Depression is a mood disorder that causes persistent feelings of sadness, emptiness, and loss of joy. It is different from the mood fluctuations that people regularly experience as a part of life.
Behavioural health problems such as depression, anxiety, alcohol or substance abuse are among the most common and disabling health conditions worldwide and common in primary care settings. Depending on the clinical setting, between 5 and 20 % of adult patients, including adolescents, and older adults, seen in primary care have clinically significant depressive symptoms. Depression is one of the most common conditions treated in primary care and nearly 10% of all primary care office visits are depression related. From 1997 to 2002, the proportion of depression visits that took place in primary care increased from 51% to 64%. For many patients, depression is a chronic or recurrent illness. For example, up to 40 % of depressed older adults meet criteria for chronic depression. And depressed patients with chronic medical illnesses are at greater risk for a chronic course of depression or less complete recovery.
National surveys have consistently demonstrated that more Americans receive mental health care from primary care providers than from mental health specialists and primary care has been identified as the ‘de facto mental health services system’ for adults, children, and older adults with common mental disorders. Most patients would prefer an integrated approach in which primary care and mental health providers work together to address medical and behavioural health needs. In reality, however, we have a fragmented system in which medical, mental health, substance abuse, and social services are delivered in geographically and organizationally separate ‘silos’ with little to no effective collaboration. A recent national survey concluded that two thirds of primary care providers reported that they could not get effective mental health services for their patients. Barriers to mental health care access included shortage of mental health care providers, and lack of insurance coverage.
Causes of Depression
The medical community does not fully understand the causes of depression. There are many possible causes, and sometimes, various factors combine to trigger symptoms.
Factors that are likely to play a role include:
• genetic features
• changes in the brain’s neurotransmitter levels
• environmental factors such as exposure to trauma or lack of social support
• psychological and social factors
• additional conditions, such as bipolar disorder
Interactions between various factors may increase the risk of depression. For instance, a person with a family history or a genetic risk of depression may become depressed following a traumatic event.
The symptoms of depression can include:
• a depressed mood
• reduced interest or pleasure in activities that a person previously enjoyed
• a loss of sexual desire
• changes in appetite
• unintentional weight loss or gain
• sleeping too much or too little
• agitation, restlessness, and pacing up and down
• slowed movement and speech
• fatigue or loss of energy
• feelings of worthlessness or guilt
• difficulty thinking, concentrating or making decisions
• recurrent thoughts of death or suicide, or an attempt at suicide
Depression is nearly twice as common in females than males, according to the Centers for Disease Control and Prevention (CDC).
Researchers do not know why depression appears to be more common in females. However, a 2021 study proposes that the difference may be due to disparities in reporting. Researchers found that females were more likely than males to report and seek treatment for depression symptoms. Some research suggests that exposure to gender discrimination increases the risk of depression. Also, some types of depression are unique to females, such as postpartum depression and premenstrual dysphoric disorder.
According to data from the National Health and Nutrition study, which relies on self-reports of mental health symptoms, 5.5% of males report depression symptoms in a given 2-week period, compared with 10.4% of females. Males with depression are more likely than females to drink alcohol in excess, display anger, and engage in risk-taking as a result of the disorder.
Other symptoms of depression in males may include:
• avoiding family and social situations
• working without a break
• having difficulty keeping up with work and family responsibilities
• displaying abusive or controlling behaviour in relationships
Triggers are emotional, psychological, or physical events or circumstances that can cause depression symptoms to appear or return.
These are some of the most common triggers:
• stressful life events, such as loss, family conflicts, and changes in relationships
• incomplete recovery after having stopped depression treatment too soon
• medical conditions, especially a medical crisis such as a new diagnosis or a chronic illness such as heart disease or diabetes
Some people have a higher risk of depression than others.
Risk factors include:
• experiencing certain life events, such as bereavement, work issues, changes in relationships, financial problems, and medical concerns
• experiencing acute stress
• having a lack of successful coping strategies
• having a close relative with depression
• using some prescription drugs, such as corticosteroids, some beta-blockers, and interferon
• using recreational drugs, such as alcohol or amphetamines
• having sustained a head injury
• having a neurodegenerative disease such as Alzheimer’s or Parkinson’s
• having had a previous episode of major depression
• having a chronic condition, such as diabetes, chronic obstructive pulmonary disease (COPD), or cardiovascular disease
• living with chronic pain
• lacking social support
Self-help tips to recover from Depression
• Look for support from people who make you feel safe and cared for. The person you talk to doesn’t have to be able to fix you; they just need to be a good listener—someone who’ll listen attentively and compassionately without being distracted or judging you.
• Make face-time a priority. Phone calls, social media, and texting are great ways to stay in touch, but they don’t replace good old-fashioned in-person quality time. The simple act of talking to someone face to face about how you feel can play a big role in relieving depression and keeping it away.
• Try to keep up with social activities even if you don’t feel like it. Often when you’re depressed, it feels more comfortable to retreat into your shell, but being around other people will make you feel less depressed.
• Find ways to support others. It’s nice to receive support, but research shows you get an even bigger mood boost from providing support yourself. So find ways to help others: volunteer, be a listening ear for a friend, do something nice for somebody.
• Care for a pet. While nothing can replace the human connection, pets can bring joy and companionship into your life and help you feel less isolated. Caring for a pet can also get you outside of yourself and give you a sense of being needed—both powerful antidotes to depression.
• Join a support group for depression. Being with others dealing with depression can go a long way in reducing your sense of isolation. You can also encourage each other, give and receive advice on how to cope, and share your experiences.
• Do things that makes you feel good or things that you enjoy doing. Pick up a former hobby or a sport you used to like. Express yourself creatively through music, art, or writing. Go out with friends. Take a day trip to a museum, the mountains, or the ballpark.
• Aim for eight hours of sleep. Depression typically involves sleep problems; whether you’re sleeping too little or too much, your mood suffers. Get on a better sleep schedule by learning healthy sleep habits.
• Keep stress in check. Not only does stress prolong and worsen depression, but it can also trigger it. Figure out all the things in your life that stress you out, such as work overload, money problems, or unsupportive relationships, and find ways to relieve the pressure and regain control.
• Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress, and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.
• Starting to exercise can be difficult when you’re depressed and feeling exhausted. But research shows that your energy levels will improve if you keep with it. Exercise will help you to feel energized and less fatigued, not more
If self-help steps and positive lifestyle changes doesn’t help and still the depression gets worse, one should seek professional help. Needing additional help doesn’t mean make anyone weak. Sometimes the negative thinking in depression can makes one feel like a lost cause, but depression can be treated. But these self-help tips help a lot. Even if someone is receiving professional help, these tips can be part of their treatment plan, it speeds the recovery and prevents depression from returning.
Amity University, Kolkata