Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

Depression

Overview

Depression is a medical condition that can affect your mood, daily activities and potential to work .As per the World Health Organization (WHO) prevalence of depressive disorders among elderly is 10 to 20%.

Depression in elderly is a distress for the affected person as well as the family as it is associated with higher risk of suicide in untreated cases. Timely recognition and appropriate management of depression among elderly help in improving the quality of life and reducing suicidal death rate.

There are many types of depression such as clinical depression, bipolar depression, dysthymia, seasonal affective disorder etc.

Causes

 There are various causes for depression to develop in an individual. The main risk factors causing depression are the following:

•    Genes 

 Depression runs in families with strong genetic predisposition.

•    Life events

 Stress, traumatic life events, grief, isolation and lack of support can cause depression.

•    Medical causes

  Experiencing physical pain and illnesses over a long period of time can cause depression.

Certain diseases also are associated with depression, like diabetes, cancer and Parkinson’s disease.

•    Medications

Depression may occur as side effects of certain medications.

•    Personality

 People who have trouble in coping with life situations may be prone to depression. Abnormalities in brain chemical [neurotransmitters] levels may lead to depression.

• Gender: Depression is more common in women than in men.

Types of depression

  Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle with daily activities and requires medical aid as early as possible.

There are different types of depression; some are of mild type while other types are severe.

·        Persistent depressive disorder (dysthymia)

It often includes less severe symptoms of depression[but not mild] that last much longer, typically for at least 2 years. The Greek word dysthymia means "bad state of mind" or "ill humor."

As one of the two chief forms of clinical depression, it usually has fewer or less serious symptoms than major depression but lasts longer.

Poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness are the symptoms of this type of depression, which may last for a long period. More than half of people with dysthymia eventually have an episode of major depression.

·        Perinatal depression - this is depression occurring in woman during pregnancy or after delivery (postpartum depression).

·        Premenstrual dysphoric disorder (PMDD):

Premenstrual dysphoric disorder is a severe form of premenstrual disorder (PMS). It affects women in the days or weeks before their menstrual period.

·        Seasonal affective disorder

It is depressive mood related to the seasons, typically starting in late fall and early winter and going away during spring and summer.

·        Depression with symptoms of psychosis

It is a severe form of depression where a person experiences psychosis symptoms, such as delusions (disturbing, false fixed beliefs) or hallucinations (hearing or seeing things that others do not see or hear).

·        Depression with bipolar disorder or MDP

Individuals with bipolar disorder (formerly called manic depression or manic-depressive illness) also experience depressive episodes, in which they feel sad, indifferent, or hopeless, combined with a very low activity level. But a person with bipolar disorder also suffers from manic episodes, or unusually elevated moods in which the individual might feel very happy, irritable or angry.

·        Major depression

It includes symptoms of depression most of the time for at least 2 weeks that typically interfere with one’s ability to work, sleep, study, and eat. It is a severe type of depression.

Symptoms of major depression:

Persistent sad, anxious mood

 Hopelessness or pessimism

 Irritability, frustration, or restlessness

Difficulty concentrating, remembering, or making decisions

Difficulty sleeping, early morning awakening, or oversleeping

Changes in appetite or unplanned weight changes

Feelings of guilt, worthlessness, or helplessness

Lack of interest or pleasure in hobbies and activities

Decreased energy, weakness or sluggishness or slowness of activities

 Suicidal thoughts 

Aches or pains, headaches, cramps.

Digestive problems without a clear physical cause

Suicide attempts

Severe persistent symptoms in addition to low mood are required for a diagnosis of major depression.  Research suggests that genetic, biological, environmental, and psychological factors play a role in depression.

Depression may occur at any age, but often it is manifested more in adulthood.

Of late it has been noticed that depression occurs in children and adolescents, although it sometimes presents with more prominent irritability than low mood.

Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression with other diseases [ co morbidity]

Depression, especially in elderly people, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease.

These conditions often get worse when depression is present, and research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses.

In children with Hashimoto’s thyroiditis also irritability and depression are common and treating thyroid helps to relieve depression too.

