Clinical Depression and Its Causes

 Clinical Depression and Its Causes

¹ Arooba Tariq, MBBS Student ² Dr. Muhammad Naeem

¹ Federal Medical and Dental College, SZABMU PIMS

² Laureate Folks International

ERC, PAKISTAN

https://laureatefolks.blogspot.com

laureatefolks@gmail.com, WhatsApp: +923334446261

 

ABSTRACT

Clinical Depression, also known as major depressive disorder, is the most severe form of depression characterized by symptoms of sadness, tearfulness, loss of interest, sleep disturbances, tiredness and lack of energy, outbursts of emotions, reduced appetite, anxiety and hopelessness, etc. caused by a loss such as a death of loved one or a medical condition like thyroid disorder, Diagnosis is made by clinicians according to the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders DSM-5.

It is a psychological illness treated mostly with a set of medication and counseling or in some cases with a combination of both.

Clinical Depression also referred to as MDD, affect women more than men due to their biological differences and affect the victims in various aspects of life including personal, work-related, studies and home environment's, sometimes also in relationships domain with affecting around 7.8 percent of U.S. adults as Statistical Data 2019.

Most people do not seek treatment. However, some people seek professional help and learn to cope with symptoms in order to cope and function well in life.

 

Keywords:  depressive, symptoms, caused, death, medical, thyroid, diagnosis, Manual, DSM-5, psychological, medication, counseling, MDD, women, men, adults, treatment, life.

 

1.      What is Depression?

Depression is an illness ranging from acute and short-lived to chronic and severe levels, affecting humans in every age and from every walk or gender level. Based on it its severity level it is subdivided into minor and major categories. With minor depression, people can maintain a healthy and normal functioning of life with much ease and without even medication being prescribed to them. In major depression, life however becomes difficult, and it is more trouble for an individual to carry out basic functions of life from getting up on time, going to school, college, university or work to even having not the urge to eat and having loss of interest in daily activities of life. It is a very common psychological disorder with more than a million cases per year in the U.S. It doesn’t require any laboratory tests or imaging to be diagnosed, as it is mostly done by medical professionals by asking questions related to a daily routine with people aged from 15-45 years. It is more common in females and if left untreated can be more dangerous and life-threatening. A person's family history increases the likelihood of disease and proper medical treatment is recommended for the patients to recover. Depression can happen to anyone regardless of gender, age, background, or socioeconomic status. However, 12% of women (nearly 12 million) suffer from it compared to 7% of men (over 6 million) in a year. Research at the National Institute of Mental Health has shown that most men are unaware of symptoms like headache, digestive disorders, or chronic pain than women, hence they are diagnosed less likely from depression as compared to women and lot scale. Clinical Depression is a serious disease that can last up to several weeks, months, and years maybe. It is not a willed away disease nor is it a sign of personal weakness (Daniel, Hall-Flavin, 2017).

1.1 Clinical Depression: An Introduction

Clinical Depression is a serious mental disorder that affects not just a person’s mood but how he acts, thinks, feels, and manages their life. A person diagnosed with clinical depression would have symptoms interfering with normal ability to function at work and or, at home. It is a common and serious mental disorder that impacts a person’s feelings, thinking, eating, working, and other habits for over a period of at least two weeks.

1.2 Types of Clinical Depression

There are many types of depression different from each other depending upon the unique circumstances developing over a course of time in the disease.

i)                    Persistent Depressive Disorder: It is called dysthymia. It lasts for over a time span of two years with less severe symptoms but only if they persist for straight two years.

ii)                  Post-Partum Depression: It is a serious type of disorder which is called baby blues; relatively mild with symptoms of anxiousness lasting for two weeks and cleared within meanwhile after delivery. Women in postpartum depression experience major depression blew in pregnancy and after it. The feelings of anxiety, sadness, and exhaustion accompany the new mothers and it is difficult for them to complete daily activities.

iii)                Psychotic Depression: It is a type of depression associated with psychosis in which a person faces fixed false beliefs called delusions and g=hearing or seeing disturbing things which others can’t see called as hallucinations. The disease typically has people with a depressive theme of life associated with symptoms of guilt, poverty, or illness.

iv)                Seasonal Affective Disorder: As the name indicates, it starts in the winter season, when the time span of natural sunlight is reduced. It heals on its own in the spring and summer seasons. It is typically associated with social withdrawal, increase in sleep and weight, predictably returning every year.

v)                  Bipolar Disorder: It is different from depression but included in the list due to some symptoms of low mood levels indicating similarity with major depressive disorder. But differing to an extent that such person experiences high mood levels called euphoria, mania, or a less severe form called hypomania.

