Depression is expressed in everyday language with words such as depression, melancholy, depression, sorrow, grief and mourning. Feeling sad and down from time to time for various reasons is part of normal life. However, when this condition lasts for a long time (days to weeks) and is severe, it disrupts normal life and requires treatment. People suffering from depression also experience physical complaints such as impaired appetite and sleep, and lack of energy (weakness). If left untreated, depression can last for months, become chronic, and even become unbearable, leading to dangerous consequences such as suicidal tendencies and attempts.
What are the symptoms of depression?
Depression symptoms are examined in two parts: psychological and physical:
Psychological symptoms of depression can be listed as follows:
- Joylessness, sadness, pain that lasts almost every day
- pessimistic thoughts
- Lack of enjoyment of life, reluctance
- Intense distress (anxiety, worry)
- Lack of concentration and indecisiveness, forgetfulness
- not wanting to work
- Thoughts of worthlessness and guilt
- Suicidal ideation or attempt
- Physical symptoms are;Lack of energy, weakness, fatigue,
- Physical symptoms of anxiety (palpitations, shortness of breath)
- Sleep disturbance (increase or decrease)
- Appetite disturbance (increase or decrease)
- Sexual reluctance or dysfunction
- Restlessness, restlessness,
- Irregularity in the gastrointestinal system
Although depression is a mental disorder, due to these physical symptoms, the person may have the impression that he or she is suffering from a physical illness. For this reason, there are many patients with depression who visit different specialties before applying to psychiatry and whose examination and laboratory examinations do not reveal any findings that would explain their complaints.
How is Depression Diagnosed?
In the diagnostic evaluation of depression, it is an important feature that the mood in which joylessness and distress are at the forefront is present almost every day for at least two weeks, that is, it becomes permanent. The person has started to not enjoy life. On the other hand, many people get used to the symptoms of slow-onset depression and seek diagnosis and treatment after months or sometimes several years have passed. Exacerbation of symptoms triggered by various factors brings the person to a psychiatrist.
In order to make a diagnosis, other symptoms of depression are also looked for, and if there are other psychiatric disorders or physical diseases that may cause these symptoms, they are also detected.
Other symptoms of depression include lack of energy, weakness, pessimistic thoughts, crying easily, getting angry, sleeping too little or too much, waking up in distress, especially early in the morning, not being able to do housework or not wanting to go to work, loss of appetite and weight loss, or, conversely, not wanting to go to work. eating and weight gain may occur. When most of the symptoms are observed, the condition is called major depression .
A state of inner distress and anxiety called anxiety is encountered in almost every depressed patient. The person may not even be aware of the underlying depression due to the tension created by anxiety, and first wants to find a solution to the anxiety.
Who Gets Depression?
Depression or depression occurs due to biopsychosocial factors. Genetic predisposition is important; it is common for extended family members of the person to have similar episodes of depression.
- Psychological features include;Triggering life events (death, disappointment, financial difficulties, physical illnesses, etc.),
- Meticulous and anxious personality structure,
- Having a stressful childhood
- Difficulty getting used to change,
- Insecure attachment features can be listed.
Social factors include threatening events that affect society in general (economic crisis, terrorism, natural disasters, epidemics).
What are the Types of Depression?
Bipolar or unipolar depression
The most common example is recurrent depression. The duration of these attacks can last from a few weeks to a few months, and if left untreated, several years. The role of genetic factors in bipolar and unipolar depression is important. People with bipolar depression also experience mania attacks, which manifest themselves with features such as acceleration and excess energy, at some periods of their lives.
Seasonal depression
Some depressions are not related to life events and recur at approximately the same time of the year. While this may be related to the biological clock mechanism in the body, winter months, especially in climates where sunlight is not very strong, paves the way for depression. In general, seasonal changes carry a risk for mood disorders.
Reactive depression
Some episodes of depression occur after a life event. Usually, after a very tiring period of life, and sometimes after the stressors end, the person enters a period of abandonment and shows symptoms of depression. Loss of a valued person or relationship and major disappointments are the main causes of reactive depression.
Dissociative depression
The characteristic of this type of depression is that although it begins in childhood and continues for years, the person can also show different moods (such as cheerful, angry, introverted, extroverted, energetic or calm). Depression in these people has a "mosaic"-like feature. Many emotions go together. Suicidal thoughts may occur, but these people usually seek help, overcome these thoughts, or remain at the attempt level.
