What is not depression?

Usual blues, short lived sad mood, negative emotional reactions to stressful events is not depression. Feeling restless or occasionally feeling overwhelmed or distressed might make you wonder if I have depression. However, despite the casual use of the term depression by laymen it is important to understand that depression is a clinical syndrome comprising of a specific diagnostic criterion. For the diagnosis of depression, it is important that the sad mood experienced by the individual should be persistent, pervasive and cause clinically significant distress and disruption in various domains of life like personal, social and occupational. 

Why is it important to talk about depression?

• Depression is a common disorder that leads to poor quality of life and impaired role functioning being  a major contributor to the global burden of diseases and  a leading cause of disability.
• Depression is also associated with high rates of suicidal behaviour and mortality. 
• When depression occurs in the context of medical morbidity, it is associated with increased health care cost, longer duration of hospitalization, poor cooperation in treatment, poor treatment compliance and high rates of morbidity. 
• Depression is also known to be associated with difficulties in role transitions (e.g., low education, high teen child-bearing, marital disruption, unstable employment) and poor role functioning (e.g., low marital quality, low work performance, low earnings). 
• It is also reported to be a risk factor for the onset and persistence of a wide range of secondary disorders. 
• Available data also suggests that between one-third and one-half of patients also experience recurrence of depressive episodes.

What causes depression?

There may be multiple causes underlying depression like genetic, biological, psychological and social factors. Biologically depression is associated with multiple interacting disturbances among neurophysiological, neuroendocrine and neuroanatomical factors. Psychologically many cognitive, behavioural, attachment, psychoanalytic and humanistic theories have been useful in explaining the emergence of depression. Personality variables like neuroticism have also been seen as a vulnerability factor in depression.

When you say mood disorders, does it mean fluctuations in mood?

Experiencing mood swings or fluctuations in mood is not the same as a mood disorder. Changes in mood states that are related to events that we encounter from time to time are usually short-lived. Mood disorders comprise of alterations in mood that are intense and persistent and are sufficiently serious to interfere with our daily life and functioning.

So, does this sad mood come in episodes or is it long-lasting?

In terms of the duration of symptoms a major depressive disorder is diagnosed when the sad mood, lack of interest or pleasure and related symptoms of depression are present for a period of two weeks and the number of clinical symptoms should meet the diagnostic criteria. Additionally, the symptoms should cause significant distress or impairment.

Dysthymia is a persistent mood disorder. The diagnosis of dysthymia is given when the depression of mood last for a duration of two years without fulfilling the criteria for a major depressive episode. Interestingly the depressed mood as defined by dysthymia and major depressive episode is qualitatively similar with no inherent difference however the intensity of sad mood in dysthymia is not severe enough to be called major depression. Whereas dysthymia is more chronic and tend to last for a longer duration, major depression is more severe. 

However, after individuals are treated for and have fully recovered from a major depressive episode, they might experience another episode of depression after a period of several months it is called recurrent depressive disorder. Importantly there is no clinically significant inter-episodic mood disturbance and between the episodes the personal has relatively normal functioning.

How does depression effect an individual?

Depression impacts how we think, feel and behave. Often an individual going through a depressive episode might find it difficult to accomplish their day to day activities. Depression also gives rise to various forms of negative thinking for instance thoughts of self-contempt or self-harm. Feelings of worthless and hopeless are also common in depression, the individual experiences tremendous guilt and their self-esteem declines. The individual appears restless or fatigued and might demonstrate general lack of motivation and diminished interest in activities. It is often challenging for them to concentrate on the task at hand thereby making it difficult to accomplish goals and maintain a schedule for activities.

Does depression always manifest in the same way?

Different symptom patterns of depression are associated with different manifestations. Sometimes depression presents itself with atypical features like increase in the total number of sleep hours per day and clear increase in appetite, ability to feel better when exposed to positive events and sensitivity to interpersonal rejection. Sometimes the experience of depression might be masked and the outward manifestation would largely include different forms of somatic pains, sleep and appetite disturbances. Often individuals with pre-exiting non-psychiatric disorders, incapacitating, life-threatening or serious medical illness might also develop depression known as secondary depression.