What is depression?

Depression, if we go by the dictionary meaning is of two types first type is the feeling of sadness and dejection. Self-doubt creeps into the mind and turns into depression. The second meaning is the long and severe recession in the economy. I am not going into the second meaning here but will discuss the first meaning, which is turning into an epidemic. We are not discussing enough so need to talk about it more. In our daily interactions, or in our interpersonal communication. We need to educate everyone, on how people suffer silently and need help, to support them.

Depression is a condition or disorder, as the dictionary meaning says is a lack of interest in things, or a feeling of sadness and hopelessness, experienced by the person. A person’s, emotions and cognitive state are affected. This later transcends into the physical state. It is a complex condition and affects the daily functioning of the person. It is not just the feeling of hopelessness itself but is a serious condition.

“There is a tendency to self-blame, feelings of guilt, and worthlessness. You find it more difficult to concentrate on things. Even things which you were good at earlier become difficult to do.”

To provide a summary of the symptoms, it is the loss of interest in activities that the person used to enjoy earlier. A term referred to in psychology as anhedonia. There is a tendency to self-blame, feelings of guilt, and worthlessness. You find it more difficult to concentrate on things. Even things which you were good at earlier become difficult to do. Severe cases can also cause a feeling of self-harm, think about death, or suicide.

Type of depression.

There are mainly three major types of depression. MDD or Major Depressive disorder, Dysthymia or Persistent depressive disorder, and bipolar disorder which is rarer among the three. There are some others too like SAD, seasonal affective disorder, psychotic depression, PMDD premenstrual dysphoric disorder, Postpartum depression, situational depression, atypical depression, and cyclothymic disorder.

“The second one PDD or Dysthymia is the more chronic form of it where people may experience a milder version of MDD symptoms but for a longer duration.”

MDD is also known as unipolar depression or clinical depression. It is the experience of severe depression lasting for more than two weeks. It has the usual symptoms of low mood, fatigue, self-doubts, and difficulty in concentration. Loss of interest and affecting sleep and appetite. The second one PDD or Dysthymia is the more chronic form of it where people may experience a milder version of MDD symptoms but for a longer duration, greater than two years for adults and a year for children.

The third bipolar disorder is the other extreme of mood swings cycling between low mood and episodes of mania and hypomania. The depressive episode has symptoms like the ones experienced by someone with MDD. The other extreme is accompanied by episodes of extreme impulsiveness. The mood is high and a person has a lot of energy often indulging in risky behavior. Bipolar is also of two types, Type I and Type II.

“Psychotic depression generally follows the severe symptoms of depression. Where a person experiences delusions or hallucinations.”

The other types like SAD occur seasonally when there is less sunlight like the period of fall and winter. Postpartum depression occurs after childbirth. Psychotic depression generally follows the severe symptoms of depression. Where a person experiences delusions or hallucinations. Atypical is a little different in that the person may experience weight gain and may end up sleeping more. They may temporarily feel better when something positive happens in their lives.

PMDD is a severe form of PMS (premenstrual syndrome) for women. The person can experience significant mood swings and some physical symptoms just before their cycle. Situational depression also known as adjustment disorder occurs in reaction to some life event. A significant trauma or loss experienced by the person. These symptoms are temporary and go away with time. Cyclothymic disorder is a lower form of bipolar disorder in that sense. A person experiences a lesser form of depressive mood, mania, and hypomania than those experienced by someone with bipolar disorder.

MDD — Major Depressive disorder

A person experiences symptoms that persist throughout the day and are there for more than two weeks. Along with the usual symptoms of depression, the person can also experience slowness in movement and become more restless. The symptoms cause major distress or impairment in activity. They can be due to environmental, biological, or psychological reasons. Anhedonia or loss of interest in things that used to excite the person earlier.

“They do not get any joy from social situations and interactions. The physical type is when the person does not get any joy from the physical or sensory experiences. It could be that the food smell or taste is no longer enjoyable.”

