...and then suddenly I became sad for no reason

FM Bureau | 01-July-2014

Most of  the people  have moments or short periods of sadness when they feel lonely or depressed. These sensations are usually normal ones that sometimes occur in life. They can be the result of a recent loss, having a particularly challenging day or week, or a reaction to a hurtful comment. However, when feelings of sadness and being unable to cope overwhelm the person, so much so that they undermine their ability to live a normal and active life, it is possible that they have what is known as a major depressive disorder (MDD), also called clinical depression, unipolar depression or major depression

By FM Bureau

Depression , in general terms is a medical illness that causes a constant feeling of sadness and lack of interest. It affects how the person feels, behaves and thinks. It can lead to emotional and physical problems. Typically, people with depression find it hard to go about their day-to-day activities, and may also feel that life is not worth living.

What is depression?

Feeling sad, or what we  may call “depressed”, happens to all of us. The sensation usually passes after a while. However, people with a depressive disorder - clinical depression - find that their state interferes with daily life.

For people with clinical depression, their normal functioning is undermined to such an extent that both they and those who care about them are affected by it.

Melancholia: clinical depression is a fairly modern term. Hippocrates, known as the father of Western medicine, described a syndrome of “melancholia”. He said melancholia was a distinct disease with specific physical and mental symptoms. Hippocrates characterised it as “(all) fears and despondencies, if they last a long time” as being symptomatic of the illness.

An article published in Philosophy, Psychiatry & Psychology5 explains that melancholia included a broader range of symptoms compared to clinical depression. It included dejection, sadness, despondency, anger, fear, delusions and obsessions.

How common is clinical depression? Nobody is sure exactly how many people are affected by depression. Health authorities from country to country and even within the same nation publish different figures:

Different forms of depression?

There are several forms of depression (depressive disorders). Major depressive disorder and dysthymic disorder are the most common.

Major depressive disorder (major depression)

Major depressive disorder is also known as major depression. The patients suffer from a combination of symptoms that undermine their ability to sleep, study, work, eat, and enjoy activities they used to find pleasurable.

Dysthymic disorder (dysthymia)

Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. The symptoms are not as severe as in major depression - they do not disable the patient. However, people affected with dysthymic disorder may find it hard to function normally and feel well. Some people experience only one episode during their lifetime, while others may have recurrences.

Postpartum depression (postnatal depression)

Postpartum depression is also known as postnatal depression or PND. This is not to be confused with ‘baby blues’ which a mother may feel for a very short period after giving birth.

If a mother develops a major depressive episode within a few weeks of giving birth it is most likely she has developed postpartum depression. Experts believe that about 10% to 15% of all women experience this type of depression after giving birth. Sadly, many of them go undiagnosed and suffer for long periods without treatment and support.

SAD (seasonal affective disorder)

SAD is much more common the further from the equator you go, where the end of summer means the beginning of  less sunlight and more dark hours. A person who develops a depressive illness during the winter months might have SAD.

SAD symptoms go away during spring and/or summer. In Scandinavia, where winter can be very dark for many months, patients commonly undergo light therapy - they sit in front of a special light. Light therapy works for about half of all SAD patients.

Bipolar disorder (manic-depressive illness)

Bipolar disorder is also known as manic-depressive illness. It used to be known as manic depression. It is not as common as major depression or dysthymia. A patient with bipolar disorder experiences moments of extreme highs and extreme lows. These extremes are known as manias.

• A constant feeling of sadness, anxiety, and emptiness
• A general feeling of pessimism sets in (the glass is always half empty)
• The person feels hopeless
• Individuals can feel restless
• The sufferer may experience irritability
• Patients may lose interest in activities or hobbies they once enjoyed
• He/she may lose interest in sex
• Levels of energy feel lower, fatigue sets in
• Many people with a depressive illness find it hard to concentrate, remember details, and make decisions
• Sleep patterns are disturbed - the person may sleep too little or too much
• Eating habits may change - he/she may either eat too much or have no appetite
• Suicidal thoughts may occur - some may act on those thoughts
• The sufferer may complain more of aches and pains, headaches, cramps, or digestive problems. These problems do not get better with treatment.

