What is Depression? 10 Symptoms and causes

Aaradhana Reddy
Apr 15, 2021
5 min read

Updated: Jun 23, 2021

Against the background of hill silhouettes in the night, depression, one of the most common mental health disorders in the world is written.

According to WHO , globally, more than 264 million people of all ages suffer from depression. Its a major contributor to the overall global burden of disease. Although there are known, effective treatments for mental disorders, between76% and 85% of people in low- and middle-income countries receive no treatment for their disorder.

Prevalence of depression is 1.2% to 21% in the clinic-based studies; 3%–68%in school-based studies and 0.1%–6.94% in community studies, in India. Read more.

The age onset of depression is decreasing and has increasingly been found in children and Adolescence. The most common symptoms experienced are low mood/sadness, crying spells, decreased interest in activities, problems with concentration.

Symptoms of Major Depressive Disorder

The following are the symptoms of Major Depressive Disorder (MDD). Five or more of the following present in a two week period

Depressed mood for most of the day and almost every day. Feelings of emptiness, appearing tearful. In children and adolescence- irritability can also be considered. Diurnal variation- sadness varies through the day- sad during mornings or evenings only.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. (Anhedonia) and social withdrawal.
Decreased functioning in workplace and interpersonal areas (functional deficit).
Significant weight loss or weight gain or decrease or increase in appetite nearly every day. In children, failure to gain expected weight can also be considered.
Insomnia (lack of sleep) or hypersomnia (excessive sleep) nearly every day.
Psychomotor retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).slowed thinking and activity, decreased energy and monotonous voice. In severe cases depressive stupor- no movement (catatonic) and lack of response to stimuli.
Fatigue or loss of energy nearly every day. Getting tired easily.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day. Hopelessness of the future, Helplessness (nobody nothing can help) and worthlessness (low self- esteem, inferiority, inadequacy)
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Loss of Libido
The symptoms cause clinically significant distress.
The episode is not attributable to the physiological effects of a substance or to another medical condition.

Persistent Depressive Disorder (PDD)- Persistent Depressive Disorder is long term depression. With symptoms of Major Depressive Disorder continuously present for two years. Risk factors are childhood parental loss and separation, higher levels of neuroticism, genetic first degree relatives with PDD.

Thoughts

Ruminations- repetitive, intrusive thoughts of pessimistic ideas.
Anxiety is also common with anger, frustrations etc.
Hypochondriacal features- Maybe anxious about their health. May even feel that they have a certain physical condition despite what the reports show. Person may consult physician before a psychologist or a psychiatrist.
Delusions- Delusions are illogical, irrational and strongly held thoughts and beliefs. Nihilistic delusions, delusions of guilt etc. are common.
Suicidal ideations- Presence of thoughts of committing suicide, preoccupation with death etc. Risk of suicide though always present, some factors increase the risk. Being impulsive, previous unsuccessful suicidal attempt, hopelessness in the future, having a detailed suicidal plan, lack of perceived social support and living alone are all factors that increase risk.

Risk Factors and Prognosis :

Neuroticism (negative affectivity) is a well-established risk factor.
Stressful life events are recognized as precipitants of major depressive episodes.
First-degree family members with major depressive disorder have a higher risk for major depressive disorder.

Prognosis- Prognosis relates to the expected course, severity or outcome a condition may take. Some factors lead to good prognosis and some lead to bad.

Good Prognostic Factors: Acute or abrupt onset. Typical clinical features. Well-adjusted premorbid personality. Good response to treatment
Bad Prognostic factors: Co-morbidity medical disorder, personality disorder or alcohol dependence, catastrophic stress or chronic ongoing stress, unfavorable early environment and poor drug compliance are all bad prognostic factors.

Causes

Biological Theories: Heritability rate for depression is 37%. Heritability is also seen in severe types of depression. Family studies- 2-3 fold increase in the risk of depression in first offspring of patients with depression. Read more.
Biochemical Theories: Insufficiency of monoamine neuromediators (serotonin, norepinephrine, dopamine) in structures of the central nervous system may lead to depression. Depression as a psychoneuroimmunological disease in which there less of anti-inflammatory cytokines can cause the various behavioral, neuroendocrine, and neurochemical changes observed in this disorder.
Psychosocial Theories: Chronic stress and stressful life events early in life are strong proximal predictors of the initiation and onset of depression.

The “stress-induced” theory onset hypothesized that hyperactivity of the HPA- (Hypothalamic–pituitary–adrenal axis)- plays key role in body’s response to stress system may be an important mechanism underlying the development of depression after exposure to stress.
Diathesis stress Model- Individual’s vulnerability or predisposition to depression may be activated by environmental stressors, resulting in the development of depression.
Vulnerability model of self-esteem- The vulnerability model of low self-esteem claims that low self-esteem contributes to depression. There is also the Scar Model which posits that depression contributes to low self-esteem. Although most of the studies show support for the vulnerability model rather than the scar model. Read more.

Treatment

There are two modes of treatment. On with medications provided by a psychiatrist after a diagnosis and the second from a psychologist who provides therapy or counselling. The best mode would be a combinations of these two.

• Medications: Antidepressants, Selective serotonin reuptake inhibitors (SSRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs).

Psychological Counselling/Psychotherapy

• Cognitive Behavior Therapy- The central belief of the therapy is that, our cognitions (thoughts) affect our emotions and behaviors. Certain thoughts we hold that are harmful, dysfunctional and irrational, which may be triggered due to our childhood experiences; lead to disturbances. Aron T Beck developed Cognitive Therapy as a result of his research on depression. He observed that negative biases in their interpretation of certain life events resulted in psychological problems. He introduced the cognitive triad- consists of three forms of negative core beliefs a person with depression has about the world- Negative core beliefs about the world, self and future. Cognitive Behavior Therapy deals with these negative thoughts, challenges them and with techniques like self-help forms, thought records etc. helps individuals change these thoughts into more functional ones. As a result of these changes in thoughts, behaviors and emotions change as well, reducing depression. Read more.

• Behavioral Activation for Depression- As the symptoms suggested, people stop engaging in activities that previously used to give them pleasure. In more severe cases, they may stop completely from engaging in any activity either due to the fatigue, low mood or because they just don't feel like it. Behavior Activation helps individuals to re-engage in positive activities that used to give them please, stop engaging in behaviors that maintain or increase depression. It can help individuals to learn to cope and involve themselves slowly in making short term goals and helping to achieve them.

• Interpersonal Therapy: Improving interpersonal relationships by expressing emotions and solving problems. Helps in gaining a sense of social support for coping with depression and life events. Builds social skills.

If you are going through any of above please seek help. There are suicidal helplines to help out. We also provide help for depression. You can check out our services page for more information. For an appointment with a therapist you can check our Book a session page.

Additional Readings

•DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION DSM-5

•A short Textbook of Psychiatry- Neeraj Ahuja 7th Edition- 2011

•Overcoming depression: How psychologists help with depressive disorders- American Psychological Association, 2016 https://www.apa.org/topics/overcoming-depression.

•Cognitive Behavioral Therapy for Depression, Manaswi Gautam, Adarsh Tripathi, Deepanjali Deshmukh, and Manisha Gaur, 2020. Indian Journal of Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001356/