“Masked” depression
Depression is difficult to recognize from the outside in some people. On the contrary, the person may even act as if he is cheerful and devoted to life. Some people cannot realize that they are depressed themselves. When depression is accompanied by physical symptoms, the person perceives himself as suffering from a physical illness rather than a mental distress.
Double depression
In some people, depression, also called dysthymic disorder, has mild symptoms but has a chronic course. These people may experience major depression attacks, which may worsen from time to time. During the period when they tend to recover, they may return to a chronic course.
Postpartum depression
Postpartum depression has both psychological and biological causes. It may be severe. It needs to be treated urgently. ECT can be used in cases where the mother is breastfeeding and is reluctant to use medication.
Depression due to other psychiatric disorders
Depression can also occur as a result of other psychiatric disorders. For example, depression may additionally develop in conditions such as post-traumatic stress disorder, dissociative disorders, obsessive-compulsive disorder, social phobia, narcissistic personality disorder, and schizophrenia.
Depression due to physical illnesses
Endocrine diseases, hypertension, Parkinson's disease and many other physical diseases can cause symptoms of depression. So much so that the person's first examination may even be a psychiatrist. In cases of doubt, laboratory tests and consultation with relevant specialties are preferred instead.
What are the causes of depression?
Depression occurs due to biopsychosocial reasons. There is a genetic predisposition to this in some people and even in families. On the other hand, there are also depressions that arise entirely from life events. Between these two extremes, depression resulting from different reasons forms a spectrum. Generally, both biological, psychological and even social factors play a role in the formation of depression. Depression is slightly more common in women than in men. Certain life periods (midlife crisis, menopause, adolescence, etc.) may predispose to depression. For some people, depression accompanies periods when they undergo significant psychological changes. Depression should not be thought of as a personality weakness, as it is a condition that is completely curable with appropriate treatment.
What are the Methods for Coping with Depression? How to Get Over Depression?
Mild and temporary dejection is part of normal life. Treatment may not be required unless it disrupts the person's daily life and reaches a damaging level in the person's inner world. In this case, lifestyle changes, addressing neglected problems (at home, at work, in social life), and improving communication within oneself and with others would be beneficial. For those who require treatment, coping with the symptoms is important until they benefit from the treatment. Because even under the best conditions, depression treatments usually start to yield results after 3 weeks.
During this period, the person should take into account that pessimistic thoughts caused by depression may not reflect the real situation. One should also remember that depression, no matter how severe it is, is a completely recoverable condition.
What are Depression Treatment Methods? How to Treat?
Drug Treatments and Psychotherapy
Depression, like other psychiatric disorders, is treated with medication and psychotherapy. It must be acknowledged that, especially in the early stages of a severe depression attack, it cannot be cured by psychotherapy alone. At that time, drug treatments were very effective and were at the forefront of treatment. On the other hand, supportive psychotherapy is necessary from the very beginning in terms of reassurance.
A reassuring, calming attitude and information (psychoeducation) reduces the person's anxiety. Providing brief information to the person's relatives and family members, with the patient's permission, prevents wrong attitudes that may cause an increase in the patient's depressive state. Attitudes that will increase feelings of guilt, such as forcing the patient to be unnecessarily active, are prevented.
The main drugs used in the treatment of depression are substances also known as antidepressive agents. However, if the accompanying anxiety is very severe, medications called anxiolytics can be added to this treatment to keep the patient comfortable during the period until the antidepressant medication takes effect.
The feature of anxiolytic drugs is that their effects begin quickly (within half an hour), but this relaxing effect disappears in a period of time that does not last a whole day. A negative feature of this second group of drugs is that tolerance (loss of effect) develops when used for a long time (for months) and the use has the potential to turn into an addiction. Therefore, they cannot replace antidepressant medications as long-term treatment.
Different types of psychotherapy have short, medium and long-term effects in the treatment of depression. Another important aspect of this is that it is beneficial in reducing the need for medication in the long term.
While psychotherapy is more supportive in the first period of treatment, when the person is better, it would be appropriate to establish a dialogue about his life and inner world and to evaluate with a more investigative approach.
