Depression (Major Depressive Disorder) – Symptoms and Causes
Generalities
Depression is a common illness worldwide, estimated to affect 3.8% of the population, including 5% of adults and 5.7% of adults over 60 years of age (1). . Worldwide, approximately 280 million people have depression (1). Depression is different from habitual mood swings and brief emotional responses to problems in everyday life. It can become a serious health problem, especially when it is recurrent and of moderate to severe intensity. It can cause great suffering to the affected person and disrupt their work, school, and family activities. At worst, it can lead to suicide. Every year more than 700,000 people commit suicide. Suicide is the fourth leading cause of death in the 15-29 age group.
Although there are known and effective treatments for mental disorders, more than 75% of people affected in low- and middle-income countries do not receive any treatment (2). Barriers to effective care include a lack of resources and trained healthcare providers, as well as the stigma associated with mental disorders. In countries of all incomes, people who experience depression are often misdiagnosed, while others who do not actually have the disorder are often misdiagnosed and treated with antidepressants.
Symptoms and typologies
In a depressive episode, the person experiences a depressed mood (sadness, irritability, empty feeling) or a loss of enjoyment or interest in activities most of the day, nearly every day, for at least 2 weeks. Various other symptoms occur, including difficulty concentrating, excessive guilt or low self-esteem, lack of hope for the future, thoughts of death or suicide, sleep disturbances, changes in appetite or in weight and a feeling of marked tiredness or lack of energy.
In certain cultural contexts, some people may more easily express their mood changes in the form of somatic symptoms (eg, pain, tiredness, fatigue), even though those physical symptoms are not due to another medical condition.
During a depressive episode, the affected person experiences considerable difficulties in personal, family, social, educational, occupational, and other important areas of functioning.
Depressive episodes can be classified as mild, moderate, or severe, depending on the number and intensity of the symptoms, as well as the repercussions on the person’s functioning.
There are different types of mood disorders:
single-episode depressive disorder: the person experiences a first and only episode;
recurrent depressive disorder: the person has already suffered at least two depressive episodes; and
bipolar disorder: depressive episodes alternate with periods of manic episodes, including elation or irritability, increased activity or energy, and other symptoms such as increased verbiage, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive and reckless behavior .
Concomitant causes and prevention
Depression is the result of complex interactions between social, psychological, and biological factors. Those who have gone through adverse life circumstances (unemployment, bereavement, traumatic events) are more likely to suffer from depression. In turn, depression can generate more stress and dysfunction, and worsen the life situation of the affected person and, consequently, the depression itself.
There are relationships between depression and physical health. For example, cardiovascular diseases can cause depression and vice versa.
Prevention programs have been shown to reduce depression. Effective community strategies to prevent it include school programs to promote a positive coping model among children and adolescents. Targeted interventions for parents of children with conduct problems may reduce parents’ depressive symptoms and improve outcomes for their children. Exercise programs for the elderly can also be effective in preventing depression.
Diagnosis and treatment
There are effective treatments for depression.
Depending on the intensity and type of depressive episodes over time, healthcare providers may offer psychological treatments, such as behavioral activation, cognitive behavioral therapy, and interpersonal psychotherapy, and/or antidepressant medications, such as selective inhibitors. serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. Different medications are used for bipolar disorder. Healthcare providers must take into account the possible adverse effects of antidepressants, the possibilities of carrying out one or another type of intervention (due to the availability of technical knowledge or the treatment in question) and individual preferences. Among the different psychological treatments that may be considered are face-to-face, individual or group psychological treatments delivered by professionals and supervised lay therapists. Antidepressants are not the first choice treatment for mild depression. They should not be used to treat depression in children or as first-line treatment in adolescents, in whom they must be used with great caution.
WHO response
The WHO Mental Health Action Plan 2013-2030 establishes the steps required to offer appropriate interventions to people with mental disorders, particularly depression.
Depression is one of the priority conditions addressed in the Mental Health Gap Action Program (mhGAP) . The Program is intended to help countries advance services for people with mental, neurological, and substance use disorders through care provided by health workers who are not mental health specialists.
WHO has produced short manuals on psychological interventions for depression that can be delivered by lay workers to individuals and groups. One example is the Coping Problems Plus (EP+) manual, which explains the use of behavioral activation, stress management, problem-solving treatment, and strengthening social support. In addition, the Group Interpersonal Therapy for Depression manual describes group treatment of depression. Finally, the Healthy Thinking manual deals with the use of cognitive-behavioral therapy to treat perinatal depression.
