Depression: Signs & Symptoms, Types, Causes, and Treatment

What is Depression?

Despite the growing understanding about mental health conditions like depression, the term is still often misused and confused with sadness. Sadness is a normal human emotion, and is often a healthy response to life’s ups and downs. For example, if your best friend moves abroad, it’s natural for you to feel sad for some time.

Depression, on the other hand, is a mental health condition which encompasses more than feelings of sadness. In depression, one may feel not just sad but also hopeless and helpless. For a diagnosis of depression to be made, it is also important that this feeling last for a while.

Clinical depression is characterized by prolonged feelings of sadness, hopelessness and helplessness. One may experience a loss of interest in things one previously enjoyed. There may also be changes in appetite or sleep. One may feel worthless and have difficulty with executive functioning such as decision making. In severe cases of depression, daily tasks like brushing one’s teeth or taking a shower can seem overwhelming.

While both sadness and depression can occur in response to stressful life events, depression impacts the overall functioning of the individual and doesn’t “lift” easily. Meaning, even as time passes or even with positive experiences, one may continue to experience the symptoms of depression. While sadness is a normal and often healthy part of the human condition, depression is a mental illness that needs intervention.

Recognising the Signs and Symptoms

The first step to seeking help is knowing that you need help. When it comes to our mental health, many of us don’t reach out for help because we don’t know what it means to have poor mental health. Learning about the signs and symptoms can help us recognise the need for support, too.

Here are the common signs and symptoms of depression:

Emotional symptoms of depression:

Persistent feelings of sadness
Feeling hopeless about the future
Irritability, increased anger and frustration
Feelings of guilt or low self-worth

Physical symptoms of depression:

Fatigue or extreme tiredness, including waking up feeling tired and unrested
Changes in appetite
Changes in sleep
Physical discomfort not explained by a medical condition. This can include unexplained aches, digestive issues, and low immunity
Decreased libido

Behavioural symptoms of depression:

Loss of interest in activities one enjoyed previously
Social withdrawal and self-isolation
Difficult focusing on tasks
Forgetfulness
Restlessness or feeling sluggish and slowed down
Neglecting personal hygiene and care

In cases of severe depression, one may experience suicidal thoughts and ideation.

Different Types of Depression

While the lay use of depression paints a singular image of gloominess, depression can manifest in different ways. The DSM mentions different types of depression, which include major depression, persistent depression or dysthymia, postpartum depression, seasonal affective depression and bipolar depression where depressive episodes alternate with episodes of mania or hypomania.

Major Depressive Disorder (MDD) or Clinical Depression

This is the most common type of depression, and perhaps the closest to what we envision when we think of depression. Major depressive disorder is also called clinical depression. In MDD, one experiences a depressed mood or loss of interest in activities for at least two weeks. Other symptoms like changes in sleep, appetite, energy levels, level of concentration, forgetfulness and weak decision-making may also be present.

Persistent Depressive Disorder (PDD) (Dysthymia)

Think of PDD, also called dysthymia, as a less severe but more long-lasting form of depression compared to major depressive disorder. In PDD, an individual experiences low mood on most days for a period of two years. The severity of symptoms may be low, and the individual’s daily functioning may not be impaired as much as it might be in severe or major depression.

Postpartum Depression

Postpartum depression develops after childbirth. Unlike popular belief, most new mothers struggle with the transition of welcoming and caring for a baby. With this in mind, most women experience “baby blues” or a period of emotional and physical difficulty after giving birth. But, in cases of postpartum depression, one may experience more than temporary distress. Postpartum depression is a mood disorder characterized by intense sadness, anxiety and fatigue, which may make it difficult to care for or bond with the baby. The onset of postpartum depression can be at any time during the first year after childbirth.

Major Depressive Disorder with Seasonal Pattern (Seasonal Affective Disorder - SAD)

As is the case with “baby blues” after childbirth, some people may experience “winter blues” during colder months. While mild alterations in mood as the seasons change is expected, “winter blues” can sometimes point to seasonal affective disorder. Seasonal affective disorder includes feeling low, losing interest in activities and changes in appetite and sleeping during the winter. Symptoms may begin as the temperature starts dipping, and elevate once the weather starts becoming warmer.

Bipolar Disorder - I and II

In bipolar disorder, one fluctuates between two mood states - depressive and manic. In between these two mood states, there may be periods of equilibrium, or what is known as ‘euthymic mood’. There are two types of bipolar disorders. In bipolar I, the individual may experience episodes of depression and episodes of mania. In bipolar II, the individual experiences depression and episodes of hypomania. The difference in the severity of manic episode is the key differentiator between bipolar I and II.

