e.g., news, violent movies or video games)

  • Consider taking a break from work. Work can be one of the main sources of stress in our life. While connecting with other people can reduce vulnerability to stress, a stressful, competitive and confrontational working environment can play an important role in making things worse.

  • Start your day with nurturing rituals. For example, instead of checking the news, watching a short video of your favourite comedian can put you in a good mood and give room to more positive emotions during the rest of the day.

  • Reduce or stop drinking tea and/or coffee and see if this helps you get more sleep

  • Avoid using electronic devices in your bedroom. Instead, give yourself a good break from exposure to technology, internet etc…before going to sleep.

  • Improve your diet. Try to avoid sugars, fried food and fats, preferring instead a more balanced diet. Research, for example, has shown that the consumption of a traditional Mediterranean style diet rich in fruits, vegetables, legumes, olive oil, fish, and whole grains is associated with reduced depression. Further, there is evidence that probiotic supplements have anxiolytic effects.

  • Reduce or avoid alcohol intake. Alcohol has strong effects on mood, especially in subjects with depression or at risk to experience depressive episodes.

  • Start a journal. This can help you keep a record of how you feel every day, thoughts that you might want to share with your doctor and also make to-do lists for the changes you want to bring into your life

  • Try to focus on positive thoughts. Positive thoughts are simply thoughts that make you feel good about yourself. Make sure you write these on your journal so you can recall them when your feel gloomy.

  • Look for help. Talk to your most supportive family members and/or friends. Look for support line numbers and consider joining a support group. However, it is crucial that you talk to a mental health professional as soon as possible to get qualified and expert advice on what to do when you feel down.

References

  1. Whiteford, H.A., et al., The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS One, 2015. 10(2): p. e0116820.

  2. Lopez, A.D., et al., Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet, 2006. 367(9524): p. 1747-57.

  3. Cooper, R., Understanding the DSM-5: stasis and change. Hist Psychiatry, 2018. 29(1): p. 49-65.

  4. Gaebel, W., J. Zielasek, and G.M. Reed, Mental and behavioural disorders in the ICD-11: concepts, methodologies, and current status. Psychiatr Pol, 2017. 51(2): p. 169-195.

  5. Sabella, D., Antidepressant Medications. Am J Nurs, 2018. 118(9): p. 52-59.

  6. Koopman, M., S. El Aidy, and M.I. consortium, Depressed gut? The microbiota-diet-inflammation trialogue in depression. Curr Opin Psychiatry, 2017. 30(5): p. 369-377.

  7. Ruusunen A, Lehto SM, Mursu J, et al. Dietary patterns are associated with the prevalence of elevated depressive symptoms and the risk of getting a hospital discharge diagnosis of depression in middle-aged or older Finnish men. J Affect Disord 2014; 159:1–6.

  8. Kvam, S., et al., Exercise as a treatment for depression: A meta-analysis. J Affect Disord, 2016. 202: p. 67-86.

  9. Jamieson, P.E., D. Romer, and K.H. Jamieson, Do films about mentally disturbed characters promote ineffective coping in vulnerable youth? J Adolesc, 2006. 29(5): p. 749-60.

  10. Montag, C., et al., Does excessive play of violent first-person-shooter-video-games dampen brain activity in response to emotional stimuli? Biol Psychol, 2012. 89(1): p. 107-11.

  11. Till, B., et al., Associations between film preferences and risk factors for suicide: an online survey. PLoS One, 2014. 9(7): p. e102293.

  12. Madsen, I.E.H., et al., Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data. Psychol Med, 2017. 47(8): p. 1342-1356.

  13. Sakuragi, S., Y. Sugiyama, and K. Takeuchi, Effects of laughing and weeping on mood and heart rate variability. J Physiol Anthropol Appl Human Sci, 2002. 21(3): p. 159-65.

  14. Yoshikawa, Y., et al., Beneficial effect of laughter therapy on physiological and psychological function in elders. Nurs Open, 2019. 6(1): p. 93-99.

  15. Tsuno, N., A. Besset, and K. Ritchie, Sleep and depression. J Clin Psychiatry, 2005. 66(10): p. 1254-69.

  16. Seo, J.H., et al., Late use of electronic media and its association with sleep, depression, and suicidality among Korean adolescents. Sleep Med, 2017. 29: p. 76-80.

  17. Thomee, S., A. Harenstam, and M. Hagberg, Computer use and stress, sleep disturbances, and symptoms of depression among young adults--a prospective cohort study. BMC Psychiatry, 2012. 12: p. 176.

  18. Matar Boumosleh, J. and D. Jaalouk, Depression, anxiety, and smartphone addiction in university students- A cross sectional study. PLoS One, 2017. 12(8): p. e0182239.

  19. Endo, T., D.F. Kripke, and S. Ancoli-Israel, Wake up time, light, and mood in a population sample age 40-64 years. Psychiatry Investig, 2015. 12(2): p. 177-82.

  20. Boden, J.M. and D.M. Fergusson, Alcohol and depression. Addiction, 2011. 106(5): p. 906-14.

  21. Lepping, P., et al., Clinical relevance of findings in trials of CBT for depression. Eur Psychiatry, 2017. 45: p. 207-211.

  22. Possel, P., et al., Associations between Social Support from Family, Friends, and Teachers and depressive Symptoms in Adolescents. J Youth Adolesc, 2018. 47(2): p. 398-412.

  23. Gariepy, G., H. Honkaniemi, and A. Quesnel-Vallee, Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry, 2016. 209(4): p. 284-293.