Let’s Talk About Depression: What You Need to Know.

Depression is a mental condition characterized by a persistently low mood. There are various types of depression, but when people refer to depression, they usually mean major depressive disorder.

It's projected to be the leading cause of disease burden globally by 2030. The term "major depressive disorder" came about in the 1970s and was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the 1980s. Currently, we use the DSM-5, which outlines nine criteria for diagnosis.

Key symptoms include feeling down most of the day, nearly every day, and anhedonia, which is the loss of interest in things you once enjoyed. At least one of these core symptoms must be present for a diagnosis. Other criteria involve significant weight changes, sleep issues (either too little or too much), fatigue, noticeable slowing down in thoughts and movements, feelings of guilt or worthlessness, trouble concentrating, and recurring thoughts of death. To be diagnosed, a person must have five or more of these symptoms for at least two weeks, causing significant distress or impairment in daily life, and these symptoms shouldn't be due to substance use or another medical issue.

Depression is a mental health issue marked by a consistently low mood. There are different forms of depression, but major depressive disorder is the one most people are talking about. It's expected to become the top cause of disease burden around the world by 2030. The phrase "major depressive disorder" was first introduced in the 1970s and made its way into the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the 1980s. Now, with the DSM-5, there are nine criteria for diagnosing it. The main symptoms include feeling low most of the day, nearly every day, and anhedonia, which is when you lose interest in things you used to enjoy. At least one of these core symptoms needs to be present for a diagnosis. Other criteria include significant weight loss or gain, sleep disturbances (either not enough or too much), fatigue, a noticeable slowdown in thoughts and movements, feelings of guilt or worthlessness, difficulty concentrating, and recurring thoughts about death. To be diagnosed, a person must experience five or more of these symptoms for at least two weeks, leading to significant distress or problems in functioning, and these symptoms shouldn't be caused by substance abuse or another health condition.

Major depressive disorder is believed to stem from a mix of factors, both genetic and environmental. Some research indicates that about 40% of the differences in risk among people can be linked to genetics. For instance, identical twins show a high rate of depression similarity, which suggests that having a family history can increase risk. On the environmental side, things like stressful life events and childhood abuse are also tied to how severe the depression can get. Other medical conditions or substance abuse can play a role too, but they aren't the direct causes. This brings us to the diathesis-stress model, which is often illustrated with two cups. It suggests that if someone has a vulnerability and then faces a stressful event, their chances of developing depression go up. So, when two people go through the same stress, one might end up with depression while the other doesn't, kind of like one cup overflowing while the other stays steady. Now, diving deeper into the pathophysiology of depression, we still don’t fully understand the exact mechanisms at play. One theory, the monoamine theory, points to a deficiency in certain neurotransmitters like serotonin, dopamine, and norepinephrine as a potential cause. There’s some evidence backing this up, but it’s worth noting that lower serotonin levels in healthy people don’t necessarily lead to depression.

2. Major depressive disorder is thought to arise from a combination of genetic and environmental influences. Research has shown that around 40% of the differences in risk among individuals can be attributed to genetics. For example, identical twins often have similar rates of depression, indicating that a family history can be a risk factor. On the environmental side, factors like stressful life events and childhood abuse are linked to the severity of depression. Other medical issues or substance abuse can contribute as well, but they aren't the direct causes. This leads us to the diathesis-stress model, often depicted with two cups. It suggests that if someone has a vulnerability and then experiences a stressful event, their chances of developing depression increase. So, when two people face the same stress, one might develop depression while the other might not, similar to one cup overflowing while the other remains full. When we look at the pathophysiology of depression, the exact mechanisms are still not completely understood. One theory, known as the monoamine theory, suggests that a shortage of certain neurotransmitters like serotonin, dopamine, and norepinephrine could be the culprit. While there’s some evidence supporting this idea, it’s important to note that lower serotonin.

Depression and antidepressants quickly boost neurotransmitter levels, but you won’t feel the effects for a few weeks. Other theories suggest issues with the hypothalamic-pituitary axis, as those with depression often show higher cortisol levels and reduced dexamethasone suppression. There’s also a possible connection between thyroid hormones and growth hormone levels in relation to depression. Plus, immune system irregularities might play a role, like too much cytokine release. This idea is backed by the fact that symptoms can improve with non-steroidal anti-inflammatory drugs and that cytokine levels normalize after treatment. It might also explain the links to immune-related diseases like asthma. When it comes to the numbers, the lifetime risk of developing major depressive disorder is about 12 percent, or roughly one in eight people. It’s almost twice as common in women compared to men, which could be due to different stress factors and hormonal variations, but the exact reasons are still unclear. The average age for the onset of depression is around 40, but it’s becoming more common in younger individuals. We’ve touched on the clinical criteria for diagnosing depression according to the DSM-5, and there’s also the ICD-11 criteria mainly used in Europe. The severity of depression can be assessed using scoring systems like the patient.

Health Questionnaire 9. It's worth mentioning that people with depression often have other disorders too, like anxiety and substance abuse, particularly with alcohol. There can also be links to ADHD, PTSD, and chronic pain.

When it comes to treating major depressive disorder, the approach can differ, but combinations of treatments tend to work best. This usually includes making lifestyle changes such as exercising, eating healthier, cutting back on alcohol and smoking, quitting drugs, and sticking to a regular routine.

Psychotherapy, or talking therapy, is another key part of treatment. Techniques like cognitive behavioral therapy and interpersonal therapy are commonly used and have proven effective. These therapies are often the go-to option for those under 18, according to NICE guidelines.

For those dealing with moderate to severe depression, or mild cases that aren't improving with other methods, medication may be necessary. Commonly prescribed drugs include selective serotonin reuptake inhibitors like sertraline, citalopram, or fluoxetine, which are typically the first choice. Serotonin norepinephrine reuptake inhibitors like duloxetine and venlafaxine can also be helpful, especially for patients with pain issues. Additionally, atypical antidepressants like metazepine can provide support as well.

Boosting appetite and managing sleep patterns is key. Then we have tricyclic antidepressants, like amitriptyline, and monoamine oxidase inhibitors, such as celleduline. These aren’t used as much because they come with a lot of side effects. There’s also some proof that vitamin D supplements can help with depression for those who are low on it. Plus, cox-2 inhibitors like celecoxib have shown effectiveness in some research. Electroconvulsive therapy is the top treatment for major depressive disorder. It works by electrically triggering seizures to help alleviate the condition. About 50% of patients with treatment-resistant major depressive disorder find it effective, and it’s usually done with a muscle relaxant while under general anesthesia. However, around half of those who respond to it might relapse within a year.