The American Psychiatric Association defines depression as a common and serious medical illness that negatively affects how a person feels, thinks and acts. Though the duration of a depressive episode can vary, the mean duration is thought to be six to eight months long. People can experience one or several episodes of depression in their lifetime. These episodes may also vary from mild to severe symptoms.
Depressive episodes can occur at any age, although it is most commonly seen in the age groups of 18 to 29, 30 to 44, 45 to 64 and 65 years and older. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to various emotional and physical problems and reduce a person’s ability to function at work and home.
Fortunately, depression is treatable. With appropriate medical treatment, therapy and emotional support, 70 to 80 percent of patients may be cured or at least experience a drastic reduction of their symptoms.
What are the signs and symptoms of depression?
At least five of the following symptoms must have been present during the same two-week period and at least one of the symptoms must be diminished interest/pleasure or a depressed mood.
- Depressed mood: For children and adolescents, this can also be irritability
- Significant weight change or appetite disturbance: Failure to gain weight in children and weight gain in adults
- Anhedonia (diminished interest or loss of pleasure in almost all activities)
- Sleep disturbance (insomnia or hypersomnia)
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness
- Diminished ability to think or concentrate and indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan or a suicide attempt or specific plan for committing suicide
Depression with anxious distress
Anxious distress is defined as the presence of at least two of the following symptoms:
- Feeling keyed up or tense
- Feeling unusually restless
- Difficulty concentrating because of worry
- Fear that something awful may happen
- The feeling of potential loss of control
Severity is further specified as:
- Mild: Two symptoms
- Moderate: Three symptoms
- Moderate-severe: Four or five symptoms
- Severe: Four or five symptoms with motor agitation
Depression with melancholic features
At least three of the following are required:
- A depressed mood that is distinctly different from the kind that is felt when a loved one is deceased
- Depression that is worse in the morning
- Waking up two hours earlier than usual
- Observable psychomotor retardation or agitation
- Significant weight loss or anorexia
- Excessive or inappropriate guilt
Depression with catatonia (abnormal movement and behavior)
- Stupor (near state of unconsciousness)
- Catalepsy (trance/seizure with unconsciousness, rigidity and loss of sensation)
- Mutism
- Negativism
- Stereotypy (purposeless persistent repetition of an act)
- Agitation, without provocation
- Grimacing
- Echolalia (meaningless repetition of another person’s words)
- Echopraxia (meaningless repetition of movements of others)
Postpartum depression (postpartum blues)
Depression in the postpartum period is common and potentially serious:
- Up to 85 percent of women can develop mood disturbances during this period.
- Fluctuating mood, tearfulness, irritability and anxiety
Seasonal affective disorder
About 70 percent of depressed patients feel worse during winters and better during summers.
Major depressive disorder with psychotic features
It is depression with psychotic features, such as delusions, hallucination and mood instability.
Metabolic depression
Larger the waistline, the higher the incidence of depression. Individuals with depression who have metabolic syndrome may be more likely to have persistent or recurrent depression.
Does depression require treatment?
There is significant potential morbidity and mortality that contribute to suicide, substance abuse, disruption in interpersonal relationships and work. Hence, it requires treatment. With appropriate medical treatment, therapy and emotional support, 70 to 80 percent of patients may be cured or at least drastically reduce their symptoms.
What are the risk factors for suicide?
Risk factors for suicide include:
- Major depression
- Older age
- Male sex
- Previous history of suicide attempts
- The burden of medical disease and presence of a current serious medical condition
- Recent stressful life events, especially family discord
- Lack of social support
- Being widowed or divorced
- Presence of a gun in the home
- Unexplained weight loss
- Severe anxiety
- Lack of a reason not to commit suicide
- Presence of a specific plan that can be carried out and rehearsed
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