Depression - Causes, Symptoms, Types, And Treatment in India

What is Depression? An Overview of Depressive Disorder

Depressive disorder, also known as depression, is a common mental health disorder. It involves a depressed mood or loss of pleasure or interest in activities for long periods of time. Depression is different from regular mood changes and feelings about everyday life. It can affect all aspects of life, including relationships with family, friends and community. It can result from or lead to problems at school and at work. Depression can happen to anyone. People who have lived through abuse, severe losses or other stressful events are more likely to develop depression. Women are more likely to have depression than men.

Are you becoming highly intolerant and irritable day by day? Have you been sad all the time and just want to keep crying?
Or are you having continuous thoughts of suicide or selfharm lately?

You must visit a mental health professional right away. Yes, you are suffering from severe Depression. If it remains untreated, will impact whole life starting from your thoughts, sleeping patterns, diet, and behavior putting you in chronic sense of sorrow. It can even change your nature and behaviour completely.

How to Understand Whether You Are Suffering from Depression?

Depression does not require any pathological test, there are certain symptoms through which you can understand that you might be suffering from depression.

Symptoms And Patterns of Depression

During a depressive episode, a person experiences a depressed mood characterised by feeling deeply sad, irritable, and empty. Person may feel a loss of pleasure or interest in activities. A depressive episode is very different from regular mood fluctuations. They last most of the day, nearly every day, for at least two weeks or more.
Below are the symptoms to track and notice the changes due to depression:

1. Poor concentration
2. Feelings of excessive guilt or low self-worth
3. Feeling hopeless about the future
4. Constant thoughts about dying or suicide
5. Disturbed circadian rhythm i.e., disrupted sleep
6. Changes in appetite or weight
7. Feeling very tired or low in energy throughout the day

Depression can cause difficulties in all aspects of life, including social and at home, work and school. Further, depressive episodes can be categorised as mild, moderate, or severe depending on the number and severity of symptoms, as well as the impact on the individual’s functioning.

Different Patterns of Depressive Episodes

Single Episode Depressive Disorder:

It is when the person is having first and only episode of depression

Recurrent Depressive Disorder:

It is when the person has a history of at least two depressive episodes in their life.

Bipolar Disorder:

It is when the depressive episodes alternate with periods of manic symptoms. These may include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing and confused thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour, etc.

Read now - Depression and Isolation, Stay Connected.

So, What Are The General Causes of Depression?

Depression can occur from any of the following reasons -

Your Brain Chemistry:

An imbalance of neurotransmitters, including serotonin and dopamine are the major contributors to the development of depression.

Genetical Reasons:

If an individual has a first-degree relative i.e., a biological parent or sibling with depression, then the individual is about three times as likely to develop the condition as compared with the general population. However, one can develop depression without having a family history of it.

Highly Stressful Life Events:

Difficult lived experiences, such as the death of a loved one, violence and trauma, divorce, isolation and lack of support, can trigger depression to a great extent.

Pre-Existing Medical Conditions:

Chronic pain and chronic conditions like diabetes, heart condition, paralysis etc. can lead to depression and other mental health concerns.

On-Going or Prolonged Medication:

Some medications can cause depression as a side effect.

Substance Use:

The usage of alcohol and dependency on toxic substances can also cause depression or can even make it worse by creating a vicious loop of helplessness and worthlessness in life.

Now Let’s Discuss about Different Types of Depression

According to the spectrum view of mood disorders creating independent categories for depression may not be possible as several types of depression lie along a continuum, which does not have sharp boundaries between the categories, hence following a dimensional approach. This dimensional view of depression describes depression mainly by the grading of its severity and by associated features highlighted in the text of DSM-IV-TR.