Other types of Clinical Depressive Disorder included in DSM-5 include disruptive mood dysregulation disorder (in children and adults) and premenstrual dysphoric disorder (PMDD).

Each year, it affects 17 million American men and women according to Psychiatric American Association. While the disease is common, it is unrecognized and untreated in many cases. The different types depicted can be anxious distress, mixed features, melancholic features, atypical features, psychotic features, peripartum onset, and seasonal patterns (Felix Torres, 2020).   

1.3 What Causes Clinical Depression?

At some times, people know why they are depressed, while at other times, they must be confused about its occurrence.

 The exact causes are unknown as they are complex in nature. It is often a combination of genetic, biochemical, and environmental factors.

1.      Biochemistry: Specific brain chemicals called neurotransmitters carry the signals in the human brain and the imbalances associated with such substances cause depression in an individual. Chemicals called serotonin, dopamine and norepinephrine indicate to cause such disease. The use of antidepressants has revealed the neurotransmitters to be involved in the happening of depression so it is possible to say that biological changes can also occur as a result of being depressed.

2.      Genetics: Depression runs in families. If you have a suffering parent, sibling, you are more likely to be suffering from the disease and chances to have acquired the linked disorders are increased.

3.      Environmental Factors: Exposure to violence, abuse, neglect during childhood can increase the likeliness of disease Poverty makes a person more vulnerable to disease. The stress of academic demands, transitions in college, balancing school, college, work, social life, financial responsibilities, family concerns, social isolations, difficulties in relations with friends, family, romantic partners, temptations of sexual orientation, career decision-making. A lot of depressed people have issues like alcoholism and drugs. Sometimes people use it as an escape from the depression. Sometimes the usage comes first, and the withdrawal symptoms initiate the disease. The important thing is to get the treatment as soon as possible. Medication should always be taken in accordance with the prescription of the doctor and never tapered off at the decision of your own.

 

The Centers for Disease Control and Prevention has made this recognized that people affected with disorders like depression and schizophrenia are more likely to affect by COVID-19.

If the following symptoms last in a person’s daily life for more than two weeks, then he/she is likely to be suffering from the disease called depression:

1.4 Physical Symptoms

·         No or decreased energy levels and getting exhausted easily

·         Moving/talking/acting slow than normal

·         Pains, aches, cramps, and other digestive disorders without a clear physical sign.

·         Loss of appetite and changes in weight

1.5 Behavioral Symptoms

·         Difficult in concentration and or, remembering things

·         Having issues in taking decisions and tackling difficult circumstances

·         Hopelessness and pessimistic outlook towards life

·         Feelings Of Guilt, Worthlessness

1.6 Emotional Symptoms

·         Suicidal thoughts and attempts

·         Feelings of irritation

·         Crying for no reason

·         Lasting hours of sadness, anxiousness, and emptiness

·         Not every individual facing the disease has all the symptoms of disease Some have fewer symptoms even though falling in the diseased category.

1.7 Diagnosis of Clinical Depression

It usually involves physical and behavioral assessments along with some mental and diagnostic tests to rule out any physical disease. The diagnosis begins with a physical examination, lab tests, and another diagnostic criterion to minimize the chances of any physical condition such as thyroid, especially hypothyroidism. After the initial diagnosis, the primary healthcare provider directs the patient to a licensed clinical social worker called a psychologist.

The evaluation on the basis of physical examination includes:

1.      A psychiatric evaluation including symptoms and assessments of thoughts, feelings, and behaviors. Some questionnaire is provided by the worker to be answered by the patient/client,

2.      A history of the family to decipher the genetic incidences of disease and or related psychological illnesses.

3.      A diagnostic evaluation called DSM-5 diagnostic tool was designed especially for this purpose.

Table 1

The illness associated with depression is linked in the table below:

2.      Risk Factors Associated with Clinical Depression

It cannot be predicted whether a person will become depressed or not but there are some risk factors that increase the likelihood of the disease.

·         Diagnosed with clinical depression previously

·         Family history of depression, alcoholism, drug abuse, and having tried suicide

·         Going through significant changes in life

·         High levels of stress in life

·         Traumatic experiences

·         Certain medical conditions such as tumors, hypothyroidism, and cancer, etc.

·         Taking some types of medication

·         Having certain personality traits such as low self-esteem

Clinical Depression is the most common type of mental disorder in States caused by a multifactorial combination of biochemical, genetic, psychological, and environmental agents. It can co-occur with other serious medical conditions such as cancer, heart disease, and Parkinson’s.

