Are you under risk of depression?
From time to time, we have allexperienced depressive moments when we have a sense of being down and listless, with a sinking feeling and failure to take joy in whatever we do. However, when sadness, hopelessness or disinterest in daily activities last for weeks, it may point to a more serious condition called "Major Depression”.Depressive symptoms disappears by eliminating causes or adapting the current situation.
Major Depression is a disorder that lowers the person's quality of life and must be treated. Depression is a disease of modern ages and does not discriminate for occupation, age or income and may be very serious. It may cause failure at school, work, social and economic settings and even sex life; suicidal tendencies are also observed in connection with depression. Depression is a "mood" disorder. In other words, it is a sense of being down that develops due to genetic, environmental or hormonal factors. Depression is considered a serious health problem that affects the person and may be observed on its own or accompanying substance or pharmaceuticals use or certain diseases (ex. cancer).
Some people have experienced depression once in their lives but for many, it can be recurring. Some cases start without any visible cause whereas others are connected to certain events and stress. People suffering from depression are sometimes unable to fulfill daily activities such as getting out of bed and getting dressed.
According to American Psychiatric Association's identification and classification system for mental disorders published in 2000(DSM IV TR)when at least five of the below symptoms - at least one of the first two (depressive mood or loss of interest and failure to enjoy life) - are present for at least two weeks, it is called "major depression". The symptoms are:
1. Self-expressed (feeling sad or empty) or observed (ex. the patient looks teary) sense of being down almost every day or a major part of the day.
2. Self-expressed or observed decrease in interest to most or all activities or failure to take joy in these (ex. previously enjoyed activities and hobbies no longer bring joy, feel obligatory, tedious; low libido) almost every day or major part of the day.
3. Significant weight loss or weight gain when not following a special diet (ex. more than 5% of body weight) or increased or decreased appetite almost every day.
4. Daily insomnia or hypersomnia.
5. Decreased brain and body functions, decreased mobility (ex. preferring to sit or lie down) or unrest (ex. failure to sit in one spot) observed almost every day. (It is not sufficient for the patient to self-express unrest or heaviness; these should be observed by others as well).
6. Almost daily fatigue, tiredness or loss of energy.
7. Experiencing worthlessness, excessive or inappropriate feelings of guilt almost every day. (This sense of guilt is not only about finding oneself guilty of being ill.)
8. Decreased ability to focus on a subject (concentrate) or indecisiveness (ex. not being able to focus on what is said, read, watched, etc.) almost daily. This is either expressed by the patient or is observed by others.
9. Repetitive thoughts about death (not just being afraid to die), unplanned and repetitive suicidal thoughts, suicide attempts or plans.
Along these lines, a patient suffering from depression may often utter these words:
• Life doesn't give me joy like it did before. I am not interested in anything.
• This stress will never end!
• I wish to be left alone!
• I feel very tired!
• I lost my appetite!
• I can't fall asleep!
• I can't take care of my kids; I am feelingdisinterested!
• I forget everything!
• I can't decide anything!
• Life has no meaning, I want to die!
Causes of depression
There are many causes that lead to depression:
1. Hereditary causes
2. Biochemical changes
3. Hormonal imbalances
4. Certain medication
5. Organic reasons
6. Psycho-social events
7. Socio-cultural factors
8. Certain life events
Types of depression
• Masked depression (Instead of classic depression symptoms, underlying depression is expressed in aches and numbness of the body, eating and behavioral disorders and substance dependency)
• Atypical depression (Some symptoms displayed do not match typical depression symptoms. Changes occur during the day)
• Depression in children and teenagers
• Post-menopause depression and geriatric depression
• Post-partum depression
• Dysthymic disorder (Accompanied by depression symptoms that last for at least two years and are not severe. The "healthy" periods are no longer than 2 months).
• Post-psychotic depression (Depression caused by mental diseases such as schizophrenia.)
• Organically induced depression (Depression resulting from physical, metabolic, toxic or endocrine disorder.)
Who is at risk?
Depression is the most common psychological disorder in medicine. Depression can be observed at all ages, social classes, in all countries and cultures. Most research has displayed major depression level depressive complaints at a rate between 8 and 20%. One in ten people suffers from depression in our country. Environmental stress factors are important in the emergence of first depression. People who lose a parent before age 11 tend to show signs of depression more frequently in following years. The most influential environmental factor for depression in later years is loss of spouse.
Sex: Depression in women is observed twice as often as it is in men. Probability of major depression being observed in men during their lifetime is between 2 and 12%, whereas this rate is between 5 and 26% for women. The most probable reason for this difference is considered to be that women are subject to more stress due to the physico-social factors (having to take on multiple responsibilities at once, such as being a mother, wife, housewife and businesswoman) in their lives. Hormonal and cerebral differences also play a role.
Age: It is argued that the rate of depression increases with age. Studies show the starting age of depression is late 20s. Major depression cases with hereditary inclination are observed to peak around 30s.
Socio-economic level: Depression rates are inversely linked to income and education levels. Heavier depression types are usually observed in lower socio-economic groups. A study has shown that people who were unemployed for at least six months within the last five years were observed to have 3 times more major depression.
Marital status: It has been observed that separated or divorced people have twice or four times more risk of depression, as compared to those who are married. According to a study, single women were found to be less depressed than married ones; whereas for men, marriage reduced the risk of depression. That is to say, separated or divorced men have a higher risk of depression than women.
Family History: In families with a history or depression, the risk of depression is 2-3 times higher.
Other illnesses:According to research, 10 to 15% of patients who were hospitalized for long periods or patients with acute diseases suffer from depression. Additionally, depressive symptoms were observed at around 20 to 30%.
Course and Treatment of the Disorder
Essential and sometimes the hardest step of the depression treatment is asking for help. Depression affects one's feelings, actions, mood and health and cannot be solved on one's own - that it is a biologically founded disease that requires medical treatment. A treatable disease depression can be completely cured. Untreated depression cases may cause suicide. Depression lowers people's success levels at work and may result in job loss. It may cause sexual disorders and thus marital problems. A person suffering from depression may resort to alcohol and substance abuse to get away from the situation; which may result in traffic accidents, fights and criminal tendencies - thus creating a vast array of social problems. It is very costly for the patient and the society for depression to go undiagnosed and untreated. Diagnosis and treatment are only possible by educating the public as well as doctors.
At least 50% of people who have a depressive attack experience this attack again. When it is observed more than twice, the risk of recurrence within the next three years increases to 70%. At the end of the first year, major depression cases were observed to be cured, 20% showed decrease in the severity of depression, with minor complaints and 40% showed continued major depression. Untreated depression lasts on average 7 to 14 months. Chance of not recurring for life is less than 25%.
Depression treatments usually last 2 to 6 months and consist of pharmacotherapy mostly accompanied by psychotherapy. Treatment supported with social arrangements and combined with psychotherapy yields better results. In dynamic psychotherapy;
• the person's life story is learned;
• roots of current problems, aims, defense mechanisms in face of difficulty and depressive basic ways of thinking are discovered and worked on.
There are various good quality medications for depression. The medication must be used under supervision of a psychiatrist. Selection of antidepressants is very important in the treatment of depression - especially in outpatients. This is because inappropriate medication will hinder use of medication and thus treatment due to its side effects.
The treatment duration is set according to the duration of the disease and whether it is recurring. When the treatment is cut short (due to patient feeling better, economic reasons, side effects of medication, etc.) it has been observed that the first 4 to 8 weeks are extremely risky, but following this time, the risk is still high.