The categories or types are explained below:

Major Depressive Disorder

Major depression or largely understood as the traditional kind of sadness being characterised by an overwhelming and constant sense of gloom and a loss of interest in most activities, including those that were enjoyable previously. This kind of depression manifests largely through difficulty in sleeping, fluctuations in weight and/or appetite, mild to chronic fatigue, and a sense of worthlessness. These symptoms may increase or decrease depending on the external environment yet these will be constantly felt by someone going through the depressive episode. Suicidal or death-related thoughts are possible. Usually psychotherapy, counselling and medication are used to treat it. Electroconvulsive therapy (ECT) may be useful for certain patients with severe depression for whom psychotherapy or antidepressant medicines are ineffective. ECT is rarely used and only under the guidance of a psychiatrist alongwith a clinical psychologist.

Atypical Depression

This type is different from the persistent sadness of usual depression. It is considered to be a 'specifier' that describes a pattern of depressive symptoms. It is defined by mood reactivity plus weight gain or increased eating, while there is a chance that a positive event can temporarily improve the mood. Other symptoms of atypical depression can include:

• Increased appetite
• Sleeping more than usual
• Feeling of heaviness in arms and legs
• Oversensitive to criticism

Read now - Insomnia and Depression, Breaking The Cycle.

Melancholic Depression

Melancholic depression is more common in older age. A person may experience loss of pleasure in activities or lack of reactivity to any pleasurable stimuli (food, sex, hobbies) etc, with a certain distinct quality of mood. Depression gets worse in the morning hours and the person may find it difficult to wake up in the morning, marked with psychomotor retardation or agitation. There will be a significant decrease in eating and/or weight loss, and prevalence of excessive guilt.

Seasonal Affective Disorder (SAD)

It is a period of major depression that usually often occurs during the colder days like: winter months. This is also experienced more when the days grow short and there is less sunlight. It typically goes away in the spring and summer. Symptoms of seasonal depression can be hypersomnia and overeating, while the depressions range between usually mild to moderate.

Psychotic Depression

People with psychotic depression have the symptoms of major depression along with 'psychotic' symptoms, such as:

• Hallucinations - marked by seeing or hearing things that aren't there in reality.
• Delusions - false beliefs that surpass the creative sense or any form of imagination
• Paranoia - wrongly believing that others are trying to harm you while in reality they are not bothered.

Read now - Depression Due to Learning Disability

Persistent Depressive Disorder (PDD)

If you have depression that lasts for 2 years or longer, it's called persistent depressive disorder. This term is used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression. You may have symptoms such as:

• Change in your appetite (not eating enough or overeating)
• Sleeping too much or too little.
• Lack of energy, or fatigue.
• Low self-esteem and critical about self and others.
• Trouble concentrating or making decisions.
• Feeling hopeless and negative.
• External and internal blame.

Peripartum (Postpartum) Depression (PD or PDD)

Women who have major depression in the weeks and months after childbirth may have postpartum or peripartum depression. Approximately 1 in 10 men also experience depression in the peripartum period. Antidepressant drugs can help similarly to treating major depression that is unrelated to childbirth.

Premenstrual Dysphoric Disorder (PMDD)

Women with PMDD have depression and other symptoms at the start of their period. Besides feeling depressed, you may also have:

• Mood swings
• Irritability
• Anxiety
• Trouble concentrating
• Constant fatigue
• Change in appetite or sleep habits
• Feelings of being overwhelmed

Treatment Resistant Depression

One-third of patients receiving treatment for depression attempt many approaches without finding improvement, and this is a major indicator of developing depression that is resistant to treatment. Your depression may not respond to treatment for a variety of reasons. For instance, treating your depression may be challenging due to other medical issues you may have.

Minor depressive disorder

This type is more towards mood and cognitive symptoms yet the understanding around Minor Depressive Disorder is mostly covered under bipolar I disorder and in bipolar II disorder.

Now that we have a better understanding of different aspects of depression let’s understand how serious this issue is.
Read now - The Best Ways to Create Awareness about Depression.

Depression Scenario in India

Several studies have identified how severe depression is. Here are a few statistical observations.