Anhedonia is the core of the first type of depression, Major Depressive disorder (MDD). It is of two types Social and physical. The first one is when a person, is not enthused, by the presence of others or in a social gathering. They do not get any joy from social situations and interactions. The physical type is when the person does not get any joy from the physical or sensory experiences. It could be that the food smell or taste is no longer enjoyable. The person has less interest, in pleasure, desired from physical touch or sex. This is often followed by other symptoms of low appetite, low mood, and sleep is also affected. It is accompanied by negative thoughts and a person will feel fatigued, even when doing nothing.

Treatment for MDD.

MDD is a treatable condition and can be managed with some help from therapy, meditation, or medication (such as antidepressants). Psychotherapy, mainly of the type of CBT or IPT and psychodynamic therapy. CBT or cognitive behavioral therapy can be highly effective in its treatment. CBT is based on the principle that our thoughts and behavior can influence each other and are interconnected. Helping the person to recognize and identify negative thought patterns like guilt and feelings of doom. It then helps the person to change their thoughts, in a more balanced way. Evaluating the thoughts, against the actual evidence and replacing them, with positive thoughts.

“Exercises are given by the therapist and evaluated in the next session and monitors the progress through the sessions. The therapist will also teach the person about ways to identify the early warning signs.”

Anhedonia is addressed, by setting small goals, achieved by the individual. They are taught skills related to problem-solving and stress management. Communication techniques are taught, along with tools for relaxation. Exercises are given by the therapist and evaluated in the next session and monitors the progress through the sessions. The therapist will also teach the person about ways to identify the early warning signs of the negative patterns triggering the depression. CBT is highly effective in the treatment of MDD. It can last from 12 to 20 weeks. When mindful techniques are combined with CBT, it is called MBCT- Mindfulness-based cognitive therapy.

IPT or interpersonal therapy is an evidence-based therapy, to help individuals cope with their physiological issues. It is generally done, for a short duration of 12 to 16 weeks. In this, the therapist studies the interpersonal relationships of the person. Identify the patterns and their impacts, on their well-being. IPT mainly addresses issues with grief and transition to a new role, like a parent or a new job. It involves role-playing, and communication skills building.

“Analyzes the unconscious mind and its relation to the person’s thoughts and behaviors. It looks at early childhood experiences and their impact on current behavior.”

Psychodynamic therapy focuses on understanding the unconscious mind. Emotions and memories from the past, affecting the mental state of the person. It is based on the Freudian principles of psychoanalysis. This therapeutic approach was developed, by Sigmond Freud and analyzes the unconscious mind and its relation to the person’s thoughts and behaviors. It looks at early childhood experiences and their impact on current behavior. The person transfers feelings and emotions to the therapist through the sessions.

The therapist looks for emotions and how they have an impact on the individual. How do their emotions and verbal expressions change, during the open-ended question-and-answer sessions? The therapist interprets those emotions, from the past and their impact on the current behavior. The therapist engages in sessions, related to self-awareness without any judgments. The therapist often discusses with the person’s colleagues, or family and friends. Therapists examine how the person protects themselves from these painful feelings and their thoughts.

“As the serotonin remains in the brain the mood improves and symptoms of depression decrease.”

Medicines mainly antidepressants like SSRIs and SNRIs, are also useful in managing depression symptoms. Though they both target depression and have some things in common the main difference is in the neurotransmitters they affect. SSRI-Selective serotonin reuptake inhibitors, increase the level of serotonin, in the brain, by blocking the serotonin, reabsorbed by the nerve cells. As the serotonin remains in the brain, the mood improves, and symptoms of depression decrease. Common SSRIs are Prozac, Paxil, Lexapro, Celexa, and Zoloft. However, these do have some side effects that a person experiences. Weight gain, sleep changes, nausea, or diarrhea

SNRI — serotonin-norepinephrine reuptake inhibitors on the other hand affect both the serotonin and norepinephrine levels in the brain. SNRIs in addition to serotonin, also block the reabsorption of norepinephrine, by the nerve cells. Common brands are Cymbalta, Pristiq, and Effexor. In addition to the side effects of SSRIs, SNRIs can also have additional side effects, due to norepinephrine, related to increased blood pressure and heart rate.