What Causes Depression?

The causes of depression may include both biological and environmental or psychosocial factors.

Biological causes of depression include:

Genetics and heredity: Having a family history of depression increases one’s chances of developing depression. This suggests that there is a genetic predisposition to depression.
Hormonal imbalances: Hormonal changes, fluctuations and imbalances may contribute to the development of depression. This is most commonly seen in cases of premenstrual dysphoria and postpartum depression.
Other medical illnesses: Various medical illnesses including chronic illnesses like diabetes, hypertension and cancer can contribute to the development of depression.

Some environmental or psychosocial causes of depression include:

Stressful life events: Job loss, loss of a loved one, divorce or separation are some stressful life events that can contribute to depression
Interpersonal conflict: Unresolved or ongoing conflict in close relationships can take a toll on one’s sense of self, and in some cases, lead to depression.
Adverse childhood experiences: Childhood adversity includes neglect, abuse and household dysfunction. Adverse experiences during childhood can have lasting impact, one of which is making one more vulnerable to developing depression.

A Note About Sex and Gender Differences

We live in a highly gendered society. This shows up in our relationships, careers we choose, what we do with our finances and free time, responsibilities at home and friendships. It’s no surprise then that gender differences would also show up in how mental health conditions are expressed.

While men tend to express depression more commonly through substance use, anger bouts, irritability and fatigue, women are more likely to speak about their experiences of sadnes and worthlessness. The transgender and non-binary community face stigma at many levels, including their gender identity. There is also a dearth of services that are gender-affirming. This further complicates how a non-binary individual may express depression.

Specific Concerns

In Females - Biological factors such as hormonal changes during puberty, menstruation, pregnancy and menopause must be kept in mind when assessing and treating depression among women.
In Males - Depression among men can be atypical, with more focus on anger and irritability. Men may have a difficult time speaking about feelings of hopelessness and helplessness. This must be kept in mind when assessing males for depression.
In College Students - College can be a time of transitions and changes. This is the first foray into adulthood, and the new responsibilities that come with it can precipitate depression.
In Teens - Peer pressure, struggles with the changing body, learning about one’s sexuality, boundaries and identity can be stressful for a teenager. Teenage is a tumultuous time in any case. Extra attention may be needed if a teenager is not able to adapt.
In Children - Children respond to the environment they inhabit. If a child shows symptoms of depression, it is wise to investigate what is going on the family system that the child may be expressing.
In Historically Marginalized Groups - Marginalization in itself can take a toll on one’s mental health and can contribute to the development of depression. Marginalized communities may also hesitate to access healthcare, or may not have easy access. When working with historically marginalized groups, it’s valuable to address how their social position impacts their wellbeing.

When Depression is a Symptom

Sometimes, depression may be a symptom of another medical or psychological condition. For example, health conditions such as hypothyroidism, heart disease, Parkinson’s and cancer may lead to depression. Usually, treating the underlying disease also helps ease the symptoms of depression. Depression can also co-occur with other mental health conditions such as anxiety, psychosis, panic disorder, PTSD or substance abuse.

Getting Diagnosed with Depression

Only a trained mental health professional can provide a diagnosis of depression. In India, diagnoses are provided by either psychiatrists or clinical psychologists. The MHP will conduct a thorough evaluation and may recommend medical tests to rule out biological causes.

Depression Tests and Evaluations

To diagnose depression, a detailed evaluation is conducted. The MHP will ask you questions about your symptoms, thoughts, feelings and behaviours. They will also try to understand how long you’ve been feeling this way, how you have coped so far, what has worked and what hasn’t. They may also ask about psychosocial factors such as important life effects that occurred before the symptoms began. They may also ask you about family history of depression. Lastly, they may recommend medical tests to rule out any biological causes.

Can Depression Be Cured?

While there is no cure for depression, it can be successfully managed with the right treatment, support and lifestyle modifications.

Treatment Options for Depression

Depending on the severity of symptoms, the treatment of depression may involve a combination of medication and psychotherapy, or psychotherapy alone. Various therapy modalities including cognitive behavioural therapy, psychodynamic therapy, interpersonal therapy and mindfulness-based therapy are used for the management of depression. Lifestyle modifications like regular exercise, a balanced diet, and getting enough sleep (while not sleeping too much) are also important for the management of depression.