1. Approximately 280 million people in the world have depression. Meanwhile WHO estimates that the burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 10000 population.
2. Further to this, a recent report by the World Health Organization estimates that 56 million, i.e., 4.5% of Indians suffer from depression and a population of 38 million i.e 3.5% Indians suffer from anxiety disorders.
3. Rate of Depressive Disorders in India State wise: States with prevalence rate above the national prevalence rate are Jharkhand (4.7%), Tamil Nadu (4.5%), West Bengal (4.3%) and Manipur (3.7%).
4. An estimated 3.8% of the population experience depression, including 5% of adults (4% among men and 6% among women), and 5.7% of adults older than 60 years.
5. A study conducted by the Schizophrenia Research Foundation (SCARF) in Chennai found that over 30% of students suffer from anxiety and depression. Out of the 15,000 students screened, 32% had moderate to severe depression, while 30% had anxiety.
   Read now - Can Menopause Cause Depression?
6. March 2022, Ministry of Health and Family Welfare data mentions that nearly 1 in 40 and 1 in 20 persons suffer from past and current depression, respectively. Neurosis and stress related disorders affect 3.5% of the population and were reported to be higher among females (nearly twice as much in males). The data further indicates that 0.9 % of the survey population were at high risk of suicide.
7. The same survey highlights that nearly 50% of persons with major depressive disorders reported difficulties in carrying out their daily activities.
8. According to a survey conducted in 2022 by Ipsos, about 37 percent of the public in India reported that they felt stressed to the point where it had an impact on their daily life. In the same survey, 24 percent of the respondents said that they seriously considered suicide or self-hurt.
9. In a 2021 UNICEF survey, around 14% of 15 to 24-year-olds in India reported frequently feeling depressed or disinterested.
10. The National Institutes of Health (NIH) reports that 57.8 million adults live with some form of mental illness. The severity of a mental illness can vary from person to person.

    Although there are known, effective treatments for mental disorders, more than 75% of people in low- and middle-income countries receive no treatment. Barriers to effective care include a lack of investment in mental health care, lack of trained health-care providers and social stigma associated with mental disorders.

    Isn’t the data shocking? So, the best option to get rid of this issue is to seek help and support. You can always visit Mpower for any of your mental health issues. You can understand the overall situation of your mental health with Mpower as well. Check your Mental Health Score now.

Diagnosis and Treatment for Depression or Depressive Disorder

Depression can be effectively treated through medication (only with psychiatric consultation), counselling, therapy and other ways. It is very essential to seek support, care and help to get rid of depression. The initial line of treatment for depression is psychological intervention. In cases of moderate to severe depression, counselling and therapy can be taken in addition to antidepressant drugs which are prescribed by a psychiatrist. For moderate depression, antidepressant medicines may not be necessary unless there is a comorbidity. Cognitive behavioural therapies or pop can impart new ways of thinking, adjusting, or interacting with people.

So, What Are The Effective Psychological Treatments for Depression?

Behavioural Activation or Behavioural Therapy:

Behavioural therapy focuses on the relationship between behavior and mood to target current problems and symptoms and focus on changing patterns of behavior that lead to difficulties in functioning.

Cognitive Behavioural Therapy (CBT) for Depression:

Cognitive therapy entails modifying pessimistic conclusions of the current concern and unhelpful thinking patterns with the goal of disrupting and reducing interference with daily life. CBT targets current problems and symptoms in order to focus on recognizing the relationship between behaviours, thoughts, and feelings through replacing patterns that reduce pleasure and interfere with a person’s ability to function at their best on a daily basis.

Interpersonal Psychotherapy (IPT):

Interpersonal psychotherapy focuses on improving problematic relationships and circumstances that are most closely linked to the current depressive episode. IPT seeks to enhance an individual's interpersonal relationships by teaching them how to solve problems and express needs and feelings in meaningful ways to others. IPT therapists place a strong emphasis on the biopsychosocial theory of depression, which holds that upsetting or unfavourable life experiences can intensify depressive and worthless sentiments in people. The person may see a decrease in depression symptoms and an improvement in their functioning in several aspects of their life as their interactions with others improve.

Mindfulness-Based Cognitive Therapy (MBCT):

This variation of cognitive combines strategies of cognitive therapy with mindfulness meditation to modify unhelpful thoughts and develop a kinder, more loving self-view. People with depressive episodes learn how to focus and pay attention to their thoughts even when they wander often from the current scenario. MCBT aims to make people learn to change their thoughts, stay in the present, and avoid being wired in negative ideas with practice.

