Understanding Depression: Symptoms, Diagnosis, Treatment and Prognosis

Depression is a mental health disorder that affects the way one thinks, feels and conducts themselves. It has various forms such as persistent depressive disorder, postpartum depression, psychotic depression, and seasonal affective disorder. Diagnosis is done through talking to the patient and going through thorough history and physical check. Treatment includes lifestyle changes, exercise, healthy eating, and getting rid of negative thoughts. Prognosis is good if treated early. Future treatments are being discovered to improve rates of remission and response among patients.

NON COMMUNICABLE DISEASES
DEPRESSION
INTRODUCTION
According to (Morgan, D., 2003. Mindfulness-based cognitive therapy for depression:),
depression is a mental health disorder. It has symptoms which are severe that affect the way one
thinks, feels and how you conduct yourself in the day to day activities such as walking, talking
and sleeping. Each person has a different way of dealing with depression; some may use alcohol
or drugs to feel better about their situation. This is not a proper method of dealing with
depression as alcohol leads to irresponsible behavior. According to world health organization,
depression is the lead cause of disability and also one of the most common illnesses.
Depression occurs in many forms such as persistent depressive disorder which is also referred to
as dysthymia. This a form of depression that occurs for a period of at least two years. A person
suffering from this depression often has episodes of major depression which may be followed by
less severe episodes. Another form is postpartum depression which mainly occurs in women
after giving birth. It is worse than “baby blues” since these women experience full blown
depression during pregnancy and after delivery of the baby. They feel extremely tired, anxious
and sad that prevents them from effectively taking care of their new born (Miranda, R. and
Mennin, D.S., 2007. Depression, generalized anxiety disorder, and certainty in pessimistic
predictions about the future)
A person suffers from severe depression in psychotic depression and some various forms of
psychosis such as hallucinations whereby they see and hear their own things and delusions where
they have false fixed belief. There is a depressive theme of poverty and illness. In seasonal
affective disorder, depression mainly occurs during the winter season where natural sunlight is
minimal. It is closely followed by social withdrawal, increase in weight, changes in sleep
patterns which favors sleeping more. It lifts during summer and spring and returns when winter
approaches (.Miranda, R. and Mennin, D.S., 2007. Depression, generalized anxiety disorder, and
certainty in pessimistic predictions about the future).
PREVALENCE VERSUS INCIDENCE
Incidence of depression has increased every year since the 20th century. Many reasons are
attributed to this such as socioeconomic changes brought about by post world war II “baby
boomer” generation.( Ananth, J., 2000. Treatment-resistant depression )
Prevalence of depression varies all over the world. The lowest rates are recorded in Asia and
south east Asian countries. Percentages are used to determine the chance at which depression
might occur that may be annually or more. We can look at the example of Taiwan, which reports
less than 2 percent, that may be attributed to lower cases of divorce and separation, Korea 3

percent, Canada has a higher percentage of 7, new Zealand 11 percent and France 16 percent.
Countries that are mostly affected by civil war such as Northern Ireland report higher rates of
depression.( Ananth, J., 2000. Treatment-resistant depression)
The prevalence data being used is from national survey on drug use and health,2016. We will
look at the prevalence occurrence of depression in the USA as an example. Over the past year, an
estimated 16.2 million adults were found to be suffering from at least one episode of depression.
This number represented 6.7 percent of all adults in the US. This depressive episode occurred
more on females (8.5%) compared to male which was 4.8%.
Prevalence of depression mainly occurred to adults who were in their late teens and early
twenties. Only fifty percent of people who suffer from depression get treatment which makes it
difficult to know the number of people suffering from this disorder (Miranda, R. and Mennin,
D.S., 2007. Depression, generalized anxiety disorder, and certainty in pessimistic predictions
about the future)
SYMPTOMS
Depressed mood
Weight loss without dieting that is unplanned
Insomnia
Hypersomnia - this is where one sleeps more hours than is medically required
Excessive fatigue
Guilt and feelings of being worthless
Impaired decision making, thinking ability and concentration levels
Constant thoughts of death or suicide
Delayed psychomotor skills such as slowed movement and speech
Pessimism and hopelessness
Irritability
Appetite loss or over eating
There is constant aches, pains, headaches, or cramps.
Loss of interest in pleasurable things such as sex and hanging out with friends.
Digestive problems like constipation that don’t et better even when treated

Suicidal thoughts, or attempts.
DIAGNOSIS
There is no test that a doctor can conduct so as to know if one is depressed. Doctors figure out by
talking to the patients and going through thorough history and physical check(Gaynes, B.N,
Gavin,2005.) talking to the patients enable the doctor know lifestyle habits, daily moods and
behaviors of the patient.
The doctor will ask questions such as when the symptoms started, how long you’ve had these
symptoms, any history of alcohol and drug abuse, how severe were the symptoms, if there is
presence of depression or mental illness in the family. Screening should also be done regularly,
doctors should screen patients when they come for a visit due to a chronic disease, annual
checkup or when they are pregnant.
It is hard to diagnose depression especially clinical depression as it manifests itself differently in
each person. Some patients may become irritable and hard to talk to while others may withdraw
into a state of apathy, and may become aggressive and agitated. Depression may cause excessive
sleep and eating or entirely lead to elimination of these things.
AETIOLOGY
Aetiology of depression still remains poorly known among individuals. Evidence suggests there
is presence of genetic components to depression but no specific genetic factors have been
identified. Genetic factors control stressful life events in adolescent and adult life.( Gotlib, I.H.
and Joormann, J., 2010. Cognition and depression: current status and future directions)
Earlier age of occurrence of depression is associated with greater chances of it occurring again,
chronity and impairement. Aetiologically, occurrence of depression at different ages may reflect
different casual factors. There are different etiological models for depression which include
diathesis-stress models whereby if one is undergoing a stressful experience, depression may be
triggered, mostly to those who easily react to biological and psychological changes and
characteristics.
Some of the environmental stressors which trigger depression include life events that are acute
such as loss of a loved one, stress which is chronic and exposure to adversity as a child.
Surrounding environment, personal insecurities and some biological components, may coincide
and therefore contribute to the occurrence of depression to an individual. This affects
depressive states in a bidirectional process.

