Understanding depression

As advances in mental health disorders have been made, so too has the efficiency in diagnosing clinical depression. (Photo: Freepik)
Despite how common it is, depression is an often misunderstood mood disorder. And while many feel sad or depressed, it is important to note that it is not necessarily the same as being diagnosed with depression. اضافة اعلان

As advances in mental health disorders have been made, so too has the efficiency in diagnosing clinical depression. While data may suggest that depression rates are increasing, it is more likely that depression diagnoses are what are on the rise, which can be attributed to an increased understanding of the disorder.

Nevertheless, understanding and treating depression is of the utmost importance in order to form a better and more functional society.

Depression and its prevalence

Diagnosed depression is also known as clinical depression or major depression disorder (MDD). According to the World Health Organization (WHO), it is estimated that 3.8 percent of the world’s population suffers from MDD. Despite WHO’s statistics, it is believed that depression’s prevalence may be much higher.

Social and economic factors can play a significant role in poor MDD diagnosis. In societies that are poorly educated on mental health or stigmatize it, individuals may face difficulty or not be capable of being officially diagnosed. Similarly, financial difficulties may play a role in poor diagnostic outcomes on a global and individual level.

Globally, lower-income countries may not be able to afford awareness campaigns to spread awareness on MDD, and on an individual level, one may find expenses towards mental health not within their budget.

All of these factors were reflected in a 2018 study conducted in Jordan on the prevalence of depressive symptoms among adolescents. This study involved Jordanian participants between the ages of 12–17, in which participants were asked to fill out a self-administered questionnaire.

Based on their reports, 34 percent of participants were classified as moderately to severely depressed. Albeit not a formal diagnosis of MDD, this study suggests that, at the very least, depressive symptoms are far more prevalent than internationally suggested, including in Jordan.

MDD diagnosis

Diagnosis of MDD follows the diagnostic criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-5.

Before an individual can be diagnosed with MDD, the symptoms of depression must cause the individual significant distress or affect the functioning of everyday life. Additionally, the symptoms of depression must not be associated with substance abuse or any other medical condition.

In order to be diagnosed with MDD, five or more depressive symptoms must be present nearly daily during a two-week period.

The symptoms of MDD are as follows:

Depressed mood most of the day

Markedly diminished interest or pleasure in almost all activities most of the day

 Weight gain or weight loss when not dieting

An increase or decrease in appetite

A slowing down of thoughts and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down)

Fatigue or loss of energy

• Feelings of worthlessness or excessive guilt

Diminished ability to think or concentrate

Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt

MDD causes

Loosely speaking, MDD is caused by an imbalance of natural biochemicals known as neurotransmitters. Neurotransmitters serve the function of communication in the brain and each one delivers a specific message.

MDD is characterized by decreased levels of serotonin, dopamine, and norepinephrine. Serotonin is responsible for regulating mood, dopamine is responsible for feelings of euphoria, and norepinephrine is responsible for feelings of alertness and concentration.

The exact cause of this imbalance is extremely complex and is likely a combination of social, developmental, or biological factors. Genetic predisposition seems to play a role in the risk of developing MDD.

While having a family history of MDD puts people at a higher risk of developing the disorder, there has been no single gene found responsible. Similarly, women are twice as likely to develop MDD compared to men and the reason is thought to be related to hormonal changes.

Developmental factors also seem to play a major role in the risk of developing MDD. Those who are exposed to emotional, physical, or sexual abuse are at higher risk. Similarly, those impacted by major life events such as death, divorce, or losing a job are also at higher risk.

Lastly, other medical conditions, both mental and physical, can increase the risk of developing MDD. It is important to note that these medical conditions do not directly cause depression, but instead negatively affect the person’s quality of life which can result in MDD.

MDD and mortality

Unfortunately, MDD is associated with high mortality, often attributed to suicide. In the aforementioned study involving adolescents in Jordan, there is mention of a relation between mortality and mental and behavioral disorders.

Different research notes that of all the mental and behavioral disorders, depression is the most common and that all of them combined are responsible for roughly 25 percent of Arab adolescent premature mortality and disability.

When compared globally, this prevalence is considerably higher and is likely due to factors such as poverty, regional conflicts, and changing family environments.

Similarly, a 2017 longitudinal study assessing the relationship between depression and mortality between 1952 and 2011, found that both men and women who suffered from depression had reduced life expectancies compared to those who are not depressed.

When comparing the differences between men and women there were also more unsettling discoveries. Although women are nearly twice as likely to develop depression, the mortality risk was roughly three times higher in men. Additionally, the mortality risk in women did not change greatly in the early decades of the study but, later in the study, the risk began to increase.

The cause for increased mortality is due to a number of factors including chronic and long-standing depression without treatment or lifestyle choices and habits such as a poor diet, infrequent exercise, and substance abuse.

Treating MDD

If you or a loved one are concerned about MDD, it is important to see a psychiatrist as soon as possible. With the advances in medicine, MDD is manageable and has decent success rates.

Seeing your healthcare professional is especially important if you have thoughts of suicide no matter how seemingly mild. It is also important to not self-medicate nor experiment with recreational substances. Your healthcare provider needs to be able to properly assess your symptoms and management with medication.

Lifestyle changes should also be implemented to better help manage MDD, as deficiencies in certain nutrients can worsen symptoms of depression so foods rich in omega-3 fatty acids, B vitamins, and magnesium may help.

Although depression can make you feel lethargic, exercise is also important in managing symptoms. Exercise helps release endorphins which can help improve your mood.

Finally, sleep is also important for those with depression. However, too much or too little sleep can worsen depression, and therefore, it is important to have a regular sleep schedule of 7–8 hours.

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