Depression is one of the commonest mental health conditions worldwide, affecting over 350 million people according to the WHO. It is now recognized as an extremely important medical condition and is one of the leading causes of disability. Depressive disorder affects individuals from all walks of life. Women are at higher risk for depression compared with men but the prevalence of major depression is thought to decline with age, according to some studies.
Depression is a term that is often used outside of clinical settings to describe a variety of symptoms. These can range from mild/transient symptoms (being “bummed out”) from experiencing an adverse life event or a transition (such as moving away from home to college, joining the military or starting a new job) to the normal grieving reaction that is a part of any major loss, to the actual clinical disorder which will be the main focus of this article.
In clinical settings “depression” is used to describe a set of symptoms that can occur as part of various psychiatric conditions such as Major Depressive Disorder, Bipolar disorder, Seasonal Affective disorder, post-partum depression and the less-severe form of depression known as dysthymia. While its onset can be insidious and hard for many individuals experiencing it to recognize, its symptoms are fairly consistent. Depression is diagnosed clinically when individuals simultaneously experience any 5 of the following 9 symptoms within a 2 week period.
DSM V Diagnostic Criteria
Five or more of the following present daily/nearly daily for 2 weeks.
- Depressed mood (core symptom)
- Anhedonia (core symptom), which means a loss of ability to enjoy things one previously found pleasurable
- Significant weight loss or gain (>5%) in a month)
- Insomnia or hypersomnia nearly daily
- Psychomotor agitation or retardation
- Fatigue nearly daily
- Feelings of worthlessness/excessive or inappropriate grief
- Inability to concentrate, indecisiveness
- Recurrent thoughts of death/suicidal ideation or plan
In many cultures (US included) primary complaints are somatic (e.g. pain) or may manifest as anxiety or irritability.
Depression can sometimes be hard to distinguish from grieving. Some individuals can suffer from a milder form of depression known as Dysthymia. Depression also often accompanies or co-exists with other psychiatric conditions such as anxiety, panic symptoms and psychosis. Most significantly, it can be a major factor that leads to completed suicide. Depression manifests differently in children and adolescents compared with adults. Individuals in these age groups suffering from depression often will report irritable mood and exhibit a change in/problematic behavior(s), rather than the typical symptoms reported by adults.
Depressive symptoms can occur de-novo, as part of any one of the psychiatric illnesses above. While it is not possible to provide a detailed list of possible causes of depression here, it is well known that individuals can be predisposed to depression by underlying psychological problems. Depression also can and does frequently follow major adverse life events like divorce or being laid off of work. It is increasingly recognized that depression can accompany many medical problems such as diabetes, HIV infection, heart disease, stroke, myocardial infarctions (heart attacks), chronic pain and other neurological and hormonal problems. Depressive symptoms can also be induced by illicit drug use or even by prescription medication.
Untreated depression has serious consequences. It worsens outcomes for virtually all health conditions that occur at the same time (co-morbid conditions). For example, it is
- Often associated with or exacerbates chronic pain
- A predictor of worse health outcomes post-MI, post-stroke
- Associated with poor adherence to treatment recommendations and poor outcomes (diabetes, HTN, post-MI)
- Strongly associated with alcohol abuse/dependence and other SUDs
- Reduces overall health more than chronic diseases
- Known to increase risky behaviors such as smoking, overeating, inactivity
- Known to be a key factor in suicide
Treatment for depression is often quite effective, although finding the right combination can take time. Not everyone responds to the same thing(s). Also, persons suffering from depression are frequently unaware or reluctant to accept the diagnosis. This can unnecessarily delay getting treatment and prolong suffering.
Current evidence suggests that the most effective treatment typically consists of counseling (or talk therapy), medication and lifestyle adjustments. Talk therapy is particularly underutilized and often dismissed as “psychobabble or mumbo-jumbo”. However, there is solid scientific evidence to back the effectiveness of treatments such as cognitive behavioral therapy (CBT), and interpersonal therapy (IPT). In particular, cognitive behavioral therapy, which focuses on changing an individual’s thought processes to affect their mood has found widespread application in treating a variety of mental health conditions including depression, anxiety states, drug addictions and even psychosis. In a sense, the basic principles of CBT seem consistent with the principles of spiritual warfare documented in 2 Cor 10.4. However, it must be emphasized that therapy of any kind should only be delivered by trained, licensed professionals within the context of a therapeutic relationship.
The Role of Medication
Taking medication for mental health conditions remains a somewhat contentious issue for some, although it need not be. The medications currently approved for depression treatment by the Food and Drug Administration have undergone extensive testing and after market surveys. For depression and many other serious mental health conditions, they are frequently the mainstay of treatment, without which many individuals do not attain relief from their symptoms. There is a wide variety of safe options to choose from. These medications can and often are prescribed by general/family medical practitioners. Sometimes people do not respond to the first choice or experience side effects that are not tolerable. For these reasons, it often takes several trials to find the right medication. People sometimes can stop their medication after their symptoms become controlled, but this needs to be a decision discussed with their doctor or nurse. Many persons need to take medication on an ongoing basis, similar to taking insulin for Type 1 diabetes or blood pressure medication. People who become depressed in the cold, dark season of the year frequently find light therapy very helpful.
In addition to getting therapy and taking medication, there are a number of things that an individual can do on their own to help improve their mood. There is some evidence that exercise can improve one’s mood and can be a useful additional practice. Quitting drugs and alcohol is often necessary to address mood symptoms. Learning to re-frame one’s thinking about life challenges, stresses and experiences can help significantly as well. Prayer and mindfulness (living in the moment) can be extremely helpful as are reducing stress and surrounding oneself with a supportive community. It has been interesting to me to observe that many measures now advocated for and supported by research have been written in the scriptures for centuries!
However, in many instances it is appropriate, necessary and helpful to seek the services of a mental health professional. It is probably better to do so sooner than later. Clear warning signs for families include voicing suicidal thoughts or making attempts, loss of touch with reality, or being unable to cope with day-to-day tasks of living. In such cases individuals, should be taken to see a medical or mental health professional (possibly to the ER) as soon as possible: it may save their lives.