Depression occurs due to factors such as drug abuse, anxiety, personality disorders and
behavioral changes and other related mental illnesses (Comstock, G.W. and Helsing, K.J., 2000.
Symptoms of depression in two communities )
TREATMENT
Depression can be treated by changing physical activity, lifestyle and way of thinking.( Ananth,
J., 2000. Treatment-resistant depression.) There are several natural treatment methods for
treating diabetes which include:
Getting in to a routine which helps you get back on track as depression may prevent you from
doing work you would otherwise have enjoyed.
Goal setting: When one is depressed they feel hopeless with no sense of motivation, like they are
failures, which makes them feel worse . Start with small goals like washing the dishes and add
more tasks as time goes by.
Exercise: the brain has feel good chemicals called endorphins that are triggered when one
exercises. Regular exercise encourages the brain to think in a positive way due to the endorphins
which is very important for people with depression. Walking may also significantly help.
Healthy eating: food with omega 3 such as tuna and salmon may help in depression. If you
overeat when depressed then careful diet watch should be observed.
Good sleeping habits. Depression may make it difficult for someone to sleep which makes it
worse. You should go to sleep at the same time and wake up at the same time to create a routine.
Naps should be avoided. This will improve sleep.
Responsibilities: When depressed one may not want to be in charge of anything at home or in the
work place such as taking care of the baby. This is not a good idea. Maintaining a healthy
lifestyle by staying in control of your responsibilities can help in countering depression.
(Hosseini, S.H., Naghibi, A.A. and Khademlou, M., 2008) they give a person a sense of
accomplishment.
Get rid of negative thoughts: When depressed, you only think of the worst possible scenario and
conclusions. Logic treatment can be used when a depressed person starts feeling bad about
themselves. This can help get rid of the negative thoughts before they get out of control and
cause damage.

Always consult with your doctor before starting taking supplements such as fish oil, folic acid
and same, especially when under medication. This is because they have not been clinically
proven to help with depression.
When feeling depressed push yourself to move out of your comfort zone and do something new
like got to the park and read a book or volunteer to work at a shelter for a few hours, sewing or
watching an interesting documentary. Trying something new triggers chemical changes that
allow production of dopamine which enhances enjoyment learning and pleasure of individuals. It
is triggered in the brain.
Work at having fun as everything may not seem fun anymore. One should plan things that used
to be fun for you even if they seem time consuming and a bore now. Keep socializing and
hanging out with friends and watching movies. You have to learn to redo having fun and things
will really feel fun again.
PROGNOSIS
There is poor diagnosis for both unipolar depression and bipolar depression due to recent
longitudinal studies. Introduction of new treatment methods have offered a tremendous
improvement although use of antidepressant agents may be an inadequate method of treatment as
they are currently not available to all. Each episode in depression should be treated as first as
possible with vigor so as to optimize the outcome of depression. The symptoms being felt by the
patient should be the main goal used in prognosis.
For a period of 6 months and more, treatment should be executed and applied. Many patients
lack funds and therefore may not benefit from maintenance therapy as most of them do not go
for the treatment. More constructive treatment, such as the use of psychological approaches,
education, close follow-up and support, are under-utilized and poorly evaluated in prognosis. If
someone is being treated for depression then in the vast majority of cases, the prognosis for
depression is good.
Untreated depression gets worse with time and cannot naturally treat itsel. And, if left untreated
depression can then be chronic or terminal, this is because it is the main cause of suicides and
suicidal attempts. Depression is not a disease that can be taken lightly. It is a serious illnesses
that demands treatment at a very early age. Patients who take their time to go for treatments
recover from the disease fully.
EMERGING PERSPECTIVES / FUTURE TREATMENT DIRECTIONS
There have been years and decades whereby depression was being researched. This
neuroscience research which is basic has led to improved understanding of the neurobiology of
depression. Most effective treatments have been established by clinical studies. (Gotlib, I.H.
and Joormann, J., 2010. Cognition and depression) these studies have enabled us to see that

algorithm based treatments can be used in the real world. Insight has been provided to the
molecular, cellular and neuron anatomical bases of depression by the clinical researchers
Despite all this advances, depression still remains one of the most common and inadequately
treated diseases. There are a number of future treatments that are being discovered as the path
physiology of depression is becoming more knowledgeable among people and researchers. These
treatments are meant to allow clinicians improve on rates of remission and response among the
patients as they offer unique mechanisms of action.
Monoamine deficiency is among one of the oldest methods that is associated in diagnosis of
depression. There is a neurotransmitter system known as monoamine which is distributed within
the nervous system and is inclusive of serotonin, nor epinephrine and dopamine. These
monoamines help in regulation of mood, in that there would be reduced mood swings, cognition,
movement, sleep, appetite to moderate, libido, arousal, anxiety and aggression. They act as
moregulators of neurotransmitter circuits that are involved in excitatory and inhibitory.
Cells of rostral and caudal raphe nuclei assist in production of serotonin. It is widely distributed
within the central nervous system. Several brain regions are involved in the path physiology of
depression, they include hypothalamus, thalamus, hippocampus, amygdale, basal ganglia,
prefrontal cortex and cingulated cortex. Serotonergic dysfunction has been linked with all forms
of depression.
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