Lifestyle changes

Though Medications and Therapy can help immediately, lifestyle changes can complement them, to improve the quality of life. Focus on having a healthy and balanced diet, rich in nutrients. Limit or eliminate, the intake of sugar, caffeine, alcohol, and processed food. Exercise for at least half an hour daily, as it affects the mood positively.

“Isolation worsens depression so engage in social interactions. Establish realistic goals for yourself and have a set routine to achieve them. Being part of a routine provides stability and predictability to the individual.”

When we exercise endorphins, natural mood improvers, are released in the brain. Reduce stress by learning techniques like mindfulness and meditation, deep breathing pranayama, and yoga, can also help. Aim to sleep, for at least, 7–9 hours every day. Isolation worsens depression so engage in social interactions. Establish realistic goals for yourself and have a set routine to achieve them. Being part of a routine provides stability and predictability to the individual. Seek support and help, everyday resources for managing these conditions are increasing. Seek guidance and educate yourself.

Some resources available for help

There are crisis helplines that you can seek. National Suicide Prevention Lifeline (U.S.): Call 1–800–273-TALK (1–800–273–8255) to seek immediate help if you or someone you know is in crisis. Crisis Text Line (U.S.): Text “HOME” to 741741 to connect with a trained crisis counselor via text messaging. In addition, organizations like the National Alliance on Mental Illness (NAMI), Depression and Bipolar Support Alliance (DBSA), and Mental Health America (MHA) can help.

“The Feeling Good Handbook by David D. Burns and The Mindful Way Through Depression by Mark Williams are excellent resources.”

MoodTools, Woebot, and Calm are some apps that can help manage depression symptoms. Some books like The Feeling Good Handbook by David D. Burns and The Mindful Way Through Depression by Mark Williams are excellent resources. BetterHelp and Talkspace, provide access to licensed therapists for online counseling and support. Many companies offer employee Assistance Programs (EAPs) through their insurance, take advantage of those resources. Family and friends are a great source of help, tap into them.

Together we can and we will.

Together we can all target the Mental health epidemic. Provide the help needed by our loved ones. Ignorance is not acceptable. We need to tackle this head-on and make a difference. Let’s educate ourselves to learn about depression and notice the symptoms when someone exhibits them so that we can offer more compassionate and informed support. Listen actively when someone wants to talk to you. Work or anything else can wait, nothing is more important than the wellbeing of your loved ones. Offer them the support they need, both emotionally and for the resources they need.

“The most important point that we often overlook from a family and friend’s perspective is our own mental well-being. Taking care of someone or being in contact with people experiencing depression can be challenging.”

Show empathy, encourage them, and avoid passing judgment or dismissing their feelings. Provide them with the professional help they may need. therapist, psychiatrist, or counselor knows what needs to be done and can tailor the treatment according to their needs.

Respect their boundaries, your loved ones may not want to talk to you sometimes, they may need their me space. Leave them alone and let them have their breaks at that time. Always circle back though and check with them later. Provide them with help, related to completing their chores, or planning their tasks. Things they may be struggling with.

“Don’t lose hope as that will guide you in the recovery. Depression can be managed; we just have to stand up for it.”

Provide them the motivation and lift their spirits. Patience is the key. You must be patient and supportive. They will have setbacks and have their ups and downs. The most important point that we often overlook from a family and friend’s perspective is our own mental well-being. Taking care of someone or being in contact with people experiencing depression can be challenging. Take care of yourself first before you can provide the help to others. Don’t lose hope as that will guide you in the recovery. Depression can be managed; we just have to stand up for it.