Psychodynamic Therapy:

This form of therapy focuses on unconscious thoughts, early experiences and the therapeutic relationship to understand current challenges, improve self-awareness and support the patient in developing more adaptive patterns of functioning. Psychodynamic therapists support their clients in exploring their feelings and thoughts without restriction so they can start to see patterns of behaviour and suppressed emotions. The therapeutic learnings are frequently utilised to pinpoint the client's typical verbal and nonverbal cues and nuances that adversely affect their perception of themselves and other significant relationships.

Supportive Therapy:

This form of therapy incorporates a humanistic view. The therapy offers a supportive relationship that focuses on helping people explore and understand their experience in their current situation. The focus is on strengthening a person’s ability to make choices that help them cope effectively with various life stressors, with a view of genuine empathy and supportive listening.

Antidepressant Medications:

Antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine. Adult depression is frequently treated with medication prescribed by a psychiatrist. Medication and dosage are based on the requirement of an individual as there will be differences in response to different medicines and dosages.

Mental health professionals at Mpower plan and consider each client’s preference and the medication that the person is consuming currently. Usually, antidepressants shouldn't be the first line of treatment for depression in children or adolescents, also medication should be used extremely carefully when treating depression in these age groups due to the vulnerability of developmental stages.

MPOWER the holistic mental health care provider in India provides psychological treatments for concerns around depression, bi-polar, anxiety, ADHD, eating disorders etc. and follows an 8-step process of providing support through the easy access

MPOWER works with all the stakeholders in colleges and schools i.e., parents, teachers and students. Children, adolescents and young adults undergo continuous developmental changes within themselves. It is imperative to elicit support from their stakeholders in order to strengthen their coping mechanisms and support their mental health.

Self-Care

Self-care can play a pivotal role in managing symptoms of depression and promoting overall well-being of someone going through depression or any other mental health condition.

What Can You Do for Self Care :

• Engage in the activities you used to enjoy.
• Stay in contact with friends and family.
• Exercise regularly – even a walk counts!
• Try to stick to regular eating and sleeping habits as much as possible.
• Avoid or cut down on alcohol consumption. Also use of illicit drugs can make depression worse.
• Be courageous and speak about your feelings to someone you trust.
• Seek professional support as friends and family members cannot replace field expertise.

What to Do If You Are Dealing with Thoughts of Suicide?

• Remember you are not alone, as many people have gone through a similar experience.
• Talk to someone you trust about how you feel. Avoid judging and belittling your thoughts and situation.
• Seek professional support.
• Join a support group.

If you think you are in immediate danger of harming yourself, contact MPOWER’s 24x7 Mental Health Helpline ⬇️ ☎️1800 120 8200 50

The National Mental Health Programme (NMHP), which includes services such as workplace stress management, suicide prevention, life skills training and counselling at educational institutions, demonstrates the commitment of the Indian Government towards the cause of mental health and well-being. Various programs of MPOWER like Saathi, Saksham, Masoom, Oorja etc. support the Indian Government’s ideology to move ahead with the commitment to ensure overall well-being of the Indian citizens.

References:
https://pubmed.ncbi.nlm.nih.gov/29173244/
https://pubmed.ncbi.nlm.nih.gov/28531848/
https://www.health.harvard.edu/mind-and-mood/six-common-depression-types
https://indianmhs.nimhans.ac.in/phase1/Docs/publications/Prevalence_and_socioeconomic_impact_of_Depressive_disorder.pdf
https://www.pib.gov.in/Pressreleaseshare.aspx?PRID=1808230#:~:text=Nearly%201%20in%2040%20and,at%20high%20risk%20of%20suicide
https://www.statista.com/statistics/1368247/india-opinion-on-experience-stress-and-depression/#:~:text=According%20to%20a%20survey%20conducted,considered%20suicide%20or%20self%2Dhurt.
https://www.who.int/news-room/fact-sheets/detail/depression
https://iris.who.int/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146226/