How can you diagnose depression?

Consult a physician if you experience any of the depressive symptoms mentioned above. Your healthcare provider will ask a few questions or you may have to respond to a questionnaire provided there.

Your healthcare provider may also perform a few clinical examinations on your body or order lab tests to see if you have any other medical conditions that can lead to depressive symptoms. Both physical and mental evaluation is performed to diagnose the problem precisely.

How can you manage depression?

The severity of depression and symptoms of complete lack of energy and suicidal thoughts demands immediate medical attention. Medications like antidepressants are commonly used to treat depression major.

For less severe types of depression, which persist long, along with some prescribed medications some life style and dietary changes are advised.

·        Exercise regularly:

Regular exercise is very essential in managing depression as research studies show that physical activity can reduce depression. Physical activity causes feel-good chemicals endorphins   to be released in the body. This aids in mind relaxation and sense of wellbeing. Do swimming, running, walking and some aerobics also.

·        Ensure adequate sleep

Avoid erratic diet and erratic sleep patterns. Ensure that you get adequate & sound sleep. To get sound and good sleep avoid bright light exposure a few hours before sleeping .

•   Relaxation techniques – This typically involves meditation or mindfulness. These techniques can often help to remedy both disorders and improve quality of life. Practice mind relaxation techniques, do them before you going to bed also. Adopt yoga into your life style. Spending time with positive people can improve depressive symptoms.

Yoga also [pranayama, yoga asana, yoga mudras] helps in relieving depressive mood.

·        Diet

Clinical studies have shown with clear cut evidence that omega-3 fatty acids can effectively treat depression.  Evidences indicate a link between high fish consumption and low incidence of mental disorders; this lower incidence rate being the direct result of omega–3 fatty acid intake   [Read more ]

·        Counseling:

 Counseling or psychotherapy is your personal interaction with a mental health professional or counselor, who may help you after hearing your problems to address your difficulties. Psychotherapy may help you to develop coping skills.

·        Medications [ Conventional treatment ]

  Antidepressants can help change brain chemistry that causes depression. Antidepressants can take a few weeks to have an effect. Some antidepressants have side effects and your physician can change the medicine if it doesn’t suit you. Common side effects are dryness of mouth, drowsiness, insomnia, constipation, dizziness etc.

Common antidepressants are selective serotonin reuptake inhibitors, norepinephrine reuptake inhibitors. 

·        Brain stimulation therapy:

Brain stimulation therapy can help people who have severe depression or depression with psychosis. Types of brain stimulation therapy include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS). 

·        Alternative and complementary medicine (CAM) interventions.

 CAM therapies are defined by the National Center for Complementary and Alternative Medicine as a group of diverse medical and health systems, practices, and products that are not currently considered to be a part of conventional medicine. Some clinicians believe that these interventions are helpful and safe alternatives, or adjuncts to conventional psychotropic medications. People with mild depression or ongoing symptoms can improve their well-being with complementary therapy.

Therapy may include different methods and systems of medicine like Ayurveda, homeopathy, Herbal medicine, massage, acupuncture, hypnosis and biofeedback etc. 

 It cannot be claimed that all these therapies are very effective to root out the depression or cure it completely. However a few of the national government approved systems of alternative medicines can do some good as an adjuvant therapy in mild depression.

·        Homeopathy: Homeopathic medications are used for treating depression arising from various causes and in an individualized way. 

Aurum metallicum, HYoscyamus,ignatia amara,natrum muriaticum etc.are a few major remedies used in homeopathic treatment for depression.[Readmore]

             REFERENCES

1.     https://pubmed.ncbi.nlm.nih.gov/18456339/

2.     https://www.health.harvard.edu/newsletter_article/dysthymia

3.     https://www.ncbi.nlm.nih.gov/books/NBK559078/

4.     https://pubmed.ncbi.nlm.nih.gov/17066209/  

5.     https://pubmed.ncbi.nlm.nih.gov/12559660/  

6.     https://pubmed.ncbi.nlm.nih.gov/12906343/