 

 

3.      Treatment and Management of Clinical Depression

Depression even in most severe cases is treatable. The earlier the diagnosis and the sooner the treatment begins, the more is the healing and recovery process. Depression is usually treated with medication, psychotherapy, and /or a combination of both to reduce the symptoms as much as possible. If the symptoms aren’t reduced, Electroconvulsive therapy and other brain stimulation therapies are used.

3.1  Medication: Since some basic chemicals in the brain can affect your mood that is called neurotransmitters, a health care provider may prescribe antidepressant medication. These are medicines used to treat depression. The dosage and timings of these medicines are regularly adjusted by the doctor to ensure effectiveness. In general, they are prescribed for over a period of six months to ensure effectiveness. These drugs do not form your habits, but they affect brain chemistry. One drawback of these medicines is that their effective time of action may take several weeks. The side effects linked to these medications are relatively less henceforth they are used in abundance. The major types of medications are SSRI’s Selective Serotonin Reuptake Inhibitors, the tricyclic antidepressants (TCA’s), the monoamine oxidase inhibitors (MAOIs), and atypical antidepressants.

SSRIs affect serotonin levels. And most common SSRIs are (Generic name is first, brand name in parentheses)

·         Fluoxetine (Prozac)

·         Sertraline (Zoloft)

·         Paroxetine (Paxil)

·         Fluvoxamine (Luvox)

·         Citalopram (Celexa)

·         Escitalopram (Lexapro)

3.2  Psychotherapy: It is talk therapy. A counselor i.e., a trained therapist figure out ways to help the patient solves his problems and cope up with daily challenges helping the patient to have his/her depression symptoms reduced

In the general talk, therapies take weeks to months to complete. There are different types of therapies:

i)                    Interpersonal Therapy: It employs two strategies to achieve the goals of interpersonal and social harmony with others. The first is knowledge or insight of the nature of depression. The second is defining your problem.

ii)                  Cognitive Behavioral Therapy: It involves changing in way of thinking of a patient. Three strategies are used to achieve it.

a)      Didactic component includes positive expectations for therapy.

b)     Cognitive component involves thoughts and assumptions that influence behaviors.

c)      Behavioral component which employs behavioral modifications.

iii)                Behavioral Therapy: It involves goal-oriented structured therapy which involves functional analysis of behavior, selection of the techniques to modify behavior, and relaxation training.

iv)                Monitoring Behaviors: By keeping logs and records.

3.3  Electroconvulsive Therapy: It is an effective treatment but for those patients who do not respond to other therapies. It began in the 1940s and today it is done under anesthesia. It comprises 6 to 12 sessions with a brief electrical stimulation after a person has been put to sleep. It is not painful but causes some side effects such as confusion, disorientation, and/or memory loss.

4.      REFERENCES

Daniel K. Hall-Flavin, M.D. (May 13, 2017) https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770 (10th November 2019) https://www.nhs.uk/mental-health/conditions/clinical-depression/overview/

https://www.webmd.com/depression/guide/major-depression © 2020 WebMD, LLC. All rights reserved. (18th October,2021) https://www.healthline.com/health/clinical-depression

Felix Torres, M.D., MBA, DFAPA (October 2020)  https://www.psychiatry.org/patients-families/depression/what-is-depression

https://uhs.berkeley.edu/health-topics/mental-health/clinical-depression

https://www.verywellhealth.com/what-is-clinical-depression-5092915

https://www.nimh.nih.gov/health/topics/depression

https://psychcentral.com/blog/7-ways-to-manage-clinical-depression

https://www.health.harvard.edu/mind-and-mood/six-common-depression-types

https://www.emedicinehealth.com/depression_health/article_em.htm

Indian J Psychiatry. (2017 Jan) https://jasondeanmd.com/causes-clinical-depression/

5.      AUTHOR NOTE

This is my first writing as a professional and academic writer. I am hoping to have this piece of the article a good reflection of my insights on this topic as I selected this topic after having suffered from clinical depression for the last many years while facing troubles of managing with a bipolar sister, adjustment at the hostel in Faisalabad at an early age of 18 and then managing detention years at medical college with the peer pressure of job, marriage and difficult relatives. It has been a long journey and studying this subject has been my favorite pass time.

I meanwhile taught at a local school the subject of Physics and Chemistry and noticed a good number of people suffering from depression and not recognizing or getting treatment at middle age level, those however young at age and studying at college and university level are more to seek counseling sessions and help for clinical depression at an early age as I worked in Institute of Medical Rehabilitation as an assistant to psychologist Dr. Uzma Masroor.

I happened to learn that how an hour-long session twice a week can help people change their dimensions of life and be more active and productive in their work and overcome the apathy of basic symptoms of depression. Currently, I am teaching at Brainstorm Academy the subjects of Biology and Chemistry along with studying full time as a Medical Student.