Some illnesses accompany, precede, or cause depression

Anxiety disorders, such as PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), social phobia, generalised anxiety disorder and panic disorder often accompany depression.  People who are dependent on alcohol or narcotics have a significantly higher chance of also having depression.

Depression is much more common for people who suffer from HIV/AIDS, heart disease, stroke cancer, diabetes, Parkinson’s disease, and many other illnesses. According to studies, if a person has depression as well as another serious illness he is more likely to have severe symptoms, and will find it harder to adapt to his medical condition. Studies have also shown that if these people have their depression treated the symptoms of their co-occurring illness improve.

The treatment options

Depression is highly treatable - even in its most severe forms. The sooner a person is treated the more effective that treatment will be. Studies have also shown that prompt treatment reduces significantly the likelihood of recurrence.

As some medications can cause the same symptoms as depression, you need to get your doctor to make sure this is not the cause.

Medication for depression - Antidepressants

The aim of an antidepressant is to stabilise and normalise the neurotransmitters in our brain (naturally occurring brain chemicals), such as serotonin, dopamine, and norepeniphrine. According to various studies, these neurotransmitters play a vital role in regulating mood. We know they regulate mood, but we are not exactly sure how they do it.

Antidepressants take time to work - in the majority of cases patients will not notice any really significant benefit from an antidepressant until they  been taking it for a few weeks. It is important to continue taking them for this reason.

Make sure you take your medication according to your doctor’s instructions. Even if you feel better, do not stop the drug unless your doctor tells you to. Not only do antidepressants help to make you feel better, they also significantly reduce your chances of having a recurrence or relapse.

If an antidepressant does not work - if you find one drug does not improve symptoms after a few weeks tell your doctor and see if he or she can get you on to another one. Research has shown that treatment is much more successful if a patient switches from a drug that does not seem to be working to another one.

What are the side effects of antidepressants?

Most people who experience side effects will find they are mild and short-lived. It is rare for a patient to have long-term effects, but there are cases. Any unusual reaction you experience should be reported to your doctor straight away.

Suicidal thoughts and behaviour - in the USA in 2005 the FDA made drug makers include a ‘black box’ warning label on all antidepressants warning about the possibility of suicidal thoughts or attempts at suicide by children and adolescents who take an antidepressant.

The warning \ says that those taking antidepressants should be watched closely by their doctors during the first weeks of treatment. It asks health care professionals to look out for warning signs, such as worsening depression, suicidal thinking or behavior, or any changes in behavior which are out of the ordinary, such as sleeplessness, agitation, or withdrawal from normal social situations.  It  also states that family members and caregivers should also be told that close monitoring is needed, and to report any changes to the doctor.

Psychological signs and symptoms

• Persistent sadness or low mood
• Thoughts and feelings of worthlessness
• Feelings of self hatred
• A feeling of hopelessness
• A feeling of helplessness
• Feeling like crying
• A feeling of guilt
• Irritability - even trivial things become annoying
• Angry outbursts
• Intolerance towards others
• Persistent doubting - finding it very hard to decide on things
• Finding it impossible to enjoy life
• Thoughts of self harm
• Thoughts of suicide
• Persistent worry
• Persistent anxiety

Physical signs and symptoms

• Body movements may be slower than they used to be
• Problems with focusing, the person’s concentration span may be reduced
• Speech may be slower than it used to be
• Eating patterns change, appetite changes - typically, the patient eats less and loses weight. However, some people may eat more and gain weight.
• Low sex drive
• Lack of energy, fatigue, tiredness - even small and easy chores feel like unpleasant ordeals
• The woman’s menstrual cycle may change
• Restlessness - the patient may pace up and down more, wring his/her hands, and find it hard to keep still
• Unexplained aches and pains, such as headache, backache or digestive problems
• Sleeping disturbances - the individual may find it hard to get to sleep, or wakes up during the night and cannot get back to sleep. Studies have shown that over 80% of people with depression suffer from some kind of insomnia. Hypesomnia (oversleeping) is also possible. Some medications used for treating depression may cause insomnia.

Social signs and symptoms may include

• Underperforming at work
• Not doing well at school
• Avoiding keeping in touch with friends
• Abandoning interests and hobbies
• Having family/home problems
• In severe depression, the patient may experience symptoms of psychosis - delusions or hallucinations (less common).

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