Electroconvulsive Therapy
This biological treatment method, also known as ECT, gives positive results in severe depression attacks. Especially in people whose nutrition is severely impaired or who have intense suicidal tendencies and are at risk, resorting to ECT may be preferable to medication due to the urgency of the situation. Antidepressant medication is still used along with or after ECT, but results are quicker. Sessions of this treatment last 1-2 minutes and are applied under muscle relaxants and anesthesia. During the treatment, the patient's doctor and an anesthesiologist are at the bedside. The treatment is not painful, the application is not remembered, the person wakes up within a few minutes and rests for 1-2 hours. It can be applied during pregnancy and older ages.
EMDR
In some cases, Eye Movement Desensitization and Reprocessing (EMDR) can also be used as a type of psychotherapy. Such situations are often useful in processing events that had a traumatic impact on the person in childhood or adulthood. It may be especially useful in depression due to Post-Traumatic Stress Disorder.
How Long Does Depression Treatment Take?
Initial (emergency) treatment of depression takes about one to one and a half months. The positive effects of antidepressant drugs begin to appear three weeks after you start using the full dose. In terms of follow-up, support and, if necessary, further psychological analysis, it would be appropriate to continue the entire treatment for up to 6 months. It is necessary to use the antidepressant drug, which is determined to be effective after one month, for at least six months, often up to a year . This practice, known as maintenance treatment, aims to prevent symptoms from returning in the short term.
However, as in every medical condition, a resistant or complicated process may be encountered. For example, not getting the expected positive response to the medications used, experiencing undesirable effects, and adding other disorders to the picture can be counted among these. When a certain drug treatment is increased to the appropriate dose and there is no response after waiting for one or one and a half months, it becomes inevitable to change the drug. Response to antidepressants is individual . Finding the appropriate medication for the person is critical.
In recurrent unipolar depression, some medications called mood stabilizers are used to prevent new attacks. In people with frequent recurrences, preventing each attack rather than treating it has a much more positive effect on their quality of life.
Can Depression Be Treated Without Medication?
Mild depression can be treated without medication. However, when it exceeds a certain level of severity, persistent avoidance of medication reduces the quality of life. Considering psychotherapy together with drug treatment provides support in reducing and discontinuing the drug dose in the long term. However, in the initial stages when depression is severe, conducting this psychotherapy in a supportive rather than analytical manner will yield more positive results.
Electroconvulsive Therapy (ECT) can be applied in emergencies or in cases where drug treatment is at an impasse (such as absolute suicidal tendencies, drug resistance, etc.). This treatment method, which is applied under anesthesia with a special device, repeated every other day at least 7 times, usually gives good results.
What Happens If Depression Is Untreated?
Not treating depression negatively affects quality of life. It is common to encounter people who turn to alcohol and similar substances to relieve stress, or who use medication irregularly on their own. Lack of concentration, sleep disturbance, and fatigue also affect business and social life.
Depression and Suicide
Not every depressed patient is suicidal or thinks about it to varying degrees. In cases of suspicion, this possibility may need to be clearly evaluated during a psychiatric examination and discussed with the patient and their relatives. Avoiding this may lead to the postponement of urgent and necessary interventions in treatment. Some patients hide it. Most people say it openly. If a person diagnosed with depression says that he/she may commit suicide, this should be taken seriously and the patient should be immediately admitted to a safe closed psychiatric service.
This decision cannot be left to the patient and his/her relatives in cases where there is a definite risk. If necessary, law enforcement and emergency aid (ambulance) teams are notified and the patient is safely transported to an inpatient facility. After hospitalization, a medical board report is issued on the same day and the patient is placed under temporary guardianship by the local court until his inpatient treatment is completed. In order to prevent such a situation from being abused, the patient is given the right to appeal to a higher court. However, not every mention of suicide does not mean that an attempt will definitely occur, and it would be appropriate for the risk to be evaluated by the psychiatrist conducting the examination. If the psychiatrist does not think that hospitalization will reduce this risk and it is believed that it will negatively affect the subsequent course of treatment and cooperation with the patient, this situation should be evaluated and the appropriate strategy should be chosen.
In cases where there is a definite risk of suicide, switching to ECT treatment in hospital conditions, rather than just being hospitalized and waiting for the three-week effect period of antidepressant drugs, will be an appropriate measure to prevent suicide events that can occur even in hospital conditions, despite all surveillance efforts, although rare.
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