Depression

What is Depression

Depression is a mental health symptom marked by unexplained difficulty finding interest or enjoyment carrying out normal daily activities due to varying degrees of low mood or poor energy. These three elements; low mood, poor energy levels and lack of interest are the main features necessary to to consider if an individual might be experiencing depressive disorder. In addition to the main symptoms, people experiencing low mood may often report accompanying symptoms.

Specialist mental health workers often separate the symptoms into two groups - cognitive and vegetative(biological) signs of depression.

How common is depression

It is important to recognise and differentiate between depressive symptoms and clinical depression.

Depressive symptoms are very common and may occur following stressful events. Studies show that 50 per cent of any given population would have experienced at least one of the major symptoms of depression at one time or the other. Clinical depression is a specific entity and may occur in one out of every five or six persons. Globally the incidence  of clinical depression varies in each country and depends on a number of prevailing factors e.g chronic physical health conditions, unemployment rates, famine, war or socio-economic stresses etc. The World Health Organisation has done a lot of work to understand the prevalence and impact of depression in many communities. Population studies estimates the prevalence of clinical depression as averaging around 5% globally. However this rate varies in different communities and also differs in females when compared to males. Studies have shown that life time prevalence of clinical depression range from 20 to 25% in females and 7 to 12% in males.  

It is normal to experience mild symptoms of low mood especially following negative experiences such as disappointments, loss events or grief.  This is often referred to as reactive depression as different from endogenous or biological depression. Reactive depression often passes with time. 

Depending on the degree of stress and ones coping ability, reactive depression if persistent may progress to more severe depressive symptoms especially when the individual is prone to depression for various reasons.  

Cognitive signs

This include difficulty with concentration, harbouring negative or sad thoughts including wishing they were not alive or indeed considering ending their lives or just 'disappearing'. As the depression worsens, some may start experiencing odd ideas or beliefs such as feeling guilty or blaming themselves about past events or actions with no clear reason. They may indeed entertain self critical beliefs of being a failure or worthless and as a result ought to be dead. These negative thoughts sometimes become so intense that they may start contemplating how to end  things. Suicide becomes an appealing option, justifying this by asserting no body would miss them or they are a burden to others.

In severe depression, some may become quite deluded and may claim they were already dead or parts of their body was non-existent or contaminated or cancerous. In severe depression some may also experience extreme ideas not in keeping with reality such as feeling they are in communication with unknown agencies or experiencing hallucination. This is referred to as psychotic depression or depression with psychotic symptoms.

Biological signs

Sleep

People who are depressed may report difficulty with sleep which may be disrupted and broken or in some cases excessive. Insomnia is a common feature and refers to poor or insufficient amounts of sleep during the night. The normal sleep patterns are affected due to  imbalance in brain regulatory substances to control sleep-wake cycles. Hypersomnia or excessive day time sleep may also occur and reflects the poor energy state that is prevalent in depression. The process of wakefulness is energy dependent. 

Appetite

Changes in appetite is a common feature in depressive disorder. There is often a loss of appetite. But less commonly appetite could be excessive with a tendency to depend on food as a source of enjoyment or comfort. Loss of appetite would often lead to weight loss. The converse may occur with excessive craving for food.

Loss of libido 

This again is an energy dependent activity. Persons with low mood may loose interest in sex or intimacy. This may affect their relationship and may contribute to suspicion as their partner may misinterpret their loss of interest as due to infidelity.

Self-neglect

With increasing low mood individuals with depression loose interest activities of daily living. Progressively, they may start neglecting to attend to tasks at work or at home, often due to difficulty with motivation and energy levels. Self neglect may include not washing as often as they normally would do or not shaving or grooming as may be considered appropriate. 

Isolation

Avoiding to meet up with friends or family as they would normally do is a very useful indicator of depression. This can be a problem and easily missed when people live on their own. It is therefore important that friends or family who have not seen or heard from their loved ones should consider checking on them especially if there is a history of depression.