Depression is a clinical syndrome which needs clinical attention. Sadness is one of the emotions which a normal individual experiences. These two conditions need to be differentiated since untreated depression may be a threat to a person’s life.
Presentation can slightly vary in certain age groups in addition to the above symptoms. In children, there can be irritability, clinging behaviours, avoidance of school and other activities like play, school refusal. In elderly, it may present with more of unexplained pains in multiple body parts, irritability, memory disturbances.
Type of symptoms: In depression, along with sadness there will be anhedonia, suicidal ideas, and the above symptoms. In sadness, usually the accompanying symptoms are not significant.
Intensity of symptoms: In depression, symptoms will usually cause significant distress and dysfunction in sleep, appetite, work, personal and social life.
Duration of symptoms: Depression usually diagnosed if above symptoms last for two or more weeks.
Temporal correlation with stressful events: It is common to feel sad after stressful life events for a short period. However, in depression the symptoms are prolonged and extend for a long time.
Genes: Certain genes are associated with depression. There are chances of inheriting these genes from family. This will cause vulnerability for depression and when interacted with environmental factors may precipitate clinical depression.
Early life adversities: Prolonged stressors in childhood like physical, emotional or sexual abuse or neglect. Lack of secure attachment pattern in childhood, fights in family, psychiatric illnesses or substance abuse in parents, bullying, etc. These can also increase vulnerability to depression.
Substance use: Prolonged use of substances like alcohol and cannabis can predispose to clinical depression.
General medical conditions: Conditions like cancer, diabetes mellitus, hypertension, connective tissue and musculoskeletal disorders, endocrine disorders (hypothyroidism, Addison’s disease, Cushing’s syndrome), neurological disorders (stroke, epilepsy, Parkinson’s disease, dementia), infections (HIV, neurosyphilis). Medications used for the treatment of these conditions like certain antihypertensives, antidiabetic drugs, steroids can also cause depression.
Certain phases of life: Natural phases of life like premenstrual phase, post delivery of a child, old age have higher chances of depression.
Life events: Death or separation from loved ones, failure in examinations or relationships, loss in business, divorce, interpersonal issues with loved ones can precipitate depression.
Psychiatric conditions: Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder, Substance use disorders, Personality disorders, Schizophrenia and related psychosis, can predispose to depression.
There are various treatment options for depression.
Pharmacotherapy: Medicines from different classes of drugs are available for treatment of depression. Different medicines have different receptor and hence therapeutic profile which will be matched with clinical profile of the patient and given. There can be certain side effects like gastric disturbances which can be managed symptomatically. Some patients may experience weight gain, sexual dysfunction, hyponatremia, but however newer medicines do not have these side effects. There are chances of interactions between these drugs and drugs used for other conditions and hence it is important to inform the doctors regarding the medicines that one is taking. Also, it is important to seek help from a qualified psychiatrist and not self-medicate with these medicines.
Psychotherapy: There are various psychotherapeutic techniques available for treatment in depression. In mild depression, the clinician may choose to just treat with psychotherapy. In moderate to severe cases, it can be combined with medicines. Cognitive Behaviour Therapy (CBT) is the most commonly used technique. It is an active and collaborative process where the therapist and the client discuss and manage the cognitions and behaviours that have precipitated and are maintaining depression. There are other methods like Interpersonal therapy, psychodynamic therapy, mindfulness-based strategies, Acceptance and Commitment Therapy, etc.
Brain stimulation methods: Electroconvulsive therapy, transcranial magnetic stimulation, transcranial direct current stimulation, are available for the management of carefully selected cases.
Psychosurgery: It can be very rarely used for extreme treatment resistant cases after carefully selecting a patient. Deep brain stimulation is a neurosurgical treatment where electrodes are placed in certain areas of brain and stimulation parameters can be adjusted.