Depression is a word that means different things to different people. It is a common problem, and accounts for over 5% of those that see a GP and 40% of concerns regarding mental health. The lifetime risk can be 15%. It can be a debilitating illness with recurrence and incomplete recovery, and tragically, suicide.
There are theories behind the causes of depression which include genetics, childhood experiences, life events and vulnerability factors. Our early experiences can lead to core beliefs that impede our recovery. Physical illness, stressors, losses, chronic pain, substances, childbirth can all precipitate or predispose to developing a depressive disorder.
Usually there are core symptoms of low mood, low energy and loss of pleasure which are persistent for over two weeks. This can be accompanied by symptoms in other domains:
- physiological (impact on sleep, appetite, weight, libido)
- physical (constipation, aches and pains)
- thinking (pessimism about self, the world, the future, loss of confidence)
- cognitive (impaired concentration, decision-making and memory)
- behaviours (suicidality and self neglect).
When severe, psychotic symptoms can emerge, as well as increased risk due to suicide, self-harm or malnutrition.
Attending a doctor is paramount, as these symptoms can be secondary to physical causes. Screening for medical conditions is very important, as treating the underlying causes are required for improvement. In addition, accurate assessment of the psychiatric illness is important to ensure the correct management plan is implemented targeting the biological, psychological and social factors.
Treatment plans depend on severity, risk and patient choice. Interventions may include psychotherapy, practical and social interventions, lifestyle factors, education, partnerships and advocacy, skill-building, family therapy, support groups, monitoring, and follow-up. Different classes of medications may be discussed, with duration and type of treatment dependent on individual factors. Sometimes hospital admission, ECT, rTMS or rehabilitation options may be recommended.
The most important thing is to seek help, as early intervention leads to better recovery and outcomes.