Medication

Think of medication as the windshield of a car. In moderate to severe cases of depression, sometimes one’s thoughts and feelings get foggy. Medication helps clear this fog so that one can think and feel with more clarity, and take on the transformative work of psychotherapy.

Common medications used for the treatment of depression include SSRIs, SNRIs, tricyclic antidepressants, monoamine oxidase inhibitors and atypical antidepressants. Like any other medication, antidepressants too, have some common side-effects. These include low libido, nasuea, drowsiness, changes in weight, changes in sleep, digestive issues, headaches and dry mouth.

Antidepressants must be consumed under the supervision of a psychiatrist. A common mistake people make is to wean off or change dosage without consultation. But, it is imperative that one consult with their healthcare provider before making any changes in the use of antidepressants.

Non-Medication Treatments

While medication may be necessary and useful in some cases of depression, it is not enough. The recommended course of treatment of depression is a combination of medication and psychotherapy, and lifestyle modifications. Along with this, there are also some alternative treatments one can consider.

Psychotherapy

There are different therapy modalities that can be useful in the treatment of depression. CBT or cognitive behavioural therapy examines and challenges negative thought patterns and core beliefs that may be precipitating depression. Psychodynamic therapy helps uncover and process childhood experiences and subconscious factors that may be contributing to depression. IPT or Interpersonal therapy examines the role of interpersonal relationships in depression.

Ultimately, the relationship one shares with their therapist is of utmost importance when it comes to the success of therapy. While different people prefer different modalities, the quality of the therapeutic alliance matters immensely.

Exercise

A physically active lifestyle with a sustainable exercise routine helps regulate one’s stress hormones and boost neurotransmitters responsible for mood regulation. For this reason, regular exercise is a lifestyle habit that is recommended as a part of treatment of depression. Having said this, it is important to keep in mind that depression can make it difficult to find the motivation to exercise. This can become a loop wherein we feel stuck and can’t seem to do something that would help us feel better. If getting a full workout in is difficult for someone with depression, one can think about movement - any form of movement, even a slow, short walk around the house, can help one feel mobilized.

Brain Stimulation Therapies

When medication and psychotherapy don’t work, one may consider brain stimulation therapies for depression. The oldest form of brain stimulation therapy is ECT, or electroconvulsive therapy. Research has shown that ECT can be effective in cases of severe depression and suicidal ideation.

Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are two other forms of brain stimulation therapies that are fast gaining popularity. tDSC is a non-invasive procedure used to bring about changes in cognitive functioning.

Mave Health’s ARC is a wearable device which delivers tDCS with no side effects. Users have seen improvement in their symptoms in just 21 days!

Food and Diet

The phrase, ‘we are what we eat’ is not out of line. In the last decade or so, abundant research has shown the connection between what we eat and how we feel. In particular, nutrient deficiencies and processed or ultraprocessed foods have been associated with a greater risk of depression.

Suicide Prevention

In severe cases of depression, one may experience suicidal thoughts or ideation. This is usually a crisis situation and must be handled accordingly. Some signs of suidical thoughts or tendencies include thinking or talking about death, wrapping up open ends in one’s life, withdrawing from social relationships, and feeling hopeless about the future.

If you or someone you know may be experiencing suicidal thoughts, you may reach out to the helpline iCALL. Immediately consulting with a psychiatrist is also advisable as in some cases, hospitalisation may be needed.

Frequently Asked Questions (FAQ)

What does depression do to the brain?

Our body and mind are connected and changes in one tend to impact the other, too. Depression can lead to changes in the brain, and viceversa. In individuals with depression, one may find imbalances in neurotransmitters such as serotonin, norepinephrine and dopamine.

Does depression change your personality?

While personalities more or less remain the same, depression can lead to changes in one’s behaviour and mood, making it feel like one is a different person. One may feel low, lack enjoyment and motivation, and feel worthless.

Does depression affect your thinking?

Depression can make one’s thinking cloudy and impact executive functioning, like decision-making. One may feel low on confidence and because of this, delegate decision-making to others. Reduced concentration and attention are also sometimes seen in depression.

Summary

Depression is a mental health condition which leads to behavioural, emotional and cognitive changes. The causes of depression may be biological or psychosocial. Effective treatment addresses all three aspects of depression - biological, psychological and social. If one is struggling with depression, it is imperative to seek support from a qualified mental health professional.